Tissue-based categorisation of fibrotic interstitial pneumonias: when early diagnosis can make the difference

Extract Time represents a critical determinant in oncology, as prompt treatment initiation is essential to prevent further cancer progression and, ideally, cure the disease. In contrast, treatment is often deferred in fibrotic interstitial pneumonias (IPs) until there is evidence of irreversible disease progression, resulting in a missed therapeutic opportunity. Earlier identification of relevant biological processes and initiation of appropriate pharmacotherapy therefore provides major potential benefit to patients. Most relevant to this is the identification of usual interstitial pneumonia (UIP), which is associated with more rapid progression compared to other major patterns such as nonspecific interstitial pneumonia (NSIP) and bronchiolocentric interstitial pneumonia (BIP), as well as indeterminate cases [1, 2]. Idiopathic pulmonary fibrosis (IPF) is the prototypical fibrotic lung disease associated with a UIP pattern, although other diagnoses can also present with a UIP pattern and a progressive phenotype. Fibrotic BIP may be associated with progressive lung function decline in a large percentage of cases.