CHEST 2026: Day 1 Recap — 5 Headlines to Know

Day 1 of the American College of Chest Physicians (CHEST) 2026 Annual Meeting in Phoenix, Arizona, brought a broad mix of pulmonology news spanning asthma, COPD, bronchiectasis, pulmonary rehabilitation, and interstitial lung disease.

Highlights included a large propensity-matched analysis linking empiric proton pump inhibitor use to worse outcomes in biologic-treated asthma, pooled phase 3 corticosteroid-sparing data for mepolizumab in eosinophilic COPD, and a post hoc ASPEN analysis tying patient-reported sputum color to neutrophil-driven disease activity in bronchiectasis. An expert case for individualized pulmonary rehabilitation and an early biomarker study in fibrotic ILD rounded out the day.

Check out our rundown of the top 5 headlines from day 1.

CHEST 2026 Day 1 Highlights in Asthma, COPD, Bronchiectasis, and ILD

1. Chronic Proton Pump Inhibitor Use Linked to More Asthma Exacerbations
A retrospective propensity score–matched cohort study of 1228 pairs of adults with biologic-treated, difficult-to-treat asthma found empiric chronic proton pump inhibitor (PPI) use, without an ulcer-related indication, was associated with more asthma exacerbations (31.9% vs 22.6%; OR, 1.60). PPI users also had greater odds of rescue systemic corticosteroid use (OR, 3.88), respiratory infections (OR, 3.83), and intensive care unit admissions (OR, 3.65), prompting investigators to call for structured deprescribing in this population.

2. Mepolizumab Reduces Systemic Corticosteroid Exposure in Eosinophilic COPD
A pooled analysis of the phase 3 METREX, METREO, and MATINEE trials found mepolizumab reduced mean total yearly systemic corticosteroid exposure vs placebo in patients with COPD and type 2 inflammation receiving inhaled triple therapy, by 178.97 mg/year at a blood eosinophil count of ≥ 150 cells/µL and 193.58 mg/year at ≥300 cells/µL. The difference was driven by fewer high-dose courses, with low-dose days similar between arms.

3. ASPEN: Sputum Color Associated With Bronchiectasis Disease Activity
A post hoc analysis of the phase 3 ASPEN trial linked more purulent patient-reported sputum to greater neutrophil elastase activity, along with greater Pseudomonas aeruginosa positivity, exacerbation rates, and lower lung function in patients with bronchiectasis. Brensocatib was associated with greater reductions in neutrophil elastase activity than placebo across mucoid, mucopurulent, and purulent sputum categories.

4. Tailoring Pulmonary Rehab to Close the COPD Gap, With Omid Pourshahid, MD
Arguing the pro side of a CHEST 2026 debate, Omid Pourshahid, MD, MPH, FCCP, of Temple University Hospital, made the case for matching patients to center-based, hybrid, or virtual pulmonary rehabilitation based on clinical status and barriers to care. He pointed to persistently low uptake, with only about 1.5% of Medicare beneficiaries hospitalized for COPD starting rehab within 90 days and urged clinicians to treat referrals as a prescription rather than a form.

5. Sphingolipid Profiles May Distinguish IPF From Fibrotic HP
A single-center study found plasma and exhaled breath condensate sphingolipid signatures differed between idiopathic pulmonary fibrosis and fibrotic hypersensitivity pneumonitis and correlated with markers of disease severity, including GAP score, DLCO, and FVC. The findings support further study of noninvasive sphingolipid profiling as a complement to multidisciplinary ILD evaluation, though diagnostic accuracy was not reported and external validation is needed.

Looking ahead: Catch up on the late-breaking COPD, asthma, pulmonary hypertension, and bronchoscopy data still to come at CHEST 2026 in our late-breakers preview.