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Idiopathic Pulmonary Fibrosis and the Elderly: Diagnosis and Management Considerations

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Abstract

Idiopathic pulmonary fibrosis (IPF) is a severe and progressive fibrosing interstitial lung disease, which ultimately results in respiratory failure and death. The median age at diagnosis is 66 years, and the incidence increases with age, making this a disease that predominantly affects the elderly population. IPF can often be difficult to diagnose, as its symptoms—cough, dyspnoea and fatigue—are non-specific and can often be attributed to co-morbidities such as heart failure and chronic obstructive pulmonary disease. Making an accurate diagnosis of IPF is imperative, as new treatments that appear to slow the progression of IPF have recently become available. Pirfenidone and nintedanib are two such treatments, which have shown efficacy in randomised controlled trials. As with all new treatments, caution must be advocated in the elderly, as these patients often lie outside the narrow clinical trial cohorts that are studied, and the benefits of therapy must be weighed against potential toxicities. Both medications, while relatively safe, have been associated with adverse effects, particularly gastrointestinal symptoms such as nausea, diarrhoea and anorexia. In this review, we highlight measures to improve recognition and accurate diagnosis of IPF, as well as co-morbidities that often affect the diagnosis and disease course. The gold standard for IPF diagnosis is a multidisciplinary meeting whereby clinicians, radiologists and histopathologists reach a consensus after interactive discussion. In many cases, a lung biopsy may not be available because of high risk or patient choice, particularly in the elderly. In these cases, there is debate as to whether a biopsy is required, given the high rates of IPF in patients over the age of 70 years with interstitial changes on computed tomography. We also discuss the management of IPF, drawing particular attention to specific issues affecting the elderly population, especially with regard to polypharmacy and end-of-life care. Through this article, we endeavour to improve awareness of this devastating disease and thus improve recognition of the disease and its outcomes in elderly patients.

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Authors and Affiliations

  1. Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia

    Helen E. Jo & Tamera J. Corte

  2. University of Sydney, Sydney, NSW, Australia

    Helen E. Jo & Tamera J. Corte

  3. Department of Respiratory Medicine, Fiona Stanely Hospital, Perth, WA, Australia

    Sharan Randhawa & Yuben Moodley

  4. University of Western Australia, Perth, WA, Australia

    Sharan Randhawa & Yuben Moodley

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  1. Helen E. Jo
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  2. Sharan Randhawa
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  3. Tamera J. Corte
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  4. Yuben Moodley
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Correspondence to Yuben Moodley.

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Conflict of interest

Tamera J. Corte has received unrestricted educational grants from Boehringer Ingelheim (BI), Roche, Gilead, Bayer and Medimmune; fees for consulting for BI, Roche and Astra Zeneca; fees for lectures/speaking for BI; and travel reimbursement from BI. Yuben Moodley has received fees for consulting for BI and GSK. Helen E. Jo has received travel reimbursement from BI. Sharan Randhawa reports no conflicts of interest.

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No sources of funding were used to support the writing of this article.

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T. J. Corte and Y. Moodley share joint senior authorship of this article.

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Jo, H.E., Randhawa, S., Corte, T.J. et al. Idiopathic Pulmonary Fibrosis and the Elderly: Diagnosis and Management Considerations. Drugs Aging 33, 321–334 (2016). https://doi.org/10.1007/s40266-016-0366-1

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