The edition · Pulmonology
ATS recommends steroid-containing relievers across asthma severity
An American Thoracic Society guideline makes strong recommendations against SABA-only relief in mild asthma and for maintenance-and-reliever therapy at higher steps. Also: prone positioning and oscillation in paediatric ARDS, nasal nitric oxide to find ciliary dyskinesia in bronchiectasis, and adjuvant crizotinib.
The edition in brief
Today's pulmonology edition closes on an American Thoracic Society guideline on inhaled corticosteroid-containing relievers in adolescents and adults. At the two mildest treatment steps it strongly recommends as-needed ICS-formoterol or ICS-SABA over SABA alone, and conditionally over daily ICS with SABA. At steps 3 to 5 it strongly recommends maintenance-and-reliever therapy with ICS-formoterol over fixed ICS-LABA with SABA, and conditionally an ICS-SABA reliever for those staying on ICS-LABA. PROSpect, stopped early after 424 children with moderate-to-severe paediatric ARDS, found neither prone positioning nor high-frequency oscillation increased ventilator-free days; proning raised airway obstruction and pressure injuries, and oscillation raised haemodynamic instability. In 373 adults and adolescents with bronchiectasis in Shanghai, 7.4% had primary ciliary dyskinesia, and nasal nitric oxide screened with 85% sensitivity and 97% specificity. E4512 found two years of adjuvant crizotinib did not improve disease-free survival after resection of ALK-positive lung cancer (hazard ratio 1.08). The pearl covers SABA canister counts as a marker of poor control.
Paediatric ARDS: prone positioning and oscillation did not add ventilator-free days, and added harms
Neither routine prone positioning nor high-frequency oscillation improved ventilator-free days in early paediatric ARDS, and both added harms; keep them for rescue.
Bronchiectasis: one in 14 had primary ciliary dyskinesia, and nasal nitric oxide found most
Screen bronchiectasis patients with early onset, chronic rhinosinusitis or situs inversus for primary ciliary dyskinesia.
Adjuvant crizotinib did not improve disease-free survival in resected ALK-positive lung cancer
Adjuvant crizotinib did not improve disease-free survival after resection of ALK-positive lung cancer and should not be used in place of alectinib.
Count the reliever canisters
Ask every asthma patient how many reliever canisters they used last year, and treat high use as a reason to review, not refill.
ATS guideline: steroid-containing relievers recommended at every asthma step
Replace SABA-only relief with an inhaled-steroid-containing reliever in adolescents and adults with asthma, and use ICS-formoterol as maintenance and reliever at higher steps.
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