European guideline ties CPAP to sleepiness, not to every sleep study, and contrast ultrasound lifts lung biopsy yield

The edition in brief

A joint ERS/ESRS guideline strongly recommends CPAP for adults with obstructive sleep apnoea and excessive daytime sleepiness, and conditionally suggests it for most others for sleepiness, quality of life and blood pressure, with specific conditional recommendations for moderate to severe disease, older adults and resistant hypertension. For patients without sleepiness, with atrial fibrillation (to prevent recurrence) or with impaired glucose metabolism, it suggests either CPAP or no treatment. In a Chinese trial of 2,485 patients with subpleural lung lesions, contrast-enhanced ultrasound-guided biopsy gave a diagnostic yield of 88.8% against 78.9% for CT and 76.0% for plain ultrasound, with complications in 4.6%, 15.8% and 7.5%. In a community cohort of 1,939 Chinese adults, three or more mucus plugs on CT in people with preserved spirometry were associated with more exacerbations and with developing COPD (18.2% vs 7.6%) over three years. A study of 121 pregnancies in women with bronchiectasis found exacerbations in 58.6%, stable lung function, and birth weight correlated with pre-pregnancy FEV1. The pearl covers the first weeks of CPAP.