Respiratory physicians not following IPF best practice

There is a clear need for local guidelines on the diagnosis and management of idiopathic pulmonary fibrosis say respiratory physicians after their survey found a third of specialists were diverging from current best practice.

Lauren Troy from the Department of Respiratory and Sleep Medicine at the Royal Prince Alfred Hospital in Sydney and colleagues sent a questionnaire on IPF diagnosis and management to all respiratory physicians in Australia and New Zealand. They then compared the results with a similar survey conducted in 1999.

Not surprisingly the researchers discovered that the approach to IPF diagnosis and management had changed over the past 15 years.

But while most physicians said they would not offer any treatment a substantial proportion (33%) said they would commence corticosteroids and or azathioprine.

Smaller numbers said they would prescribe N-acetyl cysteine (9%) or cyclophosphamide (2%).

This was despite lack of efficacy and evidence of harm, the study authors said.

This highlighted a lack of diagnostic lack of confidence in some cases but may also reflect the unwillingness of some to ‘do nothing’ for a progressive disease, particularly in those patients ineligible for trials or transplantation, they said.

Clinicians whose treatment decisions were discordant with best evidence were most likely to be working outside tertiary care and were more likely to have been practising for 20 years or more.

“It is imperative that physicians are aware of recent changes in the field and practice variations that potentially compromise patient outcomes point towards a clear need for standardization of care across centres,” they wrote in their paper which was published this week in Respirology.

“Local guidelines may help to address some of the divergence from current best-evidence practice,” they concluded.

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