Statements achieving consensus when agree and strongly agree is combined as one answer (excludes the five statements in table 1)
| Statement | Responses: agree or strongly agree |
| DI-ILD should not be discounted if there is no clear temporal relationship between drug commencement and symptom onset | 27 (82%) |
| DI-ILD should be considered if an alternative cause of symptoms, abnormal physiology and radiological changes cannot be identified, or if the patient fails to respond to treatment for the alternative cause | 25 (76%) |
| A diagnosis of DI-ILD should not be made without the involvement of a specialist ILD MDT | 28 (85%) |
| When a patient presents with new respiratory symptoms while using a medication known to cause DI-ILD, and should initial investigations and treatment not resolve the clinical scenario, investigations should include bronchoalveolar lavage with samples sent to exclude infection (typical/atypical), should the patient be deemed able to undertake the procedure | 28 (85%) |
| When a patient presents with new respiratory symptoms while using a medication known to cause DI-ILD, and should initial investigations and treatment not resolve the clinical scenario, investigations should include bronchoalveolar lavage with samples examined for differential cell count, should the patient be deemed able to undertake the procedure | 28 (85%) |
| When a patient presents with new respiratory symptoms while using a medication known to cause DI-ILD, and should initial investigations and treatment not resolve the clinical scenario, investigations should include blood tests including tests for infection, to assess underlying comorbid disease activity and to assess the inflammatory response | 28 (85%) |
| When a patient presents with new respiratory symptoms while using a medication known to cause DI-ILD, and should initial investigations and treatment not resolve the clinical scenario, investigations should not routinely include transbronchial lung biopsy | 29 (88%) |
| When a patient presents with new respiratory symptoms while using a medication known to cause DI-ILD, and should initial investigations and treatment not resolve the clinical scenario, investigations should not routinely include open lung biopsy | 28 (85%) |
| Prior to making any modification to drug therapy, discussion with colleagues that initiated therapy should occur to ensure the safety of drug cessation and to consider alternative options | 30 (91%) |
| In patients without significant hypoxia (oxygen saturation on room air ≥94%), initial management should be to stop the offending drug | 28 (85%) |
| In patients with significant hypoxia (oxygen saturation on room air <94%), initial management should include drug cessation and commencement of oral corticosteroid | 28 (85%) |
| Recommended dosage of first line oral corticosteroid is prednisolone 0.5–1 mg·kg−1 | 28 (85%) |
| In patients with life threatening hypoxia due to presumptive DI-ILD, treatment should initially be with i.v. methylprednisolone | 31 (94%) |
| Recommended doses of i.v. methylprednisolone are 500–1000 mg once daily for 3 successive days | 30 (91%) |
| Long term monitoring of response should include assessment of symptoms, pulmonary physiology (spirometry/transfer factor), blood tests (if appropriate) and radiology (chest radiography, HRCT; dependent on presence or absence of abnormalities on chest radiography that can be reliably monitored) | 33 (100%) |
| In patients showing response to therapy, consideration of weaning of medication to lowest dose that controls disease activity (which may include no treatment) should occur at 2–4 weekly intervals | 28 (85%) |
| In patients that respond to initial corticosteroid therapy, and following a weaning protocol cannot be reduced to levels of oral prednisolone (or equivalent) of <20 mg once daily, a steroid sparing agent should be considered | 27 (82%) |
| Steroid sparing agents may include mycophenolate mofetil (preferred), azathioprine, methotrexate or cyclophosphamide | 25 (76%) |
| If a drug has been proven, or is highly suspected, to have caused DI-ILD, unless no alternative agent is available and treatment is absolutely required, the offending drug should not be re-used | 31 (94%) |
| If a patient has experienced a DI-ILD in the past, careful consideration of the likelihood or possibility of further DI-ILD from future therapeutic interventions should be considered. If possible, the use of agents not known to be associated with DI-ILD should be selected. | 26 (79%) |
DI-ILD: drug-induced interstitial lung disease; ILD: interstitial lung disease; MDT: multidisciplinary team; HRCT: high-resolution computed tomography.