Conclusions: The new classification system is a modest step towards a phenotype approach. It is probably an improvement for the prediction of exacerbations, but a deterioration for predicting mortality and lung function decline.
Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) represents one of main worst pulmonary diseases and presents conflictive scenarios for pulmonologist and intensivists. Although a few optimal pharmacological and non-pharmacological (mechanical ventilation) treatments are available, decisions and prognosis for AE-IPF are not well standardized, and outcome predictions are difficult to make. We have read with interest the article by Kishaba T et al. who propose a predictive outcome model based on parameters of severity evaluation at immediate admission. Authors select best parameters in AE of IPF for an appropriate acute staging and mortality prediction at 3 months. Although, this study highlights recommendations for making decisions in AE, there are some aspects are controversial and were not reported previously. First, regarding the rate of in-hospital mortality (56.9 %) and the 3-month mortality rate (63.8 %), other determinants were unknown as ...