In this study, the rate of therapy alterations after OLB was 73% (30/41) and was not lower than those in previous reports (range 59 to 75%) [10, 14, 15] . For groups with nonspecific and specific pathological diagnoses, the rate of changed therapy was higher in the nonspecific group (87% versus 56%; p = 0.0243). This analytical finding resulted from a large number of patients with nonspecific pathological diagnoses undergoing corticosteroid treatment as a rescue or anti-inflammatory therapy after excluding potential active infection, such as the fibroproliferative stage of DAD [16] [17] [18] , interstitial pneumonitis, nonspecific interstitial pneumonitis, and organizing pneumonia. Early OLB can achieve diagnoses other than fibrosis that are potentially treatable with corticosteroid. Furthermore, the recent study by the ARDS Clinical Trials Network [19] did not support the routine use of methylprednisolone in patients with persistent ARDS (at least seven days after the onset) and