RATIONALE:The efficacy and safety of astegolimab, an anti-ST2 monoclonal antibody, was evaluated in participants with chronic obstructive pulmonary disease (COPD) and frequent exacerbations in the pivotal ALIENTO and ARNASA trials. OBJECTIVES:To report the prespecified pooled analysis of ALIENTO and ARNASA. METHODS:ALIENTO and ARNASA were randomized, double-blind, placebo-controlled trials with similar designs and included participants with COPD, a history of frequent exacerbations, and current/former smoking status, irrespective of blood eosinophil count and chronic bronchitis. Participants were randomized 1:1:1 to astegolimab 476 mg every 2 weeks (Q2W), astegolimab every 4 weeks (Q4W), or placebo for 52 weeks, plus optimized maintenance therapy. The primary endpoint was annualized rate of moderate/severe exacerbations. Secondary endpoints included annualized rate of severe exacerbations. A hierarchical statistical plan was followed with hypothesis testing of secondary efficacy endpoints gated on the primary efficacy endpoint success. MEASUREMENTS AND MAIN RESULTS:A total of 2682 participants were included in the pooled intent-to-treat population. Astegolimab significantly reduced the annualized rate of moderate/severe exacerbations by 15% in the Q2W arm (adjusted rate ratio, 0.85 [95% CI, 0.76-0.96]; P = .0077) and by 12% in the Q4W arm (rate ratio, 0.88 [95% CI, 0.78-0.99]; P = .0265). -A -nominally significant reduction in the annualized rate of severe COPD exacerbations (rate ratio, 0.68 [95% CI, 0.52-0.87]; P = .0028) was observed for astegolimab Q2W vs placebo. Astegolimab was well tolerated. CONCLUSIONS:Astegolimab every 2 weeks reduced the annualized rate of moderate/severe exacerbations in a clinically heterogeneous population of participants with COPD and frequent exacerbations. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov: NCT05037929; NCT05595642.

BACKGROUND:Sarcoidosis is a multisystemic granulomatous disease that can involve the skeletal system, although bone manifestations are considered relatively uncommon and often underdiagnosed. OBJECTIVES:To describe the prevalence, clinical characteristics, and treatment outcomes of bone involvement in a large multicenter Italian cohort of patients with sarcoidosis. METHODS:This retrospective, two-center observational study included 867 patients with histologically confirmed sarcoidosis followed at two Italian referral centers (2018-2025). Bone localization was identified by imaging (PET/CT, MRI, X-ray) and/or biopsy. Clinical, functional, laboratory, and therapeutic data were collected. RESULTS:Bone involvement was found in 46 patients (5.3%), predominantly women (58.7%), with mean age at diagnosis of 49.7 ± 12.2 years. Osseous lesions were most frequently localized in the axial skeleton, particularly pelvis (54.3%) and vertebrae (52.2%). Bone sarcoidosis was significantly associated with extra-thoracic lymphadenopathy, hepatic, and splenic involvement (p < 0.001), reflecting a pattern of clustered multi-organ disease. Osteoporosis and osteopenia were present in 15.2% and 13.0% of cases, respectively. Corticosteroid monotherapy was the most common initial treatment (56.5%), while 30.4% received combination therapy with csDMARDs or biologics. At one-year PET/CT re-evaluation, 56.5% showed a reduction of SUV at bone sites, with no significant correlation between therapeutic regimen and metabolic response. CONCLUSIONS:Bone involvement in sarcoidosis, though relatively rare, represents a clinically relevant phenotype strongly associated with hepatosplenic and lymphatic disease and characterized by a preferential axial skeleton localization. Recognition of this pattern is essential for diagnosis and management. Given the retrospective design and the limited follow-up sample, these findings should be interpreted with caution. Close radiological monitoring and tailored therapeutic strategies are warranted to improve outcomes.

