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British Thoracic Society Pleural Disease Guidelines - 2010 update
  1. Nick Maskell on behalf of the British Thoracic Society Pleural Disease Guideline Group
  1. Correspondence to Dr Nick Maskell, North Bristol Lung Centre, Southmead Hospital, Bristol, UK; nick.maskell{at}

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Pleural disease remains common, affecting over 3000 people per million population each year. It therefore presents a significant contribution to the workload of respiratory physicians. These guidelines attempt to summarise the available evidence to aid the healthcare professional in delivering good quality patient care.

Aims and objectives of the guideline

Since the last BTS pleural disease guidelines were published in 20031 a large number of good quality primary research papers have been published and the guidelines need to reflect this new data. In addition, there was a need to develop new sections on local anaesthetic (LA) thoracoscopy and thoracic ultrasound to reflect changes in clinical practice.

Areas covered

The guideline is divided into the following sections:

  1. Investigation of a unilateral pleural effusion in adults

  2. Management of spontaneous pneumothorax

  3. Management of a malignant pleural effusion

  4. Management of pleural infection in adults

  5. Local anaesthetic thoracoscopy

  6. Chest drain insertion and thoracic ultrasound


A working party was established with representation from a range of professionals with an interest in pleural disease together with a lay representative. The guidelines are based upon the best available evidence. The methodology followed the criteria as set out by the AGREE collaboration in the document, The AGREE instrument, available on-line at: The scope and purpose of the guideline had been agreed and defined in consultation with all potential stakeholders representing the medical and nursing professions, patient groups, health management and industry. Guideline members identified and formulated a set of key clinical questions in PICO(T) (Population, Intervention, Comparison, Outcome and Time) format to inform the search strategies for the literature search.The BTS commissioned a bespoke literature search using the search strategies shown in detail on the BTS website ( Searches were limited to English and adult literature. 19,425 potential papers were identified by the search. 17393 abstracts were rejected through the criteria …

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