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COPD is a heterogeneous condition, with tobacco smoking being the main environmental risk factor. The presence of type 2 (T2) inflammation is a well-recognised feature of asthma; however, it is now apparent that a subset of COPD patients also displays evidence of T2 inflammation with respect to elevated eosinophil counts and altered gene and protein expression of several T2 inflammatory mediators. T2 inflammatory mediators represent an attractive therapeutic target in both COPD and asthma; however, the efficacy of pharmaceutical interventions varies between diseases. Furthermore, the nature of some shared clinical features also differs. We provide a narrative review of differences in the nature of T2 inflammation between COPD and asthma, which may partly explain phenotypic differences between diseases. We focus on evidence from studies of pulmonary histopathology, sputum and epithelial gene and protein expression, and response to pharmacological interventions targeted at T2 inflammation., Competing Interests: Conflict of interest: D. Singh has received sponsorship to attend and speak at international meetings, honoraria for lecturing or attending advisory boards from the following companies: Aerogen, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, CSL Behring, Epiendo, Genentech, GlaxoSmithKline, Glenmark, Gossamerbio, Kinaset, Menarini, Novartis, Pulmatrix, Sanofi, Teva, Theravance and Verona. F. Trinkmann reports grants from AstraZeneca, Bayer Boehringer Ingelheim, Chiesi, Novartis, Roche, BMBF, DZL, Markedsmodningsfonden and E+H Knorr Stiftung, as well as consulting fees and honoraria from AstraZeneca, Berlin Chemie, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Fisher & Paykel, GlaxoSmithKline, Janssen-Cilag, Merck Healthcare, Novartis, Omron, OM-Pharma, Roche, Sanofi, Aventis and Thorasys, and travel support from AstraZeneca, Actelion, Bayer, Berlin Chemie, Boehringer Ingelheim, Chiesi, Mundipharma, Novartis, Pfizer and TEVA. V. Tejwani reports grants from NIH NHLBI and payment or honoraria from Thermofisher. A. Beech, A. Higham and S. Booth have no conflicts of interest to declare., (Copyright ©ERS 2024.)

In this review, early career and senior members of Assembly 5 (Airway Diseases, Asthma, COPD and Chronic Cough) present key recent findings pertinent to airway diseases that were presented during the European Respiratory Society International Congress 2023 in Milan, Italy, with a particular focus on asthma, COPD, chronic cough and bronchiectasis. During the congress, an increased number of symposia, workshops and abstract presentations were organised. In total, 739 abstracts were submitted for Assembly 5 and the majority of these were presented by early career members. These data highlight the increased interest in this group of respiratory diseases., Competing Interests: Conflict of interest: A. Bossios reports grants from the Swedish Heart–Lung Foundation and lecture honoraria to his institution, not related to this manuscript. Conflict of interest: G-J. Braunstahl reports honoraria for lectures and consultancy from GlaxoSmithKline, AstraZeneca, Novartis and Sanofi Genzyme, as well as research grants from Sanofi Genzyme, GlaxoSmithKline and AstraZeneca, not related to this manuscript. Conflict of interest: L.H. Conemans reports honoraria from GlaxoSmithKline, Sanofi, AstraZeneca and Vertex, as well as travel support from TEVA and Novartis. Conflict of interest: A.G. Mathioudakis reports lecture fees from GlaxoSmithKline. Conflict of interest: P. Pobeha reports consulting fees from Pfizer; consulting fees and honoraria from Chiesi, Angeliny and Boehringer Ingelheim; and honoraria from Berlin-Chemie. Conflict of interest: F.L.M. Ricciardolo reports grants from Chiesi, Sanofi and GlaxoSmithKline; consulting fees and honoraria from Sanofi Novartis and GlaxoSmithKline; and personal fees from AstraZeneca, Sanofi, GlaxoSmithKline and Novartis. Conflict of interest: F. Schleich reports grants, consulting fees and honoraria from Chiesi, AstraZeneca, GlaxoSmithKline and Novartis, as well as grants and consulting fees from TEVA. Conflict of interest: R.J. Snelgrove reports grants from The Wellcome Trust, Rosetrees Trust and The Stoneygate Trust. Conflict of interest: F. Trinkmann reports grants from AstraZeneca, Bayer Boehringer Ingelheim, Chiesi, Novartis, Roche, BMBF, DZL, Markedsmodningsfonden and E+H Knorr Stiftung; consulting fees and honoraria from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Fisher and Paykel, GlaxoSmithKline, Janssen-Cilag, Merck Healthcare, Novartis, Omron, OM-Pharma, Roche, Sanofi, Aventis and Thorasys; and travel support from AstraZeneca, Actelion, Bayer, Berlin-Chemie, Boehringer Ingelheim, Chiesi, Mundipharma, Novartis, Pfizer and TEVA. Conflict of interest: L. Uller reports lecture fees from AstraZeneca. Conflict of interest: L. Bergantini, J. Baker, F. Lombardi, L.P. Prada Romero and A. Beech have no conflicts of interest., (Copyright ©The authors 2024.)

