Chronic cough is one of the most frequent and burdensome symptoms in patients with interstitial lung disease (ILD), substantially impairing quality of life and, in idiopathic pulmonary fibrosis (IPF), being associated with disease progression. Despite its clinical relevance, the mechanisms underlying cough in ILD remain incompletely understood, and effective therapeutic options are limited. This narrative review summarizes current evidence on the epidemiology, pathophysiology, clinical assessment, and management of cough across the spectrum of ILD. Current data support the concept that ILD-related cough results from a complex interplay between cough reflex hypersensitivity, mechanical distortion of the fibrotic lung, airway and parenchymal inflammation, neural remodeling, and common comorbidities such as gastroesophageal reflux disease and obstructive sleep apnea. Disease-specific mechanisms are also discussed in connective tissue disease-associated ILD, sarcoidosis, and hypersensitivity pneumonitis. We review currently available qualitative and quantitative methods for cough assessment, including patient-reported outcome measures and objective cough monitoring technologies, highlighting their strengths and limitations in clinical practice and research. Finally, we examine established and emerging therapeutic approaches. While antifibrotic therapies have shown limited and inconsistent effects on cough, recent randomized clinical trials provide encouraging evidence for low-dose morphine and extended-release nalbuphine in IPF-associated chronic cough. Nonpharmacological interventions, particularly physiotherapy and speech and language therapy, also demonstrate meaningful benefits. Several novel therapeutic strategies targeting neural and inflammatory pathways are currently under investigation. A better understanding of the mechanisms driving cough in ILD, together with standardized assessment tools and adequately powered clinical trials, will be essential to develop effective, disease-specific treatments for this disabling symptom.
Obesity-associated asthma is an increasingly prevalent and clinically challenging phenotype, characterized by poorer response to conventional asthma therapies, greater disease burden, and a distinct immunometabolic profile that sets it apart from classical eosinophilic asthma. Given the growing interest in therapies targeting the treatment of obesity, understanding the underlying biological mechanisms that drive inflammatory processes in this cohort is essential. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as transformative agents in the management of obesity and type 2 diabetes mellitus (T2DM), with a growing basis of evidence that their utility may extend beyond these indications and exert potent anti-inflammatory effects. In late 2025, the World Health Organization endorsed GLP-1RAs for obesity management, reframing how we contextualize care for patients living with obesity. In this review, we examine the immunopathological mechanisms underpinning obesity-associated asthma, and explore the biology of GLP-1 receptor signaling and the emerging preclinical and observational evidence supporting a direct role for GLP-1RAs in modulating pulmonary inflammation, airway remodeling, and immune cell activation. This could have important implications on future therapeutic directions. Key questions remain regarding whether any respiratory benefits are weight loss dependent or driven by direct immunomodulatory effects, and how GLP-1RAs should be positioned within treatment algorithms. Future prospective trials will be essential to define which patients derive the greatest benefit from these agents. GLP-1RAs represent a compelling and novel therapeutic avenue in obesity-associated asthma and potentially across the broader spectrum of chronic inflammatory airway disease.
Peripheral pulmonary lesions (PPLs), defined by their location in the outer one-third of the lung, are expected to be identified with increasing frequency following the widespread adoption of lung cancer screening. The majority of PPLs will have a benign aetiology; however, obtaining tissue to exclude malignancy can be challenging, leading to high rates of benign surgical resections or prolonged surveillance imaging. Over the last two decades, there has been rapid advancement in bronchoscopic technologies, with the adoption of radial probe endobronchial ultrasound (RP-EBUS), ultrathin bronchoscopes, electromagnetic navigation bronchoscopy (ENB), virtual bronchoscopic navigation (VBN) and robotic assisted bronchoscopy (RAB). These technologies provide access to lesions that are inaccessible by conventional bronchoscopic approaches, with diagnostic yields comparable to those of CT-guided transthoracic needle biopsy (TTNB). Whilst these advanced technologies offer a lower risk of complications than CT-guided TTNB, they are significantly more expensive. In addition, advances in biopsy techniques, such as transbronchial cryobiopsy, have further enhanced the diagnostic yield for PPLs.Recent data supports the potential for a one-stop 'diagnose and treat' approach, where advanced bronchoscopic platforms are combined with thoracic surgery and rapid onsite evaluation. This offers the potential to locate and diagnose nodules prior to potential resection, thereby reducing benign resections and shortening the diagnostic pathway. The therapeutic potential of these advanced bronchoscopic platforms is an active area of research, with the potential to deliver thermal ablation therapies and intralesional brachytherapy and chemotherapy agents. This narrative review summarises the current evidence base of this rapidly evolving field.
