Breathe最新文献

Sleep disordered breathing (SDB) has a significant impact on public health, with obesity being a major contributing factor. Obstructive sleep apnoea (OSA) and obesity hypoventilation syndrome (OHS) are primary conditions in SDB, strongly linked to increased body mass index. Obesity exacerbates airway narrowing, reduces lung volumes and promotes inflammation, aggravating OSA and OHS. Weight loss, achieved through nutritional therapies, pharmacotherapy or surgical therapies, reduces apnoea-hypopnea index and associated obesity-related complications. Caloric restriction and exercise provide modest improvements, often independently of substantial weight reduction. Bariatric surgery achieves substantial improvements in many cases but displays variability in outcomes. Emerging pharmacological treatments, such as glucagon-like peptide-1 receptor agonists, show promise for patients with concurrent obesity and SDB. Personalised interventions, including physiological phenotyping and multidisciplinary management, would provide effective treatment strategies. Further research into long-term outcomes, novel therapies and mechanisms beyond weight reduction is essential. Obesity prevention also remains crucial for mitigating the burden of SDB globally. This review will evaluate the role of obesity management strategies in improving SDB outcomes, and will highlight the bidirectional relationship between obesity and SDB, emphasising an integrated patient-centred approach.

Massive haemoptysis is a life-threatening condition requiring immediate and systematic management. Initial steps should focus on airway stabilisation, haemodynamic support and rapid identification of the bleeding source. Due to the complexity in diagnosis and management, along with a high associated mortality rate, massive haemoptysis offers an excellent opportunity for simulation training. Herein we present a simulated case of massive haemoptysis in a hospitalised patient. The scenario is crafted to help learners develop proficiency in the rapid recognition and multidisciplinary management of this high-risk condition, with an emphasis on airway protection and haemodynamic stabilisation. The script is widely adaptable across institutions and medical disciplines, and customisable to the needs of diverse learner populations.

Meigs syndrome is associated with unilateral or bilateral pleural effusions, ascites, high CA-125 levels and ovarian fibromas. Concurrent arterial and venous thromboses have also been described. Surgical removal of the fibroma is curative. https://bit.ly/4jZsB4D.

Pulmonary rehabilitation is a multidisciplinary intervention aimed at improving the physical and psychological conditions of people with chronic respiratory diseases, and promoting long-term adherence to health-enhancing behaviours. The field has evolved significantly over the past decades, integrating advancements in medical knowledge, technology and therapeutic techniques. This review aims to provide a comprehensive account of the history of pulmonary rehabilitation, highlighting key milestones, influential figures and significant developments that have shaped the practice as it is known today, as well as a focus on current research, innovations and future perspectives.

Thoracic ultrasound (TUS) is becoming a key diagnostic tool in pulmonary medicine. However, use of this tool may vary between older pulmonologists with less TUS experience and younger generations, including residents, who see the need for TUS training. This review explores nationwide differences in ultrasound training and seeks to improve education quality. We surveyed all Dutch pulmonary medicine programme directors and residents with four sections: baseline questions, applicability, skills and attitude, and future perspectives. Between March and June 2024, we distributed the questionnaire to 193 residents and 26 programme directors. 72 residents (37%) and 19 programme directors (78%) responded. While ultrasound was widely available (95%), the integration with electronic health records remained limited (53%). The majority of respondents considered TUS an essential skill: 92% of the residents and 78% of programme directors (p=0.279). However, several barriers hindered effective training, including a lack of supervisors (reported by 67% of residents), supervisor time constraints (35%), limited access to ultrasound equipment (28%) and resident time constraints (28%). Pulmonary education must move beyond the mentor-apprentice model for ultrasound training, due to a lack of experienced mentors. This review highlights the need for a structured, standardised TUS training programme with proper infrastructure, supervision and hands-on practice.

Malignant pleural effusion (MPE) affects up to 15% of cancer patients, with nearly 30% of symptomatic cases developing non-expandable lung (NEL), a condition characterised by the lung's failure to fully re-expand post-drainage, thereby impeding proper pleural apposition and leading to several adverse outcomes. Inadequate diagnostic certainty leads to prolonged hospitalisation, repeated invasive procedures, drainage complications, high pleurodesis failure rates, increased healthcare costs and diminished patient quality of life. Conventional diagnostic methods, predominantly based on post-procedural chest radiography and computed tomography, frequently delay accurate diagnosis, underscoring the need for noninvasive pre-procedural techniques. Emerging evidence supports thoracic ultrasound, particularly the application of M-mode during breath-hold, as a promising modality for early NEL detection by identifying the absent sinusoidal sign and reduced lung movement. Experimental approaches, including speckle tracking imaging, two-dimensional shear wave elastography and quantitative ultrasound assessments via the lung/liver echogenicity ratio, also show potential, albeit with limitations that warrant further validation. Integration of artificial intelligence into multimodal imaging workflows may enhance diagnostic precision and predictive modelling, ultimately facilitating personalised therapeutic strategies and transforming the management of NEL in MPE. These innovations promise to reduce invasive diagnostics and healthcare costs while improving patient outcomes and quality of life in MPE-associated NEL.

Recently, the spirometry procedure for the flow-volume curve has been extended to add a forced complete inspiration after end of expiration, yielding the FIVC. A new acceptability criterion based on FIVC-FVC difference has been added as a quality check. https://bit.ly/44Cqz6v.

Negative pressure pulmonary oedema is an under-recognised cause of acute respiratory distress in post-operative patients. Presentations include acute pulmonary oedema and possibly DAH. Prompt recognition and intervention are essential. https://bit.ly/4jYzOmn.

An intriguing case of a 28-year-old woman with chronic respiratory symptoms and situs inversus. Ultrastructural analysis by electron microscopy is a highlight in the discovery of a rare syndrome. A lesson in complex diagnostics! @cime_conicet, @virkinal https://bit.ly/4jHzdW5.

Pneumothorax arises from pulmonary air leaking into the pleural space. If the air leak has healed, the pneumothorax may not require intervention but will take time to resolve. Procedural management may be warranted, despite resolution of the air leak, depending on patient preference. An ongoing air leak carries a risk of tension pneumothorax and requires intervention. Surgical prevention of recurrent pneumothorax should be considered in cases with a second episode or for patient factors (e.g. occupational risk). This review aims to describe the evidence base for the recent paradigm shift towards individualised management in the treatment of pneumothorax, supported by new guidelines, and the utility of novel diagnostic/management adjuncts such as thoracic ultrasound and digital drainage systems.