Pneumologie最新文献

{"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":"[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":"[COPD in elderly patients].","authors":"Sven Stieglitz, Helmut Frohnhofen","doi":"10.1055/a-1849-4555","DOIUrl":"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":"[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}

{"title":"Negative impact of face masks in patients with interstitial lung disease: A prospective study.","authors":"Arno Mohr, Stefanie Zahn, Florian Geismann, Stefan Blaas, Michael Pfeifer, Maximilian Malfertheiner, Bernd Salzberger, Frank Hanses, Stilla Bauernfeind, Myriam Koch, Florian Hitzenbichler","doi":"10.1055/a-2361-4723","DOIUrl":"10.1055/a-2361-4723","url":null,"abstract":"<p><p>Face masks increase airway resistance, data on the actual extent of this effect are scarce. The aim of this study was to assess the effect of different mask types on clinical parameters during moderate exercise in healthy non-smokers, active smokers and patients with interstitial lung disease (ILD) without the need of oxygen therapy.In a prospective observational pilot study participants performed a six-minute walk test without mask, with a surgical mask, a well-fitted FFP2 mask and with a valved FFP3 mask. Respiratory rate, blood pressure, heart rate, blood gas analysis parameters, dyspnoea and six-minute walk distance were measured. Data were analysed in an ANOVA model.21 healthy participants, 17 active smokers without known pulmonary disease and 15 patients with interstitial lung disease were included. Participants with ILD had a significant lower walking distance, a higher respiratory rate and a lower pO₂ when using FFP2 masks, but not with valved FFP3 masks or surgical masks compared to not wearing a mask.For patients with ILD without the need of oxygen therapy wearing an FFP2 mask had a negative impact on pO₂, respiratory rate and walking distance in the six-minute walk test. This effect was not seen with valved FFP3 masks or surgical masks.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"292-296"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856283","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":"[Epidemiology, diagnosis and treatment of adult patients with nosocomial pneumonia].","authors":"Jessica Rademacher, Santiago Ewig, Béatrice Grabein, Irit Nachtigall, Marianne Abele-Horn, Maria Deja, Martina Gaßner, Sören Gatermann, Christine Geffers, Herwig Gerlach, Stefan Hagel, Claus Peter Heußel, Stefan Kluge, Martin Kolditz, Evelyn Kramme, Hilmar Kühl, Marcus Panning, Peter-Michael Rath, Gernot Rohde, Bernhard Schaaf, Helmut J F Salzer, Dierk Schreiter, Hans Schweisfurth, Susanne Unverzagt, Markus A Weigand, Tobias Welte, Mathias W Pletz","doi":"10.1055/a-2541-9872","DOIUrl":"https://doi.org/10.1055/a-2541-9872","url":null,"abstract":"<p><strong>Background: </strong> Nosocomial pneumonia, encompassing hospital-acquired (HAP) and ventilator-associated pneumonia (VAP), remains a major cause of morbidity and mortality in hospitalized adults. In response to evolving pathogen profiles and emerging resistance patterns, this updated S3 guideline (AWMF Register No. 020-013) provides an evidence-based framework to enhance the diagnosis, risk stratification, and treatment of nosocomial pneumonia.</p><p><strong>Methods: </strong> The guideline update was developed by a multidisciplinary panel representing key German professional societies. A systematic literature review was conducted with subsequent critical appraisal using the GRADE methodology. Structured consensus conferences and external reviews ensured that the recommendations were clinically relevant, methodologically sound, and aligned with current antimicrobial stewardship principles.</p><p><strong>Results: </strong> For the management of nosocomial pneumonia patients should be divided in those with and without risk factors for multidrug-resistant pathogens and/or <i>Pseudomonas aeruginosa</i>. Bacterial multiplex-polymerase chain reaction (PCR) should not be used routinely. Bronchoscopic diagnosis is not considered superior to non-bronchoscopic sampling in terms of main outcomes. Combination antibiotic therapy is now reserved for patients in septic shock and high risk for multidrug-resistant pathogens, while select patients may be managed with monotherapy (e. g., meropenem). In clinically stabilized patients, antibiotic therapy should be de-escalated and focused, as well as duration shortened to 7-8 days. In critically ill patients, prolonged application of suitable beta-lactam antibiotics should be preferred. Patients on the intensive care unit (ICU) are at risk for invasive pulmonary aspergillosis (IPA). Diagnostics for <i>Aspergillus</i> should be performed with an antigen test from bronchial lavage fluid.