Speaker's Highlight

• Don Sin University of British Columbia, St. Paul Hospital (Canada)
  Kenneth R. Chapman Toronto General Hospital Research Institute (Canada)
• Parameswaran Nair McMaster University (Canada)
  Carolyn Calfee UCSF (U.S.A.)
• Gregory P. Downey University of Colorado School of Medicine (U.S.A.)
  David A. Schwartz University of Colorado School of Medicine (U.S.A.)
• Neil Schluger Tuberculosis Control Branch, California Department of Public Health (U.S.A.)
  Nick Kim Critical Care & Sleep Medicine, University of California San Diego (U.S.A.)
• Nicola Hananiah Baylor College of Medicine (U.S.A.)
  Jae-Joon Yim Seoul National University College of Medicine (Republic of Korea)
• Koichiro Asano Tokai University School of Medicine (Japan)
  Diahn-Warng Perng Taipei Veterans General Hospital (Taiwan)
• Konstantinos Kostikas University of Ioannina (Greece)
  Karin Klooster University Medical Center Groningen (Kingdom of the Netherlands)

• New Frontiers in Managing Idiopathic Pulmonary Fibrosis

  Idiopathic pulmonary fibrosis (IPF) remains one of the most demanding conditions in respiratory medicine. Its progressive scarring, variable clinical course, and often subtle early symptoms can delay diagnosis and limit opportunities for intervention. Advances in imaging, molecular science, antifibrotic treatment, and multidisciplinary care are changing how clinicians approach this complex disease.

  The next phase of IPF management will depend on earlier recognition, closer monitoring, and more individualized decisions. Rather than treating pulmonary fibrosis as a single, predictable disorder, specialists are increasingly studying distinct disease patterns, risk profiles, and treatment responses.

  These developments are central to the scientific conversation surrounding respiratory healthcare. At an international congress associated with APSR and KATRD, clinicians, researchers, and allied health professionals can examine how new evidence is moving from laboratories and clinical trials into daily practice.

  Reframing Disease Progression

  IPF is characterized by irreversible fibrosis of the lung interstitium, but its pace of progression differs substantially between patients. Some experience a gradual decline in lung function, while others develop rapid deterioration or acute exacerbations. This variability makes a fixed, infrequent treatment strategy unsuitable for many patients.

  Current care increasingly emphasizes longitudinal assessment. Forced vital capacity, diffusing capacity for carbon monoxide, six-minute walk performance, oxygen requirements, symptoms, and high-resolution computed tomography can provide complementary information. A meaningful change in any one measure should be interpreted alongside the wider clinical picture.

  The concept of progressive pulmonary fibrosis has also broadened clinical awareness. Patients with other fibrosing interstitial lung diseases may develop a similar pattern of worsening fibrosis, declining respiratory function, and increasing symptoms. Recognizing this phenotype supports earlier referral to specialist services and more timely treatment decisions.

  Improving Diagnostic Precision

  A confident diagnosis requires the exclusion of alternative causes, including occupational exposures, connective tissue disease, medication toxicity, and chronic hypersensitivity pneumonitis. A multidisciplinary discussion involving pulmonologists, radiologists, and pathologists remains especially valuable when imaging findings are indeterminate.

  High-resolution CT is central to this process. A usual interstitial pneumonia pattern can support an IPF diagnosis in the appropriate clinical setting, while atypical features may require additional investigation. Blood tests, exposure histories, autoimmune assessment, and, in selected cases, bronchoscopy or lung biopsy help refine the differential diagnosis.

  Digital tools and artificial intelligence may eventually assist image interpretation and risk prediction. However, these technologies should complement expert judgment rather than replace it. Their value will depend on validation across populations, standardized data, transparent performance measures, and careful integration into clinical workflows.

  Expanding the Treatment Toolkit

  Nintedanib and pirfenidone have established roles in slowing the decline of lung function for many people with IPF. They do not reverse established scarring, and tolerability can influence adherence. Gastrointestinal symptoms, liver enzyme abnormalities, photosensitivity, fatigue, and appetite changes should be anticipated and actively managed.

  Treatment planning is becoming more individualized. Clinicians may need to adjust dosing, address drug interactions, monitor laboratory results, and consider patient priorities when selecting or continuing an antifibrotic. Shared decision-making is particularly important when the potential benefit is measured through slower decline rather than immediate symptom relief.

  Research is examining new targets involved in epithelial injury, fibroblast activation, extracellular matrix remodeling, and immune regulation. Investigational therapies may eventually be used in combination with approved antifibrotics, although safety, sequencing, and clinical benefit require evidence from well-designed trials. The detailed scientific program offers an opportunity to follow how these approaches are being evaluated across respiratory medicine.

