The edition · Pulmonology
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.
The edition in brief
In a randomised crossover trial of 40 patients with COPD or interstitial lung disease who desaturated on exertion, 1–2 L/min of pulsed oxygen from a portable concentrator did not change six-minute walk distance compared with air (difference 0 m, 95% CI −14 to 13) but reduced breathlessness; patients were split on which they preferred. In SPRAY-CB, 203 patients with COPD and chronic bronchitis randomised to bronchoscopic liquid-nitrogen cryospray improved quality of life (SGRQ −5.9, CAT −3.4) against sham, with a 3.6% pneumothorax rate per treatment. A registry analysis of 9,241 people with severe asthma found remission after biologics was less likely the longer asthma and lung function impairment had lasted. A Taiwanese cohort associated COPD with a higher risk of osteoporosis than type 2 diabetes (aHR 1.51), particularly in men. A small French study suggested a rise in anti-Aspergillus IgG may flag worsening chronic pulmonary aspergillosis.
Cryospray for chronic bronchitis improved symptom scores in a sham-controlled trial
Cryospray improved symptom scores in chronic bronchitis, but the effect was modest; exhaust standard treatment first.
Severe asthma: the longer biologics were delayed, the less likely remission
Refer eligible severe asthma for biologic assessment early, before repeated steroid courses and fixed airflow obstruction accumulate.
COPD carried a higher osteoporosis risk than type 2 diabetes, especially in men
Screen patients with COPD, including men, for osteoporosis and fracture risk.
Chronic pulmonary aspergillosis: a rising IgG may flag worsening disease
A clear rise in anti-Aspergillus IgG should prompt earlier CT in chronic pulmonary aspergillosis; a stable level does not exclude progression.
FDA: a dexamethasone supplement with no respiratory bearing
No respiratory action: today's only FDA item concerns an intravitreal dexamethasone implant.
Pulse settings are not litres per minute
Titrate ambulatory oxygen by measuring SpO2 during walking on the patient's own device, not by a number on the dial.
Ambulatory oxygen in COPD and ILD: prescribe for breathlessness, and test each patient
Before prescribing ambulatory oxygen, test the patient walking on air and on oxygen, and prescribe it for those whose breathlessness or distance clearly improves.
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