BreathePub Date : 2024-12-10eCollection Date: 2024-10-01DOI: 10.1183/20734735.0122-2024
Neeraj M Shah, Nicholas Hart, Georgios Kaltsakas
{"title":"Prolonged weaning from mechanical ventilation: who, what, when and how?","authors":"Neeraj M Shah, Nicholas Hart, Georgios Kaltsakas","doi":"10.1183/20734735.0122-2024","DOIUrl":"10.1183/20734735.0122-2024","url":null,"abstract":"<p><p>Weaning from invasive mechanical ventilation is an important part of the management of respiratory failure patients. Patients can be classified into those who wean on the first attempt (simple weaning), those who require up to three attempts (difficult weaning) and those who require more than three attempts (prolonged weaning). The process of weaning includes adequately treating the underlying cause of respiratory failure, assessing the readiness to wean, evaluating the response to a reduction in ventilatory support, and eventually liberation from mechanical ventilation and extubation or decannulation. Post-extubation respiratory failure is a contributor to poorer outcomes. Identifying and addressing modifiable risk factors for post-extubation respiratory failure is important; noninvasive ventilation and high-flow nasal cannulae may be useful bridging aids after extubation. Factors to consider in the pathophysiology of prolonged mechanical ventilation include increased respiratory muscle load, reduced respiratory muscle capacity and reduced respiratory drive. Management of these patients involves a multidisciplinary team, to first identify the cause of failed weaning attempts, and subsequently optimise the patient's physiology to improve the likelihood of being successfully weaned from invasive mechanical ventilation.</p>","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"20 3","pages":"240122"},"PeriodicalIF":2.3,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806450","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}
BreathePub Date : 2024-12-10eCollection Date: 2024-10-01DOI: 10.1183/20734735.0001-2024
Gráinne d'Ancona, Brian D Kent
{"title":"Does inhaler adherence really matter in severe asthma?","authors":"Gráinne d'Ancona, Brian D Kent","doi":"10.1183/20734735.0001-2024","DOIUrl":"10.1183/20734735.0001-2024","url":null,"abstract":"<p><p>Inhaled therapies, primarily the inhaled corticosteroid (ICS), have been the cornerstone of asthma treatment since the 1960s. They have been shown to reduce symptom burden, morbidity and mortality, and potentially avoid unnecessary and unscheduled healthcare. However, some people have severe asthma, defined by an inability to gain or maintain consistent disease control despite appropriate use of high dose ICS-containing inhalers. In this review, we discuss whether it is appropriate to demand adherence to a treatment this cohort are demonstrably resistant to.</p>","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"20 3","pages":"240001"},"PeriodicalIF":2.3,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806442","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}
BreathePub Date : 2024-12-10eCollection Date: 2024-10-01DOI: 10.1183/20734735.0141-2024
Alannah Murray, Laura Piggott, James O'Hanlon, Ignacio Martin-Loeches, Barry Kennedy
{"title":"An unusual case of a dry cough.","authors":"Alannah Murray, Laura Piggott, James O'Hanlon, Ignacio Martin-Loeches, Barry Kennedy","doi":"10.1183/20734735.0141-2024","DOIUrl":"10.1183/20734735.0141-2024","url":null,"abstract":"<p><p><b>This is the first case report detailing co-infection with both PJP and disseminated histoplasmosis in a patient without HIV infection, and it highlights the immune-suppressive potential of poorly controlled diabetes and liver cirrhosis</b> https://bit.ly/4dXUOX4.</p>","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"20 3","pages":"240141"},"PeriodicalIF":2.3,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806418","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}
BreathePub Date : 2024-12-10eCollection Date: 2024-10-01DOI: 10.1183/20734735.0083-2024
Roshini Kurian, Sajeel Ahmed, Avinash Aujayeb, Ben Thompson
