OBJECTIVES We aimed to assess the symptom burden and health related quality of life in patients with idiopathic lung fibrosis. METHODS Patients have been consecutively enrolled in an ongoing prospective non-interventional registry in Germany, investigating clinical characteristics, clinical management practices and quality of life. IPF diagnoses were in agreement with the international IPF guideline published in 2011. Clinical parameters and treatment practice were recorded by the physician. Patients filled out the EQ-5D-5L, St George's Respiratory Questionnaire (SGRQ), WHO-5 and the UCSD shortness of breath (SOB) scale. The time trade off (TTO) score was calculated for the EQ-5D. RESULTS To date (04 June 2014), 421 patients with IPF have been enrolled in the registry (mean age 68.6±9.5; 77% male). The mean six-minute walk distance was 271±200, mean % of predicted forced vital capacity was 72±20 and the mean % predicted DLCO was 35±16. Patients were treated with oral steroids (22.1%, as monotherapy in 7.1%); N-acetylcysteine (34.8%), pirfenidone (47.2%), and long-term O2 therapy (34.4%). The physician rated the disease in 35.6% as stable, in 31.1% as slowly progressing and in 11.9% as rapidly progressing. One in four patients described their current state of health as at least good, and every fifth as poor. The mean EQ-5D TTO score was 0.8±0.2. 45% of the patients showed depressive symptoms based on the WHO-5. The mean SGRQ sum score was 47.7±20.1 describing difficulties with breathing in the previous 3 months. Higher EQ-5D TTO scores were significantly associated with a lower number of comorbid diseases (r=-0.31), higher 6-minute walk distance (r=0.20), higher FVC % pred (r=0.27), less depression (r=0.66) and lower SGRQ scores (r=-0.72). CONCLUSIONS The IPF patients in this large registry had a more severe disease, a higher symptom burden and more compromised quality of life compared to recent randomised controlled trials.