Pulse steroids did not improve survival over standard doses in acute exacerbation of IPF

The edition in brief

SAFER randomised 100 Korean adults with acute exacerbation of idiopathic pulmonary fibrosis to pulse methylprednisolone (10 mg/kg for 3 days) or a non-pulse regimen (1 mg/kg for 7 days), both followed by tapering. Mortality at 28 days was 10.0% against 14.6% and at 90 days 24.5% against 29.8%, neither significantly different, and the trial was too small to exclude a moderate effect either way. In a Chinese cohort of 2,251 inpatients with pulmonary embolism, the 2026 AHA/ACC clinical categories discriminated 30-day mortality better than the 2019 ESC classification (AUC 0.885 vs 0.763) and flagged a group the ESC scheme called intermediate risk in which three-quarters died. A meta-analysis of six trials (1,069 adults) found liraglutide and tirzepatide reduced the apnoea-hypopnoea index by about 10 events an hour, with high heterogeneity and no change in oxygen desaturation measures. A Cambodian cohort reports that respiratory symptoms, depressive symptoms and stigma can persist two years after tuberculosis treatment. The pearl: before stepping up an inhaler, watch the patient use it.