This Week in Pulmonary — Jun 8, 2026

Welcome to This Week in Pulmonary. This week we're covering 9 notable papers spanning diagnostics and staging in lung disease, advances in therapeutics for critical care and cardiorenal syndromes, and a look at health systems and future research priorities. Let's dive in.

First up, we have several papers refining how we diagnose, classify, and stage chronic lung diseases, from rare genetic disorders to common cancers. Starting with primary ciliary dyskinesia, or PCD, a new study in Chest provides valuable guidance on diagnosing this condition in adults [6]. In a retrospective analysis of 156 adults referred for possible PCD, investigators assessed the accuracy of the four key clinical criteria, which include year-round wet cough and nasal congestion from early childhood, neonatal respiratory distress at term, and organ laterality defects. They found that having two or more of these four criteria had a high sensitivity of 95% and specificity of 88% for a definite PCD diagnosis. The key clinical pearl here is that adding infertility or subfertility as a fifth criterion improved diagnostic accuracy even further. The presence of at least two of these five features increased sensitivity to a full 100%, with only a slight drop in specificity to 84%. The study also confirmed that a low nasal nitric oxide level below 77 nanoliters per minute is a highly accurate screening tool, with 88% sensitivity and 98% specificity. The takeaway for clinicians is to actively assess for these five features in adults with a suggestive history and to use nasal nitric oxide for screening when it's available. Complementing this diagnostic work, another paper in Chest uses magnetic resonance imaging to track the longitudinal progression of PCD from infancy through adulthood [7]. In a study of 75 patients, researchers found that lung abnormalities are not a late-stage phenomenon; in fact, bronchiectasis and mucus plugging were highly prevalent even in infants. MRI scores remained relatively stable through childhood and adolescence but showed a significant elevation in adulthood, indicating disease progression. These MRI scores correlated well with declines in FEV1 and with the Bronchiectasis Severity Index. This work underscores the early onset of lung disease in PCD, reinforcing the need for early diagnosis and intervention, and supports the use of MRI as a non-radiation endpoint for monitoring disease and for future clinical trials. Shifting to pulmonary oncology, the International Association for the Study of Lung Cancer has published a position paper in the Journal of Thoracic Oncology proposing updates to the classification of pulmonary neuroendocrine neoplasms [1]. This new framework continues the shift from traditional carcinoid terminology toward the broader adoption of the 'NET' nomenclature used for other organ systems, though it wisely retains the term 'carcinoid' as a primary diagnosis to ensure clear communication with thoracic clinicians. The two major proposed changes are the incorporation of Ki-67 as a diagnostic criterion, which aligns pulmonary NETs with classifications in other systems, and the formal recognition of 'carcinoid/NET G3,' a rare subset of tumors with higher proliferative activity. This refined classification aims to improve prognostic stratification and guide treatment strategies. Building on this theme of more precise classification, a second paper in the Journal of Thoracic Oncology explores whether common molecular alterations could refine the next edition of the TNM staging system for resected lung adenocarcinoma [3]. In a large analysis of over 5,800 patients, the authors found that specific gene mutations carried prognostic weight within TNM stages. For instance, in stage I disease, TP53 and KRAS mutations were associated with significantly worse overall survival, while EGFR mutations were linked to better survival. The effect was so pronounced that patients with TP53- or KRAS-mutated stage IA tumors had survival outcomes comparable to patients with stage IB disease, supporting a potential 'upstaging'. Conversely, patients with stage III-IV tumors harboring ALK fusions had survival similar to stage II patients, suggesting a 'downstaging' potential. These findings provide a strong rationale for integrating molecular data into future staging systems to better predict outcomes and personalize therapy.

