Quality of Life: The Pending Outcome in Idiopathic Pulmonary Fibrosis

Recent real-world evidence on idiopathic pulmonary fibrosis (IPF) has provided important insights into survival and disease progression; however, critical patient-centered outcomes remain insufficiently addressed. The article "Real-World Data on the Course of Idiopathic Pulmonary Fibrosis," published in an October 2024 supplement to The American Journal of Managed Care , highlights this limitation by focusing predominantly on objective clinical parameters while lacking systematic evaluation of health-related quality of life (HRQOL). This gap is particularly relevant given limited evidence on how antifibrotic therapies affect symptoms, pulmonary function, and psychosocial well-being beyond radiologic progression. QOL is especially relevant in resource-limited settings, where demonstrating benefits in symptom control and functional status may influence therapeutic decisions, coverage policies, and resource allocation. Although international clinical practice guidelines, including those of the American Thoracic Society and the European Respiratory Society, recognize QOL as a key domain in IPF management, they also acknowledge the paucity of evidence addressing psychosocial and functional outcomes. Notably, major clinical trials such as INPULSIS and ASCEND, while demonstrating efficacy in slowing forced vital capacity decline, did not incorporate HRQOL as a primary outcome. Recent guideline updates propose a conceptual framework integrating validated measures of symptoms, pulmonary function, and psychosocial impact. However, these dimensions have not yet been systematically embedded in clinical research. Reanalysis of existing data and future studies using this framework are warranted. A comprehensive evaluation of quality of life is therefore a clinical and ethical imperative for advancing patient-centered and holistic care in IPF.