Despite anti-fibrotic therapies’ ability to help idiopathic pulmonary fibrosis patients, more than half of Europeans who have the disease are not receiving them.

That’s because a lot fo physicians are reluctant to prescribe them to people with mild or stable forms of IPF, according to a survey published in the journal BMC Pulmonary Medicine. These doctors adopt a wait-and-see attitude instead.

An anti-fibrotic treatment is one that’s designed to slow lung tissue scarring.

“There is a need to increase physician awareness of the benefits associated with anti-fibrotic treatment across the spectrum of IPF severity,” the researchers wrote. “More education is required to address diagnostic uncertainty, poor understanding of IPF and its treatments, and issues of treatment access.”

IPF is a progressive, life-threatening disease. Patients’ median survival is only two to five years after diagnosis. Estimates of IPF’s prevalence range from 1.25 to 23.4 cases per 100,000 people in Europe, with evidence indicating that the rate is increasing.

European and U.S. approval of Genentech’s anti-fibrotic drug Esbriet (pirfenidone) and Boehringer Ingelheim’s  Ofev (nintedanib) has brought hope to IPF patients.

Clinical trials showed that they can significantly reduce the risk of fibrosis progression and death,  compared with a placebo. These findings not only supported the therapies’ approval, but also led to them being added to international IPF treatment guidelines.

British researchers wondered whether as many European patients as possible were benefitting from the therapies, however. They surveyed physicians online to identify treatment patterns and look for indications that some patients’ needs were not being met.

A key finding was that physicians were not prescribing the treatments to more than half of their patients.

Dr. Toby Maher, an Imperial College London professor who is chair of respiratory research at the British Lung Foundation, directed the survey. The article based on its findings was titled “Unmet needs in the treatment of idiopathic pulmonary fibrosis―insights from patient chart review in five European countries.”

Two hundred ninety physicians from Britain, France, Germany, Italy, and Spain responded to the survey between February and March 2016. Their answers covered 1,783 patients with confirmed or suspected cases of IPF.

The doctors reported that 54 percent of their patients were not on Esbriet or Ofev. This included 40 percent of patients with confirmed cases of IPF. At the time the survey was done, the treatments had been available for two years.

Breaking down treatments by disease category, the study indicated that physicians were prescribing the drugs to 59 percent of patients with a moderate disease, 40 percent with a severe disease, and 29 percent with a mild disease.

The treated population was slightly younger than the untreated population — 67 years old, versus 70.

The key takeaway from the survey was that a lot of patients who are diagnosed with IPF are not receiving anti-fibrotic medicines. One reason for this, researchers believe, is that doctors are uncertain about some patients’ diagnosis. Other reasons are lack of physician understanding about the disease and its treatments, the team added.

“The adoption by physicians of a ‘watch and wait’ approach is of particular concern when evidence suggests immediate intervention can improve outcomes for patients with IPF,” the researchers wrote.

“More education is required to address diagnostic uncertainty, poor understanding of IPF and its treatments, and issues of treatment access,” they wrote. “There is a need to increase physician awareness of the benefits associated with antifibrotic treatment across the spectrum of IPF severity.”