The lack of medical options for the treatment of idiopathic pulmonary fibrosis (IPF) has long been a source of frustration and consternation for pulmonologists treating this deadly disorder. This previously led to the adoption of therapies with little supportive data, some of which have subsequently proved not only to be ineffective but also deleterious., The early 2000s heralded a new era in clinical trials for IPF, with multiple multicenter studies being successfully completed. A wealth of valuable information about the natural history of the disease, but few positive studies, emanated from these robust clinical trials. These studies also spawned a certain amount of controversy regarding suitable and acceptable end points for IPF clinical trials. The labor and commitment of many patients, physicians, principal investigators, research coordinators, pharmaceutical companies, and governmental agencies finally bore fruit with two drugs being approved for the treatment of IPF contemporaneously by the US Food and Drug Administration (FDA). This has marked a turning point and a new era in the management of these patients. Although the development of efficacious pharmacologic therapy for IPF has provided renewed hope for this deadly disease, it has also led to many questions regarding the optimal use of these agents. Who should be prescribed these medications, when should they be started, and when, if ever, should they be stopped?