Daily Respiratory Research Analysis
A neonatal randomized trial showed that initial nasal CPAP at birth improves noninvasive respiratory support success in very preterm infants versus face mask CPAP. ERS/EULAR released evidence-based clinical practice guidelines for connective tissue disease–associated interstitial lung disease to standardize screening, diagnosis, monitoring, and treatment. A large U.S. claims cohort highlighted high 1-year cardiopulmonary events and mortality after COPD exacerbation discharge and substantial gaps
Summary
A neonatal randomized trial showed that initial nasal CPAP at birth improves noninvasive respiratory support success in very preterm infants versus face mask CPAP. ERS/EULAR released evidence-based clinical practice guidelines for connective tissue disease–associated interstitial lung disease to standardize screening, diagnosis, monitoring, and treatment. A large U.S. claims cohort highlighted high 1-year cardiopulmonary events and mortality after COPD exacerbation discharge and substantial gaps in guideline-concordant triple therapy.
Research Themes
- Optimization of neonatal noninvasive respiratory support
- Evidence-based guidance for CTD-associated interstitial lung disease
- Post-exacerbation COPD outcomes and treatment gaps
Selected Articles
1. Face mask versus nasal mask device use for initial resuscitation in extremely and very preterm infants (FONDUE): an open-label, single-centre, randomised, controlled trial.
In very preterm infants, initial nasal CPAP at birth increased CPAP success (58% vs 39% with face mask) and reduced escalation to positive pressure ventilation. Safety profiles were similar, with no increase in major adverse events.
Impact: This pragmatic RCT challenges a common default (face mask) in neonatal resuscitation and provides actionable evidence to favor nasal CPAP to avoid invasive support.
Clinical Implications: Delivery rooms caring for very preterm infants should preferentially use nasal CPAP to improve noninvasive stabilization and reduce the need for positive pressure ventilation and intubation.
Key Findings
- Primary endpoint: CPAP success was higher with nasal CPAP vs face mask CPAP (58% [43/74] vs 39% [30/77]; RR 1.49, 95% CI 1.06–2.10).
- Trends toward fewer escalations to positive pressure ventilation/intubation in the nasal CPAP group.
- Safety: No increase in major adverse events; pneumothorax occurred only in face mask group (3/77).
Methodological Strengths
- Randomized controlled design with prespecified primary outcome.
- Clinically relevant, pragmatic comparison at birth in very preterm infants.
Limitations
- Single-centre, open-label design may limit generalizability and introduce performance bias.
- Short-term primary outcome; longer-term respiratory outcomes were not assessed.
Future Directions: Multicentre trials with longer follow-up should assess longer-term respiratory outcomes, neurodevelopment, and implementation strategies for nasal CPAP in diverse delivery settings.
BACKGROUND: More than 85% of very preterm infants (born <32 weeks' gestation) breathe spontaneously within 1 min of birth, however, more than 60% of infants receive positive pressure ventilation. Face mask application soon after birth might suppress breathing through the trigeminal nerve reflex, causing vocal cord closure and hypoxia. We aimed to investigate whether nasal mask continuous positive airway pressure (nCPAP) would improve CPAP success, reducing the need for positive pressure ventilation and intubation at birth, compared with face mask CPAP (fCPAP). METHODS: This open-label, randomised controlled trial was done at Monash Medical Centre (Melb...
2. ERS/EULAR clinical practice guidelines for connective tissue disease-associated interstitial lung diseaseDeveloped by the task force for connective tissue disease-associated interstitial lung disease of the European Respiratory Society (ERS) and the European Alliance of Associations for Rheumatology (EULAR)Endorsed by the European Reference Network on rare respiratory diseases (ERN-LUNG).
ERS/EULAR convened a multidisciplinary task force to issue evidence-based recommendations and algorithms for CTD-ILD across six CTDs using GRADE. The guideline addresses screening, diagnosis, monitoring, and pharmacologic management, and identifies key evidence gaps.
