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Background: The principal aim of malignant pleural effusion (MPE) management is to improve health-related quality of life (HRQoL) and symptoms., Methods: In this open-label randomised controlled trial, patients with symptomatic MPE were randomly assigned to either indwelling pleural catheter (IPC) insertion with the option of talc pleurodesis or chest drain and talc pleurodesis. The primary end-point was global health status, measured with the 30-item European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) at 30 days post-intervention. 142 participants were enrolled from July 2015 to December 2019., Results: Of participants randomly assigned to the IPC (n=70) and chest drain (n=72) groups, primary outcome data were available in 58 and 56 patients, respectively. Global health status improved in both groups at day 30 compared with baseline: IPC (mean difference 13.11; p=0.001) and chest drain (mean difference 10.11; p=0.001). However, there was no significant between-group difference at day 30 (mean intergroup difference in baseline-adjusted global health status 2.06, 95% CI -5.86-9.99; p=0.61), day 60 or day 90. No significant differences were identified between groups in breathlessness and chest pain scores. All chest drain arm patients were admitted (median length of stay 4 days); seven patients in the IPC arm required intervention-related hospitalisation., Conclusions: While HRQoL significantly improved in both groups, there were no differences in patient-reported global health status at 30 days. The outpatient pathway using an IPC was not superior to inpatient treatment with a chest drain., Competing Interests: Conflict of interest: P. Sivakumar reports grants from Rocket Medical, outside the submitted work. D.B. Fitzgerald reports grants from the European Respiratory Society, outside the submitted work. N. Maskell reports grants and personal fees from Beckton Dickinson and Company, outside the submitted work. Y.C.G. Lee reports non-financial support and grants from Rocket Medical, outside the submitted work. L. Ahmed reports grants from GE, outside the submitted work. No other disclosures were reported., (Copyright ©The authors 2024. For reproduction rights and permissions contact permissions@ersnet.org.)

Objective: Refractory symptomatic transudative pleural effusions are an indication for pleural drainage. There has been supportive observational evidence for the use of indwelling pleural catheters (IPCs) for transudative effusions, but no randomised trials. We aimed to investigate the effect of IPCs on breathlessness in patients with transudative pleural effusions when compared with standard care., Methods: A multicentre randomised controlled trial, in which patients with transudative pleural effusions were randomly assigned to either an IPC (intervention) or therapeutic thoracentesis (TT; standard care). The primary outcome was mean daily breathlessness score over 12 weeks from randomisation., Results: 220 patients were screened from April 2015 to August 2019 across 13 centres, with 33 randomised to intervention (IPC) and 35 to standard care (TT). Underlying aetiology was heart failure in 46 patients, liver failure in 16 and renal failure in six. In primary outcome analysis, the mean±sd breathlessness score over the 12-week study period was 39.7±29.4 mm in the IPC group and 45.0±26.1 mm in the TT group (p=0.67). Secondary outcomes analysis demonstrated that mean±sd drainage was 17 412±17 936 mL and 2901±2416 mL in the IPC and TT groups, respectively. A greater proportion of patients had at least one adverse event in the IPC group (p=0.04)., Conclusion: We found no significant difference in breathlessness over 12 weeks between IPCs or TT. TT is associated with fewer complications and IPCs reduced the number of invasive pleural procedures required. Patient preference and circumstances should be considered in selecting the intervention in this cohort., Competing Interests: Conflict of interest: S.P. Walker has nothing to disclose. Conflict of interest: O. Bintcliffe has nothing to disclose. Conflict of interest: E. Keenan has nothing to disclose. Conflict of interest: L. Stadon has nothing to disclose. Conflict of interest: M. Evison has nothing to disclose. Conflict of interest: M. Haris has nothing to disclose. Conflict of interest: T. Nagarajan has nothing to disclose. Conflict of interest: A. West has nothing to disclose. Conflict of interest: A. Ionescu has nothing to disclose. Conflict of interest: B. Prudon has nothing to disclose. Conflict of interest: A. Guhan has nothing to disclose. Conflict of interest: R. Mustafa has nothing to disclose. Conflict of interest: J. Herre has nothing to disclose. Conflict of interest: D. Arnold has nothing to disclose. Conflict of interest: R. Bhatnagar has nothing to disclose. Conflict of interest: B. Kahan has nothing to disclose. Conflict of interest: R.F. Miller has nothing to disclose. Conflict of interest: N.M. Rahman reports personal fees for consultancy from Rocket Medical, outside the submitted work. Conflict of interest: N.A. Maskell reports grants from BD Carefusion, during the conduct of the study; personal fees from BD Carefusion and Cook Medical, outside the submitted work., (Copyright ©The authors 2022. For reproduction rights and permissions contact permissions@ersnet.org.)

