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What causes pulmonary fibrosis in an elderly?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

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Published At January 18, 2018
Reviewed AtApril 18, 2024

Patient's Query

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 tests, two barium enemas, and one angiogram. Normal 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?

Hello,

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 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, 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, as you listed above, is not significant to cause fibrosis of the 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, 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 find out the exact cause of lung fibrosis.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Amol Kumar Wasudeorao Diwan
Dr. Amol Kumar Wasudeorao Diwan

Allergy Specialist

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