Pneumologie (Stuttgart, Germany)最新文献

{"title":"[Asthma Management and Control in Germany in Light of Current Guidelines].","authors":"Roland Buhl, Charles Adarkwah, Annmarie Gähler, Kathrin Kahnert, Sylva Mitterdiami, Patricia Preusse, Maren Schuhmann, Kai-Michael Beeh","doi":"10.1055/a-2739-3886","DOIUrl":"10.1055/a-2739-3886","url":null,"abstract":"<p><strong>Background: </strong>Clinical studies and surveys indicate a significant need for improvement in asthma control, despite continuously advancing treatment options.</p><p><strong>Objective: </strong>To assess asthma control and patients' attitudes toward asthma therapy in Germany and to analyze the findings in the context of current guideline recommendations.</p><p><strong>Methods: </strong>Adults with asthma in Germany were recruited via the online panel forsa.omninet in November 2024 and surveyed regarding their asthma symptoms and management. Cross-correlation analyses were subsequently conducted. Asthma control was analyzed according to German guideline criteria.</p><p><strong>Results: </strong>A total of 1,002 adults with self-reported asthma participated in the survey. Asthma was not well controlled in 61% of respondents, especially the elderly of 60 years and older. 63% of respondents were on a daily maintenance therapy. However, patients on maintenance therapy reported poorer asthma control. A large number of respondents were unfamiliar with the terms \"asthma control\" and \"asthma remission\". 75% did not use any self-management tools. Only 47% believed that symptom-free asthma could be achieved through adequate maintenance therapy.</p><p><strong>Conclusion: </strong>Asthma control in Germany remains inadequate. This survey confirms relevant discrepancies between guideline recommendations and clinical reality. Improved asthma management and patient education are urgently needed.</p>","PeriodicalId":520755,"journal":{"name":"Pneumologie (Stuttgart, Germany)","volume":" ","pages":"641-647"},"PeriodicalIF":1.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710725","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":"[PRiVENT in the selective care contract: Structured care for high-risk patients to prevent long-term invasive ventilation and tracheostomy].","authors":"Franziska Trudzinski, Anna Lena Flagmeier, Felix Gaiser, Philipp Höger, Biljana Joves, Axel Kempa, Claus Neurohr, Armin Schneider, Max Barre, Elena Biehler, Thomas Fleischhauer, Andreas Gutscher, Joachim Szecsenyi, Felix Herth, Benjamin Neetz","doi":"10.1055/a-2939-9867","DOIUrl":"https://doi.org/10.1055/a-2939-9867","url":null,"abstract":"<p><strong>Abstract: </strong>PRiVENT (Prevention of Invasive Ventilation through Early Identification and Early Intervention in Patients at Risk) is a cross-sectoral care model developed within the framework of the Innovation Fund of the German Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA). The aim of the project was to identify patients at increased risk of prolonged mechanical ventilation at an early stage and to promote successful weaning from mechanical ventilation through the early involvement of certified weaning centres and structured, interprofessional interventions. By doing so, the project seeks to prevent long-term invasive mechanical ventilation, tracheostomy, and the need for long-term out-of-hospital intensive care.Based on the initial positive results of the Innovation Fund project, a selective integrated care contract pursuant to § 140a of the German Social Code Book V (SGB V) was developed in collaboration with AOK Baden-Württemberg. The objective of this contract was to sustainably transfer the care structures established during the project into routine clinical care and to make them available throughout Baden-Württemberg for insured members of AOK Baden-Württemberg.The core components of the PRiVENT care pathway are the Weaning Board and the Weaning Consultation, both of which are conducted by an interprofessional team consisting of at least a pulmonologist and a respiratory therapist from a certified specialised weaning centre. Consultations may be performed via telemedicine, in a hybrid format, or entirely on site. The following section describes the healthcare services provided within the PRiVENT selective care contract under § 140a SGB V.</p>","PeriodicalId":520755,"journal":{"name":"Pneumologie (Stuttgart, Germany)","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868872","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":"[Giant Chondroid Pulmonary Hamartoma with a Diameter of 10 cm: A Case Report].","authors":"Erdi Çiğdem, Fatma Babacan, Soner Gürsoy, Vasıf Inan, Erdem Ayik","doi":"10.1055/a-2931-2212","DOIUrl":"10.1055/a-2931-2212","url":null,"abstract":"<p><strong>Abstract: </strong>Pulmonary hamartomas are benign, predominantly mesenchymal lung neoplasms that represent the most common benign lung tumors and typically do not exceed 4 cm in diameter. Lesions larger than this size are considered \"giant\" hamartomas and have been only rarely described in the literature. We report the case of a 62-year-old male patient with dyspnea, in whom a chest X-ray revealed a mass in the right lower lobe. The