Adaptive D-dimer cut-offs ruled out pulmonary embolism safely, even above 500

The edition in brief

Six prospective management studies of 12,194 patients with suspected pulmonary embolism, in which age-adjusted or clinical probability-adjusted D-dimer thresholds decided who had CT pulmonary angiography, showed a pooled 3-month failure rate of 0.12% when PE was excluded without imaging, and 0.50% in the adaptive window between 500 ng/mL and the adjusted cut-off. In a Chinese community cohort of 1,939 adults, three or more CT mucus plugs in people with preserved spirometry were associated with more exacerbations and a higher risk of developing spirometric COPD (18.2% vs 7.6%). A pooled analysis of three mepolizumab trials in COPD found benefit in patients with eosinophils of 300 cells/µL or more at any point in the prior year, including variable counts, but none in those persistently below 150. The PASSAGE real-world study found tezepelumab associated with 70% fewer asthma exacerbations across phenotypes. And China's Clean Heating Policy, which replaced household coal, was associated with a 7.5-point fall in the prevalence of respiratory symptoms.