This Week in Pulmonary — Sep 1, 2026

Welcome to This Week in Pulmonary. This week we're covering 10 notable papers spanning pulmonary vascular disease and right heart assessment, interstitial lung disease and lung cancer toxicity, and obstructive airways disease and respiratory infection prevention. Let's dive in.

We start with the pulmonary circulation, where the New England Journal of Medicine published a multicentre randomised trial from China testing pulmonary-artery denervation in patients with pulmonary hypertension due to left heart disease and heart failure — a group for whom we have essentially no targeted therapy [1]. Two hundred and sixty-four patients were randomised to catheter-based denervation on top of guideline-directed medical therapy, or to medical therapy alone, and followed for a median of just under a year. The estimated two-year rate of clinical worsening — a composite of death, transplantation, heart failure hospitalisation, outpatient worsening, or a fall in six-minute walk distance — was about a quarter in the denervation arm compared with roughly half in the medical therapy arm, which works out to about a halving of the hazard. Procedural safety looked reassuring, with three access-site haematomas across both groups and no other procedural complications. The caveats matter: this was an unblinded trial in a single country, the follow-up was short relative to the two-year event projections, and part of the composite is a walk-distance decline that is vulnerable to open-label effects. Still, for a phenotype where pulmonary vasodilators have repeatedly disappointed, this is the first randomised signal of benefit and it deserves confirmation in a sham-controlled, multinational setting before it changes referral patterns. Staying with the pulmonary vasculature, Chest published a multicentre Italian validation of the Venous Excess Ultrasound score, or VExUS, against invasively measured right atrial pressure in 187 patients referred for pulmonary hypertension, with the ultrasound and the right heart catheter performed within an hour of each other [3]. Mean right atrial pressure rose in a stepwise fashion across the four VExUS grades, from about 4 millimetres of mercury at grade zero to nearly 16 at grade three, and discrimination for a right atrial pressure above 12 was excellent — better than isolated echocardiographic markers and comparable to full echocardiographic estimation of right atrial pressure. The practical read is that VExUS is a legitimate bedside congestion tool in pulmonary hypertension, consistent across pre-capillary and post-capillary phenotypes, though it did not outperform a careful conventional echo assessment.

Turning to interstitial lung disease, two papers address problems we manage badly — cough and prognostication. In Chest, a single-centre randomised, double-blind, placebo-controlled trial from Tongji Hospital tested gabapentin for chronic cough in idiopathic pulmonary fibrosis, enrolling 68 patients with cough lasting more than eight weeks and titrating to a maximum of 900 milligrams a day over twelve weeks [2]. Cough relief, defined as at least a halving of the cough symptom score, was achieved by close to three quarters of patients on gabapentin versus about a quarter on placebo — an absolute difference of roughly 47 percentage points. Adverse events, mostly drowsiness, fatigue and dizziness, occurred in about a third of gabapentin patients compared with fewer than one in ten on placebo. This is a small, single-centre trial with a subjective primary endpoint, so it is not definitive, but given how few options exist for IPF cough, a cautious gabapentin trial with clear counselling about sedation is a defensible step. Meanwhile in Respiratory Medicine, a prospective cohort of 323 patients with fibrotic interstitial lung disease compared static baseline measures against serial functional testing [6]. Both baseline sit-to-stand performance and baseline six-minute walk distance predicted mortality, but in time-dependent analysis only longitudinal decline in walk distance added independent prognostic information; serial sit-to-stand changes did not. Patients starting below roughly 490 metres who then declined further had the highest mortality, while those with preserved baseline capacity and a stable trajectory did very well over the long term. The message is that a single walk test is a snapshot, and repeating it is where the prognostic value lives.

Still within the thoracic space, the Journal of Thoracic Oncology published a systematic review and meta-analysis of pulmonary toxicity from antibody-drug conjugates in small cell and non-small cell lung cancer, pooling 24 studies and nearly 2,900 treated patients [5]. Pulmonary adverse events of any grade occurred in roughly 31 percent of patients, with severe events in about 7 percent, pneumonitis or interstitial lung disease in about 8 percent overall, treatment discontinuation for lung toxicity in about 6 percent, and death attributed to pulmonary toxicity in about 2 percent. Interestingly, any-grade pulmonary events were much more common in small cell than non-small cell disease — roughly 52 percent versus 23 percent — while pneumonitis specifically was more frequent in non-small cell disease, around 12 percent versus under 3 percent. As these agents move into earlier lines, pulmonologists will increasingly be the ones asked to adjudicate a new infiltrate, and a baseline symptom and imaging assessment before ADC initiation is now a reasonable expectation.