RATIONALE:Asthma and chronic obstructive pulmonary disease (COPD) significantly overlap by conventional diagnostic criteria, yet important treatment differences remain, and people with both asthma and COPD (asthma + COPD) have worse clinical outcomes than people with a single diagnosis. Hyperpolarized xenon-129 magnetic resonance imaging (129Xe MRI) and pulmonary function tests (PFTs) are sensitive to lung function and structure. OBJECTIVE:To determine whether 129Xe MRI alongside PFTs can aid phenotyping of real-world patients with asthma and/or COPD. METHODS:Patients ≥16 years with physician-assigned asthma and/or COPD were recruited from primary care. 129Xe and proton MRI, multiple-breath nitrogen washout, airwave oscillometry, transfer factor of the lung for carbon monoxide (TLco), body plethysmography, and spirometry were assessed post-bronchodilator. Differences between diagnostic groups were assessed. RESULTS:The study assessed 165 patients. 129Xe MRI and PFT metrics differed significantly between diagnostic groups. On 129Xe MRI, patients with COPD had significantly reduced and more heterogeneous ventilation, greater acinar dimensions, and lower gas transfer, in addition to lower spirometry, greater airways resistance and reactance, and more air trapping than patients with asthma. Similarly, 129Xe MRI metrics demonstrated greater abnormalities in COPD than asthma when comparing only those with normal forced expiratory volume in 1 s or TLco. Lung function and structure were worse in asthma + COPD than asthma and better than COPD. CONCLUSIONS:129Xe MRI alongside PFTs provide phenotypically distinct airway disease signatures to aid diagnosis of asthma and/or COPD. 129Xe MRI is highly sensitive to minimal lung disease and identifies functional/structural phenotypes that may help to guide treatment decisions.

The study highlights the role of JAK/STAT signalling in COPD, with STAT3 linked to neutrophilic inflammation and STAT6 to eosinophilic inflammation and chronic bronchitis. Findings support targeted therapies to address specific clinical traits in COPD. https://bit.ly/4qoEs0h.

RATIONALE:In chronic obstructive pulmonary disease (COPD), exacerbations drive morbidity, healthcare resource utilization, and mortality. Hospitalization and emergency department (ED) visits reflect acute clinical instability. Systemic corticosteroids are usually prescribed for exacerbations, but cumulative exposure is a concern. OBJECTIVES:To evaluate the effect of dupilumab on ED visits/hospital admissions and systemic corticosteroid use in patients experiencing exacerbations. METHODS:BOREAS and NOTUS, two phase 3, randomized, double-blind, placebo-controlled trials, enrolled patients (40-85 years) with COPD, moderate-to-severe airflow limitation, and type 2 inflammation (screening blood eosinophil count ≥300 cells/µL). Patients received dupilumab 300 mg (N = 938) or placebo (N = 936) for 52 weeks. Systemic corticosteroid use and annualized rate and time to first ED visit/hospital admission were assessed. MEASUREMENTS AND MAIN RESULTS:Dupilumab versus placebo reduced ED visits/hospital admissions of any duration by 38% (rate ratio, 0.62 [95% CI, 0.43-0.90]; P = .0121), delayed time to first event, and reduced risk of a first event by 45% (hazard ratio, 0.55 [95% CI, 0.38-0.78]; P = .0010). Compared with placebo, systemic corticosteroid use was reduced in patients treated with dupilumab who experienced severe exacerbations by 42% (rate ratio, 0.58 [95% CI, 0.38-0.89]; P = .0126) and moderate exacerbations by 28% (rate ratio, 0.72 [95% CI, 0.60-0.87]; P = .0005). CONCLUSIONS:Dupilumab reduced ED visits/hospital admissions of any duration. Patients who experienced moderate and/or severe exacerbations required fewer systemic corticosteroids with dupilumab compared with placebo. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov (NCT03930732, NCT04456673).

