Establishing the cause of a pleural effusion can be challenging. Analysis of pleural fluid (PF) is a powerful tool to determine the cause of a pleural effusion. Surprisingly, despite the diagnostic power of PF analysis (PFA), it is often underused. This review provides a practical framework to maximize the diagnostic potential of the PFA. We describe the role of a PFA in establishing the cause of a pleural effusion. We also discuss challenges and limitations of PFA.

A 54-year-old woman with a history of recurrent exertional dyspnea for 5 years was admitted for evaluation. Six months prior, she noted a worsening of her symptoms, with progressive physical activity limitation caused by exertional fatigue and dyspnea (climbing 2 to 3 flights of stairs). She also experienced palpitations, with an estimated heart rate that ranged from 120 to 150 beats per minute. The patient denied chest pain, hemoptysis, or other notable symptoms. Notably, the patient underwent surgical repair of an atrial septal defect more than 20 years earlier, with a good postoperative recovery. Regular postoperative echocardiograms revealed no residual shunt, no valvular abnormalities, and no pulmonary hypertension. The patient had no history of smoking, drug abuse, or alcohol consumption.

A 94-year-old man presented with a 1-day history of dyspnea and no infective symptoms. There was no associated chest pain, cough, or fever. Systemic review was negative for loss of appetite or weight. He had a medical history of ischemic heart disease with an ejection fraction of 45%, hypertension, hyperlipidemia, and Alzheimer dementia.

A 47-year-old woman initially presented with recurrent coughing caused by the ingestion of gritty foods such as nuts over 20 years ago. Subsequently, she experienced frequent postprandial episodes of white sputum containing food particles and suffered from acid reflux and heartburn, which were originally overlooked.

Pulmonary alveolar proteinosis (PAP) is a rare lung condition characterized by the accumulation of proteinaceous material within the alveoli. The acquired form is often autoimmune, driven by autoantibodies against granulocyte-macrophage colony-stimulating factor. Presentation of autoimmune PAP may range from incidental detection in asymptomatic patients to advanced respiratory failure. Treatment typically involves whole lung lavage or granulocyte-macrophage colony-stimulating factor therapy in symptomatic patients; spontaneous resolution is rare in severe cases. Here, we report 3 cases of autoimmune PAP who presented with resting hypoxia and exhibited spontaneous resolution without significant treatment. All 3 cases had a history of occupational inhalational exposure to noxious gases, and they improved following sustained cessation of exposure. We hypothesize that occupational or environmental noxious inhalation exposure may have a role in disease expression in some cases of autoimmune PAP, and such cases may show spontaneous resolution following cessation of the offending exposure.

There is increasing recognition that health behaviors may contribute to outcomes following COVID-19, but information on the role of alcohol use is limited.

Identifying biomarkers is vital for interstitial lung disease (ILD) management and prognostication. Although anti-Ro52 antibodies frequently are detected in autoimmune diseases, their significance in ILD remains unclear.

Although surrogates are often required to participate in the informed consent process for critical care research, how to best engage surrogates in this process remains unclear.

Rheumatoid arthritis-related interstitial lung disease (RA-ILD) represents an important disease manifestation of rheumatoid arthritis. A scarcity of population-level information on hospitalization rates in RA-ILD exists.

Pulmonary hypertension (PH) is a high-risk finding in end-stage kidney disease (ESKD) and is independently associated with increased mortality.

Functional status and frailty are important considerations in lung transplantation (LT) candidacy because of the potential impact on outcomes after LT. Once listed, waitlist duration can be unpredictable, and preservation of functional capacity is critical to prevent deterioration in conditioning. Pulmonary rehabilitation (PR) has been deemed to be a cornerstone of management of chronic lung disease; its role is often emphasized in lung transplantation.

The routine use of CT imaging and lung cancer screening has increased the incidence of peripheral pulmonary lesions (PPLs). Sampling may be needed for some nodules. Many new technologies are available to improve the diagnostic performance of bronchoscopy for the sampling of PPLs, but few comparative trials exist. The objective of this study was to compare the diagnostic performance of bronchoscopy with radial endobronchial ultrasound (rEBUS) using an ultrathin bronchoscope (BF-MP190F; Olympus) with a non-ultrathin bronchoscope and to compare the diagnostic performance of bronchoscopy with and without rapid on-site evaluation (ROSE).

Becoming a clinician requires not only the accumulation of medical knowledge but also the development of a professional identity. The humanities may illuminate how professional and personal experiences shape identity, support meaning-making, and foster resilience through reflection and creative expression.

Challenges facing health care professionals (HCPs) in selecting an inhaled medication delivery system for patients with COPD include (1) numerous maintenance medications and combinations; (2) at least 22 different handheld inhaler devices; (3) management recommendations focusing mainly on classes of medications; (4) lack of knowledge about available medications/combinations, delivery systems, and guidelines/expert recommendations for treating patients with COPD; (5) in some countries, contracts between health insurance and pharmaceutical companies limit which medications or devices are covered. In this article, we address 3 considerations for HCPs related to treating patients with COPD: selecting an inhaled delivery system; assessing whether the inhaled medication device has provided symptomatic benefit; and providing educational materials for patients on how to use their prescribed medication device correctly. Four patient cases are presented to illustrate these clinical aspects. The main patient factors for selecting an inhaled delivery system include cognitive function, manual dexterity, and inhalation ability. Continuity of the type of handheld inhaler can be beneficial if the patient is using it correctly. To assess the efficacy of the inhaled medication-device at follow-up, HCPs can ask the patient, "Does your current treatment help your breathing?" If the response is Yes, it is appropriate to continue the therapy and to also review inhaler technique; if the response is No, then the next step is to assess the patient's inhaler technique as well as adherence. If the patient demonstrates or describes good technique, is adherent, and does not report subjective benefit, it is reasonable to change the medication or the device.

Airway inflammation is a hallmark feature of asthma characterized by elevated eosinophils and/or neutrophils. Eosinophils in sputum can contribute to ventilation defects. The functional consequence of other types of cellularity on ventilation is unknown.

Pulmonary embolism (PE) is one of the leading causes of pregnancy-related deaths in high-income countries. Maternal mortality from PE has been attributed to delayed recognition and investigations. The diagnosis of PE may be challenging, as its early signs and symptoms may overlap with physiological changes of pregnancy. As such, promptly ruling out suspected PE using diagnostic testing is of paramount importance. This narrative review provides a contemporary overview of risk assessment tools, diagnostic modalities, counseling needs, and existing best practice guidance for the diagnosis of PE in pregnancy.

Accurate risk prediction of exacerbations is pivotal in severe asthma management. Multiple risk factors are at play, but the pathway of risk prediction remains unclear.

The low spirometry testing rate for screening of COPD is partly attributed to complex procedures, stringent quality control requirements, and long examination times. Simplifying the spirometry protocol may increase the feasibility of COPD screening in community settings.

Limited real-world data exist on the health impacts of the Philips Respironics recall for positive airway pressure (PAP) devices.

Right heart catheterization is the gold standard for the diagnosis of pulmonary hypertension. There are variations in practice and several pitfalls introducing errors in diagnosis that can significantly affect treatment. Errors in assessing the correct pulmonary artery wedge pressure can significantly affect accurate classification of patients with pulmonary hypertension and lead to potentially deleterious treatment decisions. This review focuses on best practices in right heart catheterization performance, emphasizing practical and pathophysiological principles to obtain the most accurate result, as well as advanced applications in pulmonary hypertension.