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)

• Precision Medicine In Idiopathic Pulmonary Fibrosis

  Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease marked by scarring of the lung tissue and declining respiratory function. Its course varies considerably between patients, which makes a uniform treatment model increasingly inadequate. Precision medicine aims to match diagnosis, monitoring and therapy to each person’s biology, exposures, symptoms and goals.

  For respiratory physicians, this approach combines high-resolution computed tomography, pulmonary function testing, pathology, genomic research and digital health data. The objective is not to promise a single predictive test, but to build a more accurate clinical picture that supports earlier decisions and better-managed care.

  The topic is especially relevant for Australia, where specialist services are concentrated in major centres such as Sydney, Melbourne, Brisbane and Perth. Patients living in regional and remote communities may face long travel distances, limited access to interstitial lung disease clinics and substantial out-of-pocket costs, making coordinated models of care essential.

  The APSR and KATRD congress context provides a useful setting for examining these developments. Clinicians, researchers and allied health professionals can connect scientific advances with practical questions about antifibrotic treatment, transplantation, pulmonary rehabilitation and equitable access across the Australian healthcare system.

  Clinical area	Conventional approach	Precision-focused approach
  Diagnosis	Pattern recognition and exclusion of known causes	Multidisciplinary review supported by imaging, exposure history and biomarkers
  Prognosis	Broad population averages	Individual risk assessment using serial lung function and clinical features
  Treatment	Standard antifibrotic therapy when criteria are met	Therapy selected alongside comorbidity, tolerability and patient priorities
  Monitoring	Periodic clinic-based assessment	Integrated data from testing, symptoms, rehabilitation and remote review
  Research	Large groups treated as broadly similar	Molecular and clinical subgroups studied for treatment response

  Why Individual Variation Matters

  IPF is commonly diagnosed in older adults, but age alone does not explain the differences in progression. Smoking history, occupational exposure, gastro-oesophageal reflux, cardiovascular disease, emphysema and frailty can alter symptoms and outcomes. Some patients experience a gradual decline, while others have rapid deterioration or acute exacerbations.

  A precision approach begins with a careful diagnostic process. High-resolution CT should be reviewed by experienced radiologists alongside respiratory clinicians and, when necessary, pathologists. A multidisciplinary discussion can reduce misclassification with conditions such as hypersensitivity pneumonitis, connective tissue disease-associated interstitial lung disease and other fibrotic lung disorders.

  Biomarkers And Molecular Signals

  Research into telomere biology, epithelial injury, immune pathways and extracellular matrix remodelling is helping explain why lung scarring develops and progresses. Genetic variants may identify susceptibility in selected families, while blood-based and imaging biomarkers are being investigated as indicators of disease activity or treatment response.

  Most candidate biomarkers are not yet ready to guide routine prescribing. Their clinical value depends on reproducibility, affordability and evidence that they improve decisions. Australian research networks can contribute valuable data by including diverse populations and accounting for the different environmental exposures found across urban, agricultural and remote settings.

  Imaging And Functional Monitoring

  Serial forced vital capacity (FVC), diffusing capacity for carbon monoxide (DLCO), six-minute walk distance and oxygen requirements remain central to monitoring. A single result rarely tells the full story; trends over time are more informative. Changes in cough, fatigue, exercise tolerance and weight can also signal clinically meaningful progression.

  Digital tools may extend specialist oversight beyond major hospitals. Secure symptom reporting, home spirometry and telehealth can support patients in regional New South Wales, Queensland or Western Australia, although device accuracy, broadband access and digital confidence must be considered. Remote monitoring should complement, rather than replace, a trusted clinical relationship.

  Antifibrotic Treatment In Practice

  Nintedanib and pirfenidone can slow the decline in lung function for many people with IPF, but they do not reverse established fibrosis. Treatment decisions require attention to liver function, gastrointestinal effects, photosensitivity, drug interactions and the patient’s ability to maintain long-term therapy. Access and reimbursement pathways through Australia’s Pharmaceutical Benefits Scheme also influence practical choices.

  Precision prescribing therefore includes medication education and regular review. A patient who works outdoors may need a tailored plan for pirfenidone-related photosensitivity, while someone with frailty or complex cardiovascular disease may need closer assessment of tolerability. Shared decision-making should cover expected benefits, adverse effects and the possibility of transplantation referral.

  Congress Learning And Collaboration

  Scientific meetings help translate emerging evidence into clinical practice. The APSR 2022 program brought together themes relevant to respiratory medicine, including research, multidisciplinary care and evolving approaches to fibrotic lung disease. The detailed schedule can be reviewed through the congress program, providing context for how precision approaches fit within a broader professional agenda.

  For Australian clinicians, international collaboration is particularly valuable because patient numbers at individual hospitals may be modest. Shared registries, common definitions and biobanks can strengthen studies of rare disease. Collaboration with Korean and Asia-Pacific institutions may also improve understanding of genetic diversity, healthcare delivery and environmental risk across the region.

  Building Fair Access To Personalised Care

  Precision medicine must be clinically useful and socially practical. Patients in metropolitan areas may reach an interstitial lung disease clinic within weeks, whereas those in the Northern Territory or remote Western Australia may depend on visiting specialists and telehealth. Travel assistance, culturally safe communication and local respiratory support can reduce some of this imbalance.

  Care should also reflect Aboriginal and Torres Strait Islander perspectives, family responsibilities and different experiences of health services. Interpreters, Aboriginal health workers and community-controlled services can help make complex discussions about prognosis and transplantation more meaningful. A personalised plan is incomplete if the healthcare system cannot deliver it reliably.

  Practical Priorities For Respiratory Teams

  A clinic can make progress without waiting for every biomarker to enter routine practice. Consistent data collection, multidisciplinary review and early supportive care already provide a strong foundation for individualised management.

  Useful priorities include:

  • Confirming the diagnosis through a multidisciplinary interstitial lung disease meeting
  • Recording serial FVC, DLCO, exercise capacity, oxygen use and symptom burden
  • Reviewing medication tolerance, comorbidities and interactions at every significant visit
  • Offering pulmonary rehabilitation, vaccination advice, smoking cessation and nutrition support
  • Discussing advance care planning and transplantation assessment at an appropriate stage
  • Using telehealth and shared-care arrangements for patients outside metropolitan centres

  Turning Evidence Into Care

  The future of IPF management will depend on connecting molecular research with dependable clinical routines. Biomarkers may eventually refine prognosis or identify treatment-responsive subgroups, but current precision care already comes from accurate phenotyping, repeated assessment and attention to the person behind the test results.

  For an Australian respiratory service, the immediate next step is to audit its IPF pathway against multidisciplinary diagnosis, longitudinal monitoring, antifibrotic review and regional access, then record one agreed improvement in the next clinical meeting.

  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)