Pulmonology
Structured rehabilitation nearly quadrupled weaning success in ventilated patients over 80
A single-centre randomised trial in prolonged mechanical ventilation; the CPAP comfort setting that let the airway narrow; high-intensity intervals matched standard rehabilitation in fibrotic lung disease; and why TB care should not end at cure.
COPD patients who reached 'stability' at 28 weeks had about half the later risk of exacerbation and death
Post hoc trial data propose stability as a COPD treatment target; awake and extubated ECMO in ARDS lives or dies on the first ten days; and one year of CT emphysema progression predicts faster FEV1 loss.
Adaptive D-dimer cut-offs ruled out pulmonary embolism safely, even above 500
A meta-analysis of 12,194 prospectively managed patients found age- and probability-adjusted D-dimer thresholds missed very few emboli; mucus plugs on CT predicted exacerbations and new COPD in people with normal spirometry; and intermittently raised eosinophils still marked mepolizumab responders in COPD.
ERS recommends add-on sotatercept for PAH patients not at low risk
The updated ERS guideline gives a strong, high-certainty recommendation for sotatercept on top of existing PAH therapy. Also: every bronchiectasis exacerbation raises future risk, PAP adherence and cardiovascular events in high-risk sleep apnoea, and aumolertinib with radiotherapy in stage III EGFR-mutant lung cancer.
FeNO of 65 ppb or more ruled asthma in and under 20 ppb largely ruled it out, in a meta-analysis validated in primary care
A Lancet Respiratory Medicine analysis gives usable thresholds for suspected asthma with normal spirometry — and shows blood eosinophils add nothing. Also: pooled TETON trials of inhaled treprostinil in IPF, dupilumab cut COPD admissions, and GLP-1 agonists did not prevent new sleep apnoea in type 2 diabetes.
ATS guideline: high-flow for hypoxaemic failure, NIV for hypercapnic
The American Thoracic Society's first comprehensive guideline on noninvasive respiratory support gives strong recommendations for high-flow nasal oxygen in hypoxaemic failure and NIV in hypercapnic failure. Also: biologics work in smokers with severe asthma, astegolimab in frequently exacerbating COPD, and gabapentin for IPF cough.
Portable oxygen for exertional desaturation: breathlessness eased, walking distance did not change
A crossover trial in COPD and ILD tests what ambulatory oxygen actually buys. Also: bronchoscopic cryospray for chronic bronchitis, earlier biologics in severe asthma, COPD and bone, and IgG trends in chronic pulmonary aspergillosis.
Healthy lungs lose 20–30 mL of FVC a year, and most ILD trials never said so
A synthesis of 35 cohorts and 365,000 people finally gives the normal ageing benchmark that interstitial lung disease trials are measured against, 251 studies map what else IPF patients actually have, and a network meta-analysis puts numbers on GOLD grade mortality.
The comfort feature on a CPAP machine is making the treatment worse
Expiratory pressure alleviation halved peak inspiratory flow and raised residual apnoea without improving adherence; mucus plugging on CT marks exacerbation risk where emphysema is mild; and interval training in fibrotic lung disease found no advantage over continuous training.
TP53 status doubles the case for adding chemotherapy to osimertinib
A 294-patient phase 3 trial in EGFR-mutant lung cancer with concurrent TP53 mutation reports progression-free survival of 34.0 against 15.6 months; a COPD composite endpoint predicts later exacerbations and death; and awake ECMO fails in four of ten selected patients.
A bacterial lysate fails to prevent preschool wheeze, and one low eosinophil count is not enough
ORBEX found no reduction in wheezing illness with OM-85 in 822 high-risk toddlers; pooled mepolizumab data show intermittently raised eosinophils identify a treatable COPD phenotype; and tezepelumab cut exacerbations by 70% in a real-world severe asthma population.
ERS recommends add-on sotatercept across three risk strata in PAH, and sugammadex edges neostigmine on postoperative pulmonary complications
The European Respiratory Society updates its pulmonary arterial hypertension guideline around sotatercept with high certainty of evidence; an indirect comparison finds nothing between mepolizumab and dupilumab in eosinophilic COPD; hypoxic burden identifies which sleep apnoea patients gain most from PAP adherence; and SNaPP puts numbers on a reversal-agent choice made thousands of times a day.
