The 2025 European Respiratory Society Congress in Amsterdam highlighted both the emerging challenges and the innovations reshaping respiratory medicine. In this report, Ravijyot Saggu explores the key scientific, clinical and policy themes driving this year’s focus on respiratory health worldwide.
Anchored by the theme of respiratory health around the globe, the European Respiratory Society (ERS) Congress 2025 emphasised international collaboration and shared solutions across regions and life stages, fostering a deeper understanding of the global burden of respiratory disease.
Over five days, clinicians and researchers discussed advances in a range of areas such as air-quality science, the classification and terminology of lung diseases, biologics and person-centred care, reflecting a clear shift towards earlier intervention and more equitable access to optimal patient care and emerging innovations.
Hot topics and debates at ERS Congress 2025
Respiratory infections and equity
Major themes in the infections track were prevention – including vaccination, environmental controls and microbiome and host-directed strategies – alongside the persistent challenge of global inequities in the burden of respiratory infections and access to care.
Sessions on the management of non-tuberculous mycobacteria and antimicrobial resistance were flagged as particularly important, given ongoing medicine shortages that are impacting tuberculosis care across various countries.
Indoor and outdoor air pollution was elegantly discussed in a session by Kristie Ebi, professor of global health at the University of Washington, US, who showed clear links to increased illness and death.
She noted that the total number of deaths caused by ambient particulate matter rose by 93% between 1990 and 2021, including from outdoor air pollution, ozone, nitrous oxide and household air pollution, with children, older adults and more deprived communities most affected.
Actions to reduce air pollution not only helps to tackle this inequity for these populations, but it can also mitigate climate change – another key point of discussion and exhibition at the Congress.
Next-generation propellants were discussed as being central to the reduction of greenhouse gas emissions, along with the promotion of a recently launched combined single inhaler for triple therapy in COPD.
Interstitial lung disease
Sessions on interstitial lung disease (ILD) included discussions on updates to the classification of interstitial pneumonias beyond just ‘idiopathic’ and CT scan pattern, into primary and secondary causes.
Terminology of ILDs has also been updated, which some clinicians have referred to as being controversial and confusing to apply clinically in practice. For example, some terminology differed from that used in a recent guideline on hypersensitivity pneumonitis, although the authors acknowledged this but concluded that the updates will encourage more precise classification.
Connective tissue disease-associated ILD screening and monitoring guidelines have now been revised to standardise care across Europe. Developed by a task force from the ERS and the European Alliance of Associations for Rheumatology, these updates were discussed at length at the Congress. It was noted that the recommended monitoring frequency may be difficult to achieve in practice due to the way in which some services are set up and the long waits to access tests.
Small lung syndrome
Peter Burney, emeritus professor of respiratory epidemiology at Imperial College London, argued that the current classifications of chronic lung diseases are insufficient, and continued his endorsement of a new disease category of ‘small lung syndrome’.
He explained that while chronic obstructive pulmonary disease (COPD) has long been tied to tobacco smoking and air pollution, global data reveal striking disparities in mortality rates that these risk factors alone cannot explain.
Small lung syndrome, he explained, refers to persistently low lung volume without obstructive disease and is strongly associated with comorbidities such as hypertension, atherosclerosis and diabetes.
Professor Burney further urged the creation of a new International Classification of Diseases code to improve diagnosis and epidemiologic monitoring.
In the same session, it was noted that preterm birth and other exposures may cause underdeveloped lungs in infants, resulting in smaller lungs during adulthood. Indeed, long-term cohort data showed that children with poor lung growth trajectories may carry risks into adulthood, underscoring the value of early detection and intervention with follow-up at regular time points.
More on lung function trajectories
Separately, the observational Breakthrough asthma attacks treated with Oral Steroids (BOOST) study found that fractional exhaled nitric oxide (FeNO) can identify patients who may benefit most from a short course of prednisolone to manage symptoms and improve lung function.
High FeNO levels were linked to increased steroid responsiveness in patients with severe asthma on biologics experiencing outpatient exacerbations. The results also highlighted that, for patients already on biologics, FeNO levels can predict response to prednisolone.
Mucus plugging is linked to poorer lung function and asthma exacerbations, associated with inflammation and airway remodelling. A discussion from Aileen Hsieh, a PhD candidate in pharmacology and therapeutics at the University of British Columbia, Canada, centred on reversing this with inhaled triple therapy and biologic agents. She surmised a correlation between mucus plugs and airway remodelling modifiable with inhaled corticosteroid and biologic therapy. As mucus plugs are measurable, they could serve as a novel target in future studies, she said.
Spotlight on biologics at ERS Congress
Unsurprisingly, the use of biologic therapies in respiratory disease dominated many sessions, prompting thought-provoking discussions and debates.
