A Single-Arm Study of Patient Satisfaction and Clinical Outcomes with an Anti-Inflammatory Reliever Algorithm in Relation to Baseline GINA Step

Presenter:Ross Sayers.

Patient satisfaction with the stepwise anti-inflammatory reliever (AIR) Algorithm has been reported alongside improved asthma control, but whether these benefits are consistent across asthma severity levels is uncertain. This secondary analysis of a 52-week single-arm study included 100 adults with mild, moderate, and severe asthma receiving budesonide/formoterol 200/6 μg according to baseline treatment, with treatment steps adjusted based on reliever use and asthma attacks. Associations between baseline GINA Step and changes in outcomes over time were examined using linear mixed models. For TSQM-II Global Satisfaction, change over time differed by baseline GINA Step (P_interaction=0.025), with the greatest improvement at Step 1: mean week 52 versus baseline change 14.3 (95% CI 6.6 to 22.1), P<0.001. No evidence indicated that changes in asthma control or other clinical outcomes varied by baseline GINA Step. Patient satisfaction therefore improved differently across GINA levels, with the greatest benefit observed in mild asthma at Step 1.

Efficacy of Inhaled Corticosteroid/Long-Acting Beta-agonist on Post Infectious Cough: A Pilot Study

Presenter:Dr. Trent Chang-Wei WU.

Post-infectious cough has reportedly become more prevalent in the post-COVID-19 pandemic era, prompting evaluation of inhaled corticosteroid/long-acting beta-agonist (ICS/LABA) therapy as a potential treatment approach. This prospective cohort study included 25 adults with cough occurring 3–8 weeks after an upper respiratory tract infection; patients with concurrent airway disease or steroid use were excluded. Participants received ICS/LABA (Symbicort or Relvar) for up to 4 weeks, with weekly follow-up. Mean age was 50.8 years, mean cough duration was 4.8 ± 2.5 weeks, 56% were female, and 92% were never-smokers. Mean cough VAS decreased from 10.0 at baseline to 3.7 on day 7 and 1.2 on day 28 (p < 0.001). Cure/significant improvement rates increased from 24%/68% at day 7 to 68%/84% at day 28 (p < 0.001). No pneumonia cases occurred. In this small cohort, ICS/LABA was associated with substantial improvement in cough severity and reported as safe over 28 days; randomized controlled evaluation is warranted.

Efficacy of Nebulized N-Acetylcysteine for Improvement of Symptoms in Adults with Non-Cystic Fibrosis Bronchiectasis Patients: A Randomized Controlled Trial

Presenter:Dr. Supiya Kijlertsuphasri.

Despite standard airway clearance therapy, many patients with non-cystic bronchiectasis continue to have symptoms. Nebulized acetylcysteine (NAC) may enhance mucus clearance. NAC was compared with 0.9% normal saline (NSS) for sputum and symptom outcomes.  In this randomized, crossover-controlled trial, adults (≥18 years) with imaging-confirmed bronchiectasis and productive cough were randomized (1:1) to receive nebulized NAC 300 mg/3 mL BID for 2 weeks, followed by a 1-month washout and nebulized NSS 5 mL BID for 2 weeks, or vice versa. All participants received standardized airway clearance training. Across 44 treatment periods, mean daily sputum volume was significantly greater with NAC than NSS (8.30 vs 4.80 mL/day; mean difference 3.12 mL/day, 95% CI 2.02–4.18; p<0.001). NAC also improved the SGRQ activity domain (mean change −8.29; 95% CI −16.58 to −0.07; p=0.02), exceeding the minimum clinically important difference. No significant differences were observed in LCQ, CAT, or mMRC scores. Overall, nebulized NAC increased sputum expectoration and was associated with a clinically meaningful improvement in the SGRQ activity domain.

Impact of Digital Breath-Guiding on Inhalation Technique and Drug Deposition

Presenter:Lea Botermann.

