Treatment for IPF
Treatment can include medication to slow the rate of scarring (pirfenidone and nintedanib) and treatment of your symptoms.
You should be treated at a specialist centre, or by a team that comes from the specialist centre to your local hospital, and have hospital appointments every 3-6 months.
Your specialist team will discuss treatments including:
- Medication to slow the rate of scarring, if you’re eligible. The two drugs that can be prescribed are:
- Best supportive care
- Treatment of specific symptoms
Several clinical trials are currently looking at possible new treatments, including combinations of existing treatments, so other options may be available in the coming years. You may want to discuss with your specialist team if you can take part in trials studying new treatments or therapies.
You may also be asked if data about your lungs can be collected for a national database, the British Thoracic Society IPF Registry, to help improve care for people with pulmonary fibrosis.
Currently 2 anti-fibrotic drugs can be prescribed
Both slow down the development of scar tissue in the lungs of people with IPF.
But, at the moment, they can only be prescribed to people whose lung function is within a set range. If your lung function is outside this range, you might be able to access this treatment by taking part in clinical trials.
Pirfenidone and nintedanib have not been directly compared in clinical trials. Your lung specialist will be able to discuss the pros and cons of each with you to help you decide which drug is best for you.
If you take either drug and your lung function gets worse and outside the recommended range, these treatments may be stopped. Your specialist will discuss this with you.
This treatment comes in the form of capsules or tablets taken with meals. Scientists don’t know exactly how pirfenidone works yet, but they think it slows down inflammation and the build-up of scar tissue in the lungs. In clinical trials it slowed down the loss of lung function in most people with IPF, decreased the rate at which their symptoms got worse and also improved life expectancy.
There are some common side effects. These are feeling sick or nauseous, tiredness, indigestion and sometimes skin reactions to sunlight. Talk to your doctor about possible side effects if you’re considering taking pirfenidone and ask about using sunscreen to prevent skin problems.
Nintedanib has also been shown in trials to slow the rate at which lungs become scarred in IPF. This drug is also taken in the form of capsules.
Common side effects include diarrhoea, abdominal pain and nausea. If you’re taking certain medications such as blood thinners, you may be advised not to take nintedanib.
The National Institute for Health and Care Excellence (NICE), which advises the NHS on using new drug treatments, has only recommended the use of pirfenidone and nintedanib for people whose lung function is within a certain range.
This means there’s a chance that your doctor may not be able to prescribe you either drug – sometimes because your lung function has not yet declined sufficiently. NICE has also recommended that if your IPF continues to get worse, these drug treatments should be stopped. Your consultant will discuss this with you.
The BLF and the Taskforce for Lung Health are campaigning to change the prescribing rules so people in the early stages of the disease and more advanced stages are also eligible for these drugs. The UK is the only country worldwide to impose the current restrictions.
Treating just the symptoms rather than the cause of a disease is often called best supportive care. Your lung specialist may suggest asking other specialists, such as palliative care specialists, to help you with specific problems. They are experts at symptom control and can also give psychological support to you and your family to improve quality of life. They can help with troublesome symptoms at any stage of your illness, not just at the very end of life.
Your team should discuss if you’d benefit from a course of pulmonary rehabilitation to improve your breathlessness and your ability to do your day-to-day activities.
Your care might include:
- medication to help with symptoms
- oxygen therapy – if the level of oxygen in your blood falls when you’re active or when you’re resting
- help to stop smoking, if you smoke
For a very few people, having a lung transplant might be an option if the IPF progresses and isn’t stabilised by treatment. Your specialist team should discuss lung transplant with you within six months of your diagnosis, if it’s suitable for you.
For coughing, your doctor will look for and treat problems that could be making it worse, such as heartburn (acid reflux) or a stuffy nose. Your doctor may also be able to refer you to a physiotherapist who can suggest ways to manage your cough, for example sipping water or swallowing.
Severe coughing can often be suppressed with low doses of liquid morphine. It is usually given by syringe into the mouth and works quite quickly. There are some potential side effects, so your doctor will discuss these with you before you decide if you want to take it.
If you find it difficult to cough mucus up, your doctor may recommend a medicine such as carbocisteine or N-acetyl-cysteine (NAC) to help loosen and thin mucus in the lungs. Some people find it helps their cough, but others may experience side effects such as stomach discomfort, trapped wind or nausea.
Tell your doctor if you have symptoms of gastro-oesophageal reflux, such as heartburn, indigestion or a sour taste at the back of your mouth. There’s evidence this may make fibrosis worse and also make a cough worse. You can have treatments that reduce the amount of acid your stomach makes, such as omeprazole. Liquid antacids such as Gaviscon can also be helpful in preventing reflux at night.
For more severe symptoms of breathlessness, which can sometimes make you very anxious, your doctor might recommend low doses of a short-acting medication such as lorazepam which can help take away sensations of severe breathlessness and panic. These tablets dissolve under your tongue.
You might feel very anxious or even depressed when living with a long term, progressive condition and your symptoms. Talking about your concerns with your medical team, friends and family can be helpful. But some people may also need medication or other therapies to help improve their mood. Don’t be afraid to ask if you or your family member needs help to improve their mental wellbeing.