This article focused on the histopathologic subclassification of IPF, and the relationship with patient survival. In this carefully executed, prospective cohort study of 87 patients with biopsy-proven usual interstitial pneumonia (UIP), a greater degree of granulation/connective tissue deposition (characteristic of fibroblastic foci) was correlated with shorter survival. The median survival time was 23 months in patients with scores of > 2, compared with a median survival time of 66 months for those with scores of < 1.8. This finding is consistent with the view that UIP is not a disease of active inflammation, but one of abnormal lung fibroblast proliferation and dysregulated fibrogenesis. Moreover, these findings suggest that we should refocus our efforts on controlling the ongoing epithelial damage and its repair process, which is associated with persistent fibroblastic proliferation, rather than on stopping inflammation.