The role of hospital pharmacists in shaping global respiratory care: ERS Congress 2025

The 2025 European Respiratory Society (ERS) Congress focused on themes of global collaboration, innovation and equity in respiratory care. Ahead of the launch of a new ERS Pharmacist Group in 2026, the expanding role of pharmacists was underscored, reinforcing their position as essential partners in delivering safer, more personalised and sustainable respiratory care, as respiratory pharmacist Ravijyot Saggu explains.

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 in Amsterdam, healthcare professionals and researchers discussed advances in a range of areas such as climate action, e-cigarettes, a shift from inhaled corticosteroids (ICS) to biologics and person-centred care.

Sessions aligned on the need for earlier intervention and more equitable access to optimal patient care and emerging innovations, with pharmacists championed for their central role guiding safe and effective pharmacotherapy within multidisciplinary teams.

Hot topics and debates at ERS Congress 2025

Respiratory infections and equity

Major themes in the ERS Congress 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 ERS 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.

The inhaler provides a lower global warming potential option that pharmacists can consider during shared decision-making, while dry-powder inhalers remain an equally low-carbon alternative that may better suit a patient’s inspiratory flow or preferences.

E-cigarettes

A highly anticipated session that drew significant attention was the discussion on the role of e-cigarettes in smoking cessation, weighing potential benefits against risks and the long-term harms, especially in young people.

E-cigarettes were initially viewed as preferable to nicotine replacement therapy for smoking cessation. However, concerns regarding their use have emerged over time, including e-cigarette/vaping-associated lung injury, which Jayesh Mahendra Bhatt, consultant at Nottingham University Hospitals NHS Trust, discussed at length.

It is now recognised that vaping carries public health risks, which include dual use with tobacco, addiction and the appeal of flavoured products, as well as its perception as ‘trendy’, leading to young people taking up the habit.

Professor Hayden McRobbie, professor of population health at Queen Mary University of London and an honorary public health doctor at Barts NHS Health Trust, UK, and Professor Aslı Görek Dilektaşlı, professor of pulmonary medicine at Uludağ University in Bursa, Turkey, spoke about public health risks and benefits of vaping in a pro-con debate.

Professor McRobbie argued that e-cigarettes can be an effective tool for smoking cessation when appropriately regulated and he called for quality standards and licensed medicinal e-cigarettes, with the option of selling these only in pharmacies.

Professor Görek Dilektaşlı noted that the introduction of e-cigarettes in some countries has not accelerated reductions in smoking prevalence. She recommended policies to prioritise nicotine-free abstinence using established evidence-based cessation approaches rather than promoting e-cigarettes as a solution.

An ERS Congress session on vaping being the new pandemic from Sophie Cohen from Amsterdam, Netherlands, highlighted the role that healthcare professionals can play in stopping it.

Use among never-smokers is particularly worrying, and uncertainties remain regarding long-term health and cancer risks, as well as regulatory oversight. This reinforces the need for balanced discussions with patients to outline current and future risks, including potential harms from second-hand aerosol exposure, she said. Long-term safety data remain limited.

In the UK, National Institute for Health and Care Excellence guidance on smoking cessation emphasises that the evidence-based approach requires behavioural support alongside pharmacotherapy. Pharmacists can facilitate this by initiating open conversations at every touchpoint and signposting or referring patients for treatment whenever they express readiness to quit.

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 noted 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.

Preterm birth and other exposures may cause underdeveloped lungs in infants, leading to lung problems in later life. 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.

A shift from ICS to biologics: a view from ERS Congress

Inhaled corticosteroids (ICS) carry well-recognised long-term risks, including cataracts, pneumonia, osteoporosis and type 2 diabetes, with higher doses associated with greater harm.

In an ERS Congress session on the lifelong burden of high-dose ICS, Chloë Bloom, honorary consultant in respiratory medicine at Imperial College Healthcare NHS Trust presented findings on the association of ICS dose and the frequency of adverse events.

This real-world UK data in patients with asthma showed a number needed to harm for cardiac events of 473 with medium-dose ICS and 224 with high-dose ICS, underscoring the dose-dependent nature of these adverse effects and the need to adhere to guideline recommendations of using the lowest effective ICS dose.

Pharmacists have an important role in steroid stewardship, whether prescribing or supporting other prescribers, to minimise patient harm.

To support this stewardship, discussion around the use of biologic therapies in respiratory disease dominated many sessions, prompting thought-provoking 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 ERS 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.

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.

Pharmacists gather patient information with empathy through holistic consultations and often lead clinics and play a key role in counselling and education. Their responsibilities include empowering patients, normalising participation in research, and identifying candidates for relevant clinical trials, making person-centred care an imperative part of their role.

Take-home messages from ERS Congress 2025

• Disparities in infection burden, access to care and exposure to air pollution remain global priorities and pharmacists play a vital role in promoting equitable care through antimicrobial stewardship and personalised patient guidance
• Sustainable care intersects with respiratory therapy and next-generation inhalers with lower global warming potential present opportunities to incorporate sustainability into shared decision-making. Pharmacists can guide patients in choosing inhalers that balance environmental impact with suitability for their inspiratory flow and preferences
• E-cigarettes pose evolving risks and pharmacists can provide balanced, evidence-based counselling and facilitate access to behavioural and pharmacological smoking cessation support at every patient touchpoint
• New disease classifications such as small lung syndrome highlight the need for accurate medication management and ongoing monitoring
• Early intervention and prevention are critical and there is growing momentum to identify and manage respiratory disease earlier, including modifying lung growth trajectories and lung function across the life course
• Biologics expand treatment opportunities and the growing availability of these therapies across severe asthma, chronic rhinosinusitis with nasal polyps and COPD provides new options for steroid-sparing treatment
• Holistic, person-centred care is essential. Beyond medication management, pharmacists gather patient information empathetically, lead clinics and provide education that empowers patients to make informed decisions. They help integrate research participation into routine care and strengthen the connection between patients and multidisciplinary teams.

Author

Ravijyot Saggu
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