What are the indications for referring a patient with suspected idiopathic pulmonary fibrosis to a specialist?

Refer a patient with suspected idiopathic pulmonary fibrosis to a specialist if the diagnosis cannot be confidently made based on clinical features, lung function, and radiological findings, and further investigations such as bronchoalveolar lavage, transbronchial biopsy, or surgical lung biopsy are being considered, with the patient's agreement and understanding of the risks and benefits ¹.

Refer if the patient has clinical features suggestive of idiopathic pulmonary fibrosis, such as age over 45, persistent exertional breathlessness, persistent cough, bilateral inspiratory crackles, finger clubbing, or abnormal spirometry, and the diagnosis remains uncertain after initial assessment ¹.

Referral is also indicated if the multidisciplinary team cannot establish a confident diagnosis from initial investigations, and additional diagnostic procedures are being contemplated ¹.