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Journal articleChin D, Hernandez-Beeftink T, Donoghue L, et al., 2026,
Genome-wide association study of idiopathic pulmonary fibrosis susceptibility using clinically curated European ancestry datasets.
, Eur Respir J, Vol: 68New association signals suggest a potentially causal role for the gene encoding KL-6, a known biomarker of fibrosis, and implicate genes involved in angiogenesis in IPF development https://bit.ly/3Ocr01s
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Journal articleBunyavanich S, Akdis M, Berin MC, et al., 2026,
Novel Biomarkers and Diagnostic Tools in Food Allergy.
, Allergy, Vol: 81, Pages: 2276-2289The double-blind placebo-controlled oral food challenge (DBPCFC) has been the "gold standard" for diagnosing IgE-mediated food allergy for the past 50 years. Despite tremendous strides in our understanding of basic mechanisms and clinical features of food allergy, we remain dependent on refinements of old technologies, i.e., skin tests and serum IgE measurements, to complement clinical history in making an accurate diagnosis of food allergies. However, recent technical advances in two effector cell assays, i.e., the basophil and mast cell activation tests, may soon bring these diagnostic biomarkers to the clinic. In addition, new advances in antibody assays, T-cell assays, transcriptomics, and metabolomics in conjunction with machine learning and artificial intelligence may soon enable us to diagnose food allergy and accurately monitor immunotherapeutic outcomes without the need for an oral food challenge.
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Journal articleCarlsten C, Chung KF, Salvi S, et al., 2026,
Air pollution and respiratory health: a multinational needs assessment of physicians.
, ERJ Open Res, Vol: 12, ISSN: 2312-0541BACKGROUND: Air pollution is a major threat to human health globally, but physicians' awareness of its specific health impacts and the extent they educate patients remain poorly understood. METHODS: We sought out the perceptions of general practitioners and pulmonologists regarding their role in managing impacts of air pollution on patients. We also assessed the educational and behavioural gaps, and contextual challenges relevant to respiratory health management from these professional perspectives. Computer-assisted telephone interviews were conducted across eight countries (Brazil, Canada, China, France, Germany, India, Mexico and the United States) with 600 physicians (primary care and respiratory medicine specialties). RESULTS: While 95% of respondents agreed that it was their role to assess and manage air pollution exposure and proactively educate patients, fewer reported concrete demonstrations of this role in practice. Over half (55%) recommended medical treatment addressing exposure, and 20% engaged in normal monitoring but without preventive action for patients exposed to air pollution. Only 11% recommended concrete lifestyle changes for patients. In addition, 34% of respondents were unsure whether they should prioritise only acute cases for counselling. Significant country differences in awareness of air pollution health impacts and management were found. Inadequate integration of air quality indices in patient care and costly protective equipment were identified as systemic barriers. CONCLUSION: Although general practitioners and pulmonologists recognise their role in assessing, managing and educating patients about air pollution exposure, their perception of this role and competencies within it indicate the need for educational support translating to impactful practice.
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Journal articleHernandez-Beeftink T, Allen RJ, Leavy OC, et al., 2026,
Genes, gut microbiome and lungs: untangling the web of idiopathic pulmonary fibrosis.
, ERJ Open Res, Vol: 12, ISSN: 2312-0541This work highlights the use of genetics to explore potential causal links between the gut microbiome and IPF, underscoring the importance of integrating gut and lung microbiome data with host genetics to better understand IPF mechanisms https://bit.ly/4bdzf4V.
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Journal articleLevy ML, Bush A, 2026,
Draft charter for asthma in children and young people, inspired by Martha's rule.
, Arch Dis Child -
Journal articleCecchi L, Annesi-Maesano I, Biagioni B, et al., 2026,
EAACI Guidelines on Environmental Science for Allergy and Asthma-Evidence-Based Recommendations for Prevention and Public Health Action to Mitigate the Impact of Pollen Exposure on Respiratory Allergy.
