Breathe最新文献

In recent years, our clinical practice as paediatric pulmonologists has focused on refining strategies to optimise pulmonary function tests (PFTs) for preschool children, particularly those aged as young as 2 years and 5 months. This viewpoint reflects on our experience conducting over 7000 spirometry and impulse oscillometry (IOS) tests, sharing practical insights into achieving high success rates with young children. We emphasise the importance of creating a child-friendly, minimally stimulating environment, tailored communication using familiar and engaging language, and leveraging gamification and positive reinforcement. In particular, we highlight the use of role-playing as an effective engagement strategy, allowing children to teach a stuffed toy how to perform the test. Furthermore, we differentiate the approaches required for spirometry, which demands active cooperation, and IOS, which allows for tidal breathing and is more suitable for younger or less cooperative children. Through these strategies, we have achieved consistent, technically acceptable results in preschool-aged children, aligning with the latest standardisation guidelines. Our findings demonstrate the value of adaptability, patience and creativity in paediatric PFTs, suggesting that these approaches improve not only test accuracy but also the overall experience for both children and caregivers. Future research should further investigate these techniques to enhance paediatric pulmonary testing protocols.

Despite a rapidly evolving role for advanced therapeutic interventions, the majority of patients with high-risk pulmonary embolism (PE) are still undertreated. Due to complex diagnosis and management, along with a high associated mortality rate, high-risk PE offers an excellent opportunity for simulation training. We present a simulated case of high-risk PE in a post-operative patient that is designed to teach key principles of diagnosis and management. The script is widely adaptable to many institutions and customisable to diverse learner populations.

Pulmonary arterial hypertension (PAH) is a severe disorder of the pulmonary vasculature leading to right ventricular failure. This pulmonary vascular remodelling leads to increased pulmonary vascular resistance and high pulmonary arterial pressures. Despite the development of new therapies, many patients continue to experience significant morbidity and mortality. This review offers a comprehensive overview of the current understanding of PAH pathophysiology, with a focus on key mechanisms that contribute to pulmonary endothelial cell dysfunction and the pathological accumulation of pulmonary artery smooth muscle cells, mesenchymal cells and inflammatory cells in the walls of remodelled small pulmonary vessels, three processes central to the progression of PAH. In particular, it highlights recent developments in targeting the activin signalling pathway, a novel therapeutic approach that shows promise in modulating these pathological processes. The review also addresses the ongoing challenges in translating preclinical findings into effective clinical treatments, emphasising the importance of integrating human data with preclinical models and adopting innovative strategies to bridge the gap between research and clinical practice.

This issue of Breathe focuses on cardiopulmonary disease https://bit.ly/402TYmt.

Extracorporeal membrane oxygenation (ECMO) can support patients with severe cardiorespiratory failure presenting with hypoxia who would otherwise have not survived. Patient selection for ECMO is challenging and relies on the integration of physiological variables with an assessment of reversibility of the underlying condition or suitability for transplantation. In this review, we focus on patients with cardiorespiratory disease who may present with severe hypoxia. We will discuss the indications and contraindications for ECMO; the evidence for ECMO, which is limited to a small number of clinical trials and registry data; the complications of ECMO; expanding technologies and indications; the development of a multidisciplinary ECMO network; and future research. The aim is to increase knowledge of this important area for respiratory physicians.

Nursing plays a critical role in delivering healthcare services. It is a health discipline encompassing both science and art, designed to support people from birth to the end of life, in health and illness. Nurses are required to identify the physical and psychological needs of individuals, families and society with a comprehensive, human-oriented approach and to meet these needs. Nursing provides essential services at every stage of healthcare, from health protection and improvement to disease treatment and rehabilitation. In Türkiye, nursing education is offered at high school, associate and undergraduate levels. Specialisation in a specific branch is possible through Master's and doctoral studies. However, there is no specialised branch or recognised certificate programme in respiratory nursing. Nurses specialising in respiratory diseases typically work in respiratory or intensive care units. Respiratory nurses play a crucial role in care and treatment management within the multidisciplinary team. This viewpoint provides information about the historical development of nursing, nursing education, and the status and development of respiratory nursing in Türkiye, as well as the efforts by the International Coalition for Respiratory Nursing to recognise respiratory nursing as a specialty worldwide.

A patient with pulmonary arterial hypertension shares their experiences, from diagnosis to daily life, including the physical and psychological battle of breathlessness in management of chronic lung disease https://bit.ly/4gxgIBC.

Patients with multisystemic presentation including respiratory symptoms and generalised lymphadenopathy should alert the clinician to this potential diagnosis https://bit.ly/4eJ0PHT.

Artificial intelligence (AI) is transforming respiratory healthcare through a wide range of deep learning and generative tools, and is increasingly integrated into both patients' lives and routine respiratory care. The implications of AI in respiratory care are vast and multifaceted, presenting both promises and uncertainties from the perspectives of clinicians, patients and society. Clinicians contemplate whether AI will streamline or complicate their daily tasks, while patients weigh the potential benefits of personalised self-management support against risks such as data privacy concerns and misinformation. The impact of AI on the clinician-patient relationship remains a pivotal consideration, with the potential to either enhance collaborative care or create depersonalised interactions. Societally, there is an imperative to leverage AI in respiratory care to bridge healthcare disparities, while safeguarding against the widening of inequalities. Strategic efforts to promote transparency and prioritise inclusivity and ease of understanding in algorithm co-design will be crucial in shaping future AI to maximise benefits and minimise risks for all stakeholders.

Among the most discussed issues in the field of pulmonary function testing are reference equations and standardised methods of interpreting pulmonary function test (PFT) results. The Global Lung Function Initiative (GLI) task force gathered information from multiple countries with diverse ethnicities to create a multi-ethnic reference formula suitable for a broad age range. Their first output was the GLI-2012 spirometry reference equations. Together with the GLI-2012 reference equations, the GLI document recommended the use of z-scores to standardise the interpretation of PFT results. Z-scores were introduced as an alternative to per cent predicted and fixed thresholds in interpreting PFTs. After more than a decade, there is still debate on which method of interpretation is better.