Management of idiopathic pulmonary fibrosis: A survey of Canadian respirologists

Abstract

RATIONALE: International consensus guidelines provide both strong and conditional recommendations for treatment of idiopathic pulmonary fibrosis (IPF), but many recommendations are based on limited evidence. We aimed to characterize the practice patterns of IPF treatment by Canadian Respirologists and their opinions regarding the need for future clinical trials. METHODS: We conducted a cross-sectional survey of Canadian Respirologists who are members of the Canadian Thoracic Society or attended the 2018 Canadian Respiratory Conference. Survey domains were related to guideline recommendations and other challenging aspects of IPF care. We evaluated physician confidence and analyzed associations between responses and demographics. MEASUREMENTS AND MAIN RESULTS: Sixty-three Respirologists completed the survey (17% response rate). Corticosteroids were unanimously prescribed (100%) for treatment of IPF exacerbations but with substantial variability in dose and duration. Most respondents believe that placebo-controlled trials of corticosteroid treatment for IPF exacerbations are needed (92%) and ethical (83%). Pulmonary rehabilitation was always or often recommended by 67% of Respirologists; however, 25% reported poor access to exercise programs as a key barrier to participation. In patients with preserved (FVC > 90%) and severely reduced (FVC < 50%) lung function, 62% and 78% of respondents reported recommending antifibrotic therapy, respectively. For patients experiencing a decline in lung function on antifibrotics, most physicians (63%) recommend switching to the alternative antifibrotic, whereas some recommended discontinuing antifibrotic therapy (6%) or dual antifibrotics (5%). CONCLUSIONS: Despite treatment guidelines, Canadian Respirologists have diverse opinions regarding IPF treatments. This survey provides insight into the frequency of particular treatment strategies and may guide future trial design.