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Accurate hilar and mediastinal staging is critical for prognosis and treatment selection in non-metastatic non-small cell lung cancer (NSCLC). While current guidelines recommend systematic mediastinal lymph node staging by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for early-stage disease, its utility in wider populations is increasingly recognized. We aimed to determine the rate of nodal upstaging following systematic endoscopic mediastinal staging in non-metastatic NSCLC. MEDLINE, Embase, and Cochrane databases were searched from inception to February 2025. We included prospective and retrospective studies of adults with curative-intent NSCLC undergoing systematic EBUS-TBNA staging that reported per-patient nodal upstaging. Two reviewers independently extracted data. A random-effects meta-analysis assessed the pooled proportion of PET-occult lymph node metastases. Upstaging rates were quantified across clinical N stages. Subgroup analyses and meta-regression assessed methodological variables (PROSPERO: CRD42024547873). Twenty-six studies comprising 5,161 participants were included. The pooled rate of PET-occult nodal metastases was 8.6% (95% CI: 6.7-11.0%), corresponding to a number needed to test of 12. Nodal upstaging rates varied by clinical stage: 7.2% for cN0, 10.6% for cN1, 5.0% for cN2, and 0.3% for cN3. Statistical heterogeneity was substantial (I2 = 82.0%); however, subgroup analyses and meta-regression did not identify significant sources of variance. This is the first published systematic review to evaluate the rate of PET-occult nodal disease in non-metastatic NSCLC using systematic staging EBUS-TBNA. Approximately 1 in 12 patients were identified to have PET-occult nodal metastases. These findings support the routine implementation of systematic endoscopic staging to guide curative-intent treatment decisions across non-metastatic disease stages.

Photodynamic therapy (PDT) is a minimally invasive, organ-preserving treatment option for patients with centrally located early-stage non-small cell lung cancer. While first-generation photosensitizers such as Photofrin are well established, second-generation agents like Chlorin e6 offer improved pharmacokinetics and potentially better clinical outcomes. The objective of this study was to assess the safety profile and therapeutic efficacy of different photosensitizers used in PDT for centrally located early-stage lung cancer (CELC). We retrospectively analyzed 62 CELC lesions in 36 patients treated with PDT between 2015 and 2024. Patients received one of three photosensitizers - Photofrin, Chlorin e6, or Foscan - followed by bronchoscopic light activation. Outcomes included complete remission (CR), local tumor control (LTC), disease-free survival (DFS), and treatment-related adverse events. CR rates were 87.5% (28/32) for Chlorin e6, 100% (3/3) for Foscan, and 68.8% (22/32) for Photofrin, with a nonsignificant trend favoring Chlorin e6 over Photofrin (p = 0.13). Mean DFS was longest in the Chlorin e6 group (43.3 months; 95% CI: 32.5-54.1), followed by Photofrin (24.0 months; 95% CI: 17.2-30.8) and Foscan (7.3 months; 95% CI: 6.3-8.4). Durable LTC was achieved in 84.1% of lesions without need for escalation to systemic or surgical treatment. Chlorin e6 demonstrated a more favorable safety profile than Photofrin. PDT is a safe and effective treatment modality for CELC, achieving high rates of LTC. Among the evaluated photosensitizers, Chlorin e6 showed a favorable balance of efficacy and safety.

Diagnosing intrathoracic tuberculosis (TB) in children under five years of age remains challenging. Clinical symptoms often overlap with those of other common childhood illnesses, and microbiological confirmation is frequently difficult to obtain in this age group. Despite advances in diagnostic technologies, few studies focus specifically on children younger than five years, the population in whom diagnosis is most complex. Intrathoracic lymphadenopathy on chest X-ray (CXR) is the hallmark radiological features of TB in this age group, but identification by trained physicians currently demonstrates only moderate diagnostic performance, with reported sensitivities ranging from 67% to 74% and specificities between 39% and 59%. We aimed to develop and evaluate an automated deep learning-based approach for identifying severe pulmonary lymphobronchial tuberculosis (LBTB) in children under five years of age using anterior-posterior (AP) chest X-ray images, with confirmed airway compression serving as the primary radiographic reference. A total of 402 AP chest X-ray images were included in this study. Half of the images were obtained from children diagnosed with intrathoracic TB and with confirmed airway obstruction on bronchoscopy and/or chest computed tomography (CT). The remaining half of images were normal AP chest X-rays from children without TB disease. Three convolutional neural network (CNN) architectures-VGG16, ResNet50, and InceptionV3-were evaluated and compared for their ability to classify pulmonary LBTB based on radiographic features. A fine-tuned ResNet50 model achieved a statistically significant mean test sensitivity of 94.43% and mean test specificity of 94.79% in identifying TB-positive cases. The model classified disease presence by detecting radiographic manifestations of LBTB affecting the trachea and main bronchi on CXR images.