, AllergyDeveloped using the GRADE methodology, these EAACI guidelines provide evidence-based recommendations on the effectiveness of pollen reduction/avoidance strategies for allergic rhinitis (AR) and asthma, the utility of biomarkers for monitoring pollen-induced asthma and the efficiency of mitigation measures and of public health strategies. Systematic and narrative reviews and health economic analysis support the recommendations. According to GRADE, the certainty of evidence was moderate to very low, therefore conditional recommendations are provided to guide healthcare professionals, patients, and policymakers in developing personalized, preventive, and scalable interventions. Reducing/avoiding exposure to pollen should be recommended to reduce the risk of severe asthma exacerbations. Lung function decrease and exhaled nitric oxide increase may be predictive for pollen-induced asthma exacerbations. Real-time pollen monitoring and pollen concentration-based forecast may be recommended for managing pollen-induced AR and/or asthma. Pollutant information should be included in pollen information systems. Combined forecast (weather, pollen, pollutants) and warning systems might reduce the impact of thunderstorm asthma (TA). Emergency department/asthma-related services should be strengthened during pollen season and in TA. Personalized frameworks covering the types and allergenic potential of pollen, the coaggressors and the vulnerability of each patient are needed in daily practice. The fundamental role of prevention should be further prioritized.
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Journal articleAlzahrani A, Alghamdi S, Majrshi M, et al., 2026,
Use of oscillatory positive expiratory pressure (OPEP) devices to augment sputum clearance in COPD: an updated systematic review and meta-analysis
, Chronic Respiratory Disease, Vol: 23, ISSN: 1479-9723IntroductionEffective airway clearance is crucial in COPD management, and oscillatory positive expiratory pressure (OPEP) devices are a potential adjunct therapy for this. However, their clinical efficacy remains uncertain due to limited trial data.AimTo update our previous (2020) systematic review investigating the use of OPEP devices to augment sputum clearance in COPD.MethodsRandomised Clinical Trails s evaluating OPEP devices in COPD were identified from PubMed, CINAHL, Medline, Cochrane, and Embase (2020–2024). Outcomes included lung function, exercise capacity, exacerbations, and health-related quality of life (HRQoL), with pooled estimates calculated using random-effects models.ResultsTwelve trials (741 participants) were included. OPEP devices significantly reduced exacerbations (Odds Ratio: 0.39) and improved exercise capacity (+49 m at 6MWD). Small improvements were observed in FVC%, while HRQoL changes were not statistically significant. Accumulating evidence suggests benefits for sputum clearance and reduced antibiotic use. Devices were generally well accepted and safe.ConclusionOPEP devices appear to be safe and may reduce exacerbations, improve functional exercise capacity, and support sputum clearance in COPD.
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Journal articleMajrshi MS, Alzahrani AA, George PM, et al., 2026,
Effect of Dietary Nitrate Supplementation on Exercise Performance in Hypoxic IPF (EDEN-OX3): a double-blind, placebo-controlled, randomised crossover study
, Thorax, ISSN: 0040-6376Dietary nitrate (NO₃⁻) supplementation has been shown to improve vascular function and exercise capacity in COPD and in pulmonary hypertension. In a double-blind, placebo-controlled cross-over study in 20 patients with idiopathic pulmonary fibrosis who desaturated on exercise, endurance shuttle walk test improved by a median[IQR] difference of 31s [–9.5 to 100.0;(p=0.043], following a single dose of 140mls nitrate rich beetroot juice, as did brachial artery flow mediated dilatation; +4.25% (95% CI: –0.71 to 8.45; p=0.036), compared to following placebo nitrate depleted placebo juice. Longer-term studies are needed to see if these acute effects translate into sustained benefit.
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Journal articleKinoshita R, Sathyapala A, Polkey MI, 2026,
Has the time come for workplace screening for obstructive sleep apnoea (OSA)?
, Thorax, Vol: 81, Pages: 638-641 -
Journal articleWilliams PJ, Hopkinson NS, 2026,
The 2026 Tobacco and Vapes Act: on to the tobacco endgame.
