Breathlessness and Cough Signal Pulmonary Fibrosis Years Before Diagnosis, Study Reports

Patients with idiopathic pulmonary fibrosis (IPF) are likely to experience symptoms for years before their diagnosis, a British study reports.

University of Nottingham researchers analyzed symptoms in the medical charts of newly diagnosed patients to reach their conclusion. Breathlessness was the most common symptom, the team found.

The research, “Timing of onset of symptoms in people with idiopathic pulmonary fibrosis,” was published in the journal Thorax.

A key underpinning of the study is that by the time a lot of people with IPF are diagnosed, the disease has already reached an advanced stage.

But asking people when they first started noticing symptoms is a poor way to get a handle on the disease’s emergence because human memory is unreliable.

Seeking an alternative approach, researchers identified 1,671 newly diagnosed IPF patients whose medical records stretched back at least five years. They also recruited 7,187 healthy controls for their study. Sixty-three percent of the IPF group was men.

The team tracked all doctor consultations that the patient and control groups had for breathlessness, cough, fatigue, and weight loss. They also noted which patients had consultations for chronic obstructive pulmonary disease (COPD) or heart failure — because IPF is often mistaken for these conditions.

One of the team’s findings was that IPF patients smoked more often than controls. They were also far more likely to seek medical attention for breathlessness. Forty-three percent had done so in the five years leading up to a diagnosis, compared with only 7 percent of controls.

The frequency of consultations for breathlessness was evenly spread out among the controls over the five study years. But IPF patients sought more help in the years leading up to a diagnosis, with visits skyrocketing in the last year.

Cough was another common cause of patients seeking medical attention, with 32 percent saying they had sough help for it

IPF patients were nearly three times more likely than controls to seek attention for breathlessness and twice as likely to seek a consultation for cough, even four to five years before a diagnosis. Fatigue and weight loss were also more common in patients than controls, as were diagnoses of COPD or heart failure.

Doctors have long asserted that early diagnosis of IPF can improve patients’ survival by allowing them to start treatment early. The British team said that if primary care physicians followed National Institute for Health and Care Excellence guidelines, and increased the use of chest X-rays in people with breathlessness and cough, earlier identification of IPF might be possible.