IPF exacerbations lack an eff ective treatment. Intensive immunosuppression proved harmful and fatal [2] . Patients presenting with IPF exacerbations must be managed in centers specializing in interstitial lung diseases (ILDs) with the availability of various specialties and departments such as a respiratory ward with a respiratory ICU/highdependency unit (RICU/HDU), an ICU, and possibly a cardiothoracic transplantation center on a 24-hour basis. Lung transplantation constitutes a treat ment option for IPF 'true' exacerbations [2, 38] but faces insurmountable diffi culties, even in specialized centers.