Three weeks of steroids fell short of six for mild immune-related pneumonitis

The edition in brief

In a Japanese trial of 106 patients with grade 1–2 immune checkpoint inhibitor pneumonitis, a three-week steroid taper failed to show non-inferiority to the guideline six-week taper. Treatment success at eight weeks was 66.7% versus 85.2%, and an exploratory analysis favoured six weeks. Grade 3 or worse adverse events were more frequent with six weeks (24% vs 12%) but manageable, and survival was similar. The 2026 GINA strategy report keeps its core message: every adult and adolescent with asthma should receive inhaled corticosteroid-containing treatment, SABA-only treatment is not recommended, and as-needed or maintenance-and-reliever low-dose ICS-formoterol is preferred. This year's changes widen anti-inflammatory reliever options, revise biologic selection and update acute asthma care. A patient-level meta-analysis of 7,161 people found the ACQ-5 symptom score added little to prediction of severe attacks (rate ratio 1.09 per 0.5 points). Blood eosinophils and FeNO better identified who was at risk and who would respond to mepolizumab. In two US cohorts with idiopathic pulmonary fibrosis, about four in ten patients reduced or stopped antifibrotics, and progression was common whatever the dose, with a signal of faster progression after stopping in one cohort. The pearl covers checking inhaler technique before escalating asthma treatment.