RESPIRATORY Medicine / Pulmonology Updates
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Channel Posts
[Articles] Cryobiopsy versus conventional bronchoscopic sampling for peripheral pulmonary lesions (Cryo-RCT): an open-label, parallel-group, randomised trial
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00191-8/fulltext?rss=yes
In patients with peripheral pulmonary lesions undergoing radial endobronchial ultrasound-guided bronchoscopy, cryobiopsy achieved a higher histology-based diagnostic yield than conventional sampling, although moderate bleeding and pneumothorax were more frequent. These findings support cryobiopsy as a valuable tissue-acquisition strategy for peripheral pulmonary lesions, particularly when the probe–lesion relationship is adjacent to or eccentric.
| 2 | [Comment] Intensive care in global conflicts: brace for impact
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00186-4/fulltext?rss=yes
Not a day goes by without the news reporting new and ongoing conflicts globally. Over the past few decades, the frequency and complexity of both intrastate and interstate conflicts have increased, with consequences extending beyond geopolitical boundaries into everyday life, including health-care systems.1 This evolving context raises the question of what the implications are for health-care professionals in the intensive care unit (ICU). | 176 |
| 3 | [Comment] The PERC-Peds rule: a promising step towards structured pulmonary embolism risk assessment in children
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00222-5/fulltext?rss=yes
Pulmonary embolism accounts for 10–15% of all paediatric venous thromboembolism (VTE) events, with an annual incidence of 0·14–0·9 per 100 000 children.1,2 Although rare, pulmonary embolism is a severe and potentially life-threatening complication in children.1 In adults, efforts to improve pulmonary embolism diagnosis have focused on increasing the accuracy of risk-stratification tools to reduce unnecessary testing and overtreatment.3 By contrast, in children, the main challenge has been delayed recognition and underdiagnosis. | 153 |
| 4 | [Comment] Heterogeneity of severe asthma in Europe: a SHARP-er view
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00165-7/fulltext?rss=yes
Disease-modifying anti-asthmatic drugs, especially biologics, have fundamentally changed the therapeutic landscape of severe asthma, making asthma remission a realistic treatment goal in many patients.1 Although asthma remission concepts continue to evolve, definitions include minimal asthma symptoms, no exacerbations, no use of systemic corticosteroids, and stable or normal lung function, for at least 12 months.2 It has become evident that several challenges reduce remission rates in patients with severe asthma. | 128 |
| 5 | [Articles] Severe asthma and remission prospects in Europe (SHARP): insights from a multicentre observational study based on the European Severe Asthma Registry
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00141-4/fulltext?rss=yes
This pan-European analysis of severe asthma revealed significant clinical heterogeneity and a substantial disease burden despite advanced therapies, highlighting the enduring nature of type 2 inflammation, the potential inadequacy of current remission strategies with available therapeutic approaches, and the necessity for early identification of high-risk patients. | 111 |
| 6 | [Corrections] Correction to Lancet Respir Med 2026; 14: e51–52
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00199-2/fulltext?rss=yes
Moitra S, Annesi-Maesano I, Alghamdi MS, et al. Toxic skies of war. Lancet Respir Med 2026; 14 e51–51—In the Declaration of interests section of this Correspondence, the statements for Sara De Matteis and Ane Johannessen have been corrected. These corrections have been made to the online version as of June 22, 2026. | 105 |
| 7 | [News] Trump Administration sparks furore and resignations over fruit-flavoured vape authorisations
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00190-6/fulltext?rss=yes
On May 5, the White House overruled objections from US Food and Drug Administration (FDA) commissioner Marty Makary and ordered the agency to authorise sales of two fruit-flavoured e-cigarette products. | 101 |
| 8 | [Articles] Global economic burden attributable to asthma, 2025–50: a global modelling analysis of 154 countries and territories
