Management depends on the clinical scenario ( Figure 1 ). In case of progression to the fi nal end (Figure 1a) , palliation is more appropriate [2] . Noninvasive ventilation (NIV), by decreasing breathing work, is considered a major palliative option that, together with best supportive care, may help to reduce patient discomfort and permits management in an RICU [58, 59] . Patients with 'true' IPF exacerbations (Figure 1b) , in which the diagnostic approach fails to identify a possible infective etiology, must continue to receive empirical antimicrobial therapy that takes into consideration factors such as immunosuppression, previous colonization, BAL timing, onset of mechanical support, and results of obtained cultures [2] . 'Specifi c' therapies for 'true' IPF exacerbations until now have consisted of highdose intravenous corticosteroids plus an immunosuppressant [2] . However, Cochrane reviews for the effi cacy of these therapies concluded that there is no evidence for any benefi t of both cortico steroids and immunosuppressants in IPF [60, 61] . Besides, both progression of fi brosis on native lung in single-lung transplant patients and IPF 'true' exacerbations have been described in the heavily immunodepressed trans planted patient [10] . NIV may also help to wean the very few survivors from the IPF exacerbations and also constitutes the bridge to transplantation [62] . To promptly recognize and treat reversible precipitating factors implicated in IPF exacerbations (Figure 1c) , recovery in the RICU/HDU or (in case of multiorgan failure) in the ICU is mandatory [63] .