We sought to establish whether continuous positive airway pressure (CPAP) for obstructive sleep apnoea (OSA) in people with type 2 diabetes and diabetic macular oedema (DMO) improved visual acuity.We randomly assigned 131 eligible patients aged 30-85 years from 23 UK centres with significant DMO causing visual impairment (LogMAR letters identified ≥39 and ≤78, score 0.92-0.14) plus severe OSA on screening to either usual ophthalmology care (n=67) or usual ophthalmology care plus CPAP (n=64) for 12 months.Mean age of participants was 64 years, 73% male, mean body mass index 35.0 kg·m - 2 Mean 4% oxygen desaturation index was 36 events·h -1 There was no significant difference in the visual acuity at 12 months between the CPAP group and the control group (mean LogMAR 0.33 (95% CI 0.29-0.37) versus 0.31 (95% CI 0.27-0.35); p=0.39), and no significant correlation between change in LogMAR and average CPAP use. The median±sd (range) daily CPAP use was 3.33±2.25 (0-7.93) h at 3 months, 3.19±2.54 (0-8.07) h at 6 months and 3.21±2.70 (0-7.98) h at 12 months.CPAP therapy for OSA did not improve visual acuity in people with type 2 diabetes and DMO compared with usual care alone over 12 months., Competing Interests: Conflict of interest: S.D. West has nothing to disclose. Conflict of interest: B. Prudon reports grants (paid to institution) and supply of equipment for the project from ResMed UK, during the conduct of the study. Conflict of interest: J. Hughes has nothing to disclose. Conflict of interest: R. Gupta reports travel support from Bayer and Novartis, and personal fees from Bayer, outside the submitted work. Conflict of interest: S.B. Mohammed has nothing to disclose. Conflict of interest: S. Gerry has nothing to disclose. Conflict of interest: J.R. Stradling reports grants from ResMed Foundation, during the conduct of the study; personal fees for consultancy work from ResMed UK and Bayer Germany, outside the submitted work., (Copyright ©ERS 2018.)

Tonsillar enlargement is sometimes seen in patients with otherwise unexplained chronic cough although its significance is unclear. In this study, the authors set out to test the hypothesis that cough symptoms and cough reflex sensitivity will improve after tonsillectomy in patients with otherwise unexplained chronic cough and enlarged tonsils. Eight consecutive patients with unexplained chronic cough and enlarged tonsils were recruited from 236 patients seen in a cough clinic between 2000 and 2001. Six patients with enlarged tonsils and no cough who were undergoing tonsillectomy for other reasons were recruited as a control group. All patients rated cough severity on a cough visual analogue score (0-100 mm) and had capsaicin cough reflex sensitivity measurement twice before and again 3 months after tonsillectomy. Patients with a chronic cough had heightened cough reflex sensitivity compared with the control group at baseline. There was a significant improvement in mean cough visual analogue score 3 months after tonsillectomy in patients with chronic cough (mean difference 30 mm; 95% confidence interval of difference 8-51 mm). The geometric mean concentration of capsaicin required to cause five coughs increased from 4 to 207 micromol L(-1) after tonsillectomy in patients with chronic cough (mean difference from baseline 5.6 doubling concentrations; 95% confidence interval of difference 3.1-8.2). There was no change in cough reflex sensitivity in control patients after tonsillectomy. These preliminary findings suggest for the first time a possible role for tonsillectomy in patients with enlarged tonsils in whom other causes of cough have been ruled out.