Pneumologie最新文献

{"title":"[A rare case of hemoptysis].","authors":"Julika Merres, Pascal Fischer, Erich Stoelben","doi":"10.1055/a-2512-8290","DOIUrl":"10.1055/a-2512-8290","url":null,"abstract":"<p><p>The present case report involves a young patient with hemoptysis for several months. A CT chest examination and bronchoscopy revealed the rare finding of squamous cell carcinoma of the trachea. Further diagnostics showed no evidence of lymph node or distant metastasis. Because of the length of the tumor, we performed a median sternotomy and tracheal resection, extending from subglottis to mid-trachea. Carcinoma of the trachea is a rare cause of hemoptysis but should be considered as a differential diagnosis and then presented to an appropriate center with expertise.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"513-516"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441788","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":"[Pneumonia due to silent aspiration: a diagnostic and therapeutic challenge].","authors":"Santiago Ewig, Sören Gatermann, Kai Wiesweg","doi":"10.1055/a-2486-6598","DOIUrl":"10.1055/a-2486-6598","url":null,"abstract":"<p><p>Aspiration pneumonia (AP) may present as gross aspiration of large gastric contents or as a consequence of silent aspiration of contaminated oropharyngeal secretions.AP due to silent aspiration is caused by dysphagia and, in some instances, impaired cough reflex. Factors favouring the development of pneumonia include advanced age as well as severe comorbidity and impaired functional status.Therefore, silent aspiration is a frequent etiology of community-acquired pneumonia in aged patients but also of nosocomial pneumonia. Recurrent pneumonia should always prompt the consideration of AP.Treatment of acute AP should include not only the use of antimicrobial agents but also chest physiotherapy and airway clearance techniques. In addition, all patients with silent aspiration and AP should be subject to an investigation of swallowing function and, in the presence of dysphagia, also receive treatment for this condition. This includes methods of restitution, compensation and adaptation of impaired swallowing function.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"501-512"},"PeriodicalIF":1.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822527","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":"Criteria for evaluation of response to biologics in severe asthma - the Biologics Asthma Response Score (BARS).","authors":"Katrin Milger, Stephanie Korn, Claudia Feder, Jan Fuge, Andreas Mühle, Wolfgang Schütte, Dirk Skowasch, Hartmut Timmermann, Hendrik Suhling","doi":"10.1055/a-2102-8128","DOIUrl":"10.1055/a-2102-8128","url":null,"abstract":"<p><strong>Background: </strong> The introduction of monoclonal antibodies (biologics) has revolutionized the therapy of severe asthma. Even though there is a response in the majority of patients, the degree of response varies. To date criteria for assessment of response to biologics are not consistently defined.</p><p><strong>Aim: </strong> To define criteria for evaluation of response to biologics that are precise, simple and suitable for daily use in order to guide decision-making regarding continuation, switching or stopping of biological therapy.</p><p><strong>Methods: </strong> 8 physicians with large experience in this indication, supported by a data-scientist, developed a consensus on criteria to evaluate response to biologics in patients with severe asthma.</p><p><strong>Result: </strong> We developed a combined score based on current literature, own experience and practicability. It uses the main criteria exacerbations, oral corticosteroid (OCS) therapy and asthma control (asthma control test, ACT). We defined thresholds for \"good response\", \"response\" and \"insufficient response\" rated with a score of \"2\", \"1\" and \"0\" respectively: annual exacerbations (\"0 or reduction ≥ 75 %\", \"reduction 50-74 %\", \"reductio < 50 %\"), daily OCS dose (\"stopping or reduction ≥ 75 %\", \"reduction 50-74 %\", \"reduction < 50 %\"), asthma control (\"ACT increase ≥ 6 or ≥ 3 with result ≥ 20\", \"ACT increase 3-5 with result < 20\", \"ACT increase < 3\"). Additional individual criteria like lung function and comorbidities may be important for evaluation of response. We propose 3, 6 and 12 months timepoint for assessment of tolerability and response. Using the combined score, we developed a scheme to guide the decision whether switching the biologic should be considered.</p><p><strong>Conclusion: </strong> The Biologic Asthma Response Score (BARS) serves as objective and simple tool to evaluate response to biologic therapy using the three main criteria exacerbations, OCS use and asthma control. A validation of the score was initiated.