PURPOSE: The consensus statement on the Diagnosis and Therapy of Idiopathic Pulmonary Fibrosis formulated by the American Thoracic Society/ European Respiratory Society (ATS/ERS) was published in 2000. Acceptance and implementation of these guidelines by pulmonologists has not been assessed. We used this survey to establish current practice patterns regarding the diagnosis and therapy of IPF among fellows of the American College of Chest Physicians (FCCP).
METHODS: A 32-item questionnaire was designed and distributed by e-mail to all 6443 pulmonary medicine board-certified FCCP with the support of the ACCP Interstitial Lung Disease (ILD) NetWork. We received 814 responses (12.6%). Demographics (age and gender distribution, time of graduation from fellowship training and practice location) did not differ statistically between respondents and non-respondents, suggesting a representative sample.
RESULTS: Seventy-two percent of respondents were familiar with the ATS/ERS consensus statement. Sixty-three percent of these individuals found it clinically useful, but the same number of respondents indicated that an update is needed. Sixty-four percent of respondents use the clinical criteria for the diagnosis of IPF. High resolution CT-scan of the chest is the most common diagnostic test employed. Bronchoscopy and surgical lung biopsy are only performed in the minority of patients. A majority of respondents felt that lung transplantation represents the only effective therapy for IPF (61%), and 86% refer their patients to lung transplant centers. Forty-five percent of pulmonary physicians advocate providing only supportive care for patients outside of clinical trials. If pharmacological therapy is recommended, prednisone (either alone or in combination with azathioprine) or off-label agents are preferentially prescribed. Despite physician awareness (79%) of clinical trials, interested patients are not consistently referred (54%). IPF patients are frequently treated empirically or screened for gastroesophageal reflux and pulmonary hypertension.
CONCLUSION: There is substantial variability among pulmonary physicians in the diagnosis and management of IPF. This may, in part, reflect the current lack of effective pharmacologic therapy.
CLINICAL IMPLICATIONS: Updated practice guidelines are needed for the diagnosis and therapy of IPF.
DISCLOSURE: Tobias Peikert, None.