BACKGROUND:Asthma remission is a feasible treatment goal. However, remission definitions vary, and predictive biomarkers remain underexplored. METHODS:We conducted a post hoc analysis of ATLANTIS (NCT02123667), a multinational prospective study including 684 adult asthmatics. Remission was defined by 3-component (3C) and 4-component (4C) criteria. 3C remission included: (1) ACQ-6 < 1.5, (2) no maintenance oral corticosteroids, (3) no exacerbations. An absolute decline < 10% in pre-bronchodilator FEV1% predicted, was added for the 4C definition. Multivariate logistic regression identified remission predictors. A novel Low Disease Activity (LDA) score was developed using factor analysis of five clinical variables (ACQ-6, FeNO, BEC, and FEV1) including an innovative small airways dysfunction questionnaire tool (SADT). Nasal transcriptomics were analysed for differential gene expression and pathway enrichment and were replicated in U-BIOPRED (NCT01976767) using sputum transcriptomics. U-BIOPRED was included only to study omics replication of remission pathways identified in ATLANTIS. FINDINGS:Remission occurred in 48% (3C) and 45% (4C) of patients. Predictors included male sex, better lung function, fewer previous exacerbations, and higher SADT (fewer small airways symptoms). LDA identified milder disease and was associated with remission [OR 3C 4.43 (2.80, 7.10) and 4C 3.46 (2.23, 5.43)], improved QoL [OR 2.07 (1.65, 2.60)], and fewer future exacerbations [OR 0.43 (0.22, 0.85)]. Transcriptomic analyses revealed remission-associated upregulation of interleukin 4/13 signalling and downregulation of coagulation pathways, in both ATLANTIS and U-BIOPRED. INTERPRETATION:SAD was associated with reduced asthma remission. A novel LDA tool demonstrated clinical utility in stratifying prospective asthma risk. Key immunologic and haemostatic pathways may underpin remission, offering potential targets for future intervention.

BACKGROUND:Long-acting muscarinic antagonists (LAMA) can be added to inhaled corticosteroid- (ICS)-long-acting β2-agonist (LABA) therapy for inadequately controlled asthma. We aimed to evaluate the efficacy and safety of budesonide-glycopyrronium-formoterol fumarate dihydrate (BGF) versus budesonide-formoterol fumarate dihydrate using Aerosphere co-suspension delivery technology (BFFA) and the current suspension formulation (Symbicort, BFFS). METHODS:Two multicentre, randomised, double-blind, double-dummy, phase 3 studies (KALOS and LOGOS) recruited participants aged 12-80 years with inadequately-controlled asthma despite daily medium-dose or high-dose ICS-LABA use from across 378 sites in 20 countries (KALOS), and 324 sites in 15 countries (LOGOS). Participants were randomly assigned (1:1:1:1) to BGF 320 μg, 28·8 μg, 10 μg (BGF 28·8); BGF 320 μg, 14·4 μg, 10 μg (BGF 14·4); BFFA 320 μg, 10 μg; or BFFS 320 μg, 9 μg, twice a day via pressurised metered-dose inhaler for 24-52 weeks. Primary lung function endpoints were change from baseline in FEV1 area under the curve from 0 h to 3 h (AUC0-3) and in morning pre-dose trough FEV1 from day 1 to week 24 (over 24 weeks; depending on regional health authority guidance). The primary pooled analysis across both studies was annualised severe exacerbations. The efficacy analysis set and safety set included all randomly assigned participants receiving any amount of study treatment but were analysed according to randomly assigned treatment and received treatment, respectively. The KALOS and LOGOS studies are registered with ClinicalTrials.gov (NCT04609878 and NCT04609904, respectively) and are complete. FINDINGS:Between Dec 15, 2020, and March 21, 2025 (KALOS), and between March 1, 2021, and March 20, 2025 (LOGOS), 8820 participants were recruited and 4311 received treatment (1179 received BGF 28·8, 726 received BGF 14·4, 1210 received BFFA, and 1196 received BFFS). In each study, the pre-specified multiplicity-adjusted primary endpoints for all regulatory comparisons were met. Least squares mean differences favoured BGF 28·8 for change from baseline in trough FEV1 and FEV1 AUC0-3 across all comparisons (all p<0·05). Least squares mean differences in change from baseline in morning pre-dose trough FEV1 and in FEV1 AUC0-3 over 24 weeks for BGF 28·8 versus BFFcombined were 76 mL (95% CI 57-94; p<0·0001) and 90 mL (72-108; p<0·0001), respectively. BGF 28·8 reduced severe exacerbation rates versus BFFcombined (incidence rate ratio 0·86, 95% CI 0·76-0·97; p=0·012) and versus BFFS (0·82, 0·71-0·94; p=0·0043). Exacerbation rate ratio for BGF 28·8 versus BFFA was 0·90 (95% CI 0·78-1·03; p=0·12). 627 (53·2%) adverse events were observed with BGF 28·8, 436 (60·0%) with BGF 14·4, 666 (55·2%) with BFFA, and 698 (58·4%) with BFFS. No deaths were treatment related. INTERPRETATION:These findings show that BGF improves lung function and reduces severe exacerbation rates in a broad population with asthma inadequately controlled despite medium-dose or high-dose ICS-LABA use. Given that these findings were observed regardless of recent exacerbation history, BGF could benefit individuals with inadequately controlled asthma without requiring a recent episode of acute deterioration on ICS-LABA before escalation. FUNDING:AstraZeneca.

