The edition · Pulmonology
Immune pneumonitis: keep the six-week steroid taper
The first randomised trial of steroid duration for mild checkpoint-inhibitor pneumonitis found a three-week taper did not match six weeks. Plus the 2026 GINA changes, a new definition of acute exacerbation across fibrotic lung disease, and what happens when antifibrotic doses are cut.
The edition in brief
Checkpoint-inhibitor pneumonitis: 106 patients with grade 1–2 immune-related pneumonitis were randomised to a 3-week or 6-week corticosteroid taper. Treatment success at 8 weeks was 66.7% against 85.2%, so the shorter course failed non-inferiority, and an exploratory analysis favoured 6 weeks. Grade 3 or higher adverse events were 12% against 24%, and survival was similar. GINA 2026: the strategy report keeps inhaled corticosteroid-containing treatment for all ages, advises against SABA-only treatment, and prefers as-needed or maintenance-and-reliever low-dose ICS-formoterol for adults and adolescents; 2026 changes expand anti-inflammatory reliever options to children, revise severe asthma and biologic selection guidance, and substantially update acute asthma management. Fibrotic ILD: an international working group extended the acute exacerbation definition from IPF to all fibrotic ILD — new respiratory worsening with diffuse alveolar damage on imaging or histology — and separated it from 'acute respiratory worsening' due to causes such as heart failure or infection. Antifibrotics: in two US cohorts of 1,572 patients with IPF, 36–41% reduced or stopped therapy; progression was common whatever the dose, and associations with dose change were inconsistent.
GINA 2026: ICS-formoterol reliever options expand, and acute asthma care is revised
Put every asthma patient on inhaled corticosteroid-containing treatment, favouring ICS-formoterol as reliever in adults and adolescents.
Acute exacerbation now defined across all fibrotic ILD, separate from other acute worsening
In acute worsening of fibrotic ILD, image for diffuse alveolar damage and exclude treatable mimics before labelling it an exacerbation.
Antifibrotic dose cuts were common, and progression frequent whatever the dose
When antifibrotics are poorly tolerated, consider reducing the dose rather than stopping, and keep monitoring lung function.
Watch the inhaler being used before you step up asthma treatment
Check inhaler technique and adherence before every step-up in asthma treatment.
A three-week steroid taper for mild checkpoint-inhibitor pneumonitis failed against six weeks
For mild checkpoint-inhibitor pneumonitis, keep the 6-week steroid taper; a 3-week course led to more treatment failure.
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