Pulmonary fibrosis: symptoms, causes, tests and treatment
What lung fibrosis is, early symptoms, causes from dust and pigeons to autoimmune disease, the tests, treatment and when to see a pulmonologist.
Also known as: IPF; Idiopathic pulmonary fibrosis
What pulmonary fibrosis is
Pulmonary fibrosis means scarring of the lungs. The thin, delicate tissue around the tiny air sacs becomes thick and stiff, so the lungs cannot expand easily and oxygen passes into the blood less well. Over time this makes people breathless, first on exertion and later even at rest.
It is part of a larger group of conditions called interstitial lung diseases (ILD). Some forms have a clear cause, such as long exposure to certain dusts, or an autoimmune disease like rheumatoid arthritis. When no cause can be found, it is called idiopathic pulmonary fibrosis (IPF), which mostly affects people over sixty, more often men and former smokers. The scarring cannot be reversed, but treatment can slow some forms, and finding the cause early can stop further damage.
Symptoms
- Breathlessness that slowly gets worse over months or years, first noticed climbing stairs, walking uphill or carrying shopping
- A dry cough that does not go away
- Fatigue and loss of energy
- Unexplained weight loss
- Aching muscles and joints
- Clubbing — widening and rounding of the fingertips, with nails that curve around them
Because the breathlessness comes on slowly, people often blame age, weight or lack of fitness. A doctor listening to the chest may hear fine crackles at the base of the lungs, like velcro being pulled apart. A dry cough with breathlessness that lasts more than a few weeks should be checked.
Causes and risk factors
- Work and environmental dusts — silica from stone cutting, quarrying, mining, sandblasting and glass work; asbestos; coal dust; and some metal dusts. These are a real risk in some Indian workplaces where dust control is poor
- Hypersensitivity pneumonitis — an allergic reaction in the lungs to things breathed in repeatedly, such as pigeon or other bird droppings and feathers, mould in damp homes or air-conditioners, and some farm dusts. Pigeons nesting on balconies and window ledges are an exposure many people in Indian cities live with
- Autoimmune diseases — rheumatoid arthritis, scleroderma, myositis, Sjögren's syndrome and lupus can all affect the lungs
- Medicines — some heart, cancer, arthritis and antibiotic medicines can rarely cause lung scarring
- Radiation therapy to the chest
- Smoking, which raises the risk of IPF and makes most lung disease worse
- Family history — a small number of families have inherited forms
Scarring left behind after tuberculosis is common in India and is a different condition, though the two can be confused. Pulmonary fibrosis is also different from COPD, where the airways and air sacs are damaged mainly by smoke. The treatment for each is different, so getting the right diagnosis matters.
How it is diagnosed
A pulmonologist will ask in detail about your work over the years, birds and pets, damp at home, medicines, joint and skin symptoms, and family history. The questions about pigeons and dust can seem odd, but they often hold the key. Tests include:
- HRCT scan — a high-resolution CT scan of the chest, which shows the pattern of scarring and is the most important test
- Lung function tests — spirometry and a test of how well oxygen passes into the blood (gas transfer)
- Walk test — usually a six-minute walk with a clip on your finger to check whether oxygen levels fall on exercise
- Blood tests — for autoimmune disease and, sometimes, antibodies to birds or mould
- Bronchoscopy, where a thin tube is passed into the lungs to take washings or small samples
- Lung biopsy — a tissue sample, needed only in some cases when the scan and other tests are not conclusive
- An echocardiogram, to check whether the scarring is straining the heart
In larger centres, a team of lung specialists, radiologists and pathologists reviews the results together to reach a diagnosis.
Treatment
Treatment depends on the type of fibrosis. The aims are to remove any cause, slow the scarring where possible, ease symptoms and keep you as active as possible.
- Removing the cause — avoiding the dust, birds, mould or medicine responsible. In hypersensitivity pneumonitis this can lead to real improvement if done early
- Antifibrotic medicines — medicines that slow the loss of lung function in IPF and in some other forms of progressive fibrosis. They do not repair existing scarring and can cause stomach upset or liver problems, so they need monitoring
- Immune-suppressing medicines — steroids and other medicines used for fibrosis linked to autoimmune disease or hypersensitivity pneumonitis. They are generally not used for IPF, where they can do more harm than good
- Oxygen therapy — for people whose oxygen level falls at rest or on exertion
- Pulmonary rehabilitation — a supervised programme of exercise, breathing techniques and education that improves breathlessness, stamina and quality of life
- Lung transplant — an option for a small number of carefully selected people with advanced disease
Vaccination against flu, pneumonia and COVID-19, as advised by your doctor, helps protect lungs that have less reserve. Treating acid reflux, sleep apnoea and heart strain, when present, is also part of care. Discussing goals and comfort care early is good practice, not a sign of giving up.