Endoscopic lung volume reduction (ELVR) via valves is a proven therapeutic option for patients with advanced chronic obstructive pulmonary disease (COPD) and emphysema without collateral ventilation. Body mass index (BMI), a simple measure of adiposity, has a complex relationship with COPD. A lower BMI is associated with increased mortality in this patient population. However, the influence of BMI on the outcome of ELVR remains unclear. This analysis was conducted with data from the Lung Emphysema Registry (<ext-link ext-link-type="uri" xlink:href="http://www.lungenemphysemregister.de" xmlns:xlink="http://www.w3.org/1999/xlink">www.lungenemphysemregister.de</ext-link>), a national, prospective, multicentric, producer-independent, open-label clinical trial. The aim of this study was to evaluate the impact of baseline BMI on treatment outcomes after ELVR. Patients were grouped according to their BMI as follows: underweight (BMI <20 kg/m2, n = 76), normal weight (20-24.9 kg/m2, n = 282), overweight (BMI = 25-30 kg/m2, n = 146), and obese (BMI >30 kg/m2, n = 45). Baseline parameters were characteristic of patients with advanced lung emphysema. Emphysema scores and heterogeneity indices of the target lobe were greater in patients with lower BMI. Patients with a lower BMI had worse lung function parameters (FEV1, RV, DLCO, pCO2) and a higher CAT score. All groups showed significant improvements after ELVR at the 3-month follow-up in terms of lung function parameters, exercise capacity, and quality of life. Treatment outcomes were comparable across BMI groups, with the notable exception of more pronounced improvement in CAT scores among underweight patients. The complication rates were low and comparable among the groups, although obese patients had a higher rate of ICU admissions. This study suggests that ELVR provides meaningful clinical benefits regardless of BMI in patients with advanced lung emphysema, particularly when dyspnea is primarily attributable to pulmonary pathology. The findings suggest that BMI should be considered as a reflection of disease phenotype and clinical state rather than serving as a predictor for treatment response after ELVR.

Bronchiectasis is a chronic, often progressive respiratory disease characterized by irreversible dilation of the bronchi. It is etiologically heterogeneous and frequently associated with a significant symptom burden, multiple complications, and reduced quality of life. In recent years, the global prevalence of bronchiectasis has increased markedly, placing a substantial economic burden on healthcare systems. These consensus-based guidelines are the first German-language guidelines focused on the management of bronchiectasis in adults. They underscore the critical role of thoracic imaging - particularly computed tomography - in diagnosing and distinguishing bronchiectasis and highlight the importance of identifying the underlying etiology in guiding treatment decisions. The guidelines provide comprehensive recommendations for both pharmacological and non-pharmacological treatment strategies. Non-drug interventions include smoking cessation, physiotherapy, physical training, pulmonary rehabilitation, non-invasive ventilation, thoracic surgery, and lung transplantation. Pharmacological therapies emphasize the long-term use of mucolytics, bronchodilators, anti-inflammatory agents, and antibiotics. In addition, the guidelines address the management of upper airway involvement, common comorbidities, and acute exacerbations. They also cover socio-medical issues, disability rights, and the role of patient education and self-management in optimizing care. Special life stages - such as transition from pediatric to adult care, family planning, pregnancy, parenthood, and palliative care - are also considered. The overarching goal is to promote comprehensive, consensus-driven, and patient-centered care that accounts for individual risks and needs.

