Diagnosis

Idiopathic pulmonary fibrosis (IPF) can be hard to diagnose because its symptoms are similar to other lungconditions, such as chronic obstructive pulmonary disease (COPD) .

Your GPcan refer you to hospital specialists for a number of tests to help rule out other conditions and confirm the diagnosis.

The checks and tests you may have include:

Medical history and examination

Breathing and blood tests

Chest X-ray and CT scan

Bronchoscopy

Lung biopsy

Medical history and examination

Your doctor will ask about your medical history and whether there are other factors that could be causing a problem with your lungs, such as whether you:

• smoke or have smoked in the past
• have been exposed to harmful substances at work, such as asbestos
• haveother medical conditions

They may also:

• check the sound of your breathing through a stethoscope a crackling sound can suggest lung scarring (fibrosis)
• look at your fingers to see if the ends are swollen ( finger clubbing )
• ask you to walk around for a few minutes to see if you become breathless

Breathing and blood tests

Lung function tests (also called pulmonary function tests) assess how well your lungs work and can help indicate what the problem may be.

These tests measure:

• how quickly you can move air in and out of your lungs
• how much airyour lungscan hold
• how wellyour lungstransfer oxygen into your blood andremove carbon dioxide from it (this can be checked using a blood test )

A commonly used lung function test is spirometry . During the test, you breathe into a mouthpiece that's attached to a monitor.

Chest X-ray and CT scan

A chest X-ray doesn't show the lungs in much detail, but it can help doctors spot some more obvious problems that could be causing your symptoms,such as cancer or a build-up of fluid.

If IPF is suspected, the chest x-ray will be followed by a computerised tomography (CT) scan .

A CT scan is similar to an X-ray,but lots more images are taken and these are put together by a computer to create a more detailed image of your lungs.

This can help your doctor spot signs of scarring in your lungs.

Bronchoscopy

If doctors still aren't sure what the problem is after the tests described above, they may suggest having abronchoscopy.

This is a test where a narrow, flexible tube with a camera (bronchoscope) is passed down into your airways.

Your doctor can then look for anything abnormal and can take small tissue samples for testing.

You'll usually be awake for a bronchoscopy and it may cause coughing. Local anaesthetic will be used to numb your throat so it doesn't hurt and you may also be given a sedative injection which will make you feel sleepy during the procedure.

Lung biopsy

If other tests aren't conclusive, a lung biopsy may need to be carried out.

This involves keyhole surgery to remove a small sample of lung tissue so it can be analysed for signs of scarring.

The procedure is performed under a general anaesthetic (where you're asleep).Your surgeon makes several small incisions (cuts) in your side and an endoscope (a thin tube with a camera and a light at the end) is inserted into the area between the lungs and the chest wall.

The surgeon can see the lung tissue through the endoscope and is able obtain a small sample.