5 Pulmonology Headlines You Missed in July

July 2026 brought a diverse set of pulmonology updates spanning clinical guidelines, pipeline data, and emerging science across interstitial lung disease, COPD, and pulmonary vascular disease. One of the month’s most clinically significant development came from a post hoc pooled analysis of the FIBRONEER-IPF and FIBRONEER-ILD trials, which found that nerandomilast (Jascayd; Boehringer Ingelheim) — the oral PDE4B inhibitor approved last year for IPF and progressive pulmonary fibrosis — reduced the risk of death by 33% at the 9 mg twice-daily dose (HR, 0.67; P =.009) and 43% at 18 mg twice daily (HR, 0.57; P <.001) vs placebo in pooled data; the mortality reduction reached nominal significance in FIBRONEER-ILD at both doses (HR, 0.51) but not in FIBRONEER-IPF as a standalone trial. Because the key secondary composite endpoint was not met in either trial at the first database lock, stopping hierarchical testing, all mortality P values are nominal rather than confirmatory — an important caveat that limits the regulatory implications but does not diminish the clinical interest in a drug already on the market.

The month also brought the first North American bronchiectasis guideline, continued pipeline progress in pulmonary arterial hypertension, and a pair of practice-focused updates from the APAPP National Conference. CHEST published its first clinical guideline on management of adult bronchiectasis, offering 13 conditional recommendations covering culture-guided antibiotics for exacerbations, long-term macrolide and brensocatib therapy for frequent exacerbators, airway clearance techniques, tranexamic acid for hemoptysis, and surgical resection for localized refractory disease.

In pulmonary vascular disease, treprostinil palmitil inhalation powder (TPIP; Insmed) demonstrated sustained improvements across all secondary efficacy endpoints at 12 months in an open-label extension of its phase 2b PAH trial, with placebo crossover patients achieving comparable outcomes to those on continuous TPIP — though the single-arm, uncontrolled nature of the OLE warrants caution before phase 3 results are available. MV-130, a sublingual mucosal trained immunity vaccine, reduced moderate and severe COPD exacerbations vs placebo over 18 months in a phase 3 trial (IRR, 0.70 and 0.51, respectively), with a sustained effect after treatment ended; the novel mechanism and complementary positioning alongside existing COPD therapies make it a noteworthy pipeline development. Rounding out the month, a session at APAPP addressed interstitial lung abnormalities as underrecognized precursors to ILD — with 20% to 60% progressing to ILD over 2 to 5 years — and outlined the 2025 ATS ILA guidelines as a practical framework for monitoring and risk stratification in clinical practice.

Check out this July 2026 pulmonology month in review for full coverage of these stories and more:

1. CHEST Guideline 2026: 13 Recommendations for Non-CF Bronchiectasis

CHEST published 13 evidence-based recommendations for the management of adult non-CF bronchiectasis, addressing antibiotic treatment for acute exacerbations, duration and route of antibiotic therapy, long-term suppressive and anti-inflammatory therapies, airway clearance strategies, management of hemoptysis, and consideration of surgical resection — the first North American guideline to cover this disease area comprehensively. All 13 recommendations are conditional, with certainty of evidence ranging from moderate (macrolides, brensocatib) down to very low across most other domains, reflecting a literature base built largely on small trials and observational data. The panel recommended shared decision-making with patients using a multidisciplinary approach and emphasized individualizing airway clearance prescriptions in coordination with a respiratory physiotherapist or therapist.

2. Nerandomilast Reduces Mortality Risk in Pulmonary Fibrosis Analysis

A pooled post hoc analysis of the FIBRONEER-IPF and FIBRONEER-ILD trials found that nerandomilast reduced the risk of death by 33% at 9 mg twice daily and 43% at 18 mg twice daily versus placebo, with sensitivity and tipping-point analyses supporting the robustness of the finding despite its exploratory nature. Deaths occurred in 13.5% of placebo-treated patients compared with 9.2% and 7.7% in patients receiving nerandomilast 9 mg and 18 mg twice daily, respectively; the mortality reduction reached nominal significance in the FIBRONEER-ILD subpopulation at both doses but not in FIBRONEER-IPF as a standalone trial. Because hierarchical testing stopped after the key secondary composite endpoint missed significance, all P values reported are nominal and the findings remain exploratory — nerandomilast is FDA-approved for IPF and progressive pulmonary fibrosis based on FVC decline data.

