BACKGROUND AND AIMS:Real-world evaluation of clinical characteristics and treatment profile of patients with idiopathic pulmonary fibrosis (IPF) is needed to establish areas for improvement according to evidence-based recommendations. This study evaluated the clinical characteristics and treatment profile of patients with IPF from the Australasian ILD Registry (AILDR), comparing them to the Australian IPF Registry (AIPFR) cohort, to identify differences in baseline characteristics among IPF patients treated with antifibrotics and immunosuppressants. METHODS:Consecutive patients with IPF enrolled between May 2016 and December 2023 from the AILDR and data of patients enrolled in the AIPFR between 2012 and 2016 were included. RESULTS:A total of 842 and 647 patients with IPF were included from the AILDR and the AIPFR respectively. Both cohorts were male predominant (AILDR: 72.0%; AIPFR: 67.7%) of similar mean body mass index (AILDR: 29.2 ± 4.9 kg/m2; AIPFR: 28.7 ± 4.8 kg/m2). With regard to disease-targeted treatment, 572 (67.9%) and 108 (12.8%) participants of the AILDR cohort were on antifibrotic medications and immunosuppressants respectively. There were a total of 35.6% (n = 300) IPF patients on pirfenidone and 40.4% (n = 340) on nintedanib in AILDR. Only 146 (23%) of the AIPFR cohort were receiving antifibrotics. Of newly registered patients in 2016 (n = 18), 2020 (n = 71) and 2023 (n = 151), 50.0%, 18.3% and 15.2% respectively had received immunosuppressive therapy. CONCLUSION:Baseline demographics from the IPF cohorts for both AILDR and AIPFR are largely comparable, with increasing antifibrotic and decreasing use of immunosuppressants since 2016. Immunosuppressive therapy in IPF remains relatively higher than expected despite guideline recommendations.

OBJECTIVES:To facilitate earlier access to palliative care (PC) for interstitial lung disease (ILD) patients, a combined ILD-PC clinic was launched at Royal Prince Alfred Hospital. We describe referral patterns and clinical practice 16 months post-implementation. METHODS:A review of consecutive patients referred to the ILD-PC clinic was performed. Reasons for referral, PC interventions implemented and clinical outcomes were documented. RESULTS:36 patients were referred to the ILD-PC clinic (75±8 years; 57% men). Diagnoses included idiopathic pulmonary fibrosis (49%), unclassifiable ILD (14%), chronic hypersensitivity pneumonitis (14%) and connective tissue disease-associated ILD (11%). Reasons for referral included high symptom burden (91%), advanced disease (66%) and disease progression (49%). PC management strategies encompassed symptom management (60%), referral to community PC services (40%), advance care planning (26%) and the prescription of opioids and benzodiazepines (23%). During the follow-up period, 23% of patients self-reported worsening symptoms, 40% demonstrated lung function decline, 11% died and 6% were listed for lung transplantation. CONCLUSIONS:The ILD-PC clinic incorporates a multidisciplinary, patient-centred approach to ILD care by enabling early access to symptom management, community services and advance care planning.

PurposeTo evaluate a 4-week pulmonary telerehabilitation (PTR) program compared to usual care for people with persistent respiratory post-acute sequelae of COVID-19 (PASC).MethodsA multi-centre randomised controlled trial with remote assessment and assessor blinding. Participants were randomised 1:1 to 4-weeks, twice-weekly PTR or usual care (Control Group (CG)). PTR exercise intensity was titrated based on fatigue and dyspnoea. After the control period, participants in CG could cross-over into PTR to form a combined group (PTR-X). Primary outcome: 1-minute sit-to-stand test (1-minSTST). Secondary outcomes: 5-repetition sit-to-stand test; Montreal Cognitive Assessment blind-version; COVID-19 Yorkshire Rehabilitation Scale; COPD Assessment Test; 36-Item Short-Form Health Survey; Hospital Anxiety and Depression Scale; Fatigue Severity Scale; Kessler Psychological Distress Scale, all assessed at baseline and following intervention or control periods. Data were analysed using a linear mixed effects model.ResultsOf 50 participants recruited, 39 completed the study (PTR group n = 14, CG n = 25). There were no statistically significant between-group differences in any outcomes. For the PTR-X group (n = 27) there was a statistically significant within-group improvement in 1-minSTST (2.4 repetitions, 95%CI 0.6-4.2).ConclusionsA 4-week (8 session) PTR intervention for respiratory PASC showed no significant between-groups differences suggesting that longer PTR programs or alternative interventions should be evaluated.