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00144-X/fulltext?rss=yes
Our findings suggest that asthma imposes a substantial and uneven macroeconomic burden across countries, with differences by income level and region. Productivity reductions dominate in LMICs, whereas physical capital-related effects are more important in high-income settings. Improving asthma prevention and control could yield economic gain. | 127 |
| 9 | [Comment] From the cost of asthma to the economic dividends of asthma control
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00224-9/fulltext?rss=yes
Asthma affects more than 360 million people worldwide and remains one of the most common chronic diseases across the life course. Although effective therapies and evidence-based management strategies have transformed asthma care, the disease continues to impose a substantial burden through persistent symptoms, recurrent exacerbations, impaired quality of life, health-care use, and preventable deaths.1 Consequently, the success of asthma programmes has traditionally been measured by their ability to reduce symptoms, prevent exacerbations, and lower mortality. | 130 |
| 10 | [Articles] FEF25–75% trajectories from age 7 to 53 years, associations with childhood and parental preconception factors, and midlife COPD risk: a prospective cohort study
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00163-3/fulltext?rss=yes
FEF25–75% across the life course, particularly from early life, could be more relevant to COPD than previously recognised. Several childhood and novel parental preconception factors were associated with FEF25–75% trajectories, although causality cannot be inferred due to no clear temporality of these associations. Our findings on the relationship between FEF25–75% and COPD should be interpreted as life-course associations rather than as predictive. As COPD was rare in the average trajectory, the magnitude of effect estimates could be inflated. | 405 |
| 11 | [Comment] Small airways, early origins, and precision prevention of COPD
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00201-8/fulltext?rss=yes
Prevention of chronic obstructive pulmonary disease (COPD) cannot begin at the time of diagnosis.1 When fixed airflow obstruction is identified in adulthood, the biological pathway leading to disease might already have been active for decades.2–4 Lung growth, airway remodelling, immune maturation, respiratory infections, asthma, tobacco exposure, and intergenerational susceptibility all shape adult respiratory reserve. In this issue of The Lancet Respiratory Medicine, Jiacheng Liu and colleagues move this life-course framework into the so-called silent zone of the lung by examining trajectories of forced expiratory flow between 25% and 75% of the forced vital capacity (FEF25–75%), a spirometric marker supposed to be a proxy for smaller-airway dysfunction. | 379 |
| 12 | Optimising response to immunotherapies in pleural mesothelioma: clinical data and alternative models for the evaluation of new strategies
http://thorax.bmj.com/cgi/content/short/81/8/806?rss=1
Background
Pleural mesothelioma (PM) is a rare tumour, usually associated with previous asbestos exposure. Standard frontline, pemetrexed/platinum-based chemotherapy has been challenged since 2020 by dual immunotherapy, that is, anti-programmed cell death-1 (anti-PD-1) + anti-cytotoxic T lymphocyte-associated antigen-4 immune checkpoint inhibitors and recently by combination of chemotherapy + anti-PD-1. However, PM prognosis remains globally poor, without validated curative treatment to date.
Methods
We reviewed alternative pre-clinical models and clinical data for the evaluation of new treatments and strategies to optimize response to immunotherapies in pleural mesothelioma.
Results
Various innovative immunotherapies alone or combined with standard treatments and/or targeted therapies are currently assessed by clinical trials. The evaluation of these new strategies deserves relevant preclinical models, requiring the use of human models in addition to or even instead of mouse models. These models recapitulate, at least partially, heterogeneity of the tumours and offer new perspectives for the development and evaluation of immunotherapies. However, like all models, they exhibit advantages and disadvantages needing to be identified in order to use them to answer a well-defined biological question.