Clinicians often extend antibiotic therapy for refractory nontuberculous mycobacterial pulmonary disease (NTM-PD), despite potential side effects and the uncertain benefits of extended therapy. In this study, we present our real-world experience with prolonged antibiotic therapy in patients with treatment-refractory NTM-PD. We reviewed adult patients with treatment-refractory NTM-PD treated at a tertiary referral center in South Korea between April 2003 and July 2024. Eligible patients did not achieve sustained culture conversion within 6 months and received macrolide-based therapy for at least 18 months. Patients were grouped into prolonged treatment (&#x2265;24 months) and shorter treatment (18-24 months) groups. The microbiological, radiographic, and clinical outcomes were analyzed. Among the 123 patients, 50 (40.7%) received prolonged therapy. Patients who underwent prolonged treatment had a more frequent history of tuberculosis (44.0% vs. 24.7%, p = 0.040) and autoimmune diseases (14.0% vs. 1.4%, p = 0.016), although the other baseline characteristics were similar. The use of clofazimine, intravenous aminoglycosides, and inhaled amikacin was significantly higher in the prolonged group, along with a higher incidence of anemia as a side effect (14.0% vs. 2.7%, p = 0.030). Acquired macrolide resistance appeared to be more common in the prolonged group (14.0% vs. 6.8%), but the difference was not statistically significant (p = 0.315). Over a median follow-up of 4.4 years, prolonged treatment was not associated with a lower risk of retreatment or all-cause mortality. The rates of microbiological cure, sputum smear conversion, radiographic progression, and weight change did not differ between groups. Extending antibiotic therapy beyond 24 months in patients with treatment-refractory NTM-PD does not necessarily confer additional microbiological, radiographic, or survival benefits, and may increase the risk of adverse events. Therefore, prolonged therapy should be reserved for selected patients, with close monitoring for side effects and macrolide resistance.

Shape-sensing robotic-assisted bronchoscopy (ssRAB) represents a major advancement in the bronchoscopic evaluation of pulmonary nodules suspicious for malignancy. Its use has expanded across multiple countries and healthcare systems; however, no global consensus currently exists to guide clinical practice or address areas of uncertainty. This first world expert consensus was developed by an international panel of 18 specialists in interventional pulmonology and ssRAB, representing 13 hospitals across three continents. The process included a systematic literature review, followed by multiple rounds of structured questionnaires, sharing of clinical experience, and informed discussion, in order to identify key domains and establish consensus statements. A total of 38 recommendations were generated across domains including indications and contraindications, procedural set up, practical workflow, anesthesia considerations, diagnostic tools, training, reporting standards, and safety practices of ssRAB. Full consensus (100% agreement) was achieved for all 38 statements following three voting rounds and extensive discussion. This first international expert consensus provides comprehensive, evidence-informed guidance on the clinical use of ssRAB. It also highlights areas of ongoing uncertainty and can serve as a foundation for future research, education, and guideline development in this rapidly evolving field.

Airway secretion retention represents a major clinical challenge in critically ill patients, promoting gas exchange impairment and atelectasis, precipitating failure of noninvasive respiratory support, and prolonging invasive mechanical ventilation, with an associated increase in respiratory-related complications and mortality. High-frequency chest wall oscillation (HFCWO) is a noninvasive airway clearance technique widely used in chronic respiratory diseases, but its role in the intensive care unit (ICU) remains unclear. This systematic review aimed to evaluate the available evidence on the efficacy and safety of HFCWO in adult ICU patients. A systematic literature search was conducted in PubMed/MEDLINE, Embase, and Cochrane Library from inception to December 2025 in accordance with PRISMA guidelines. Studies evaluating HFCWO in adult ICU patients, including those receiving invasive or noninvasive respiratory support, were eligible. Primary outcomes included duration of mechanical ventilation, ICU length of stay, and mortality. Secondary outcomes included impact on secretion airway clearance and its radiographic/functional surrogates as well as safety and treatment tolerance. A limited number of studies met the inclusion criteria, mainly small randomized controlled trials and observational studies, characterized by substantial heterogeneity in patient populations, intervention protocols, and assessed outcomes. HFCWO effects on clinically meaningful primary endpoints, including duration of mechanical ventilation, length of ICU stay, and mortality, remain variable and inconclusive. Overall, HFCWO was well tolerated and appeared to enhance secretion clearance, with some studies reporting modest improvements in oxygenation and respiratory mechanics. Current evidence suggests that HFCWO is a safe and feasible airway clearance strategy in selected ICU patients with secretion burden and without proved effects on the main clinical outcomes. Lack of physiopathologically driven criteria for selection of patients more likely to respond to HFCWO either alone or integrated with other cough-assisting techniques may partially explain these scanty findings from the overall published studies. This precludes its routine use in clinical practice. Well-designed, adequately powered randomized trials are needed to define patient selection criteria, optimal timing, and the true clinical impact of HFCWO in the ICU setting.