subsequent computed tomography confirmed a well-circumscribed mass with a maximum diameter of 98 mm. Complementary thoracic MRI showed a heterogeneous mass in the right lower lobe measuring approximately 97 × 87 mm. Sonography over the right intercostal space revealed a solid mass with hypoechoic internal structure; in correlation with the cross-sectional imaging findings, the lesion was most consistent with a hamartoma. Due to the size of the mass and the inability to rule out malignancy, a parenchyma-sparing surgical enucleation was performed. Histopathological examination confirmed the diagnosis of a pulmonary hamartoma of the chondroid type. The postoperative course was uneventful. This case underscores that unusually large intrapulmonary masses can also be of benign nature and highlights the importance of careful radiological and histopathological evaluation prior to therapeutic decision-making.</p>","PeriodicalId":520755,"journal":{"name":"Pneumologie (Stuttgart, Germany)","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805319","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":"[Bronchoalveolar lavage: a current overview].","authors":"Niels Schröder, Christopher Breyer, Maximilian Breyer, Francesco Bonella, Ralf Heine","doi":"10.1055/a-2890-6912","DOIUrl":"https://doi.org/10.1055/a-2890-6912","url":null,"abstract":"<p><strong>Abstract: </strong>Bronchoalveolar lavage (BAL) is a minimally invasive procedure frequently used in the evaluation of pulmonary diseases. The primary indications for its use include the diagnosis of inflammation, infection, and interstitial lung diseases. Additionally, BAL plays a role in tumor diagnostics, detection of rejection following lung transplantation, and the diagnosis of occupational lung diseases (e.g., berylliosis, asbestosis).Although BAL alone mostly does not enable a definitive diagnosis, analysis of the BAL fluid provides important findings that are essential when interpreted in the clinical context. Successful analysis and interpretation require careful sample collection and rapid processing. Sample preparation is technically straightforward, and routine staining (Giemsa) is uncomplicated. BAL is widely available, cost-effective, and an indispensable tool in the diagnostic workup of pulmonary diseases.</p>","PeriodicalId":520755,"journal":{"name":"Pneumologie (Stuttgart, Germany)","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687509","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":"[Prescribing biologics to adults with asthma - step by step].","authors":"Sabine Lampert, Inka Hübner, Marcus Joest, Kathrin Kahnert, Rembert Koczulla, Stephanie Korn, Katrin Milger, Florian Schmitz, Frederik Trinkmann, Sabina Wehgartner-Winkler, Marek Lommatzsch, Roland Buhl","doi":"10.1055/a-2867-1834","DOIUrl":"https://doi.org/10.1055/a-2867-1834","url":null,"abstract":"<p><strong>Abstract: </strong>Systemic corticosteroids are no longer recommended for the treatment of severe, uncontrolled asthma. Instead, various biologics are available. When prescribing these, it is important to ensure the correct indication, select the appropriate biologic and apply the correct ICD coding.</p>","PeriodicalId":520755,"journal":{"name":"Pneumologie (Stuttgart, Germany)","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687490","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":"[Suspected radiologic tumor progression in metastatic squamous cell carcinoma with an unexpected etiology].","authors":"Debi Durgo Ali Abdel Rahman, Ahmed Ehab, Yousef Abomuammar, Uta Wülfing, Anke Reinacher-Schick, Karsten Schulmann, Kaid Darwiche","doi":"10.1055/a-2890-7148","DOIUrl":"https://doi.org/10.1055/a-2890-7148","url":null,"abstract":"<p><strong>History: </strong>A 77-year-old man was admitted due to radiologic suspicion of right hilar tumor progression and newly developed right-sided pleural effusion. He had known NSCLC of the left lower lobe (keratinizing squamous cell carcinoma), initially staged T4N1M1c (contralateral lesion and hepatic metastasis), stage IVb. Comorbidities included COPD II, peripheral arterial disease, coronary artery disease, hypertension, and type 2 diabetes. Current oncologic therapy consisted of carboplatin, paclitaxel, and pembrolizumab.The patient presented with exertional dyspnea and reduced breath sounds with dullness to percussion at the right lung base. Bronchoscopic re-biopsy (EBUS-TBNA and transbronchial biopsy) was performed. Pleural cytology was negative for malignancy; therefore, thoracoscopy was conducted, revealing chronic pleuritis without malignant involvement.</p><p><strong>Findings: </strong>Histology showed no metastatic disease but demonstrated diffuse alveolar damage (DAD), consistent with immune-related pneumonitis. A pronounced sarcoid-like granulomatous reaction was observed, also involving the pleura.</p><p><strong>Diagnosis: </strong>Immune-related pneumonitis and pleuritis under PD-1 inhibitor therapy.