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"439-451"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10074147","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":"[Critical Closing Pressure (Pcrit) and Negative (Subatmospheric) Expiratory Pressure (NEP) for Diagnosis of Pharyngeal Collapsibility in Patients With Obstructive Sleep Apnea (OSA)].","authors":"Mikail Aykut Degerli, Olaf Hildebrandt, Ulrich Koehler, Christian Viniol, Klara Mia Garben, Niklas Koehler, Manuel Stenger, Janine Sambale, Heike Korbmacher-Steiner, Karl Kesper","doi":"10.1055/a-2368-4972","DOIUrl":"10.1055/a-2368-4972","url":null,"abstract":"<p><p>The determination of critical closing pressure (Pcrit) is the diagnostic gold standard for assessing the severity of pharyngeal instability. Pcrit measurements are typically performed during natural nocturnal sleep (NREM Stage 2) in combination with polysomnography. However, determining Pcrit during sleep is time-consuming and impractical for routine use. Alternatively, Pcrit measurements can also be done during drug-induced sleep. A disadvantage of this method is the varying doses of propofol needed to induce sleep, which can affect muscle tone differently. As an alternative to these methods, the application of negative pressure during wakefulness (NEP test) has proven effective. In this test, the patient is administered a subatmospheric pressure of -5 or -10 cmH₂O via mask at the beginning of expiration, and the change in expiratory airflow in the pharynx is measured. NEP test can be performed in both sitting and lying position. According to current knowledge, the NEP test appears to be a diagnostic procedure comparable to critical closing pressure (Pcrit) for assessing upper airway collapsibility.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"415-420"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142293692","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":"Lungensonografie auf der Intensivstation – Schritt für Schritt.","authors":"Thomas Flohr, Christoph Laußer","doi":"10.1055/a-2348-5975","DOIUrl":"10.1055/a-2348-5975","url":null,"abstract":"","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"465-471"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811836","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":"[Cannabis and nicotine in German music videos].","authors":"Reiner Hanewinkel, Clemens Neumann, Matthis Morgenstern","doi":"10.1055/a-2486-6646","DOIUrl":"10.1055/a-2486-6646","url":null,"abstract":"<p><p>Smoking of tobacco and cannabis is widespread in Germany. Preventing children and adolescents from starting to use these products is an important goal of prevention. The aim of the present study was to examine how often depiction or mention of cannabis and nicotine use occurs in German-language music videos, which can be seen as advertising for smoking.The sample, which comprised the population of all German-language music videos listed in the YouTube Top 100 Charts in 2023, included 600 music videos. Using a coding scheme, the music videos were categorised as 'smoke-free' or 'not smoke-free' and the depiction or mention of consumption was counted.Of the videos examined, 54.7% (n=328) contained at least one depiction or mention of cannabis or tobacco use; 31.7% of the videos (n=190) were exclusively about tobacco use, 12.5% of the videos (n=75) were exclusively about cannabis use, and 10.5% (n=63) were about both. While tobacco or cannabis use was shown or mentioned in 67.0% of the videos from the 'German rap' genre, the average for the other genres was 20.6% (OR=7.83; p<0.001). When considering cannabis use alone, the difference between the genres was even more pronounced. The proportion of videos in which cannabis was shown or mentioned was 29.7% in the 'German rap' genre and 4.4% in the other genres (OR=9.27; p<0.001). The 328 videos in which tobacco or cannabis use was shown received 3.2 billion clicks (64.5% of clicks). This means that these 328 videos generated a total of 9.7 trillion impressions. Of these, 5.8 trillion impressions were about nicotine use and 3.9 trillion about cannabis use.Music videos expose children and adolescents to a wide range of scenes of nicotine and cannabis use, which remains largely unregulated.