Idiopathic pulmonary fibrosis (IPF) remains a challenging disease with no drugs available to change the trajectory. It is a condition associated with excessive and highly progressive scarring of the lungs with remodelling and extracellular matrix deposition. It is a highly “destructive” disease of the lungs. The diagnosis of IPF is challenging due to continuous evolution of the disease, which also makes early interventions very difficult. The role of vascular endothelial cells has not been explored in IPF in great detail. We do not know much about their contribution to arterial or vascular remodelling, extracellular matrix changes and contribution to pulmonary hypertension and lung fibrosis in general. Endothelial to mesenchymal transition appears to be central to such changes in IPF. Similarly, for epithelial changes, the process of epithelial to mesenchymal transition seem to be the key both for airway epithelial cells and type-2 pneumocytes. We focus here on endothelial and epithelial cell changes and its contributions to IPF. In this review we revisit the pathology of IPF, mechanistic signalling pathways, clinical definition, update on diagnosis and new advances made in treatment of this disease. We discuss ongoing clinical trials with mode of action. A multidisciplinary collaborative approach is needed to understand this treacherous disease for new therapeutic targets.

AIM:To describe the implementation of a trauma-informed model of care in the Post COVID Respiratory Clinic of a large tertiary referral centre in NSW. DESIGN:Discussion paper. DATA SOURCES:Evidence gathered from a literature search (2008-2022) was used to develop a framework for management of patients presenting to this Post COVID Respiratory Clinic. This paper outlines the personal reflections of the clinic staff as they developed and implemented this framework. Ethical approval was obtained to report the data collected from patient reviews. DISCUSSION:The literature highlights the high prevalence of trauma in patients following COVID-19 infection, as well as the larger population both during and after the pandemic. This experience of trauma was observed in patients seen within the clinic, indicating a need for specialized care. In response, a trauma-informed model of care was implemented. CONCLUSION:Reconceptualizing COVID-19 as a 'collective trauma' can help healthcare workers understand the needs of post-COVID patients and enable them to respond empathetically. A trauma-informed model is complementary to this cohort as it specifically addresses vulnerable populations, many of whom have been further marginalized by the pandemic. IMPLICATIONS FOR NURSING AND PATIENT CARE:Frontline healthcare workers, particularly nurses, are well positioned to implement trauma-informed care due to their high-level of patient contact. Adequate allocation of resources and investment in staff is essential to ensure such care can be provided. IMPACT:The COVID-19 pandemic has led to adverse physical and mental health outcomes for many. Trauma-informed care is a way to promote reengagement with the healthcare system in this group. Post COVID patients globally may benefit from this approach, as it aims to build trust and independence. PATIENT OR PUBLIC CONTRIBUTION:Feedback was sought from a patient representative to ensure this paper adequately reflected the experience of the post-COVID patient.

OBJECTIVE:COVID-19 has led to significant morbidity and mortality globally. Post-COVID sequelae can persist beyond the acute and subacute phases of infection, often termed post-COVID syndrome (PCS). There is limited evidence on the appropriate rehabilitation for people with PCS. The aim of this study is to evaluate the effect on exercise capacity, symptoms, cognition, anxiety, depression, health-related quality of life, and fatigue of a 4-week, twice-weekly supervised pulmonary telerehabilitation program compared with usual medical care for people with PCS with persistent respiratory symptoms. METHODS:The study will be a multi-site randomized controlled trial with assessor blinding. Participants with confirmed previous COVID-19 infection and persistent respiratory symptoms who attend a post-COVID respiratory clinic will be randomized 1:1 to either an intervention group of 4 weeks, twice-weekly pulmonary telerehabilitation or a control group of usual medical care. Participants in the control group will be invited to cross-over into the intervention group after the week 4 assessment. Primary outcome: exercise capacity measured by the 1-minute sit-to-stand test. Secondary outcomes: 5 repetition sit-to-stand test; Montreal Cognitive Assessment; COVID-19 Yorkshire Rehabilitation Scale; Chronic Obstructive Pulmonary Disease Assessment Test; 36-Item Short-Form Health Survey; Hospital Anxiety and Depression Scale; Fatigue Severity Scale; and the Kessler Psychological Distress Scale. Outcomes will be collected at baseline, after 4-weeks intervention or control period, after intervention in the cross-over group, and at 12-month follow-up. IMPACT:Research into effective rehabilitation programs is crucial given the substantial morbidity associated with PCS and the lack of long-term data for COVID-19 recovery. A short-duration pulmonary telerehabilitation program, if effective compared with usual care, could inform practice guidelines and direct future clinical trials for the benefit of individuals with persistent respiratory symptoms post-COVID.