Several biologics, such as monoclonal antibodies, are already available, offering options for steroid-sparing or reduction. Their use is well established in treating severe asthma, but there are expanding indications and potential uses on the horizon.
This includes the recent approval of the anti-interleukin-5 (anti-IL5) agent benralizumab for eosinophilic granulomatosis with polyangiitis – formerly known as Churg-Strauss syndrome – as well as reducing COPD exacerbations and treating chronic rhinosinusitis with nasal polyps (CRSwNP).
Biologic developments in CRSwNP
Dupilumab demonstrated superiority over omalizumab (anti-IgE) for chronic rhinosinusitis with nasal polyps and coexisting asthma in the EVEREST head-to-head trial, which Enrico Marco Heffler, associate professor in internal medicine at Humanitas University in Milan, Italy, presented.
Other research presented at the Congress showed that depemokimab (anti-IL5), administered every six months, led to promising early improvements in the SWIFT and ANCHOR trials, while tezepelumab, which blocks thymic stromal lymphopoietin, demonstrated partial eosinophil suppression in patients with comorbid asthma in the WAYPOINT trial.
Emerging data presented as part of a set of oral presentations on biologics suggest that blood eosinophils are not a reliable biomarker in CRSwNP, unlike in asthma, highlighting the need for alternative markers of disease activity.
Biologic developments in COPD
Dr Neil Greening, associate professor at the University of Leicester and honorary consultant respiratory physician at Leicester’s Glenfield Hospital, UK, was involved in two trials presented at the ERS Congress. His COPD-HELP trial of mepolizumab as add-on therapy at acute hospitalisation for eosinophilic exacerbation showed no difference in time to hospitalisation or death. However, it did lead to a reduction in the annual number of moderate-to-severe exacerbations and a clinically meaningful improvement in symptoms.
Findings from the ALIENTO trial, which looked at the monoclonal human antibody astegolimab (anti-IL33), were presented in a late breaking abstract. Dr Greening said the trial demonstrated reductions in the annualised exacerbation rate with two- or four-weekly dosing of astegolimab in patients with moderate-to-severe COPD.
A statistically significant 15.5% reduction was observed with two-weekly dosing versus placebo, whereas the reduction with four-weekly dosing was more modest, he said.
There were no restrictions on smoking status or eosinophil counts for participating patients, and a generally consistent treatment effect of astegolimab was observed in subgroup analyses, with greater benefits noted with two-weekly dosing in patients who had experienced more than two exacerbations.
At the time of writing, no biologics are approved for the treatment of COPD in the UK.
However, the anti-IL33 agents itepekimab and tozorakimab are still in early phase trials but are showing promise, various Congress sessions suggested.
In addition, dupilumab and mepolizumab have both demonstrated benefits in reducing exacerbations and are currently being evaluated for use in healthcare settings by relevant authorities, such as the National Institute for Health and Care Excellence in the UK, with patient eligibility expected to align with trial criteria.
Patient involvement and representation at ERS Congress
The ERS and European Lung Foundation strengthened patient involvement through a dedicated Patient Organisation Networking Day during the Congress, where patients contributed as speakers, shared video testimonials and took part in interactive studio sessions.
This commitment to person-centred care was illustrated in a session on transitions of care for children and young people with asthma, during which a young patient offered powerful insights into his experience of moving from paediatric to adult services.
In addition, Dr Kirsten Stewart-Knight, clinical psychologist at Guy’s and St Thomas’ NHS Foundation Trust, UK, delivered a standout session that revisited the importance of understanding children’s psychological needs and how these play into health beliefs and adherence to therapy.
Similarly, Dr Sabrina Bajwah, clinical reader and honorary consultant in palliative care at King’s College London, delivered a thought-provoking lecture on cultural discussions with patients and how these considerations impact patient decision-making.
Her session highlighted the importance of including such lines of enquiry in patient consultations to tease out patients’ beliefs, especially in palliative care and advance care planning.
Take-home messages from ERS Congress 2025
- Addressing global disparities in both disease burden and access to care is central, not peripheral, to the future of respiratory health. Reducing air pollution remains a key factor in reducing morbidity and mortality and mitigating climate change
- New disease concepts are challenging traditional paradigms, prompting calls for updated classifications and improved epidemiological monitoring
- There is increasing momentum towards earlier identification and preventive strategies in respiratory medicine, aiming not only to treat late-stage disease but also to modify trajectories such as lung growth or function
- Biologics are showing greater utility across respiratory diseases, although further research is required to deepen our understanding for more targeted use
- Person-centred approaches to care are increasingly important amid the shift towards more personalised care. It shouldn’t be considered as an add-on but core to how respiratory medicine is framed.
Author
Respiratory and medicines optimisation pharmacist, London; chair of the UK Clinical Pharmacy Association’s Respiratory Committee; and clinical member of the NHS England Respiratory Clinical Reference Group, UK