Key Takeaways
- Idiopathic pulmonary fibrosis (IPF) prevalence in the US is 14-43 per 100,000.
- Global IPF incidence is 0.6-4.1 per 100,000 person-years.
- IPF incidence in Europe ranges from 1.3-10.7 per 100,000.
- Cigarette smoking associated with 48% of IPF cases.
- Metal dust exposure increases IPF risk by 2.5-fold.
- Familial history raises risk 3.3-13-fold.
- Dry cough present in 70-85% of IPF patients.
- Progressive dyspnea in 90% at diagnosis.
- Bibasilar crackles in 80-90% on exam.
- 80% of IPF patients die within 5 years of diagnosis.
- Median survival 3-5 years from diagnosis.
- 1-year mortality 10-15%.
Despite being rare, this aging-related lung disease carries an eighty percent five-year mortality rate.
Clinical Presentation and Diagnosis
- Dry cough present in 70-85% of IPF patients.
- Progressive dyspnea in 90% at diagnosis.
- Bibasilar crackles in 80-90% on exam.
- Median FVC decline 180-250 ml/year.
- 6MWD average 250-350 meters at diagnosis.
- Clubbing in 25-50% of cases.
- HRCT usual interstitial pneumonia (UIP) pattern in 50-60%.
- DLCO <40% predicted in 50% advanced IPF.
- Weight loss in 20-30% patients.
- Cyanosis in 50% at rest in severe disease.
- Fatigue reported by 70%.
- SGRQ score average 45-50 in IPF.
- Acute exacerbations in 5-10% per year.
- Chest X-ray abnormal in 90%.
- BAL lymphocytosis <15% in UIP.
- GAP index stage I: 6% 1-yr mortality.
- Velcro rales on auscultation hallmark.
- Desaturation <88% on 6MWT in 50%.
- Composite physiologic index >50 in 40%.
- Orthodeoxia in 20% advanced cases.
- MRC dyspnea score 3-4 in 60%.
- HRCT honeycombing in 90% definite UIP.
- Finger clubbing OR 5.37 for IPF diagnosis.
- PFT restriction: FVC <80% in 90%.
- Echo right ventricular systolic pressure >50 mmHg in 30%.
- LDH elevated in 70% acute exacerbations.
- KL-6 biomarker elevated in 80%.
Clinical Presentation and Diagnosis Interpretation
Prevalence and Incidence
- Idiopathic pulmonary fibrosis (IPF) prevalence in the US is 14-43 per 100,000.
- Global IPF incidence is 0.6-4.1 per 100,000 person-years.
- IPF incidence in Europe ranges from 1.3-10.7 per 100,000.
- UK IPF prevalence increased from 20.1 to 29.8 per 100,000 between 1991-2003.
- Male predominance in IPF: 1.6-2.4:1 male-to-female ratio.
- IPF median age at diagnosis is 66 years.
- IPF accounts for 50% of pulmonary fibrosis cases.
- Familial IPF represents 2-20% of cases.
- IPF prevalence in Japan: 5.39 per 100,000.
- US IPF hospitalizations rose 135% from 2001-2011.
- IPF mortality in US: 6.8-8.6 per 100,000.
- IPF prevalence in Olmsted County, MN: 42.7 per 100,000.
- Global PF prevalence: 13-20 per 100,000.
- IPF cases in US estimated at 50,000-80,000.
- Incidence in Australia: 2.3 per 100,000.
- IPF more common in Caucasians.
- Annual IPF diagnoses in Europe: ~13,000.
- Prevalence doubles every decade after 55 years.
- IPF in US males: 20.25 per 100,000.
- IPF in US females: 13.51 per 100,000.
- Pediatric PF incidence: <1 per 100,000.
- IPF mortality doubled from 1996-2007 in US.
- Prevalence in Canada: 18.4 per 100,000.
- IPF incidence in Spain: 2.4 per 100,000.
- Higher prevalence in rural areas.
- IPF cases projected to rise 11% by 2025 in US.
- Familial clustering in 2.2-3.7% of cases.
- IPF prevalence in Israel: 4.5 per 100,000.
- Incidence in New Zealand: 4.1 per 100,000.
Prevalence and Incidence Interpretation
Prognosis and Outcomes
- 80% of IPF patients die within 5 years of diagnosis.
- Median survival 3-5 years from diagnosis.
- 1-year mortality 10-15%.
- GAP stage III: 39% 1-year mortality.
- Lung transplant 5-year survival 50-60%.
- Acute exacerbation mortality 50% per event.
- FVC decline >10% predicts 1-year mortality 40%.
- DLCO <35% predicted: median survival 1.5 years.
- DES score >4: poor prognosis.
- Male gender HR 1.3 for mortality.
- UIP pattern on HRCT better prognosis than NSIP.
- Age >65 HR 1.8.
- Pulmonary hypertension present in 30-50%, worsens survival.
- 6MWD <250m: 1-year mortality 24%.
- Hospitalization mortality 20-30%.
- Nintedanib slows FVC decline by 107 ml/year.
- Pirfenidone reduces mortality risk 48% at 1 year.
- Oxygen therapy improves survival by 50%.
- BMI <21 kg/m2 HR 1.58.
- Composite GAP index c-statistic 0.80 for mortality.
- Post-transplant survival median 4.5 years.
- Annual FVC decline predicts 2-year mortality AUROC 0.73.
- Serum SP-D >100 ng/ml poor prognosis.
- Right heart failure in 20%, median survival 8 months.
- Lung cancer co-occurrence 10-20%, worsens survival.
- CPI >70: median survival 11 months.
- 5-year survival post-diagnosis 20-40%.
- Antifibrotic therapy improves 1-year survival to 95%.
- GAP stage II: 16% 1-year mortality.
- Pirfenidone slows FVC decline 110 ml/year.
- Nintedanib reduces acute exacerbations by 38%.
Prognosis and Outcomes Interpretation
Risk Factors and Etiology
- Cigarette smoking associated with 48% of IPF cases.
- Metal dust exposure increases IPF risk by 2.5-fold.
- Familial history raises risk 3.3-13-fold.
- Gastroesophageal reflux disease (GERD) in 87% of IPF patients.
- Smoking history in 63% of IPF cases.
- Asbestos exposure linked to 5-10% of cases.
- Genetic mutations (MUC5B) increase risk 3-7 fold.
- Wood dust exposure OR 1.95 for IPF.
- Hypersensitivity pneumonitis as precursor in 10-15%.
- Telomerase mutations in 1-8% familial IPF.
- Chronic aspiration risk factor in 30-90%.
- Farming occupation OR 1.3-2.0.
- TERT gene mutation risk RR 2.7.
- Obesity BMI>30 reduces IPF risk OR 0.7.
- Viral infections (EBV, CMV) associated in 20-40%.
- Stone cutting/polishing OR 2.49.
- Emphysema co-occurrence in 30-42%.
- Autoimmune disease overlap in 10-30%.
- Hairdressing occupation risk increased.
- SFTPC mutations in familial PF.
- Socioeconomic status inverse association.
- Welding fumes OR 1.8.
- Connective tissue disease in 15% IPF.
- MUC5B promoter variant in 35% IPF.
- Pesticide exposure OR 1.6.
- Raynaud's phenomenon in 15-20%.
- ABCA3 mutations rare cause.
Risk Factors and Etiology Interpretation
Sources & References
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