The edition · Pulmonology
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 edition in brief
Today's pulmonology edition opens with a meta-analysis of 251 observational studies covering 606,398 patients with idiopathic pulmonary fibrosis. Systemic hypertension was present in 39%, dyslipidaemia in 30%, gastro-oesophageal reflux in 27%, obesity in 22%, diabetes in 21%, ischaemic heart disease in 20% and heart failure in 15% — rates generally higher than in the trial cohorts that generate treatment evidence. Lung cancer was the only comorbidity consistently associated with higher short- and long-term mortality. A network meta-analysis of 34 publications and 1,459,685 participants gives mortality hazard ratios by GOLD grade against normal spirometry: 1.09 (95% CI 0.97–1.22) for GOLD 1, rising to 4.54 (3.44–6.01) for GOLD 4, with derived one-year mortality in Germany ranging from 0.15% to 64.8% depending on grade, age and sex. A Chest framework sets out how to adapt bronchiectasis and nontuberculous mycobacterial care to health systems that cannot assume subspecialty access or costly therapy. The regulatory sweep carries an administrative supplement to a generic triamcinolone acetonide application. The edition closes on a systematic review of 35 cohorts and over 365,000 adults without lung disease establishing that forced vital capacity peaks in the mid-20s and then falls by roughly 20–30 mL a year — the benchmark against which every interstitial lung disease trial endpoint should be read.
Two in five patients with IPF have hypertension, and one in four has reflux
Assume more comorbidity than the trials described, and screen actively for cardiovascular disease, reflux and lung cancer.
GOLD 1 barely raises mortality; GOLD 4 more than quadruples it
Give prognosis by GOLD grade, not by the COPD label — and note that mild obstruction alone does not clearly raise mortality.
Bronchiectasis guidelines assume a health system many patients do not have
Where full guideline care is not deliverable, prioritise early recognition, risk-based referral and airway clearance — and always exclude NTM before a long-term macrolide.
FDA approved a supplement to a generic triamcinolone acetonide application
Nothing to act on; an administrative supplement to a generic application with no change to how the drug is used.
A generic inhaler switch is a device switch — check the technique again
Watch the patient use the inhaler they actually have, especially after a generic substitution.
The normal lung loses 20–30 mL of FVC a year, which changes how to read every ILD trial
Hold every FVC decline — in a trial report or in your own patient — against a normal of 20–30 mL a year.
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