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decline was observed in most patients (exacerbation over a period of > 4 wk to months) prior
to their death. A considerable minority of patients although witnessed acute decline resulting
in death (instant exacerbation of less than 4 wk time) (Raghu et al., 2008; Daniels et al., 2010;
Fernández Pérez et al., 2010; Martinez et al., 2005; King et al., 2009). The significant
reasons of mortality in IPF include ischemic heart disease, heart failure, infection, pulmonary
embolism and bronchogenic carcinomas (Hubbard et al., 2008; Martinez et al., 2005; Olson
et al., 2007; King et al., 2009).
2.2.4 Risk factors associated with IPF
2.2.4.1 Acquired risk factors
IPF is a disease of unspecified division by description, since no particular reason has
been strongly recognized so far. Number of possible risk factors although have been
described which may have some relation to the evolution of this disease (Raghu et al., 2011).
• Cigarette smoking: It is assumed that heavy smoking may be related with IPF, and
this relation is comparable to both sporadic and familial IPF (Baumgartner et al.,
1997; Steele et al., 2005; Antoniou et al., 2008).
• Environmental exposures: A remarkable risk for evolution of IPF includes
exposure to metal dusts, in specific lead, brass and steel as well as wood dust
(Hubbard et al., 1996; MIYAKE, 2005; Gustafson et al., 2007). Relation to IPF
has also been observed with few occupational hazards that are associated to
farming, hair dressing, stone cutting/polishing, bird raising and livestock
(Baumgartner et al., 1997).
• Microorganisms: The instigation of IPF is also observed to have close relation to
chronic viral infections, specifically, Epstein-Barr-Virus (EBV) (Egan et al., 1995;
Stewart et al., 1999; Tsukamoto et al., 2000; Lok et al., 2001; Kelly et al., 2002)
and hepatitis C virus (Ueda et al., 1992; Meliconi et al., 1996) infections. It was
observed in a study conducted on 33 IPF patients that in 97% of IPF cases
confirmation of herpes virus infection comprising of EBV, cytomegalovirus,
Human Herpes Virus (HHV)-7 and human HHV-8 (Tang et al., 2003). On the
contrary, some other studies although described no association between viral
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