Interstitial lung abnormalities (ILAs) are incidental findings on chest computed tomography and may represent an early stage of interstitial lung disease. Some ILAs progress to pulmonary fibrosis and functional impairment, others remain stable. Criteria for diagnostic evaluation, monitoring and treatment are not clearly established. Current guidelines emphasize risk stratification and long-term follow-up. Some patients may benefit from early treatment, others from conservative observation to avoid over-therapy in asymptomatic cases. The review analyzes the evidence on the epidemiology, natural history and management of ILA. Gaps in knowledge persist, such as the definition of progression, follow-up intervals, and drug indications. ILAs are a heterogeneous entity, the review guides clinicians in the dilemma "to treat or not to treat".