Breathe最新文献

Surgical resection remains the most effective curative option for early-stage nonsmall cell lung cancer (NSCLC) in fit patients. However, many individuals with NSCLC have comorbidities that elevate surgical risks and complicate postoperative recovery. These challenges necessitate thorough preoperative assessments to evaluate patient suitability and predict postoperative lung function. Pulmonary function tests (PFTs) and imaging modalities, including computed tomography (CT), ventilation-perfusion scintigraphy and ultrasound, are integral to these evaluations. Advances in technology, such as ventilation and perfusion single-photon emission computed tomography (SPECT)/CT, quantitative CT and magnetic resonance imaging (MRI) techniques, have enhanced the accuracy of postoperative predictions, offering valuable insights into respiratory mechanics and regional lung function. Despite these advancements, no comprehensive evaluation exists to establish the reliability of various prediction methods. This review explores the role of traditional and emerging preoperative tools in assessing lung resection candidates, emphasising their contributions to clinical decision-making. By improving the precision of postoperative lung function predictions, these tools not only optimise surgical outcomes but also support shared decision-making, balancing risks and patient preferences. Further refinement and integration of these methods promises to enhance the management of high-risk patients and advance the standard of care in thoracic surgery.

This issue of Breathe focuses on interventional pulmonology https://bit.ly/4ef45Lm.

"This is not the heart; this is the lung." Who among paediatric pulmonologists has never faced this situation with a cardiologist? Joking aside, discussions for some cases may be tricky and our common ultimate goal is always to provide the best care to the patients and their families. In this review, we will focus on the links between the heart, or more widely the cardiovascular system, and bronchopulmonary dysplasia, in order to determine if this quote is a myth or a maxim.

After decades of development and experience, lung implantable devices have proven to be invaluable in the management of respiratory diseases and complications. Unfortunately, granulation tissue hyperplasia remains a common and challenging complication, compromising implant function through obstruction, migration and increased susceptibility to infection, ultimately requiring frequent reinterventions. Reinterventions often involve bronchoscopy for tissue debulking or device replacement, all of which significantly affect patient wellbeing and healthcare resources. Granulation tissue hyperplasia results from an imbalance in the interactions between the host and the implant. While most patients achieve implant integration, persistent stressors cause chronic inflammation leading to granulation tissue hyperplasia. While several studies have provided insights, the disease endotype remains largely undefined. Variability in incidence and severity across devices and patient populations complicates characterisation. Surface factors, including implant material, adsorbed proteins and the colonising microorganisms, as well as geometrical and biomechanical mismatches with the airways may contribute to pathological tissue responses. Future research aimed at gaining a fundamental understanding of the stressors and biological mechanisms driving granulation tissue hyperplasia is essential for preventing and treating this complication. Ultimately, the goal is to reduce morbidity and improve the longevity of implants and treatment benefit.

In this review, we explore the importance of accurate mediastinal staging in nonsmall cell lung cancer, which directly impacts management options and prognosis. We outline the various means of staging, including radiological and interventional techniques, with a focus on the advantages and limitations of the different approaches. The review also identifies ways in which mediastinal staging has changed over time, particularly with the advent of effective endoscopic nodal sampling, and how emerging research and developments may lead to further adjustments in clinical practice. The role of multidisciplinary decision making, particularly in complex cases, remains integral to the process of mediastinal staging in lung cancer.

Therapeutic anticoagulation is the mainstay therapy in acute pulmonary embolism (PE), however, select patients benefit from emergent reperfusion to prevent or rescue acute right ventricular failure and haemodynamic collapse. Compared to other leading causes of cardiovascular mortality such as myocardial infarction and stroke, there is a substantial paucity of literature informing on advanced therapies in PE. Recent years have seen significant evolution in the armamentarium available for PE care with the uptake of several endovascular treatment modalities and increased use of mechanical circulatory support. While several ongoing randomised controlled trials may alter the therapeutic landscape and approach to PE management, at present, we are left with multiple selections with limited guidance. In this review, we discuss the latest therapeutic options available for acute PE and offer an approach to their implementation.

Pulmonary involvement is common in patients with underlying autoimmune and connective tissue diseases (CTDs) and can encompass a broad spectrum of disorders involving the airways, pleura, parenchyma, vascular system, bronchiectasis and nodules with significant overlap in these pathologies. Interstitial lung disease (ILD) is the most common pulmonary manifestation of systemic autoimmune rheumatic diseases and CTDs. Particular diseases, such as systemic sclerosis, rheumatoid arthritis and inflammatory myopathies, frequently associate with ILD and high-risk patients should be screened. Antibody profiling and imaging characteristics should be used to prognosticate where possible, along with regular surveillance to ensure therapies are optimised. Immunosuppressive therapies can be effective for patients with CTD-associated ILD, but difficulties arise in distinguishing between treatment failures and complications of immunosuppression.

Assembly 12 has developed an online and onsite mentoring programme for early career members. This article discusses the content of the programme, experiences from mentees and mentors and future plans. https://bit.ly/4iGBr6G.

Pulmonary hypertension (PH) is an important cause of morbidity and mortality in connective tissue diseases (CTDs) and may develop either in isolation or in combination with interstitial lung disease (ILD). Based on the World Health Organization PH classification into five groups, patients with CTDs typically belong either to group 1 pulmonary arterial hypertension or to group 3 PH due to chronic lung disease and hypoxaemia (PH-ILD). Recent epidemiological studies have delineated the phenotypical complexity of CTD patients who present with both PH and ILD. This review explores the prevalence, diagnosis, pathophysiology, survival and management strategies for CTD-ILD-PH.

"Breathlessness" or dyspnoea is a common, subjective symptom that can be multifactorial. It is a frequent complaint encountered by cardiologists, both in the outpatient and inpatient clinical setting. It requires a comprehensive clinical evaluation including accurate history taking and pursuing appropriate clinical investigations. It is imperative to distinguish cardiac causes of dyspnoea from other causes, including pulmonary, neurological and other systemic conditions. In this review we attempt to summarise the approach to the evaluation of dyspnoea.