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Ihre Pr\u00e4valenz variiert zwischen 3 und 10\u202f% in der Allgemeinbev\u00f6lkerung mit h\u00f6heren Raten bei \u00e4lteren Personen und RaucherInnen. ILA umfassen bilaterale und nicht-hypostasebedingte Milchglasver\u00e4nderungen, retikul\u00e4re Anomalien, Traktionsbronchiektasien, Architekturst\u00f6rungen und Honeycombing und betreffen mehr als 5\u202f% einer Lungenzone. Das Progressionsrisiko zu ILD liegt je nach Subtyp und Risikofaktoren zwischen 20 und 80\u202f%. Klinische Progressions- und Risikofaktoren sind Alter, Nikotinexposition, inhalative Noxen, thoraxchirurgische Eingriffe, pneumotoxische Therapien und abnorme Lungenfunktionsparameter. Radiologisch erh\u00f6hen fibrotische ILA mit subpleuraler und basaler Pr\u00e4dominanz sowie eine gr\u00f6\u00dfere Ausdehnung das Progressionsrisiko signifikant. Das klinische Management basiert auf einer strukturierten Abkl\u00e4rung inklusive hochaufl\u00f6sender CT, Lungenfunktionsdiagnostik und Risikostratifizierung. Bei fehlenden Zeichen einer manifesten ILD empfiehlt sich ein individuelles Follow-up-Intervall von 6\u00a0bis 36\u00a0Monaten, abh\u00e4ngig vom Risikoprofil. Dieses Positionspapier formuliert praxisnahe Empfehlungen zum Umgang mit ILA und orientiert sich an aktuellen internationalen Leitlinien unter Ber\u00fccksichtigung neuer Evidenz zu genetischen Risikofaktoren, progressionsassoziierten Bildgebungsmerkmalen und klinischen Pr\u00e4diktoren. 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