Understanding Lung Fibrosis: Causes, Symptoms, Diagnosis, and Treatment

Lung fibrosis, also called pulmonary fibrosis, is a condition where the tissues in your lungs become thick and stiff. Imagine your lungs as balloons. Lung fibrosis is like those balloons getting stiff and hard, making it difficult to inflate and deflate. As a result, it leads to breathing difficulties.

Common Causes of Lung Fibrosis

Lung fibrosis can happen for many reasons. Most common causes include:

1. Environmental Exposure:
   • Long-term exposure to harmful substances like asbestos, coal dust, or silica dust.
   • Breathing in moldy hay (farmer’s lung) or bird droppings.
2. Medical Conditions:
   • Autoimmune diseases, such as rheumatoid arthritis, scleroderma, lupus, et. al..
   • Sarcoidosis, a condition that causes inflammation in various organs, including the lungs.
3. Medications and Therapies:
   • Certain cancer treatments, including radiation therapy, certain drugs for chemotherapy or immunotherapy.
   • Some medications, including amiodarone, nitrofurantoin, et. al.. 
4. Infections:
   • Bacterial pneumonia.
   • Viral pneumonia, for instance influenza, COVID-19.
5. Others:
   • In many cases, the cause is unknown, and the condition is labeled as idiopathic pulmonary fibrosis. 
   • Inhalation injury, for instance vaping induced lung injury.

Recognizing the Symptoms

Pulmonary fibrosis causes the lungs to become stiff and lose their normal elasticity. This gradually disrupts the mechanics of breathing and gas exchange (namely oxygen and carbon dioxide). In the early stages of pulmonary fibrosis, many people experience no symptoms because their lung function still exceeds their typical daily demands. However, as the disease progresses, the lungs no longer meet the body’s needs, which leads to the onset of symptoms.

• Shortness of Breath: Initially noticeable during physical activity, and then become more frequent and severe as the fibrosis progresses.
• Chronic Dry Cough: A persistent, dry cough, less responsive to coughing medication.
• Fatigue: Feeling unusually tired or weak.
• Chest Discomfort: A feeling of tightness or discomfort in the chest.
• Clubbing of Fingers: Swelling or rounding of the fingertips, often a sign of chronic low oxygen levels. 

It is important to know that all of these symptoms are not unique to pulmonary fibrosis. They can be seen in any pulmonary diseases.

How is Lung Fibrosis Diagnosed?

Identifying lung fibrosis is often straightforward, mainly  based on chest imaging. However, it can be tricky to figure out what the causes are. The evaluation typically involves several steps and tests:

1. Medical History and Physical Exam:
   • Your doctor will ask about your symptoms, exposure to harmful substances, living environment, occupation history, and any family history of lung diseases.
   • A detailed medical history and list of your medications.
2. Imaging Tests:
   • Chest X-ray: Can show changes in the structure of your lungs. It is a cheap and quick test, but usually won’t detect the early stage of lung fibrosis. 
   • High-Resolution CT Scan: Provide detailed images of your lungs, and assist providers in making a plan for further investigation.
3. Lung Function Tests:
   • Measures the size of your lungs
   • Provide physiologic data about your lungs
4. Blood Tests:
   • Helps rule out autoimmune diseases
   • Check for oxygen levels in your blood
   • Investigate environmental factors
5. Lung Biopsy:
   • A small sample of lung tissue may be taken to determine the extent and type of lung damage.
   • Gold standard for a definitive diagnosis, but the result can be inconclusive in some cases.

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Treatment Options

While there is no cure for lung fibrosis, treatments can help slow its progression and manage symptoms. Here are some common approaches:

1. Medications:
   • Drugs like pirfenidone or nintedanib can slow the decline of lung functoin in people with idiopathic pulmonary fibrosis.
   • Anti-inflammatory or immune-suppressing medications may be considered if the lung fibrosis is related to autoimmune diseases.
   • Acid reflux can cause the fibrosis among a small group of individuals, and medications for acid reflux should be considered.
2. Oxygen Therapy:
   • Crucial treatment for all individuals with a low oxygen level.
   • Improve the quality of life, avoid other complications.
3. Pulmonary Rehabilitation:
   • A program that combines exercise, breathing techniques, and education to improve lung function and quality of life.
4. Lung Transplant:
   • Lung transplant should be considered for all eligible patients.
5. Lifestyle Adjustments:
   • Quitting smoking and avoiding lung irritants.
   • Eating a balanced diet, avoiding malnutrition, and staying physically active.

Coping with Lung Fibrosis

Living with lung fibrosis can be challenging, but support is available. Joining support groups, staying informed about your condition, and working closely with your healthcare team can make a big difference. If you or a loved one has lung fibrosis, early diagnosis and treatment can significantly improve quality of life.

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