Clinical trials report no increased malignancy risk with benralizumab in severe asthma; however, trial populations are highly selective. To better define real-world safety, malignancy risk was compared among patients treated with benralizumab, other (non-benralizumab) biologics, or non-biologic therapies. Data from adults with severe asthma accrued to the International Severe Asthma Registry (ISAR) and a United States severe asthma registry (CHRONICLE) between 1 November 2017, and 31 December 2023, were analyzed. Cohorts were defined by exposure to benralizumab, other asthma biologics, and non-exposure to biologic therapies. First new-onset malignancies were assessed. Incidence per 1000 person-years (PY) and adjusted incidence rate ratios (aIRR) were estimated with an inverse probability-weighted Poisson model, with propensity scores incorporating demographics, comorbidities, baseline asthma medication, systemic steroid use, and relevant medical history, with residual adjustment for age, sex, body mass index, region, and smoking. Among 12,493 patients, 43,434.8 PY were accrued (benralizumab, 7749.1 PY; other biologics, 21,054.1 PY; non-biologics, 14,631.6 PY), with a median (range) follow-up of 3.3 (0–6.2) years across cohorts. Seventy-five patients reported new malignancies: benralizumab, 17 (0.7
Monoclonal antibodies (mAb) play a central role in modern medicine; however, several of them have been associated with the development of drug-induced interstitial lung diseases (ILD). We present a case of a patient affected by psoriatic arthritis (PsA) treated with secukinumab, an anti-IL17 mAb, who developed a histological organising pneumonia pattern with microgranulomas. After resolution, the patient relapsed when exposed to guselkumab, an anti-IL23 mAb, with further histological confirmation. Treatment withdrawal and steroids resolved the ILD in both cases. To evaluate the risk of developing ILD in the context of those two drugs, we also performed a review of the literature and the clinical trials for the drugs in PsA. Papers presenting drug-induced ILD in patients treated with secukinumab and/or guselkumab in PubMed and Embase were searched and summarised. Respiratory-related adverse events reported in secukinumab and guselkumab clinical trials for PsA were summarised. We summarised seven papers, finding a rare presentation (between 0.1
Pleural disease is a subspecialist area of respiratory medicine, requiring diagnostic and therapeutic interventions. The most invasive pleural procedure is local anaesthetic thoracoscopy (LAT) used in the context of unexplained exudative pleural effusions. LAT can be exquisitely painful because of instrumentation of the parietal pleura which carries all nociceptive nerve endings. The optimal anaesthetic and analgesic requirement for LAT is not known, and recommendations are based on expert opinions and small usually single-centre studies. We provide a narrative description of existing literature, show the potential application of regional nerve blocks for LAT and provide practice points.
Pediatric asthma remains a leading cause of emergency department visits and hospitalizations worldwide. Patients with critical asthma represents a subset of patients requiring respiratory support beyond standard pharmacologic therapy. Management of respiratory support in these patients has evolved dramatically, with intubation rates decreasing from 6.9
INTRODUCTION:The true number of coronavirus disease-19 (COVID-19) cases may be highly underestimated because of reduced efforts to track cases through testing in the postpandemic era. Earlier estimates of this underreporting have varied across regions, and countries in Asia, Africa, the Middle East, and Latin America have been notably impacted. This study investigates the true burden of COVID-19 cases in 2023 and 2024 across Asia, Africa, the Middle East, and Latin America. METHODS:We conducted a retrospective analysis of national public health surveillance data from 2022 to 2024 on COVID-19 cases, hospitalizations, and deaths in Asia, Africa, the Middle East, and Latin America. Using a method developed by the US Centers for Disease Control and Prevention to estimate the burden of COVID-19 and influenza, we estimated the number of cases for 2023 and 2024 by calculating the ratio of cases to hospitalization and cases to deaths, using 2022 as the baseline. We compared the estimated and reported number of cases each year to assess the level of underreporting. RESULTS:The mean ratio of estimated cases to reported cases showed a high albeit variable level of underreporting in 2023 and 2024 across regions. In 2023, the levels of underreported cases were 1295%, 319%, 560%, and 3703% in Asia, the Middle East, Latin America, and Africa, respectively. The number of estimated underreported cases generally increased in 2024 to 2326%, 1415% and 16,664% in Asia, Latin America, and Africa, respectively, but in the Middle East decreased to 87% based on hospitalization data. The trend for death data was similar. CONCLUSIONS:The results highlight the high level of underreporting of COVID-19 cases, which has increased over time in many regions. Therefore, the true global burden of COVID-19 could be substantially higher than indicated by publicly available data. Continued COVID-19 surveillance is crucial for stabilizing public health measures such as prevention and target vaccination programs.
