MANILA, Philippines -- By Lee Han-soo / Korea Biomedical Review correspondent -- Boehringer Ingelheim is expanding its leadership in interstitial lung disease (ILD) research through a combination of scientific innovation and patient-centered collaboration across the Asia-Pacific region. As part of its long-term respiratory strategy, the company aims to accelerate development of new treatments that prevent lung function decline and improve outcomes for patients with pulmonary fibrosis.

During the Asia-Pacific Society of Respirology (APSR) 2025 Congress held in Manila, Korea Biomedical Review met with Dr. Siok Shen Ng, Medical Affairs ILD Lead at Boehringer Ingelheim’s Regional Operating Unit ASKAN (ASEAN, South Korea, Australia, and New Zealand), to discuss the company’s scientific priorities and long-term commitment to improving care for patients with pulmonary fibrosis across the region.

Overseeing ILD portfolio for multiple Asia-Pacific markets, Dr. Ng plays a pivotal role in driving evidence-based medical engagement in one of respiratory medicine’s most challenging therapeutic areas.

“My main focus is ensuring that everything we do provides evidence-based solutions for patients living with pulmonary fibrosis,” she said.

A disease with high mortality and unpredictable progression

Pulmonary fibrosis remains a devastating and progressive disease characterized by irreversible scarring of the lungs, leading to declining lung function and poor quality of life.

According to Dr. Ng, mortality remains high, with many patients dying within five years of diagnosis.

“The biggest problem is that disease progression is very unpredictable, which makes it difficult to manage and leaves patients anxious because they don’t know what to expect,” she said.

She also emphasized that diagnosis is often delayed because symptoms such as breathlessness are nonspecific and commonly mistaken for other conditions. “Many patients are simply not aware of this disease yet,” she added.

Limited treatment options and tolerability challenges in Asia

Currently, only two antifibrotic drugs -- pirfenidone and nintedanib -- are approved for the treatment of pulmonary fibrosis. While both slow disease progression, they cannot stop or reverse fibrosis.

“What’s particularly challenging is that many patients in Asia cannot tolerate these medications,” Dr. Ng said. “Most experience diarrhea and have to discontinue treatment after three to six months. Once they stop, there are no other therapeutic options available.”

This reality, she noted, underscores the urgent need for new treatments that target different molecular pathways and mechanisms of action.

A key focus to resolve this issue for Boehringer Ingelheim has been advancing research into the phosphodiesterase 4B (PDE4B) pathway, which plays a novel role in fibrosis and inflammation.

“PDE4B is an enzyme that breaks down cyclic AMP, a messenger involved in fibrosis, inflammatory and immune responses,” Dr. Ng explained. “By inhibiting PDE4B, we can achieve both antifibrotic and immunomodulatory effects -- two mechanisms that are critical in pulmonary fibrosis.”

She added that nerandomilast, Boehringer Ingelheim’s first-in-class PDE4B inhibitor, is designed to selectively target PDE4B over PDE4D, reducing side effects such as diarrhea and nausea while maintaining efficacy.

“This unique mechanism of action addresses aspects of lung fibrosis that have not yet been effectively targeted,” she said.

A long-term commitment to respiratory innovation

Dr. Ng highlighted that Boehringer Ingelheim’s broader vision for respiratory diseases centers on long-term innovation and collaboration.

“We are committed to transforming lives for generations -- that’s our motto,” she said. “Our main goal in pulmonary fibrosis is to prevent lung function decline, restore functionality, and eventually develop therapies that can fully prevent fibrosis and inflammation.”

Achieving this vision, she added, requires a collaborative ecosystem involving academia, physicians, biotech partners, and patient communities.

Within Boehringer Ingelheim’s global network, the ASKAN region is taking on an increasingly central role achieving this goal. “A large portion of clinical trial recruitment now comes from this region -- especially from Korea and Australia,” Dr. Ng said. “Even smaller countries are beginning to take part in early clinical trials.”

She also noted that data from Asian populations are essential to understanding regional disease characteristics.

“We know that Asian patients are somewhat different from Western populations, but the data has been limited,” she said. “Through our studies, we’re starting to uncover these differences, which will help tailor treatment strategies for Asian patients in the future.”

Dr. Ng also emphasized Boehringer Ingelheim’s efforts to integrate the patient voice into clinical development.

“We’re working closely with patient advocacy groups to understand their experiences and unmet needs,” she said. “Their insights help us design trials that measure outcomes that truly matter to patients -- sometimes quality-of-life or symptom outcomes that traditional endpoints overlook.”

In addition to shaping trial design, these partnerships aim to raise disease awareness across the region. “We encourage people who may have symptoms -- or know someone who does -- to talk to their doctors and explore the possibility of joining clinical trials,” she said.

To this end, Boehringer Ingelheim has been collaborating with various organizations in APAC such as the Lung Foundation Australia and the Korean Organization for Rare Diseases to improve patient engagement and advocacy.

“In Australia, we’ve worked to generate patient experience data and improve awareness,” Dr. Ng explained. “In Korea, we work closely with the Korean Organization for Rare Diseases to help patients share their stories in the National Assembly, gather petitions, and engage with media to increase awareness among policymakers and the public.”

The road ahead

While AI-based diagnostics and predictive tools for ILD remain in the research phase, Dr. Ng believes they will play an important role in the future of personalized care.

“A lot of experts are exploring how AI can help predict disease progression, which is currently very unpredictable,” she said. “In the future, combining early diagnosis, multidisciplinary care, and innovative therapies like PDE4B inhibitors could change the outlook for patients with pulmonary fibrosis.”

Through sustained research and patient-centered collaboration, Boehringer Ingelheim aims to make that vision a reality for patients across the ASKAN region.