RESPIRATORY Medicine / Pulmonology Updates

[Comment] Sugammadex versus neostigmine and postoperative pulmonary complications: a word of caution https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00185-2/fulltext?rss=yes Neuromuscular blockade is often used to optimise muscle relaxation and surgical conditions in anaesthetised patients with endotracheal intubation. At the end of surgery, it is of paramount importance that patients have a complete recovery of this neuromuscular blockade so that respiratory and upper airway muscles ensure an adequate breathing pattern and intact oropharyngeal reflexes to prevent aspiration, respiratory insufficiency, and other postoperative pulmonary complications.1 Many patients receive medications for a timely neuromuscular blockade reversal, and the most efficient pharmacological strategy has been investigated for decades.

[Articles] Sugammadex versus neostigmine for reversal of neuromuscular blockade and postoperative pulmonary complications (SNaPP): an international, randomised, controlled, phase 4 trial https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00158-X/fulltext?rss=yes Sugammadex reduced the incidence of postoperative pulmonary complications or death compared with neostigmine. The risk reduction was small with atelectasis of uncertain clinical significance being the most common complication. Sugammadex can be considered as a first-line drug for reversal of aminosteroid-induced neuromuscular blockade at the end of surgery.

Think twice before the refill: chronic PPI use was associated with higher airway exacerbation risk. Full Article

[Spotlight] Africa's inhaler dilemma: balancing cost, climate, and care https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00164-5/fulltext?rss=yes When baby Sidrah Isaacs was born, she appeared well. At around 6 weeks of age, her mother, Sasha Leigh, began to notice concerning symptoms, including a silent cough, a weak cry, and breathing difficulties. “I noticed that she did not swallow properly, and when she did, she would often vomit”, Leigh said. “I took her to a nearby clinic, but no conclusive diagnosis was made.” Sidrah was referred to the Red Cross War Memorial Children's Hospital in Cape Town, South Africa, where she was admitted to the intensive care unit (ICU) for respiratory support.

[Position Paper] Rheumatoid arthritis-associated interstitial lung disease: screening, diagnosis, and treatment—an expert group consensus statement https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00094-9/fulltext?rss=yes Interstitial lung disease (ILD) is a common and morbid complication of rheumatoid arthritis. Despite its prevalence and impact on patients, there is no agreement on how to screen for rheumatoid arthritis-associated ILD, when to initiate treatment, and the optimal treatment regimen. Due to a scarcity of high-quality studies to guide strict evidence-based guidelines, a multidisciplinary group of rheumatoid arthritis-associated ILD experts was convened to discuss the current body of evidence, synthesise the evidence qualitatively, and provide clinically useful consensus statements pertaining to the risk factors for rheumatoid arthritis-associated ILD, screening for ILD in rheumatoid arthritis, and the treatment of rheumatoid arthritis-associated ILD.

[Comment] Rheumatoid arthritis-associated interstitial lung disease: between evidence, expertise, and guidelines https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00146-3/fulltext?rss=yes Rheumatoid arthritis-associated interstitial lung disease (ILD) presents a paradox: it is common and a major cause of morbidity and mortality, yet continues to lack a consistent, evidence-based approach to screening, diagnosis, and treatment. Differences in guidance from the American College of Rheumatology (ACR) in collaboration with the American College of Chest Physicians (CHEST)1 and from the European Respiratory Society (ERS) and European Alliance of Associations for Rheumatology (EULAR),2 including the role of screening, the importance of systemic disease control, and the positioning of immunosuppressive and antifibrotic therapies reflect the considerable challenges of formulating recommendations in a field where high-quality evidence remains scarce.

[Articles] Clinical characteristics and outcomes in the adult cystic fibrosis population in Europe from 2014 to 2024: analysis of the European Cystic Fibrosis Society Patient Registry https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00149-9/fulltext?rss=yes From 2014 to 2024, the adult cystic fibrosis population in Europe expanded substantially due to marked improvements in treatment, particularly following the availability of ETI triple therapy from 2018–19 onwards. The growing number of people with CF surviving to adulthood is consistent with substantial effects from improved care and cystic fibrosis transmembrane conductance regulator modulators, such as ETI, and highlight evolving care needs of people with cystic fibrosis.

[Comment] Beyond efficacy: registries, equity, and outcomes in the ETI era https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00189-X/fulltext?rss=yes Cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy, particularly elexacaftor-tezacaftor-ivacaftor (ETI), has fundamentally changed what it means to live with cystic fibrosis.1 Longer-term open-label extension studies have shown that initial improvements in lung function, nutrition, quality of life, and pulmonary exacerbations observed in the pivotal trial population appear to be durable over time.2 Further, post-marketing prospective studies have shown broader real-world efficacy of ETI.

[Correspondence] endTB-Q trial: a caveat on confounding by baseline drug resistance https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00151-7/fulltext?rss=yes With very low certainty of evidence, WHO has conditionally recommended two 6-month or 9-month regimens for pre-extensively drug-resistant (pre-XDR) tuberculosis: one comprising bedaquiline, pretomanid, and linezolid, the other comprising bedaquiline, delamanid, linezolid, and clofazimine.1

[Correspondence] Top ten research priorities for community-acquired pneumonia research: UK James Lind Alliance priority setting partnership https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00116-5/fulltext?rss=yes Community-acquired pneumonia (CAP) remains a substantial global health challenge. In the UK alone, more than 200 000 hospital admissions occur annually, with a substantially larger volume of cases managed in primary care.1 CAP is associated with a substantial mortality rate of 10–20% for patients who are hospitalised, with high rates of readmission, substantial health-care use following hospitalisation, and impaired long-term quality-of-life.2–5 Despite this association, research into CAP has historically been underfunded relative to disease burden.