, Thorax, Vol: 81, Pages: 635-637 -
Journal articleHopkinson NS, 2026,
A London Lark Rising: the story of the people and places of the East India Company.
, BMJ, Vol: 393 -
Journal articleButtery SC, Barraclough R, Batchelor TJP, et al., 2026,
Establishing the top ten research priorities for lung volume reduction treatment for people with COPD
, Thorax, ISSN: 0040-6376Lung volume reduction procedures are an established evidence-based aspect of chronic obstructive pulmonary disease (COPD) care. We conducted a research prioritisation exercise involving people with COPD and healthcare professionals across a range of disciplines, to identify a clear set of 10 questions to guide the development of research proposals in this area. Priorities were identified using an iterative approach based on the James Lind Alliance methodology. The final set of 10 priorities address the identification, assessment and optimisation of patients with COPD prior to any procedure, how lung volume reduction procedures are conducted and how care after the procedure has taken place should be organised.
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Journal articleBostic C, Huber L, Romeo-Stuppy K, et al., 2026,
Low hanging fruit: climate change and tobacco endgame measures
, Frontiers in Environmental Science, Vol: 14The health risks of tobacco use are well-documented and widely acknowledged by the public. Tobacco consumption is a leading cause of preventable diseases and deaths worldwide. However, the impact of tobacco goes beyond human health, extending to environmental degradation, climate change, and pollution. The environmental footprint of tobacco includes not only the production and distribution of tobacco products but also the waste generated, which continues to harm ecosystems for decades. These environmental costs—spanning deforestation, soil degradation, pollution from cigarette butts, and other forms of waste—are significant and unbalanced by any benefits to society. By addressing the tobacco epidemic, the global community could mitigate a substantial environmental burden and refocus resources on pressing climate change issues.
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Journal articleBloom CI, 2026,
When the reliever becomes the risk.
, Thorax -
Journal articleBaraldi E, Bonadies L, Grutta SL, et al., 2026,
Long term lung health in children: new emerging threats and preventive strategies.
, Paediatr Respir RevThe long-term consequences of early adverse exposures are well known but is becoming clear that early means not just in pregnancy but also in at least the two preceding generations. Furthermore, there are new existential threats to long term respiratory health, some of which have been presented at the INSPiRED meeting in Bologna and are reviewed in this manuscript. One such is premature delivery, with ever smaller babies surviving with new respiratory and systemic complications, but there is also an appreciation that even those who do not develop bronchopulmonary dysplasia may have long term complications. New environmental hazards include vapes and other devices designed to produce a new generation of nicotine addicts; gas flaring which ruthlessly maximises profit at the expense of the environment and those living close by; and climate change, perhaps the greatest threat of all. Compounding these challenges is the effects of displacement by war or natural disasters on increasing numbers of children. On the other hand, encouragingly, two new highly effective strategies for the prevention of respiratory syncytial virus infection are becoming widely available, namely maternal immunisation with a pre-fusion vaccine in the third trimester of pregnancy and a long-acting monoclonal antibody. We await data as to whether these strategies will prevent impairment of lung function and later asthma. However, strong political action is essential if the expanding range of threats to the health of children and young people are to be averted. Awareness of new threats and advocacy are important roles for all paediatricians.
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Journal articleSakamachi Y, Wiley E, Trempus CS, et al., 2026,
Toll-like receptor 5 protects against murine lung fibrosis through reduced dysbiosis, and TLR5 deficiency is associated with human IPF.
