In this episode of the RCP Medicine Podcast, Consultant Respiratory Physician Milind Savani 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. References<ul><li>A retrospective cohort study of idiopathic diaphragmatic palsy: a diagnostic triad, natural history and prognosis ERJ Open Research 2021 00953-2020; DOI: <a href='https://doi.org/10.1183/23120541.00953-2020'>https://doi.org/10.1183/23120541.00953-2020</a> </li><li><a href='https://www.uptodate.com/contents/diagnosis-and-management-of-nontraumatic-unilateral-diaphragmatic-paralysis-complete-or-partial-in-adults'>Diagnosis and management of nontraumatic unilateral diaphragmatic paralysis (complete or partial) in adults - UpToDate</a></li><li>Treatment of diaphragmatic paralysis using an expanded surgical protocol: review of the largest worldwide experience  European Respiratory Journal 2018 52 (suppl 62): PA806; DOI: <a href='https://doi.org/10.1183/13993003.congress-2018.PA806'>https://doi.org/10.1183/13993003.congress-2018.PA806</a> </li><li>Diaphragm dysfunction: how to diagnose and how to treat? Breathe 2025 21(1): 240218; DOI: <a href='https://doi.org/10.1183/20734735.0218-2024'>https://doi.org/10.1183/20734735.0218-2024</a> </li></ul> 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.RCP Links <ul> <li><a href='https://www.rcp.ac.uk/events-and-education/education-and-learning/'>Education</a></li> <li><a href='https://www.rcp.ac.uk/events-and-education/events/'>Events</a></li> <li><a href='https://www.rcp.ac.uk/membership/'>Membership</a></li> <li><a href='https://www.rcp.ac.uk/improving-care/'>Improving care</a></li> <li><a href='https://www.rcp.ac.uk/policy-and-campaigns/'>Policy and campaigns</a></li> </ul> RCP Social Media <ul> <li><a href='https://www.instagram.com/rcphysicians%20'>Instagram</a></li> <li><a href='https://uk.linkedin.com/company/royal-college-of-physicians'>LinkedIn</a></li> <li><a href='https://www.facebook.com/RoyalCollegeofPhysicians'>Facebook</a></li> <li><a href='https://x.com/RCPhysicians'>X</a></li> <li><a href='https://bsky.app/profile/rcphysicians.bsky.social'>Bluesky</a></li> </ul> Music: Episode 50 onward - Bensound.com Episodes 1 - 49 'Impressive Deals' - Nicolai Heidlas

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Episode 92: Respiratory - diaphragm palsy

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