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IPF treatment — SCE Respiratory MCQ

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ModerateInterstitial lung diseaseIPF treatmentSCE Respiratory

A 69-year-old woman is diagnosed with IPF by the regional ILD MDT. FVC is 82% predicted, TLCO is 48% predicted and HRCT shows definite UIP. She remains independent but has worsening exertional breathlessness over six months. Liver function tests are normal and she takes no interacting anticoagulants. What is the most appropriate management?

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Correct answer: C — Discuss antifibrotic therapy with nintedanib or pirfenidone

Antifibrotic therapy should be discussed in IPF when eligibility criteria are met, including preserved FVC in current NICE technology appraisals. Steroid and azathioprine-based regimens are harmful in IPF and are a classic trap. Treatment aims to slow decline rather than reverse established fibrosis.

Reference: NICE CG163 IPF; NICE TA504 and TA864; ATS/ERS/JRS/ALAT 2022