Australian research was strongly represented at this year’s American Thoracic Society International Conference, with studies spanning asthma, COPD, lung cancer and interstitial lung disease.

Presentations highlighted recurring challenges across respiratory medicine, including delayed diagnosis of chronic airways disease, persistent reliever overuse and growing efforts to better identify patients at risk of progression or poor outcomes.

Acute respiratory visits may represent missed windows for earlier COPD diagnosis

Dr Sanjay Ramakrishnan

Many Australians experienced repeated respiratory presentations and prolonged delays before receiving a diagnosis of asthma or COPD in primary care, according to new Australian data presented at ATS.

Researchers led by Dr Sanjay Ramakrishnan, from the University of Western Australia analysed de-identified electronic medical record data from 129 Australian general practices, capturing more than 242,000 respiratory visits among 61,812 patients with obstructive lung disease between 1995 and 2025.

Median time from first respiratory visit to diagnosis was:

• 93 days for asthma
• 695 days for COPD
• 977 days for asthma-COPD overlap syndrome

Overall, 42.2% of patients were diagnosed at least one year after their first respiratory presentation.

Among all patients, 40.2% were diagnosed within 90 days of an exacerbation, suggesting acute respiratory events may commonly serve as a trigger for recognition of underlying chronic airways disease.

The investigators also reported delays in preventer initiation, with patients receiving a median of two respiratory visits and waiting a median of 199 days before starting preventer therapy.

SABA overuse remained common in Australian airways disease

Professor Helen Reddel

Short-acting beta-agonist overuse remained common among Australians with asthma and/or COPD and was associated with higher urgent health care use, according to a study led by Professor Helen Reddel, respiratory physician and research leader at the Woolcock Institute of Medical Research.

The nationally representative survey included 10,700 Australian adults, of whom 1,722 reported current asthma and/or COPD.

Nearly half required urgent health care for breathing problems in the previous 12 months.

Among those using SABA inhalers:

• 67.8% obtained three or more inhalers over 12 months
• 22.3% obtained seven or more inhalers

Patients obtaining seven or more SABA inhalers annually were about three times more likely to require urgent health care than those obtaining one or two inhalers.

Younger age, female sex and concession card status were also associated with increased urgent health care utilisation.

MART regimens showed similar asthma outcomes

Professor Christine Jenkins

A large real-world analysis involving Australian investigators found beclometasone/formoterol maintenance and reliever therapy was non-inferior to budesonide/formoterol MART for asthma exacerbations and disease control.

The study included investigators from several Australian respiratory centres and was co-authored by Professor Christine Jenkins, respiratory physician and head of the respiratory group at The George Institute for Global Health.

The historical cohort study included 63,966 adults with asthma initiating either BDP/FF-MART or BUD/FF-MART.

BDP/FF-MART was non-inferior for:

• Severe exacerbations: IRR 0.98 (95% CI 0.93-1.04)
• Asthma control: OR 0.92 (95% CI 0.88-0.96)

Both regimens were associated with improved asthma control and reduced exacerbations, including among patients who continued using SABA early after MART initiation.

Investigators also reported reductions in inhaler-related greenhouse gas emissions and lower SABA use following BDP/FF-MART initiation.

Pre-screening lung cancer pathways revealed low screening eligibility

A Sydney study examining lung cancer diagnostic pathways before implementation of the National Lung Cancer Screening Program found relatively few patients undergoing diagnostic procedures would have met screening eligibility criteria.

The study was led by Tarunpreet Saluja, BMed, BMedSci (Hons), from Royal Prince Alfred Hospital.

Researchers reviewed 221 interventional pulmonology and interventional radiology procedures performed in 206 patients with suspected lung malignancy between July 2023 and June 2024.

Only 15% of patients met Australian screening criteria, while 29.1% met US Preventive Services Task Force criteria.

Interventional pulmonology and interventional radiology demonstrated similar:

• Diagnostic yield
• Molecular adequacy
• PD-L1 adequacy
• Need for second diagnostic procedures

However, complication rates were substantially lower with interventional pulmonology than interventional radiology – 6.2% versus 29.7%.

The investigators also identified differences in referral patterns according to sex, age and primary language.

COPD treatable traits clustered in higher-risk patients

Australian primary care researchers also reported that pulmonary and extra-pulmonary treatable traits clustered among patients with COPD who had higher symptom burden or frequent exacerbations.

The study was led by Dr Sanduni Madawala (PhD) from the Centre for Medicine Use and Safety at Monash University’s Institute of Pharmaceutical Sciences.

The study included 404 adults with spirometry-confirmed COPD recruited from 50 Australian primary care clinics.

Compared with patients with lower symptom burden, those with COPD Assessment Test scores of 20 or higher had substantially higher rates of:

• Breathlessness
• Cough and sputum production
• Anxiety and depression
• Dysfunctional breathing
• Physical activity limitation

Frequent exacerbators demonstrated a similar pattern, particularly for breathlessness, anxiety, dysfunctional breathing and reduced activity levels.

Severe airflow limitation was primarily associated with increased breathlessness.

Australasian ILD registry data sharpened prognostic signals

Two analyses from the Australasian Interstitial Lung Disease Registry highlighted the growing role of longitudinal real-world data in understanding fibrotic lung disease progression.

One registry analysis, led by Dr Ashley Fraser from Royal Prince Alfred Hospital, included 5,114 participants enrolled across 23 Australian and New Zealand sites, with idiopathic pulmonary fibrosis representing the largest subgroup.

Over a median follow-up of just over three years:

• 25.4% of patients died
• 2.6% underwent lung transplantation

Idiopathic pulmonary fibrosis was associated with significantly worse transplant-free survival relative to the broader cohort, while hypersensitivity pneumonitis and unclassifiable ILD were also linked to poorer outcomes.

A second registry analysis, led by Dr Andrew Li from Tan Tock Seng Hospital and involving Australasian ILD Registry investigators, examined 4,503 patients with fibrotic ILD.

Researchers found that early forced vital capacity decline at six months was associated with both reduced transplant-free survival and subsequent physiological progression.

Among patients with idiopathic pulmonary fibrosis, a 5% relative FVC decline at six months was associated with an average 22.6% fall in percent predicted FVC over three years.

The association was also observed in non-IPF fibrotic ILD.