About Pulmonary Fibrosis

We understand how challenging it is to navigate PF and all the information available. Because of this, we’ve compiled a list of FAQs about PF – all based on real conversations between people in our support group and community forum. This page defines PF, describes the symptoms, discusses the diagnostic process, and debunks common myths about the prognosis. As you read, please feel free to reach out with your own questions.

Common Questions About Pulmonary Fibrosis:

What is Idiopathic Pulmonary Fibrosis?

The first step to understanding your condition is to learn what pulmonary fibrosis means.  There are more than 200 different types of this disorder with a variety of causes.  However, all of them result in heavy scarring in the lungs.  The word idiopathic means the cause is unknown.

When we breathe in, the air travels to one of the 300 million little air sacs in the lungs called aveoli.  These tiny sacs are basically giant air bubbles bathed in blood that make it easy for their oxygen to diffuse into the blood cells and then be distributed throughout our bodies.  Carbon dioxide in your blood also diffuses from the blood cells into the aveoli to be released when you breathe out.

The process of fibrosis causes scarring both within these sacs and on the outside.  As their walls thicken due to the scar tissue, it becomes more difficult for the oxygen to transfer from the aveoli into the blood.  The end result is a constant lack of oxygen which leads to chronic shortness of breath.

What is PF, and is it different than IPF?

Pulmonary fibrosis (or PF) is a condition characterized by thickening and scarring of the tissue in the lungs. It impacts breathing, the oxygen concentration in the blood, and many other aspects of a person’s lifestyle and health. Sometimes, the cause of PF is known – such as environmental exposures, genetics, or side effects from certain medications (like chemotherapy drugs, heart medications, or antibiotics). Often, however, the cause is unknown. When the exact cause of the PF is unknown, it is called Idiopathic Pulmonary fibrosis (or IPF). 

What are the symptoms of PF?

The most common symptoms of PF are shortness of breath and a dry, hacking cough due to the scarring of the lungs. It can also cause muscle aches and sore joints. People with pulmonary fibrosis who experience pain are often suffering from another problem like an injury to the rib cage or back from severe coughing, or from other parts of the body due to a lack of oxygenated blood flow. Additional symptoms of PF include severe fatigue, weight loss and clubbing of the fingertips. Pulmonary hypertension, cardiac failure, respiratory failure, and lung cancer can all be complications of pulmonary fibrosis.

How is PF diagnosed?

Unfortunately, PF can go undiagnosed or initially be misdiagnosed. Before receiving a diagnosis for Pulmonary Fibrosis (PF), many people receive treatment for asthma, pneumonia, or bronchitis instead. Idiopathic pulmonary fibrosis (IPF) is particularly hard to diagnose because there are many other interstitial lung diseases that mimic it. Many potential causes must be considered and ruled out before IPF can be diagnosed. Knowing about risk factors and early symptoms of pulmonary fibrosis is the key to getting diagnosed with the disease as soon as possible. Here are some tips:

  1. First, determine whether you’re at risk for developing PF. A complete list of risk factors is available here: https://pulmonaryfibrosisnow.org/2018/06/13/the-warning-signs-early-symptoms-of-pulmonary-fibrosis/
  2. Next, notice if you’re experiencing these early symptoms: shortness of breath, a dry cough, unexplained weight loss, fatigue, muscle & joint aches/pains, and clubbing of fingers & toes. If so, see your doctor right away to avoid long-term complications!
  3. Then, you can connect with or be referred to a lung specialist known as a pulmonologist. Your pulmonologist will conduct a non-invasive screening which includes reviewing your health history, giving a physical exam, and ordering relevant testing (such as imaging tests, lung function tests, blood tests, or tissue tests).

If I have a PF diagnosis, what’s the prognosis?

Unfortunately, with the current treatments available for PF, scarring of the lung tissue is irreversible. No matter how scary it seems, there are still helpful treatment options – and we have heard many encouraging and empowering stories in our community forum. The estimated life expectancy at the time of diagnosis used to be 3-5 years, but it’s important to note that many individuals have lived much longer due to advances in modern medicine. Plus, the actual rate of progression varies drastically from one person to the next. Some people may experience mild to moderate symptoms that worsen slowly over the course of several years, some may experience “acute exacerbation” in which their symptoms worsen quickly over the course of days or weeks, and others experience extended periods of stability followed by periods of more rapid disease progression.

What are the Stages of Idiopathic Pulmonary Fibrosis?

Once you have been diagnosed with idiopathic pulmonary fibrosis (IPF), you will want to know what stage you are at. Knowing this will help you know what to expect and what treatments are most likely to help slow the progression of the disease.

Traditionally, doctors rated your condition on a scale from “early” or “mild” to “advanced” or “severe.”  Researchers are working to nail down precise measurements to better assess your stage of IPF.

You may get your initial diagnosis early-on in the disease – the mild stage.  However, you may not show symptoms until your lungs already have quite a bit of scarring.  If this is the case, you may have already reached the moderate stage.

You might be able to go for years with only a minimal change in your ability to breathe, or you might decline suddenly and quickly advance to the moderate or advanced stage.  A sudden deterioration in your condition is known as an acute exacerbation which can be life-threatening.

