What causes pulmonary fibrosis in an elderly?

Question

Hello doctor,

I am a 74-year-old male with a weight of 142 pounds and a height of 5 feet 10 inches. I take no medications except Ativan. I take vitamins. I am a non-smoker, worked in the auto body shop for two years painting cars, quit grain farming at the age of 44, and had minimal asbestos exposure. I have been suffering from panic disorder for 56 years. Last winter, I got a whiff of hot coal while cleaning my fireplace.

Radiation exposure includes two thallium tests, two barium enemas, and one angiogram—routine chest X-rays until last spring. Last spring's X-ray showed scattered fibrosis. Normal pulmonary function test - FVC liters - Ref 4.11, Pre meas 4.18, Pre % Ref 102; FEV1 liters- Ref 2.70, Pre meas 3.10, Pre % Ref 115; FEV1/FVC % Ref 68, Pre meas 74; FEF 25 % to75 % L/sec Ref 2.40, Pre meas 2.35, Pre % Ref 98; FEV3 Liters Pre meas 3.67; PEF L/sec Ref 7.87, Pre meas 10.63, Pre % Ref 135. What could be causing the fibrosis? Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

A single chest X-ray cannot diagnose lung fibrosis; further tests are required to rule out other causes. As you said, the chest X-ray was expected a few months ago and now shows scattered fibrosis. It is advised to repeat the X-ray after a few days. Once the X-ray is reported as fibrosis, there is suspicion of a chronic irreversible disease known as IPF, which is idiopathic pulmonary fibrosis. After this, having no significant past medical history of any risk factors, it is advisable to rule out common reversible infective causes like TB (tuberculosis) or pneumonia.

Radiation exposure, as you listed above, is not significant in causing fibrosis of the lungs. But it can be a contributing factor. Chest X-ray is not very sensitive to rule out lung fibrosis. The following critical investigation advised is an HRCT (high-resolution computed tomography) scan to rule out IPF or other ILD (immature lung disease). In your case, the advancing age of the patient is the most critical risk factor for causing scattered lung fibrosis. Looking at the spirometry, it is normal and cannot rule out IPF. Further tests like DLCO (diffusing lung capacity for carbon monoxide) with body plethysmography are advised.

So, in summary, a single chest X-ray cannot diagnose lung fibrosis. Further investigations like HRCT scan, DLCO with body plethysmography, and, in some cases, lung biopsy must determine the exact cause of lung fibrosis.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.