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Meyer FJ, Borst MM, Buschmann HC, Claussen M, Dumitrescu D, Ewert R, Friedmann-Bette B, Gläser S, Glöckl R, Haring K, Lehnigk B, Ochmann U, Preisser AM, Sorichter S, Westhoff M, Worth H. [Exercise Testing in Respiratory Medicine - DGP Recommendations]. Pneumologie 2018; 72:687-731. [PMID: 30304755 DOI: 10.1055/a-0637-8593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This document replaces the DGP recommendations published in 1998 and 2013. Based on recent studies and a consensus conference, the indications, choice and performance of the adequate exercise testing method and its necessary technical and staffing setting are discussed. Detailed recommendations are provided: for blood gas analysis and right heart catheterization during exercise, walk tests, spiroergometry, and stress echocardiography. The correct use of different exercise tests is discussed for specific situations in respiratory medicine: exercise induced asthma, obesity, monitoring of rehabilitation or therapeutical interventions, preoperative risk stratification, and evaluation in occupational medicine.
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Affiliation(s)
- F J Meyer
- Lungenzentrum München (LZM Bogenhausen-Harlaching), Städtisches Klinikum München GmbH
| | - M M Borst
- Medizinische Klinik I, Caritas-Krankenhaus, Bad Mergentheim
| | - H-C Buschmann
- Klinik für Pneumologie und Allgemeine Innere Medizin, Brüderkrankenhaus St. Josef, Paderborn
| | - M Claussen
- LungenClinic Grosshansdorf, Großhansdorf
| | - D Dumitrescu
- Herzzentrum Uniklinik Köln, Klinik für Innere Medizin III
| | - R Ewert
- Klinik und Poliklinik für Innere Medizin B, Bereich Pneumologie/Infektiologie, Universitätsmedizin Greifswald
| | | | - S Gläser
- Klinik für Innere Medizin - Pneumologie, Vivantes Klinikum Spandau, Berlin
| | - R Glöckl
- Schön Klinik Berchtesgadener Land, Schönau am Königssee
| | - K Haring
- Lungenzentrum München (LZM Bogenhausen-Harlaching), Städtisches Klinikum München GmbH
| | - B Lehnigk
- Paracelsus-Harz-Klinik, Abt. Pneumologie OT Bad Suderode, Quedlinburg
| | - U Ochmann
- Institut für Arbeits-, Sozial- und Umweltmedizin, Klinikum der Universität München
| | - A M Preisser
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - S Sorichter
- St. Josefskrankenhaus, Klinik für Pneumologie und Beatmungsmedizin, Freiburg
| | - M Westhoff
- Universität Witten-Herdecke, Klinik für Pneumologie, Lungenklinik Hemer
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Lang S, Preisser AM, Herold R, Kraft A, Harth V. Spiroergometrische Messungen bei erhöhter inspiratorischer Sauerstoffkonzentration (FIO2) – Die Haldane Transformation auf dem Prüfstand. Pneumologie 2018. [DOI: 10.1055/s-0037-1619130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S Lang
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf
| | - AM Preisser
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Klinische Arbeitsmedizin, Hamburg
| | - R Herold
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf
| | - A Kraft
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf
| | - V Harth
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Klinische Arbeitsmedizin, Hamburg
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Bittner C, Garrido MV, Harth V, Preisser AM. IgE Reactivity, Work Related Allergic Symptoms, Asthma Severity, and Quality of Life in Bakers with Occupational Asthma. Adv Exp Med Biol 2017; 921:51-60. [PMID: 27161107 DOI: 10.1007/5584_2016_226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In Germany, bakers with occupational asthma willing to stay in their job are included in an interdisciplinary program of the Social Accident Insurance for Foodstuff and Catering Industry (BGN). The primary aim is to reduce flour dust exposure, and to provide adequate medical treatment. Our aim was to evaluate the program's effect on the disease's course using routinely collected data. Forty three bakers with allergic occupational asthma and with the available baseline level of IgE (f4, f5) were investigated. Changes in IgE related to wheat and rye flour exposure were measured by ImmunoCAP test during follow-up visits. A questionnaire on work-related allergic complaints (WRAC), the Asthma Control Test (ACT), a 10-point scale of asthma severity grade, and quality of life instruments (EQ-5D-5L, Mini-AQLQ) were administered. We found an improvement of asthma severity in 88.4 % of the bakers. WRAC were reported by 65 %; 77 % had good asthma control (ACT ≥ 20); and 81 % had regular asthma medication. A relevant reduction of ≥2 CAP-classes for both allergens was seen in 12 % of the subjects. Health-related and asthma-specific quality of life was high. We conclude that satisfactory asthma control is probably the result of adequate medical management. In a subgroup of bakers with decreased specific IgE, it may also be attributed to reduced allergen exposure.
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Affiliation(s)
- C Bittner
- Division of Clinical Occupational Medicine, Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, 10 Seewartenstraße, 20459, Hamburg, Germany.
| | - M V Garrido
- Division of Clinical Occupational Medicine, Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, 10 Seewartenstraße, 20459, Hamburg, Germany
| | - V Harth
- Division of Clinical Occupational Medicine, Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, 10 Seewartenstraße, 20459, Hamburg, