Pneumologie最新文献

{"title":"[Climate conscious prescription of inhaled medication].","authors":"Guido Schmiemann, Michael Dörks, Christian Grah","doi":"10.1055/a-2561-9329","DOIUrl":"https://doi.org/10.1055/a-2561-9329","url":null,"abstract":"<p><p>The aim of the guideline on climate-conscious prescribing of inhaled medicines is to reduce the carbon footprint of the healthcare system. Chronic respiratory diseases such as asthma and COPD are at risk by climate change. At the same time while inhalants are used to treat these diseases, their use contributes to global warming in several ways. Metered-dose inhalers (MDIs) contain propellants that are potent greenhouse gases, while powder inhalers (DPIs) are considered a more environmentally friendly alternative.Factors such as individual preferences, abilities and skills play a decisive role in the individual selection of the most suitable inhalation system. The guideline provides assistance and recommendations for selecting the most suitable products, taking into account the environmental footprint of the available products.The guideline recommends inhaled therapy, preferably with DPI, for adolescents over the age of 12 and adults with obstructive pulmonary disease. The aim is to enable and inform a climate-conscious choice of therapy in order to reduce the use of emission-intensive DA. When prescribing DA, a preparation with a counter should be selected.A therapy review is required if patients require a prescription for short-acting β-mimetics (SABA) more than twice a year, as this indicates inadequate asthma control.Decision aids explain the differences between DA and DPI to find the optimal therapy. It also emphasises the importance of training for children and adolescents, as their ability to use inhalers varies.The implementation of the guideline is supported by various materials (slide sets, short version, information for patients, https://register.awmf.org/de/leitlinien/detail/053-059).</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Challenges and opportunities of the Intensive Care and Rehabilitation Strengthening Act (GKV-IPReG): Opinion survey and interprofessional cross-sector dialogue].","authors":"Jana Christina Dahlhoff, Biljana Joves, Benjamin Neetz, Gabriele Iberl, Annett Heinze, Urte Sommerwerck, Jens Geiseler, Konrad Brennauer, Felix Gaiser, Michael Westhoff, Julia Michels, Max Barre, Felix Herth, Franziska Trudzinski","doi":"10.1055/a-2592-0331","DOIUrl":"https://doi.org/10.1055/a-2592-0331","url":null,"abstract":"<p><p>The implementation of the requirements of the \"Intensivpflege- und Rehabilitationsstärkungsgesetz (IPReG)\" requires the establishment of new cross-sectoral care structures. As part of an online survey and a multi-professional panel discussion, which took place on April 27, 2024 at the Thorax Clinic of Heidelberg University, this topic was highlighted from various perspectives. Medical representatives from the fields of intensive care medicine and weaning, respiratory therapists and representatives of the WeanNet board, the AOK Baden-Württemberg and the head of an outpatient intensive care service took part in the discussion. The participants in the survey and the panel discussion still saw potential for optimisation in practical implementation to make the task of assessing weaning or decannulation potential more attractive for appropriately qualified doctors, as implementation currently depends very much on the motivation of individuals. Some patients and their relatives also have reservations about ventilator weaning and decannulation, as it often involves a change of care facility. Optimisation potential was seen mainly in including respiratory therapists and using telemedical options; furthermore, a structural, nationwide provision of care would be desirable, but this does not seem feasible everywhere from an infrastructural standpoint. Although telemedicine could be a good option to improve coverage, especially in more rural areas, the legal framework for this, as well as for potential assessment conduction by respiratory therapists, is not sufficient yet. These legal regulations need to be discussed and developed in constructive collaboration with all involved professions and patient representatives. In general, the law was seen as an opportunity to identify patients with weaning and decannulation potential and to improve the situation of patients with long-term ventilation in Germany due to its requirement of regular on-site visits by professionals with expertise in weaning.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"At-home validation of a non-contact, radar-based breathing monitor for long-term care of patients with respiratory diseases: A proof-of-concept study.","authors":"Tobit Fischer, Torsten Eggert, Alina Wildenauer, Sarah Dietz-Terjung, Rainer Voisard, Christoph Schöbel","doi":"10.1055/a-2542-5101","DOIUrl":"https://doi.org/10.1055/a-2542-5101","url":null,"abstract":"<p><p>Long-term monitoring of respiratory rate (RR) is an important component in the management of chronic respiratory diseases (CRDs). Specifically, predicting acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is of significant scientific and clinical interest. This study aimed to evaluate the long-term validity of a novel contactless sleep monitor (CSM) in the home environment of CRD patients receiving ventilatory support. Additionally, we assessed patient acceptance, device usability, and RR fluctuations associated with AECOPD to establish a robust foundation for future research.In this prospective proof-of-concept study, nineteen patients requiring non-invasive ventilation (NIV) were provided with the CSM in their home environment for six months and seven patients requiring invasive mechanical ventilation (IMV) for one month. The primary indication for NIV therapy was chronic obstructive pulmonary disease (COPD).The CSM was validated under real-life conditions by comparing its nocturnal RR values with software data from both types of ventilators. Acceptability and usability of the sensor were assessed using a questionnaire. Additionally, COPD exacerbations occurring during the study period were analyzed for potential RR fluctuations preceding these events.Mean absolute error (MAE) of median RR between the NIV device and the CSM, based on 2326 nights, was 0.78 (SD: 1.96) breaths per minute (brpm). MAE between the IMV device and the CSM was 0.12 brpm (SD: 0.52) for 215 nights. The non-contact device was accepted by the patients and proved to be easy in use. In some of the overall only 13 cases of AECOPD, RR time courses showed variations of increased nocturnal respiratory activity a few days before the occurrence of such events.The present CSM is suitable for valid long-term monitoring of nocturnal RR in patients' home environment and is well accepted by the patients. The exploratory findings related to AECOPD events may serve as a starting point for larger studies aimed at developing robust prediction rules.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Use of long-acting triple therapy for chronic obstructive pulmonary disease (COPD) in practice: The ELETHON physicians' survey].","authors":"Kai-Michael Beeh, Saskia Krüger","doi":"10.1055/a-2414-4197","DOIUrl":"10.1055/a-2414-4197","url":null,"abstract":"<p><p>Gaps in optimal COPD management have been identified in clinical practice, with discrepancies between guideline recommendations and routine care. The reasons for such discrepancies are incompletely understood. The ELETHON survey aimed to identify physicians' attitudes towards general concepts of COPD management and, in particular, initiation of inhaled triple therapies.ELETHON was a nationwide cross-sectional survey with general practitioners (GP) and pulmonary specialists (PS) working in the ambulatory outpatient setting in Germany, using a structured 17-item questionnaire (single or multiple choice questions) addressing the topics of secondary prevention, exacerbation detection, strategies for therapy escalation, choice of inhaled triple therapies and evaluation of treatment benefits.Questionnaires filled by n=2028 GPs and n=371 PS were analyzed. In both groups, secondary prevention was deemed important in COPD care (GP/PS 76.4%/90.6%), with inhalation technique, vaccination status, and appropriate inhaled pharmacotherapy as key components. Activity/rehabilitation was rarely mentioned by GPs (48.3% vs. 84.5%). Exacerbations and symptomatic worsening were the main triggers for therapy escalation, but were not recorded in a structured way. \"Hospitalization\" and \"≥2 ambulatory exacerbations\" were mentioned most frequently as thresholds. Neither GPs nor PS measured eosinophils in the majority of patients. Fixed triple combinations were preferred, with availability of different treatment steps in the same device as important decision aid. Treatment success was evaluated by exacerbations, quality of life, symptoms, lung function and rescue medication use, while COPD Assessment Test (CAT) score was rarely used by GPs and PS.The ELETHON survey identified gaps in COPD management in Germany. While secondary prevention is deemed important, escalation of inhaled therapy is undertaken rather late, the reported importance of vaccinations does not match current quota in German COPD patients, and non-pharmacological measures are often unused. Exacerbation and symptom documentation is rather subjective, validated questionnaires and blood eosinophils are of minor relevance. These results provide evidence of barriers and hidden potentials towards optimization of routine ambulatory care for COPD patients in Germany.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"366-376"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[17 years of WeanNet - review and perspective].","authors":"Jens Geiseler, Michael Westhoff, Franziska C Trudzinski, Urte Sommwerck, Winfried Randerath","doi":"10.1055/a-2546-1496","DOIUrl":"10.1055/a-2546-1496","url":null,"abstract":"<p><p>The present article describes the 17-year success story of WeanNet, the Competence Network of Pulmonological Weaning Centers, from its founding and the development of a dedicated certification process to the establishment of a database now comprising more than 55.000 patients undergoing prolonged weaning. It discusses past evaluations of the database as well as an ongoing analysis currently in preparation.Due to the frequent successful weaning (approximately two-thirds of treated patients) WeanNet, alongside other organisations, has been actively involved in developing guidelines, laws and regulations for out-of-hospital intensive care, OPS codes, and further initiatives aimed at reducing the number of patients requiring invasive mechanical ventilation outside clinical settings. The guideline of prolonged weaning is currently being revised and, with the results of AI-supported data analysis, is expected to contribute to further quality improvements in the prolonged weaning process.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"377-381"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[COPD in elderly patients].","authors":"Sven Stieglitz, Helmut Frohnhofen","doi":"10.1055/a-1849-4555","DOIUrl":"https://doi.org/10.1055/a-1849-4555","url":null,"abstract":"<p><p>The lifetime risk of developing COPD is estimated to be between 25 and 30% (10% risk for COPD stage II or worse). It is projected that COPD will become the third leading cause of death within the next decade. COPD may be understood as a disease of accelerated lung ageing: The accumulation of senescent cells in the lungs results in the loss of repair ability and the release of inflammatory mediators. Geriatric patients typically present with multimorbidity, polypharmacy, restrictions in daily life, frailty and sarcopenia. Up to two-thirds of elderly patients with COPD have dysphagia, which leads to aspiration in 40% of cases and is prognostically unfavourable. Older patients with COPD are less likely to experience breathlessness than younger patients. In old patients with COPD, spirometry is the most important lung function test. FEV₆ instead of the FVC may be used. The clock test, mini-cog and the ability to draw two pentagons on top of each other are the best ways to screen patients with dementia to determine whether spirometry is feasible. Impulse oscillometry is a well investigated lung function test for elderly patients with COPD with the advantage not to require special cooperation. The 1-minute walking test or the 1-minute sit-to-stand test are good geriatric alternatives for the 6-minute walking test. The treatment is based on the current COPD guidelines. Substances with a long duration of action, such as fluticasone furoate, vilanterol and umeclidinium, are the best option. The capillary PO₂ is 6 mmHg higher than the arterial PO₂. The difference is even greater in heart failure. The ventilation-perfusion distribution disorder also increases with age, particularly when lying down. This is due to the increase in occlusion capacity, which causes the small airways to collapse earlier. It is essential to consider comorbidities and body position during blood gas sampling to avoid an oversupply of home oxygen therapy in old age.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":"79 5","pages":"382-394"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Specialist Guidelines of The German Respiratory Society for Diagnosis and Treatment of adult Patients Suffering from Cough].","authors":"Peter Kardos, Sven Becker, Kai-Roland Heidenreich, Ludger Klimek, Thomas Köhnlein, Joachim Labenz, Norbert Mülleneisen, Dorothea Pfeiffer-Kascha, Isabell Pink, Helmut Sitter, Frederik Trinkmann, Heinrich Worth, Cordula Winterholler","doi":"10.1055/a-2550-3738","DOIUrl":"10.1055/a-2550-3738","url":null,"abstract":"<p><p>This is the 4^th edition of the Cough Guidelines of the German Respiratory Society written by respiratory, gastroenterology, ear-nose-throat specialists, including respiratory physiotherapists and speech pathology specialists; importantly, a patient representative was also involved.Compared with earlier versions we used a new methodology: after discussion in the guidelines group, we asked and answered the 12 most important and most frequent \"key\" questions regarding the clinical practice. The extent of the guideline could thus be significantly reduced.We added a short scientific background to each of the answers including the most recent references. The recommendations and statements were created in consensus and graded as strong, or weak. If sufficient literature was not available, we suggested discussing joint decisions with the patient.The 12 key questions are as follows:- Key question 1: <i>The classification of cough</i> (acute, i. e. up to three weeks duration; chronic, i. e. after 8 weeks duration and subacute in between) did not change, but we added \"cough with or without expectoration as an additional classification aspect with therapeutic consequences.