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Guideline summary
British Thoracic Society Guideline for pleural disease
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  1. Mark E Roberts1,
  2. Najib M Rahman2,3,4,
  3. Nick A Maskell5,
  4. Anna C Bibby5,
  5. Kevin G Blyth6,7,
  6. John P Corcoran8,
  7. Anthony Edey9,
  8. Matthew Evison10,
  9. Duneesha de Fonseka11,
  10. Rob Hallifax12,
  11. Susan Harden13,
  12. Iain Lawrie14,
  13. Eric Lim15,
  14. David McCracken16,
  15. Rachel Mercer17,
  16. Eleanor K Mishra18,
  17. Andrew G Nicholson19,
  18. Farinaz Noorzad20,
  19. Kirstie S Opstad21,
  20. Maria Parsonage22,
  21. Andrew E Stanton23,
  22. Steven Walker5
  1. 1 Respiratory Medicine, Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK
  2. 2 University of Oxford, Oxford Respiratory Trials Unit, Oxford, UK
  3. 3 Oxford NIHR Biomedical Research Centre, Oxford, UK
  4. 4 Oxford Pleural Unit, Churchill Hospital, Oxford, UK
  5. 5 Academic Respiratory Unit, University of Brisol and North Bristol NHS Trust, UK
  6. 6 Glasgow Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK
  7. 7 School of Cancer Sciences, University of Glasgow/Cancer Research UK Beatson Institute, Glasgow, UK
  8. 8 Interventional Pulmonology Service, University Hospitals Plymouth NHS Trust, Plymouth, UK
  9. 9 North Bristol NHS Trust, Westbury on Trym, UK
  10. 10 North West Lung Centre, Manchester University NHS Foundation Trust, Manchester, UK
  11. 11 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  12. 12 Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  13. 13 Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  14. 14 Manchester University NHS Foundation Trust, Manchester, UK
  15. 15 Academic Division of Thoracic Surgery, The Royal Brompton Hospital and Imperial College London, London, UK
  16. 16 Regional Respiratory Centre, Belfast Health and Social Care Trust, Belfast, UK
  17. 17 Portsmouth Hospitals University NHS Trust, Portsmouth, UK
  18. 18 Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  19. 19 Department of Histopathology, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust and National Heart and Lung Institute, London, UK
  20. 20 St George's University Hospitals NHS Foundation Trust, London, UK
  21. 21 British Thoracic Society, London, UK
  22. 22 North Cumbria Integrated Care NHS Foundation Trust, Cumbria, UK
  23. 23 Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  1. Correspondence to Dr Mark E Roberts, Department of Respiratory Medicine, King’s Mill Hospital, Sutton-in-Ashfield, UK; mark.roberts{at}nhs.net

https://doi.org/10.1136/thorax-2023-220304

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    Introduction

    The following is a summary of the British Thoracic Society (BTS) Guideline for pleural disease and includes a summary of the guideline recommendations and good practice points (GPPs). The full guideline is published as a separate Thorax Supplement1 and is available from the BTS website.2 Please refer to the full guideline for full information about each section.1 All online supplemental appendices are also available via the BTS website.2

    Background

    The aim of the guideline was to provide evidence-based guidance on the investigation and management of pleural disease. Pleural disease is common and represents a major and rapidly developing subspecialty that presents to many different hospital services. Since the last BTS Guideline for pleural disease published in 2010,3–9 many high quality and practice changing studies, using patient centred outcomes, have been published. The paradigms for the investigation and management of pleural disease have therefore shifted, so this guideline aimed to capture this evidence and use it to answer the most important questions relevant to today’s practice.

    Target audience for the guideline

    The guideline will be of interest to UK based clinicians caring for adults with pleural disease, including chest physicians, respiratory trainees, specialist respiratory nurses, specialist lung cancer nurses, specialist pleural disease nurses, pathologists, thoracic surgeons, thoracic surgeon trainees, acute physicians, oncologists, emergency physicians, hospital practitioners, intensive care physicians, palliative care physicians, radiologists, other allied health professional and patients and carers.

    Areas covered by the guideline

    The guideline focuses on the investigation and management of pleural disease in adults and covers four broad areas of pleural disease:

    1. Spontaneous pneumothorax

    2. Undiagnosed unilateral pleural effusion

    3. Pleural infection

    4. Pleural malignancy

    Adult patients in both inpatient and ambulatory settings are considered.

    The guideline does not cover mesothelioma (as alternative guidance is available10), benign (non-infectious, non-pneumothorax) pleural disease or rare pleural diseases. Guidance on pleural interventions is also covered in the …

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