Having a robust diagnosis of idiopathic pulmonary fibrosis (IPF) is absolutely critical, drugs do work so use them, and patients require information and opportunity to access the treatment they need and deserve.
These were the key messages of a talk in the interstitial lung disease: from beginning to end session given by Dr Michael Gibbons, a consultant respiratory physician at the Royal Devon and Exeter Foundation NHS trust.
Speaking at the British Thoracic Society 2018 meeting in Manchester on 14 June, he said studies showed there was evidence that drugs used to treat patients with IPF worked but there was a debate around when patients should commence treatment, he told delegates during his talk called The drugs do work: who, when, which and what next.
“I don’t have what I think is the right answer I just have what I think one should do” he said.
“And I think that when the diagnosis is robust, so when you’ve gone through an interstitial lung disease multidisciplinary meeting and you can’t find anything else and you’re sure this is IPF then you should strongly consider starting treatment at that point,” he advised.
Dr Gibbons told delegates that he still sees patients with an FVC of 55% because they’ve been under a ‘watch and wait’ approach, been back out to the community and subsequently deteriorated because they had become lost to follow-up.
“It’s important to start patients [on treatment] early, but we also need to be mindful that we work in an environment where patients don’t get seen as regularly as they should be or they don’t want to call the doctor,” he added.
Dr Gibbons said he was a strong advocate of patient choice, urging delegates to factor in a long discussion with their patients around the pros and cons of treatment, including potential side effects.
It was also imperative that patients were given all options available to them, including the opportunity to participate in clinical trials.
“They may need to travel but in my experience people are really happy to travel. I’ve got patients who travel two hours every month to clinical trials so don’t assume that you know what patients want, give them the options and let them make the decision,” he said.
Dr Gibbons concluded that it was an exciting time for IPF: “In the words of the great man Winston Churchill, ‘Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning,’” he concluded.