Smoking, biologics, and the long view in lung disease

The edition in brief

A subgroup analysis of a multicentre cessation trial in COPD found that immediate referral to a smoking-cessation clinic more than doubled one-year abstinence against usual care (25.8% vs 10.1%); absence of comorbidity and repeated exacerbation-related hospitalisation also favoured quitting, though the sample was small and a fifth were lost to follow-up. The SHARP registry (3,876 adults with severe asthma across 16 countries) found biologics improved symptom control, exacerbations, quality of life and oral-steroid use to a similar degree in current and ex-smokers as in never-smokers — yet nearly a third of countries report reluctance to prescribe biologics to smokers, a practice the data suggest is unwarranted. A polygenic risk score for idiopathic pulmonary fibrosis, tested across four biobanks, was associated with an IPF diagnosis (odds ratio 2.88) and with death or lung transplant among those diagnosed (hazard ratio 1.23) — a research-stage tool, not yet for clinical use. In the ITALUNG lung-cancer screening trial — where low-dose CT reduced long-term lung-cancer and cardiovascular mortality, especially in women — a blood-and-sputum biomarker panel detected most cancers close to diagnosis and over 80% within three years before it, in a small sample. A clinic pearl: before escalating therapy for uncontrolled asthma or COPD, watch the patient use their inhaler and correct technique and adherence first, since poor technique mimics treatment failure. The thread: the highest-value moves in lung disease — cessation, correct inhaler use, and offering effective therapy regardless of smoking — are often the simplest.