, Sci Transl Med, Vol: 18Idiopathic pulmonary fibrosis (IPF) is a devastating pulmonary disease with no curative treatment other than lung transplantation that results from maladaptive responses to lung epithelial injury; however, the underlying mechanisms remain unclear, and treatment options are limited. Here, we showed that deficiency in the innate immune receptor toll-like receptor 5 (TLR5) is associated with IPF in humans and with increased susceptibility to bleomycin-induced pulmonary fibrosis in mice and that activation of lung epithelial TLR5 through a synthetic flagellin analog protected mice from experimental fibrosis. Mechanistically, epithelial TLR5 activation induced antimicrobial gene expression and ameliorated lung dysbiosis after injury. In contrast, TLR5 deficiency in mice and patients with IPF was associated with lung dysbiosis. Elimination of the microbiome in mice through administration of antibiotics abolished the protective effect of TLR5, and reconstitution of the microbiome by fecal microbiota transplantation rescued the observed phenotype. In conclusion, these studies revealed that TLR5 protects against pulmonary fibrosis through effects on the lung microbiota, providing insight into therapeutic approaches that may ultimately benefit patients with IPF.
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Journal articleKonstantinidi R, Yates L, Lloyd C, et al., 2026,
Investigating the impact of PBAE-mediated FOXJ1 mRNA delivery on differentiation of primary human bronchial epithelial cells
, Biology Open, Vol: 15, ISSN: 2046-6390Primary human basal bronchial epithelial cells (HBECs) are an important population of progenitor cells capable of self-renewal and differentiation to maintain airway homeostasis. At air-liquid interface (ALI) culture, HBECs undergo mucociliary differentiation, providing a robust physiologic model to evaluate novel therapeutics such as in vitro transcribed messenger RNA (IVT-mRNA). However, the impact of IVT-mRNA delivery on the differentiation potential of basal HBECs remains poorly characterised. Poly (beta amino) ester (PBAE) nanoparticles have demonstrated effective airway delivery of IVT-mRNA in various pre-clinical studies. Here, we aimed to understand the impact of PBAE-mediated mRNA transfection on basal HBEC differentiation at ALI. We investigated IVT-mRNA encoding the ciliogenesis transcription factor Forkhead box J1 (FOXJ1) as a model tool for transient overexpression in primary basal HBECs and characterised its subsequent impact on epithelial integrity and differentiation at ALI. PBAE-mediated delivery of FOXJ1 mRNA to submerged primary HBECs resulted in approximately 50% FOXJ1-positive cells and transient upregulation of key ciliogenesis-related genes, including DNALI1 and RSPH9. Following 28 days of differentiation at ALI, FOXJ1 or reporter mRNA transfected cultures displayed normal epithelial morphology, with tight junction and differentiation markers, proportions of secretory and ciliated cells, and cilia ultrastructure comparable to non-transfected controls. These data indicate that PBAE-mediated IVT-mRNA delivery can transiently increase encoded protein expression in basal primary HBECs, without impeding mucociliary differentiation.
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Journal articleOgbogu PU, Roufosse F, Akuthota P, et al., 2026,
Benralizumab versus placebo for hypereosinophilic syndrome: a randomized, placebo-controlled phase 3 trial
, Nature Medicine, Vol: 32, Pages: 2017-2025, ISSN: 1078-8956Benralizumab, an eosinophil-depleting anti-IL-5 receptor α antibody, has demonstrated efficacy in severe eosinophilic asthma and eosinophilic granulomatosis with polyangiitis and shown promising results in hypereosinophilic syndrome (HES). NATRON was a randomized, double-blind placebo-controlled phase 3 study evaluating the efficacy and safety of benralizumab in FIP1L1::PDGFRA-negative HES. The primary endpoint was time to first HES flare. In total, 133 patients (median (range) age 51 (14–87) years, 62% female) were randomized (1:1) to receive benralizumab 30 mg every 4 weeks or placebo for 24 weeks, in addition to background therapy. Benralizumab significantly reduced the risk of first flare versus placebo (hazard ratio 0.35, 95% CI 0.18 to 0.69, P = 0.0024). Adverse events occurred in 64.2% and 66.7% of benralizumab- and placebo-treated patients, respectively. Benralizumab’s safety was consistent with its known profile. These results demonstrate the efficacy and safety of add-on benralizumab in the treatment of HES. ClinicalTrials.gov identifier: NCT04191304.
