30-Second Takeaway
- Start nintedanib at 100 mg BID in fibrosing ILD to enhance 12‑month treatment persistence with similar short-term FVC.
- Offer structured pulmonary rehabilitation to adults with post‑TB lung disease; it substantially improves exercise capacity and HRQoL at low cost.
- Recognize 2021 USPSTF lung cancer screening criteria miss many cancers across stages, limiting real-world screening impact.
- Do not expect AI-based CXR worklist prioritization alone to shorten lung cancer diagnostic timelines in UK-like systems.
- Use EIT-guided PEEP titration in ARDS where available to improve oxygenation and compliance, acknowledging unproven mortality benefit.
Week ending March 28, 2026
Targeted updates in ILD therapy, post-TB rehab, lung cancer pathways, ARDS ventilation, and bronchiectasis care
Lower starting dose of nintedanib improves 12‑month persistence in fibrosing ILD
This target-trial emulation compared initiating nintedanib 100 mg versus 150 mg twice daily in 172 fibrosing ILD patients. Starting at 100 mg increased 12‑month restricted mean time on treatment by about 53 days versus 150 mg. The 12‑month discontinuation risk was lower with 100 mg initiation than with 150 mg dosing. Among survivors, change in FVC % predicted at about 1 year was broadly similar between groups, though estimates were imprecise.
Pulmonary rehabilitation for post-TB lung disease improves function and quality of life at low cost
This single-blind RCT in Bishkek randomized 114 adults with post‑tuberculosis lung disease to supervised pulmonary rehabilitation or usual care. Pulmonary rehabilitation produced much greater gains in exercise capacity, with an incremental shuttle walking distance increase of 123 m versus control. Health-related quality of life improved more with rehabilitation, with a 20.2‑point EQ‑5D‑5L VAS advantage. Rehabilitation increased QALYs and cost about US$95 per patient, yielding a low cost per QALY gained.
USPSTF 2021 lung cancer screening criteria miss many early and late cancers
This analysis evaluated 7,017 BLCS, 1,807 SCCS, and 5,681 MECS lung cancer cases for eligibility under 2021 USPSTF screening criteria. Among late-stage cancers, only 41–59% would have qualified for screening across cohorts. Similar proportions of early-stage cancers met criteria, indicating many potentially curable cases remain ineligible. Key reasons for ineligibility were less than 20 pack‑years in SCCS and MECS and smoking cessation more than 15 years prior in BLCS.
AI worklist prioritization of primary-care CXRs does not speed lung cancer diagnosis
The LungIMPACT multicentre RCT tested whether AI-based prioritization of primary-care chest X‑rays shortened time to CT and lung cancer diagnosis. Over 93,000 CXRs were analyzed, with AI prioritization randomized by day while AI remained available in both arms. Median time to CT was 53 days in both groups, with no significant difference in geometric mean times. Median time to lung cancer diagnosis was similar, 44 versus 46 days, with no significant difference in referral time, treatment time, or stage.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.