Bilateral Interstitial Pneumonia

Medically Reviewed by Dan Brennan, MD on December 02, 2022
4 min read

Bilateral interstitial pneumonia is a serious infection that can inflame and scar your lungs. It's one of many types of interstitial lung diseases, which affect the tissue around the tiny air sacs in your lungs. You can get this type of pneumonia as a result of COVID-19.

Bilateral types of pneumonia affect both lungs. In bilateral interstitial pneumonia, the tissue around your air sacs (interstitial tissue) get irritated and may fill with pus and other fluids. As the pneumonia gets worse, your lungs can develop permanent scars.

When interstitial tissue gets scarred, it may stiffen and make it hard for you to breathe. Your condition can quickly get worse, leading to respiratory failure.

Infection by bacteria or viruses is one cause of pneumonia. Infected people cough or sneeze particles into the air that you breathe or onto surfaces that you touch. You can get pneumonia as a result.

The new coronavirus is also spread by contact with droplets spread into the air or onto a surface when someone who is infected coughs or sneezes. Most people who get it have only mild symptoms similar to a cold or the flu. But others end up with severe pneumonia as a complication of COVID-19.

Bilateral interstitial pneumonia symptoms often include:

Warning signs of COVID-19 are similar.

In people with serious COVID-19 symptoms, doctors may use CT scans to look for signs of pneumonia. These powerful X-rays show visual signs of damage to your lungs.

When people with bilateral interstitial pneumonia have CT scans, doctors can often see white patches they call "ground glass." These are a sign of sores on the lungs.

If you have symptoms of interstitial lung disease but aren't thought to have COVID-19, your doctor will start by giving you a physical exam. They may also give you some tests to rule out other problems. These include chest X-rays and CT scans as well as:

  • Pulmonary function test. These tests measure how well your lungs are working. The doctor may ask you to exhale into a tube for this type of test.
  • Bronchoscopy. In this test, your doctor inserts a long, flexible tube into your lungs to flush out your airways with saline solution. They’ll remove the fluid and examine it. They’re looking for high levels of white blood cells in your lungs. This is seen in about half of people with interstitial pneumonia.
  • Biopsy. It’s not always necessary, but your doctor may remove a small piece of lung tissue during your bronchoscopy to test for signs of inflammation or scarring.

While most cases of COVID-19 are mild, your doctor may prescribe an antiviral medicine to keep your symptom from getting worse. The antiviral that doctors prefer to use is a pill called ritonavir-boosted nirmatrelvir (Paxlovid) which has been given emergency use authorization from the FDA. Remdesivir (Veklury), which is given by IV is the only antiviral drug that has full FDA approval. A EUA has also been given to the antiviral molnupiravir (Lageviro) but that should only be used when the other treatments are not available.

 If you get pneumonia as a result of the virus, your doctor may help you breathe by giving you oxygen through a mask or tubes. If it's very serious, you might need a breathing machine.

If you’re diagnosed with interstitial pneumonia, your doctor may prescribe oral corticosteroids like prednisone. But they don't work for everyone. They can also have lots of side effects.

Drugs that suppress your immune system may help, too. These include:

Some people take steroids along with one of these drugs.

Once your lungs are scarred, you can't reverse the damage. But anti-fibrotic drugs like nintedanib (Ofev) and pirfenidone (Esbriet) help keep the scarring from getting worse.

Other treatments include oxygen therapy and pulmonary rehab, which includes breathing exercises to improve your lung strength. If nothing else works for you, you might need a lung transplant.

To keep your lungs healthy, don't smoke. To prevent any infection, including COVID-19:

  • Wash your hands often with soap and water for at least 20 seconds.
  • Avoid touching your hands, eyes, or mouth until you’ve washed your hands.
  • Use hand sanitizer gels that are at least 60% alcohol if you’re not in a place where you can wash your hands.
  • Stay away from others who are sick. Keep a safe distance when you go out.
  • Stay home if you’re sick except to go to the doctor.