Background Addition of the long-acting muscarinic antagonist umeclidinium (UMEC) to the inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) combination fluticasone furoate/vilanterol (FF/VI) improved lung function in adults with uncontrolled moderate to severe asthma in the CAPTAIN (Clinical study of Asthma Patients receiving Triple therapy through A single INhaler) study; however, the impact on symptoms requires further investigation. Objective We sought to evaluate the effect of adding UMEC to FF/VI on asthma symptoms. Methods The CAPTAIN study was a phase IIIA, randomized, controlled, 24- to 52-week study of patients with uncontrolled moderate to severe asthma despite ICS/LABA receiving once-daily single-inhaler FF/VI (100/25 or 200/25 μg) or FF/UMEC/VI (100/31.25/25, 100/62.5/25, 200/31.25/25, or 200/62.5/25 μg). Here, we compare the effect of pooled FF/UMEC 62.5/VI (100/62.5/25 and 200/62.5/25 μg) versus FF/VI (100/25 and 200/25 μg) on symptom control using prespecified analyses of change from baseline in Evaluating Respiratory Symptoms in Asthma (E-RS: Asthma) total and domain scores, and proportion of patients meeting an E-RS: Asthma total score responder threshold. We also performed post hoc analyses assessing the impact of baseline type 2 inflammation status on treatment response. Results Least-squares mean (95% CI) reductions from baseline in E-RS: Asthma total score exceeded the minimum clinically important difference (−2.0 units) and were numerically greater with FF/UMEC 62.5/VI (−2.89 [−3.15 to −2.64]; n = 814) versus FF/VI (−2.47 [−2.73 to −2.22]; n = 813). The proportion of responders (45% [n = 360] vs 41% [n = 327]) and odds of response (odds ratio, 1.18 [95% CI, 0.96 to 1.45]) were numerically greater with FF/UMEC 62.5/VI versus FF/VI. Similar trends were observed irrespective of type 2 status. Conclusions Patients with symptomatic asthma may benefit from optimized treatment interventions, such as adding a long-acting muscarinic antagonist to ICS/LABA.

Chronic obstructive pulmonary disease (COPD) remains a major public health challenge, characterized by substantial underdiagnosis, high morbidity and mortality, and significant healthcare burden. In Italy, the gap between estimated and diagnosed prevalence highlights the need for improved early detection and proactive management. This expert opinion, developed by a multidisciplinary panel, translates current evidence into practical recommendations tailored to the Italian healthcare context. Patient characterization has moved from a spirometry-centered approach to a proactive, multidimensional model integrating symptom burden, exacerbation history, and cardiopulmonary risk. Early diagnosis should be driven by structured case-finding in primary care and internal medicine, using spirometry for confirmation. Early identification of uncontrolled patients relies on standardized tools, including symptom quantification (CAAT score) and indirect markers like recurrent antibiotic or oral corticosteroid use. Exacerbations are critical events that accelerate both pulmonary and cardiovascular deterioration, identifying a high-risk phase requiring prompt reassessment and optimization. In this context, single-inhaler triple therapy (SITT) is the only pharmacological strategy consistently associated with reduced exacerbations and all-cause mortality in high-risk populations. Timely SITT use may also reduce cardiopulmonary risk. Furthermore, preventing exacerbations limits antibiotic and systemic corticosteroid use, promoting antimicrobial stewardship and mitigating resistance. This expert opinion emphasizes the need for integrated care pathways, standardized clinical tools, and multidisciplinary coordination to overcome therapeutic inertia. A shift toward early identification, timely intervention, and prevention-oriented strategies is essential to improve outcomes and reduce the systemic burden of COPD.

