Pulmonology

Limited HRCT fibrosis predicts FVC and DLCO gains from immunomodulation in chronic hypersensitivity pneumonitis

In this retrospective two-center cohort of 108 chronic HP patients, immunomodulatory therapy produced only modest overall FVC improvement over 12 months. When HRCT fibrosis was <10%, immunomodulation was associated with clinically meaningful increases in both FVC and DLCO at 12 months. Patients with ≥10% radiographic fibrosis showed no significant FVC or DLCO improvement despite similar baseline demographics and antigen profiles. Visual estimation of fibrosis extent on HRCT may help select chronic HP patients more likely to benefit from systemic immunomodulatory therapy. 1

Male sex and higher blood eosinophils identify COPD patients at increased MACE risk

This real-life COPD cohort found male sex and elevated blood eosinophils independently associated with major adverse cardiovascular events. These associations were evident even among patients in early GOLD stages, not only advanced disease. Findings support earlier, proactive cardiovascular risk evaluation in male and eosinophilic COPD patients. Such patients may warrant more aggressive risk factor modification when selecting inhaled regimens and systemic therapies. 2

Asthma remission is achievable in severe asthma and is predicted by baseline control and steroid dependence

This nationwide Korean registry analysis followed 405 severe asthma patients for 12 months to classify remission status. Complete clinical remission was achieved in a minority, while most patients reached partial remission based on at least one remission criterion. Higher baseline ACT score increased the odds of higher remission category, whereas maintenance OCS use and chronic cough reduced remission likelihood. Patients achieving remission had better baseline lung function, fewer exacerbations, lower WBC counts, and more frequent biologic use. These easily assessable predictors can help target remission-oriented strategies and prioritize steroid-sparing interventions in severe asthma management. 3

Personalized ARDS management guided by evolving definitions and emerging phenotypes

This narrative review summarizes current evidence for medical and ventilatory management of ARDS amid persistently high mortality. The Global ARDS definition promotes earlier recognition across a broader spectrum of patients, regardless of supportive interventions used. The authors emphasize emerging physiological, biological, and radiologic phenotypes that may modify responses to therapies with previously equivocal results. They propose a framework for phenotype-informed, individualized ARDS management and identify priorities for future trials. 4