[Corrections] Correction to Lancet Respir Med 2026; 14: 472–75 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00157-8/fulltext?rss=yes Spinou A, Abu Hussein NS, Kaminski N, Al-Farra A, Amirav I. Children's respiratory health risks in the Gaza war: a call to act. Lancet Respir Med 2026; 14: 472–75. In this Correspondence, Israel Amirav's affiliation should have been “Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada”. This correction has been made to the online version as of May 8, 2026, and will be made to the printed version.

[Correspondence] Videolaryngoscopy in tactical environments: a word of caution https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00140-2/fulltext?rss=yes We read with great interest the Comment by Manuel Ángel Gómez-Ríos and André A J Van Zundert1 advocating for videolaryngoscopy as the universal default for tracheal intubation. We fully concur with the authors regarding the substantial body of evidence supporting videolaryngoscopy's superiority in first-pass success and overall patient safety. However, we wish to highlight a crucial operational limitation that has received little attention in the current literature: the use of videolaryngoscopy in high-intensity combat environments.

[Review] Respiratory infections due to human common cold coronaviruses, SARS-CoV, MERS-CoV, and SARS-CoV-2: epidemiology, pathogenesis, clinical features, diagnostics, therapeutics, and vaccine landscapes https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00049-4/fulltext?rss=yes Over the past half-century, perceptions of human coronaviruses have evolved from their initial characterisation as causes of the common cold to recognition of their capacity to trigger severe disease and global epidemics. The emergence of three zoonotic coronaviruses—severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002, Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012, and SARS-CoV-2 in 2019, has had profound health, economic, and societal consequences and continues to influence global epidemic-preparedness strategies.

[News] 2026 GINA report for asthma https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00188-8/fulltext?rss=yes On May 5, 2025, the Global Initiative For Asthma (GINA) published the 2026 update to their Global Strategy for Asthma Management and Prevention. On the same date, an online discussion hosted by GINA panel members and the European Respiratory Society gave an overview of the major changes.

[Articles] Asthma exacerbation profile of benralizumab for severe eosinophilic asthma (the BenRex study): a multicentre, prospective cohort study https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00096-2/fulltext?rss=yes Our findings suggested that eosinophilic inflammation is not involved in exacerbations when a patient is being treated with benralizumab. Airway neutrophilia, viral pathogens, and alteration of the sputum microbiome point to infection as the most prominent causes of exacerbations. This observation should improve precision management of asthma exacerbations occurring despite treatment with benralizumab.

[Correspondence] Toxic skies of war https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00160-8/fulltext?rss=yes Recent reports indicate that the burden of chronic respiratory diseases has increased by 80% in the Middle East and Northern Africa region between 1990 and 2019,1 and air pollution in the region, particularly due to sandstorms, has been a major risk factor for this increasing incidence.2 Although population growth, energy production, and rapid industrialisation and urbanisation primarily contribute to rising air pollution, this region also faces a substantial threat from its climate and geographical position.

[Articles] Comorbid diabetes disease severity and microbial changes in patients with bronchiectasis: a combined analysis of data from the EMBARC, EMBARC-India, Australian, and BE-China registries https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00057-3/fulltext?rss=yes Patients with diabetes and bronchiectasis are a high-risk population with more severe disease, worse outcomes, increased comorbidities, and increased risk of infections compared with patients without diabetes. These findings support inclusion of diabetes as a risk factor in individualised risk assessments for bronchiectasis.

[Comment] Biology meets physiology in ARDS precision medicine https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00088-3/fulltext?rss=yes Acute respiratory distress syndrome (ARDS) is a severe form of acute respiratory failure with high mortality and morbidity. ARDS has substantial heterogeneity, which is a likely reason for the scarcity of proven therapies. Research focus has shifted towards precision medicine, in which patients are subphenotyped based on their biology, physiology, or imaging, with the goal of selecting the population that benefits from a specific therapy.1 Currently, it is a research priority to understand the integration between these different subphenotype domains.

[Comment] Rethinking bronchiectasis through a metabolic lens https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00089-5/fulltext?rss=yes Bronchiectasis has emerged from being a neglected condition to a recognised global respiratory health challenge. It is characterised by airway dilatation, recurrent infection, and persistent airway inflammation, and carries a substantial burden of comorbidity.1 In their study in The Lancet Respiratory Medicine, Rebecca Hull and colleagues report the results of the largest multinational analysis to date, exploring the impact of diabetes in bronchiectasis, drawing together data from four registries across Europe, Asia, and Australia.

[Articles] Effects of inflammatory phenotypes in acute respiratory distress syndrome on mortality and partitioning of lung and chest wall mechanics in patients in the USA and Canada: a retrospective cohort study https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00045-7/fulltext?rss=yes Our findings suggested that in ARDS, the association between lung-protective mechanical ventilation and 60-day mortality is greater in patients with the hypoinflammatory phenotype than the hyperinflammatory phenotype, therefore patients with hypoinflammatory ARDS could be an important target population for enrichment of future clinical trials. However, our findings do not support different ventilation strategies based on phenotype. Although both phenotypes present with similar lung mechanics, extrapulmonary organ failure is the key driver of excess mortality among patients with the hyperinflammatory phenotype.