The Clinical Year in Review series continued on Monday, May 20, with key results in COPD, critical care, the global burden of lung disease, and tuberculosis (TB).

COPD

The BOREAS trial showed a clear benefit for the use of dupilumab for COPD in patients with chronic bronchitis. Compared to placebo results, dupilumab had a rate ratio of 0.70 for moderate or severe exacerbations versus placebo and increases in FEV1 over 52 weeks.

The ENHANCE1 and -2 studies compared ensifentrine, a novel dual phosphodiesterase (PDE)3 and PDE4 inhibitor versus a placebo. Ensifentrine showed significant improvements in FEV1 and improved time to first COPD exacerbation.

The STARR2 trial found that using blood eosinophil as a biomarker to guide oral prednisolone for COPD exacerbations was not inferior to standard prednisolone dosing.

COPDGene® confirmed that mucus plugs, common in COPD, are associated with higher mortality.

“The higher the nose plug score, the higher the risk of mortality,” said Wassim Labaki, MD, MS, assistant professor of pulmonary and critical care medicine at the University of Michigan.

Critical Care

“It wouldn’t be the Year in Review if we didn’t talk about steroids,” said Anica Law, MD, MS, assistant professor of pulmonary, allergy, sleep, and critical care medicine at Boston University Chobanian & Avedisian School of Medicine.

The CAPE COD trial of intravenous (IV) hydrocortisone for severe community-acquired pneumonia found a 5.6 percent reduction in 28-day mortality versus placebo results, and -5.4 percent at 90 days.

A head-to-head comparison of video-guided versus direct laryngoscopy at 11 medical centers found significantly better first-pass intubation success for video-guided vs. direct procedures, 85.1 percent compared to 70.8 percent.

The PATCH-TRAUMA study compared tranexamic acid (TXA) against a placebo for coagulation in adults with major trauma. TXA patients exhibited better survival rates but more severe disability. Rates of moderate disability to good recovery were similar.

The PROPHY-VAP trial found that antibiotic prophylaxis reduced ventilator-associated pneumonia (VAP) compared with placebo, HR=0.60. Prophylaxis also led to more ventilator-free days, antibiotic-free days, and improved mortality.

Global Lung Health

The fuel used for household cooking and heating can impact lung health. A meta-analysis found that compared to wood/charcoal, domestic gas reduced pneumonia (OR=0.54), wheeze (OR=0.44), breathlessness (OR=0.40), and COPD (OR=0.37).

However, compared to electricity, domestic gas increased the risk of pneumonia (OR=1.26) and COPD (OR=1.15).

Longitudinal data from the BOLD study found that isolated small airway obstruction can predict future chronic airway obstruction.

“Modifying risk factors leading to small airway disease could help in reducing the risk of developing COPD,” said Daniel Obaseki, MD, MPH, Obafemi Awolowo University, Ile-Ife, Nigeria.

A prospective study revealed 10.8 percent mortality for patients with both tuberculosis and COVID-19. The diseases share multiple risk factors for mortality, including older age, HIV infection, and invasive ventilation. 

Also discussed were the consequences of childhood TB. New data from The Gambia showed children who had completed TB treatment reported increased failure to gain weight, lower quality of life, and abnormal spirometry compared to children in the same household with no TB history.

Tuberculosis

A shorter duration for treatment is the current trend in TB. The TRUNCATE-TB trial demonstrated non-inferiority for two novel two-month regiments, rifampin-linezolid and bedaquiline-linezolid, in rifampin-susceptible TB. The STREAM-2 trial showed non-inferiority for different 40-week, oral six-month regimens in rifampin-resistant TB.

New work has demonstrated a spectrum of Mycobacterium TB infection from latent to subclinical to active TB. Two-thirds of those who develop the disease are infectious, and half of the infectious TB patients are symptomatic, noted Sara Auld, MD, MS, associate professor of medicine at Emory University, which might help to explain real-world transmission patterns.

Undernourishment is the single most important factor contributing to TB. The RATIONS trial found that providing 750 Kcal of supplemental nutrition to those in contact with households containing someone with TB for six months reduces incidents of TB by 40 percent.

“Food is the TB vaccine we already have,” Dr. Auld said. “We just need to feed people.”