Pleural effusion remains diagnostically challenging when standard thoracentesis does not establish an aetiology. This pilot analysis described sequential biomarker measurements in patients proceeding to medical thoracoscopy and explored their associations and discrimination across final diagnostic classifications. Prospectively collected data from a single-centre tertiary referral cohort were analysed. Pleural-fluid adenosine deaminase (ADA) and serum complement components 3 and 4 (C3 and C4) were obtained on day 1, whereas pleural-fluid cancer antigen 125 (CA125) and lactate dehydrogenase (LDH) were obtained at the day 7/thoracoscopy evaluation. Final classifications were based on a composite reference standard integrating thoracoscopy, histopathology, microbiology, cytology, imaging, and clinical follow-up. Analyses were exploratory. Amongst 75 patients, 6 (8.0
Triple therapy for asthma containing long-acting beta-agonist (LABA), long-acting muscarinic antagonist (LAMA), and inhaled corticosteroid (ICS) is a newer option for asthma management, especially when all three components are combined in a single inhaler (SITT: single-inhaler triple therapy), which promotes better adherence than multiple inhalers. There are questions as to its efficacy beyond the ICS/LABA combination, and evidence certainly shows that it will improve lung function, decrease exacerbations, and potentially help with symptoms. Global Initiative for Asthma (GINA) suggests these are Step 5 therapies, as they add on to medium-dose ICS/LABA. Fortunately, these compounds are quite safe and well tolerated. GINA recommendations for Step 5 will be reviewed, including particularly the place for LAMA addition as add-on therapy to ICS/LABA, and novel potential clinical applications will be reviewed.
Lung transplantation (LTx) is the definitive treatment for advanced fibrotic interstitial lung disease (ILD), but referral timing remains challenging. Data on outcomes of Northern Ireland (NI) patients referred for LTx are limited. In this multicentre retrospective cohort study, all ILD referrals for LTx from the five NI healthcare trusts between January 2014 and March 2024 were analysed. Demographic, clinical, lung function and transplant outcome data were extracted from electronic health records. Patients were classified according to transplant assessment and listing outcomes. One hundred thirty-eight patients were referred (median age 60.5 years; 64.5
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.