Interventional Pulmonology has evolved into a distinct subspecialty driven by advanced technologies, yet the global educational infrastructure to support this growth remains undefined. The shift from traditional training models to Competency-Based Medical Education (CBME) is advocated but inconsistently applied. This study aimed to comprehensively assess the current landscape of IP training, identifying geographic disparities in educational structure, resource availability, and certification requirements. We conducted a prospective, international, cross-sectional survey in May 2025. A validated 25-item web-based questionnaire was distributed to interventional pulmonologists and thoracic endoscopists across 34 countries via major international respiratory societies and professional digital networks. The instrument evaluated four domains: demographics, institutional setting, local training architecture, and assessment methodologies. Data were analyzed using descriptive statistics to map global training availability and standardization. Analysis of 102 valid responses revealed a profound global training deficit. Seventy percent (70%) of respondents reported that no structured IP training program exists in their country. In general pulmonary fellowships, 41% of respondents indicated their training offered no exposure to interventional techniques. Geographic disparities were significant; while 100% of North American respondents reported access to structured programs, respondents from Africa reported 0% availability. Furthermore, certification was not mandatory for operating in an IP unit in 70% of cases. Assessment methods lacked rigor, with 33.3% of general fellowships reporting no formal skills evaluation. Despite these gaps, 96% of respondents expressed agreement with the need for a standardized, global IP training curriculum. A critical "training divide" exists in Interventional Pulmonology, characterized by a lack of structured programs, inconsistent assessment, and severe regional inequities. The current reliance on unregulated training models is insufficient for modern procedural complexity. There is a near-unanimous consensus among practitioners for the implementation of a unified, competency-based international curriculum to ensure patient safety and standard of care worldwide.

Lung transplantation is a curative treatment for end-stage pulmonary sarcoidosis. Outcomes and prevalence of sarcoidosis recurrence are not well established despite sarcoidosis being the most common disease to recur following lung transplantation. We sought to evaluate our institution's experience of lung transplantation for pulmonary sarcoidosis. This was a retrospective, single-centre study on consecutive lung transplant recipients for pulmonary sarcoidosis from December 1994 to March 2024. Medical records were reviewed for trans-bronchial biopsies (TBBxs), thoracic computed tomography (CT), positron emission tomography (PET), and spirometry. Post-transplant clinical outcomes and survival were explored. We reviewed 40 patients who underwent lung transplantation for pulmonary sarcoidosis out of 1,789 total lung transplantations between January 1994 and March 2024. Fourteen (35%) had pulmonary sarcoidosis recurrence. The average age at transplant was 51 years and time from transplant to recurrence was 15 months. The predominant CT finding in sarcoidosis recurrence was right upper lobe nodules (42%). More than half (60%) of non-necrotising granulomas on TBBx were detected outside the surveillance protocol, at a median 9-month post-transplant. Two of 3 patients treated with infliximab for recurrence had complete metabolic response on PET. Patients with sarcoidosis recurrence were younger at time of transplant than those without recurrence (44 vs. 54.6 years, p < 0.001) and trended toward improved overall survival (15.1 vs. 8.2 years, p = 0.23). Sarcoidosis recurrence was common and did not have a significant impact on survival after lung transplantation. Right upper lobe nodules on CT and inclusion of a 9-month surveillance TBBx may be useful in identifying sarcoidosis recurrence.

