Clinical context

Pleural disease remains common, affecting over 3000 people per million population each year. They therefore represent a significant contribution to the workload of respiratory physicians. Pleural disease originates from a wide range of pathologies and a systematic approach to the investigation and management is therefore required. These guidelines attempt to summarise the available evidence to aid the healthcare professional in delivering good quality patient care.

Need for guideline

The Standards of Care Committee of the British Thoracic Society (BTS) established a Pleural Disease Guideline Group in December 2007. The objective was to produce an evidence-based update of the last pleural disease guidelines published in 2003. It was recognised that, since the last guideline, a number of good quality primary research papers have been published and the guidelines needed to reflect these new data. In addition, there was a need to develop new sections on local anaesthetic thoracoscopy and thoracic ultrasound to reflect changes in clinical practice.

Intended users and scope of the guideline

This guideline is intended for use by all healthcare professionals who may be involved in pleural disease management. This will include doctors, nurses and other healthcare professionals.

Areas covered by this guideline

The guideline addresses the investigation and medical management of pleural disease in adults. This 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.

The six sections can be downloaded individually from the website. Key points are repeated within sections to give users a full review of the individual documents without the need to cross reference repeatedly. In addition, at the end of this section (Annex 1) there is a list of good areas for audit and future research.

Areas not covered by this guideline

The following areas fall outside the scope of this guideline:

1. Paediatric pleural …