Emerging therapies & exam strategy
What's changing in each specialty: the trials, agents and guideline shifts most likely to matter for the FRACP Divisional Written Exam.
Severe Asthma: Biologic Therapies
The treatment of severe asthma has been transformed by biologics targeting type 2 inflammation, and choosing among them is now guided by biomarkers (blood eosinophils, FeNO, IgE) and comorbidities.…
Chronic Obstructive Pulmonary Disease
After decades in which COPD care meant inhaled bronchodilators and corticosteroids alone, the disease has entered a new therapeutic era with its first biologics and its first novel inhaled mechanism…
Bronchiectasis
For non-cystic-fibrosis bronchiectasis, 2025 brought a genuine milestone: the first-ever approved disease-modifying therapy. Brensocatib (Brinsupri), an oral inhibitor of dipeptidyl peptidase-1…
Idiopathic Pulmonary Fibrosis
Idiopathic pulmonary fibrosis (IPF) gained its first new drug in a decade in 2025. Nerandomilast (Jascayd), a first-in-class oral preferential PDE4B inhibitor, slowed the decline in forced vital…
Pulmonary Sarcoidosis
Corticosteroids remain first-line for symptomatic pulmonary sarcoidosis, with steroid-sparing agents (methotrexate, azathioprine) and anti-TNF therapy (infliximab) for refractory disease — and the…
Pneumoconiosis and Progressive Fibrosing Interstitial Lung Disease
The occupational fibrotic lung diseases (the pneumoconioses) still have no approved disease-modifying therapy, so management rests on removing further exposure and supportive care. The most useful…
Pulmonary Arterial Hypertension
The major advance in pulmonary arterial hypertension (PAH) is a therapy that targets a fourth biological pathway. Sotatercept (Winrevair), a first-in-class activin signaling inhibitor, rebalances…
Pleural Infection and Empyema
Management of pleural infection has become less invasive and more protocolized. Guidelines now favor small-bore, image-guided chest tubes as the initial drainage approach for most cases — as…
Pleural Mesothelioma
Immunotherapy has reshaped the first-line treatment of pleural mesothelioma, an aggressive asbestos-related cancer. The combination of nivolumab and ipilimumab became a standard of care on the…
Cystic Fibrosis
CFTR modulator therapy has transformed cystic fibrosis (CF) from a fatal childhood disease into an increasingly manageable chronic condition for most patients. The triple combination…
Alpha-1 Antitrypsin Deficiency
Alpha-1 antitrypsin deficiency (AATD) causes both lung disease (early emphysema) and, in some, liver disease from accumulation of misfolded Z-AAT protein — and emerging therapies are increasingly…
Primary Ciliary Dyskinesia
Primary ciliary dyskinesia (PCD) is a rare inherited disorder of ciliary function causing chronic airway infection and bronchiectasis, and its management has largely been extrapolated from cystic…
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