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A practical approach to the diagnosis and management of malignant pleural effusions in resource-constrained settings. 在资源有限的情况下诊断和管理恶性胸腔积液的实用方法。

IF 2

Breathe Pub Date : 2023-12-01 Epub Date: 2023-12-19 DOI: 10.1183/20734735.0140-2023

Jane A Shaw, Elizabeth H Louw, Coenraad F N Koegelenberg

{"title":"A practical approach to the diagnosis and management of malignant pleural effusions in resource-constrained settings.","authors":"Jane A Shaw, Elizabeth H Louw, Coenraad F N Koegelenberg","doi":"10.1183/20734735.0140-2023","DOIUrl":"https://doi.org/10.1183/20734735.0140-2023","url":null,"abstract":"No pleural intervention in a patient with confirmed malignant pleural effusion (MPE) prolongs life, but even the recommended interventions for diagnosis and palliation can be costly and therefore unavailable in large parts of the world. However, there is good evidence to guide clinicians working in low- and middle-income countries on the most cost-effective and clinically effective strategies for the diagnosis and management of MPE. Transthoracic ultrasound-guided closed pleural biopsy is a safe method of pleural biopsy with a diagnostic yield approaching that of thoracoscopy. With the use of pleural fluid cytology and ultrasound-guided biopsy, ≥90% of cases can be diagnosed. Cases with an associated mass lesion are best suited to an ultrasound-guided fine needle aspiration with/without core needle biopsy. Those with diffuse pleural thickening and/or nodularity should have an Abrams needle (<1 cm thickening) or core needle (≥1 cm thickening) biopsy of the area of interest. Those with insignificant pleural thickening should have an ultrasound-guided Abrams needle biopsy close to the diaphragm. The goals of management are to alleviate dyspnoea, prevent re-accumulation of the pleural effusion and minimise re-admissions to hospital. As the most cost-effective strategy, we suggest early use of indwelling pleural catheters with daily drainage for 14 days, followed by talc pleurodesis if the lung expands. The insertion of an intercostal drain with talc slurry is an alternative strategy which is noninferior to thoracoscopy with talc poudrage.Educational aims: To provide clinicians practising in resource-constrained settings with a practical evidence-based approach to the diagnosis and management of malignant pleural effusions.To explain how to perform an ultrasound-guided closed pleural biopsy.To explain the cost-effective use of indwelling pleural catheters.","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"19 4","pages":"230140"},"PeriodicalIF":2.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10729815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138828262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Diagnosis and management of pleural infection. 胸膜感染的诊断和处理。

IF 2

Breathe Pub Date : 2023-12-01 Epub Date: 2024-01-16 DOI: 10.1183/20734735.0146-2023

Alguili Elsheikh, Malvika Bhatnagar, Najib M Rahman

{"title":"Diagnosis and management of pleural infection.","authors":"Alguili Elsheikh, Malvika Bhatnagar, Najib M Rahman","doi":"10.1183/20734735.0146-2023","DOIUrl":"10.1183/20734735.0146-2023","url":null,"abstract":"Pleural infection remains a medical challenge. Although closed tube drainage revolutionised treatment in the 19th century, pleural infection still poses a significant health burden with increasing incidence. Diagnosis presents challenges due to non-specific clinical presenting features. Imaging techniques such as chest radiographs, thoracic ultrasound and computed tomography scans aid diagnosis. Pleural fluid analysis, the gold standard, involves assessing gross appearance, biochemical markers and microbiology. Novel biomarkers such as suPAR (soluble urokinase plasminogen activator receptor) and PAI-1 (plasminogen activator inhibitor-1) show promise in diagnosis and prognosis, and microbiology demonstrates complex microbial diversity and is associated with outcomes. The management of pleural infection involves antibiotic therapy, chest drain insertion, intrapleural fibrinolytic therapy and surgery. Antibiotic therapy relies on empirical broad-spectrum antibiotics based on local policies, infection setting and resistance patterns. Chest drain insertion is the mainstay of management, and use of intrapleural fibrinolytics facilitates effective drainage. Surgical interventions such as video-assisted thoracoscopic surgery and decortication are considered in cases not responding to medical therapy. Risk stratification tools such as the RAPID (renal, age, purulence, infection source and dietary factors) score may help guide tailored management. The roles of other modalities such as local anaesthetic medical thoracoscopy and intrapleural antibiotics are debated. Ongoing research aims to improve outcomes by matching interventions with risk profile and to better understand the development of disease.","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"19 4","pages":"230146"},"PeriodicalIF":2.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10790177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139477987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The tuberculous pleural effusion. 结核性胸腔积液

IF 2

Breathe Pub Date : 2023-12-01 Epub Date: 2023-12-19 DOI: 10.1183/20734735.0143-2023

