TY - JOUR T1 - Interstitial lung disease: new challenges and evolving phenotypes JF - European Respiratory Review JO - EUROPEAN RESPIRATORY REVIEW SP - 91 LP - 93 DO - 10.1183/09059180.00003910 VL - 19 IS - 116 AU - V. Cottin Y1 - 2010/06/01 UR - http://err.ersjournals.com/content/19/116/91.abstract N2 - There have been major changes in the field of interstitial lung disease (ILD) in the past decade, mostly in disease classification and diagnostic processes, and in the role of high-resolution computed tomography (HRCT) of the chest in assessment of diagnosis and prognosis. In the present issue of the European Respiratory Review, Harari and Caminati [1] review the current evidence related to ILD. This editorial emphasises some of the most important challenges in idiopathic pulmonary fibrosis (IPF) as well as some of the recent and changing concepts among the many phenotypes of ILD. IPF is the most severe of the chronic ILDs. One major advance has been made by the better delineating of the disease and the well-adopted international definition of IPF that allowed large clinical trials to be conducted. As some inconsistencies remain in the classification of the idiopathic interstitial pneumonias, an international collaborative task force has begun working under the auspices of the American Thoracic Society and the European Respiratory Society on a possible revision of the current classification. Among many other issues, the task force will have to address the still ongoing debate of usual interstitial pneumonia versus nonspecific pneumonia and their frequently overlapping features; the recently individualised syndrome of combined pulmonary fibrosis and emphysema [2]; and new histopathological patterns that might correspond to clinically relevant entities (e.g. acute fibrinous and organising pneumonia, smoking-related interstitial fibrosis [3], etc.) [4]; and will question the adequacy of maintaining, in the group of idiopathic interstitial pneumonias, entities that are mostly due to environmental exposure or tobacco smoking and therefore not idiopathic (e.g. desquamative interstitial pneumonia) or that are characterised by prominent alveolar, rather than interstitial, changes in histopathology (e.g. organising pneumonia). Several messages emerge from the review by H … ER -