3. MV-130 Mucosal Vaccine Reduces COPD Exacerbations in Phase 3 Trial

Daily sublingual MV-130 for 12 months reduced total exacerbations over 18 months vs placebo (median 2.0 vs 3.0; 216 vs 363 events), with moderate and severe exacerbations declining (IRR, 0.70 and 0.51, respectively) while mild events were unaffected, supporting a clinically meaningful shift in exacerbation severity distribution. Post-treatment follow-up showed delayed time to first exacerbation in the MV-130 arm (HR, 2.15), suggesting a durable or time-dependent trained immunity effect that persists after the 12-month dosing period ends. Healthcare utilization also decreased, including antibiotic use, systemic corticosteroid prescriptions, hospitalizations, and emergency visits — positioning MV-130 as a potentially complementary preventive strategy in the frequent-exacerbator phenotype.

4. Daily Inhaled TPIP Improved PAH Measures at 12 Months in OLE

Treprostinil palmitil inhalation powder (TPIP; Insmed), an investigational once-daily dry powder prostanoid prodrug, demonstrated sustained improvements across all secondary efficacy endpoints at 12 months in an ongoing open-label extension study in patients with pulmonary arterial hypertension; patients who had received placebo in the lead-in phase 2b trial and crossed over to TPIP in the OLE achieved outcomes comparable to those who had received TPIP continuously. The 12-month OLE data build on phase 2b results showing a 35% placebo-adjusted reduction in pulmonary vascular resistance at week 16 and a 35.5-meter improvement in 6-minute walk distance. Clinicians should note that the OLE is a single-arm, open-label study without concurrent placebo control and secondary endpoints are not adjusted for multiplicity; the phase 3 PALM-PAH randomized trial remains the confirmatory program.

5. Interstitial Lung Abnormalities: Recognition, Risk Stratification, and When to Act

Jessica Glennie, MSN, APRN, of the Cleveland Clinic ILD Center addressed interstitial lung abnormalities at APAPP 2026, noting that between 20% and 60% progress to interstitial lung disease over 2 to 5 years and describing the 2025 ATS ILA guidelines as a meaningful improvement over prior Fleischner Society guidance — providing more granular direction on monitoring intervals, biomarker testing, and which subgroups warrant closer surveillance. Glennie emphasized risk factor management as a unifying priority regardless of ILA subtype — smoking cessation, vaccination to reduce the risk of infections that can accelerate progression, and optimization of underlying rheumatologic disease. She noted that monitoring frequency via CT and pulmonary function testing should be guided by whether fibrotic features are present, and that counseling patients who feel well requires calibrating an honest message about the range of outcomes.

References

1. Johnson V. CHEST Guideline 2026: 13 Recommendations for Non-CF Bronchiectasis. HCPLive. August 4, 2026. https://www.hcplive.com/view/chest-guideline-2026-13-recommendations-bronchiectasis

2. Johnson V. Nerandomilast Reduces Mortality Risk in Pulmonary Fibrosis Analysis. HCPLive. July 31, 2026. https://www.hcplive.com/view/nerandomilast-reduces-mortality-risk-pulmonary-fibrosis-analysis

3. Johnson V. MV130 Mucosal Vaccine Reduces COPD Exacerbations in Phase 3 Trial. HCPLive. July 30, 2026. https://www.hcplive.com/view/mv130-mucosal-vaccine-reduces-copd-exacerbations-phase-3-trial

4. Johnson V. Daily Inhaled TPIP Improved PAH Measures at 12 Months in OLE. HCPLive. July 16, 2026. https://www.hcplive.com/view/daily-inhaled-tpip-improved-pah-measures-12-months-ole

5. Johnson V. Interstitial Lung Abnormalities: Recognition, Risk Stratification, and When to Act. HCPLive. June 27, 2026. https://www.hcplive.com/view/interstitial-lung-abnormalities-recognition-risk-stratification-when-to-act