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Journal articleLayhadi JA, Gutierrez LC, Keane ST, et al., 2026,
Fel d 1‐expressing plant‐derived bioparticle: a novel treatment for cat allergy
, Allergy, Vol: 81, Pages: 2156-2171, ISSN: 0105-4538BackgroundAllergen immunotherapy (AIT) is the only disease-modifying therapeutic approach for cat allergy, though it requires at least three years of treatment and can potentially induce severe systemic reactions. Plant-derived bioparticles expressing Fel d 1 allergen (Fel d 1 eBP) have been developed as a novel therapeutic candidate for cat allergy. We aimed to investigate the allergenicity and immunogenicity profile of Fel d 1 eBP.MethodsFel d 1 eBP was synthesised in vivo in Nicotiana benthamiana and confirmed by cryo-electron microscopy and tomography. Immune modulatory properties of purified natural Fel d 1 (nFel d 1) and Fel d 1 eBP were assessed at T and B cells by flow cytometry in 12 cat-allergic subjects (CA) and 12 non-atopic controls (NAC). Single-cell RNA-seq was used to assess molecular mechanisms of Fel d 1 eBP immune skewing. The safety of Fel d 1 eBP was assessed by measuring basophil responsiveness in whole blood and further confirmed in vivo by its administration as a skin prick test (SPT) in 20 cat-allergic individuals.ResultsFel d 1 eBP was shown to be a strong inducer of Th1 cells (p < 0.05) and IL-10+ non-Th2 cells (p < 0.05) in CA subjects. Fel d 1 eBP showed a stronger trend for inducing IL-10+ Breg cells compared to nFel d 1, peaking at 3 μg/mL. scRNA-seq analyses demonstrated that Fel d 1 eBP targets the induction of protective metallothionein genes, CCL18+ monocytes and naïve B cells that are interferon responsive and metabolically activated. Moreover, Fel d 1 eBP demonstrated reduced capacity to elicit basophil activation (p < 0.001) and histamine release (p < 0.01), indicating their hypoallergenic nature. Administration of titrated doses of Fel d 1 eBP through skin prick test revealed that they are well-tolerated with reduced mean wheal compared to native Fel d 1 in an open-label Phase 0 study (all, p < 0.001).ConclusionsWe demonstrate th
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Journal articleTian K, Labeur-Iurman L, Walker SA, et al., 2026,
Inhaled acinetobacter lwoffii exposure promotes lung pd-l1+ neutrophils and dampens viral-induced type 2 immunity
, Mucosal Immunology, Vol: 19, ISSN: 1933-0219Wheeze is a common childhood respiratory symptom triggered by seasonal viral infections. Approximately 30–50% of children are diagnosed with at least one wheezing episode in the first three years of life.1 Wheezing disorders resolve in most children, but approximately 30% of children under 5 years continue to have recurrent wheezing episodes triggered by viral infections and an increased risk of developing asthma in childhood.2,3Accumulating evidence from numerous epidemiological studies has shown the protective effect of the farming environment in reducing the risk of childhood allergies and asthma4,5. Exposure to farmyard microbes has been identified as being important in mediating this protective effect.6,7 Experimental studies have demonstrated intranasal administration of inactivated cowshed-derived bacteria strains, Lactococcus lactis, Acinetobacter lwoffii (A.lwoffii)8 or Staphyloccus sciuri9 can protect from allergen-induced airway inflammation in adult mice. We have shown protection from house dust mite (HDM)-induced airways disease in early life following inhaled, lyophilised A.lwoffii in neonatal mice.10 Epidemiological studies suggest farm environments also protect from wheezing independent of allergen sensitisation11, while children with the risk allele in the 17q21 locus, common to both viral wheeze and asthma, are protected if they are brought up on farms.12 We hypothesised that exposure to inhaled farmyard microbes would protect against viral-induced pulmonary pathology that is associated with wheezing. Using a previously established neonatal murine model of recurrent RSV infection,13 we investigated the effect of inhaled, lyophilised A.lwoffii exposure on viral-induced immune responses and the molecular mechanisms mediating immune protection.
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