CHEST Guidelines-Management-of-Recurrent-Malignant-Pleural-Effusion

Management-of-Recurrent-Malignant-Pleural-Effusion

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The document comprises two letters to the editor discussing articles published in CHEST, a journal of respiratory medicine. The first letter addresses the debate between thoracoscopic talc pleurodesis (TTP) and an indwelling pleural catheter for managing recurrent malignant pleural effusions. Dr. Fabien Maldonado and Dr. Philippe Astoul emphasize the advantages of TTP, including visual assessment during the procedure that allows for better outcomes, despite its associated complications in some cases, such as atelectasis and postoperative death. They highlight regional variations in healthcare delivery and the economic benefits of pleurodesis, particularly given the proven safety of calibrated French talc used widely, excluding the US, which supports TTP as the preferred method globally.<br /><br />In response, Dr. Pyng Lee argues for the cost-effectiveness and reduced complications of TTP when performed by pulmonologists using large-particle talc, as demonstrated by European studies. Lee emphasizes TTP’s superiority for malignant pleural effusions when the patient's survival is projected over six weeks, due to shorter hospital stays and effective cost management.<br /><br />The second letter from Dr. Luis J. Nannini discusses the implications of hospitalization due to acute exacerbations of COPD (AECOPD). He supports Dr. Rabe's call for high-quality data in not only retrospective cohort studies but also randomized controlled trials, suggesting that hospitalization for AECOPD signals poorer prognosis and high mortality rates comparable to cancer. Nannini advocates for comprehensive reporting of AECOPD hospitalizations in clinical studies to enable thorough analyses and potential intervention strategies. <br /><br />Both letters collectively push for improved clinical practices based on comprehensive data to ensure safety and efficacy in pulmonary healthcare management.

Keywords

thoracoscopic talc pleurodesis

indwelling pleural catheter

malignant pleural effusions

pulmonary healthcare

COPD exacerbations

hospitalization

cost-effectiveness

randomized controlled trials

clinical practices

respiratory medicine