The edition · Pulmonology
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.
The edition in brief
Post hoc analyses of IMPACT, FULFIL and the mepolizumab MATINEE/METREX/METREO trials defined COPD stability as no moderate or severe exacerbation and no worsening in COPD Assessment Test score or FEV1. Between 18% and 46% of patients reached it; those stable at week 28 had a 45.7% lower risk of later exacerbation and 51.7% lower risk of death. In an international cohort of 307 adults with ARDS supported by ECMO without invasive ventilation, 90-day mortality was 30.1% with primary awake ECMO and 14.9% when extubated on ECMO; strategy failure, mostly in the first ten days, carried six- to eightfold higher mortality. In SPIROMICS (880 participants), a one-year increase in machine-learned CT emphysema subtypes predicted faster subsequent FEV1 decline, supporting their use as trial endpoints. In US survey data, adults newly eligible for lung cancer screening under the 2023 ACS criteria, who quit more than 15 years ago, were screened at less than half the rate of USPSTF-eligible adults (8.0% vs 17.8%).
ECMO without intubation in ARDS failed in a quarter to two-fifths, and failure carried high mortality
If ARDS is managed on ECMO without intubation, watch the first ten days closely and intubate early when secretions or agitation cannot be controlled.
One year of CT emphysema progression predicted faster FEV1 decline in SPIROMICS
When a CT shows emphysema, arrange spirometry and push smoking cessation; CT progression tracks future lung function loss.
Former smokers newly eligible for lung cancer screening were screened at under half the usual rate
Take a full smoking history including quit date; former heavy smokers remain at risk long after quitting.
Three checks at every COPD review define whether the patient is stable
At each COPD review record exacerbations, CAT and FEV1; a moderate or severe exacerbation, or a clinically meaningful worsening in CAT or FEV1, should prompt review.
Reaching COPD stability predicted about half the later risk of exacerbation and death
Consider stability as a proposed composite target in COPD; failure to reach it should prompt review of adherence, inhaler technique and diagnosis, with escalation following GOLD criteria.
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