</p><p><strong>Discussion: </strong>Immune-related pneumonitis occurs in approximately 1-5% of patients receiving immune checkpoint inhibitors. Imaging often shows bilateral ground-glass opacities. Histologically, organizing pneumonia is most common; DAD is less frequent. Diagnosis is made by excluding infection and tumor progression.Pleural effusion in oncologic patients is usually interpreted as tumor progression. Immune-mediated pleural involvement is rare and reported only in isolated cases. PD-1 blockade enhances T-cell activation and IFN-γ release, which may promote granuloma formation.Treatment consists of systemic glucocorticoids.</p>","PeriodicalId":520755,"journal":{"name":"Pneumologie (Stuttgart, Germany)","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148682069","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":"[Microbial contamination of wind instruments and associated pulmonary diseases].","authors":"Felix Schönhofer, Bernhard Schaaf, Michael Kreuter, Bernd Schönhofer","doi":"10.1055/a-2798-4678","DOIUrl":"10.1055/a-2798-4678","url":null,"abstract":"<p><strong>Abstract: </strong>Pulmonary diseases of musicians who play wind instruments that may be caused by microbial contamination of the instruments tend to be underestimated. The aerosols and microdroplets from the respiratory tract that enter the wind instrument when playing music contain both non-pathogenic and pathogenic microbes. Microbiological studies have shown a higher contamination of vital bacteria, fungi, and/or yeast in woodwind instruments compared to metal instruments.Although there are some signs of increased incidence of respiratory diseases in wind instrument players, the detection of potential pathogens in wind instruments does not necessarily mean that these microbes lead to manifest lung infections.Any type of wind instrument can be contaminated with microbes associated with Hypersensitivity Pneumonitis (HP). A series of case reports have been published dealing with HP, in particular in saxophone players (\"Sax lung\") and bagpipe players (\"Bagpipe lung\"). HP is more common among musicians playing wind instruments than previously thought. Therefore, in cases of HP of unclear cause, the medical history should be extended to include playing wind instruments and, if necessary, material taken from the instruments should be examined microbiologically.It is recommended that musicians regularly not only clean but also disinfect their wind instruments.</p>","PeriodicalId":520755,"journal":{"name":"Pneumologie (Stuttgart, Germany)","volume":" ","pages":"558-563"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208620","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":"[Prevalence of Peripheral Arterial Disease in Patients with COPD Depending on Disease Stage, Systemic Inflammation, and Exacerbation Rate].","authors":"Alexander Rech, Nina R Schwarzbach, Eva Lücke, Jens Schreiber","doi":"10.1055/a-2831-6521","DOIUrl":"10.1055/a-2831-6521","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is frequently associated with cardiovascular comorbidities, including peripheral arterial disease (PAD). The aim of this study was to assess, under real-life conditions in a general practice with a pulmonology focus, the prevalence of PAD in patients with COPD and to analyze the association between exacerbation frequency and severity and the ankle-brachial index (ABI).</p><p><strong>Methods: </strong>In this retrospective, single-center, cross-sectional observational study, 181 patients with COPD were investigated. In addition to clinical parameters and exacerbation history over the preceding 12 months, the ABI, six-minute walk distance, and inflammatory markers (high-sensitivity C-reactive protein [hs-CRP] and fibrinogen) were assessed. An ABI <0,9 was considered indicative of PAD.</p><p><strong>Results: </strong>A pathological ABI consistent with PAD was observed in 25 patients (13.8%). Both exacerbation frequency and, in particular, exacerbation severity were significantly associated with lower ABI values. Patients with one or more exacerbations had significantly lower ABI values compared with patients without exacerbations. Current smokers exhibited overall lower ABI values than never-smokers; however, the association between exacerbations and ABI was also evident in never-smokers. After adjustment, no independent associations were observed between systemic inflammatory markers, including hs-CRP and fibrinogen, and ABI.</p><p><strong>Conclusions: </strong>PAD represents a frequent comorbidity in patients with COPD. A higher exacerbation burden is associated with lower ABI values and thus with an increased risk of PAD, even after adjustment for classical risk factors. These findings highlight the value of ABI measurement as a simple, non-invasive screening tool in patients with COPD, particularly in those with frequent or severe exacerbations.