A Simple Test Can Determine Prognosis in Idiopathic Pulmonary Fibrosis

Sometimes it’s the simplest things that can make all the difference. Unfortunately, when it comes to informing patients with a new diagnosis of pulmonary fibrosis what to expect, things are anything but simple.  For years, pulmonologist, myself included, have dreaded the moment when we inform patients of a diagnosis of pulmonary fibrosis. The discussion invariably involves informing them  that this disease (which they have probably never heard of) may either kill them or have minimal effect on their lives, or have a moderate effect. Alternatively, it may have very little effect at first, but then suddenly become much worse. How can we tell which of these courses the person can expect? Well, we’re not really sure, we’ll just have to wait and see what happens.

To this day, I remain amazed at the stoicism and strength  that the  person who is sitting across from me accepts this information.  For these people there exists neither a good prognostic tool nor an effective treatment. One would think that for such a stark disease there would be 10K runs, gala fundraising dinners, and a powerful Washington lobby.

But there isn’t.

There is no nationwide clamor for research dollars. No push “for the cure” or even for any effective treatment. No distinctive ribbon clad awareness week (ok there is, but I bet you’ve never heard of it).

So it is with a great sense of excitement that we greet any new research which hints at the possibility that we can more accurately  tell our patients with this disease what they might expect in terms of prognosis. Such was the case as I read through a recent issue of Chest.

Researchers at Inova Fairfax Hospital in Falls Church, Virginia looked at the possibility of using the red cell distribution width (RDW) as a prognostic measure in patients with pulmonary fibrosis. The RDW is a blood test which measures variability in sizes of circulating red cells. The test is inexpensive, and usually drawn (and often ignored) as part of a complete blood count. Physicians who order a CBC usually pay attention to the hemoglobin, white blood cell and platelet counts, and hardly ever give the RDW a second glance.

But perhaps we should.

As variability in the size of red blood cells as measured by the RDW can tell us about pathological inflammation. The RDW has already found some use in helping with prognosis in people with Pulmonary Hypertension and Congestive Heart Failure, so why not Pulmonary Fibrosis?

In this study, they found that people who had a RDW of less than 15 had a median survival of 43 months, whereas those who had a RDW of greater than 15 had a median survival  of only 16 months. Survival appeared to be worse in those with even higher levels of RDW, and also appeared better in those with much lower levels. They also found that survival worsened in those individuals in whom the RDW increased by more than 0.01 per month on average.

Truly the idea of using a simple method to help determine the prognosis of patients with pulmonary fibrosis is exciting. Now if only we could find an equally simple method of improving that prognosis.

  • Paul Fogelberg

    Deep – Always GREAT to read more Good News about promising PF research. But, we take issue with one statement in your post: “There is no nationwide clamor for research dollars. No push “for the cure” or even for any effective treatment.” Ah, but there IS such a clamor and push! The Pulmonary Fibrosis Advocates (www.pfadvoctes.org) ARE pushing for 1) more research funding, 2) methods to speed research projects (through NIH & FDA) for treatment(s), and 3) a cure. We hope that you will help us to spread the word about the PFA. I have spoken at the BreathMatters Support Group in Richmond VA and would be happy to do so again. Legislative and Regulatory advocacy IS happening … but it needs to be more frequent and louder… and that will only happen when patients, family members, caregivers, clinicians and researchers join with us to drive home the message.

    • I stand corrected, thanks for your work!

      • Paul Fogelberg

        The cause and the need are great. It is a privilege and an honor to do advocacy work for pulmonary fibrosis.

        And, I hope that you will use your blog posting to help us spread the word about the PFA and, about the prospective RALLY FOR MEDICAL RESEARCH next September 18th: List of organizations that have expressed an interest in participating in a “Rally for Medical Research Hill Day” on Wednesday, September 18th.

        Association of American Cancer Institutes
        Melanoma Research Alliance
        American Heart Association
        American Diabetes Association
        Science Coalition
        Pancreatic Cancer Action Network
        Pulmonary Fibrosis Advocates
        National Psoriasis Foundation
        American Association of Colleges
        of Osteopathic Medicine
        Parkinson’s Action Network
        Americans for Medical Progress
        Federation of Associations in
        Behavioral & Brain Sciences
        Pennsylvania Science Policy Group
        Weill Cornell Medical College
        Columbia University
        The Children’s Hospital of Philadelphia

        Jon Retzlaff, Managing Director
        Office of Science Policy and Government Affairs
        American Association for Cancer Research

  • What should i do for low rdw