Living with pulmonary fibrosis
- Stop smoking, and avoid second-hand smoke and smoke from wood or dung cooking fires
- Stay as active as you can; breathlessness during exercise is uncomfortable but, in most cases, not harmful
- Keep pigeons off balconies and window ledges, clean up droppings with a wet method while wearing a mask, and fix damp
- Use protective masks and dust control at work, and ask your employer about safer work if dust exposure is the cause
- Eat small, frequent meals if eating makes you breathless
- Ask your doctor before flying or travelling to the hills, as oxygen levels may fall at altitude
- Seek support for low mood and anxiety, which are common with long-term breathlessness
When it is an emergency
Call 112 or 108, or go to the nearest emergency department, if you have:
- Breathlessness that suddenly gets much worse over hours or days, or breathlessness at rest that is new for you
- Blue or grey lips or fingertips
- Chest pain, or coughing up blood
- Confusion or unusual drowsiness
- High fever with worsening breathing
Sudden worsening can be caused by an infection, a blood clot in the lungs, a collapsed lung or a flare of the fibrosis itself, and needs hospital assessment.
Which doctor to see
A general physician may be the first to hear crackles or arrange a chest X-ray, but pulmonary fibrosis is diagnosed and managed by a pulmonologist. If the fibrosis is linked to an autoimmune disease, a rheumatologist shares care, and a physiotherapist can lead pulmonary rehabilitation.
You can find pulmonologists in Bengaluru or rheumatologists in Bengaluru on The Doctor Index, each with a registration you can check.
Questions to ask at your appointment
- What type of pulmonary fibrosis do I have, and what is causing it?
- Is there anything at home or at work I should avoid?
- Would antifibrotic or immune-suppressing medicines help me?
- Do I need oxygen, and can I join a pulmonary rehabilitation programme?
- How often should my lung function be checked?
- What should I do if my breathing suddenly gets worse?
Common questions
Questions people ask
- Can pulmonary fibrosis be reversed?
- Scarring that has already formed generally cannot be reversed. However, removing a cause such as birds, mould or dust early can stop further damage, and some forms improve with treatment. Antifibrotic medicines can slow progression in idiopathic pulmonary fibrosis and some other types.
- Can pigeons cause lung disease?
- Yes. In some people, repeatedly breathing in dust from pigeon droppings and feathers triggers an allergic lung inflammation called hypersensitivity pneumonitis, which can lead to fibrosis. Tell your doctor if pigeons nest near your home, and reduce exposure if you have this condition.
- Is pulmonary fibrosis the same as TB scarring?
- No. Tuberculosis can leave scarred areas in the lungs after it is treated, which is common in India. Pulmonary fibrosis is a different process, often affecting both lungs widely. A CT scan and a pulmonologist's assessment help tell them apart.
- Is pulmonary fibrosis contagious?
- No. Pulmonary fibrosis cannot be passed from one person to another. It is caused by scarring from dust, allergies, autoimmune disease, some medicines or unknown causes. Family members can safely live with and care for someone who has it.
This condition is usually assessed by a pulmonologist. Every profile shows the doctor’s registration and what has been checked.
Pulmonologists in Bangalore
A few pulmonologists listed on The Doctor Index. They are shown because of their speciality, not a stated interest in Pulmonary Fibrosis; ask the clinic whether the doctor sees it.
Related conditions
- Acute Bronchitis
- Asthma
- Chronic Bronchitis
- COPD
- Emphysema
- Pulmonary Embolism
- Pulmonary Hypertension
- Sleep Apnea
Practical reading
All postsSources
- MedlinePlus, US National Library of Medicine — Pulmonary Fibrosis
- Emergency Response Support System, Government of India — 112
- MedlinePlus, National Library of Medicine — Pulmonary Fibrosis — Public-domain health-topic summary
- Human Phenotype Ontology Consortium — terminology definitions — HPO licence; definitions reproduced without alteration
Pulmonary fibrosis: symptoms, causes, tests and treatment is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.
General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-1987.