uworld 20410 is asking for IPF treatment and the answer is antifibrotic agents; no cards on this at all; also lists Smoking cessation & treatment of GERD, Supplemental oxygen & pulmonary rehabilitation, and Lung transplantation as other treatments in table with antifibriotic; educational obj is "Idiopathic pulmonary fibrosis is a disorder of epithelial injury that has been pathologically repaired by fibrotic responses. Antifibrotic drugs inhibit fibroblasts to slow the rate of lung function decline and are first-line therapy"; explanation for a steroid answer and nonsteroid answer is as follows "Because low levels of lung inflammation are common in IPF, pharmacologic immunosuppression was once regarded as a promising treatment strategy. However, inflammatory responses are likely reactive to the primary epithelial injury and fibrosis. Clinical trials of immunosuppression (eg, prednisone [corticosteroid], azathioprine [noncorticosteroid]) demonstrated harm, including increased mortality. If lung fibrosis is suspected to be driven by a systemic autoimmune disease (eg, scleroderma-associated UIP), immunosuppression is considered on an individual basis. Forms of ILD that tend to be corticosteroid-responsive include cryptogenic organizing pneumonia (eg, groundglass/consolidative opacities on HRCT, alveolar granulation tissue on histopathology)"; says antifibrotic have "revolutionized" IPF treatment so this needs to be at least in extras or added to the cloze here
