REVIEWS   

Minerva Pneumologica 2015 December;54(4):183-92

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Challenges in idiopathic interstitial lung disease

Luppi F. ¹, Cerri S. ¹, Sgalla G. ², Richeldi L. ²

¹ Centre for Rare Lung Disease, University Hospital of Modena, Modena, Italy; ² NIHR Southampton Respiratory Biomedical Research Unit, University Hospital of Southampton, Southampton, UK

Idiopathic interstitial pneumonias (IIPs) are a group of pulmonary disorders with distinct histologic and radiologic appearances and no identifiable cause. The new classification of IIPs published in 2013 distinguishes six distinct major entities, including chronic, usually progressive fibrosing diseases, such as idiopathic pulmonary fibrosis (IPF) and idiopathic nonspecific interstitial pneumonia. IPF, an invariably progressive and ultimately fatal lung disease that occurs in older adults, is the most frequent among the IIPs. Recent evidence and international guidelines advocate the importance of chest high-resolution computed tomography and multidisciplinary discussion (MDD) in the initial diagnostic assessment of patients with suspected IPF. MDD is currently considered the gold standard because improves the accuracy of IIPs diagnosis, avoiding unnecessary testing, and optimizing patient management, particularly nowadays that two drugs have been approved by regulatory agencies for the treatment of IPF. In this review, we focus on the revised diagnostic criteria for IIPs and IPF and provide an overview of the most recent clinical trials. Finally, we stress the fact that NSIP, one of the most frequent differential diagnosis in cases presenting with suspected IPF, is not anymore considered a provisional entity, but a definite clinical-pathological entity.