AbstractBackground and ObjectiveReal‐life data on suspected familial fibrosis, defined as the occurrence of the disease in a patient younger than 50 and/or having at least one relative affected by pulmonary fibrosis remain scarce.MethodsThe Belgian and Luxembourg IPF registry (PROOF‐Next) is a multicentric prospective longitudinal and observational study set in Belgium and Luxembourg. We compared characteristics and clinical course of patients with suspected familial pulmonary fibrosis (FPF) and sporadic IPF.ResultsWe included 618 patients in the analysis, of whom 76 (12%) fulfilled criteria for FPF. They were significantly younger than sIPF (median age (range) 65 (43–87), vs. 72 (51–98), p = 0.0001). Male gender proportion and smoking status did not differ between groups, but the number of pack‐year among current and former smokers was lower in FPF (20 vs. 25, p = 0.02). Besides, 87% of FPF and 76% of sIPF were treated with antifibrotic (p = 0.047).Baseline pulmonary function tests were similar in both groups, as well as median time before progression and transplant‐free survival. Finally, genetic testing, performed in a minority, led to the identification of 10 telomerase‐related gene variants.ConclusionAlthough younger and exposed to less tobacco, patients with FPF show an equally aggressive progression as observed in sporadic IPF patients. These results warrant early referral of FPF patients to expert centres for optimal management.