Daily Respiratory Research Analysis
Three impactful respiratory studies stand out today: a Cochrane meta-analysis finds no mortality benefit of sustained inflations during neonatal resuscitation and suggests little to no advantage on major respiratory outcomes; an updated ATS guideline provides targeted recommendations for diagnosing and managing adult community-acquired pneumonia; and a multi-ancestry GWAS reveals neurological pathways underpinning chronic dry cough and ACE inhibitor–induced cough.
Summary
Three impactful respiratory studies stand out today: a Cochrane meta-analysis finds no mortality benefit of sustained inflations during neonatal resuscitation and suggests little to no advantage on major respiratory outcomes; an updated ATS guideline provides targeted recommendations for diagnosing and managing adult community-acquired pneumonia; and a multi-ancestry GWAS reveals neurological pathways underpinning chronic dry cough and ACE inhibitor–induced cough.
Research Themes
- Neonatal resuscitation ventilation strategies and outcomes
- Evidence-based guidelines for community-acquired pneumonia
- Genetic architecture of chronic cough and shared mechanisms with drug-induced cough
Selected Articles
1. Sustained versus standard inflations during neonatal resuscitation to prevent mortality and improve respiratory outcomes.
Across 14 RCTs involving 1,766 newborns, sustained inflations did not reduce delivery-room or in-hospital mortality and had little to no effect on chronic lung disease, pneumothorax, or severe IVH. A possible reduction in the need for mechanical ventilation was borderline and the certainty of evidence was low due to bias and imprecision.
Impact: This high-quality Cochrane review challenges the clinical practice of using sustained inflations in neonatal resuscitation, emphasizing the lack of mortality or major respiratory benefit.
Clinical Implications: Routine use of sustained inflations during neonatal resuscitation should be avoided. Standard intermittent PPV should remain the approach, and future studies should target high-risk infants with better physiological monitoring and long-term outcomes.
Key Findings
- No reduction in delivery-room mortality (RR 1.72; low-certainty) or death before discharge (RR 0.99; low-certainty) with sustained inflations.
- Little to no difference in chronic lung disease, pneumothorax, or severe IVH compared with intermittent ventilation.
- Possible borderline reduction in need for mechanical ventilation (RR 0.90; low-certainty), but overall evidence downgraded for bias and imprecision.
Methodological Strengths
- Cochrane methodology with comprehensive multi-database search and GRADE assessment
- Inclusion of 14 randomized trials across five continents with predefined critical outcomes
Limitations
- Overall low certainty due to risk of bias (allocation concealment, blinding) and imprecision
- Limited physiological monitoring and lack of long-term neurodevelopmental outcomes
Future Directions: Conduct RCTs in high-risk subgroups with standardized SLI protocols, detailed respiratory mechanics/lung volume monitoring, stratification by gestational age, and long-term neurodevelopmental follow-up.
2. Diagnosis and Management of Community-acquired Pneumonia. An Official American Thoracic Society Clinical Practice Guideline.
The 2025 ATS guideline updates adult CAP management around four questions: diagnostic lung ultrasound, empiric antibiotics when a respiratory virus test is positive, optimal antibiotic duration, and systemic corticosteroid use. Recommendations reflect systematic evidence assessment via GRADE and Evidence-to-Decision frameworks.
Impact: Guidelines directly shape clinical practice by synthesizing current evidence into actionable recommendations for common and high-burden disease.
Clinical Implications: Clinicians should consider lung ultrasound for CAP diagnosis, tailor empiric therapy in the context of positive respiratory viral tests, shorten antibiotic duration when appropriate, and use systemic corticosteroids selectively based on evidence and patient factors.
Key Findings
- Formulates recommendations on the role of lung ultrasound for diagnosing CAP.
- Provides guidance on empiric antibacterial therapy when respiratory viral testing is positive.
- Defines evidence-based antibiotic durations and clarifies when systemic corticosteroids should be used.
Methodological Strengths
- GRADE and Evidence-to-Decision frameworks with multidisciplinary expert panel
- Integration of systematic reviews of comparative evidence with clinical experience
Limitations
- Scope limited to four key questions; not a comprehensive review of all CAP topics
- Some recommendations may rely on moderate or low certainty evidence due to available data
Future Directions: Prospective comparative studies to validate lung ultrasound pathways, trials optimizing antibiotic duration in diverse risk strata, and refined criteria for corticosteroid use in CAP.
3. Genomics of chronic dry cough unravels neurological pathways.
Multi-ancestry and multi-trait GWAS identified seven novel loci for chronic dry cough and ACE inhibitor–induced cough, implicating neuronal pathways in cough hypersensitivity. PheWAS and polygenic score analyses highlighted pleiotropic links with neurological traits, supporting neuro-sensory mechanisms.
Impact: Reveals genetic architecture and neuronal mechanisms of chronic cough, a prevalent symptom with limited targeted therapies, opening avenues for mechanism-based drug development.
Clinical Implications: While not immediately practice-changing, these findings support focusing on neuronal targets for chronic cough, and may inform risk stratification and pharmacogenomic considerations for ACE inhibitor–induced cough.
Key Findings
- Seven novel genome-wide significant loci associated with chronic dry cough and ACE inhibitor–induced cough.
- Shared genetic architecture and PheWAS links point to neuronal dysfunction underlying cough hypersensitivity.
- Polygenic scores for ACEi-induced cough showed pleiotropic associations with neurological traits.
Methodological Strengths
- Multi-ancestry, multi-cohort GWAS with a multi-trait approach
- Gene mapping combined with PheWAS and polygenic score analyses to explore pleiotropy
Limitations
- Phenotype definitions rely on questionnaires and EHR-derived proxies, introducing heterogeneity
- Observational genetic associations limit causal inference; clinical translation requires validation
Future Directions: Functional validation of implicated genes, experimental models to probe neuronal pathways in cough hypersensitivity, and translational studies to test mechanism-based therapeutics.