We read with interest the paper by Mackay et al on the use of disease progression in patients with pulmonary fibrosis as a trigger for referral for lung transplantation.1 The authors attempt to identify the reasons why patients with idiopathic pulmonary fibrosis (IPF) have a higher mortality on the waiting list for lung transplantation than non-IPF patients. Although mortality on the waiting list is a major concern, physicians dealing with these patients face even more difficulties such as deciding which treatment to administer to a given patient: transplantation, inclusion in a clinical trial or classical treatment (corticosteroids, …