Impact: Provides comprehensive, consensus-based guidance likely to standardize care and improve outcomes for CTD-ILD, a high-morbidity area with heterogeneous practices.
Clinical Implications: Adopt guideline algorithms for risk stratification, imaging and serologic workup, monitoring cadence, and selection/sequencing of immunosuppressants/antifibrotics tailored to CTD subtype.
Key Findings
- Recommendations formulated for 25 PICO and 28 narrative questions spanning SSc, RA, IIM, SjD, SLE, and MCTD.
- Screening, diagnostic, monitoring, and treatment algorithms developed to guide clinical workflows.
- Evidence gaps remain for some CTDs and therapies (e.g., pirfenidone in non-RA CTD-ILD), prompting research priorities.
Methodological Strengths
- Formal GRADE methodology with multidisciplinary expert and patient input.
- Comprehensive scope across multiple CTD subtypes with practical algorithms.
Limitations
- Guideline relies on variable-quality evidence across CTDs; several recommendations are conditional.
- Lack of new primary data; implementation and outcomes depend on local resources and expertise.
Future Directions: Prospective comparative studies of immunosuppressants/antifibrotics by CTD subtype, standardized monitoring endpoints, and pragmatic implementation research.
BACKGROUND: Interstitial lung disease (ILD) is a frequent manifestation of connective tissue diseases (CTDs) and is associated with high morbidity and mortality. Clinical practice guidelines to standardise screening, diagnosis, treatment and follow-up for CTD-ILD are of high importance for optimised patient care. METHODS: A European Respiratory Society and European Alliance of Associations for Rheumatology task force committee, composed of pulmonologists, rheumatologists, pathologists, radiologists, methodologists and patient representatives, developed recommendations based on PICO (Patients, Interventi...
3. Disease burden and health-related outcomes of patients discharged from hospital following a COPD exacerbation in the United States.
In 38,483 U.S. patients discharged after a COPD exacerbation, 1-year risks were high: severe cardiopulmonary events 34.6%, COPD readmission 16.7%, and death 18.2%. Only 17.5% were discharged on triple therapy, and nearly a third eventually escalated after an average of 338 days, indicating major implementation gaps relative to GOLD recommendations.
Impact: Quantifies real-world post-discharge risks and exposes substantial underuse and delays of triple therapy, highlighting urgent opportunities to improve COPD care transitions.
Clinical Implications: Implement guideline-concordant initiation or early escalation to triple therapy where indicated at or soon after discharge, structured follow-up within 30 days, and multidisciplinary pathways to reduce readmissions and cardiopulmonary events.
Key Findings
- At 1 year post-discharge: severe cardiopulmonary events 34.6% (IR 42.2/100 PY), COPD readmission 16.7% (IR 20.4/100 PY), mortality 18.2% (IR 22.2/100 PY).
- Discharge prescriptions: reliever-only/no COPD treatment in 27.4%, triple therapy in 17.5%.
- Among 17,991 not already on triple therapy, only 29.5% escalated within follow-up; mean time to escalation 337.6 days.
Methodological Strengths
- Large, contemporary national cohort with standardized administrative data.
- Predefined outcomes and incidence rates enabling actionable benchmarking.
Limitations
- Retrospective design with potential misclassification and residual confounding.
- Medication fills may not reflect adherence; clinical severity and spirometry data limited.
Future Directions: Prospective care-transition interventions (early triple therapy, 30-day clinics, remote monitoring) should be tested to reduce post-discharge events; integrate physiology and exacerbation phenotypes to personalize therapy.
BACKGROUND: Evidence on trajectory of readmission rates post-hospitalization for COPD exacerbations and combined cardiopulmonary risk in the U.S. is sparse. OBJECTIVE: To describe incidence of outcomes and treatment patterns post-hospitalization for a COPD exacerbation. METHODS: This was an observational study of patients discharged from hospital post-COPD exacerbation in the U.S. (01.01.18-09.30.21) using data from the Optum® Clinformatics® Data Mart database. Index date was the discharge date of first recorded hospitalization for a COPD exacerbation during the study period. P...