Researchers have been looking at whether it is better to aggressively drain pleural effusions or to only drain them when symptoms appear.

For many pleural mesothelioma patients, the first symptom they will experience is shortness of breath. In some cases, this is caused by a pleural effusion which is a build-up of fluid around the lungs. In mesothelioma, pleural effusions are caused when cancer cells in the pleura (the thin protective membrane around the lung) create irritation, causing the fluid to build up.

Pleural effusions can be drained. If the effusion is small, a doctor can insert a small needle into the chest and draw the fluid off. For a larger effusion, a chest drain will be used. A small incision is made in the chest and a tube is inserted to drain the fluid.

Draining a pleural effusion can immediately improve shortness of breath symptoms as well as chest pain.

Aggressive vs symptom-led drainage

Researchers at the University of Western Australia have studied whether daily drainage of pleural effusions can improve the quality of life of mesothelioma patients, rather than allowing the effusion to build up.

One solution to fluid build-up on the lungs is a pleurodesis. This is an invasive procedure whereby talc is introduced to the pleura, causing the two layers to seal so that fluid cannot build-up. This can be a painful and uncomfortable procedure.

An alternative to a pleurodesis is an indwelling pleural catheter, this allows the patient to drain fluid at home and is a less invasive procedure than a pleurodesis.

The study has concluded that mesothelioma patients who complete daily drainage rather than waiting for a build-up that causes symptoms, experience the best results.

The study looked at 87 pleural mesothelioma patients who had indwelling pleural catheters. Half were told to drain their catheters daily and the other half were told to drain their catheters only when they were bothered by their symptoms.

Although there were no significant differences in pain or breathlessness between the groups, those who drained their catheters daily, reported a better quality of life and were more likely to experience spontaneous pleurodesis than the other group.

It was also found that rates of infection were slightly higher in the group who drained according to their symptoms.

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Muruganandan, S, et al, “Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial”, July 20, 2018, Lancet Respiratory Medicine, Epub ahead of print

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