Pulmonology

GOLD 2026 centers COPD care on early, multidimensional, eosinophil-guided intervention

GOLD 2026 keeps spirometric COPD diagnosis but moves daily care beyond a spirometry-centric approach. Disease activity becomes an explicit treatment target, and Group E now captures patients with a lower exacerbation-risk threshold. Blood eosinophils are integrated to guide inhaled corticosteroid use and escalation to triple or other anti-inflammatory therapy. Dual bronchodilation is preferred as initial pharmacologic treatment, with biomarker-guided intensification reserved for persistent symptoms or exacerbations. 1

Once-daily fluticasone furoate–vilanterol modestly lowers COPD exacerbation risk vs budesonide–formoterol

This large US claims cohort compared new users of fluticasone furoate–vilanterol, budesonide–formoterol, and fluticasone propionate–salmeterol in routine COPD care. Among 38,070 matched pairs, fluticasone furoate–vilanterol users had a 9% lower risk of first moderate or severe exacerbation than budesonide–formoterol users. Comparisons with fluticasone propionate–salmeterol and pneumonia hospitalizations were performed, but detailed results are not provided in the abstract. Findings challenge full class equivalence of ICS–LABAs and support once-daily fluticasone furoate–vilanterol as a reasonable default option. 2

Inhaled dual PDE3/4 inhibitor TQC3721 adds FEV1 and symptom benefits on top of LABA/LAMA

PACER-II was a phase 2 randomized, double-blind trial of inhaled TQC3721 3 mg or 6 mg twice daily vs placebo for 4 weeks in COPD. Participants had post-bronchodilator FEV1 30–70% predicted and were on background LAMA or LABA/LAMA therapy. Both doses significantly increased peak FEV1 over 4 weeks vs placebo, with larger gains at 6 mg. The 6 mg dose improved 0–12 hour FEV1 area under the curve and reduced St George’s Respiratory Questionnaire scores by about 5 points vs placebo. 3

Post–cardiovascular-surgery sivelestat lowers ARDS incidence and 90-day mortality

This single-center randomized, placebo-controlled trial enrolled 424 adults undergoing major cardiovascular surgery with 90-day follow-up. Continuous IV sivelestat, started at ICU admission and continued up to 7 days, significantly reduced ARDS incidence vs placebo (16.8% vs 31.2%). Ninety-day mortality was also lower with sivelestat (1.1% vs 5.2%) without an increase in monitored adverse events. Sivelestat reduced postoperative neutrophil elastase and interleukin-6 levels, consistent with attenuated inflammatory injury. 4