Conclusions
Along with ongoing trials testing innovative immunotherapies and strategies in pleural mesothelioma, original pre-clinical models are required to optimize these strategies and discover new ones for our patients. | 573 |
| 13 | Rethinking pleural tuberculosis through the lens of cell-free DNA
http://thorax.bmj.com/cgi/content/short/81/8/721?rss=1
Tuberculous pleuritis (TBP) remains one of the most diagnostically challenging manifestations of tuberculosis.1 2 Despite its global prevalence, particularly in high-burden settings, confirmation of TBP is frequently elusive. Conventional microbiological techniques perform poorly in pleural fluid,3 4 where mycobacterial burden is low and organisms are often non-viable. Diagnostic confidence is therefore commonly inferred from surrogate markers such as adenosine deaminase (ADA), immunological assays5 6 or clinical response to therapy. The result is a persistent trade-off between diagnostic delay, empirical treatment and invasive pleural biopsy. In this issue of Thorax, Zhang and colleagues describe an approach that reframes this problem by leveraging modern molecular diagnostics to overcome paucicellularity in the pleural space.1 7 8 Rather than continuing to search for intact Mycobacterium tuberculosis (MTB) organisms or their genomic DNA (gDNA), the authors... | 400 |
| 14 | Inducible laryngeal obstruction/vocal cord obstruction: still happening under our noses
http://thorax.bmj.com/cgi/content/short/81/8/733?rss=1
Inducible laryngeal obstruction (ILO) is an enigmatic condition with considerable impact on clinical practice. Historically, this condition has been known by several names, most notably vocal cord dysfunction (VCD) coined by Christopher and colleagues in 1983.1 However, it has been proposed to replace this terminology by the umbrella term ‘ILO’ and the term ILO will therefore be used throughout the manuscript. The prevalence of ILO in a general population has not been reported. However, it often acts as an asthma mimic, with a pooled prevalence in adults with asthma of approximately 25%.2 Progress in chronic cough3 and severe asthma has reignited interest in ILO as a key treatable trait that could be impeding remission and contributing to ‘difficult-to-treat asthma’.4 Approximately 10 years ago, we published a paper in Thorax entitled: ‘Middle airway obstruction: it is happening under our noses’ to draw... | 365 |
| 15 | Aligning management of chronic cough in asthma with BTS/NICE/SIGN guidance
http://thorax.bmj.com/cgi/content/short/81/8/736?rss=1
We welcome the recently updated British Thoracic Society (BTS)/National Institute for Health and Care Excellence (NICE)/Scottish Intercollegiate Guidelines Network (SIGN) approach to asthma treatment1 which provides simple, clear guidance to clinicians, based on robust evidence. Going further than Global Initiative for Asthma (GINA) guidance,2 the use of short-acting beta agonists and inhaled corticosteroid (ICS) monotherapy is no longer recommended. Initial treatment is with a combined inhaled corticosteroid/formoterol inhaler either as required for mild symptoms (as-needed therapy (AIR)) or a regular dose supplemented by as required use if symptoms are more persistent (maintenance and reliever therapy (MART)). For individuals presenting with chronic cough, we propose a pragmatic approach for clinicians, to ensure consistent and safe asthma treatment for individuals, aligning with the new guidelines. Chronic cough in adults, defined as >8 weeks (note >4 weeks in children), is an important and troublesome symptom that is a... | 267 |
| 16 | Running away from the smoke, the role of physical activity in tobacco dependency treatment
http://thorax.bmj.com/cgi/content/short/81/8/729?rss=1
The tobacco epidemic is far from over. Tobacco smoking still causes an estimated eight million deaths a year and is the largest preventative healthcare issue we face worldwide.1 Tobacco smoking is responsible for a multitude of chronic diseases and cancers, and a main factor driving health inequalities,2 making smoking cessation a vital intervention across physical, mental and social health.3 Smoking cessation programmes traditionally combine behavioural support with pharmacological tools to reduce withdrawal symptoms, including alternative sources of nicotine such as dual nicotine replacement therapy and nicotine analogues like varenicline or cytisine, delivered in an outpatient setting.4 However, researchers have investigated novel deviations from this model, via embedding services into clinical lung cancer screening, using digital tools and physical activity interventions.5 6 Physical activity has been proposed as a tool in cessation due to potential impacts in helping... | 234 |
| 17 | What constitutes meaningful gain in skeletal muscle strength in COPD?
