ERS 2022’s 40 late-breakers showcased advances in understanding and management of a wide range of respiratory illnesses. Here are a few with early potential to impact clinical practice:

Research reveals clinical predictors of mucus plugging in asthma

UK researchers have identified “real-life clinical predictors” of mucus plugging (MP) in patients with asthma.

In the study, researchers compared MP scores in 126 patients with moderate to severe disease, alongside type 2 (T2) biomarkers, spirometry, severe exacerbations and asthma control.

Findings showed that those with MP had “significantly worse” FEV1%, FEF25-75% and FEV1/FVC, as well as higher levels of blood eosinophils, FeNO, and total IgE and A. fumigatus IgE titres linked with more frequent severe exacerbations.

The research calculated that A. fumigatus IgE titres had the highest odds ratio for MP (9.37), followed by two or more exacerbations/yr 5.00; blood eosinophils 3.23, total IgE 3.20 and FEV1/FVC 3.01.

Data reveals significant burden of bronchiectasis in AATD patients

Up to 30% of patients with Alpha1 antitrypsin deficiency (AATD) have bronchiectasis, suggests the first report based on the EARCO database.

Of 408 patients with the PiZZ genotype and macroscopic reports of high resolution CT, 77 scans were normal, 190 showed emphysema alone or emphysema with bronchiectasis (113), and 38 were showed bronchiectasis alone, according to the UK research team.

Results also showed that “whereas a male preponderance and smoking history was a feature of the emphysema groups with or without bronchiectasis (>55% males ~70% smoking history), the opposite was true of those with bronchiectasis alone (71% female, 76.3% never smokers),” they noted.

Also, those with bronchiectasis had an FEV1% predicted of 87.7, but those with emphysema and bronchiectasis fared worse with FEV1% of 53.

According to the researchers, the study showed that bronchiectasis was present in 29.9% of AATD patients scanned most of whom had emphysema, though bronchiectasis also was found to be present in 9.2%. However, “how this clinical phenotype affects prognosis and management remains to be determined.”

Nalbuphine linked with 77% reduction in IPF cough

Interim analysis of a proof-of-concept study has shown a dramatic reduction in cough frequency in idiopathic pulmonary fibrosis (IPF) patients taking the mixed opioid agonist/antagonist nalbuphine.

Data from the small trial, which involved 26 patients with IPF and was funded by Trevi Therapeutics, showed a 77.3% reduction in cough frequency in those taking extended release nalbuphine versus a 25.7% reduction for the placebo group.

The findings showed that at baseline IPF patients had a cough frequency of 31 coughs/hour, which dropped by 23.1 for those taking extended-release nalbuphine, and 8.2 for those in the control arm.

“In this interim analysis of Phase 2 data, nalbuphine extended release is the first therapy to show a significant reduction in IPF-related hourly daytime chronic cough frequency,” the researchers said.

Lung impact of neonatal airway colonisation tapers through childhood

Neonatal airway colonisation has been linked with a higher risk of asthma, but its impact diminishes in the latter part of childhood and is no longer evident by adulthood, researchers have found.

The team explored the association between airway colonisation in one-month-old newborns (in the Copenhagen Prospective Studies on Asthma in Childhood cohort), and the development of asthma endpoints up to 18 years old.

Neonatal airway colonisation was present in 21% of 319 children, and that this was linked with an overall increased risk of asthma (adjusted odds ratio, 4.01), as well as an increased number of exacerbations during the first 7 years of life (adjusted incidence rate ratio, 3.20). However, not from age 7 to 18 years.

Similarly, blood eosinophils were also increased in colonised children from age 6 months to 12 years, but not at age 18 years.

Also, “there were no significant associations with lung function, bronchial reactivity, atopic dermatitis or other asthma and allergy-related endpoints”, the researchers noted.

Undernutrition linked with increased risk of death in CAP

Under-nourished patients with community acquired pneumonia (CAP) are three-times more likely to die within 30 days of hospitalisation than their well-nourished peers, indicates new research.

The prospective study, which included 310 patients from the Danish Surviving Pneumonia Cohort, also found that obese patients admitted for CAP were at higher risk of a new hospitalisation within 180 days (Hazard ration 1.5).

“With a 3-fold higher risk of 30-day mortality, undernourished patients admitted with CAP are high risk patients and systematic in-hospital nutritional screening and therapy could be crucial and potentially improve the outcomes,” according to the researchers.

No association was detected between undernutrition or obesity and higher risk of within-hospital or 180-day mortality, or a new hospital admission within 30-days.