  Comparing Clinical Priorities

  The most effective management strategy brings pharmacological treatment together with supportive and preventive care. Each element addresses a different source of risk, and the balance may change as the disease progresses.

  Clinical priority	Main purpose	Practical considerations
  Antifibrotic therapy	Slow decline in lung function	Monitor tolerability, liver function, adherence, and patient preferences
  Oxygen assessment	Relieve hypoxemia and support activity	Evaluate exertional and nocturnal needs, not just resting saturation
  Pulmonary rehabilitation	Improve exercise capacity and confidence	Adapt programs to symptoms, frailty, and oxygen requirements
  Vaccination and infection prevention	Reduce avoidable respiratory complications	Review seasonal, pneumococcal, and other appropriate immunizations
  Lung transplant referral	Consider a potentially life-extending option	Refer early enough to allow full assessment and optimization
  Symptom-focused care	Reduce breathlessness, cough, anxiety, and fatigue	Integrate palliative expertise alongside disease-directed treatment

  Supportive care should begin early rather than being reserved for advanced disease. Pulmonary rehabilitation, nutritional advice, vaccination, smoking cessation, oxygen evaluation, and management of gastroesophageal symptoms can improve function and quality of life.

  Cough and breathlessness often remain burdensome even when antifibrotic therapy is tolerated. Breathing strategies, pacing, psychological support, carefully selected medicines, and advance care planning can help patients retain control over daily activities and future decisions.

  Using Monitoring To Guide Action

  Follow-up should be structured around trends rather than isolated measurements. A modest fall in forced vital capacity may be clinically important when accompanied by worsening exertional dyspnea, declining walk distance, or increased oxygen use. Regular review creates opportunities to identify progression before severe functional loss occurs.

  Remote monitoring and digital health tools may support this approach. Home spirometry, activity tracking, symptom diaries, and virtual consultations can provide additional information between hospital visits. Yet these tools require clear escalation pathways, reliable devices, and safeguards against creating anxiety from normal day-to-day variation.

  Biomarkers remain an active area of investigation. Blood proteins, genetic signals, imaging characteristics, and cellular profiles could eventually help identify patients at higher risk of rapid progression or predict treatment response. For now, most proposed biomarkers remain investigational and should not substitute for established clinical assessment.

  Coordinating Long-Term Care

  IPF management is strongest when delivered through a multidisciplinary team. Pulmonologists, specialist nurses, radiologists, pathologists, physiotherapists, pharmacists, nutrition professionals, transplant teams, and palliative care clinicians each contribute a distinct perspective.

  Communication is especially important when care crosses institutions or regions. Patients benefit from a clear treatment plan that explains medication use, monitoring schedules, warning signs, oxygen guidance, rehabilitation options, and emergency contacts. Families and caregivers should receive practical information because they often support adherence and recognize functional changes first.

  Clinical congresses help connect these perspectives. Sessions on interstitial lung disease, emerging therapies, imaging, transplantation, and patient-centered care can provide a broader view than any single specialty meeting. The exchange of regional experience is also valuable because access to diagnostics, antifibrotics, rehabilitation, and transplant services varies considerably.

  Priorities For Better Patient Outcomes

  Clinicians and healthcare teams can translate emerging evidence into practice by focusing on a few durable principles:

  • Refer suspected cases early to an experienced interstitial lung disease service.
  • Use multidisciplinary review when the diagnosis or radiological pattern is uncertain.
  • Monitor lung function, symptoms, exercise tolerance, oxygen needs, and treatment safety together.
  • Offer rehabilitation, vaccination, symptom control, and psychosocial support alongside antifibrotic therapy.
  • Discuss clinical trials and transplant assessment before advanced disease limits available options.

  Patients should receive information in language that reflects uncertainty without creating confusion. A transparent conversation about expected benefits, adverse effects, prognosis, and personal goals can strengthen trust and improve adherence.

  The future of IPF care will be shaped by earlier diagnosis, precision monitoring, combination strategies, and more accessible supportive services. Explore the congress schedule and scientific sessions through the detailed program to follow the ideas and collaborations shaping the next generation of respiratory medicine.

  Richard Russell Nuffield Department of Clinical Medicine, University of Oxford (United Kingdom)
• Mona Bafadhel King’s College London (United Kingdom)
  David Jackson Guy’s and St Thomas’ Hospital, King’s College London (United Kingdom)
• James Chalmers University of Dundee (United Kingdom)
  David Price University of Aberdeen (United Kingdom)