Background Lung function testing remains a cornerstone in the assessment and management of interstitial lung disease (ILD) patients. The clinical implications of the Global Lung function Initiative (GLI) reference equations and the updated interpretation strategies remain uncertain. Methods Adult patients with ILD with baseline forced vital capacity (FVC) were included from the Australasian ILD registry and the National Healthcare Group ILD registry, Singapore. The European Coal and Steel Community and Miller reference equations were compared with the GLI reference equations to assess (a) differences in lung function percent predicted values; (b) ILD risk prediction models and (c) eligibility for ILD clinical trial enrolment. Results Among 2219 patients with ILD, 1712 (77.2%) were white individuals. Idiopathic pulmonary fibrosis (IPF), connective tissue disease-associated ILD and unclassifiable ILD predominated. Median FVC was 2.60 (2.01-3.36)L, forced expiratory volume in 1 s was 2.09 (1.67-2.66)L and diffusing capacity of the lungs for carbon monoxide (DLCO) was 13.60 (10.16-17.60)mL/min/mm Hg. When applying the GLI reference equations, the mean FVC percentage predicted was 8.8% lower (87.7% vs 78.9%, p<0.01) while the mean DLCO percentage predicted was 4.9% higher (58.5% vs 63.4%, p<0.01). There was a decrease in 19 IPF and 119 non-IPF patients who qualified for the nintedanib clinical trials when the GLI reference equations were applied. Risk prediction models performed similarly in predicting mortality using both reference equations. Conclusion Applying the GLI reference equations in patients with ILD leads to higher DLCO percentage predicted values and smaller lung volume percentage predicted values. While applying the GLI reference equations did not impact on prognostication, fewer patients met the clinical trial criteria for antifibrotic agents.

Background and objective: The interstitial lung diseases (ILD) are a heterogenous group of disorders with similar clinical presentation, but widely varying prognoses. The use of a pragmatic disease behaviour classification (DBC), first proposed in international guidelines in 2013, categorises diseases into five behavioural classes based on their predicted clinical course. This study aimed to determine the prognostic utility of the DBC in an ILD cohort. Methods: Consecutive patients presented at the weekly multidisciplinary meeting (MDM) of a specialist ILD centre were included. MDM consensus was obtained for diagnosis and DBC category (1-5). Baseline and serial clinical and physiological data were collected over the study period (median 3.9 years, range 0-5.4 years). The relationship between DBC and prognostic outcomes was explored. Results: 137 ILD patients, [64 (47%) female] were included with mean age 67.0 +/- 1.1 years, baseline FVC% 72.7 +/- 1.7, and baseline DLco% 57.8 +/- 1.6%. Patients were stratified into DBC by consensus at MDM: DBC1 n = 0 (0%), DBC2 n = 16 (12%), DBC3 n = 10 (7.3%), DBC4 n = 55 (40%), and DBC5 n = 56 (41%). On univariable Cox regression, increasing DBC class was associated with poorer progression-free survival (HR 1.6, 95% CI 1.2-2.0, p < 0.001). On multivariable Cox regression, DBC remained predictive of PFS when combined with age and gender (HR 1.4, 95% CI 1.1-1.9, p = 0.011), baseline FVC% (HR 1.5, 95% CI 1.1-1.8, p = 0.003) and ILD diagnosis (HR 1.6, 95% CI 1.2-2.2, p < 0.0001). Conclusion: DBC as determined at ILD multidisciplinary meeting may be a useful prognostic tool for the management of ILD patients.

