ERS guideline adds sotatercept for pulmonary arterial hypertension; exhaled nitric oxide gets rule-in and rule-out thresholds for asthma

The edition in brief

An ERS guideline update recommends add-on sotatercept in pulmonary arterial hypertension patients already on PAH drugs who are at intermediate-low, intermediate-high or high risk of death (high-certainty evidence), makes no recommendation for low-risk patients, advises treatment in pulmonary hypertension centres, and suggests right heart catheterisation during follow-up where treatment would change. A meta-analysis of six prospective studies (12,194 patients) found diagnostic failure of 0.12% (95% CI 0.06 to 0.26) when pulmonary embolism was ruled out without CT using age-adjusted or probability-adjusted D-dimer cut-offs, and 0.50% (0.20 to 1.11) in the adaptive window. In the ENCORE phase 3b trial of 425 adults with newly diagnosed Mycobacterium avium complex lung disease, adding inhaled amikacin liposome to azithromycin and ethambutol improved respiratory symptom score by 3.11 points more and raised culture conversion by month 13 (82.4% vs 55.6%). A 627-patient trial found cryobiopsy gave a higher histological yield than conventional sampling for peripheral lung lesions (83% vs 75%) at the cost of more moderate bleeding. A meta-analysis of 30 studies found exhaled nitric oxide had good accuracy for diagnosing asthma in adults (AUC 0.80), with thresholds of 65 ppb or more to rule in and below 20 ppb to rule out in primary care, while blood eosinophils added nothing.