Emma McNally, Clare Ross, Laura E Gleeson

{"title":"The tuberculous pleural effusion.","authors":"Emma McNally, Clare Ross, Laura E Gleeson","doi":"10.1183/20734735.0143-2023","DOIUrl":"https://doi.org/10.1183/20734735.0143-2023","url":null,"abstract":"Pleural tuberculosis (TB) is a common entity with similar epidemiological characteristics to pulmonary TB. It represents a spectrum of disease that can variably self-resolve or progress to TB empyema with severe sequelae such as chronic fibrothorax or empyema necessitans. Coexistence of and progression to pulmonary TB is high. Diagnosis is challenging, as pleural TB is paucibacillary in most cases, but every effort should be made to obtain microbiological diagnosis, especially where drug resistance is suspected. Much attention has been focussed on adjunctive investigations to support diagnosis, but clinicians must be aware that apparent diagnostic accuracy is affected both by the underlying TB prevalence in the population, and by the diagnostic standard against which the specified investigation is being evaluated. Pharmacological treatment of pleural TB is similar to that of pulmonary TB, but penetration of the pleural space may be suboptimal in complicated effusions. Evidence for routine drainage is limited, but evacuation of the pleural space is indicated in complicated disease.Educational aims: To demonstrate that pleural TB incorporates a wide spectrum of disease, ranging from self-resolving lymphocytic effusions to severe TB empyema with serious sequelae.To emphasise the high coexistence of pulmonary TB with pleural TB, and the importance of obtaining sputum for culture (induced if necessary) in all cases.To explore the significant diagnostic challenges posed by pleural TB, and consequently the frequent lack of information about drug sensitivity prior to initiating treatment.To highlight the influence of underlying TB prevalence in the population on the diagnostic accuracy of adjunctive investigations for the diagnosis of pleural TB.To discuss concerns around penetration of anti-TB medications into the pleural space and how this can influence decisions around treatment duration in practice.","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"19 4","pages":"230143"},"PeriodicalIF":2.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10729824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138828268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Breathe Podcast December 2023: Early career members' highlights from the ERS Congress. 呼吸播客 2023 年 12 月：早期职业会员在 ERS 大会上的精彩发言。

IF 2

Breathe Pub Date : 2023-12-01 Epub Date: 2023-12-19 DOI: 10.1183/20734735.E194-2023

引用次数: 0

An interesting case of pulmonary infiltrates with eosinophilia: out of sight out of mind 肺浸润伴嗜酸性粒细胞增多的有趣病例:眼不见心不烦

Breathe Pub Date : 2023-09-01 DOI: 10.1183/20734735.0097-2023

Amit Panjwani, Mohamed Redha Salman, Umesh Nabar

引用次数: 0

Lung functional imaging 肺功能成像

Breathe Pub Date : 2023-09-01 DOI: 10.1183/20734735.0272-2022

Sam Bayat, Jim Wild, Tilo Winkler

引用次数: 0

Lung Science Conference highlights 2023: Post-viral lung diseases – from basic immunology to clinical phenotypes and therapy 2023年肺科学会议亮点:病毒性后肺部疾病-从基本免疫学到临床表型和治疗

Breathe Pub Date : 2023-09-01 DOI: 10.1183/20734735.0169-2023

Sara Cuevas Ocaña, Chiara DeSanti, Katie Daly, Christina Shrees, Nimród László, Carla Bellinghausen, Carola Voss, Joana Cruz

引用次数: 0

Management of comorbidities in difficult and severe asthma 难治性和重度哮喘合并症的管理

Breathe Pub Date : 2023-09-01 DOI: 10.1183/20734735.0133-2023

Jehangir Khan, Barry Moran, Cormac McCarthy, Marcus W. Butler, Alessandro N. Franciosi

引用次数: 0

Sleep and Breathing Conference highlights 2023: a summary by ERS Assembly 4 睡眠与呼吸会议亮点2023:ERS大会总结

Breathe Pub Date : 2023-09-01 DOI: 10.1183/20734735.0168-2023

Matteo Bradicich, Matteo Siciliano, Federico Donfrancesco, Radostina Cherneva, Beatriz Ferraz, Dries Testelmans, Manuel Sánchez-de-la-Torre, Winfried Randerath, Sophia Schiza, Joana Cruz

引用次数: 0

Shape your career: opportunities for Early Career Members in 2022 and the experience of applying for an ERS fellowship 塑造你的职业生涯:2022年早期职业会员的机会以及申请ERS奖学金的经历

IF 2

Breathe Pub Date : 2022-03-01 DOI: 10.1183/20734735.0218-2021

C. Ardura-Garcia, D. Kohlbrenner, Joana Cruz

引用次数: 2