Is Lumenac and Pirfenex safe in lung fibrosis cases?

Question

Hello doctor,

My mother is 68 years old. She has been diagnosed with lung fibrosis. She was taking Lumenac 600mg three times, Ivermectin 10 mg for the last year, no progression in disease, but her saturation was 90, and later fell to 60 on excretion. Now she is taking Pirfenex 800 mg a day, and Benz for her cough. Her saturation is 84 while sitting and 65 while walking. She is also on two LPM oxygen. Also, her feet and face are swelling, but her echo test is normal.

We like to know the following questions,

1. Why are her feet and face swelling?

2. Can she take both Lumenac and Prifenex together?

3. Her pulmonary function test (PFT) is excellent, but still, saturation is not returning.

4. Her X-ray shows that each lung is 35 % white shading, and the rest looks black.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

After going through your history, it is obvious that your mother is suffering from idiopathic pulmonary fibrosis (IPF) (UIP). She has been taking Ivepred 10 (Methylprednisolone) and Lumenac 600 mg (Acetylcysteine) for the last two years. Swelling on the face and legs could be because of the steroid side effects, as she is on long-term Ivepred. You said her X-ray shows white shadows, and her pulmonary function test (PFT) is within normal limits.

For your information, IPF is a chronic progressive lung disease. Though she has started on tablet Pirfenex (Pirfenidone), it will not convert the fibrosed lung to normal. It is only to save the remaining lung from further damage (fibrosis). Now the question is, can she take Lumenac and Pirfenex together? Yes, she can take both tablets together.

The next issue is about her saturation. As the damaged lung is not capable of coping with ventilation, her baseline resting saturation remains good, but on exertion, it decreases because of decreased lung function due to fibrosis. The only way to maintain saturation throughout any activity is to supplement oxygen from outside.

It should be set to 2 LPM to maintain saturation above 90%. Intermittently, it should be checked in the hospital by performing an ABG (arterial blood gas). Overall, she should continue taking the tablet Pirfenex (Pirfenadone) and Lumenac and supplemental oxygen as required. Try to avoid steroids, as they have their own sets of side effects.

I hope this helps.

Thank you.