</p><p><strong>Conclusion: </strong> This updated S3 guideline offers a comprehensive, multidisciplinary approach to the management of nosocomial pneumonia in adults. By integrating novel diagnostic modalities and refined therapeutic strategies, it aims to standardize care, improve patient outcomes, and enhance antimicrobial stewardship to curb the emergence of resistant pathogens.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764943","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":"[Role of respiratory therapists in weaning patients from invasive mechanical ventilation: a description of their responsibilities from a certified weaning centre].","authors":"Benjamin Neetz, Gabriele Iberl, Nicole Kraus, Cornelia Weißmann, Florian Bornitz, Michael Martin Müller, Lars Reinhardt, Felix Herth, Julia Michels, Franziska Trudzinski","doi":"10.1055/a-2529-6367","DOIUrl":"10.1055/a-2529-6367","url":null,"abstract":"<p><p>Respiratory therapists have been trained by the German Respiratory Society (DGP) since 2005. Respiratory therapeutic interventions related to weaning patients from invasive mechanical ventilation are a major focus. Respiratory therapists have been an integral part of the therapeutic team at the Thorax Clinic Heidelberg for more than 10 years. This article describes their tasks and responsibilities in the context of weaning from invasive mechanical ventilation. The acute treatment phase of invasively ventilated patients in the acute intensive care unit and the prolonged weaning phase in the pneumological intensive care unit are presented in chronological order. The therapeutic focus of each phase is presented and described.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"284-291"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143503521","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":"[Respiratory therapists in Germany: An analysis of their current training and work situation].","authors":"Dennis Flügge, Matthias Held","doi":"10.1055/a-2510-2625","DOIUrl":"10.1055/a-2510-2625","url":null,"abstract":"<p><p>Although there has been a trainee program for respiratory therapists since 18 years, a representative survey of this field of activity is lacking. The aim of this study was to find out which professional groups felt addressed by the training program, how satisfied they were with the training and where the respiratory therapists were employed, to take a look at the organisation of the working conditions after further training and how cooperation with other professional groups functioned. An investigation into whether there were factors that had an influence on the above-mentioned points should provide an outlook on how respiratory therapy in Germany was likely to develop in the future and what would be important for its future work.In a quantitative cross-sectional study, a partially anonymised electronic survey was conducted among prospective and trained respiratory therapists in Germany. The survey was analysed using the (browser-based) programme \"Online Umfrage.com\" and the spreadsheet programme Microsoft Excel. The open questions were analysed using Mayring's qualitative content analysis.307 prospective and postgraduate respiratory therapists from all federal states and with varying years of continuing education took part in the survey. Most of the respondents worked in the clinical field; 90% of the respondents were rather or very satisfied with their further training. A quarter of them got no time off at all from work or only partially to participate in continuing education. Half of the respondents had not been able to get better salaries following their further training. Nevertheless, 81.25% of respiratory therapists said they would recommend the training programme to others. When asked what was important for the future, the answers varied and ranged from state recognition and better cooperation between training providers to better public relations work.Further training to become a respiratory therapist is seen as very positive. However, there are still significant problems in the areas of remuneration, time off and further training development. The type of supervisor was identified as one of the most important influencing factors. Thus, respiratory therapists who were subordinated to the medical service were more satisfied than those placed under the nursing service management.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"274-283"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441790","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}