Abstract

Background:
Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease with high mortality and limited treatment options. Approximately 30,000 people in the UK live with IPF, which accounts for 1% of all deaths and has a five-year survival rate of 25%. The NHS has approved antifibrotic therapies, delivered via 23 specialist ILD centers. Since 2017, referrals to these centers have sharply increased—exceeding 10,000 annually. Despite a target of specialist review within eight weeks, average treatment initiation times remain at 15 weeks, hindered by rising demand and workforce limitations.

Objective:
To assess antifibrotic therapy uptake and identify real-world barriers to access for IPF patients at a District General Hospital (DGH).

Methods:
A six-month retrospective study (March–September 2024) was conducted using data from an ILD clinic at a Northwest UK DGH. Patient demographics, diagnostic delays, referral timelines, and treatment initiation were analyzed to explore barriers to antifibrotic access.

Results:
Over six months, 159 patients were diagnosed with ILD, of whom 67% were male, with a mean age of 73.5 ± 10.7 years. The average duration of symptoms before ILD diagnosis was 2.53 ± 2.01 years. The mean DLCO and FVC were 53.10 ± 17.3% and 83.3 ± 21.3%, respectively.
Among these patients, 33 (20.8%) met the criteria for antifibrotic therapy (3) and were referred to a specialist center for assessment, while 126 (79.2%) received alternative treatments, including palliative care.
Of those referred, 27 (81.8%) accepted the specialist center appointment, while 6 (18.2%) declined (Table 1). Four patients (12.1%) died before their review, and three (9.1%) were still awaiting assessment at the time of data collection.
Following assessment, 15 patients (55.6%) commenced antifibrotic therapy, 2 (7.4%) awaited further MDT decisions, 2 (7.4%) received alternative treatments, and 1 (3.7%) was lost to follow-up.
The average waiting time from referral to the initial appointment at a specialist center was 6.7 ± 1.8 months.

Conclusion:
Significant delays in diagnosis, referral, and treatment initiation limit access to antifibrotics. Earlier recognition, faster referrals, and broader prescribing capabilities may improve care for IPF patients.