The British Thoracic Society (BTS) has published the first comprehensive long-term analysis of the UK Idiopathic Pulmonary Fibrosis (IPF) Registry, offering crucial insights into disease progression, treatment patterns, and patient outcomes over a decade of data collection.
The landmark analysis examined 5,052 IPF cases across 64 UK hospitals, including 13 specialist centers. The cohort predominantly consisted of older males (mean age 74, 77.8% male) with significant comorbidity burden (76% had at least one comorbidity). Most patients were ex-smokers (66%), with only 6.1% reporting a family history of IPF and 10% presenting with pulmonary hypertension.
Diagnostic Challenges and Treatment Patterns
The registry data revealed concerning trends in diagnostic timelines. Patients waited an average of 13 weeks from referral to first clinic visit, with 60% reporting symptoms for over a year before their initial clinical evaluation. This highlights a critical gap in early detection and intervention.
High-resolution computed tomography (HRCT) emerged as the primary diagnostic tool, with 97% of cases showing interstitial pneumonia patterns. The analysis also documented evolving treatment preferences, with 48% of patients receiving antifibrotic therapy at presentation. Notably, nintedanib usage surpassed pirfenidone from 2017 onward, reflecting changing clinical practice patterns.
Dr. Ahmed Fahim, lead author of the analysis, emphasized the significance of these findings: "It is exciting to present a decade of data from the BTS Registry and highlighting the importance of workforce expansion to deliver high-quality care and improve clinical outcomes."
The registry recorded a 31% mortality rate, with increasing numbers of patients deemed ineligible for lung transplantation over time. The researchers identified delayed diagnosis, timely access to treatment, and insufficient involvement in clinical research as key factors impacting care quality.
Shifting Paradigms in Progressive Pulmonary Fibrosis
The BTS registry findings align with broader shifts in the field of pulmonary fibrosis. At the recent American Thoracic Society (ATS) 2025 International Conference, experts discussed how the management of progressive pulmonary fibrosis (PPF) is evolving beyond rigid consensus-based criteria toward more personalized approaches.
Associate Professor Yet Hong Khor of Monash University noted that while the concept of progression in interstitial lung disease (ILD) has existed for over 70 years, it remained largely overlooked until recently. The 2019 INBUILD trial helped formalize the broader concept of progressive fibrosing ILD, leading to the 2022 international guidelines that introduced the term PPF.
Professor Philip Molyneaux of Imperial College London highlighted that a ≥10% decline in forced vital capacity (FVC) remains the most consistently predictive marker of poor outcomes, whereas symptom worsening or imaging progression are less reliable as standalone indicators.
Future Directions: Personalized Risk Assessment
Looking ahead, experts are advocating for earlier, individualized intervention strategies. Dr. Fernando J. Martinez of UMass Chan Medical School outlined a vision where patients can be assessed and treated based on their individualized risk of progression before meeting traditional PPF criteria.
The global PRIME-PPF cohort study is currently underway across 40 sites worldwide to refine how PPF is defined and predicted. This initiative will incorporate circulating biomarkers, imaging data, clinical characteristics, and physiologic measurements to build a more comprehensive model for risk stratification.
"This is trying to identify, when you first see that patient with fibrotic lung disease, how are we going to define progression in a practical manner that you and your office can use when that is linked to a clinical outcome," explained Dr. Martinez.
The MAVRICK-IPF trial represents another step toward personalized treatment strategies, using a validated biomarker risk score to identify high-risk IPF patients for targeted intervention.
Implications for Clinical Practice
The BTS Registry analysis provides a valuable benchmarking model for IPF care in the UK and beyond. The researchers anticipate that their findings will help shape future care pathways by improving both knowledge and clinical management approaches.
The convergence of long-term registry data with emerging personalized medicine approaches suggests a promising future direction for IPF management. By addressing the identified challenges of delayed diagnosis and treatment access while implementing more sophisticated risk stratification tools, clinicians may be able to significantly improve outcomes for patients with this devastating disease.
As the field moves toward earlier intervention and more precise patient categorization, the lessons from a decade of real-world IPF data will prove invaluable in guiding these transformative changes in clinical practice.
