Introduction and objectives Idiopathic Pulmonary Fibrosis (IPF) is strongly associated with advanced age. Our aim is to identify if the baseline characteristics of patients aged >80 who are excluded from pharmaceutical trials differ compared to patients aged <80 years.
Methods Consecutively diagnosed IPF patients ≥80 (n = 61) and <80 (n = 320) presenting to the ILD Unit of the Royal Brompton Hospital from 1/1/2010 to 31/12/2013 were included in this analysis. Data regarding age, smoking status, pulmonary function tests including (FEV1, FVC, DLco and Kco) were extracted from medical records. All cases were discussed by an ILD multi-disciplinary panel for the purpose of assigning a consensus diagnosis.
Results The baseline characteristics of both study groups are summarised in Table 1. Patients were also grouped by smoking status; the smoking history of 10 patients in the ≥80 and 3 patients in the <80 groups was unavailable.
We divided both groups to smokers and non-smokers. FEV1 and FVC did not differ between non-smokers from both study groups whereas were both significantly lower in the smokers aged <80 years than in smokers aged >80 years (74,44 ± 18,24 versus 86,34 ± 12,67 p = 0.0005 for FEV1 and 72,96 ± 20,77 versus 88,34 ± 13,68 p = 0.0001 for FVC). DLco and Kco did not differ between smokers and non-smokers.
Conclusion Patients with IPF aged ≥80 years present with higher spirometric values than those < 80 in particular when a history of smoking is taken into consideration. Mean FVC did not differ between the non-smoking cohorts in each age-separated group while baseline DLco and Kco were not different between the two study groups regardless of smoking status. The higher FVC in smokers with IPF aged >80 compared to younger smokers could be due to the concomitant presence of radiologically evident emphysema. This finding has clinical implications with respect to eligibility for NICE-approved anti-fibrotic treatment. Analysis of the extent of emphysema in these patients and further studies of a higher number of patients is underway.
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