Diagnosing pulmonary fibrosis
If you have symptoms that might be due to pulmonary fibrosis, your GP will refer you to a consultant who specialises in lung conditions.
It’s important to identify the cause of your symptoms if possible, and what type of pulmonary fibrosis you have, as it will influence your treatment.
The doctor will ask questions about your medical and work history, listen to your chest, and order some blood tests to rule out possible known causes.
Further tests used to diagnose pulmonary fibrosis are described below - you might not need to have all of them. Your consultant will assess this when they see you.
X-rays and scans
You will have a chest X-ray. If your doctor thinks you might have pulmonary fibrosis, this will be followed by a CT (computed tomography) scan, which uses X-rays to produce a very detailed image of your lungs. For some types of pulmonary fibrosis, the results from the scan can be very clear.
On a CT scan, idiopathic pulmonary fibrosis (IPF) often shows up as a distinctive pattern on the lungs. You might hear your doctor call this ‘honeycomb’ lung, as the image shows lots of empty pockets or bubbles appearing where more solid-looking lung tissue would normally appear.
These are also known as lung function tests. There are different types, but most involve breathing into a machine through a mouthpiece or tube. The equipment measures how well you can breathe in or out.
The results can tell your doctor how much your lungs and breathing ability have been affected. If you are found to have pulmonary fibrosis, these tests will be used to monitor your condition.
You may also take a walking assessment. This usually involves walking for a few minutes, to see what happens when you exercise, including changes to the level of oxygen in your blood. This is measured by pulse oximetry, using a sensor placed on your finger or earlobe.
Looking inside your lungs
To confirm the diagnosis, your doctor may need to look inside your lungs and possibly remove some cells or tissue for testing. The samples are examined under a microscope by a pathologist – a doctor who is expert in laboratory tests.
Different procedures can be used to get some lung tissue:
- flexible bronchoscopy involves inserting a narrow tube through your nose or mouth, down into your lungs. You will have a local anaesthetic sprayed inside your nose and throat and often a sedative injection into your vein for your comfort.
The tube has a camera on the end so the doctor can see inside your lungs. The doctor may flush some water through the tubing to remove and collect cells for analysis.
Your doctor may also remove samples of tissue at the same time. These are called biopsies and are painless. This is usually an outpatient or day case procedure.
- video-assisted thoracoscopy or VATS involves surgery under a general anaesthetic to get a larger piece of lung tissue. A surgeon makes keyhole incisions in your chest for a video-assisted surgical telescope to enter, and to remove tissue samples from your lungs.
It has higher risks than a bronchoscopy. It’s undertaken only if your specialist thinks more tissue is needed to make a diagnosis and treatment plan. Your doctor will discuss the risks with you. You’ll stay in hospital for a few days for this test.
Identifying and diagnosing pulmonary fibrosis is a joint effort by your specialist team, which will include several doctors who are experts in lung conditions, surgery, X-rays and scans, and laboratory tests.
The specialist nurse is an important part of this team and a good source of information and support for you. The team will put together the findings from all of your tests to give you a diagnosis.