Daily Respiratory Research Analysis
A component network meta-analysis of 337 RCTs clarifies which pulmonary rehabilitation components most improve outcomes in COPD—showing strongest effects for in-person supervised, high-intensity aerobic training and psychological support. A randomized trial found azelastine nasal spray reduced PCR-confirmed SARS-CoV-2 infections in healthy adults. A 2-year follow-up of the Baby-OSCAR RCT showed early ibuprofen for patent ductus arteriosus did not improve neurodevelopmental or respiratory outcome
Summary
A component network meta-analysis of 337 RCTs clarifies which pulmonary rehabilitation components most improve outcomes in COPD—showing strongest effects for in-person supervised, high-intensity aerobic training and psychological support. A randomized trial found azelastine nasal spray reduced PCR-confirmed SARS-CoV-2 infections in healthy adults. A 2-year follow-up of the Baby-OSCAR RCT showed early ibuprofen for patent ductus arteriosus did not improve neurodevelopmental or respiratory outcomes.
Research Themes
- Optimization of pulmonary rehabilitation components in COPD
- Non-vaccine pharmacologic prophylaxis for respiratory viral infections
- Long-term outcomes of early PDA treatment in extremely preterm infants
Selected Articles
1. Impact of pulmonary rehabilitation programme design on effectiveness in COPD: a systematic review and component network meta-analysis.
Across 337 RCTs (18,911 participants), in-person supervised and high/very-high intensity aerobic training yielded the largest improvements in exercise capacity, HRQoL, and dyspnea. Psychological interventions added benefits, whereas structured education and program duration did not meaningfully affect outcomes. Remote supervision improved exercise capacity but with lower certainty.
Impact: This is the most comprehensive, methodologically advanced synthesis to date clarifying which pulmonary rehab components drive benefit, directly informing program design and resource allocation.
Clinical Implications: Prioritize in-person supervised, high-intensity aerobic training and incorporate psychological support into COPD rehab. De-emphasize routine structured education add-ons and program elongation without component upgrades; consider remote supervision when in-person is not feasible.
Key Findings
- In-person supervision improved exercise capacity (SMD 0.41), HRQoL (0.43), and dyspnea (0.31) versus exercise alone.
- High/very-high intensity aerobic training had the strongest effects across outcomes (low certainty).
- Psychological interventions improved exercise capacity (SMD 0.37) and HRQoL (0.54).
- Structured education add-ons and program duration did not enhance outcomes.
- Remote supervision improved exercise capacity (SMD 0.40) with lower certainty.
Methodological Strengths
- Use of component network meta-analysis to disentangle effects of individual program elements
- Large evidence base (337 RCTs; 18,911 participants) with protocol registration (PROSPERO)
Limitations
- High risk of bias in a substantial proportion of included trials
- Low certainty for some component effects (e.g., high-intensity aerobic training, breathing exercises)
Future Directions: Prospective, pragmatic trials testing streamlined PR packages (supervised high-intensity aerobic + psychological interventions) versus usual care; hybrid delivery models optimizing remote supervision.
2. Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections: A Phase 2 Randomized Clinical Trial.
In a phase 2, double-blind RCT (n=450), azelastine 0.1% nasal spray three times daily for 56 days reduced PCR-confirmed SARS-CoV-2 infections versus placebo (2.2% vs 6.7%; OR 0.31). It also delayed time to infection, reduced symptomatic PCR-confirmed infections, and lowered rhinovirus infections, with similar adverse events.
Impact: Provides randomized evidence for an accessible, safe nasal prophylaxis that could complement vaccination and nonpharmacologic measures for respiratory virus prevention.
Clinical Implications: Consider azelastine nasal spray as adjunct pre-exposure prophylaxis in high-exposure settings, pending multicenter confirmation. Monitor for adherence and integrate with vaccination, masking, and ventilation strategies.
Key Findings
- PCR-confirmed SARS-CoV-2 infections were lower with azelastine (2.2%) vs placebo (6.7%) (OR 0.31; 95% CI 0.11–0.87).
- Azelastine increased time to infection (31.2 vs 19.5 days) and reduced symptomatic PCR-confirmed infections.
- PCR-confirmed rhinovirus infections were reduced (1.8% vs 6.3%); adverse events were comparable between groups.
Methodological Strengths
- Randomized, double-blind, placebo-controlled design with predefined primary endpoint
- Frequent surveillance testing with PCR confirmation of positive rapid tests
Limitations
- Single-center, phase 2 trial limits generalizability
- Healthy adult population; effect in high-risk or older groups unknown
Future Directions: Multicenter, diverse-population RCTs assessing durability, optimal dosing, variant-agnostic efficacy, and combined strategies with vaccines and antivirals.
3. Two-year outcomes after selective early treatment of patent ductus arteriosus with ibuprofen in preterm babies: follow-up of Baby-OSCAR-a randomised controlled trial.
In extremely preterm infants with a PDA ≥1.5 mm, early selective ibuprofen therapy did not improve survival without moderate–severe neurodevelopmental impairment or survival without respiratory morbidity at 24 months’ corrected age. Oxygen supplementation duration was similar between groups.
Impact: Delivers high-quality negative evidence against routine early ibuprofen for PDA to improve long-term neurodevelopmental and respiratory outcomes, informing neonatal care pathways.
Clinical Implications: Routine early ibuprofen for PDA ≥1.5 mm should not be expected to improve 2-year neurodevelopmental or respiratory outcomes; watchful waiting and individualized management remain appropriate.
Key Findings
- No difference in survival without moderate–severe neurodevelopmental impairment at 24 months (53.0% vs 51.9%; adjusted RR 1.01, p=0.901).
- No improvement in survival without respiratory morbidity (30% vs 32.9%; adjusted RR 0.89).
- Median oxygen supplementation duration similar (76 vs 78 days; adjusted median difference −1.5 days).
Methodological Strengths
- Placebo-controlled, masked, multicenter randomized design
- Prespecified long-term follow-up with standardized outcomes at 24 months corrected age
Limitations
- Incomplete follow-up data for a subset of randomized infants
- Trial powered for primary neonatal outcomes; subgroup effects may be underpowered
Future Directions: Refine PDA treatment thresholds and biomarkers to identify subgroups that may benefit; evaluate non-pharmacologic and hemodynamically guided strategies on long-term outcomes.