Pulmonology

Z-scores reduce measured spirometric severity and align with lower clinical risk.

Switching from percent-predicted cutoffs to z-score thresholds reclassified many adults to a lesser severity, with no one moved to higher severity. In NHANES (n=14,863) and a COPD cohort (n=14,238), those reclassified to lesser severity had lower odds of dyspnea and COPD exacerbation. Reclassification correlated with lower mortality risk (NHANES HR 0.82, 95% CI 0.71–0.93). These results support adopting z-score thresholds for adult spirometry interpretation, noting applicability to routine clinical reporting. 1

Higher baseline FVC predicts substantially lower mortality across multinational sites.

In 9,927 BOLD participants (mean follow-up 8.7 years), higher baseline post-bronchodilator FVC was inversely associated with mortality. Each SD higher baseline FVC was linked to a 44% lower mortality in men and 28% lower in women after mutual adjustment for FEV1/FVC. FEV1/FVC showed smaller and less consistent associations when adjusted for FVC. Regional lung-function differences did not explain prognostic associations, arguing against regional re-scaling when assessing prognosis. 2

Women remain underrepresented in lung cancer RCTs, with impacts on adverse-event reporting.

Systematic review of 636 lung cancer RCTs (265,989 participants) found pooled enrolment incidence disparity of -3.17%, indicating female underrepresentation. Underrepresentation was greater in very high-HDI regions and in selected subgroups like younger or predominantly Caucasian cohorts. Trial-level differences in female enrolment correlated with differences in reported adverse-event incidence across settings. These patterns limit direct generalisability of trial safety and possibly efficacy data to women. 3