title: Long-term course and prognosis of idiopathic pulmonary fibrosis in the new millennium.
abstract: The American Thoracic Society and European Respiratory Society guidelines for the diagnosis and treatment of idiopathic pulmonary fibrosis (IPF) have been published recently. However, the influence, practical application, and utility of the prior consensus statement for IPF have never been evaluated. Demographics, diagnostic criteria, pulmonary function data, and disposition of patients with IPF evaluated at an interstitial lung disease center between 2000 and 2009 were analyzed. Enrollment in clinical drug trials, lung transplantation, and mortality also were assessed. A total of 521 patients with IPF were evaluated, with pulmonary function testing available in 446. In the 64% of patients without surgical lung biopsy, the most common major criterion not fulfilled was bronchoscopy. Lung transplantation was performed in 16.1% of patients, whereas 27.4% of prescreened patients were enrolled in a prospective drug study. Patients with mild, moderate, and severe disease categorized by FVC % predicted had median survivals of 55.6, 38.7, and 27.4 months, respectively. The attrition rate of patients who survived beyond 5 years was attenuated in subsequent years. IPF remains a deadly disease with a poor prognosis. Bronchoscopy does not appear to be required for an accurate diagnosis. A minority of patients were accommodated within a clinical trial or with transplantation. Categorization by baseline FVC % predicted effectively discriminates groups with different long-term outcomes. Our analysis supports the view that the value of statements also can be realized in the subsequent demonstration of their impact on patient management, which might enable further refinements in a continuous, iterative rediscovery process.
authors: Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA. Electronic address: steven.nathan@inova.org.
authors: Steven D
authors: SD
authors: Nathan
authors: Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA.
authors: Oksana A
authors: OA
authors: Shlobin
authors: Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA.
authors: Nargues
authors: N
authors: Weir
authors: Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA.
authors: Shahzad
authors: S
authors: Ahmad
authors: Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA.
authors: Julienne M
authors: JM
authors: Kaldjob
authors: Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA.
authors: Edwinia
authors: E
authors: Battle
authors: Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Hospital, Falls Church, VA.
authors: Michael J
authors: MJ
authors: Sheridan
authors: Imperial College, London, England.
authors: Roland M
authors: RM
authors: du Bois
mesh_terms: D001706:Biopsy; D001999:Bronchoscopy; D014943:Global Health; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D016040:Lung Transplantation; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012129:Respiratory Function Tests; D012955:Societies, Medical; D015996:Survival Rate / Q000639:trends; D013997:Time Factors