Next, we turn to therapeutics, with a detailed look at a common intervention in ARDS and two major papers on a medication with broad implications for patients with cardiorenal disease. In Respiratory Research, a prospective physiological study examined the effects of inhaled nitric oxide in 40 intubated patients with moderate-to-severe ARDS [2]. Using electrical impedance tomography, or EIT, to directly visualize lung function, the researchers found that 24 hours of inhaled nitric oxide significantly improved ventilation-perfusion matching compared to standard care. This was driven by a marked reduction in both EIT-measured dead space and shunt. The physiological benefit was clear in the gas exchange numbers: the median PaO2 to FiO2 ratio in the iNO group more than doubled, increasing from 114 to 240. Treatment also led to a greater reduction in pulmonary artery pressure. This study provides a direct mechanistic rationale for the oxygenation benefits of inhaled nitric oxide and suggests that EIT could be a valuable tool for guiding a more personalized therapeutic approach in the ICU. Next, two papers report significant findings on finerenone, a non-steroidal mineralocorticoid receptor antagonist. First, in The Lancet, the INFINITY study presents a pooled analysis of individual participant data from three large randomized trials, totaling over 14,000 patients with chronic kidney disease [8]. The results were robust: finerenone reduced the risk of a composite kidney outcome, including kidney failure or a sustained 57% or more decline in eGFR, by 24% compared to placebo. It also reduced the risk of a composite cardiovascular outcome of heart failure hospitalization or cardiovascular death by 20%. Furthermore, finerenone was associated with a reduction in all-cause mortality. Crucially, these benefits were consistent across a wide spectrum of patients, irrespective of their glycemic status, the underlying cause of their kidney disease, or their baseline kidney function. As expected, hyperkalemia was more frequent with finerenone, but the absolute incidence leading to hospitalization was low. These findings strongly support finerenone as a foundational therapy for CKD. The second paper, published in JAMA, provides more granular data on a specific, important subgroup: patients with CKD due to glomerular diseases [9]. This was a prespecified exploratory analysis of over 900 participants from the FIND-CKD trial with conditions like IgA nephropathy and focal segmental glomerulosclerosis. In this non-diabetic population, finerenone significantly slowed the rate of eGFR decline, reduced albuminuria by 42% at 12 months, and lowered the risk of the composite outcome of kidney failure or a substantial loss of kidney function by 26 percent. This analysis extends the evidence base for finerenone, suggesting an important role for preserving kidney function in this often difficult-to-treat population.

Finally, we'll look at two papers that zoom out to consider the broader context of pulmonary practice—our environmental impact and our research priorities. A multicenter observational study from Germany, published in Chest, quantified the waste generated by bronchoscopy and EBUS procedures [4]. The findings are striking: on average, each patient procedure generated nearly 1.5 kilograms of waste. Extrapolated nationally for Germany, this amounts to over 550 tons of waste per year. The study identified key strategies for reduction. For example, simply using reusable gowns for personal protective equipment could cut waste by over 60%. Interestingly, the authors calculated that using single-use endoscopes would have actually increased the waste burden, even after accounting for the elimination of reprocessing waste. This is a clear call to action for endoscopy units to audit their practices, prioritize reusable equipment where safe, and improve recycling efforts to reduce our specialty's environmental footprint. And in Thorax, a new paper outlines the top 10 research priorities for lung volume reduction treatment for people with COPD [5]. Using the James Lind Alliance methodology, which brings together patients, caregivers, and healthcare professionals, the exercise identified a consensus-based research agenda. The final priorities span the entire patient journey, addressing key uncertainties in how to identify, assess, and optimize patients before a procedure, how the procedures themselves are best conducted, and how post-procedure care should be organized. This work provides a valuable roadmap for researchers and funding agencies, ensuring that future studies in lung volume reduction will focus on the questions that matter most to the people who live with and treat severe COPD.

If you only have time for one paper this week, make it the INFINITY pooled analysis of finerenone in The Lancet [8]. By demonstrating consistent kidney, cardiovascular, and mortality benefits across a broad spectrum of chronic kidney disease, this paper firmly establishes finerenone as a foundational therapy alongside SGLT2 inhibitors and RAAS blockade.

Here are the key takeaways from this week in Pulmonary. First, in adults with suspected Primary Ciliary Dyskinesia, add infertility or subfertility to the four classic criteria; having at least two of these five features has 100% sensitivity for diagnosis. Nasal nitric oxide measurement remains an excellent screening tool with high specificity [6]. Second, for lung cancer staging, emerging evidence from the Journal of Thoracic Oncology suggests that molecular markers like TP53, KRAS, and ALK have prognostic value independent of TNM stage, and may be used to upstage or downstage patients in the future [3]. Third, in a large pooled analysis from The Lancet, the non-steroidal MRA finerenone reduced kidney failure, cardiovascular events, and all-cause mortality across a wide range of patients with chronic kidney disease, solidifying its role as a key therapy for cardiorenal protection [8, 9]. Fourth, for patients with moderate-to-severe ARDS, inhaled nitric oxide improves oxygenation by directly enhancing V/Q matching, reducing both shunt and dead space, as visualized by electrical impedance tomography [2]. And finally, our endoscopy suites generate significant waste, nearly 1.5 kilograms per procedure. A study in Chest shows that prioritizing reusable personal protective equipment over disposables can dramatically reduce our environmental impact [4].

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.

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