Background There are substantial advances in diagnosis and treatment for idiopathic pulmonary fibrosis (IPF), but without much evidence available on recent mortality and survival trends. Methods A narrative synthesis approach was used to investigate the mortality trends, then meta-analyses for survival trends were carried out based on various time periods. Results Six studies reported the mortality data for IPF in 22 countries, and 62 studies (covering 63 307 patients from 20 countries) reported survival data for IPF. Age-standardised mortality for IPF varied from ∼0.5 to ∼12 per 100 000 population per year after year 2000. There were increased mortality trends for IPF in Australia, Brazil, Belgium, Canada, Czech Republic, Finland, France, Germany, Hungary, Italy, Lithuania, the Netherlands, Poland, Portugal, Spain, Sweden and UK, while Austria, Croatia, Denmark, Romania and the USA showed decreased mortality trends. The overall 3-year and 5-year cumulative survival rates (CSRs) were 61.8% (95% CI 58.7–64.9; I 2 =97.1%) and 45.6% (95% CI 41.5–49.7; I 2 =97.7%), respectively. Prior to 2010, the pooled 3-year CSR was 59.9% (95% CI 55.8–64.1; I 2 =95.8%), then not significantly (p=0.067) increased to 66.2% (95% CI 62.9–69.5; I 2 =92.6%) in the 2010s decade. After excluding three studies in which no patients received antifibrotics after year 2010, the pooled 3-year CSRs significantly (p=0.039) increased to 67.4% (95% CI 63.9–70.9; I 2 =93.1%) in the 2010s decade. Discussion IPF is a diagnosis associated with high mortality. There was no observed increasing survival trend for patients with IPF before year 2010, with then a switch to an improvement, which is probably multifactorial.

Background and objective In Australia, little is known about delivery of care for people with idiopathic pulmonary fibrosis (IPF). This study examined the organization of IPF care across Australia, how it aligns with guidance for best practice, and identified barriers and facilitators to best care. Methods Data on the organization of IPF care in Australia were collected from public hospitals using a study-specific questionnaire between February and July 2020. Semi-structured telephone interviews were conducted with respiratory physicians from around Australia between April and December 2020. Interviews were transcribed verbatim and thematic analysis was undertaken. Results Almost all hospitals (n = 38, 97%) held multidisciplinary meetings (MDMs) for diagnosing IPF, with 90% of multidisciplinary teams including expert respiratory physicians and radiologists; however, rheumatologists, interstitial lung disease nurses and a histopathologist were often not available. More than 90% of institutions had access to oxygen therapy, pulmonary rehabilitation and advanced care planning, but access to psychological support and clinical trials was limited (53% and 58%, respectively). Fifteen respiratory physicians (27% regional) were interviewed. Approaches to diagnosis, treatment and access to referral services were generally consistent with best practice guidance; however, regional respondents reported barriers related to inadequate staffing, lack of a nurse coordinator, inadequate access to clinical trials and funding models. Telehealth technologies were perceived as facilitators to best care. Conclusion Clinical management of IPF in Australia generally aligns with best practice guidance, but there may be some inequity of access to specialist services, particularly in regional areas, that should be addressed to ensure optimal care for all.

