Pulmonary medicine draws on clinical guidelines, randomized trials, therapeutic advances, and risk assessment tools across a range of respiratory conditions. The following 10 references cover asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, pulmonary hypertension, and acute respiratory distress syndrome, with information spanning diagnosis, pharmacologic treatment, disease management, and risk assessment.

1. Global Initiative for Asthma (GINA) Strategy Report — The 2026 strategy report incorporated evidence identified through the GINA Science Committee's review of recent asthma literature. The document cites the supporting scientific literature and underlies additional materials produced by GINA.

2. Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report — The 2026 GOLD report incorporates literature published through July 2025 and revises several areas of chronic obstructive pulmonary disease (COPD) management. Changes include adjusted criteria for the GOLD A, B, and E groups; clarification of algorithms for initial and follow-up pharmacologic treatment; and updated vaccination recommendations. The report also adds material summarizing evidence on biologic therapy and addressing artificial intelligence and emerging technologies in COPD.

3. American Thoracic Society/European Respiratory Society/Japanese Respiratory Society/Asociación Latinoamericana de Tórax Pulmonary Fibrosis Guideline — The joint guideline covers the diagnosis and treatment of idiopathic pulmonary fibrosis and provides guidance for progressive pulmonary fibrosis arising from other interstitial lung diseases. For idiopathic pulmonary fibrosis, transbronchial lung cryobiopsy received a conditional recommendation in appropriately experienced centers, while antacid therapy and antireflux surgery received conditional recommendations against their use as treatments. Progressive pulmonary fibrosis is identified when at least 2 of 3 domains—symptoms, imaging, or physiologic measures—worsen within 1 year without another explanation. Among patients meeting the progressive pulmonary fibrosis definition, the guidance supports nintedanib conditionally.

4. European Society of Cardiology/European Respiratory Society Pulmonary Hypertension Guideline — The clinical practice guideline addresses the spectrum of pulmonary hypertension, with particular attention to the diagnosis and treatment of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. The guideline includes revised hemodynamic definitions and classification, an updated diagnostic algorithm and screening strategies, and expanded approaches to risk assessment. It also addresses treatment strategies for pulmonary arterial hypertension and management of pulmonary hypertension associated with left heart or lung disease.

5. BOREAS Trial — In the phase 3 BOREAS trial, investigators randomly assigned 939 patients with COPD, blood eosinophil counts of at least 300/μL, and elevated exacerbation risk despite standard triple therapy to receive dupilumab or placebo every 2 weeks. Compared with placebo, dupilumab was associated with fewer moderate or severe exacerbations over the treatment period and improved lung function by week 12 and persisting through week 52. Measures of respiratory symptoms and quality of life also favored dupilumab at week 52.

6. BATURA Trial — In the phase 3b BATURA trial, investigators randomly assigned 2,516 patients aged 12 years or older whose disease remained uncontrolled despite treatment for mild asthma to receive as-needed albuterol-budesonide or albuterol for up to 52 weeks. Severe exacerbations occurred in about 5% of patients receiving albuterol-budesonide and 9% receiving albuterol in both the on-treatment efficacy and intention-to-treat analyses.  The combination treatment was also associated with a lower annualized rate of severe exacerbations and less systemic glucocorticoid exposure. The frequency of adverse events was comparable between treatment groups.

7. Acute Respiratory Distress Syndrome Management Update — Updated clinical practice guidelines address corticosteroids, venovenous extracorporeal membrane oxygenation, neuromuscular blocking agents, and positive end-expiratory pressure in patients with acute respiratory distress syndrome (ARDS). The guidelines conditionally recommend corticosteroids, venovenous extracorporeal membrane oxygenation for selected patients with severe ARDS, neuromuscular blockers for early severe ARDS, and higher vs. lower positive end-expiratory pressure without lung recruitment maneuvers for moderate to severe ARDS. The guidelines strongly recommend against prolonged lung recruitment maneuvers in those with moderate to severe ARDS.

8. Ensifentrine for COPD — The US Food and Drug Administration (FDA) approved ensifentrine in 2024 as maintenance therapy for adults with COPD. The inhaled phosphodiesterase-3 and phosphodiesterase-4 inhibitor is administered twice daily by nebulizer. Clinical evidence considered for the approval came from the placebo-controlled ENHANCE-1 and ENHANCE-2 trials involving 1,553 adults with moderate to severe COPD. At week 12, improvement from baseline was greater with ensifentrine than with placebo in forced expiratory volume in 1 second area under the curve over 12 hours.

9. BODE Index for COPD — The BODE index combines body mass index, airflow obstruction, dyspnea, and exercise capacity measured by the 6-minute walk test into a 10-point scale for assessing mortality risk in patients with COPD. Investigators developed the index using data from 207 patients, subsequently validated in 625 patients. Higher scores corresponded to greater mortality risk, and the index had greater predictive performance for all-cause mortality than forced expiratory volume in 1 second.

10. MATINEE Trial — The phase 3 MATINEE trial included 804 patients with COPD, prior exacerbations, and blood eosinophil counts of at least 300 cells/μL who were receiving triple inhaled therapy. The participants were randomly assigned to subcutaneous mepolizumab or placebo every 4 weeks. Fewer moderate or severe exacerbations occurred per year with mepolizumab compared with placebo, and the median time to a first moderate or severe exacerbation was longer with mepolizumab. The agent did not show a statistically significant advantage over placebo on the assessed quality-of-life or symptom outcomes. Adverse events occurred at comparable frequencies in the 2 treatment groups.

Sources: GINA, GOLD, American Journal of Respiratory and Critical Care Medicine, European Heart Journal, The New England Journal of Medicine, FDA