title: Idiopathic pulmonary fibrosis acute exacerbations: where are we now?
abstract: Considerable controversy is haunting the treatment of IPF 'acute exacerbation', its most devastating complication. The consensus coined term 'acute exacerbation' implies that on an unknown etiology disease such as IPF, an unknown etiology superimposed acute lung injury/acute respiratory distress syndrome (ALI/ARDS) represents the end-life event in a consistent proportion of patients and are treated by high dose steroids despite unproven benefit. Inversely, ALI/ARDS treatment recommendations are based on the provision of excellent supportive care plus an extensive search and appropriate treatment of the etiologic precipitant and all intensive care clinicians in the absence of an obvious etiology, considering that occult infection is the most probable and also the most treatable underlying condition, universally administer extensive spectrum antimicrobials. Viewing the persistent high mortality in IPF 'acute exacerbations' treated with steroids we strongly believe that a study comparing the two arms of the steroid and non-steroid approach is greatly awaited by scientists and owed to the patients.
authors.affiliation: 2nd Pulmonary Medicine Department, "Attikon" University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Spyros A
authors.initials: SA
authors.lastname: Papiris
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kagouridis
authors.forename: Likurgos
authors.initials: L
authors.lastname: Kolilekas
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Bouros
authors.forename: Effrosyni D
authors.initials: ED
authors.lastname: Manali
mesh_terms: D055371:Acute Lung Injury / Q000503:physiopathology; D018450:Disease Progression; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000503:physiopathology*; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000503:physiopathology
keywords: ARDS; acute exacerbation idiopathic pulmonary fibrosis; diffuse alveolar damage; idiopathic pulmonary fibrosis; steroids