Abstract Background We explored the efficacy of AS01 E -adjuvanted respiratory syncytial virus prefusion F protein-based vaccine (adjuvanted RSVPreF3) in subpopulations of participants with underlying medical conditions in the multi-country, phase 3 AReSVi-006 trial (conducted May/2021-May/2024). Methods Medically stable ≥60-year-olds were 1:1-randomised to receive one adjuvanted RSVPreF3 or placebo dose pre-RSV season 1. In exploratory post-hoc analyses in subgroups of participants with underlying conditions (including COPD, asthma, diabetes, obesity [BMI≥30 kg/m 2 ]), we evaluated efficacy of one vaccine dose against RSV-related lower respiratory tract disease (RSV-LRTD), acute respiratory illness (RSV-ARI), and RSV-ARI-related complications (e.g., pneumonia, COPD/asthma exacerbation, cardiovascular events). We also evaluated (post-hoc) RSV-ARI-related systemic corticosteroid and antibiotics use in participants with COPD or asthma. Results The efficacy analyses comprised 12,468 vaccine and 12,498 placebo recipients. Efficacy against RSV-LRTD over three RSV seasons was similar among participants with COPD (75.1%, 95% CI: 40.2-91.4), asthma (65.8%, 31.0-84.7), diabetes (69.8%, 37.5-87.1), and obesity (74.1%, 56.4-85.5) as in the overall study population (62.9%, 97.5% CI: 46.7-74.8). Efficacy was also observed against RSV-ARI in these subgroups. Efficacy against RSV-ARI-related complications was 74.4% (95% CI: 11.2-95.2) in participants with COPD and 60.8% (−9.9-88.7) in those with asthma. Among participants with COPD, 15.4% (1.9-45.4) of RSV-ARI episodes in vaccine vs 22.4% (12.5-35.3) in placebo recipients were treated with systemic corticosteroids, and 46.2% (19.2-74.9) vs 56.9% (43.2-69.8) with antibiotics. Conclusions Post-hoc analyses of the AReSVi-006 trial suggest that adjuvanted RSVPreF3 may help prevent RSV-ARI, RSV-LRTD, and RSV-related complications in medically stable older adults with underlying medical conditions like COPD and asthma. Trial registration ClinicalTrials.gov : NCT04886596 Summary Post-hoc analyses of the AReSVi-006 trial suggest that 1 dose of adjuvanted RSVPreF3 may help prevent RSV-related illness and complications over 3 consecutive RSV seasons in subgroups of ≥60-year-olds with chronic medical conditions, e.g., COPD and asthma.

Bronchopulmonary dysplasia is a hallmark respiratory complication of prematurity and remains a major health determinant of individuals born very preterm. Its impact, however, extends far beyond the neonatal period and far beyond the lungs. Children, adolescents and adults born very preterm often follow diverse developmental trajectories that diverge from typical postnatal growth. These trajectories often display early airflow limitation, as well as features of increased cardiovascular vulnerability and altered multisystemic profiles. Although common respiratory labels such as asthma are often applied to these patients, evidence highlights distinct pathobiological mechanisms rooted in arrested alveolar and vascular growth, with a possible contribution from persistent airway inflammation and oxidative stress. Extrapulmonary involvement, including cardiovascular, neurodevelopmental, neurosensory, renal and metabolic domains, further shapes long-term outcomes and should be systematically integrated into long-term monitoring. Yet, despite improving survival and growing recognition of this multisystemic burden, current evidence remains insufficient to design a dedicated, holistic, multidisciplinary follow-up programme tailored to the diverse subgroups of preterm-born individuals. Increasing awareness among healthcare professionals of the long-term implications of prematurity is essential to ensure that these patients receive appropriate and coordinated attention. Emerging lines of research, spanning new preventive and therapeutic options, advanced imaging, mechanistic studies, and long-term cohort designs, hold promise in elucidating the biological determinants of disease. Integrating these insights into clinical pathways, together with sustained implementation of family-centred care models, will be crucial to optimise organ function trajectories, delay deterioration and ultimately improve the quality of life of the growing population of survivors of prematurity.

