University of Oulu

Minna Purokivi, Ulla Hodgson, Marjukka Myllärniemi, Eija-Riitta Salomaa & Riitta Kaarteenaho (2017) Are physicians in primary health care able to recognize pulmonary fibrosis?, European Clinical Respiratory Journal, 4:1, 1290339, DOI: 10.1080/20018525.2017.1290339

Are physicians in primary health care able to recognize pulmonary fibrosis?

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Author: Purokivi, Minna1; Hodgson, Ulla2; Myllärniemi, Marjukka2,3;
Organizations: 1Center for Medicine and Clinical Research, Division of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland
2Department of Pulmonary Medicine, Heart and Lung Center, Helsinki, Finland
3Department of Clinical Medicine and Transplantation Laboratory and Helsinki University Hospital, University of Helsinki, Helsinki, Finland
4University of Turku, Turku, Finland
5Unit of Medicine and Clinical Research, Pulmonary Division, University of Eastern Finland, Kuopio, Finland
6Respiratory Medicine, Internal Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
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Language: English
Published: Informa, 2017
Publish Date: 2017-07-07


Background: The early diagnosis of idiopathic pulmonary fibrosis (IPF) has become increasingly important due to evolving treatment options. IPF patients experience a significant delay in receiving an accurate diagnosis, thus delayed access to tertiary care is associated with higher mortality independently from disease severity.

Objective: The aims were to evaluate whether there had been a delay in the referral process, and to determine whether the referring doctors had suspected IPF or other interstitial lung disease (ILD) already during the time of referral.

Methods: Ninety-five referral letters of patients with IPF identified from the Finnish IPF registry were evaluated with respect to time of referral, referring unit, grounds for referral, symptoms, smoking status, occupational history, clinical examinations, co-morbidities, medication, radiological findings and lung function.

Results: Fifty-nine percent of referral letters originated from primary public health care. The time from symptom onset to referral was reported in 60% of cases, mean time being 1.5 (0.8–2.3) (95% CI) years. The main reason for referral was a suspicion of interstitial lung disease (ILD) (63%); changes in chest X-ray were one reason for referring in 53% of cases. Lung auscultation was reported in 70% and inspiratory crackles in 52% of referral letters.

Conclusions: Primary care doctors suspected lung fibrosis early in the course of disease. Lung auscultation and chest X-rays were the most common investigational abnormalities in the referrals. Providing general practitioners with more information of ILDs might shorten the delay from symptom onset to referral.

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Series: European clinical respiratory journal
ISSN: 2001-8525
ISSN-E: 2001-8525
ISSN-L: 2001-8525
Volume: 4
Issue: 1
Article number: 1290339
DOI: 10.1080/20018525.2017.1290339
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: Minna Purokivi had grants supplied by Research Director of Kuopio University Hospital, Foundation of the Finnish Anti- Tuberculosis Association, and the Jalmari and Rauha Ahokas Foundation. The FinnishIPF study has received grants from the Academy of Finland, Sigrid Jusélius Foundation, Jane and Aatos Erkko Foundation (MM).
Copyright information: © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.