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Recent Advances in Chest Medicine |

Management of Idiopathic Pulmonary Fibrosis in the Elderly PatientIdiopathic Pulmonary Fibrosis in the Elderly: Addressing Key Questions

Keith C. Meyer, MD, FCCP; Sonye K. Danoff, MD, FCCP; Lisa H. Lancaster, MD; Steven D. Nathan, MD, FCCP
Author and Funding Information

From the Department of Medicine (Dr Meyer), Division of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Division of Allergy, Pulmonary, and Critical Care Medicine (Dr Danoff), the Johns Hopkins University School of Medicine, Baltimore, MD; Division of Allergy, Pulmonary, and Critical Care Medicine (Dr Lancaster), the Vanderbilt University Medical Center, Nashville, TN; and Advanced Lung Disease and Transplant Program (Dr Nathan), Department of Medicine, Inova Health Systems, Falls Church, VA.

CORRESPONDENCE TO: Keith C. Meyer, MD, FCCP, University of Wisconsin School of Medicine and Public Health, K4/910 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-9988; e-mail: kcm@medicine.wisc.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(1):242-252. doi:10.1378/chest.14-2475
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Idiopathic pulmonary fibrosis (IPF) is strongly associated with advanced age. Making an accurate diagnosis of IPF is critical, as it remains only one of many potential diagnoses for an elderly patient with newly recognized interstitial lung disease. Optimal management of IPF, especially in older-aged patients, hinges on such factors as balancing the application of standard-of-care measures with the patient’s overall health status (robustness vs frailty) and considering the patient’s wishes, desires, and expectations. IPF is known to be associated with certain comorbidities that tend to be more prevalent in the elderly population. Until recently, options for the pharmacologic management of IPF were limited and included therapies such as immunosuppressive agents, which may pose substantial risk to the elderly patient. However, the antifibrotic agents pirfenidone and nintedanib have now become commercially available in the United States for the treatment of IPF. The monitoring and treatment of patients with IPF, especially elderly patients with comorbid medical conditions, require consideration of adverse side effects, the avoidance of potential drug-drug interactions, treatment of comorbidities, and the timely implementation of supportive and palliative measures. Individualized counseling to guide decision-making and enhance quality of life is also integral to optimal management of the elderly patient with IPF.


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