Background Allergic and Type 2 (T2) inflammatory biomarkers are increasingly used to predict outcomes and guide treatment in asthma and COPD. The objective of this cross-sectional study was to determine the prevalence of allergic sensitisation and T2 biomarkers and their clinical associations among patients with diagnoses of asthma and/or COPD in NOVELTY, a large multinational, observational study. Methods Participants were enrolled from primary/specialist care, stratified by physician-assigned diagnosis and severity. We assessed blood eosinophils (B-Eos ≥300 cells/μL), fractional exhaled nitric oxide (FeNO ≥25 ppb), and allergen-specific IgE sensitisation (sIgE ≥0.35 kU·L −1 ; any of 11 aeroallergens). Associations between biomarkers and clinical outcomes were examined using descriptive statistics and multivariable regression models adjusted for age, sex, body mass index, and smoking status. Results Data for all biomarkers were available for 4352 participants (asthma: n=2194; asthma+COPD: n=633; COPD: n=1525). Overall, 63% participants had ≥1 positive biomarker (asthma: 77%; asthma+COPD: 60%; COPD: 45%); only 8%, 4%, and 1% participants, respectively, were positive for all three. Women and current smokers were more likely to be triple negative. Among participants with asthma, having more positive biomarkers was associated with more severe physician-assessed disease, lower lung function, and exacerbations. By contrast, in COPD, having no positive biomarkers was associated with more severe physician-assessed disease and lower lung function. Conclusions Allergic and T2 biomarkers are highly prevalent in asthma and asthma+COPD but less frequent in COPD. Their patterns show distinct associations, sometimes with opposite trends, across diagnostic groups, suggesting distinct underlying mechanisms that differ.

RATIONALE:Chronic mucus hypersecretion contributes to airway obstruction in asthma. OBJECTIVES:To assess dupilumab efficacy by baseline mucus plug score. METHODS:In VESTIGE (NCT04400318), adults with moderate-to-severe asthma, baseline blood eosinophils ≥300 cells/μL, and fractional exhaled nitric oxide (FeNO) ≥25 ppb received dupilumab 300 mg (n = 72) or placebo (n = 37) every 2 weeks for 24 weeks. Post hoc analyses included mucus plug score change from baseline, and patient proportion achieving FeNO <25 ppb, percent predicted FEV1, and FVC stratified by baseline mucus plug score (high/low defined by score ≥4 or 0-3.5, respectively, derived from high-resolution computed tomography scans). MEASUREMENTS AND MAIN RESULTS:Fewer dupilumab-receiving patients had high mucus plug score at week 24 than at baseline (32.8% vs 67.2%); proportions remained similar in placebo-receiving patients (76.7% vs 73.3%). Dupilumab versus placebo recipients were more likely to achieve FeNO <25 ppb in high-/low-mucus-plug score subgroups (odds ratio, 6.64; P = .003/8.54; P = .024). Dupilumab versus placebo significantly increased pre-/post-bronchodilator percent predicted FEV1 (least squares mean difference [LSMD], 16.77 percentage points [95% CI, 9.81-23.73]; P <.0001 [pre] and 12.70 [95% CI, 3.87-21.52]; P = .0055 [post]) and pre-bronchodilator FVC (LSMD, 0.42 mL [95% CI, 0.17-0.66]; P = .001), and numerically improved post-bronchodilator FVC (LSMD, 0.30 mL [95% CI, 0.01-0.59]; P = .0399) in the high-mucus-plug score subgroup. CONCLUSIONS:Dupilumab reduced mucus plug scores and improved lung function in patients with moderate-to-severe asthma with high baseline mucus plug score, and increased the likelihood of achieving FeNO <25 ppb regardless of baseline mucus plug score.

