Clubbing of the fingertips and toes is a symptom seen in pulmonary fibrosis (PF) and other heart and lung diseases that reduce the amount of oxygen in the blood. The symptom is evident when fingertips are enlarged and rounded in contrast to the rest of the finger. A finger with clubbing at the tips resembles a drumstick-like shape.

The exact cause of clubbing in diseases such as pulmonary fibrosis is not fully understood, but the unusual symptom has been identified as a marker of advanced-stage disease and should be reported to a physician immediately. The American Thoracic Society notes that digital clubbing (clubbing of the fingers) may be associated with reduced survival for people with idiopathic pulmonary fibrosis (IPF), but additional studies are needed to confirm that suggestion.

What causes digital clubbing in pulmonary fibrosis?

Clubbing occurs as a result of increased fluid pooled at the ends of soft tissue in the fingers. While the exact reason for this is unknown, clubbing is directly associated with a reduced amount of oxygen in the blood.

The process of clubbing has been observed to occur in stages. It begins with the stage known as “Scarmouth’s sign” — softening nail beds and shiny skin around the nail. Some references describe the nail as seeming to float above the nail bed. The fingertips then begin to round and enlarge into the drumstick-like appearance. The nail will begin to curve along with the shape of the fingertip. The fingertips may feel warm and appear red.

Digital clubbing can also occur in the toes.

Treatments for clubbing

Clubbing is associated with reduced oxygen levels in the blood. In IPF, clubbing is usually treated in conjunction with related symptoms including shortness of breath and breathing complications. Therapeutic approaches include oxygen therapy, which increases the concentration of pure oxygen in the lungs and allows for increased absorption.

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