Pulmonary Fibrosis

Scarring in the Lung

Almost miraculously, most diseases or injuries to the lung heal so perfectly that the affected area will look normal on x-rays, CT scans and even under a microscope.

However, when the lung can not heal normally, a scar is formed. On x-ray or CT scans the scar will look like a patch where the light, air filled appearance of the normal alveoli have been replaced with a more solid material. Scarred lung cannot perform the function of the lung – getting rid of carbon dioxide and bringing in oxygen. Once the lung has scarred the damage cannot be reversed.

Pulmonary Fibrosis

Several diseases can cause a progressive scarring of the lung. Inflammation causes fibrosis when uncontrolled for long enough. Most inflammatory diseases, such as allergic disorders (like hypersensitivity pneumonitis) or autoimmune disorders (associated with Lupus or Rheumatoid Arthritis) can be treated to avoid excessive scarring.

Unfortunately, several diseases cause the lung to directly scar without much inflammation. The most important one is Idiopathic Pulmonary Fibrosis (IPF).

The pace of scarring in IPF can be different for different patients. For some it is barely noticeable, while in others it can be rapidly progressive. It usually goes through cycles of worsening (or exacerbations) then stabilization.  No cause for these cycles has been identified.

There is no blood test for IPF.  A sure diagnosis of IPF involves a surgical lung biopsy, which requires general anesthesia and a short hospital stay although it is performed through small incisions and a minimally-invasive technique.  A biopsy may not be necessary when there are enough of the usual features from the patient’s symptoms, physical exam, and CT scans.

Since treatment of IPF is difficult, there is always a consideration of how much benefit will be gained from the surgery to obtain a definite diagnosis and how much it will hurt the patient. Sometimes a biopsy will show another lung process, and suggest effective treatments.

Anti-inflammation treatment is often tried, with or without a biopsy.  These treatments are strong and require monitoring for side effects.  Patients with IPF must be watched vigilantly since there is an increased risk of lung cancer.

The physicians of respiratory health, allergy and sleep… are experienced with the difficult issues surrounding the diagnosis and treatment of Idiopathic Pulmonary Fibrosis and other interstitial lung diseases.  They will build a personalized treatment plan to fit each of our patients, since we recognize that each patient has individualized needs through the course of their illness.