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease that is entering a new era in precision medicine. Advances in disease endotyping have challenged the traditional view of COPD as a uniformly neutrophilic disorder and revealed biologically distinct subgroups in whom targeted immunomodulation may be effective. Reproducible signatures of type 2 (T2) inflammation and epithelial-derived alarmin activation have emerged as actionable pathways, reshaping therapeutic development in COPD. This narrative review synthesises mechanistic insights and clinical trial evidence for biologic therapies targeting key T2 cytokines such as interleukin-5 (IL-5) IL-4/IL-13 and upstream epithelial alarmins, including interleukin-33 (IL-33) and thymic stromal lymphopoietin (TSLP). We examine why earlier approaches targeting neutrophilic inflammation failed, and how biomarker-driven trial design has enabled success in selected populations. Across these programmes, therapeutic efficacy has depended not only on the pathway targeted but also on patient selection, disease stage and timing of intervention. We propose that the future of biologics in COPD lies in integrating biomarkers, treatable traits and longitudinal phenotyping to align the right patient with the right pathway at the right time, closing persistent treatment gaps in this common, overlooked and burdensome disease.
Chronic obstructive pulmonary disease (COPD) is a progressive lung disease that is usually caused by long-term exposure to harmful substances, such as cigarette smoke, which can lead to inflammation in the airways. Dupilumab is a drug that works by blocking the activity of interleukins 4 and 13, and helping to reduce type 2 inflammation in various organs, such as the lungs, sinuses, and skin. This summary of research provides an overview of the previously published article on the results of two phase 3 studies of patients with COPD and type 2 inflammation who were treated with either dupilumab or placebo for up to 52 weeks. Dupilumab reduced exacerbations and symptom severity, improved lung function and quality of life in these patients, and was well tolerated. These studies provide evidence that dupilumab is a safe and effective treatment option for patients with COPD who also show signs of type 2 inflammation. ClinicalTrials.gov Identifiers: BOREAS: NCT03930732; NOTUS: NCT04456673.
Destroyed lung is a radiographic and clinical end-stage condition of chronic pulmonary infection, characterized by irreversible parenchymal destruction and major functional impairment. Medical treatment may control active infection, but established structural damage is usually irreversible. Pneumonectomy remains the conventional surgical option for selected patients with unilateral destroyed lung, although it is associated with considerable perioperative risk. Lung transplantation may be considered only in highly selected patients with end-stage disease, bilateral involvement, severe functional compromise, or failure of conventional resection-based strategies. However, it should not be regarded as a routine substitute for pneumonectomy. This narrative review summarizes the major etiologies, clinical manifestations, and surgical approaches to destroyed lung, with particular attention to the selective role, indications, technical challenges, and limitations of lung transplantation in this setting.
