Seven in ten biologic-eligible severe asthma patients improved on standard care alone

The edition in brief

In 10,078 biologic-naive UK adults who first met biologic criteria for severe asthma (Chest, 5 October), 70% settled to fewer than three steroid-treated exacerbations a year on standard care, while 20% kept exacerbating about five times a year and 10% had refractory, heavy oral steroid use. The persistently frequent group had higher blood eosinophils years before becoming eligible. A US claims analysis (Chest, 31 October) put five-year bronchiectasis prevalence at about 222 per 100,000, higher in women, Asian people and older adults, with most cases not related to cystic fibrosis. A single-centre Italian trial of 88 patients with acute respiratory failure, hypersecretion and weak cough on non-invasive support (Chest, 14 October) found high-frequency chest wall oscillation lowered the need for therapeutic bronchoscopy (14% vs 32%), though not significantly after adjustment; shorter stays were exploratory. A 16-patient crossover trial (Sleep and Breathing, 28 October) found two custom mandibular advancement devices both lowered the apnoea-hypopnoea index in moderate OSA, with no difference shown between them. The pearl covers ruling out non-tuberculous mycobacteria before long-term macrolides.