In 7,161 people with asthma, symptom scores barely predicted attacks; eosinophils and FeNO picked out who would respond

The edition in brief

An individual participant data meta-analysis of 7,161 people across five datasets, led by the ORACLE2 control arms of 22 trials, found the ACQ-5 symptom score did not track lung function, comorbidity or inflammation, and each 0.5-point rise added only modestly to attack risk (rate ratio 1.09). It did not change the response to mepolizumab, whereas raised blood eosinophils with raised FeNO identified the largest benefit (rate ratio 0.38). A multicentre target-trial emulation of 2,270 patients with fibrotic ILD found mycophenolate or azathioprine started within six months was not associated with better three-year transplant-free survival or lung function in any subtype, and was associated with worse survival in non-IPF idiopathic interstitial pneumonia (HR 1.38) and fibrotic hypersensitivity pneumonitis (HR 1.62); the design is observational and guidelines are unchanged. In nine ventilated ARDS patients on pressure support, intravenous ondansetron after placebo lowered inspiratory effort, respiratory rate and diaphragm activity, with a small rise in PaCO2 and better oxygenation. In a 15-patient pilot, endobronchial optical coherence tomography agreed with the final multidisciplinary ILD diagnosis in every case, including six where cryobiopsy was non-diagnostic.