Many essential inhaled medicines recommended in guidelines are delivered to the lung via pressurized metered-dose inhalers (pMDIs). Global environmental legislation will lead to phasing out of hydrofluoroalkane propellants currently used in pMDIs, owing to their global warming potential (GWP). Furthermore, the European Chemicals Agency is reviewing proposed legislation to ban per- and polyfluoroalkyl substances (PFAS) on the basis of chemical structure, which could also impact pMDI availability. Here, we estimated pMDI use as a proportion of all inhaler use in 60 countries, spanning six geographical regions, to understand the relevance of any pMDI restrictions to patients and prescribers. pMDI use as a percentage of total inhaler use during 2022 was calculated by country and geographical region using inhaler sales data (a surrogate of use) from the IQVIA Quarterly MIDAS database; inhaler use for the 10-year period from 2013 to 2022 was also evaluated for these regions. Data were compared by individual inhalations. The total patient population living with asthma and/or chronic lower respiratory disease was calculated on the basis of Eurostat (the statistical office of the European Union [EU]) 2019 data and available disease prevalence statistics. Maintenance pMDI utilization was estimated by adjusting for ratio of maintenance pMDI use to total inhaler use. Across all countries analyzed, pMDIs accounted for the largest proportion of inhaler use in 2022 (77.3
Single-inhaler triple therapy with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) is recommended for patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic or experience exacerbations despite dual bronchodilation. However, real-world evidence on its ability to achieve multidimensional “disease stability”, integrating symptoms, lung function, and exacerbation outcomes, remains limited. The aim of our study was therefore to evaluate, in a real-world cohort of exacerbating patients with COPD, the effects of once-daily FF/UMEC/VI on lung function, respiratory symptoms, health status, and exacerbation rates over 12 months. This retrospective single-center study included 86 adults with COPD treated with FF/UMEC/VI 92/55/22 µg at the Respiratory Unit of “Magna Graecia” University Hospital (Catanzaro, Italy). Lung function tests (forced expiratory volume in the first second, FEV1; forced vital capacity, FVC; forced mid-expiratory flow between 25
Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder characterized by persistent symptoms such as dyspnea and cough, as well as exacerbations. Triple therapy with budesonide/glycopyrronium/formoterol fumarate dihydrate (BGF) is recommended for patients not adequately controlled by dual therapy. Key clinical parameters guide COPD management. The observational, retrospective ORESTES study included adults ≥ 40 years with COPD initiating BGF in routine practice. In this analysis, patients were grouped according to exacerbation history, airflow obstruction (forced expiratory volume in 1 s [FEV1]
Cigarette smoking is a major driver of airway and systemic inflammation and contributes to the development and progression of chronic obstructive pulmonary disease (COPD). This study compared peripheral blood inflammatory markers and immune cell profiles in smokers with and without COPD and in non-smoking controls. In this cross-sectional study, blood samples were collected from 80 participants (n = 20/group): non-smoker controls (NS), smokers with normal lung function (NLFS), current smokers with COPD (COPD-CS), and ex-smokers with COPD (COPD-ES). Total white cell count (WCC) and leukocyte differentials (neutrophils, lymphocytes, monocytes, eosinophils) were measured using an automated haematology analyser (Sysmex XN2000). Systemic inflammatory markers were measured using C-reactive protein (CRP, Roche Cobas Pro) and erythrocyte sedimentation rate (ESR, Diesse VES-MATIC Easy). Lung function parameters (including FEV1, FVC, DLco, FEF25–75
Real-world evidence for the use of nirmatrelvir/ritonavir in routine clinical practice remains limited in the Kingdom of Saudi Arabia (KSA). This study aimed to describe the demographic and clinical characteristics, treatment patterns, and healthcare resource utilization (HCRU) of adult patients with coronavirus disease 2019 (COVID-19) prescribed nirmatrelvir/ritonavir in the KSA. This was a multicenter, retrospective observational cohort study, including adult patients with COVID-19 who were prescribed nirmatrelvir/ritonavir between April 2022 and June 2024. Data were collected through an electronic case report form from patients’ electronic medical records and included patient demographics, clinical characteristics, vaccination history, prescribing characteristics, and HCRU. Data were collected from the index date, defined as the date of nirmatrelvir/ritonavir prescription, up to 30 days post-index. Descriptive analyses were conducted to summarize patient and clinical characteristics, treatment patterns, and HCRU. Logistic regression models were used to assess associations between patient characteristics and COVID-19-related hospitalization at the index date. A total of 248 patients were included. The mean age was 49.9 years, 59.7
