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.