In this episode of the RCP Medicine Podcast, Consultant Respiratory Physician Milind Sovani joins Respiratory Registrar Daniella Draicchio and Foundation Doctor Masooma Ali to explore a compelling case of progressive breathlessness in a 45-year-old woman. What begins as a seemingly routine presentation unfolds into a diagnostic journey.

Together, the team discusses the challenges of diagnosing chronic type 2 respiratory failure, the importance of recognising paradoxical breathing, and the role of non-invasive ventilation and surgical intervention. This episode is a masterclass in clinical reasoning, multidisciplinary collaboration, and the value of thorough bedside examination.

We would like to acknowledge Dr Patience Ehilawa, Consultant Respiratory Physician at Nottingham University Hospitals , for her contribution to the content design and planning of this podcast.

References

• A retrospective cohort study of idiopathic diaphragmatic palsy: a diagnostic triad, natural history and prognosis ERJ Open Research 2021 00953-2020; DOI: https://doi.org/10.1183/23120541.00953-2020 
• Diagnosis and management of nontraumatic unilateral diaphragmatic paralysis (complete or partial) in adults - UpToDate
• Treatment of diaphragmatic paralysis using an expanded surgical protocol: review of the largest worldwide experience  European Respiratory Journal 2018 52 (suppl 62): PA806; DOI: https://doi.org/10.1183/13993003.congress-2018.PA806 
• Diaphragm dysfunction: how to diagnose and how to treat? Breathe 2025 21(1): 240218; DOI: https://doi.org/10.1183/20734735.0218-2024 

This podcast has been made with an educational grant from Bristol-Myers Squibb Pharmaceuticals Limited (“BMS”). BMS has had no input or involvement in the design, development or content of the podcast whatsoever.

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Music:

Episode 50 onward - Bensound.com

Episodes 1 - 49 'Impressive Deals' - Nicolai Heidlas