A Clinical Study of Idiopathic Pulmonary Fibrosis Based on Autopsy Studies in Elderly Patients

Abstract

Objectives The prevalence of idiopathic pulmonary fibrosis (IPF) tends to be greater in the elderly although the precise outcome is not known. The present study investigated the outcome of IPF in elderly patients whose pathological diagnosis corresponded to usual interstitial pneumonia (UIP) on autopsy findings.Methods In a consecutive autopsy series, (n=4,554 cases), complete information was obtained in 86 cases in which the clinical and pathological diagnosis was IPF and UIP, respectively.Results Mean subject age was 80.5 years and there were 52 males and 34 females. Median survival time (MST) was 3.5 years overall. Dyspnea ranking by the MRCdyspnea scale (DR) on admission was closely related to the outcome. WhenMSTwas compared between DROand DR1, or DR2 and DR3, the former patient group survived significantly longer than the latter (p<0.05). Twenty percent of patients died of severe respiratory failure. Other causes of death were disease progression of IPF (10.5%), bacterial pneumonia (23.3%) and lung cancer (17.4%).The patients in the youngelderly group (age <75) survived for a significantly longer period than those in the old-elderly group (age^75) (MST; 5.5 vs 2.0 years; p<0.001). Both lung cancer and pneumonia were significantly more prevalent among IPF patients than among non-IPF patients; these IPF with lung cancer profoundly reflected the smoking history of IPF patients.Conclusions The poor outcome in IPF in elderly patients was characterized by more severe dyspnea, advanced age and co-morbidity. (Internal Medicine 42: 483-489, 2003)

Autopsy findings in 42 consecutive patients with idiopathic pulmonary fibrosis

“…The mean age of the patients studied by ARAKI et al [10] was 80.5 yrs and 66% of the patients were reported as current or previous smokers.…”

“…ARAKI et al [10] reported a consecutive post mortem series of 86 elderly patients (aged .65 yrs) in Japan with IPF in whom the most common causes of death included: bacterial pneumonia (23%), progressive IPF (20%), lung cancer (17.4%) or an acute exacerbation of IPF (10.5%). The mean age of the patients studied by ARAKI et al [10] was 80.5 yrs and 66% of the patients were reported as current or previous smokers.…”

Early Experience with Lung Transplantation in Patients with Idiopathic Pulmonary Fibrosis

“…Most (approximately two-thirds) patients worldwide with idiopathic pulmonary fibrosis are aged > 60 years at presentation (mean age at diagnosis, 66 y) [12]. The present patients were younger and there were more women than men ( Table 2).…”

Combinación de fibrosis pulmonar y enfisema: una entidad poco reconocida

“…(41) (45 y 37% respectivamente). La incidencia de cáncer reportada, en combinación de fibrosis pulmonar y enfisema, es significativamente mayor a la de los pacientes con enfisema sin fibrosis (14%) (42) (HR 4,62, IC95% 1,58-13,55) (44) y a la de pacientes con fibrosis pulmonar idiopática (23%) (43). Esto puede explicarse por la teoría del "triple golpe", en la que hay una predisposición genética derivada de oncogenes, precipitada por la exposición al tabaco y la alteración en la arquitectura pulmonar (enfisema y fibrosis pulmonar) (1).…”