Guidelines for Idiopathic Pulmonary Fibrosis: Everything Flows

level of consensus was scored as “perfect” (all respondents agreed), “very good” (median and middle 50% of respondents were found at 1 interval or 80% of respondents were within 1 interval of the median), “good” (50% of respondents were within 1 interval of the median or 80% of the respondents were within 2 intervals of the median), “some” (50% of respondents were within 2 intervals of the median or 80% of respondents were within 3 intervals of the median), and “no consensus” in the remaining cases. The study contains 24 recommendations and the overall consensus agreement was very good (“good” in 1, “very good” in 19, and “perfect” in 4 statements, respectively). In addition, due to the multiple languages used in Switzerland, the Swiss guidelines were compared to current international [2, 3] , German [4] , and French [5] guidelines. There are some recommendations that are worth mentioning. The Swiss report has been differentiated from the ATS/ERS/JRS/ALAT guidelines regarding the use of bronchoalveolar lavage. Bronchoalveolar lavage is not routinely recommended by the ATS/ERS guidelines [2] . However, it can offer information that can drastically alter the diagnostic and consequently therapeutic approach. Hypersensitivity pneumonitis is a characteristic example. It represents a major feature in the differential diagnosis Idiopathic pulmonary fibrosis (IPF) represents a field of constant research and breakthroughs in several areas, from pathogenesis to diagnosis and treatment [1] . This is reflected by the plethora of papers regarding IPF published during the 21st century that led to the official ATS/ ERS/JRS/ALAT evidence-based guidelines for diagnosis and management of IPF [2] . This rapid evolution is further emphasized by the fact that, in 2015, there was a need to publish updated clinical practice guidelines regarding treatment options [3] . Indeed, a number of national societies published their own guidelines in order to keep up with the increasing flow of data [4, 5] . Such an example is the Position Paper of the Working Group for Interstitial and Rare Lung Diseases of the Swiss Respiratory Society on diagnosis and treatment of IPF [6] . The authors have to be commented not only for their initiative but also for their methodology and willingness to decide on controversial questions. An initial list of questions was distributed to the members of the Working Group, and each question was classified as “very important,” “important,” “of limited interest,” and as “unimportant.” Questions considered by the majority as “very important” and “important” formed the basis for this consensus paper. A statement regarding each question was scored from 1 (fully disagree) to 9 (fully agree). The Published online: April 27, 2017