Breathe最新文献

Routine procedures in interventional pulmonology require more than technical skill. Compassionate care is key to improving the patient's experience, ensuring they feel respected, supported and understood throughout the process. https://bit.ly/3TwqjiE.

Job van Boven, ERS ECM award winner 2024, explains the importance of collaborating and networking, the power of having a vision, the future of digital technology, the ERS as a key coordinator in digital health and how to keep a good work-life balance. https://bit.ly/3ZpWxzq.

Interstitial lung diseases (ILDs) are a very heterogeneous group of diseases. Although the aetiology of many of these diseases is not fully understood, an association with specific pathogenic gene variants has been demonstrated for some of the diseases. The aim of this review is to provide genotype-phenotype correlation information on monogenic ILDs to provide guidance to pulmonologists on when to refer ILD patients for genetic testing. Most patients with monogenic ILDs suffer from multiorgan involvement and should be managed by a multidisciplinary team of specialists. Different syndromes are associated with a greater risk of (nonrespiratory) malignancies (Birt-Hogg-Dubé syndrome and telomeropathies). Isolated lung involvement has been described in surfactant-related gene variant carriers (SFTPA 1 and 2, SFTPC) and patients with pulmonary alveolar microlithiasis. The clinical suspicion of monogenic ILDs should be raised in young patients diagnosed with ILD, patients with a known family history of ILD or suspected telomeropathies, and patients suspected of having syndromes associated with ILD. Patients with suspected monogenic ILDs should be aware of the possibility of genetic counselling both to obtain a diagnosis and to select further follow-up by pulmonologists and other involved specialists. Raising awareness of monogenic ILDs and creating counselling platforms is necessary both to diagnose and manage patients with these rare diseases.

In spontaneously breathing patients, breathing exercises with positive expiratory pressure (PEP) can be used in various physiological ways to reopen closed airways by increasing the functional residual capacity (FRC) in hypoventilating patients, handle dyspnoea by decreasing the FRC, or reopen clogged airways and maintain an expiratory flow at low lung levels as part of airway clearance therapy. To make the most out of the treatment, the caregiver needs to know the pathophysiology and desired physiological effect of the treatment plan. This article presents the background of the application of PEP and gives information about frequently asked clinical questions. Based on this knowledge, individual prescriptions should be given to each patient including correct instruction and training on how to use PEP and how to adjust when the situation/condition changes. If daily long-term treatment is recommended, the patient needs regular return visits to monitor the effectiveness and evaluate it together with the patient, and to re-educate the patient as soon as needed.

Bronchoalveolar lavage examination as an important tool for diagnosing pulmonary strongyloidiasis in cases where a stool examination is negative for the parasite https://bit.ly/4kuMFMH.

Lung cancer is the leading cause of cancer-related mortality worldwide, with nonsmall cell lung cancer (NSCLC) accounting for the majority of cases. Despite advancements in therapeutics, outcomes remain poor due to late-stage diagnoses and the molecular complexity of the disease. Liquid biopsy, a minimally invasive diagnostic approach, has emerged as a potentially transformative tool in lung cancer. The detection of tumour-derived biomarkers, such as circulating-tumour DNA, circulating tumour cells and exosomes, can be analysed for molecular profiling, early detection and monitoring of disease progression. There have been significant advancements of liquid biopsy technologies, such as next-generation sequencing and droplet digital PCR, that identify actionable mutations, detect resistance mechanisms and improve therapeutic outcomes. While there are still challenges like detecting early-stage disease and the risk of false positives, the combination of multi-omics data and artificial intelligence has the potential for more personalised and precise cancer treatments. Liquid biopsy represents a paradigm shift in the early detection and personalised treatment of lung cancer, offering significant potential to improve patient outcomes.

The field of bronchoscopy has undergone remarkable evolution since its inception, transforming from a means to remove a foreign body, to the first rudimentary flexible diagnostic tool, into its current state as a sophisticated platform for both diagnostic and therapeutic intervention. The advent of robotic-assisted bronchoscopy represents one of the most significant milestones in this progression, offering unprecedented precision and safety in pulmonary procedures. This article reviews the data bolstering robotic-assisted bronchoscopy and the associated tools that can advance diagnostic yield, provides some practical tips for setting up your bronchoscopy suite, and outlines future directions.

Paediatric interventional pulmonology has evolved significantly since the introduction of flexible bronchoscopy in the 1970s, transforming the diagnosis and treatment of paediatric respiratory conditions. This review examines the current state and future directions of the field, emphasising the unique challenges in paediatric airways that necessitate specialised knowledge, instruments and expertise. Recent technological advances in bronchoscopy have expanded both diagnostic and therapeutic capabilities, enabling precise, minimally invasive procedures tailored to paediatric needs. These include airway dilation, stenting, cryotherapy, electrocautery, laser therapy and advanced imaging techniques such as endobronchial ultrasound (EBUS) and robotic navigation systems. However, significant global healthcare disparities persist in access to paediatric bronchoscopy services. While high-income countries offer comprehensive diagnostic and therapeutic capabilities, resource-limited settings face substantial gaps despite often having a higher burden of respiratory diseases, particularly tuberculosis. The review addresses implementation strategies for establishing bronchoscopy services in various resource settings and proposes innovative educational approaches for developing sustainable international training programmes. Future development of the field requires coordinated international efforts, including establishing robust networks between centres, increased funding support and addressing regulatory barriers to facilitate knowledge exchange. The advancement of paediatric interventional pulmonology as a distinct subspecialty, supported by standardised training pathways and international collaboration, is essential for ensuring optimal care for children with complex airway disorders worldwide.

This narrative review explores the complementary roles of indwelling pleural catheters (IPCs) and medical thoracoscopy (MT) in the evaluation and management of unexplained exudative pleural effusions, including malignant pleural effusion. IPCs offer a minimally invasive strategy for long-term outpatient management, which is particularly advantageous for patients with non-expandable lungs or limited functional status. Conversely, MT remains the gold standard for diagnostic accuracy and facilitates therapeutic procedures such as pleurodesis under direct visualisation. Recent evidence supports the integration of IPCs and MT as a hybrid approach, offering synergistic benefits including enhanced symptom control, reduced hospital admissions and improved patient-centred outcomes. This review synthesises current literature to provide a practical and evidence-based overview of these techniques and their evolving role in pleural disease management.

Interventional pulmonology offers a range of minimally invasive techniques to manage airway pathologies, including central airway obstruction. This review examines three commonly used hot ablation therapies: argon plasma coagulation (APC), diathermy and laser. These modalities play a crucial role in treating intrinsic central airway obstruction caused by both benign and malignant conditions, as well as managing haemoptysis by achieving effective haemostasis. APC is a non-contact technique that delivers ionised argon gas to coagulate tissue, making it useful for superficial lesions and bleeding. Diathermy applies high-frequency electric currents through direct tissue contact, allowing tumour debulking, resection and coagulation. Laser therapy is most commonly non-contact and uses the heat produced for cutting and coagulation. These techniques can be used independently or in combination with other bronchoscopy techniques, such as cryotherapy or mechanical debulking. While these procedures are widely available and generally safe, their use must be guided by patient factors, lesion location and risk of complications. Understanding their indications, contraindications and safety considerations is essential for optimising patient outcomes. This review provides a perspective on technique selection, safety considerations and procedural nuances.