{"title":"Bilateral spontaneous pneumothorax in a patient with rheumatoid arthritis and accelerated nodulosis.","authors":"Roshini Kurian, Sajeel Ahmed, Avinash Aujayeb, Ben Thompson","doi":"10.1183/20734735.0083-2024","DOIUrl":"10.1183/20734735.0083-2024","url":null,"abstract":"<p><p><b>One of the respiratory complications of rheumatoid arthritis (RA) is formation of lung nodules, which can rupture to cause pneumothoraces. We present a case of recurrent pneumothoraces due to accelerated RA nodulosis, secondary to biologic therapy.</b> https://bit.ly/3WBhgOe.</p>","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"20 3","pages":"240083"},"PeriodicalIF":2.3,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806439","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}
BreathePub Date : 2024-12-10eCollection Date: 2024-10-01DOI: 10.1183/20734735.0056-2024
Mairi McClean, Traian Constantin Panciu, Christoph Lange, Raquel Duarte, Fabian Theis
{"title":"Artificial intelligence in tuberculosis: a new ally in disease control.","authors":"Mairi McClean, Traian Constantin Panciu, Christoph Lange, Raquel Duarte, Fabian Theis","doi":"10.1183/20734735.0056-2024","DOIUrl":"10.1183/20734735.0056-2024","url":null,"abstract":"<p><p>The challenges to effective tuberculosis (TB) disease control are considerable, and the current global targets for reductions in disease burden seem unattainable. The combination of complex pathophysiology and technical limitations results in difficulties in achieving consistent, reliable diagnoses, and long treatment regimens imply serious physiological and socioeconomic consequences for patients. Artificial intelligence (AI) applications in healthcare have significantly improved patient care regarding diagnostics, treatment and basic research. However, their success relies on infrastructures prioritising comprehensive data generation and collaborative research environments to foster stakeholder engagement. This viewpoint article briefly outlines the current and potential applications of advanced AI models in global TB control and the considerations and implications of adopting these tools within the public health community.</p>","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"20 3","pages":"240056"},"PeriodicalIF":2.3,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806437","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}
BreathePub Date : 2024-12-10eCollection Date: 2024-10-01DOI: 10.1183/20734735.0185-2023
Gareth A L Jones, Padmanabhan Ramnarayan
{"title":"High-flow nasal cannula is an expensive and clunky placebo: myth or maxim?","authors":"Gareth A L Jones, Padmanabhan Ramnarayan","doi":"10.1183/20734735.0185-2023","DOIUrl":"10.1183/20734735.0185-2023","url":null,"abstract":"<p><p>High-flow nasal cannula (HFNC) is now a commonly used noninvasive method of providing respiratory support to children and young people. Its rapid spread into varied clinical applications has often left assessment of the evidence of its mechanism of action and clinical benefit lagging behind its uptake. This review will discuss the proposed mechanisms of action of HFNC, review the evidence base for its use, cover its applications in paediatrics and outline its limitations.</p>","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"20 3","pages":"230185"},"PeriodicalIF":2.3,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806446","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}
BreathePub Date : 2024-11-12eCollection Date: 2024-10-01DOI: 10.1183/20734735.0235-2023
Yizhong Zheng, Jian Eu Tai, Brendon J Yee
{"title":"Management of central sleep apnoea: a review of non-hypercapnic causes.","authors":"Yizhong Zheng, Jian Eu Tai, Brendon J Yee","doi":"10.1183/20734735.0235-2023","DOIUrl":"https://doi.org/10.1183/20734735.0235-2023","url":null,"abstract":"<p><p>Central sleep apnoea (CSA) is characterised by recurrent episodes of airway cessation or reduction in the absence of respiratory effort. Although CSA is less common than obstructive sleep apnoea, it shares similar symptoms. CSA can be secondary to various medical conditions, high altitude and medication exposure. CSA can also emerge during obstructive sleep apnoea therapy. There are a range of treatment options and selecting the right therapy requires an understanding of the pathophysiology of CSA. This review explores the aetiology, pathophysiology and clinical management of non-hypercapnic CSA.</p>","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"20 3","pages":"230235"},"PeriodicalIF":2.3,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615283","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}
