Dr. Manjunath M Negigoudara Transplant Pulmonologist · KIMS Hospital, Electronic City, Bengaluru
Home / Conditions / Pulmonary fibrosis and IPF: specialist care in Bangalore
Condition · Pulmonary fibrosisScarring of the lung is permanent, but the rate at which it progresses is not fixed, and a great deal of what determines that rate is within reach of treatment. Dr. Manjunath M Negigoudara treats pulmonary fibrosis and idiopathic pulmonary fibrosis at KIMS Hospital, Electronic City, Bengaluru, with transplant assessment in the same department.
This page is about getting treated. If you are looking for a full explanation of what pulmonary fibrosis is, how it is diagnosed and what the outlook looks like, read the detailed patient guide, pulmonary fibrosis in India. What follows here is the clinical side: what treatment is actually available in India, what it costs, what the decision points are, and what happens when you come to the clinic.
Most of what determines how a fibrosis patient does over the following years comes down to four decisions, and it is worth knowing what they are so you can ask whether each has been made.
Idiopathic means no cause has been found. It does not mean no cause exists, and a meaningful number of patients labelled idiopathic turn out to have something identifiable and more treatable underneath. Before the label is accepted, three things need to have been done thoroughly.
A complete autoimmune panel, because fibrosis is sometimes the first manifestation of rheumatoid arthritis, scleroderma, myositis or Sjogren syndrome, and connective-tissue-disease fibrosis is treated differently. A forensic exposure history, because chronic hypersensitivity pneumonitis can look identical to IPF on a scan and is driven by something in the patient's environment, most often birds, damp and mould, or feather bedding. And an HRCT read to protocol, with prone and expiratory images, because air trapping on the expiratory images points away from IPF and toward hypersensitivity pneumonitis.
Where the picture remains unclear, the case goes to a multidisciplinary discussion between the pulmonologist, a thoracic radiologist and a pathologist. This is the reference standard in international guidelines and it changes the working diagnosis often enough to justify the effort. The full diagnostic pathway is set out on the interstitial lung disease page.
Worth asking at your next appointment
Has my autoimmune panel been done and was it normal? Was my HRCT done with prone and expiratory images? Has anyone asked me in detail about birds, damp or my workplace? If the answer to any of these is no, the diagnosis has not been fully worked up.
Two drugs are established for idiopathic pulmonary fibrosis: nintedanib and pirfenidone. Both slow the rate at which lung function declines. Neither reverses scarring, and neither has been shown to be superior to the other, so the choice between them is made on side effects and on what an individual patient will tolerate and keep taking.
| Nintedanib | Pirfenidone | |
|---|---|---|
| Main side effect | Diarrhoea, usually manageable with dose adjustment and antidiarrhoeals | Nausea, rash and marked sun sensitivity |
| Monitoring | Liver function tests | Liver function tests |
| Practical notes | Taken twice daily with food. Interacts with anticoagulants. | Taken three times daily with food. Strict sun protection needed. |
| Also used in | Progressive fibrosing ILD of other causes, and scleroderma-associated ILD | Primarily IPF |
The India-specific point that matters most: both drugs are manufactured as Indian generics, which places the monthly cost at a small fraction of the originator price in Western markets. This is the single biggest practical advantage Indian fibrosis patients have, and it is the reason affordability is discussed openly in the clinic rather than avoided. An antifibrotic that a patient stops after two months because of cost has done nothing for them.
Antifibrotic treatment is not restricted to IPF. Where fibrosis of another cause behaves in a progressive fibrotic way, the same drugs are used alongside whatever treats the underlying disease. This progressive fibrosing phenotype is now a recognised treatment indication in its own right.
Patients and doctors both tend to attribute all breathlessness to the fibrosis itself. Often a meaningful part of it is coming from something else, and that part is treatable.
Idiopathic pulmonary fibrosis is the leading indication for lung transplantation worldwide, and fibrosis patients are the group most often referred too late. The reason is that fibrosis can progress unpredictably. A patient can be stable for a year and then lose substantial lung function in a few months, or after a single acute exacerbation.
International consensus is to refer at diagnosis for an otherwise suitable IPF patient. Referral means an assessment and a conversation, nothing more. Patients assessed early and found suitable are then simply followed, with a clear plan for what triggers listing. Patients who arrive already on continuous oxygen, already deconditioned, or during an acute exacerbation, frequently cannot complete the assessment at all.
Dr. Manjunath M Negigoudara performs this assessment at KIMS Electronic City. Read about lung transplantation, the cost of lung transplant in Bangalore, and life after a lung transplant.
An acute exacerbation is a sharp worsening of breathlessness over days to a few weeks, with new shadowing on imaging and no alternative explanation. It is the most dangerous event in the course of fibrosis and it needs to be treated as an emergency rather than as a routine deterioration.
Seek urgent care if your breathlessness has clearly worsened over days rather than months, if you need oxygen when you did not before, if you have a new fever or cough with sputum, or if your resting oxygen saturation has fallen below your usual reading. Call +91 79937 41199 or attend the emergency department at KIMS Electronic City. Where respiratory failure is severe and the underlying lungs may recover or a transplant may be possible, ECMO is available on site.
Bring the HRCT images themselves, not only the report, every previous pulmonary function test so the trend can be seen, your autoimmune blood results, and a complete list of current medicines including doses. Expect a detailed exposure history, an examination, a six-minute walk test with oximetry, and a plain statement of the diagnosis, the treatment plan and where you stand on transplant.
KIMS Hospital, Survey No. 37 and 38, PES University EC Campus, Hosur Road, Konappana Agrahara, Bengaluru 560100. Monday to Saturday, 9 AM to 5 PM, with evening and video consultations by prior appointment. Call or WhatsApp +91 79937 41199.
The hospital is on Hosur Road opposite the PES University EC Campus, about 15 minutes from Silk Board via the Electronic City elevated expressway. Fibrosis patients attend from HSR Layout, Koramangala, Sarjapur Road, BTM Layout, Jayanagar, JP Nagar, Bannerghatta Road, Whitefield and Marathahalli, and from Bommasandra, Anekal, Chandapura, Attibele and along Hosur Road to the south.
Patients travel from Mysuru, Mangaluru, Hubballi-Dharwad, Belagavi, Kalaburagi, Shivamogga, Tumakuru, Davangere and Ballari, and from Chennai, Coimbatore, Madurai, Tiruchirappalli, Salem, Hyderabad, Warangal, Vijayawada, Visakhapatnam, Tirupati, Guntur, Kochi, Thiruvananthapuram, Kozhikode, Kannur, Goa, Mumbai, Pune, Nagpur, Ahmedabad, Delhi NCR, Kolkata, Bhubaneswar, Guwahati, Chandigarh, Lucknow, Patna, Ranchi and Raipur. Send your HRCT and pulmonary function reports by WhatsApp before travelling so the visit can be planned around what is already known. Kempegowda International Airport is about 45 km from the hospital.
Fibrosis patients are seen from Bangladesh, Nepal, Sri Lanka, the Maldives and Bhutan, from Oman, the UAE, Saudi Arabia, Iraq, Yemen, Kuwait, Bahrain and Qatar, from Kenya, Tanzania, Ethiopia, Uganda, Rwanda, Sudan, Nigeria and Ghana, and from Myanmar, Indonesia and Malaysia. The pathway is a remote review of your imaging and reports over WhatsApp, a written clinical opinion that can support a medical visa application, a three to four day evaluation visit, and video follow-up afterwards. Indian generic antifibrotics are a substantial part of why patients from these regions choose to be worked up here.