The recent guideline on interstitial lung disease (ILD)1 has a welcome emphasis on best supportive care, including pulmonary rehabilitation. However, we were disappointed that the guideline states that “… there are no randomised controlled trials of pulmonary rehabilitation” and, as a result, ascribes a low level of evidence (C) to this intervention.

As the authors indicate, the guideline was developed during a time of rapid change and growth in the body of scientific evidence pertaining to management of ILD. Pulmonary rehabilitation is no exception. Last year we published a randomised controlled trial of exercise training for ILD in this journal, which demonstrated short-term improvements in dyspnoea and exercise tolerance.2 The gain in exercise tolerance was smaller than previously reported in chronic obstructive pulmonary disease, but was accompanied by improvements in quality of life. Also in 2008, Nishiyama and colleagues3 reported similar findings in a randomised controlled trial of patients with idiopathic pulmonary fibrosis who were diagnosed according to the consensus statement. These findings have since been synthesised in a meta-analysis.4

The guideline will be an important aid to diagnosis and management for people with ILD across many settings and countries. However, as the authors point out, there are few data on which to base recommendations in many areas. We suggest that pulmonary rehabilitation is an area where recent evidence may be helpful. Although the benefits attributable to pulmonary rehabilitation may be small and short-lived, there are few treatments which have successfully impacted on symptoms and quality of life in this patient group. We would hope that the growing evidence pertaining to pulmonary rehabilitation for ILD might be included in future editions of this document.