Lung doctors join forces to give breath to pulmonary fibrosis patients

Assoc. Prof. Nitipatana Chierakul, President of Thoracic Society of Thailand under Royal Patronage, said, “Fibrotic-ILD is a rare disease that causes tissue inflammation in the lungs. There have been challenges in screening and diagnosis because symptoms are similar to other lung and respiratory diseases. Medical professionals are more familiar with chronic obstructive pulmonary disease (COPD) in men, congestive heart failure in women, tuberculosis, lung cancer and heart disease. However, the coronavirus outbreak presents even more challenges for doctors and patients because of COVID-19-like symptoms, such as shortness of breath, a dry cough and lung inflammation. But for doctors to make a more accurate diagnosis there needs to be a better understanding of the disease and its symptoms by patients. Tell-tale signs of pulmonary fibrosis include consistent coughing or shortness of breath over an extended period, for example more than two months, especially in non-smokers. Doctors should be looking more carefully at any anomalies or abnormality in lung X-rays, and listen for abnormal breathing sounds at the base of both lungs. They should listen carefully for sounds similar to Velcro being pulled apart, and numb fingers when exercising.
 

During Covid-19 pulmonary fibrosis patients have been additional impacted as they have been unable to attend hospital or had appointments cancelled or postponed, affecting their treatment whether it is access to medication, physical therapy sessions, or receiving oxygen therapy. At times they’ve received pills only by mail, and there has been a shortage of oxygen. The pressure on the healthcare system has also resulted in some patients being diagnosed too late as lung X-rays and biopsy tests take longer to arrange and this has an impact on diagnosis.

Additionally, the lungs are the main organ that COVID-19 will attack, and around 30-50% of all patients develop pneumonia that requires medical attention. Of these, after recovery, one in ten thousand or less may develop pulmonary fibrosis similar to Fibrotic-ILD, which can cause chronic problems. It interferes with the patient's daily life and is a burden on the family and society.
 

Assoc. Prof. Kamon Kawkitinarong, President of the Subcommittee on Interstitial Lung Diseases and Lung Diseases from Work and Environment, said: “Pulmonary fibrosis is a rare disease but is more common in Western countries where the prevalence of the disease is 90-100 people per 100,000 people, but in Thailand no official data is available. However, data from the IPF Registry Project shows there are 131 patients. Inflammation of the lungs is caused by breathing in both organic and inorganic pollutants, as well as internal factors. For example, autoimmune dysfunction may cause inflammation in the lungs. Physical examination history, along with high-resolution computed tomography (HRCT), can be used by doctors to evaluate patient condition. Pulmonary fibrosis has the potential to increase in severity. Invasive type, or PF-ILD (Progressive Phenotype ILD), causes fibrosis or scars around the alveoli and bronchioles. This makes it harder for oxygen to pass through the lungs and bloodstream. The patient will be short of breath and lacking oxygen, the organs will not function fully. Lung scars will not heal back to normal lung tissue condition, meaning that after being diagnosed with pulmonary fibrosis, patients need to visit the doctor regularly to closely monitor the spread of the disease.

The COVID-19 outbreak has affected access to treatment so an official LINE account called ‘Clear Lung’ (O2LUNG) has been set up to help people self-monitor. Patients can record abnormal symptoms and send them to the doctor without having to come to the hospital, while doctors can also publish useful information.”

Assoc. Prof. Chanchai Sittipunt, Vice President of Thoracic Society of Thailand under Royal Patronage, said, “Invasive pulmonary fibrosis is more severe than many cancers. Patients will continue to suffer loss of lung function, increased breathing difficulty and ultimately death when their lungs fail to function or they have a respiratory failure. When comparing the 5-year survival rate of various cancers, around 20% of lung cancer patients survive, 35% of idiopathic pulmonary fibrosis patients survive, 60% of colon cancer patients, 85% of breast cancer 85%, and 87£+% of prostate cancer patients are able to survive. Delayed treatment can significantly increase the mortality rate. For example, if treatment is delayed by one year there is a mortality rate of 8%. However, when delayed for up to two years this rises to 18%, and up to four years sees it rise to 27%. Delaying treatment longer than four years has a mortality rate of 32%.


Currently, there is targeted therapy anti-fibrotic drug approved to cover all three conditions: idiopathic pulmonary fibrosis; pulmonary fibrosis from scleroderma; and invasive pulmonary fibrosis. These can slow the progression of the disease, reduce acute exacerbations, and reduce the number of deaths. Other types of treatment, such as oxygen therapy pulmonary rehabilitation, are used to help patients improve their quality of life. The best way to prevent pulmonary fibrosis is to wear a mask or protective gear if you are at risk and avoid infecting the lungs.”

Mr Anuwat Noreewong, a 78-year-old pulmonary fibrosis patient said, “Pulmonary fibrosis is characterized by extreme fatigue, frequent choking, and persistent coughing that can be so severe it leaves me unable to speak. The disease too a long time to diagnose and the symptoms got worse as the cause could not be found due to symptoms being similar to other diseases. It took me many years to get proper treatment. I am fortunate that my daughter did some research on the Internet and found an expert like doctor Amornpun Wongkarnjana and that’s why I’ve survived. I want to encourage people to be more aware of the disease and recognise the symptoms by themselves, especially during this time of COVID-19. If they believe they suffer from any of these common symptoms they should consult a doctor.”