Do physicians in primary health care recognize pulmonary fibrosis?

Abstract

The early diagnosis of idiopathic pulmonary fibrosis (IPF) is important due to improved treatment options. We have evaluated the quality of referral letters sent to tertiary care by primary health care physicians in relation to the recognition of IPF.

Ninety-five referral letters of patients with IPF identified from a subcohort of patients in the FinnishIPF study were evaluated with respect to time of referral, referring unit, grounds for referral, symptoms, smoking status, occupational history, clinical examinations, co-morbidities, medication, radiological findings and lung function. The overall quality of the referral letter was also estimated.

Fifty-nine percent of referral letters had originated from public health care. The quality of 53 % of the referral letters was estimated as either good or excellent. The time from symptom onset to referral was reported in 60% of cases, being 1.5 years on average. The main reason for referral was the suspicion of parenchymal lung disease (63%). Alterations in chest X-ray were listed as one reason for referring in 53% of cases. Cough (43%) and dyspnea (46%) were the most common symptoms. Inspiratory crackles in lung auscultation were reported in 52% of cases. Shortcomings in referral letters were estimated to have led to significant delays for eight (9%) subjects.

IPF can be detected in primary health care based on symptoms as well as clinical and radiological examinations. Education, however, would improve recognition of IPF among primary health care physicians. Informing the general public of parenchymal lung diseases might also shorten the delay from symptom onset to seeking help from health care professionals.