Opportunities to diagnose fibrotic lung diseases in routine care: A primary care cohort study

Background and objective: Temporal trends of healthcare use in the period before a diagnosis of pulmonary fibrosis are poorly understood. We investigated trends in respiratory symptoms and lower respiratory healthcare resource utilisation (HRU) in the 10 years prior to diagnosis.Methods: We analysed a primary care clinical cohort database (UK Optimum Patient Care Research Database) and assessed patients aged ≥40 years who had an electronically coded diagnosis of pulmonary fibrosis between 2005–2015 and a minimum two years continuous medical records prior to diagnosis. Exclusion criteria consisted of electronic codes for recognised causes of pulmonary fibrosis such as CTD, sarcoidosis or extrinsic allergic alveolitis. Results: Data for 2223 patients were assessed. Over the 10 years prior to diagnosis of pulmonary fibrosis there was a progressive increase in HRU across multiple lower respiratory (LR)-related domains. Five years before diagnosis, 18% of patients had multiple healthcare contacts for LR complaints; this increased to 79% in the year before diagnosis, with 38% of patients having five or more healthcare contacts.Conclusion: There are opportunities to diagnose pulmonary fibrosis at an earlier stage; research into case-finding algorithms and strategies to educate primary care physicians is required.