Pulmonology

Early post-discharge pulmonary rehab after AECOPD best reduces readmissions and dyspnoea

This network meta-analysis pooled 26 RCTs including 1,800 patients with AECOPD after hospitalization. Starting pulmonary rehabilitation within 2 weeks post-discharge reduced readmissions, improved mMRC dyspnoea, and improved SGRQ versus usual care, ranking best for these outcomes. Initiation after 48 hours of admission produced the largest six-minute walk distance gains but not the strongest reduction in readmissions. Mortality, FEV₁%, and Borg dyspnoea did not differ significantly by timing strategy. 1

Moderate and severe COPD exacerbation histories carry opposing risks for future events and death

This Ontario cohort followed 279,798 COPD patients ≥65 years using administrative data from 2007 to 2018. Patients with ≥2 moderate exacerbations (GOLD E moderate) had higher risks of future exacerbations but lower mortality than those with ≤1 moderate exacerbation (AB). Patients with ≥1 severe exacerbation (GOLD E severe) had slightly lower exacerbation risk but substantially higher mortality compared with AB patients. These patterns held across multiple subsequent events in Fine-Gray competing risk models. 2

Two-year ETI therapy sustains lung function gains across large and small airways in CF

German CF Registry data on 2,375 people with CF aged ≥6 years documented lung function before and 24 months after elexacaftor/tezacaftor/ivacaftor initiation. Adolescents with baseline ppFEV1 40–60% had median ppFEV1 increases around 17–20%, while adults with similar baseline function gained around 11–12%. After initial improvement, ppFEV1 remained stable for 24 months across age groups, without clear predictors of >5% additional gain. Forced mid-expiratory flow 25–75% increased substantially in all age groups, including those with normal baseline ppFEV1. 3

Adjunctive inhaled antibiotics improve cure and may lower mortality in VAP-only patients

This systematic review included 32 RCTs of adjunctive inhaled antibiotics for ventilator-associated pneumonia, plus nonrandomized studies in sensitivity analyses. Compared with placebo or no inhaled therapy, inhaled antibiotics increased clinical cure and reduced all-cause mortality in VAP-only populations, but not consistently in mixed pneumonias. They improved microbiologic eradication and reduced emergence of new drug resistance without changing ICU stay, ventilator duration, or most adverse events. Versus IV antibiotics alone, inhaled regimens shortened ventilator duration by about 2 days and reduced nephrotoxicity, based on three small RCTs. 4