A battery-powered TB test was accurate but missed more than Xpert Ultra; inhaled treprostinil slowed FVC decline in IPF

The edition in brief

A Cochrane review of near point-of-care nucleic acid amplification tests (NPOC-NAATs) for pulmonary tuberculosis pooled five studies of 3,291 people, all evaluating one marketed test (the MTB NAT Card with the MiniDock device) on sputum. Sensitivity against culture was 85.4% and specificity 97.6%; sensitivity was 79.2% in people living with HIV and 66.7% in smear-negative, culture-positive disease, and lower than Xpert MTB/RIF Ultra (85.6% vs 93.1%). Most studies tested in laboratories, so applicability to peripheral settings is uncertain. The combined TETON-1 and TETON-2 analysis of 1,191 people with idiopathic pulmonary fibrosis found a 52-week FVC decline of 45.4 mL with inhaled treprostinil against 161.7 mL with placebo (difference 111.8 mL, 95% CI 79.7 to 144.0), with deaths of 6.9% against 9.4%; cough was the commonest adverse event and the manufacturer funded the work. A UK cohort of 206,381 adults with type 2 diabetes and obesity found no lower incidence of diagnosed sleep apnoea with GLP-1 receptor agonists than DPP-4 inhibitors (HR 1.07, 0.93 to 1.23). In SPRAY-CB, a metered cryospray in 203 people with COPD and chronic bronchitis improved SGRQ by 5.9 points more than sham (95% CI -11.6 to -0.2), with a 3.6% pneumothorax rate per treatment. The pearl covers confirming COPD with spirometry.