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Pulmonary Fibrosis

Prognosis

02/03/2011

Question:

My husband of 45 years has pulmonary fibrosis. He is under the care of the V.A. doctors. They told us on 12-20-2010 this is what he has. We know there is nothing that can be done. His oxygen level drops down into the high 60’s or low 70’s just by taking about 20 to 30 steps and this is with him on oxygen all the time (at 5 liters). We just wanted to know is this in the last stages of pulmonary fibrosis?

Answer:

As idiopathic pulmonary fibrosis worsens, the blood oxygen level falls. Initially, the blood oxygen level can be maintained in a normal range (90-100%) by the use of supplemental oxygen. When the blood oxygen falls below this despite high amounts of supplemental oxygen, it is generally a sign of advanced stages of pulmonary fibrosis. 

However, it is important to be sure that there are no other medical problems that can cause a low blood oxygen level such as blood clots, infection, or heart failure. Once patients reach an advanced stage of pulmonary fibrosis and supplemental oxygen is no longer able to prevent the blood oxygen saturation from falling below 90% (or in this case into the 60% range), then the focus changes from trying to keep the oxygen level in the normal range to trying to minimize the patient's sense of breathlessness when the oxygen saturation falls. 

In some patients, hospice can be very effective in helping to provide and titrate medications (such as morphine) that can reduce the sense of breathlessness that comes with low oxygen saturations.

Although there is no cure for idiopathic pulmonary fibrosis, some patients are eligible for lung transplant; although there is not an absolute age cut-off for transplant, most transplant centers will only consider patients over the age of about 65 years old if they have no other major medical conditions and are in good enough physical condition to survive the transplant surgery.

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Response by:

Ruthann   Kennedy, CNP Ruthann Kennedy, CNP
Clinical Practice Manager of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University