- Key question 2: <i>Acute and subacute cough</i> are mostly (but not exclusively) due to the common cold. They are the first or second most frequent symptom prompting patients to seek medical (or pharmacist's) care. Antibiotic therapy is strongly discouraged for common cold- Key question 3: We defined <i>\"Red flags\"</i> for mandatory immediate diagnostic for acute cough, which usually does not require such diagnostic procedures- Key question 4: <i>Chronic cough</i> overview of the most common causes for- Key question 5: Cough in <i>acute SARS-CoV-2 infection</i> and in <i>long COVID</i> - Key question 6: <i>Refractory chronic cough and idiopathic chronic cough,</i> two recently established entities were explained more in detail- Key question 7: To <i>upper airway cough syndrome</i> - Key question 8: <i>Gastro-oesophageal-reflux-related cough</i> - Key question 9: <i>Cough-variant asthma and non-asthmatic eosinophilic bronchitis</i> - Key question 10: Overview of <i>drugs causing cough</i> - Key question 11: Basic and personalized (due to the individual history) <i>diagnostic procedures</i> for patients with cough- Key question 12: <i>Physiotherapy, speech therapy and pharmacotherapy</i> for cough.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":"79 5","pages":"329-357"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Context factors for performing endoscopic examinations as an inpatient service in adults].","authors":"Joanna Krist, Lars Hagmeyer, Nicolas Schoenfeld, Kaid Darwiche, Judith Maria Brock, Anne Piening, Dirk Skowasch, Winfried Randerath, Torsten Bauer, Ralf-Harto Hübner","doi":"10.1055/a-2567-4715","DOIUrl":"10.1055/a-2567-4715","url":null,"abstract":"","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"327-328"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[TELEMEdical moNiTORing for COPD patients (Telementor COPD): Study protocol of a multicentre, randomised, controlled study].","authors":"Franziska Püschner, Juliane Schiller, Dominika Urbanski-Rini, Katharina Scholl, Anni Bock, Margret Jandl, Andreas Thanhäuser, Lale Zils, Erwin Junker, Klaus Rabe, Henrik Watz","doi":"10.1055/a-2383-4470","DOIUrl":"10.1055/a-2383-4470","url":null,"abstract":"<p><p>COPD is one of the most common causes of death in Europe, and is associated with a high exacerbation and hospitalization rate as well as high medical costs. The aim of the study was early detection of exacerbations, preventative intervention through optimized outpatient care, and thereby to decrease rates of rehospitalizations. Telementor COPD is a prospective, multicentre, unblinded, randomized, controlled study with a study duration of 12 months, implemented at seven clinics and 16 pneumology practices in Hamburg and Schleswig-Holstein. It is funded by the Innovation Fund (01NVF20008) and is registered in the German Register of Clinical Studies (study ID: DRKS00027961). COPD patients with at least one documented exacerbation in the last year were included in the study. The primary endpoint was the number of exacerbations. Secondary endpoints were the number of COPD-associated hospitalizations, intensive care unit stays and health status. In the intervention group, symptoms were recorded daily using the SaniQ app (patients' smartphones), and the FEV₁ was measured daily using a mobile spirometer. Patients were also provided with a smartwatch to continuously measure their respiratory rate, heart rate, oxygen saturation and steps. The app displays the measured values and offers motivational components for smoking cessation and physical activity as well as video chats with the COPD nurses and doctors. If the symptoms or lung function deteriorated, the trained COPD nurse contacted the patient, reviewed the patient's measurements, and assessed the need for preventive intervention. Telementor COPD offers the opportunity to evaluate the efficacy of digital monitoring and telemedicine components and to pave the way for the implementation of telemedicine in the routine care of COPD patients with a high risk of exacerbation.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"358-365"},"PeriodicalIF":1.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12068928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142111102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Respiratory medicine in climate change].","authors":"Andrea Elmer, Christian Grah, Sophia Kirstein, Stephan Walterspacher, Anastasia Weirich","doi":"10.1055/a-2512-2993","DOIUrl":"https://doi.org/10.1055/a-2512-2993","url":null,"abstract":"<p><p>DGP pneumologists advocate measures for adaptation, prevention and the implementation of sustainable health care. To protect patients and mitigate the health threat posed by climate change, resilient systems should be built. To protect lung health, they call for action to counteract rising temperatures and the development of extreme weather events, and for further reductions in air pollution. They point out particularly vulnerable population groups that need to be protected.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}