2021 innovations in pulmonology

Charles Pilette, Thierry Pieters, Antoine Froidure Published in the journal : February 2022 Category : Pneumology

Summary :

In pulmonology, the year 2021 was marked by significant progress towards personalized medicine, particularly in the fields of asthma, interstitial diseases, and bronchopulmonary cancer. In asthma, the advent of anti-IgE and anti-IL-5 (and soon anti-IL-4R) biologics rendered it possible to wean a substantial number of patients off oral corticosteroids, with additional beneficial effects on exacerbations or lung function (1). It has therefore become essential to refer patients with severe asthma, especially those being corticosteroid-dependent, to a specialized center (2), where the management can either confirm or infirm the indication for a biologic agent, meaning after excluding difficult asthma causes, and then implement, as necessary, a progressive weaning protocol of oral corticosteroids (3). The department has been participating to a large European study that is designed to better define the criteria for (non)response to these biological treatments (4). In interstitial diseases, a personalization of the diagnostic and therapeutic approach is currently underway by integrating all the clinical, radiological, and biological patient characteristics. A good example to mention was the identification of mutations in the telomerase complex genes, with relevant therapeutic implications in terms of responses to anti-fibrotic treatments (5) and adaptation of immunosuppressive treatments in the event of lung transplantation (6). The department was and still is involved in conducting phenotyping studies of interstitial diseases complicating inflammatory rheumatism, in collaboration with the rheumatology department, along with fundamental explorations in mucosal immunology (7). In lung cancer, clinical studies conducted in 2021 were aimed at refining the positioning of anti-PD1/PD-L1 immunotherapy in non-small-cell bronchial cancer, with our department participating in some of them in its cancer center. Finally, the department remained involved in the management of COVID patients, and as a reference center for immuno-allergological reactions and contraindications to vaccines, as well (8).

Key Words

Personnalized medicine, severe asthma, interstitial lung diseases, lung fibrosis, lung cancer, COVID