Opportunities to diagnose fibrotic lung diseases in routine care: A primary care cohort study

Respirology. 2020 Dec;25(12):1274-1282. doi: 10.1111/resp.13836. Epub 2020 May 11.


Background and objective: Temporal trends of healthcare use in the period before a diagnosis of pulmonary fibrosis are poorly understood. We investigated trends in respiratory symptoms and LR HRU in the 10 years prior to diagnosis.

Methods: We analysed a primary care clinical cohort database (UK OPCRD) and assessed patients aged ≥40 years who had an electronically coded diagnosis of pulmonary fibrosis between 2005 and 2015 and a minimum 2 years of continuous medical records prior to diagnosis. Exclusion criteria consisted of electronic codes for recognized causes of pulmonary fibrosis such as CTD, sarcoidosis or EAA.

Results: Data for 2223 patients were assessed. Over the 10 years prior to diagnosis of pulmonary fibrosis, there was a progressive increase in HRU across multiple LR-related domains. Five years before diagnosis, 18% of patients had multiple healthcare contacts for LR complaints; this increased to 79% in the year before diagnosis, with 38% of patients having five or more healthcare contacts.

Conclusion: There are opportunities to diagnose pulmonary fibrosis at an earlier stage; research into case-finding algorithms and strategies to educate primary care physicians is required.

Keywords: clinical epidemiology; clinical respiratory medicine; cough; pulmonary fibrosis; respiratory function tests.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cohort Studies
  • Disease Progression
  • Female
  • Health Services Needs and Demand
  • Humans
  • Male
  • Medical Records, Problem-Oriented / statistics & numerical data
  • Middle Aged
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Primary Health Care* / methods
  • Primary Health Care* / statistics & numerical data
  • Pulmonary Fibrosis* / diagnosis
  • Pulmonary Fibrosis* / epidemiology
  • Pulmonary Fibrosis* / physiopathology
  • United Kingdom / epidemiology