Pulmonary Fibrosis

Pulmonary fibrosis is scarring of the lungs. The scarred tissue can't move oxygen into the blood properly, leading to breathlessness and dry cough. A specific subtype — idiopathic pulmonary fibrosis (IPF) — has no known cause; many others have a clear trigger. In India, post-COVID fibrosis, connective-tissue-disease-related fibrosis (scleroderma, lupus, rheumatoid), occupational (silica, asbestos), and hypersensitivity pneumonitis are the common ones.

Typical presentation

• Progressive breathlessness on exertion — first on stairs, then on the flat.
• Dry, persistent cough.
• Fatigue, unintentional weight loss.
• Clubbing of fingertips in advanced disease.
• Fine crackles ("velcro crackles") on lung examination.

Diagnosis

• High-resolution CT chest (HRCT) is the key test.
• Pulmonary function tests show a restrictive pattern.
• Autoimmune/connective-tissue screen (ANA, RF, anti-CCP, etc.).
• Serum precipitins for hypersensitivity pneumonitis.
• Occupational exposure history.
• Lung biopsy in selected cases, usually by a pulmonologist + radiologist + pathologist team.

Treatment

• Anti-fibrotic drug classes slow progression in IPF and several progressive fibrotic lung diseases — available in India and increasingly under insurance coverage.
• Treat the underlying cause — immunosuppression for connective-tissue-related fibrosis, avoidance of the trigger for hypersensitivity pneumonitis, steroid taper for some forms.
• Pulmonary rehabilitation — structured exercise and education; improves symptoms and quality of life.
• Oxygen therapy at home when oxygen levels drop.
• Vaccinations — flu, pneumococcal, COVID.
• Lung transplantation for selected advanced cases; available at a handful of Indian centres.
• Palliative care — symptom control and support, alongside active treatment, not only at end of life.

Practical points

• Smoking is a major driver — quit immediately.
• Avoid further exposure — stone cutting, cotton dust, mould, bird dander, cow-dung fuel.
• Infections decompensate fibrosis fast — treat chest infections early; flu shot every year.
• Tell your doctor about supplemental oxygen before flying — commercial flights drop cabin oxygen.
• Support groups and patient associations exist in Indian metros — ask your pulmonologist.