Interstitial lung diseases (ILDs) are a heterogeneous group of acute and chronic bilateral lung diseases of known and unknown causes and pose diagnostic and therapeutic challenges to the clinician. Clinicians and patients confronted with ILD are understandably frustrated as there is no cause or cure for most of ILDs. The challenge in diagnosing ILDs in India is confounded by environmental and cultural factors in the midst of infections, especially tuberculosis. The lack of resources and standardized health care in India, lack of standardized approach to diagnosis of ILD, and the apparent phobia, reluctance, hesitancy, and/or uncertainty that most patients in India when confronted with the need for surgical lung biopsy (SLB) express contribute to the current conservative approach to the diagnosis of new onset of ILD in India, i.e., assumed diagnosis and reliance on the individual clinician’s judgment. Thus, the treatment of ILDs is empirical in most patients. Interstitial lung disease describes a large group of disorders, most of which cause progressive scarring of lung tissue. The scarring associated with interstitial lung disease eventually affects your ability to breathe and get enough oxygen into your bloodstream..Interstitial lung disease can be caused by long-term exposure to hazardous materials, such as asbestos, some types of autoimmune diseases, such as rheumatoid arthritis, also can cause interstitial lung disease. In most cases, however, the causes remain unknown. The lung scarring that occurs in interstitial lung disease can’t be reversed, and treatment will not always be effective in stopping the ultimate progression of the disease. Some treatments may improve symptoms temporarily or slow the disease’s progress. Others help improve quality of life. Because many of the different types of scarring disorders have no approved or proven therapies, clinical studies may be an option to receive an experimental treatment.