ICYMI: Highlights From ERS 2025

Major advancements in pulmonary fibrosis treatment and critical warnings regarding both indoor air quality and scientific integrity were the key outcomes of the European Respiratory Society (ERS) Congress 2025 in Amsterdam, Netherlands. Here are the highlights:

5. Respiratory Health Risks Linked to Chemical Cleaners and Biomass Fuel in Homes

Experts at the Congress emphasized the significant dangers posed by indoor air pollution from household cleaning products and biomass combustion. In countries like India, where 41% of the population relies on solid biomass fuels (eg, wood and dung) for cooking, the inefficient burning in traditional stoves causes high concentrations of particulate matter and gases, increasing the risk of chronic obstructive pulmonary disease (COPD) by a factor of 2.65 compared with nonbiomass fuels. Women, who often spend the most time in these poorly ventilated kitchens, are particularly vulnerable.

Separately, the heightened use of disinfectants since the COVID-19 pandemic has increased exposure risks associated with cleaning products, which are linked to asthma, COPD, and other respiratory symptoms, especially among professional cleaners. Experts recommended promoting improved ventilation, providing access to safer cleaning alternatives such as vinegar and bicarbonate, and educating the public about the severe risks of mixing bleach with acid or ammonia-based products.

4. New Insight on Biologic Initiation Patterns for Treating Severe Asthma

New research quantified the extensive benefits of initiating biologic therapy earlier in patients with severe asthma. Modeling suggested that starting biologics just 5 years earlier than the typically observed age of 50 could avert 2000 deaths from exacerbations and oral corticosteroid–related adverse events. Furthermore, starting treatment 20 years earlier was projected to prevent 3100 deaths and yield over £3 billion in savings to the health care system, along with a gain of 73,319 quality-adjusted life-years (QALYs). The data also revealed differences in real-world treatment response by ethnicity in Bradford, UK: while both White and Asian patients saw reductions in exacerbations after starting biologics, White patients experienced a larger decrease (65%) compared with Asian patients (58%). Despite this difference in exacerbation reduction, both White and Asian patients demonstrated a significant reduction in eosinophil counts following biologic treatment.

3. ERS Posters Showcase Nerandomilast Benefits in IPF, ILD

Multiple posters from the FIBRONEER-IPF and FIBRONEER-ILD trials highlighted the potential of nerandomilast, an oral, preferential phosphodiesterase 4B inhibitor with antifibrotic and immunomodulatory properties, for treating idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF). Pooled trial data confirmed that nerandomilast successfully met its primary end point by reducing the decline in forced vital capacity (FVC) at 52 weeks compared with placebo, with benefits sustained across 76 weeks of observation. Importantly, nerandomilast demonstrated a highly favorable safety profile; adverse event–related discontinuation rates were similar to placebo, offering a distinct advantage over currently approved standard therapies like nintedanib and pirfenidone, which are often poorly tolerated due to gastrointestinal issues. The efficacy of nerandomilast in slowing disease progression was especially notable in patients who were not already on background antifibrotic therapy, suggesting its viability as a standalone treatment option.

2. Science Under Attack: Experts Warn of Rising Threats to Research Integrity

Experts at ERS 2025 issued a strong warning regarding rising threats to scientific independence and public trust, stemming from political interference, predatory publishing, and deliberate industry misinformation. The shift toward open-access publishing has inadvertently fostered the growth of predatory journals that prioritize profit over maintaining scientific quality and integrity. Political interference further undermines science, as illustrated by instances where funding for research in areas such as climate change was canceled despite passing rigorous peer review. Industries, particularly the tobacco industry, have historically manipulated scientific findings by creating "astroturf" organizations and funding studies designed to minimize risks, and newer sectors like e-cigarette manufacturers are adopting similar strategies. Speakers stressed that medical societies must take the lead by strengthening ethical codes, resisting inappropriate industry influence, and implementing training programs to protect early-career researchers who are vulnerable to predatory practices due to high publication pressure and limited funding.

1. Nerandomilast a "No-Brainer" for First-Line Pulmonary Fibrosis Therapy: Justin M. Oldham, MD, PhD, MS

Justin M. Oldham, MD, PhD, MS, a FIBRONEER steering committee member, strongly advocated for nerandomilast to become a first-line agent for pulmonary fibrosis, citing its demonstrated efficacy and safety profile. Pooled data from the FIBRONEER trials, covering 76 weeks of exposure, indicated a nominally significant association for improved survival, specifically with the 18-mg dose linked to a 59% reduced risk of death. Nerandomilast was shown to slow forced vital capacity (FVC) decline compared with placebo in treatment-naïve patients and when added to existing antifibrotic drugs. Furthermore, the drug’s tolerability is a major selling point: few patients discontinued the trial due to adverse effects like diarrhea, a much lower rate than typically observed with nintedanib. Oldham also noted that nerandomilast did not cause liver function test (LFT) abnormalities, which eliminates the need for longitudinal LFT monitoring in patients. Due to this combination of efficacy and safety, Oldham concluded that nerandomilast is a "no-brainer" for first-line therapy, provided that payer issues do not create access barriers.