The initial US launch of elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) coincided with the coronavirus disease 2019 (COVID-19) pandemic, altering healthcare-seeking behaviors and possibly resulting in decreased respiratory infection transmission. We evaluated real-world effectiveness of ELX/TEZ/IVA, accounting for potential impact of COVID-19 by comparing outcomes in people with cystic fibrosis (CF) treated with ELX/TEZ/IVA with ELX/TEZ/IVA-ineligible people with CF. This retrospective, observational study used US CF Foundation Patient Registry data (2017–2021) of people with CF aged ≥ 12 years initiating ELX/TEZ/IVA between Q4 2019 and Q3 2021 and a concurrent comparator cohort ineligible for ELX/TEZ/IVA. Primary outcomes (follow-up through 2021 or death) included change in percent predicted forced expiratory volume in 1 s (ppFEV1) from baseline over follow-up, annualized rate of ppFEV1 decline, rate of pulmonary exacerbations (PEx), time to lung transplantation, and overall survival. ppFEV1 increased in ELX/TEZ/IVA-treated individuals through follow-up but decreased in the comparator cohort (+6.20 versus −3.13 percentage points, respectively; mean difference 9.34, 95
In patients with acute respiratory failure (ARF) undergoing noninvasive ventilation (NIV), pressure-related skin injury is among the most frequent and clinically relevant complications. The reported prevalence of device-related pressure injuries is estimated at around 25
Obstructive sleep apnea (OSA) is associated with decreased daytime functional outcomes and increased psychological stress. However, the specific profile of this burden, particularly in the Vietnamese population, remains understudied. This study aimed to analyze sleep-related functional outcomes and psychological stress in a population of untreated Vietnamese patients with OSA. We conducted a cross-sectional study of 61 untreated patients with OSA (78.7
The prostacyclin pathway represents a foundational pathway in the treatment of patients with pulmonary arterial hypertension (PAH). Parenteral prostacyclin pathway agents (PPAs) are often used for treatment of severe PAH but their broader use is limited by administration difficulties, including a need for continuous infusion, administration side effects, and complexities of a chronic indwelling catheter. Administration of the prostacyclin receptor agonist selexipag, an oral therapy with more than 10 years’ clinical experience, may be more favorable for some patients. However, treatment protocols for transitioning from parenteral PPAs to oral selexipag are lacking. Here, we describe practical considerations for managing such transitions. The transition process requires an individualized and shared decision-making approach between the patient and multidisciplinary team to optimize treatment outcomes. Key considerations include patient selection criteria, setting expectations, transition setting (inpatient vs outpatient), transition speed, dose adjustment, and clinical follow-up. Appropriate patient candidates for transition to oral selexipag should be clinically stable and selected based on a comprehensive evaluation using validated risk scores and hemodynamic parameters. Expectations and realistic treatment goals should be discussed collaboratively and must include the possibility of returning to parenteral PPAs if clinically indicated. Transition protocols should be flexible and tailored to each patient. Outpatient transition may be considered depending on transition speed, the patient’s ability to follow dosing instructions, and access to emergency care if needed. Speed of the transition to oral selexipag varies based on individual patient needs. Close monitoring and long-term follow-up are essential following transitions to maximize success and patient safety. In summary, transitioning from parenteral PPAs to oral selexipag can be challenging and complex. However, success is achievable for suitable patients through careful planning, setting transparent expectations, and an individualized approach with close monitoring and long-term follow-up. Graphical abstract available for this article. Pulmonary arterial hypertension is often treated with medicines given through a process called infusion, where the drug is provided slowly and continuously using specialized equipment. While these drugs work well, it can be difficult for patients because of the treatment equipment needed and possible side effects. Because of these challenges, some patients may want to take a pill by mouth instead. However, switching to the pill option is not simple and there are no clear instructions for how to do it. Successfully switching to a pill needs a personalized plan made by the patient and healthcare providers together. Only certain patients will qualify for switching to the pill option based on the seriousness of their disease and laboratory test results. Clear expectations should be talked about, including the possibility of going back to infusion treatment if the disease gets worse. The switch could happen fully in the hospital or during doctor’s visits and be completed at home depending on how quick the transition needs to be, whether the patient can follow dosing instructions, and whether they can get access to emergency care. The process of switching should be flexible and include personalized dose changes to safely reach the best dose for the patient. The patient must be watched closely during and after the switch, with regular checkups. Switching from an infusion medicine to taking a pill by mouth to treat pulmonary arterial hypertension can be done safely and successfully for the right patients with careful planning, teamwork, and close monitoring.
