{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:37:14Z","timestamp":1791581834009,"version":"4.3.4"},"reference-count":28,"publisher":"European Respiratory Society (ERS)","issue":"4","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100031694","name":"Sir Charles Gairdner Hospital","doi-asserted-by":"publisher","award":["MRGP21-22_20_Pfr Y C Gary Lee"],"award-info":[{"award-number":["MRGP21-22_20_Pfr Y C Gary Lee"]}],"id":[{"id":"10.13039\/100031694","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir J"],"accepted":{"date-parts":[[2026,4,21]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bendopnoea (breathlessness on bending forward) is reported often by patients with pleural effusion, but its prevalence and clinical relevance are unexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study prospectively enrolled unselected patients with pleural effusion. Bendopnoea was assessed by time to breathlessness when bending patients forward for up to 60\u2005s (60-s bend test (60s-BT)). Post-hoc analyses using a 30-s cut-off were also conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      200 patients (median age 72\u2005years; 61% male) were included; n=88 underwent therapeutic drainage (median (interquartile range (IQR)) 1.50 (1.11\u20132.47)\u2005L). Effusions were commonly malignant (42%) and occupied &gt;25% of the hemithorax (74%). Most patients had bendopnoea on the 60s-BT (56%) and reported it \u201cimpacted daily activities\u201d (74%). The estimated median time to bendopnoea was 43 (95% CI 30\u201359)\u2005s. Bendopnoea was more common with larger pleural effusions on chest radiographs (p=0.0332 using 60-s cut-off and p=0.0217 using 30-s cut-off). Patients with bendopnoea on the 60s-BT were more breathless (median (IQR) 48 (22\u201367)\n                      <jats:italic>versus<\/jats:italic>\n                      30 (5\u201354)\u2005mm on a 100-mm Visual Analogue Scale; p=0.0002) and had shorter 6-min walk distance (6MWD) (median (IQR) 200 (128\u2013333)\n                      <jats:italic>versus<\/jats:italic>\n                      310 (223\u2013371)\u2005m; p=0.0013). Similar relevance was found using a 30-s cut-off. The proportion of patients with bendopnoea on the 60s-BT significantly decreased from 62% to 32% post-drainage (p&lt;0.001). Those with bendopnoea (\n                      <jats:italic>versus<\/jats:italic>\n                      those without) had significantly greater improvement in 6MWD post-drainage (median (IQR) 66 (2\u2013101)\n                      <jats:italic>versus<\/jats:italic>\n                      16 (\u221240\u201365)\u2005m; p=0.0165). Larger effusion (OR 5.08, 95% CI 1.25\u201320.66), inverted\/flattened hemidiaphragm on ultrasonography (OR 3.93, 95% CI 1.32\u201311.68) and higher body mass index (OR 1.18, 95% CI 1.08\u20131.28) were associated with bendopnoea (60s-BT) in multivariable analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Bendopnoea is a simple and worthwhile symptom to recognise in patients with pleural effusion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/13993003.02747-2025","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T14:39:25Z","timestamp":1778769565000},"page":"2502747","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["The Third PLeural Effusion And Symptom Evaluation (PLEASE-3) study: bendopnoea in patients with pleural effusion"],"prefix":"10.1183","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7510-5261","authenticated-orcid":false,"given":"Bianca M.","family":"Iacopetta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bapti","family":"Roy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charley A.","family":"Budgeon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9745-0214","authenticated-orcid":false,"given":"Michaela","family":"Donaghy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Ing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chloe","family":"Charlesworth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9913-4022","authenticated-orcid":false,"given":"Carolyn J.","family":"Peddle-McIntyre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai Ling","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Murray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.C. 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