University of Oulu

Pesonen, I., Carlson, L., Murgia, N., Kaarteenaho, R., Sköld, C., Myllärniemi, M., Ferrara, G. (2018) Delay and inequalities in the treatment of idiopathic pulmonary fibrosis: the case of two Nordic countries. Multidisciplinary Respiratory Medicine, 13 (1), 14. doi:10.1186/s40248-018-0126-7

Delay and inequalities in the treatment of idiopathic pulmonary fibrosis : the case of two Nordic countries

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Author: Pesonen, Ida1,2; Carlson, Lisa1; Murgia, Nicola3,4;
Organizations: 1Department of Respiratory Medicine and Allergy, Karolinska University Hospital
2Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet
3Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia
4Department of Occupational and Environmental Medicine, University of Gothenburg
5Research Unit of Internal Medicine, University of Oulu and Medical Research Center Oulu, Oulu University Hospital
6University of Helsinki and Helsinki University Hospital, Heart and Lung Center
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
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Language: English
Published: Springer Nature, 2018
Publish Date: 2018-08-10


Background: Idiopathic pulmonary fibrosis (IPF) is characterized by progressive loss of lung function with high mortality within the first 5 years from diagnosis. In 2011–2014, two drugs, pirfenidone and nintedanib, have been approved worldwide for prevention of IPF progression. National IPF-registries have been established in both Finland and Sweden. Our study explored potential differences in the care of IPF in these two countries.

Methods: Patients included consecutively in the Finnish and Swedish IPF-registries from January 1, 2014 through December 31, 2016 were included in the study. Data on demographics and lung function at the time of inclusion were collected. Access to antifibrotic drugs and data on disease outcomes, mortality and the proportion of patients who underwent lung transplantation, was collected during a 3-year follow up.

Results: One-hundred and fifty-two patients from the Finnish and 160 patients from the Swedish IPF-cohorts were included in the study. At inclusion, Finnish patients were significantly older than the Swedish patients (74.6 years vs 72.5 years, p = 0.017). The proportion of non-smokers was significantly higher in the Finnish cohort (41.7% vs 26.9%, p = 0.007). Forced vital capacity (FVC), % of predicted (78.2 vs 71.7 for Finnish and Swedish patients, respectively, p = 0.01) and diffusion capacity for carbon monoxide (DLCO), % of predicted (53.3 vs 48.2 for Finnish and Swedish patients, respectively, p = 0.002) were significantly higher in the Finnish cohort compared to the Swedish cohort at the time of inclusion. During the 3-year follow up period, 45 (29.6%) Finnish and 111 (69.4%) Swedish patients, respectively, were initiated on treatment with an antifibrotic drug (pirfenidone or nintedanib) (p <  0.001). When comparing possible determinants of treatment, patients with higher FVC % were less likely to start antifibrotic drugs (OR 0.96, 95%CI 0.93–1.00, p <  0.024). To be resident in Sweden was the main determinant for receiving antifibrotic drugs (OR 5.48, 95%CI 2.65–11.33, p < 0.0001). No significant difference in number of deaths and lung transplantation during the follow up period was found.

Conclusions: This study highlights differences concerning how IPF patients are treated in Finland and Sweden. How these differences will influence the long-term outcome of these patients is unknown.

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Series: Multidisciplinary respiratory medicine
ISSN: 1828-695X
ISSN-E: 2049-6958
ISSN-L: 1828-695X
Volume: 13
Issue: 1
Article number: 14
DOI: 10.1186/s40248-018-0126-7
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: The FinnishIPF received funding from Sigrid Jusélius Foundation and Boehringer Ingelheim. The Swedish registry received funding from the Swedish Heart and Lung Foundation, Boehringer Ingelheim and Roche. This work was also supported by personal grants from the Finnish Antituberculosis Association Foundation (IP, RK) and The Research Foundation of the Pulmonary Diseases, Finland (IP).
Copyright information: © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.