BACKGROUND:A subset of patients with asthma develops persistent airflow limitation (PAL) despite optimal treatment. The role of small airways dysfunction (SAD) in this phenotype, and its relationship with symptoms, remains incompletely understood. OBJECTIVES:To assess small airways function in asthmatic patients with PAL and compare it with patients with fully reversible asthma and with COPD; and to explore correlations between small airway indices and patient-reported outcomes. METHODS:We enrolled 60 patients (20 with asthma and PAL, 20 with fully reversible asthma, 20 with COPD) matched for age, sex, and pre-bronchodilator FEV1. Small airways function was evaluated using impulse oscillometry (IOS; R5-R20) and single-breath nitrogen washout test (SBNWT; dN2). Patients completed a daily symptom diary (dyspnea, cough, sputum, and rescue medication use) over four weeks. RESULTS:Compared with fully reversible asthma, asthmatic patients with PAL showed significantly higher dN2 and R5-R20 values, though less pronounced than in COPD. SAD (R5-R20 > 0.07 kPa·L-1·s) was present in all COPD patients, 79% of PAL patients, and 37% of reversible asthma patients (p < 0.001). In PAL, R5-R20 correlated strongly with dyspnea scores (r = 0.64, p < 0.001). In reversible asthma, R5-R20 correlated with cough and rescue medication use, whereas in COPD, symptoms were primarily related to residual volume. CONCLUSIONS:Small airways dysfunction is highly prevalent in asthmatic patients with PAL and significantly contributes to daily symptom burden. Its intermediate severity between COPD and reversible asthma suggests that SAD plays a central role in the pathogenesis of fixed obstruction, suggesting a potential role for targeted diagnostic and therapeutic strategies.

Background Preterm birth is a recognized risk factor for lung disease later in life. However, awareness of this risk among preterm-born adults and whether it is discussed with their treating physicians is unknown. The EMPOWER survey assessed awareness of the preterm status among preterm-born adults with asthma and COPD and evaluated its consideration in disease management. Methods Preterm-born subjects aged ≥18 years with physician-diagnosed asthma and/or COPD from France, Germany, Spain, the UK, and the US completed a 34-item online questionnaire. The survey covered socio-demographics, medical history, awareness of perinatal events, and interactions with healthcare providers. Results Of 3175 individuals who initiated the survey, 301 participants (median age, 55 years; IQR, 39–64 years) were included in the final analysis (9.5% response rate). Most respondents knew their gestational age (87%) and birth weight (89%), primarily from parents and caregivers (81%), with just 19% obtaining information from medical records. Over half (58%) reported receiving neonatal intensive care, most commonly assisted ventilation (36%) and nutritional support (24%). While 54% considered preterm birth relevant to respiratory management, 59% had not disclosed this history to their physician. Only 24% reported spontaneous disclosure, and just 11% shared the history in response to physician inquiry. Pediatric monitoring was reported by 45%, but follow-up rarely extended into adulthood. Conclusion Although preterm-born adults with obstructive respiratory disease are aware of their neonatal history, it is seldom integrated into adult respiratory care. Limited patient disclosure, infrequent physician inquiry, and lack of structured long-term follow-up likely contribute to this gap.

Background There is growing interest in evaluating the ability of treatments to deliver clinical remission in patients with asthma. We conducted post-hoc analyses of TRIMARAN and TRIGGER, two clinical studies comparing the efficacy and safety of fixed-dose combination beclometasone dipropionate, formoterol fumarate and glycopyrronium (BDP/FF/G: TRIMARAN, 100/6/10 μg; TRIGGER 200/6/10 µg) with BDP/FF (100/6 and 200/6 µg). Methods Clinical remission was defined as: no use of oral corticosteroids over 52 weeks, no occurrence of severe exacerbations over 52 weeks, Asthma Control Questionnaire-5 score <1.5 at Weeks 26, 40 and 52, and pre-dose forced expiratory volume in 1 s at Week 52 equal to, or higher than, the baseline value. Results Of 2291 patients included in these analyses, 598 (26.1%) met the clinical remission definition ( i.e. , met all criteria) at Week 52–315 (27.4%) in TRIMARAN and 283 (24.8%) in TRIGGER. The proportion of patients who achieved clinical remission was higher in the BDP/FF/G group than in the BDP/FF group in both studies (29.4% and 29.6% in TRIMARAN and TRIGGER, respectively, versus 25.4% and 20.0%), with the difference reaching statistical significance in TRIGGER (odds ratio 1.70 [95% confidence interval 1.29, 2.23]; p<0.001) and when data were pooled (29.5% versus 22.7%; 1.44 [1.19, 1.73]; p<0.001). Conclusions Among patients with asthma that was uncontrolled by an inhaled corticosteroid/long-acting β 2 -agonist (ICS/LABA) combination prior to study entry, a higher proportion achieved clinical remission by switching to inhaled triple therapy than by continuing ICS/LABA.