BreathePub Date : 2024-11-12eCollection Date: 2024-10-01DOI: 10.1183/20734735.0034-2024
Beenish Iqbal, Eihab Bedawi, Najib M Rahman
{"title":"Pro: indwelling pleural catheters cause harm to patients.","authors":"Beenish Iqbal, Eihab Bedawi, Najib M Rahman","doi":"10.1183/20734735.0034-2024","DOIUrl":"https://doi.org/10.1183/20734735.0034-2024","url":null,"abstract":"<p><p>Malignant pleural effusions (MPE) tend to recur and require definitive treatment with either chest drain and talc pleurodesis or indwelling pleural catheters (IPCs), which offer similar symptomatic benefits. In recent years, IPCs have become popular due to the presumed convenience of an outpatient procedure followed by home drainage leading to a misconception of IPCs being an ideal treatment for MPE. However, IPCs predispose the patient to multiple complications and have significant physical and psychological implications that are under-recognised. Patients require additional clinical reviews, hospital admissions and treatment for these complications related to IPCs. Additionally, there is a huge psychological impact of living with a home catheter that is a constant reminder of their cancer and this has been shown to affect quality of life negatively. Hence, IPCs should not be considered the \"ideal\" treatment for MPE management and clinicians should reflect the equipoise of the evidence for the benefits and accurately reflect the adverse effects of IPCs in their discussions with patients to facilitate informed decision making.</p>","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"20 3","pages":"240034"},"PeriodicalIF":2.3,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615287","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}
BreathePub Date : 2024-11-12eCollection Date: 2024-10-01DOI: 10.1183/20734735.5081-2024
{"title":"Erratum: \"Steroids in severe community-acquired pneumonia\". S. Ananth, A.G. Mathioudakis, J. Hansel. <i>Breathe</i> 2024; 20: 240081.","authors":"","doi":"10.1183/20734735.5081-2024","DOIUrl":"https://doi.org/10.1183/20734735.5081-2024","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1183/20734735.0081-2024.].</p>","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"20 3","pages":"245081"},"PeriodicalIF":2.3,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615274","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}
BreathePub Date : 2024-11-12eCollection Date: 2024-10-01DOI: 10.1183/20734735.0229-2023
Augusta Beech, Andrew Higham, Sophie Booth, Vickram Tejwani, Frederik Trinkmann, Dave Singh
{"title":"Type 2 inflammation in COPD: is it just asthma?","authors":"Augusta Beech, Andrew Higham, Sophie Booth, Vickram Tejwani, Frederik Trinkmann, Dave Singh","doi":"10.1183/20734735.0229-2023","DOIUrl":"10.1183/20734735.0229-2023","url":null,"abstract":"<p><p>COPD is a heterogeneous condition, with tobacco smoking being the main environmental risk factor. The presence of type 2 (T2) inflammation is a well-recognised feature of asthma; however, it is now apparent that a subset of COPD patients also displays evidence of T2 inflammation with respect to elevated eosinophil counts and altered gene and protein expression of several T2 inflammatory mediators. T2 inflammatory mediators represent an attractive therapeutic target in both COPD and asthma; however, the efficacy of pharmaceutical interventions varies between diseases. Furthermore, the nature of some shared clinical features also differs. We provide a narrative review of differences in the nature of T2 inflammation between COPD and asthma, which may partly explain phenotypic differences between diseases. We focus on evidence from studies of pulmonary histopathology, sputum and epithelial gene and protein expression, and response to pharmacological interventions targeted at T2 inflammation.</p>","PeriodicalId":9292,"journal":{"name":"Breathe","volume":"20 3","pages":"230229"},"PeriodicalIF":2.3,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635883","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}