http://thorax.bmj.com/cgi/content/short/81/8/731?rss=1
Low muscle mass and strength is a common systemic consequence of chronic obstructive pulmonary disease (COPD) and an important determinant of clinical outcomes.1–3 Quadriceps muscle strength, in particular, predicts transplant-free survival in COPD independent of the severity of airflow obstruction.3 While it may be assumed that low muscle strength is an inevitable feature of advanced disease, this is far from reality. Rather, it represents dysfunction of the largest organ system by mass in the human body and is often present in the absence of severe disease.4 Crucially, unlike many disease manifestations, skeletal muscle is highly modifiable, potently affected by both therapeutic (eg, resistance training) and habitual (eg, daily physical activity) patterns of mechanical tension. For individuals with COPD, progressive resistance exercise targeting the upper and lower limbs forms a key component of therapeutic interventions such as pulmonary rehabilitation (PR),... | 201 |
| 18 | An asthma-related anxiety intervention appropriate for the shift to digitalised care
http://thorax.bmj.com/cgi/content/short/81/8/727?rss=1
Asthma can cause immediate disabling symptoms such as wheezing and breathlessness. These symptoms, combined with the implications of living with a potentially fatal condition even when symptoms are well controlled, can also cause anxiety for many patients—with recent meta-analytical estimates from over 50 000 patients reporting a pooled prevalence of anxiety symptoms in 32% of people with asthma.1 As well as the impact of asthma on anxiety, anxiety symptoms can further worsen pulmonary symptoms experienced by patients.2 Recent clinical guidelines have recognised scientific consensus of the role that psychological and behavioural factors play in worsening asthma outcomes.3 Cognitive (eg, perception of breathlessness, interoception), affective (eg, chronic and acute stress) and behavioural factors (eg, poor medication adherence, avoidance behaviours) can all contribute to worse asthma outcomes—including anxiety-related catastrophic interpretation of symptom experiences, that can lead to a vicious worsening spiral of physical symptoms and anxiety in... | 217 |
| 19 | Getting more than early detection from lung cancer screening
http://thorax.bmj.com/cgi/content/short/81/8/725?rss=1
Lung cancer (LC) remains the deadliest cancer in the world and LC screening programmes continue to expand across healthcare systems to improve outcomes by earlier detection.1 Following results from screening trials, multiple countries have implemented their versions of LC screening programmes or have expanded their screening eligibility criteria.2–5 By design, these programmes aim to identify individuals at the highest risk of developing LC. The main prescreening eligibility assessment criteria are age and smoking status.1 In the UK, between one-third and 50% of participants attending ‘lung health checks’ for LC screening are actively smoking.6 To aid smoking cessation, most programmes rely on a brief advice plus onward referral approach: smokers receive short advice during the lung health check, then are asked to engage later with separate stop-smoking services.6 However, given the high number of... | 173 |
| 20 | Unraveling lung function trajectories and social determinants of health: the quest continues
http://thorax.bmj.com/cgi/content/short/81/8/723?rss=1
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, and COPD prevalence is expected to increase for decades to come.1 2 Worldwide, it is estimated that as many as 480 million people have COPD.2 Tobacco use contributes to most cases of COPD, but there are extensive data to show that social determinants of health (SDOH) contribute to lung function impairment and COPD.3 SDOH are the conditions to which people are born, raised, live and work in. These conditions include factors such as education access and attainment, socioeconomic status (SES), access to healthcare and food, and employment. Exposures like poor air quality, undernutrition and occupational hazards can impair lung function from a young age and make individuals more susceptible to respiratory diseases like asthma and COPD.4 5 Minoritised groups are disproportionately represented in those with... | 165 |
