IPF symptoms seen years before diagnosis

Some patients with idiopathic pulmonary fibrosis (IPF) may be symptomatic up to five years before they’re diagnosed, a UK matched case-control study suggests.

Cases were almost three times as likely as controls to present to a GP with breathlessness in the four to five years before they were diagnosed with IPF and almost twice as likely to present with cough.

Analysing data from around 500 general practices, researchers found fatigue and weight loss were also more common among the 1671 identified cases of IPF who had five years of records leading up to diagnosis.

“It is not clear whether these symptoms represent subclinical early interstitial lung disease or alternative respiratory complaints, but there may be the opportunity to diagnose IPF earlier,” researchers from the University of Nottingham’s epidemiology and public health division wrote in Thorax.

Cases also had more diagnoses of heart failure or COPD than controls, particularly in the year before they were diagnosed with IPF.

“[This] could either reflect coexistent diagnoses given that smoking and heart disease are both more common in IPF or misdiagnoses of common conditions with similar symptoms,” the researchers said.

Study co-author Dr John Hutchinson told the limbic that awareness of IPF has increased in recent years but it was still seen as quite rare and may not be considered as a diagnosis.

“[In addition] I suppose some GPs might not see value in giving a firm diagnosis due to the previous lack of treatment options, but this is likely to change with increased publicity around newer anti-fibrotics,” he said.

As well as more awareness about the disease, Dr Hutchinson highlighted the need for increased use of chest radiography in primary care for breathlessness and cough.

“GPs see a significant amount of minor illness and clearly can’t investigate everyone with a chest x-ray, but using this for unexplained breathlessness and cough may help pick up or rule out serious pathology such as IPF,” he said.

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