Introduction Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease (ILD) with a poor prognosis. Early diagnosis and treatment of IPF may increase lifespan and preserve quality of life. Chest CT is the best test to diagnose IPF, but it is expensive and impractical as a screening test. Fine crackles on chest auscultation may be the only best to screen for IPF. Methods We prospectively assessed the presence and type of crackles on chest auscultation in all patients referred to the ILD Clinic at the Kingston Health Sciences Center in Ontario, Canada. Clinicians with varying levels of experience recorded the presence of fine crackles, coarse crackles or both independently and unaware of the final diagnosis. We applied multinomial logistic regression to adjust for ILD severity and factors that could affect the identification of crackles. Results We evaluated 290 patients referred to the ILD Clinic. On initial presentation, 93% of patients with IPF and 73% of patients with non-IPF ILD had fine crackles on auscultation. In patients with IPF, fine crackles were more common than cough (86%), dyspnoea (80%), low diffusing capacity (87%), total lung capacity (57%) and forced vital capacity (50%). There was 90% observer agreement in identifying fine crackles at a subsequent visit. In multiple regression analysis, the identification of fine crackles was unaffected by lung function, symptoms, emphysema, chronic obstructive pulmonary disease, obesity or clinician experience (p>0.05). Conclusions Fine crackles on chest auscultation are a sensitive and robust screening tool that can lead to early diagnosis and treatment of patients with IPF. Data are available upon reasonable request. Requests can be made to Dr. Onofre Moran-Mendoza.

中文翻译：

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特发性肺纤维化早期诊断中胸部听诊的细微噼啪声：一项前瞻性队列研究

简介 特发性肺纤维化 (IPF) 是一种预后不良的间质性肺病 (ILD)。IPF 的早期诊断和治疗可以延长寿命并保持生活质量。胸部 CT 是诊断 IPF 的最佳测试，但它作为筛查测试既昂贵又不切实际。胸部听诊的细湿啰音可能是筛查 IPF 的唯一最佳方法。方法 我们前瞻性地评估了转诊至加拿大安大略省金斯顿健康科学中心 ILD 诊所的所有患者的胸部听诊噼啪声的存在和类型。具有不同经验水平的临床医生记录了细裂纹、粗裂纹或两者的存在，独立且不知道最终诊断。我们应用多项逻辑回归来调整 ILD 的严重程度和可能影响裂纹识别的因素。结果 我们评估了转诊到 ILD 诊所的 290 名患者。初次就诊时，93% 的 IPF 患者和 73% 的非 IPF ILD 患者在听诊时有细微的噼啪声。在 IPF 患者中，细湿啰音比咳嗽 (86%)、呼吸困难 (80%)、低弥散量 (87%)、肺总量 (57%) 和用力肺活量 (50%) 更常见。有 90% 的观察员同意在随后的访问中识别细裂纹。在多元回归分析中，细湿啰音的识别不受肺功能、症状、肺气肿、慢性阻塞性肺疾病、肥胖或临床医生经验的影响（p>0.05）。结论 胸部听诊的细湿啰音是一种灵敏且稳健的筛查工具，可用于 IPF 患者的早期诊断和治疗。可应合理要求提供数据。