What changed recently

The 2026 GINA report's headline addition is a set of four new flowcharts covering assessment, treatment and follow-up of acute asthma and exacerbations in adults, adolescents and children aged 6-11, in both primary and acute care settings. It also adds consensus guidance on which treatment step to start children aged 6-11 at, revised advice on biologics, oxygen saturation targets, SABA dosing and using ICS-formoterol instead of SABA for mild exacerbations, plus a stronger push to minimise oral corticosteroid exposure.

The 2026 GOLD report widens the 'exacerbator' label so a single moderate or severe exacerbation in the past year now counts (previously two or more were needed), reframes the ABE assessment around disease activity, stability and control, revises the exacerbation-severity classification, and positions high-flow nasal therapy as a first-line respiratory support option in exacerbations. A new chapter on emerging technology and artificial intelligence in COPD was also added.

Replacing the 2013 CHEST guideline on stage I and II NSCLC, the 2025 version backs minimally invasive resection over open thoracotomy on the strength of a new meta-analysis showing better overall survival, and accepts sublobar resection as equivalent to lobectomy for peripheral tumours of 2 cm or less. It also recommends adjuvant chemotherapy after complete resection of stage II disease and adjuvant targeted therapy for resected stage IB tumours carrying EGFR exon 19 deletion or L858R mutations.

The 2025 ATS guideline reverses the 2019 position that every adult with CAP and a positive influenza test should receive antibiotics, now suggesting antibiotics be withheld in otherwise healthy patients with a positive viral test. It also accepts lung ultrasound as an alternative to chest radiography where the preferred imaging is unavailable and staff are trained, supports stopping empiric antibiotics at 48-72 hours in patients with low procalcitonin and early clinical stability, and splits the steroid advice by severity: against systemic corticosteroids in non-severe inpatient CAP, in favour of them in severe CAP.

The 2025 edition supersedes the December 2022 update that introduced BPaLM, adding a recommendation for a new all-oral six-month regimen (bedaquiline, delamanid, linezolid, levofloxacin and clofazimine) for multidrug- or rifampicin-resistant TB including pre-XDR disease, plus modified nine-month regimens where fluoroquinolone resistance has been excluded. The changes rest on evidence from the BEAT-Tuberculosis and endTB trials.

This update adds a conditional recommendation for a four-month rifapentine-moxifloxacin regimen (two months of isoniazid, rifapentine, pyrazinamide and moxifloxacin followed by two months of isoniazid, rifapentine and moxifloxacin) in people aged 12 and over with drug-susceptible pulmonary TB, as an alternative to the six-month isoniazid/rifampin/pyrazinamide/ethambutol standard carried over from 2016. The shorter regimen also sidesteps the ocular toxicity risk of ethambutol, and the update extends to shorter regimens for drug-resistant disease.

The 2022 guidelines lower the haemodynamic definition of pulmonary hypertension from a mean pulmonary artery pressure of at least 25 mmHg to above 20 mmHg, and add a pulmonary vascular resistance threshold above 2 Wood units to define pre-capillary disease. Risk assessment moves from the 2015 three-strata model to a four-strata approach at follow-up, and PAH with venous/capillary involvement (PVOD/PCH) and persistent pulmonary hypertension of the newborn are folded into group 1.

The 2022 update revises the radiological and histopathological criteria for IPF by consensus and adds evidence-based recommendations on transbronchial lung cryobiopsy, genomic classifier testing, antacid medication and antireflux surgery. It also extends beyond IPF for the first time by defining and giving guidance on progressive pulmonary fibrosis in other interstitial lung diseases.

The 2021 document upgrades the 2011 ERS statement on non-CPAP therapies into a full GRADE-based clinical guideline, answering eight clinical questions on bariatric surgery, mandibular advancement devices, hypoglossal nerve stimulation, myofunctional therapy, maxillomandibular osteotomy, drug treatment and positional therapy. Hypoglossal nerve stimulation is newly covered as a therapy that entered practice after 2011, while isolated soft palate surgery was left out for lack of new evidence.

The 2019 CHEST update adds a weak recommendation for initial combination therapy with ambrisentan plus tadalafil in treatment-naive WHO functional class II-III patients to improve six-minute walk distance, and introduces consensus statements on integrating palliative care and supervised exercise training into PAH management. A visual treatment algorithm was added to make the 78 recommendations easier to apply at the bedside.

The 2017 guideline merges and replaces the 2005 practice parameters on indications for polysomnography and the 2007 clinical guideline on unattended portable monitors, setting out when home sleep apnoea testing is acceptable versus when polysomnography is required. It restricts home testing to uncomplicated patients with clinical signs of increased risk of moderate-to-severe OSA, specifies minimum technical requirements for home testing devices, and adds guidance on repeat testing after a negative or inconclusive study.

The 2016 revision dropped healthcare-associated pneumonia as a separate category, on the reasoning that recent healthcare contact is a poor predictor of multidrug-resistant organisms and that those patients belong in the community-acquired pneumonia pathway. It also moved to GRADE methodology, pushed institutions to use local antibiograms to narrow empiric MRSA and double gram-negative coverage, and favoured noninvasive sampling with semiquantitative cultures over invasive quantitative techniques.