ERS Statement on Benign Pleural Effusions in Adults

Anand Sundaralingam; Elzbieta M Grabczak; Patrizia Burra; M Inês Costa; Vineeth George; Eli Harriss; Ewa Jankowska; Julius P Janssen; Georgia Karpathiou; Christian B Laursen; Kornelija Maceviciute; Nick Maskell; Federico Mei; Blin Nagavci; Vasiliki Panou; Valentina Pinelli; José M Porcel; Sara Ricciardi; Samira Shojaee; Hugh Welch; Alberto Zanetto; Udaya Prabhakar Udayaraj; Giuseppe Cardillo; Najib M Rahman

doi:10.1183/13993003.02307-2023

ERS Statement on Benign Pleural Effusions in Adults

Eur Respir J. 2024 Jul 26:2302307. doi: 10.1183/13993003.02307-2023. Online ahead of print.

Authors

Anand Sundaralingam^{1

2

3}, Elzbieta M Grabczak⁴, Patrizia Burra⁵, M Inês Costa⁶, Vineeth George^{7

8}, Eli Harriss⁹, Ewa Jankowska¹⁰, Julius P Janssen¹¹, Georgia Karpathiou¹², Christian B Laursen^{13

14}, Kornelija Maceviciute¹⁵, Nick Maskell¹⁶, Federico Mei^{17

18}, Blin Nagavci¹⁹, Vasiliki Panou^{13

14

20}, Valentina Pinelli²¹, José M Porcel²², Sara Ricciardi^{23

24}, Samira Shojaee²⁵, Hugh Welch¹⁶, Alberto Zanetto⁵, Udaya Prabhakar Udayaraj^{26

27}, Giuseppe Cardillo^{28

29}, Najib M Rahman^{30

2

31

32}

Affiliations

¹ Oxford Respiratory Trials Unit, Churchill Hospital, Headington, UK [email protected].
² Oxford Pleural Unit, Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Oxford, UK.
³ School of Pharmacy and Biomedical sciences, University of Portsmouth.
⁴ Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw.
⁵ Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padua University Hospital, Padua, Italy.
⁶ Pulmonology Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
⁷ Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia.
⁸ Hunter Medical Research Institute, Newcastle, Australia.
⁹ Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom.
¹⁰ Division of Translational Cardiology and Clinical Registries, Institute of Heart Diseases, Wroclaw Medical University, Poland.
¹¹ Dept of Pulmonary Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
¹² Pathology Department, University Hospital of Saint Etienne, France.
¹³ Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark.
¹⁴ Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
¹⁵ St Bartholomew's Hospital, London, UK.
¹⁶ Academic Respiratory Unit, University of Bristol, Bristol, UK.
¹⁷ Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Italy.
¹⁸ Respiratory Disease Unit, University Hospital, Ancona, Italy.
¹⁹ Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Germany.
²⁰ Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.
²¹ Division of Pulmonology Pulmonology, ASL5 Spezzino, Italy.
²² Pleural Medicine Unit, Arnau de Vilanova University Hospital, Lleida, Spain.
²³ Division of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy.
²⁴ PhD program Alma Mater Studiorum, University of Bologna, Bologna, Italy.
²⁵ Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center.
²⁶ Oxford kidney Unit, Churchill hospital, Oxford, UK.
²⁷ Nuffield Department of Medicine, Henry Wellcome Building for Molecular Physiology, , University of Oxford, Oxford, UK.
²⁸ Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.
²⁹ Unicamillus, International University of Health Sciences, Rome, Italy.
³⁰ Oxford Respiratory Trials Unit, Churchill Hospital, Headington, UK.
³¹ NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
³² Chinese Academy of Medical Health Sciences, University of Oxford, Oxford, UK.

PMID: 39060018
DOI: 10.1183/13993003.02307-2023

Abstract

The incidence of non-malignant pleural effusions (NMPE) far outweighs that of malignant pleural effusions (MPE) and is estimated to be at least 3-fold higher. These so called "benign" effusions do not follow a "benign course" in many cases, with mortality rates matching and sometimes exceeding that of MPEs. In addition to the impact on patients, healthcare systems are significantly affected, with recent US epidemiological data demonstrating that 75% of resource allocation for pleural effusion management is spent on NMPEs (excluding empyema). Despite this significant burden of disease, and by existing at the junction of multiple medical specialties, reflecting a heterogenous constellation of medical conditions, NMPEs are rarely the focus of research or the subject of management guidelines. With this ERS Taskforce, we assembled a multi-specialty collaborative across eleven countries and three continents to provide a Statement based on systematic searches of the medical literature to highlight evidence in the management of the following clinical areas: a diagnostic approach to transudative effusions, heart failure, hepatic hydrothorax, end stage renal failure, benign asbestos related pleural effusion, post-surgical effusion and non-specific pleuritis.