The edition · Pulmonology
A battery-powered TB test came close to Xpert Ultra in a Cochrane review
Near point-of-care NAATs for pulmonary tuberculosis, pooled TETON results for inhaled treprostinil in IPF, bronchoscopic cryospray for chronic bronchitis, and small airway dysfunction as the link between obesity and asthma attacks.
The edition in brief
A Cochrane review for the WHO pooled five studies of 3,291 people with presumptive pulmonary tuberculosis in high-burden countries tested with a near point-of-care nucleic acid amplification test, a battery-operated platform designed for peripheral clinics. Against culture, sensitivity was 85.4% and specificity 97.6%; sensitivity was lower than Xpert MTB/RIF Ultra by about 7.5 points, much higher than smear microscopy, and weaker in people with HIV and in smear-negative disease. Most testing was done in laboratories, not peripheral settings. Pooled TETON-1 and TETON-2 data in 1,191 people with idiopathic pulmonary fibrosis showed inhaled treprostinil slowed FVC loss by about 112 mL over 52 weeks and delayed clinical worsening and exacerbations; cough was the commonest side effect. In SPRAY-CB, 203 people with COPD and chronic bronchitis randomised to bronchoscopic metered liquid nitrogen cryospray or sham improved more on SGRQ (−5.9) and CAT (−3.4), but overall exacerbations did not differ and pneumothorax followed 3.6% of treatments. In 1,169 adults with asthma, oscillometry-defined small airway dysfunction was commoner with obesity and associated with severe exacerbations, accounting for roughly a quarter to two fifths of the obesity–exacerbation link.
Inhaled treprostinil slowed FVC loss by about 110 mL a year in IPF
Inhaled treprostinil slowed lung function decline in IPF over a year, with fewer exacerbations, but its place alongside antifibrotics is still to be defined.
Bronchoscopic cryospray improved symptom scores in chronic bronchitis but not overall exacerbations
Bronchoscopic cryospray gave modest symptom gains in chronic bronchitis without reducing overall exacerbations; it is not yet a routine option.
Small airway dysfunction may explain part of why obese patients with asthma have more attacks
In obese patients with asthma and frequent attacks, small airway dysfunction is worth looking for even when spirometry is near normal.
A negative molecular test does not rule out smear-negative TB
A negative molecular TB test lowers the probability of disease but does not exclude it when clinical suspicion is high.
A battery-powered near point-of-care TB test detected 85% of culture-positive cases
Near point-of-care TB NAATs outperform smear microscopy and come close to Xpert Ultra, making them useful where molecular testing is not otherwise available.
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