The diagnostic yield of mycobacterial culture from pleural tissue in tuberculous pleurisy is high and practical. However, the yield rates of mycobacterial culture from pleural tissue obtained through different pleural biopsy techniques via medical pleuroscopy remain unclear. This study aimed to compare the efficiency of mycobacterial culture from pleural tissue obtained by cryobiopsy and forceps biopsy during medical pleuroscopy for diagnosing tuberculous pleurisy. This retrospective study included 84 patients with tuberculous pleurisy who underwent mycobacterial culture testing using pleural tissue samples. Of these, 33 patients underwent pleuroscopic cryobiopsy and 51 underwent pleuroscopic forceps biopsy from April 2016 to December 2023 at two tertiary hospitals. Mycobacterial cultures from pleural tissue obtained by cryobiopsy and forceps biopsy were analyzed. The average age of the participants was 67.1 years, with 67.9% being men. The sensitivity of Mycobacterium tuberculosis (MTB) cultures from pleural tissue was 54.5% (18/33) for cryobiopsy and 62.7% (32/51) for forceps biopsy (p = 0.455). The sensitivity of MTB culture was higher, up to 64.4% and 74.2%, in cases with pleural adhesion lesions and a combination of adhesion lesions and micronodules, respectively. There was no significant difference in the yield rate of MTB culture obtained by cryobiopsy or forceps biopsy in cases of undiagnosed pleural effusion during pleuroscopy. When tuberculous pleurisy is suspected, forceps biopsy may be the optimal method for obtaining mycobacterial cultures from pleural tissue.

Pulmonary endometriosis (PE) is an unusual cause of catamenial hemoptysis, with only a small proportion of endometriosis cases involving the thorax. Standard management often involves surgical resection combined with hormonal therapy; however, recurrence rates remain high and long-term hormonal suppression can be challenging for patients. Multiple thoracic surgical interventions may be required for these patients during their reproductive age. A more minimally intervention alternative to surgery is expected, especially those who would like to preserve lung function and warrant quality of life. We report two PE cases diagnosed clinically based on periodical hemoptysis and radiological changes relevant to menstrual cycles. Both patients were successfully treated with percutaneous radiofrequency ablation (RFA), with complete resolution of cyclical hemoptysis and a 3-year symptom-free follow-up. Percutaneous RFA may be a promising alternative to surgical resection for solitary PE lesions and could serve as part of a multidisciplinary management strategy for endometriosis, especially in young patients at risk of recurrence who wish to preserve lung function and maintain quality of life.

Introduction Optimal management of long-term home non-invasive ventilation (NIV) therapy is not clearly defined. This study determined whether patient experience of disease and NIV therapy (S3-NIV score) in the first month was associated with successful NIV delivery and termination rate at 6 months. Methods Participants were adults starting home nocturnal NIV for chronic respiratory failure in 2019-2022, who used telemonitoring, completed &#x2265;1 S3-NIV questionnaire in the first month of NIV and were followed by the same home service provider. As no S3-NIV score thresholds are defined, participants were grouped by S3-NIV score quartiles (Q) (Q1=most negative impact of symptoms/NIV; Q4=lowest impact of disease/treatment). Factors associated with successful NIV delivery at 6 months were determined using multivariate logistic regression analysis. Results 153 patients were included (mean age 65.9&#xb1;12.9 years, 60% male). The proportion of patients with successful NIV delivery at 6 months increased as initial S3-NIV score increased: Q1 42%, Q2 60%, Q3 63%, and Q4 63% (p=0.007). Individuals with lower S3-NIV scores had more home interventions and mask changes during follow-up, regardless of whether NIV was successful or not. Termination rate was higher in S3-NIV score Q1 versus Q4 (29% vs. 11%). The probability of successful NIV delivery at 6 months increased by 1.14-fold for each 1-point increase in initial S3-NIV score, independent of the association between the score and NIV data at 1 month. Conclusion The S3-NIV questionnaire helped to identify patients at higher risk of therapy termination more effectively than relying only on objective ventilator data.

