Pulmonology

Nalbuphine ER significantly reduces IPF-associated chronic cough over 6 weeks

In this phase 2b trial, 165 patients with IPF and chronic cough were randomized to nalbuphine ER (27, 54, or 108 mg) or placebo twice daily. All three nalbuphine doses produced larger relative reductions in 24-hour objective cough frequency than placebo at 6 weeks, with a dose–response pattern. The 54 mg and 108 mg doses improved patient-reported cough frequency more than placebo; the 27 mg dose showed a smaller, non-significant effect. These data position nalbuphine ER as a promising targeted antitussive candidate for IPF-associated cough, pending longer-term safety and regulatory review. 1

Antifibrotic therapy in IPF associates with substantially lower lung cancer incidence

This retrospective multisite cohort included 3313 IPF patients, of whom 1161 received antifibrotic therapy for at least 6 months. Lung cancer incidence rates were lower in treated versus untreated patients in the post-antifibrotic era (0.34 vs 1.25 per 100 person-years). After inverse probability of treatment weighting, antifibrotic use remained independently associated with reduced lung cancer risk (subdistribution HR 0.36, 95% CI 0.16–0.82). Smoking history and higher FVC were associated with increased lung cancer risk, underscoring the need for tailored surveillance strategies. These data support counseling that antifibrotics may confer additional malignancy risk reduction, while acknowledging residual confounding. 2

A simple functional score stratifies 1-year mortality in fibrotic ILD

Using the INSIGHTS-IPF registry (1232 patients), investigators derived a 1-year mortality model based on FVC, DLCO, 6MWD, and BMI. They defined low (<15%), intermediate (15–30%), and high (>30%) 1-year mortality risk groups using these routinely available measures. The model showed similar accuracy when externally validated in 490 IPF patients and in a broader 2576-patient fibrotic ILD cohort. Because these variables are potentially modifiable, the model can support goal-oriented management, escalation decisions, and endpoint selection in trials. 3

PAP therapy in OSA associates with modestly lower mortality and hospitalizations

This German claims-based study compared outcomes in treatment-naïve OSA patients prescribed PAP versus those not treated between 2015 and 2020. Among 12,297 PAP-treated and 10,020 untreated individuals, PAP use was associated with reduced all-cause mortality (HR 0.87, 95% CI 0.77–0.98). In 8768 propensity-matched pairs, PAP therapy also correlated with fewer all-cause hospitalizations (OR 0.81, 95% CI 0.74–0.89). Analyses adjusted for demographics, socioeconomic status, comorbidities, and medications, but residual confounding and adherence misclassification remain possible. 4