30-Second Takeaway
- Nerandomilast slows IPF FVC decline with acceptable safety but no clear composite clinical event benefit.
- Umeclidinium–vilanterol modestly reduces COPD exacerbations versus other LAMA–LABAs in real‑world data.
- Auto‑adjusted NIV is non‑inferior to lab‑titrated NIV for OHS PaCO2 control and lowers cost.
Week ending February 28, 2026
What’s new for pulmonary practice: IPF disease modification, COPD inhaler choices, ventilatory support, and risk tools
Nerandomilast in IPF: sustained FVC benefit, neutral composite outcomes, possible mortality signal
In the phase 3 FIBRONEER‑IPF trial, 1,177 IPF patients received nerandomilast 9 mg, 18 mg, or placebo for a mean of about 15 months. Both nerandomilast doses met the 52‑week primary endpoint of reducing FVC decline compared with placebo, indicating disease‑modifying potential. Across full follow‑up, nerandomilast did not improve the composite of first acute exacerbation, respiratory hospitalization, or death versus placebo. The 18‑mg dose showed a numerically lower all‑cause mortality (HR 0.66; 95% CI 0.41–1.08), but confidence intervals crossed 1. Adverse‑event–related discontinuation rates were similar to placebo, supporting a generally favorable safety profile at both doses.
Once‑daily umeclidinium–vilanterol outperforms key LAMA–LABA comparators for COPD exacerbation prevention
This observational active‑comparator study used claims data to compare umeclidinium–vilanterol, glycopyrrolate–formoterol, and tiotropium–olodaterol in adults with COPD starting LAMA–LABA therapy. Propensity‑matched cohorts included 9,479 umeclidinium–vilanterol vs glycopyrrolate–formoterol pairs, 9,598 tiotropium–olodaterol vs glycopyrrolate–formoterol pairs, and 36,740 umeclidinium–vilanterol vs tiotropium–olodaterol pairs. Umeclidinium–vilanterol was associated with a 14% lower hazard of first moderate or severe exacerbation than glycopyrrolate–formoterol (HR 0.86; 95% CI 0.81–0.91; NNT 17). It also conferred a 3% lower exacerbation hazard versus tiotropium–olodaterol (HR 0.97; 95% CI 0.94–0.99; NNT 100). Major adverse cardiovascular events, urinary tract infection, and pneumonia hospitalization were assessed to inform comparative safety across molecules and devices.
EIT‑guided personalized PEEP does not improve overall ARDS survival, with benefit limited to highly recruitable lungs
The EITVent RCT randomized 190 moderate–severe ARDS patients in five Chinese ICUs to EIT‑guided PEEP versus lower PEEP/FiO2 table. Mean PEEP levels over the first seven days were similar between groups, and the trial stopped early for futility. Twenty‑eight‑day mortality was comparable: 55.9% with EIT‑guided PEEP vs 52.6% with standard strategy (HR 0.96; 95% CI 0.65–1.41). Ventilator‑free days and other secondary clinical and safety endpoints did not differ between arms. In patients with higher lung recruitability, EIT‑guided PEEP used higher PEEP and reduced mortality (35.6% vs 60.0%; HR 0.49; 95% CI 0.26–0.91).
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.