Introduction Cardiac sarcoidosis is a potentially life-threatening manifestation of systemic sarcoidosis, yet its true prevalence remains uncertain. Improved imaging techniques and greater clinical awareness may have contributed to higher detection rates, but nationwide data on cardiac involvement and hospitalization burden in Switzerland are lacking. We aimed to characterize national trends, comorbidity patterns, and in-hospital outcomes of presumed cardiac sarcoidosis between 2010 and 2021. Methods This nationwide retrospective nested case-control study used the Swiss Federal Statistical Office hospitalization database. Presumed cardiac sarcoidosis was defined by co-occurrence of International Classification of Diseases, 10th Revision, German Modification (ICD-10-GM) codes for sarcoidosis (D86.0-D86.8) and cardiac involvement (I41, I42, I44, I45, I46, I49, I50), excluding coronary artery disease (I25). Controls were age-, sex-, and admission-month-matched sarcoidosis hospitalizations without cardiac involvement. Results Among 5,636 hospitalized sarcoidosis patients, 813 (14%) met criteria for presumed cardiac sarcoidosis. Between 2010 and 2021, the number of hospitalizations for presumed cardiac sarcoidosis increased significantly, approximately doubling over the study period (rate ratio 2.09, 95% CI 1.87-2.35; p<0.001). Over the same period, the proportion of patients carrying implantable cardiac devices doubled from 15% to 30% (+1.2% per year; 95% CI 0.3-2.1; p=0.015). Compared with controls, patients with presumed cardiac sarcoidosis had a greater comorbidity burden (median 10 vs 8), higher in-hospital mortality (5.5% vs 2.3%; OR 2.45 [1.59-3.85]), and more frequent rehospitalizations (0.32 vs 0.24 per year). In multivariable analyses, acute organ dysfunction was most strongly associated with in-hospital mortality, whereas heart failure and atrial fibrillation were the strongest predictors of rehospitalization. Conclusion Hospitalizations for presumed cardiac sarcoidosis in Switzerland have nearly doubled between 2010 and 2021, likely reflecting increased diagnostic awareness and improved detection, although a true increase in disease incidence cannot be excluded. Despite rising case numbers and higher comorbidity burden, overall in-hospital mortality remained stable.

To determine whether peak workload (Wpeak), expressed as a percentage of predicted value during a cardiopulmonary exercise test (CPET), can predict postoperative cardiopulmonary complications in high-risk patients undergoing lung cancer resection. A retrospective cohort study was conducted on 226 consecutive patients who underwent anatomical lung resection (lobectomy or segmentectomy) for non-small cell lung cancer between 2013 and 2017. All patients were considered high risk, with preoperative FEV1 and DLco <80% predicted and underwent full CPET within 30 days prior to surgery. The main endpoint was the occurrence of cardiopulmonary complications within 30 days postoperatively. The predictive ability of Wpeak (% predicted) for complications was evaluated using ROC analysis and optimal cutoff was identified. Outcomes were compared above and below this threshold. A Wpeak threshold of 52% predicted was identified as the optimal cutoff, with an area under the ROC curve of 0.59 (95% CI: 0.51-0.67; p = 0.015). Patients with Wpeak &#x2264;52% had a significantly higher rate of postoperative complications (58% vs. 33%, p = 0.001), particularly respiratory complications (47% vs. 28%, p = 0.008), and longer hospital stays (mean 24 vs. 15 days, p = 0.002). They also had lower FEV1, DLco, VO2peak, and heart rate responses compared to patients with Wpeak >52%. Wpeak &#x2264;52% of predicted was associated with increased risk of postoperative complications and longer hospitalization. Although the discriminatory ability was modest (AUC 0.59), Wpeak &#x2264;52% predicted was associated with higher postoperative complications and may serve as a complementary tool for risk stratification, especially in resource-limited settings. Further prospective validation is warranted.

Hospital-acquired pneumonia (HAP) is a major type of hospital-acquired infection with substantial morbidity. Large-scale epidemiological data on HAP in China remain limited. This multi-center retrospective study investigates the epidemiology, etiology, and risk factors of HAP to support clinical management. From January to December 2019, 543 patients from 37 tertiary hospitals meeting the enrollment criteria (who meet the diagnosis of HAP according to the Guidelines for the Diagnosis and Treatment of HAP in Adults in China and have clear clinical outcomes) were included. Patient data were retrospectively analyzed. The study recorded 15.8% overall mortality. Multivariate analysis identified independent risk factors including secondary ventilator-associated pneumonia, admission to the intensive care unit, positive airway secretion culture, liver dysfunction, heart failure, cancer, long-term catheter indwelling, sequential organ failure assessment (SOFA) score >2 and quick SOFA (qSOFA) score >1 (p < 0.05). The top four pathogens of HAP were Acinetobacter baumannii (24.89%), Klebsiella pneumoniae (21.57%), Pseudomonas aeruginosa (13.73%), and Staphylococcus aureus (5.88%). Given the high mortality rate associated with HAP, prevention and early diagnostic assessment of HAP during hospitalization are paramount for these patients. The main pathogens of HAP are Gram-negative bacteria, which frequently exhibit substantial antimicrobial resistance. Therefore, antibiotics should be selected carefully.

