A mild exacerbation is not a mild finding, and taking coal out of rural homes moved symptoms

The edition in brief

China's Clean Heating Policy, rolled out village by village across rural Beijing, gave a natural experiment in household air pollution: among 1,003 adults over 40 followed across four winters, exposure to the policy was associated with a 7.5 percentage point fall in the prevalence of any respiratory symptom, with no measurable change in exhaled nitric oxide. In 329 Brazilian adults with drug-susceptible pulmonary tuberculosis, blood transcriptomic signatures measured at baseline and at two months predicted later recurrence with areas under the curve from 0.71 to 0.91, and several measured at baseline predicted death with AUC of 0.80 or more — but prediction of microbiological treatment failure was poor throughout, and no signature met WHO benchmarks at the end of treatment. In 32 adults with moderate to severe asthma scanned before and after, dupilumab resolved 91% of individual mucus plugs against 58% in controls, produced far fewer new plugs, and lowered the radiodensity of those that persisted; the plugs that remained still tracked with ventilation defects. The practice-changer comes from 915 community-dwelling people with COPD: those whose only exacerbation in the previous year was mild, or a single moderate one, had 1.7 to 2.3 times the rate of subsequent exacerbations over three years, and more emphysema or air trapping on CT, than those with none — even though lung function declined at the same rate in all groups.