RESPIRATORY MEDICINE: FIVE CHANGES THAT ARE REDEFINING THE FUTURE OF PULMONOLOGY

Respiratory medicine is going through an extraordinary phase of evolution. After years in which the focus was mainly on managing chronic diseases and combating the pandemic, we are now witnessing the emergence of innovations that are deeply changing the way we diagnose, monitor, and treat lung diseases.

From pulmonary fibrosis to new lung cancer screening strategies, including artificial intelligence and precision medicine, the field of pulmonology is rapidly evolving. Here are five topics that deserve particular attention.

1. Pulmonary fibrosis: a new therapeutic era

For over a decade, research on idiopathic pulmonary fibrosis faced numerous challenges. Many promising drugs failed to show effectiveness in advanced clinical trials. Today, however, a significant change is on the horizon.

The results of major international studies like FIBRONEER and TETON have shown encouraging data for nerandomilast and treprostinil, new molecules that could expand the therapeutic options available for progressive pulmonary fibrosis. The goal isn’t just to add new drugs, but to enter a phase where treatments can be increasingly personalized and potentially combined. At the same time, interest in early diagnosis is growing. Identifying genetic biomarkers and screening relatives of patients with pulmonary fibrosis represent a frontier that could allow the disease to be caught much earlier than in the past. 2. Lung cancer screening: from experimentation to health policy Lung cancer continues to be one of the main causes of cancer death.

The real novelty of recent years is that low-dose chest CT screening is gathering increasingly solid evidence. Data from Italian and international programs show that early diagnosis allows many tumors to be detected at an initial stage, when the chances of recovery are significantly higher. Several scientific organizations are calling for screening to be permanently included in national care pathways for high-risk individuals. The challenge in the coming years will be to ensure uniform access across the territory, integrating prevention, smoking cessation, and early diagnosis into a single organized pathway. 3. Artificial intelligence enters clinical practice Artificial intelligence is no longer a futuristic prospect.

In thoracic radiology and in interstitial lung diseases, it is already showing the ability to support image interpretation and to identify complex patterns that can escape the human eye. Algorithms will not replace the doctor, but they can help them make faster and more accurate decisions, especially in contexts characterized by large volumes of data. Moreover, the integration of imaging, clinical data, and biomarkers paves the way for predictive models capable of estimating disease progression and treatment response. The real revolution will probably be the ability to use artificial intelligence as a tool for personalized medicine. 4. Precision medicine: the patient at the center Pulmonology is gradually moving away from the 'one-size-fits-all' treatment paradigm. Today we know that apparently similar diseases can have profoundly different biological mechanisms

This concept is now well established in severe asthma, where biologic drugs allow therapy to be chosen based on the inflammatory characteristics of each patient. The same approach is emerging in interstitial diseases and thoracic oncology, thanks to the increasing availability of molecular markers. Precision medicine doesn't just mean using new drugs, but finding the right treatment for the right patient at the right time. 5. Prevention and early diagnosis take center stage For many years, pulmonology has been mainly seen as a care-focused discipline. Today, prevention is taking on an increasingly central role. The fight against smoking remains the main public health intervention in respiratory care. However, along with primary prevention, strategies for the early detection of diseases are becoming more important: This concept is now well established in severe asthma, where biologic drugs allow therapy to be chosen based on the inflammatory characteristics of each patient. The same approach is emerging in interstitial diseases and thoracic oncology, thanks to the increasing availability of molecular markers. Precision medicine doesn't just mean using new drugs, but finding the right treatment for the right patient at the right time. 5. Prevention and early diagnosis take center stage For many years, pulmonology has been mainly seen as a care-focused discipline. Today, prevention is taking on an increasingly central role. The fight against smoking remains the main public health intervention in respiratory care. However, along with primary prevention, strategies for the early detection of diseases are becoming more important: cancer screenings, identification of early-stage fibrosis, monitoring ...