RESPIRATORY Medicine / Pulmonology Updates

[Articles] PERC-Peds rule for bedside exclusion of pulmonary embolism without radiation in children in the USA (BEEPER): a multicentre, prospective, observational, diagnostic accuracy study https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00086-X/fulltext?rss=yes In this multicentre, prospective, observational, diagnostic accuracy study of children with suspected pulmonary embolism in the emergency department, we found a 6·3% prevalence of pulmonary embolism or proximal DVT; in this population, the PERC-Peds negative rule can safely rule out pulmonary embolism. Use of PERC-Peds might reduce low-value diagnostic testing for pulmonary embolism in children and adolescents.

[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).

[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.

[News] RSV vaccination and immunisation programmes accelerating worldwide https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00223-7/fulltext?rss=yes Respiratory syncytial virus (RSV) has been a continuous and major cause of morbidity and mortality in babies and older people, adding pressure to strained hospitals in their busy winter seasons in countries of all incomes, while of course causing the highest mortality in low-income and middle-income countries (LMICs). According to WHO estimates, each year, RSV causes more than 3·6 million hospitalisations and around 100 000 deaths in children under 5 years of age. Most paediatric RSV deaths (97%) occur in LMICs where there is limited access to supportive medical care.

[Correspondence] Precision-guided immunomodulatory therapy in sepsis https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00153-0/fulltext?rss=yes Erik H A Michels and colleagues developed a parsimonious three-biomarker framework (procalcitonin, soluble TREM-1, and IL-6) that quantifies the Dysregulated Immune Profile (DIP) as a continuous score (cDIP) beyond organ-failure-based clinical surrogates and identifies patients with differential responses to hydrocortisone.1

[Correspondence] Precision-guided immunomodulatory therapy in sepsis – Authors’ reply https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00155-4/fulltext?rss=yes We agree with Yingying Yang and colleagues that similar continuous Dysregulated Immune Profile (cDIP) values could arise from different host–pathogen configurations. Robustly decomposing immune dysregulation into discrete pathogen-driven versus host-driven components is challenging, as these processes are intrinsically coupled. Pathogen burden, identity, and infection source undoubtedly shape the host response, yet substantial heterogeneity in immune dysregulation persists within each of these factors (see appendix 2 p 39 of the original Article1).

[Correspondence] Precision-guided immunomodulatory therapy in sepsis https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00154-2/fulltext?rss=yes We commend Erik H A Michels and colleagues1 for quantifying immune dysregulation in pneumonia and sepsis. Through dimensionality reduction and clustering with 35 biomarkers, they defined three Dysregulated Immune Profiles (DIPs) and a corresponding continuous score (cDIP). By training parsimonious models with three biomarkers, they facilitated the application of these clusters and score to datasets without extensive data, such as a subset (n=425) of the CAPE-COD trial2 (hydrocortisone vs placebo in community-acquired-pneumonia).

[Editorial] Dying with Dignity—time to cut the red tape https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00198-0/fulltext?rss=yes While death is a certainty for us all, how and when we die is not. For people with a terminal illness, the reality of death must be confronted alongside common fears of prolonged pain and suffering as well as a loss of autonomy. Although good end-of-life care can manage most symptoms, there are some circumstances that cannot be palliated and a person might feel their quality of life is so poor they would prefer to die. The practice of medical aid in dying (MAiD; also called physician assisted death) allows someone with a terminal diagnosis to obtain medication from a physician to end their life.

[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.

[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.

[Articles] Prevalence and disease trajectories of pulmonary fibrosis of childhood interstitial lung disease: a register-based, multicentre observational study https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00052-4/fulltext?rss=yes The application of standardised criteria for diagnosing pulmonary fibrosis enables identification of affected children among patients with chILD. These children have lower pulmonary function, an increased risk of death, and could benefit from antifibrotic therapies.

[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.

[Comment] Pulmonary fibrosis in chILD: bridging the gap https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00117-7/fulltext?rss=yes Childhood interstitial lung disease (chILD) encompasses a group of rare, heterogeneous respiratory conditions associated with substantial morbidity and mortality ranging from 1% to 30% during childhood.1,2 The exact causes of death can differ for each one of the diverse entities.1 In adult ILD, fibrosis is the major component defining progression and carries a dismal prognosis.3 It is a tissue repair response to injury that becomes maladaptive or manifests as a failure of tissue regenerative capacity and has, so far, no effective treatment.

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[Corrections] Correction to Lancet Respir Med 2026; published online May 28. https://doi.org/10.1016/S2213-2600(26)00160-8 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; published online May 28. https://doi.org/10.1016/S2213-2600(26)00160-8—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, and will be made to the printed version.

[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.

[Correspondence] Precision-guided immunomodulatory therapy in sepsis https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00153-0/fulltext?rss=yes Erik H A Michels and colleagues developed a parsimonious three-biomarker framework (procalcitonin, soluble TREM-1, and IL-6) that quantifies the Dysregulated Immune Profile (DIP) as a continuous score (cDIP) beyond organ-failure-based clinical surrogates and identifies patients with differential responses to hydrocortisone.1

[Correspondence] Precision-guided immunomodulatory therapy in sepsis https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00154-2/fulltext?rss=yes We commend Erik H A Michels and colleagues1 for quantifying immune dysregulation in pneumonia and sepsis. Through dimensionality reduction and clustering with 35 biomarkers, they defined three Dysregulated Immune Profiles (DIPs) and a corresponding continuous score (cDIP). By training parsimonious models with three biomarkers, they facilitated the application of these clusters and score to datasets without extensive data, such as a subset (n=425) of the CAPE-COD trial2 (hydrocortisone vs placebo in community-acquired-pneumonia).

[Correspondence] Precision-guided immunomodulatory therapy in sepsis – Authors’ reply https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00155-4/fulltext?rss=yes We agree with Yingying Yang and colleagues that similar continuous Dysregulated Immune Profile (cDIP) values could arise from different host–pathogen configurations. Robustly decomposing immune dysregulation into discrete pathogen-driven versus host-driven components is challenging, as these processes are intrinsically coupled. Pathogen burden, identity, and infection source undoubtedly shape the host response, yet substantial heterogeneity in immune dysregulation persists within each of these factors (see appendix 2 p 39 of the original Article1).

[Editorial] Dying with Dignity—time to cut the red tape https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00198-0/fulltext?rss=yes While death is a certainty for us all, how and when we die is not. For people with a terminal illness, the reality of death must be confronted alongside common fears of prolonged pain and suffering as well as a loss of autonomy. Although good end-of-life care can manage most symptoms, there are some circumstances that cannot be palliated and a person might feel their quality of life is so poor they would prefer to die. The practice of medical aid in dying (MAiD; also called physician assisted death) allows someone with a terminal diagnosis to obtain medication from a physician to end their life.