Seven in ten biologic-eligible severe asthma patients improved on standard care alone

The edition in brief

In 10,078 UK adults with severe asthma who first met biologic eligibility with three or more steroid-treated exacerbations in a year, 70% fell to fewer than three exacerbations a year without a biologic, even as inhaled steroid doses fell. A fifth stayed frequent exacerbators, with higher blood eosinophils visible years earlier, and a tenth needed more than ten steroid courses a year. In 4,821 Canadian patients from a tertiary airways clinic, sputum eosinophils above 3% were linked to roughly double the rate of asthma emergency visits, while in COPD high sputum neutrophils, not eosinophils, were linked to more admissions. In 215 Chinese patients with COPD, CT-measured mucus plugs and emphysema each raised the odds of exacerbation, with mucus plugs mattering most when emphysema was mild. A 58-patient phase 2 trial of an anti-inflammatory conjugate in ARDS showed acceptable safety but an unexplained early mortality imbalance. A 60-patient trial found closed suctioning in ARDS preserved lung volume and early saturation better than open suctioning, without differences in outcomes. The pearl covers checking inhaler technique and adherence before escalating.