Scars on the lung tissue cause it to thicken and lose the elasticity of healthy lung tissue. Doctors call this pulmonary fibrosis.
Lung scars can result from illness or medical treatment, and they are permanent.
Small scars may not cause noticeable symptoms, but extensive scarring can make it hard for a person to breathe, as it can affect the transfer of oxygen into the bloodstream. As a result, the brain and other organs may not receive the oxygen that they need.
Idiopathic pulmonary fibrosis is a long-term condition in which lung scarring becomes gradually worse. It can be life threatening.
In this article, we look at why lung scarring happens and discuss some of the treatment options available.
Several conditions can cause scarring of the lungs.
Interstitial lung disease
Interstitial lung disease involves inflammation of the air sacs or the web of tissue (interstitium) that surrounds them in the lungs. The inflammation can sometimes cause scar tissue to build up within the lungs, resulting in fibrosis.
Learn more here about interstitial lung disease.
Idiopathic pulmonary fibrosis is the most common type of interstitial lung disease. If doctors describe a condition as idiopathic, this means that they do not know exactly what causes it.
Other causes and risk factors
Other risk factors include:
- previous viral infection or pneumonia
- gastroesophageal reflux disease (GERD) or acid reflux
- older age
- tuberculosis (TB)
- exposure to asbestos or silica
- radiation therapy to the chest cavity
In some cases, there may be a family history of the disease.
Some people experience exacerbations, during which symptoms suddenly worsen. These last for a while and then resolve. Exposure to triggers, such as tobacco smoke, may cause a flare.
The scarring of lung tissue makes it thick and stiff. As the lung tissue thickens, it becomes increasingly difficult for the body to transfer oxygen from the lungs into the bloodstream. As a result, the brain and other organs may not receive enough oxygen.
The symptoms depend on the amount of scarring and how much of the lung it affects, but they may include:
shortness of breath, especially during or after physical activity
- a persistent dry cough
- weight loss and loss of appetite
- rounded and swollen fingertips and nails (clubbing)
- night sweats
Scarring may also increase the risk of lung cancer.
Idiopathic pulmonary fibrosis
The symptoms of idiopathic pulmonary fibrosis may not be noticeable at first, but they tend to develop and worsen over time, making it increasingly difficult to breathe.
Eventually, pulmonary hypertension or respiratory failure can develop, both of which can be life threatening because they prevent oxygen from reaching the body’s organs.
Many factors can lead to a cough or breathlessness, and many conditions can result in lung scarring.
Anyone who has concerns about breathing symptoms should seek medical help. A doctor will carry out a physical examination.
They will ask the person about:
- individual and family medical history
- smoking habits
- possible exposure to pollutants, such as asbestos
After this, the doctor may carry out some tests, such as:
- a CT scan
- an echocardiogram (EKG) to assess heart function
- lung function tests
- pulse oximetry and other tests to measure oxygen levels in the blood
- a tissue sample or biopsy
They may also carry out specific tests to rule out other conditions, such as TB.
As with scars on the skin, scars on the lung are permanent. It is not usually possible to remove them. The lungs are resilient, however, and small scars often do not cause any adverse effects.
Proper diagnosis and monitoring of the scars is key to treatment.
Scars that remain unchanged for 2 years or more are not usually a cause for concern. However, if they spread, they could indicate pulmonary fibrosis.
Idiopathic pulmonary fibrosis
Currently, a lung transplant is the only cure for idiopathic pulmonary fibrosis. However, a doctor can prescribe medications to help slow the progression of the disease and prevent flares. Pirfenidone (Esbriet) and nintedanib (Ofev) are two drugs that have proven effective.
As the disease progresses, the symptoms can become more severe. They can also worsen during a flare. In these cases, a person may need to spend time in the hospital. Treatment will include supplemental oxygen to support the person’s breathing.
Occasionally, a doctor may recommend a transplant. This procedure can cure the condition, but the person will need to take medications for the rest of their life.
Lifestyle tips that may help prevent or relieve symptoms include:
- quitting smoking, if applicable, or avoiding secondhand smoke
- eating a healthful and varied diet
- doing regular exercise
- maintaining a moderate weight to improve breathing capacity
- taking precautions to avoid catching infections from others
- avoiding exposure to pollutants and dust
It is important to talk to a doctor before making any significant lifestyle or dietary changes. A doctor can advise on a suitable exercise regimen, for example.
The outlook for pulmonary fibrosis varies among individuals and depends partly on a person’s age and overall health. The person will need regular assessments.
In the past, only about 50% of people who received a diagnosis of idiopathic pulmonary fibrosis lived another 3 years, while close to 20% lived another 5 years.
However, new medications may slow the progression of the condition and reduce the risk of death in the first few years after diagnosis. Doctors hope that the outlook will continue to improve.