The European respiratory journal · 2025
Update of the international multidisciplinary classification of the interstitial pneumonias: an ERS/ATS statement.
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Ryerson Christopher J, Adegunsoye Ayodeji, Piciucchi Sara, Hariri Lida P, Khor Yet H, Wijsenbeek Marlies S, Wells Athol U, Sharma Amita, Cooper Wendy A, Antoniou Katerina, Borie Raphael, Fabre Aurelie, Inoue Yoshikazu, Johannson Kerri, Johkoh Takeshi, Kawano-Dourado Leticia, Kazerooni Ella, Maher Toby M, Molyneaux Philip L, Protti Raymond, Ravaglia Claudia, Renzoni Elisabetta A, Saito-Koyama Ryoko, Sverzellati Nicola, Walsh Simon L F, Wolters Paul, Yang Soo-Ryum, Travis William, Nicholson Andrew G
Аннотация
BACKGROUND: The 2013 American Thoracic Society/European Respiratory Society statement on the classification of the idiopathic interstitial pneumonias described six major and two rare subtypes of idiopathic interstitial pneumonia, as well as recognising unclassifiable disease.
OBJECTIVE: The objective of this statement is to update the 2013 classification of interstitial pneumonia.
METHODS: Five co-chairs identified a committee of 32 experts in the field, as well as two individuals with lived experience. Creation of the document was supported by a series of video meetings, first including the full committee and then subgroups assigned to draft specific sections of the document. The classification scheme was developed by consensus.
RESULTS: The multidisciplinary committee of experts identified four major advances to the classification of interstitial pneumonia: 1) expansion beyond idiopathic interstitial pneumonias to also include secondary causes; 2) identification of new subcategories and updated terms, including addition of bronchiolocentric interstitial pneumonia as a major pattern as well as changing from acute interstitial pneumonia to idiopathic diffuse alveolar damage and desquamative interstitial pneumonia to alveolar macrophage pneumonia; 3) subclassification of interstitial and alveolar filling disorders, with interstitial disorders further subclassified as fibrotic versus non-fibrotic; and 4) consideration of diagnostic confidence in patient evaluation and management. The committee also provided a comprehensive update on the status of potential molecular tools and identified future research priorities.
CONCLUSIONS: This update builds upon the previous classification approach by describing major advances in the classification of interstitial pneumonia over the past decade.
OBJECTIVE: The objective of this statement is to update the 2013 classification of interstitial pneumonia.
METHODS: Five co-chairs identified a committee of 32 experts in the field, as well as two individuals with lived experience. Creation of the document was supported by a series of video meetings, first including the full committee and then subgroups assigned to draft specific sections of the document. The classification scheme was developed by consensus.
RESULTS: The multidisciplinary committee of experts identified four major advances to the classification of interstitial pneumonia: 1) expansion beyond idiopathic interstitial pneumonias to also include secondary causes; 2) identification of new subcategories and updated terms, including addition of bronchiolocentric interstitial pneumonia as a major pattern as well as changing from acute interstitial pneumonia to idiopathic diffuse alveolar damage and desquamative interstitial pneumonia to alveolar macrophage pneumonia; 3) subclassification of interstitial and alveolar filling disorders, with interstitial disorders further subclassified as fibrotic versus non-fibrotic; and 4) consideration of diagnostic confidence in patient evaluation and management. The committee also provided a comprehensive update on the status of potential molecular tools and identified future research priorities.
CONCLUSIONS: This update builds upon the previous classification approach by describing major advances in the classification of interstitial pneumonia over the past decade.