Effective inhalation therapy depends on appropriate inhalation technique, with digital breath-guiding intended to promote breathing patterns that may support more efficient aerosol delivery. This study assessed 64 participants—25 healthy, 24 with obstructive, and 15 with restrictive lung disease—performing three dry inhalations using a continuous-output mesh nebulizer, a breath-triggered nebulizer with device-based guidance, and the latter combined with the PARI BreathGuide App. Peak inspiratory flow (PIF), inspiratory/expiratory (I/E) ratio, breath duration, tidal volume, and in silico-estimated pulmonary deposition rate were analysed. PIF was lower with the integrated device than with the continuous-output nebulizer (28.5 vs. 35.5 L/min; p<0.05), while breath-guided inhalation improved the I/E ratio (0.94 vs. 0.81; p<0.05). App use increased breath duration (8.2 s vs. 6.0 s) and tidal volume (1.4 L vs. 1.0 L; p<0.05). Simulated deposition rate increased by +3.7% with the integrated device and reached +15.5% with app guidance. Overall, digital breath-guiding was associated with more favourable inhalation parameters and higher simulated pulmonary deposition.

Inhaled Hypertonic Saline in Nontuberculous Mycobacterial Lung Disease: Clinical Outcomes and Translational Evidence

Presenter:MD, PhD Sheng-Wei Pan.

This prospective study evaluated the effects of inhaled 3% hypertonic saline (HS) in antibiotic-naïve patients with nontuberculous mycobacterial lung disease (NTM-LD). Forty-five antibiotic-naïve NTM-LD patients were enrolled during 2024–2025, including those receiving daily inhaled 3% HS and the controls. At 3 months, total VAS symptom scores decreased significantly with HS from 10 [7–17] to 6 [3–7] (p<0.001), whereas the change in controls from 7 [4–11] to 5 [4–10] was not significant (p=0.250). GEE analysis identified significant treatment-by-time interactions, with HS treatment resulting in greater improvement in VAS scores (β −4.40, 95% CI −6.41 to −2.39; p<0.001) and sustained sputum smear negativity (OR 0.18, 95% CI 0.05–0.69; p=0.013). In vitro, HS inhibited extracellular Mycobacterium abscessus growth dose-dependently, also 3% HS pretreatment reduced intracellular burden by 51% (p=0.021) without compromising macrophage viability or phagocytosis and leading to upregulation of TNF-α and IL-6. Overall, Inhaled HS improved symptoms and sputum smear outcomes in NTM-LD, supporting its potential as an adjunctive therapy.

Lung Deposition Distribution of Two Triple Combination pMDI Aerosol Drugs

Presenter:Dr. Árpád Farkas.

Lung deposition of inhaled drugs can vary according to aerosol characteristics and inhalation conditions, with regional distribution providing additional information beyond whole-lung deposition. This study compared two triple-combination pMDI formulations, BDP/GLY/FF and BUD/GLY/FF, using laser-based measurements of plume cone angle, duration, velocity, and particle size distribution, which were incorporated into computational fluid and particle dynamics simulations. Both formulations demonstrated lung deposition across flow rates of 30, 60, 90, and 120 L/min. For BDP/GLY/FF, total lung deposition was 32.1%, 39.8%, 41.2%, and 36.1% of emitted dose, respectively, compared with 31.9%, 43.0%, 44.0%, and 38.9% for BUD/GLY/FF. BDP/GLY/FF showed comparable deposition across the first eight bronchial generations and distal airways, whereas BUD/GLY/FF showed 4 to 6 times greater deposition in the large bronchi than in deeper regions. A slightly upward mouthpiece orientation increased lung deposition, while downward positioning reduced it versus horizontal positioning. Thus, while both formulations demonstrated similar whole-lung deposition, they exhibited distinct regional dose distribution patterns within the airways.

ERS Congress 2026, 5-9 September, Barcelona, Spain