Breathe最新文献

Aspergillosis is often overlooked, but recognising it early in patients with chronic or recurrent lung infections can be life-changing. Lisa's experience shows why clinicians must consider aspergillosis. https://bit.ly/3WPqas3.

Rigid bronchoscopy is a specialised endoscopic modality utilising a rigid scope instrument to afford direct visualisation and intervention within the central airways. In contradistinction to flexible bronchoscopy, the augmented working channel of the rigid instrument permits the introduction of larger-calibre instrumentation, thereby facilitating complex therapeutic procedures. These procedures encompass, inter alia, foreign body retrieval, endoluminal tumour debulking, airway stent deployment, and the management of life-threatening haemoptysis. While the procedure mandates general anaesthesia and a high level of operator expertise, rigid bronchoscopy provides superior airway control and the capacity to address complex airway pathologies that may be refractory to flexible bronchoscopy.

This Journal club aims to evaluate the recent evidence about the potential benefits of macrolides as add-on therapy in the treatment of community-acquired pneumonia (CAP), an area where the data remain conflicting. Four studies with diverse methodology (the ACCESS trial, a Greek cohort study, a UK-based cohort study and a recent meta-analysis) have aimed to assess either potential immunomodulatory effects, clinical response or hard end-points like mortality when macrolides are added to the treatment regimen for hospitalised patients with CAP. The ACCESS trial, a randomised controlled trial (RCT), demonstrated improved early clinical response and immunomodulatory effects with clarithromycin, while the Greek cohort study showed reduced 28-day mortality and delayed organ dysfunction with clarithromycin. The cohort study from the UK found no added benefit of macrolides on 30-day mortality or decline in Sequential Organ Failure Assessment score. The recent meta-analysis supported a survival advantage of macrolides, favouring clarithromycin over azithromycin. However, study limitations like heterogeneity, confounding risks and the lack of head-to-head comparisons of individual macrolides remain of concern. Macrolide treatment decisions may benefit from individualised risk assessment; however, future research should focus on identifying subgroups who might benefit from macrolides and comparative analyses of macrolide agents through large-scale RCTs.

Five years after the COVID-19 pandemic, the world continues to record acute cases of COVID-19 infection and witness its residual effects. Lung injury persisting beyond the resolution of acute viral pneumonia has been a known entity since the severe acute respiratory syndrome outbreak in 2005. However, residual interstitial lung disease (ILD) secondary to COVID-19 infection has become a new entity of interest due to the widespread and global impact of COVID-19. Post-COVID-19 ILD (PC-ILD) has emerged as a unique entity with age, male sex, smoking and the severity of acute illness as risk factors. Using current evidence, we discuss possible mechanisms for disease occurrence and the genetic similarities between PC-ILD and idiopathic pulmonary fibrosis. Characteristic radiographic findings, pulmonary function abnormalities and potential therapies are also discussed. As the world moves away from the acute phase of the pandemic, obtaining information on the long-term consequences of this disease becomes even more crucial. Continued research in this field is vital to guide decisions and obtain better outcomes in treatment and follow-up.

Epigenetic mechanisms control how and when our genes are switched on or off. They are altered by chronic environmental exposures, like cigarette smoke or air pollution, contributing to disease development. Excitingly, they can also be manipulated with the potential to target disease. Thus, epigenetic signalling provides a novel angle for understanding how chronic lung diseases develop and identifying novel biomarkers and therapeutic targets for respiratory diseases. This educational review is meant as a guide for clinicians and other lung researchers interested in epigenetic regulation. We introduce the main epigenetic modifications and the general cellular machinery that introduces and removes them. We provide selected examples of epigenetic dysregulation in response to environmental exposures and in chronic lung diseases. Finally, we discuss the promise of epigenetic biomarkers and therapies for clinical practice, including new precision medicine epigenetic editing approaches.

Mycoplasma pneumoniae is a frequent cause of respiratory tract infections in both children and adults, responsible for up to 30% of community-acquired pneumonia cases in children. While many infected individuals remain asymptomatic, common symptoms include fever - which is typically short-lived - and a persistent cough, sometimes lasting weeks. Early identification of M. pneumoniae is crucial for effective management. However, distinguishing it from other viral or bacterial lower respiratory tract infections based on symptoms alone is unreliable due to the nonspecific clinical presentation. Currently, the most accurate method for diagnosing M. pneumoniae is PCR testing, as traditional culture methods are slow and technically challenging. Paired serology testing is also used for diagnosis. It is important to evaluate locally available diagnostic resources. First-line treatment typically involves macrolide antibiotics, despite lack of robust data for their use. However, widespread use has contributed to increasing macrolide resistance, especially in Asia, prompting consideration of alternatives like fluoroquinolones and tetracyclines. In severe or treatment-resistant cases, additional therapies such as prednisolone, intravenous immunoglobulin or bronchoscopy may be used, although evidence supporting their routine application is limited. Overall, clinical decisions should be individualised, guided by local transmission patterns, available diagnostics and emerging antibiotic resistance patterns.

Diverse methods are available for assessment of the respiratory muscles; the technique used should be tailored to the question posed. https://bit.ly/3V2MNIO.

Preschool spirometry needs age-tailored FEVt indices/limits, low-dead-space hardware, AI-assisted QC, physician-led coaching and caregiver prep. Other tests may complement selectively. Expand GLI-Junior reference norms to strengthen interpretation. https://bit.ly/47ajdbH.

Pleural infection (PI) remains a serious clinical condition associated with high morbidity, prolonged hospitalisation and significant mortality, despite advances in medical therapy. Characterised by infection and inflammation within the pleural cavity, PI is increasingly complicated by antimicrobial resistance. While antibiotics and drainage constitute first-line treatment, surgical intervention becomes essential in advanced or refractory cases. Video-assisted thoracoscopic surgery (VATS) has emerged as the preferred minimally invasive approach in early-stage disease, offering advantages such as reduced post-operative pain, shorter hospital stays and faster recovery. In more complex stages, open decortication or thoracotomy may still be required. This narrative review explores the full spectrum of surgical strategies - including VATS, open decortication, open window thoracostomy, vacuum-assisted closure therapy and the innovative FlexVATS technique - highlighting their indications, timing and evolving roles in contemporary practice. We also underscore the importance of post-operative care, emphasising respiratory rehabilitation, pain management, nutritional support and infection surveillance. Prognostic tools, particularly the RAPID score, are discussed for their potential to guide early risk stratification and optimise timing of surgical intervention. Given the complex nature of PI, a multidisciplinary approach involving thoracic surgeons, pulmonologists, infectious disease specialists, physiotherapists and nutritionists is essential. A patient-centred, multimodal treatment strategy tailored to disease stage and individual risk factors remains the cornerstone of successful recovery. Continued research into long-term outcomes and advanced diagnostics is critical to improving care in this challenging clinical domain.

Tension hydrothoraces can cause significant morbidity and even mortality. The resultant heart failure caused the development of an intractable effusion and hyponatraemia which led to the patient's death. https://bit.ly/4m6jGjj.