Pulse steroids did not beat standard doses in acute IPF exacerbation

The edition in brief

The edition closes on SAFER, a randomised trial at eight Korean hospitals in 100 adults with acute exacerbation of idiopathic pulmonary fibrosis. Pulse methylprednisolone (10 mg/kg for three days) did not lower 28-day mortality (10.0% vs 14.6%) or 90-day mortality (24.5% vs 29.8%) compared with 1 mg/kg for seven days, and secondary outcomes did not differ. The trial was small, so a modest benefit cannot be excluded, but it gives no support for routinely choosing pulse doses. In 2251 hospitalised patients with pulmonary embolism, the 2026 AHA/ACC clinical categories separated 30-day mortality better than the 2019 ESC risk strata (AUC 0.885 vs 0.763) and found a group the ESC scheme called intermediate risk in which three-quarters died. In the US CHRONICLE cohort of 480 people with severe asthma, biologics were associated with a 57% fall in severe exacerbations, with the largest effects in non-smokers, those with frequent exacerbations and raised type 2 markers; spirometry-based trial exclusions did not predict response. A meta-analysis found shared decision-making or outreach combined with patient navigation raised lung cancer screening uptake, while education alone did not. The pearl covers checking inhaler technique.