To the Editors: The novel coronavirus pandemic continues to have a dramatic impact upon all aspects of health care. Interstitial lung disease (ILD) clinicians and patients alike are faced with new challenges as a result of the threat imposed by coronavirus disease 2019 (COVID-19) and the precautions implemented to reduce its impact. While much of Australia has been fortunate to have not encountered the same incidence of COVID-19 as other countries, our ILD services have nonetheless encountered the challenges which social distancing brings for the diagnosis and management of our patients. The ILD multidisciplinary meeting (MDM) is fundamental to the care of people with ILD and is directly threatened by COVID-19. The face-to-face ILD-MDM historically utilized by 97.1% of centres is not compatible with social distancing measures. However, continuation of the ILD-MDM, in our opinion, is more important now than ever. Patients with ILD and clinicians managing ILD require ready access to an MDM to provide diagnostic confidence and avoid treatment delay. Obtaining an accurate diagnosis is the foremost priority of people suffering from ILD, and is dependent on access to an ILD-MDM. In some countries, including Australia, access to diseasemodifying anti-fibrotic therapies is dependent on an MDM-endorsed idiopathic pulmonary fibrosis (IPF) diagnosis. In addition, the ILD-MDM is a fundamental component of the education of trainees and non-ILD physicians. Prior to the pandemic, ILD services across Australia had a hybrid in-person/virtual MDM approach. Our ILD services adopted entirely virtual MDMs when confronted with the threat of COVID-19, with virtual MDM being the only safe option for many centres. This virtual approach has been previously recognized. The Thoracic Society of Australia and New Zealand and the Lung Foundation Australia position statement on ILD-MDMs hinted at the potential benefits of tele/video conferencing to overcome geographical separation of ILD experts. However, the potential benefits of this approach, particularly in these unprecedented times, have not been previously detailed. We collated data from the ILD services located at The Prince Charles Hospital in Brisbane, Royal Prince Alfred in Sydney, John Hunter Hospital in Newcastle and The Alfred in Melbourne which all provide hub and spoke models of care for patients and clinicians across Australia, servicing a population of almost 25 million people spread across a large geographical area (Figure 1). We recognize that there are many other smaller ILD-MDMs which provide a valuable service to their local communities. From their early origins, our ILD-MDMs have utilized video conferencing platforms to allow and encourage remote clinicians to participate in the MDM process. We were, therefore, in a position to rapidly transition to entirely virtual platforms when confronted by COVID-19. Since the institution of entirely virtual MDMs in early 2020 at our four centres, we have provided diagnostic and management advice for 456 patients from 72 virtual MDMs (Table 1). Of all presented cases, 46.3% have originated from community respiratory physicians working outside our tertiary institutions. The virtual MDMs have been attended by a median of 20 (interquartile range 15–22) participants per meeting, many of whom had not attended our MDMs prior to the entirely virtual format. In addition to foundation ILD physicians, radiologists and pathologists, numerous general respiratory physicians and at some meetings rheumatologists have populated the virtual forum. Eleven ILD specialist nurses have joined our virtual MDMs. One hundred and fifty-three IPF diagnoses have been made allowing access to anti-fibrotic therapy through government-subsidized prescription. Specific advice on the commencement, titration and cessation of immunomodulatory therapy was provided in the 57 cases of connective tissue disease-associated ILD that were presented. Recommendations to consider bronchoalveolar lavage and surgical/cryo-biopsy were made with sites noting delays due to operating theatre closures at the height of COVID-19 restrictions. Suggestions to visit the hplung.com and pneumotox.com websites to explore potential unidentified exposures and culprit medications, respectively, were provided in several cases. Finally, treating clinicians were informed of the availability and status of clinical trials, with recommendations to consider referral once enrolment reopens. The ILD-MDM provides a forum for both the expert and novice to benefit and learn from shared knowledge and experiences of the whole. The often uninhibited and without prejudice debate at the ILD-MDM is critical learning for trainee physicians and radiologists. The potential impact of a prolonged closure of the ILD-MDM on the training of junior physicians who may otherwise receive limited exposure to this expertise is therefore not to be underestimated. Since moving Received: 11 February 2021 Accepted: 6 April 2021

The year 2020 was one like no other, as we witnessed the far-reaching impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) global pandemic. Yet despite an unprecedented and challenging year, global research in interstitial lung disease (ILD) continued to break new grounds. Research progress has led to an improved understanding in new diagnostic tools and potential biomarkers for ILD. Studies on the role of antifibrotic therapies, newer therapeutic agents, supportive care strategies and the impact of coronavirus disease 2019 (COVID-19) continue to reshape the management landscape of ILD. In this concise review, we aim to summarize the key studies published in 2020, highlighting their impact on the various aspects of ILD.

BACKGROUND AND OBJECTIVE:The research term "interstitial pneumonia with autoimmune features" (IPAF) encompasses interstitial lung disease (ILD) patients with autoimmune features not meeting diagnostic criteria for a defined connective tissue disease (CTD). It remains unclear if IPAF is a distinct disease entity with implications for management and prognosis. We describe an Australian IPAF population and compare their baseline characteristics and outcomes with distinct cohorts of idiopathic interstitial pneumonia (IIP), CTD-ILD, and unclassifiable ILD.METHODS:Review of 291 consecutive patients attending a specialist ILD clinic was performed. Patients with a diagnosis of IIP, CTD-ILD, and unclassifiable ILD by ILD-multidisciplinary meeting (ILD-MDM) were included. Patients meeting the IPAF criteria were identified. Baseline clinical data, survival, and progression were compared between ILD groups.RESULTS:226 patients were included, 36 meeting the IPAF criteria. IPAF patients demonstrated a high prevalence of autoantibodies to tRNA synthetase (35.3%), Ro52 (27.8%), and neutrophilic cytoplasmic antigens (ANCA; 20.0%). IPAF and CTD-ILD patients demonstrated similar clinical characteristics (mean age 66.6 and 63.7 years, respectively, female predominant, frequent CTD-manifestations). Lung function did not differ between ILD groups. Disease severity, pulmonary hypertension (PH), and ILD-MDM diagnosis were strong predictors of worse transplant-free survival (TFS). Meeting the IPAF criteria was not associated with TFS.CONCLUSIONS:We identified IPAF as a heterogeneous phenotype that overlaps considerably with CTD-ILD. Disease severity, PH, and ILD-MDM diagnosis were more powerful predictors of survival outcomes than meeting the IPAF criteria.

