Idiopathic pulmonary fibrosis (IPF) is the most common of the seven listed interstitial pneumonias in the American Thoracic Society/European Respiratory Society (ATS/ERS) consensus statement, and there is growing evidence that the incidence is increasing. Defined as a progressive fibrosing interstitial pneumonia of unknown cause, IPF is defined as being limited to the lungs and associated with histopathological and/or radiographical patterns consistent with usual interstitial pneumonia (UIP). A recent article by Navaratnam and colleagues documents the prevalence in UK to be around 15,000, with >5000 new cases per annum and unfortunately around 5000 deaths. With a median survival of 3–5 years after diagnosis, this is a devastating disease although the natural course of the disease varies, with some patients experiencing a steady decline over a few years, some experiencing a rapid decline, and others experiencing what appear to be similar to acute exacerbations in between relative periods of stability. Unlike the more common respiratory disorders such as chronic obstructive pulmonary disease (COPD) where patients are likely to die of other causes than the underlying COPD, those diagnosed with IPF will most often die from their disease process, estimated at around 60%, rather than with it and often during acute exacerbations. Mortality in patients with IPF increases with advancing age. Death rates are consistently higher in men than women, and there is seasonal variation, with the highest death rates occurring in the winter, even with the exclusion of infectious causes. If the cause of death is not attributable to an acute exacerbation of IPF, there are increased cardiovascular risks and an increased risk of venous thromboembolic disease which contribute to the cause of death. Other common causes of death in patients with IPF therefore include acute coronary syndromes, congestive heart failure, lung cancer, and infectious causes. Regrettably, late presentation often shortens the survival time of patients with IPF and there is often a delay of 1–2 years before presentation with symptoms and additionally there may be a problem with clinicians missing early clinical clues, although this will not alter the natural course of the disease process. The epidemiological origins and subsequent pathological developments of the process of IPF are still not completely understood, although the condition is believed to result from an inflammatory response to an unknown substance resulting in pathological scarring, and there may also be epidemiological and genetic factors. Whether the incidence and prevalence of IPF are influenced by geographic, ethnic, cultural, or racial factors is not yet clear. The ‘idiopathic’ nature of the disease meaning no cause can be found, can be particularly difficult to both understand and accept for those diagnosed. Although the disease occurs most often in people between 50 and 70 years of age, it can affect people of a younger age, and although the preponderance is in males, it is no respecter of gender. Unfortunately for people diagnosed with the condition, IPF is often a poorly understood condition with little knowledge and unfortunately no definitive treatment leaving people diagnosed with the disorder. Available information, for example, on the Internet can be distressing and documents lack of treatment and poor prognosis. Studies to date have yet to find robust evidence for any effective pharmacological treatment of IPF. Corticosteroids and other immunosuppressants are commonly tried treatments in IPF, although unfortunately ‘tried’ is the most important word here as there is little evidence that any of these are truly effective and the side effects can outweigh any potential benefit. Any decision to attempt to treat IPF needs an open and honest discussion with patients and their views taken