Mild

One thing to remember is that the exact symptoms and progression of IPF vary greatly in different patients.  There is no one size fits all treatment for this disease.  The medical literature refers to this situation as heterogeneity.

Steps that Your Doctor Will SuggestYour doctor will provide you with detailed information on what to expect and what you can do to slow the progression of the disease.  He or she will also probably recommend a support group to help you deal with the symptoms and get support from other people who are fighting IPF.  They understand what you are going through.

If your doctor thinks it’s best for you, he or she may start you on one of the pharmaceutical drugs approved to treat IPF.  He or she will also probably start you in a program of pulmonary rehabilitation which involves breathing exercises, supervised physical exercise, changes in your diet, and interacting with a support group.  You may also want consider alternative therapies that are used to improve the symptoms of IPF in other parts of the world.

Your First 6 Months After Your Diagnosis

Your medical team will immediately assess the state of your health by examining your lungs and your ability to exercise.  These measurements will help them see how you respond to treatment over time.  Your medical team will monitor the health of your lungs by checking such factors as your forced vital capacity (FVC) or any changes in your 6-minute walk distance.

Your readings at 6 months offer an indication of how likely you are to survive.  For example, if your FVC declined by 5-10% over this period, you are more likely to die sooner.  In contrast, if your readings have been stable, this is a good sign that your disease is progressing slowly.

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Moderate

At this point, your symptoms have become severe enough that you will probably need to start breathing supplemental oxygen.  You may start by breathing through an oxygen mask periodically, or you may need to breathe oxygen all the time if your oxygen levels are really low.

This is a dramatic and life-changing step, and you are likely to feel overwhelmed.  Many people feel like they are trapped at home and get anxious and/or depressed.  Your doctor may refer you to counseling if you need it.  Support from other people who have IPF will be even more critical at this stage.

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Advanced

At this point, your symptoms are so severe that there is little that the doctors can do to treat you except to give you a lung transplant.  However, not everyone is a candidate for this procedure.

Your doctors will focus on providing palliative care to keep you comfortable.  This can include powerful drugs to help you tolerate your breathing difficulties.  Drugs prescribed include opiates such as morphine or benzodiazepines – tranquilizers such as Valium, Xanax, or Klonopin.  Palliative care usually involves a team that includes doctors, religious leaders, nurses, psychologists and other health care professionals to address every aspect of your life.Advanced care planning becomes critical at this stage, so your medical team knows what your wishes are and can respect them.  For example, when it becomes extremely difficult to breathe, your doctors may recommend that you go onto a breathing machine to keep you alive.  Many people do not survive long at this stage, and you may not want to take this step.

Several conditions that are complications of IPF frequently prove fatal at this stage.  You may succumb to respiratory failure.  You may also suffer from pulmonary hypertension (high blood pressure in your lungs) or heart failure n the right side of your lungs (cor pulmonade).

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What Causes Pulmonary Fibrosis?

The term idiopathic indicates that the cause of a disorder is unknown.  Doctors have no idea what causes idiopathic pulmonary fibrosis (IPF), although smoking increases your likelihood of developing this disorder.  Certain viral infections also increase your risk.

Clearly, something must have consistently damaged your lungs to lead to such intense scarring.  Researchers currently think that some factor in the environment or inside your lungs triggers them to keep attacking themselves.

A large number of environmental factors cause other types of pulmonary fibrosis.  While this disorder is common, the individual conditions that cause it are not.

Therefore, doctors sometimes have a hard time diagnosing which type of pulmonary fibrosis you have.  It is critical to get an accurate diagnosis of IPF, because the treatments for some of the other types can increase your likelihood of dying.

Pulmonary fibrosis (PF) is a form of interstitial lung disease that causes scarring in the lungs. There are over 200 types of PF and can be caused by many conditions and substances:

1. Some cases of PF are caused by medical conditions/autoimmune diseases involving chronic inflammatory processes such as

a. Sarcoidosis
b. Wegener’s granulomatosis
c. Systemic lupus erythematosus
d. Rheumatoid arthritis
e. Mixed connective tissue disease

2. Lung infections such as

a. Pneumonia
b. Tuberculosis (TB)

3. Acid reflux disease, GERD. This is a condition in which acid from your stomach backs up into your throat. In some cases, people with GERD may breathe in tiny drops of acid from their stomachs which may injure the lungs

4. Environmental agents such as asbestos, silica, grain dust, wood dust, and exposure to certain gases. Long term exposure to any of these agents can damage your lungs

5. Exposure to ionizing radiation. Radiation therapy to treat tumors of the lung or breast may cause lung damage which may become apparent months or even years after the initial treatment

6. Certain drugs that can cause lung damage

a. Chemotherapy/anti-cancer drugs such as Methotrexate and Bleomycin
b. Antiarrhythmic drugs such as Amiodarone used to treat heart disease
c. Some Psychiatric drugs
d. Antibiotics such as Nitrofurantoin

7. Other risk factors

a. Smoking
b. Family history of PF. Though this is very rare, genetic factors may play a role in some types of PF
c. Viral infections such as Hepatitis C and Epstein Barr infection

Though there are several conditions and substances that can cause PF, the most common type of PF is idiopathic pulmonary fibrosis (IPF) which is PF with no known cause.

Want to learn more?

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Living with PF can be very difficult.

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