Background: Impulse oscillometry (IOS) allows an effort-independent evaluation of small airway function in asthma. Unfortunately, well-determined minimal clinically important differences (MCIDs) for IOS measures are lacking. Here, we provide MCIDs for frequently used IOS measures, namely frequency dependence of resistance (FDR) and area of reactance (AX), in patients with asthma., Methods: We performed IOS at baseline and 1 year later in adult patients with mild-to-severe asthma (n=235). In a two-step approach, we first applied a distribution-based method to statistically determine the MCID. Next, we validated the proposed MCID according to patient-reported outcome measures (PROMs): Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Questionnaire-7 (ACQ-7) and Asthma Control Test (ACT). We used multivariable analyses to investigate the proposed MCIDs as predictors for improvements in PROMs compared with the established MCID of forced expiratory volume in 1 s (FEV 1 )., Results: The proposed MCID was a decline of ≥0.06 kPa·L -1 ·s -1 and ≥0.65 kPa·L -1 for FDR and AX, respectively. Patients who had changes beyond the MCIDs for both FDR and AX showed greater improvements in all PROMs than those who had not. The mean improvements in PROMs were beyond the established MCIDs for ACQ-7 and AQLQ, and approximated the MCID for ACT. Multivariable analyses demonstrated the MCIDs for both FDR and AX as independent predictors for the MCIDs of all PROMs. The MCID for FDR was a stronger predictor of all PROMs than the MCID for FEV 1 ., Conclusions: This study provides MCIDs for IOS-derived measures in adult patients with asthma and emphasises that small airway function is a distinguished end-point beyond the conventional measure of FEV 1 ., Competing Interests: Conflicts of interest: M. Abdo received travel support from Chiesi and consulting fees from AstraZeneca, all outside the submitted work. E. von Mutius reports personal fees from Pharmaventures, OM Pharma SA, Springer-Verlag GmbH, Elsevier GmbH, Elsevier Ltd, Peptinnovate Ltd, Turun Yliopisto, Tampereen Yliopisto, Helsingin Yliopisto, European Respiratory Society, Deutsche Pharmazeutische Gesellschaft eV, Massachusetts Medical Society, Chinese University of Hongkong, Boehringer Ingelheim, ProtectImmun GmbH, Faculteit Diergeneeskunde, Universität Salzburg, Georg Thieme Verlag, Japanese Society of Pediatric Allergy and Clinical Immunology, and Universiteit Utrecht, all outside the submitted work. K.F. Rabe reports grants from Boehringer Ingelheim and AstraZeneca, as well as personal fees from Boehringer Ingelheim, AstraZeneca, Novartis, Roche, Chiesi Pharmaceuticals, Regeneron, Sanofi and Berlin-Chemie. F. Trinkmann received travel support from Actelion, Berlin-Chemie, Boehringer Ingelheim, Chiesi, Novartis, Mundipharma, TEVA, AstraZeneca, Berlin-Chemie, Bristol-Myers Squibb, Chiesi, GlaxoSmithKline, Novartis, Roche and Sanofi-Aventis, all outside the submitted work. T. Bahmer reports grants from Bundesministerium für Bildung und Forschung (BMBF) (an unrestricted research grant for the German Center for Lung Research (DZL)), during the conduct of the study, and personal fees from AstraZeneca, GlaxoSmithKline, Novartis and Roche, outside the submitted work. The remaining authors report no relevant conflicts of interest., (Copyright ©The authors 2023.)