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"421-426"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822524","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":"[Case report: 38-year-old male with hemoptysis, jaundice and acute kidney injury].","authors":"Ida Lechtenberg","doi":"10.1055/a-2559-9411","DOIUrl":"10.1055/a-2559-9411","url":null,"abstract":"<p><p>Globally, leptospirosis represents one of the most common zoonotic diseases, with approximately 1 million cases reported annually. It predominantly occurs in tropical and subtropical regions. In light of climate change, raising awareness of such diseases among clinicians in moderate climate zones might become increasingly important.We report the following case of a hybrid presentation of leptospirosis, characterized by predominant pulmonary involvement in the form of diffuse alveolar hemorrhage, as well as jaundice and nephritis.A 38-year-old patient presented one week after a summer riverside barbecue with fever and jaundice. Laboratory tests revealed elevated CRP and procalcitonin levels, direct hyperbilirubinemia and acute kidney injury. The following day he developed diffuse alveolar hemorrhage with rapidly progressive respiratory failure and the need for invasive ventilation. Serological testing for <i>Leptospira</i> was positive and the diagnosis was further confirmed by PCR.With supportive measures and anti-infective therapy with ceftriaxone the patient's condition progressively improved. After 8 days of invasive ventilation he was successfully extubated.This case highlights the importance of considering a broader differential diagnosis in complex and severe disease presentations. Despite the currently sporadic occurrence of this disease in Germany, leptospirosis should be considered in cases of pulmonary hemorrhage in conjunction with kidney failure and jaundice.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"462-464"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764933","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":"[Meaning and Mechanisms of Birdsong: Inspiration for Pneumology].","authors":"Bernd Schönhofer, Manfred Gahr","doi":"10.1055/a-2463-7380","DOIUrl":"10.1055/a-2463-7380","url":null,"abstract":"<p><p>In contrast to humans, the location where sound is produced in birds is not the larynx, but rather the so-called \"vocal box\" (scientific term \"Syrinx\"). In some species the syrinx is located at the bifurcation point of the trachea into the two main bronchi (tracheal vocal head), while in some in the main bronchi (bronchial vocal head). During inspiration, part of the air flows into the lungs, and the part needed for singing flows into the air sacs adjacent to the lungs. During expiration, air leaves the air sacs and flows through the syrinx, where the song is created. When birds sing in two voices at the same time, individual sequences are formed simultaneously in the right and left parts of the syrinx.The song analysis is based on spectrograms (so-called sonagrams), which graphically represent the frequency spectrum of bird song.The song consists of one or more verses, which in turn consist of the variable or constant sequence of motives or syllables. Some songbirds have an enormous repertoire of syllables and verses (max. up to 7000 verses per day). In addition to singing, most bird species also have much simpler begging, contact, threatening, flight, alarm and copulation calls.Male birds sing primarily for two reasons: 1. They use song to woo a potential partner. This song provides the females with important information about the applicant's performance and health. 2. Singing serves to defend the territory.In around 40 % of songbird species, females also sing. Pairs of some species sing in perfect synchronization.A number of songbirds imitate both the voices of other songbirds and ambient noises, and many songbirds have regional dialects.Song development depends on genetics and other factors such as the environment, metabolism and hormonal influences. It proceeds step by step and initially includes relatively primitive sequences (so-called \"subsongs\"), then leads through more complex intermediate forms (\"plastic songs\") and finally to the completed singing pattern (\"full songs\").Young birds learn the song of their species at a time when they are not yet singing themselves, often as nestlings aged 10 to 50 days from older members of the species, usually from their fathers.The song of young birds develops, based on the template of adult song, in a network of sensory-motor neurons in the forebrain.Songbirds, especially the zebra finch, currently offer the best model for the neural basis of human language learning. In birds, the so-called \"High Vocal Center\" orchestrates all brain regions relevant to songs, with the neural control of song being sensitive to sex hormones.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"427-438"},"PeriodicalIF":1.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075094","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":"[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":"[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}