Common variable immunodeficiency: an ERS guideline recommends screening every adult for GLILD with HRCT

The edition in brief

An ERS Clinical Research Collaboration guideline, developed with GRADE methodology, recommends screening all adults with common variable immunodeficiency for granulomatous-lymphocytic interstitial lung disease (GLILD), preferably with high-resolution CT, with multidisciplinary evaluation, exclusion of infection, bronchoalveolar lavage for lymphocytic alveolitis and full lung function including gas transfer; biopsy is reserved for atypical cases. Most recommendations are conditional. In a crossover study of 20 adults with obstructive sleep apnoea who had not adhered to CPAP, a digitally made mandibular advancement appliance reduced median oxygen desaturation index from 13.6 to 6.1 events per hour, against 5.3 on CPAP, with no significant difference in snoring or hypoxic burden. A randomised trial of 75 COPD patients on home non-invasive ventilation found web-based education improved patient-reported NIV symptoms at 4 and 8 weeks and insomnia severity at 8 weeks. A phase 2 trial of 58 patients with infection-related ARDS found TISA-818 tolerable, with a numerical, non-significant gain in respiratory-support-free days in non-intubated patients and an unexplained day-28 mortality imbalance. The pearl covers who suits a mandibular advancement device.