Q. What could be the reason for pulmonary fibrosis in an elderly?

Answered by
Dr. Amolkumar W Diwan
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jan 17, 2018

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, minimal exposure to asbestos. I have been suffering from panic disorder for 56 years. Last winter I got a whiff of hot coals while cleaning my fireplace.

Radiation exposure includes two thallium test, two barium enemas, one angiogram. Normal chest X-rays until last spring. Last spring 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 25-75% 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?



Welcome to icliniq.com.

Single chest X-ray cannot diagnose lung fibrosis and further tests are required to rule out other causes.

As you said, the chest X-ray was normal before a few months and now showing scattered fibrosis. It is advised to repeat the X-ray after few days.

Once the X-ray is reported as fibrosis, there is suspicion of a chronic irreversible disease known as IPF that is idiopathic pulmonary fibrosis.

After this, I would like to clarify that 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, you listed above, is not significant to cause fibrosis of lungs. But it can be a contributing factor.

Chest X-ray is not much sensitive to rule out lung fibrosis and the next important investigation advised is 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 important risk factor to be the cause of scattered lung fibrosis.

Looking at the spirometry, it is absolutely normal which cannot rule out IPF and further tests like DLCO (diffusing capacity of the lung for carbon monoxide) with body plethysmography are advised.

So in summary, as I said, single chest X-ray cannot diagnose lung fibrosis.

Further investigations like HRCT scan, DLCO with body plethysmography and in some cases lung biopsy are must find out the exact cause of lung fibrosis.

For more information consult an allergy specialist online --> https://www.icliniq.com/ask-a-doctor-online/allergy-specialist

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