This month sees publication of the new BTS guideline for pleural disease,1 the first update since 2010. In parallel, advice on pleural interventions is covered by the first BTS Clinical Statement on Pleural Procedures.2 Over the last decade, there has been a burgeoning interest in this subspeciality area and with this have come a number of advances driven by high-quality practice changing studies. For the 2023 update, rather than covering every aspect of pleural disease, the review committee has chosen to focus on spontaneous pneumothorax, undiagnosed unilateral pleural effusion, pleural infection and pleural malignancy (excluding pleural mesothelioma). As with other recent BTS guidelines, the aim is to provide high-quality evidence that has been reviewed and graded by a multidisciplinary guideline committee using the GRADE methodology.3 Although the evidence base for management of pleural disease has improved considerably, there are still a number of areas where high-quality evidence is lacking, and in these cases, lower grade evidence was considered alongside expert opinion via consensus. Unlike some guideline development organisations (eg, National Institute for Health and Care Excellence) cost-effectiveness was not considered in detail as in-depth economic analysis of recommendations falls outside of the scope of the BTS guideline production process.

So, …