</p>","PeriodicalId":520755,"journal":{"name":"Pneumologie (Stuttgart, Germany)","volume":" ","pages":"574-581"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611573","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":"Interventional management of persistent pleural air leaks.","authors":"Adrian Gillissen, Benjamin Ubl, Martin Hetzel","doi":"10.1055/a-2819-4266","DOIUrl":"10.1055/a-2819-4266","url":null,"abstract":"<p><strong>Abstract: </strong>A persistent air leak (PAL) of the pleura is a condition with a potentially fatal outcome. The development of such bronchopleural or alveolopleural fistulas is associated with a number of risk factors, including but not limited to: -a) Complications arising from larger resection of lung parenchyma; b) Emphysematous disease processes; c) Lower body mass index; d) Extensive infectious diseases, such as tuberculosis and pleural empyema, among others.The primary causes of patient mortality are the occurrence of pulmonary infections and respiratory failure. Subsequent to the localization of the PAL, implementation of timely treatment is indicated. Depending on the patient's location, the size of a PAL, the underlying cause, and the patient's individual characteristics, generally two treatment options are available if the initial placement of a pleural drainage fails to achieve the desired outcome: endoscopic and surgical. Bronchoscopic interventions are defined as the insertion of a chemical or biological sealant, or the placement of a blocking device. Examples of blocking devices include atrial septal defect (ASD) or ventricular septal defect (VSD) occluders, airway stents, endobronchial valves, coils, or endobronchial Watanabe spigots. Further, a variety of surgical options are available for treatment, including the possibility of re-operation if the fistula is based on prior lung resection surgery. Other interventions include suture repair and the placement of flap coverage from various sources. The success of surgical interventions is contingent upon several factors. These include the time between the occurrence of the fistula and the surgical intervention, the fistula size, and the extent of contamination of the ipsilateral pleural cavity or infectious involvement of the contralateral lung. The present review focuses on the effectiveness of various bronchoscopic and surgical measures for the treatment of PALs. It also presents a suggestion of an algorithm in order to rank the different treatment options.</p>","PeriodicalId":520755,"journal":{"name":"Pneumologie (Stuttgart, Germany)","volume":" ","pages":"582-593"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611589","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":"[Palliative care needs and healthcare provision for patients on the lung transplantation waiting list].","authors":"Simone Holländer, Claudia Bausewein, Jürgen Barton, Claus Neurohr, Nikolaus Kneidinger, Michaela Schunk","doi":"10.1055/a-2746-4201","DOIUrl":"10.1055/a-2746-4201","url":null,"abstract":"<p><strong>Background: </strong>For patients with advanced lung diseases, lung transplantation may represent the ultimate therapeutic option. Although support by palliative care is recommended for these highly vulnerable patients, it is rarely established in clinical practice. The present study aims to comprehensively describe the characteristics and health care of patients on the lung transplant waiting list, as well as to identify indicators for palliative care needs and risk factors for death during the waiting period.</p><p><strong>Methods: </strong>Retrospective cohort analysis of patients waiting for a lung transplantation of the LMU University Hospital Munich; evaluation of routinely collected health data between July 1st 2016 and June 30th 2018 using descriptive methods and logistic regression.</p><p><strong>Results: </strong>Overall, 242 patients were included in this study, 119 of them were female (49%). Their average age was 51 years (SD=12.1) and they had an average lung allocation score of 37.7 (SD=10.9, n=241/242) at the time they entered the waiting list. The most common diagnoses were chronic obstructive pulmonary disease (n=91/242, 38%), fibrosing lung diseases (n=73/242, 30%) and cystic fibrosis (n=36/242, 15%). Additionally, the patients had on average four chronic secondary diseases (SD=2.5; n=242). During the observation period, 137/242 patients (57%) received a transplant and 24/242 (10%) died before receiving a lung transplantation. Of the 242 patients, 195 (81%) visited the LMU University Hospital a median of two times during the study period, 54 of these 195 patients (28%) required acute care. For symptom management, 119 of 195 patients (59%) received medication relevant to palliative care. Only 5 of 195 patients (3%) had contact to the palliative care team. The number of comorbidities (p=0.03; OR=1.26; KI=1.02-1.54) and the number of days spent in the LMU University Hospital per observed month (p=0.00; OR=1.318; KI=1.134-1.531) were associated with a higher likelihood of death during the lung transplantation waiting period.</p><p><strong>Conclusions: </strong>The findings indicate palliative care needs among lung transplant candidates of the LMU University Hospital, yet palliative care services were rarely utilized. Implementation of structured assessments for symptom burden and palliative care needs may facilitate appropriate integration of palliative care services into the care of these patients.</p>","PeriodicalId":520755,"journal":{"name":"Pneumologie (Stuttgart, Germany)","volume":" ","pages":"564-573"},"PeriodicalIF":1.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021236","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}