Objectives: The detection of myositis autoantibodies (MA) in patients with interstitial lung disease (ILD) has major implications for diagnosis and management, especially amyopathic and forme frustes of idiopathic inflammatory myositis-associated ILD (IIM-ILD). Use of the MA line immunoblot assay (MA-LIA) in non-rheumatological cohorts remains unvalidated. We assessed the diagnostic performance of the MA-LIA and explored combined models with clinical variables to improve identification of patients with IIM-ILD. Methods: Consecutive patients referred to a specialist ILD clinic, with ILD-diagnosis confirmed at multidisciplinary meeting, and MA-LIA performed within six months of baseline were included. Pre-specified MA-LIA thresholds were evaluated for IIM-ILD diagnosis. Results: A total 247 ILD patients were included (IIM-ILD n = 12, non-IIM connective tissue disease-associated ILD [CTD-ILD] n = 52, idiopathic interstitial pneumonia [IIP] n = 115, other-ILD n = 68). Mean age was 64.8 years, with 45.3% female, mean FVC 75.5% and DLCO 59.2% predicted. MA were present in 13.8% overall and 83.3% of IIM-ILD patients. The most common MA in IIM-ILD and non-IIM ILD patients were anti-Jo-1 (prevalence 40%) and anti-PMScl (29.2%) autoantibodies respectively. The pre-specified low-positive threshold (>10 signal intensity) had the highest discriminative capacity for IIM-ILD (AUC 0.86). Combining MA-LIA with age, gender, clinical CTD-manifestations and an overlap non-specific interstitial pneumonia/organising pneumonia pattern on HRCT improved discrimination for IIM-ILD (AUC 0.96). Conclusion: The MA-LIA is useful to support a diagnosis of IIM-ILD as a complement to multi-disciplinary ILD assessment. Clinical interpretation is optimised by consideration of the strength of the MA-LIA result together with clinical and radiological features of IIM-ILD.

Objectives Idiopathic pulmonary fibrosis (IPF) is one of the most common forms of interstitial lung disease presenting in people aged ≥50 years. There is currently no cure for IPF, but two medications (pirfenidone and nintedanib) have been shown to slow the functional decline of the lungs. In 2017, these two medications were listed on the Pharmaceutical Benefits Scheme (PBS) for subsidisation in Australia. This study evaluated local trends in the use of these two medications. Methods Prescription data for this analysis were obtained from the PBS Item Reports for the period May 2017-May 2020. Population data were extracted from the Australian Bureau of Statistics data cubes. A descriptive approach was used to conduct and report the analysis to illustrate trends in the use of these two medications and associated costs. Results There were 44 010 prescriptions processed for the treatment for IPF in the 3-year period. Nintedanib use was higher than pirfenidone use, accounting for 54% of prescriptions. New South Wales accounted for 35% of the total prescriptions but, when standardised against population size, the Australian Capital Territory accounted for the highest proportion of prescriptions (24%). Prescriptions for nintedanib and pirfenidone were associated with a total cost of A$131 377 951 over the period 2017-20. Conclusion This study provides initial information on prescription rates, practices and expenditure for pirfenidone and nintedanib. In addition, we provide some insight into possible pharmacological and epidemiological trends based on jurisdictional differences. Together, the results from this study provide a platform for future research given the dearth of information on IPF in Australia. What is known about the topic? Data regarding trends in the utilisation of antifibrotics for the treatment of IPF in Australia are currently limited. What does this paper add? This study demonstrated that nintedanib use was slightly higher than pirfenidone use, and that there were variations in jurisdictional prescribing practices. The highest number of prescriptions and costs were attributable to New South Wales but, when standardised against population size, the Australian Capital Territory had the highest number of prescriptions and costs. What are the implications for practitioners? This study provides some insights into the use of pirfenidone and nintedanib, as well as pharmacoepidemiological trends, in Australia, which is useful for economic evaluation and modelling future health expenditure.