With normal spirometry, FeNO of 65 ppb or more pointed strongly to asthma and below 20 ppb made it unlikely
A 30-study meta-analysis with prospective validation gives primary care usable FeNO thresholds, WHO-commissioned data define who is at risk from influenza, and dupilumab cut COPD emergency visits and admissions by 38%.
Asthma symptom scores predicted attacks poorly; eosinophils and FeNO did better
A patient-level analysis of 7161 people argues for biomarkers, not symptoms alone, to guide escalation. Also: ATS guidance on high-flow and non-invasive ventilation, astegolimab in COPD, gabapentin for IPF cough, and exacerbation risk in bronchiectasis.
AI sleep apnoea screening looks excellent in pooled data and unpredictable in any one clinic
Sixty studies, pooled sensitivity 0.94 at an apnoea-hypopnoea index of 5 - and a prediction interval for specificity running from 0.30 to 0.96. Plus synchronised non-invasive ventilation in preterm infants, and a symptom endpoint from MARIPOSA.
Every year of waiting costs remission in severe asthma, and normal lungs lose 20 to 30 mL of FVC a year
Across 9,241 patients in three registries, the odds of clinical remission twelve months after starting a biologic fell by 14% for every decade of asthma beforehand - and by nearly half for every 10 g of lifetime oral steroid.
The comfort setting on the CPAP machine was making the apnoea worse
Expiratory pressure alleviation reduced airway patency and left more residual events without improving adherence; eosinophil reference ranges vary sharply by age and sex; and interval training matched standard rehabilitation in fibrotic interstitial lung disease.
Pleural and pulmonary M1a are not the same prognosis, and palliative care that starts before the end
Two-year survival in 5,632 patients split by M1a descriptor, right ventricular recovery compared after endarterectomy and angioplasty, Pseudomonas ecology in 600 bronchiectasis metagenomes, and a nurse-led model for chronic respiratory disease.
A mild exacerbation is not a mild finding, and taking coal out of rural homes moved symptoms
Three years of community COPD follow-up, a natural experiment in household fuel, blood signatures that predict who relapses after tuberculosis treatment, and what dupilumab does to individual mucus plugs.
ERS recommends sotatercept for everyone above low risk in pulmonary arterial hypertension
A guideline update places an activin signalling inhibitor as add-on therapy across intermediate-low, intermediate-high and high risk on high-certainty evidence; mucus plug burden on CT emerges as a treatable trait in asthma and COPD; and a nine-year cohort suggests CPAP's cardiovascular benefit is concentrated in a measurable high-risk group.
Adding chemotherapy doubled progression-free survival when EGFR and TP53 are both mutated
A 294-patient Chinese phase 3 trial takes median progression-free survival from 15.6 to 34.0 months with osimertinib plus pemetrexed and carboplatin; a WHO-commissioned meta-analysis of 2.15 million patients ranks the risks in seasonal influenza; and 55 per cent of adults with polysomnography-confirmed sleep apnoea meet criteria for metabolic syndrome.
Gabapentin gets a trial in fibrotic cough, and it works
A placebo-controlled trial in idiopathic pulmonary fibrosis finds three-quarters of patients get meaningful cough relief. Also: an expert consensus on when to screen rheumatoid arthritis for lung disease, who actually progresses to severe asthma after a first exacerbation, and what wood dust does to the lungs of workers who breathe it.
Tezepelumab holds up outside the trial population, and an eosinophil count no longer has to be persistently raised to justify a biologic
A phase 4 study puts tezepelumab into the patients trials usually exclude, pooled mepolizumab data show intermittently raised eosinophils respond as well as persistently raised ones, and small-airway function at age seven predicts COPD at fifty-three.
The ATS settles how to choose between high-flow oxygen, CPAP and non-invasive ventilation
A new American Thoracic Society guideline gives a strong recommendation for high-flow nasal cannula in hypoxaemic failure and for non-invasive ventilation in hypercapnic failure, and restricts high-flow in hypercapnia to pH above 7.25. Plus astegolimab cuts COPD exacerbations regardless of eosinophil count.
ATS comes down firmly for high-flow oxygen in hypoxaemic respiratory failure
A new American Thoracic Society guideline settles modality choice across acute respiratory failure, astegolimab cuts COPD exacerbations by 15% irrespective of eosinophils, and dupilumab reduces emergency attendances by 38% in eosinophilic COPD.