Adaptive D-dimer cut-offs missed few PEs even in the 'grey zone' above 500

The edition in brief

Today's pulmonology edition closes on adaptive D-dimer thresholds for suspected pulmonary embolism. Pooling six prospective management studies of 12,194 patients, the three-month failure rate when PE was excluded without CT pulmonary angiography was 0.12% overall, and 0.50% (95% CI 0.20 to 1.11%) among patients whose D-dimer was above 500 ng/mL but below the age- or probability-adjusted cut-off. In 10,078 UK adults who first met biologic criteria for severe asthma, 70% improved to fewer than three exacerbations a year on standard care alone; a persistently frequent group had higher blood eosinophils years before eligibility. A Chest review argues that extending low-dose CT screening to people without a substantial smoking history, as in China, risks more overdiagnosis than benefit unless advanced-stage incidence falls. In 373 Chinese adults and adolescents with bronchiectasis, nasal nitric oxide screening identified primary ciliary dyskinesia in 7.4%, with sensitivity 84.8% and specificity 97.1%. The pearl covers what to check before calling asthma severe.