ERS/ESRS guidance: CPAP strongly recommended for sleepy patients with sleep apnoea, conditional for the rest

The edition in brief

A joint European Respiratory Society and European Sleep Research Society guideline strongly recommends CPAP for adults with obstructive sleep apnoea and excessive daytime sleepiness, and conditionally suggests it for sleep apnoea generally because of benefits on sleepiness, patient-reported outcomes and blood pressure, with further conditional recommendations for moderate-to-severe disease, older adults and resistant hypertension. Without sleepiness, in atrial fibrillation to reduce recurrence, and in impaired glucose metabolism, it suggests either CPAP or no treatment. A Chinese multicentre trial of 2,485 patients randomised to contrast-enhanced ultrasound, plain ultrasound or CT guidance for subpleural lung biopsy found contrast ultrasound gave the highest diagnostic yield (88.8% vs 78.9% CT, 76.0% ultrasound) and the fewest complications (4.6% vs 15.8% with CT). In a Chinese community cohort, three or more CT mucus plugs in people with normal spirometry were linked to more exacerbations and more than twice the rate of developing COPD over three years. A US registry study of 3,096 people with cystic fibrosis and ABPA found adding antifungals to oral corticosteroids was not associated with better lung function or fewer exacerbations.