Daily Respiratory Research Analysis
Three impactful respiratory studies stood out today. A Cochrane network meta-analysis suggests NIPPV and NIHFV may reduce treatment failure versus CPAP/HFNC as primary non-invasive support in preterm infants, though certainty is low. A randomized audit-and-feedback intervention to family physicians reduced antibiotic prescribing across all ages, and a large real‑world pooled analysis showed mepolizumab substantially improves outcomes in severe eosinophilic asthma with and without nasal polyps.
Summary
Three impactful respiratory studies stood out today. A Cochrane network meta-analysis suggests NIPPV and NIHFV may reduce treatment failure versus CPAP/HFNC as primary non-invasive support in preterm infants, though certainty is low. A randomized audit-and-feedback intervention to family physicians reduced antibiotic prescribing across all ages, and a large real‑world pooled analysis showed mepolizumab substantially improves outcomes in severe eosinophilic asthma with and without nasal polyps.
Research Themes
- Non-invasive respiratory support strategies in preterm infants
- Antibiotic stewardship using audit-and-feedback
- Biologic therapy effectiveness in severe eosinophilic asthma with/without CRSwNP
Selected Articles
1. Non-invasive respiratory support in preterm infants as primary mode: a network meta-analysis.
Across 61 trials (n=7554), NIPPV and NIHFV may reduce treatment failure and the need for endotracheal ventilation compared with CPAP and HFNC when used as primary support in preterm infants, though certainty is low to very low. Moderate–severe CLD outcomes showed little to no difference, and extremely preterm infants (<28 weeks) remain under-studied.
Impact: This high-quality Cochrane network meta-analysis synthesizes the comparative effectiveness of all major non-invasive respiratory modes in preterm infants, directly informing first-line respiratory support choices.
Clinical Implications: Consider NIPPV or NIHFV as primary support over CPAP/HFNC—particularly in infants ≥28 weeks—while acknowledging low certainty and prioritizing individualized care. Avoid overinterpreting CLD outcomes; ensure comparable mean airway pressures in practice and trials.
Key Findings
- NIPPV may reduce treatment failure versus CPAP (network RR 0.63, 95% CrI 0.48–0.82; very low certainty).
- NIHFV may reduce treatment failure versus CPAP (network RR 0.41, 95% CrI 0.23–0.69; low certainty).
- Risk of endotracheal ventilation may be lower with NIPPV and NIHFV versus CPAP/HFNC (very low certainty).
- Little to no effect on moderate–severe CLD across modes; evidence generally very uncertain.
- Data for <28 weeks’ gestation are sparse; many studies did not match mean airway pressures across modes.
Methodological Strengths
- Comprehensive NMA with Bayesian random-effects model across 61 trials and 7554 infants.
- GRADE adapted for network meta-analysis; sensitivity analyses by risk of bias and gestational age strata.
Limitations
- Overall low to very low certainty due to risk of bias, imprecision, and network incoherence.
- Modes often not compared at equivalent mean airway pressures; very limited evidence for <28 weeks’ gestation.
Future Directions: Conduct high-quality RCTs in extremely preterm infants (<28 weeks) with standardized mean airway pressures, and assess longer-term outcomes including CLD and neurodevelopment.
2. Spillover From an Intervention on Antibiotic Prescribing for Family Physicians: A Post Hoc Secondary Analysis of a Randomized Clinical Trial.
In a post hoc analysis of a randomized trial including 4964 family physicians, a mailed peer-comparison audit-and-feedback letter reduced total antibiotic prescribing at 12 months (aRR 0.93) across all age/sex groups and antibiotics commonly used for respiratory infections. Long-duration (>7 days) prescriptions also decreased (aRR 0.82).
Impact: Demonstrates real-world, scalable spillover benefits of audit-and-feedback, supporting broad antimicrobial stewardship using routinely collected data.
Clinical Implications: Peer-comparison feedback can be implemented at scale to reduce unnecessary antibiotic use—including for respiratory infections—and shorten treatment durations, even when the primary target population is older adults.
Key Findings
- Total antibiotic prescriptions decreased at 12 months (aRR 0.93; 95% CI 0.93–0.94) in the intervention group.
- Reductions were consistent across all age and sex strata and for respiratory-use antibiotics.
- Proportion of long-duration (>7 days) prescriptions decreased significantly (aRR 0.82; 95% CI 0.82–0.83).
Methodological Strengths
- Randomized allocation with large physician sample and pragmatic implementation.
- Adjusted Poisson regression with stratified analyses; registry linkage to capture all-age prescriptions.
Limitations
- Post hoc secondary analysis using a different administrative data source than the primary trial.
- No assessment of clinical appropriateness or patient outcomes beyond prescription counts.
Future Directions: Assess impacts on clinical outcomes, antimicrobial resistance, and cost-effectiveness; test generalizability in other regions and specialties.
3. Mepolizumab Effectiveness in Severe Asthma With/Without Chronic Rhinosinusitis With Nasal Polyps: Real-World Pooled Analysis.
Pooling five cohorts (n=1037), mepolizumab reduced clinically significant exacerbations by ~73% (no CRSwNP) and ~80% (with CRSwNP) at 12 months, with a 30% incremental benefit in those with CRSwNP. Oral corticosteroid use, blood eosinophils, lung function, and ACT scores improved, and ≥3 clinical remission criteria were met in roughly half of patients.
Impact: Provides robust real-world evidence that mepolizumab markedly improves outcomes and facilitates remission in severe eosinophilic asthma irrespective of comorbid CRSwNP, supporting broader, phenotype-driven use.
Clinical Implications: Mepolizumab can substantially reduce exacerbations and OCS burden and improve control/lung function in severe eosinophilic asthma, with added benefit in CRSwNP—supporting its use in T2-high endotypes regardless of baseline eosinophils.
Key Findings
- CSE rate reduced by 72.7% (SAEP[-]CRSwNP) and 79.7% (SAEP[+]CRSwNP) at 12 months.
- Incremental 30% benefit in exacerbation reduction in the CRSwNP subgroup versus non-CRSwNP.
- OCS use and blood eosinophils decreased; lung function and ACT scores improved in both cohorts.
- ≥3 clinical remission criteria achieved by ~47–52% of patients post-mepolizumab.
Methodological Strengths
- Large pooled real-world dataset (n=1037) across multiple European cohorts.
- Consistent benefit across outcomes and irrespective of baseline eosinophil counts.
Limitations
- Observational pooled design without randomized control; potential residual confounding and heterogeneity.
- Details on adherence and concomitant treatments may vary across cohorts.
Future Directions: Prospective comparative effectiveness studies versus other biologics; remission-focused endpoints and biomarker-guided algorithms across asthma–CRSwNP overlap.