The number of paediatric patients evaluated for long-term home respiratory support has risen sharply in recent years, reflecting both improved survival of children with complex chronic conditions and expanded therapeutic indications. This population is characterized by substantial clinical heterogeneity, encompassing obstructive, restrictive, or central ventilatory disorders. Contributing comorbidities - such as severe obesity, chronic aspiration with secondary lung disease, neuromuscular weakness, impaired central respiratory drive, and dynamic upper airway obstruction - further complicate diagnostic assessment and long-term management. This consensus statement, developed by the Special Interest Group of the Swiss Society of Paediatric Pulmonology, provides comprehensive recommendations for Switzerland. It defines current indications for non-invasive and invasive home respiratory support, proposes criteria for patient selection, and outlines key competencies and composition of an optimal multidisciplinary care team. The document also specifies requirements for equipment provision, safety measures, and training of caregivers, while offering structured guidance for monitoring strategies, long-term follow-up, and management of acute exacerbations. Ethical considerations and best practices for transitioning adolescents to adult respiratory care are additionally addressed, with the aim of standardizing care pathways and improving clinical outcomes.

Preschool wheeze is common, and treatment options are limited, consisting mainly of inhaled corticosteroids (ICS). We report here a retrospective study in severe preschool wheezers not controlled by high doses of ICS, who were given azithromycin as long term additional therapy. We conducted a single center, retrospective study between 2020 and 2025, including children less than 6 years old with severe recurrent wheeze, partially or uncontrolled despite a high dose of ICS and who were given azithromycin three times a week for 6 months as maintenance treatment. Thirty-eight children with a mean age of 2.3 &#xb1; 1.2 years were retrospectively included in our center. We found an improvement in the control of wheezing, and a decrease of exacerbations, daily respiratory symptoms and dose of daily ICS after 6 months of azithromycin treatment, without major secondary effect declared. Azithromycin could therefore be considered as an adjunctive treatment in young children with persistent asthma and frequent exacerbations despite high doses of inhaled steroids. This conclusion is from a retrospective study, and it is needed to perform controlled prospective studies to validate these findings.

Malignant pleural effusion management often involves multiple procedures that are painful and have risks. Indwelling pleural catheters (IPC) are associated with reduced re-intervention rates. Recently published trials have focused on optimising IPC aftercare to improve pleurodesis rates, reduce complications and expedite catheter removal. We combined available data into one protocol and evaluated it in an unselected cohort. Is initial IPC insertion as first-line intervention for MPE (combined with talc instillation and daily drainage where suitable) safe, feasible and effective? The EPIToME protocol was developed to minimize pleural interventions and was evaluated in a prospective, unselected cohort of MPE patients. The EPIToME protocol managed all symptomatic MPEs (unless contraindicated), with IPC insertion, inpatient talc instillation via the IPC, and daily ambulatory drainage if full lung expansion was achieved. Otherwise, symptom-guided drainage was performed. Of 102 MPE patients, 47 (46.1%) patients underwent talc instillation, of which 74.5% achieved pleurodesis after 20 (median, 95%CI=6.7-33.3) days. Those unsuitable for pleurodesis (55%) underwent symptom-guided drainage. Fifty-five patients had the IPC removed after fluid cessation. The EPIToME protocol required a hospital stay of two to three days, similar to standard pleurodesis. Complications (infection 11.8%, symptomatic loculation 10.8%) were within expected ranges, but interpretation of safety is limited in the absence of a comparator group. Only 3 patients (2.9%) required further pleural re-intervention post-IPC removal. We developed and demonstrated the feasibility of the EPIToME approach which aims to minimize interventions for all-comers with MPE. Combining IPC, talc pleurodesis and daily drainage may be effective and should be evaluated in randomized trials.