Moving to obstructive airways disease, three papers this week. In the International Journal of Chronic Obstructive Pulmonary Disease, a retrospective single-hospital Chinese cohort compared inhaled corticosteroid–containing triple therapy against dual bronchodilator therapy for major adverse cardiovascular events in COPD [7]. Over a mean follow-up of about twenty months, triple therapy was associated with roughly a halving of cardiovascular events, with the association strongest in those with high Framingham risk or established cardiovascular disease. This is observational, from a single hospital, and highly vulnerable to confounding by indication — the authors themselves call for prospective verification — so treat it as hypothesis-generating rather than a reason to add an inhaled steroid for cardiac protection. From the same journal comes a more immediately actionable piece: a multicentre cross-sectional study across 70 Spanish centres measuring peak inspiratory flow in 273 stable COPD patients who were already being treated with metered-dose inhalers plus spacers [10]. Almost all of these patients — 96 percent — generated at least 30 litres per minute at medium-high resistance, and about 62 percent exceeded 60 litres per minute; even with deliberately incomplete exhalation, over nine in ten still cleared the 30 litre threshold. Spacer prescription was rarely based on any objective flow measurement, and most patients reported practical frustrations with spacers and preferred simpler devices. In other words, many patients on a spacer are on one by assumption rather than by measurement, and a quick In-Check Dial reading in clinic could simplify a lot of regimens. On the asthma side, Respiratory Medicine reports a negative trial: twelve weeks of the mitochondrial-targeted antioxidant MitoQuinone at 40 milligrams daily in 38 adults with obesity and poorly controlled asthma produced no improvement in methacholine airway reactivity, no change in asthma control or quality of life scores, and no change in lung function compared with placebo [9]. It was well tolerated, but the authors conclude that targeting oxidative stress this way is unlikely to work in obese asthma. Alongside that sits a narrative review in the same journal on interleukin-5 biology and eosinophil regulation, which argues that heterogeneous responses to anti-IL-5 biologics reflect a mix of residual eosinophilic inflammation, IL-5-independent pathways including epithelial alarmins and IL-4/IL-13 signalling, and comorbidity-driven symptoms — and that response should be judged by clinical outcomes, steroid exposure, lung function and sinonasal disease, not by the blood eosinophil count alone [8].

If you only have time for one paper this week, make it the pulmonary-artery denervation trial in the New England Journal of Medicine [1]. Pulmonary hypertension from left heart disease is the commonest form we see and the one with no approved targeted therapy, so the first randomised evidence of a device-based benefit is the finding most likely to reshape the field — pending independent, sham-controlled confirmation.

Here are the key takeaways from this week in Pulmonary. First, pulmonary-artery denervation roughly halved clinical worsening in left heart disease–associated pulmonary hypertension in an unblinded Chinese trial — promising, but not yet practice for most of us. Second, the VExUS score tracks invasive right atrial pressure closely in pulmonary hypertension and is a credible bedside congestion assessment, though not superior to careful echocardiography. Third, gabapentin at up to 900 milligrams daily meaningfully reduced cough in idiopathic pulmonary fibrosis in a small trial, at the cost of sedation in about a third of patients. Fourth, serial six-minute walk testing adds prognostic information beyond baseline in fibrotic interstitial lung disease, so repeat the test rather than relying on a single value. Fifth, pulmonary toxicity affects roughly one in three lung cancer patients receiving antibody-drug conjugates, and pneumonitis is the actionable one. And finally, most COPD patients on a spacer can in fact generate enough inspiratory flow for a dry powder inhaler — measure it rather than assume; and mitochondrial antioxidant therapy for obese asthma is a dead end.

That's your roundup for This Week in Pulmonary. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.