The first session of the Clinical Year in Review series began with an exploration of evolving concepts and practice-changing studies in asthma, interventional pulmonary medicine, pulmonary function tests (PFTs), and sleep medicine on Sunday, May 18, at the ATS 2025 International Conference.

Asthma

Lauren Eggert, MD, clinical assistant professor of pulmonary, allergy, and critical care at Stanford University, reviewed recent studies with implications for asthma care.

Dr. Eggert framed the first study, a real-world analysis of over 162,000 adults with asthma.

“Inhaled corticosteroids (ICS) are the backbone of asthma therapy,” she said. “While there are some data on the adverse effects (AEs) of ICS, they have not been as well characterized as the AEs of oral corticosteroids.”

 Moderate daily ICS dose or higher was associated with major adverse cardiovascular events, pneumonia, pulmonary embolism, and arrhythmia, in a time- and dose-dependent manner. Dr. Eggert noted that these data have been integrated into the updated 2025 Global Initiative for Asthma algorithms and highlighted the importance of using the lowest effective ICS dose and limiting higher doses to three to six months, if possible.

“One of the emerging paradigms in asthma therapy is clinical remission,” Dr. Eggert said, introducing the consensus definitions of asthma remission proposed by two expert panels led by Menzies-Gow et al. and Blaiss et al.

“The data suggest that if remission is the goal in asthma, we may want to consider earlier initiation of biologics,” she said.

Dr. Eggert also reviewed the SWIFT studies of twice-yearly depemokimab, the ABRA study of benralizumab, and the real-world XALOC-1 study of benralizumab.

Obesity and type 2 diabetes are common in asthma patients, and patients with these comorbid conditions have poor disease control and a higher risk of asthma attacks. A recent population-based cohort study of over 12,000 patients with asthma with comorbid diabetes found that metformin reduced the risk of asthma attacks by 24 percent, with an additional 40 percent reduction with combined glucagon-like peptide-1 receptor agonist and metformin treatment. The risk reduction was independent of glycemic control, BMI, and inflammatory phenotype, suggesting that this may be a promising therapy for the difficult-to-treat non-type 2 inflammation-high patients.

Interventional Pulmonary Medicine

Laura Frye, MD, associate professor of pulmonary and critical care medicine at the University of Utah, discussed the practice implications of the VERITAS study, comparing the diagnostic yield and accuracy of navigational bronchoscopy (NB) with that of computed tomography (CT)-guided bronchoscopy. While the accuracy findings have not yet been published, there were no significant differences in the diagnostic yield with NB and CT-guided bronchoscopy. Dr. Frye said that it is important to use stringent definitions of diagnostic yield and to report studies following STARD guidelines.

Dr. Frye reviewed the implications of the 9^th edition of the Tumor, Node, Metastasis (TNM) classification of lung cancer for bronchoscopists and how bronchoscopic lung volume reduction impacts post-valve revision bronchoscopy and clinical outcomes.

Discussing a study on how guideline adherence impacts care costs for managing malignant pleural effusions, Dr. Frye said that while guideline-concordant care was associated with fewer subsequent procedures, with lower cost of tunneled indwelling pleural catheter and chest tube, “we should adopt a personalized approach for each patient that reflects their values and clinical status.”

Dr. Frye also discussed the value of therapeutic bronchoscopy for managing central airway obstructions caused by non-bronchogenic cancers.

Pulmonary Function Tests

“PFTs are everywhere in pulmonary medicine, whether to diagnose a lung condition, manage symptoms, or to decide treatments,” said Sanja Stanojevic, PhD, associate professor of community health and epidemiology at Dalhousie University.

Dr. Stanojevic reviewed key changes in the use and interpretation of PFTs, focusing on reliance on z-score thresholds and race-neutral reference equations, which offer advantages over the percentage predicted metric for FEV1 (forced expiratory volume in one second).

While many PFTs for assessing large airways are available, technological and signal processing advances have enabled functional evaluation of small airways using oscillometry, a simple non-invasive method for assessing impedance (resistance to airflow) and lung elasticity (reactance).

Dr. Stanojevic discussed the Austrian LEAD study, which showed that abnormal oscillometry variables, detected in 20 percent of adults, were associated with respiratory symptoms and disease. Spirometry measurements can also be early indicators of lung disease, as shown in a UK Biobank study, demonstrating increased mortality risk in people with isolated small airways obstruction.

Dr. Stanojevic discussed the impact of artificial intelligence in improving standardization, consistency, and interpretation of PFT findings, as well as the role of longitudinal spirometry data in characterizing lifetime phenotypes of airway obstruction and restriction.

Dr. Stanojevic shared this key take-home message: “We need to embrace lung health. Every person knows their blood pressure; hardly anyone in the world knows their lung function. We need to improve access to PFTs. We need to measure lung function early and often.”  

Sleep Medicine

Luciana Oliveira Palombini, MD, PhD, Instituto do Sono, reviewed key advances in sleep medicine.

Tirzepatide represents a new pharmacological treatment for patients with obesity and obstructive sleep apnea (OSA), based on the improvements in apnea-hypopnea index (AHI) and hypoxic burden seen in the SURMOUNT-OSA studies.

“COMISA is a combination of the most common sleep disorders: insomnia and sleep apnea. Patients with COMISA have worse outcomes compared with those with either insomnia or sleep apnea alone, with the worse outcomes related mostly to the cardiovascular effects,” Dr. Palombini said. Short sleep duration was associated with the exacerbated cardiometabolic risk in patients with COMISA.

Continuous positive airway pressure (CPAP) is the mainstay of OSA therapy. Although CPAP had higher efficacy, and mandibular advancement splints (MAS) had higher adherence in the CHOICE study, having both modalities may improve long-term OSA outcomes.

Dr. Palombini also discussed a meta-analysis assessing the safety and efficacy of hypoglossal nerve stimulation devices in OSA and the impact of night-to-night AHI variability on the diagnosis of OSA.

This session and the International Conference are supported by an independent medical educational grant from Chiesi USA, Inc. All CME sessions have been planned and implemented in accordance with the Accreditation Criteria of the Accreditation Council for Continuing Medical Education (ACCME®) and are free of the control of ineligible companies (formerly commercial interests).