Patient History

From a past medical history perspective, the patient has prototypical, age-appropriate diseases, including hypertension, diabetes, hypothyroidism, and reflux disease, which has been reported in 60-80% of patients with IPF. These are very common comorbidities but should start to raise flags for interstitial lung disease. Patients will often have typical surgical histories as well, perhaps an appendectomy or cholecystectomy, neither of which will point the physician in any particular direction in terms of diagnosis.

The family history is also very typical of someone in this age group. His mother died of heart disease, and very frequently there will be a family member, such as a mother, father, uncle, or grandfather who died of a lung disease that the patient can't identify because it was before the era of modern CT scanning. And again, the patient may have active reflux disease and frequently another disease such as arthritis.

From a social history perspective, many of these patients will have smoked and most will have quit. This patient smoked 1 pack a day and quit 10 years ago. He worked as a mechanic, and this is where patients almost always have some level of exposure that needs to be teased out. What he did as a mechanic becomes very important, because if he was a brake mechanic, asbestos brakes back in the '50s and '60s would be a relevant exposure that should be discussed. However, if he was performing general mechanic work, it's probably not as important. He enjoys boating and golfing in the summer, and teasing out hobbies and activities and the level of participation over time may also be important to determine if the disease has impacted physical activity. The patient lives in the Midwest in a 12-year-old brick-frame home with an unfinished basement where the laundry is done. This is a question that, as physicians, we frequently ask because in basements, water often seeps in and the walls get laden with water, leading to mold. If so, we begin to consider something like hypersensitivity pneumonitis resulting from exposure, especially if the patients spends a great deal of time down there. A 12-year-old mix brick-frame is going to be less likely to give this type of story because it hasn't been around long enough to soak in much water, and likely with modern materials has less of a likelihood of seepage, but the question should be posed to the patient.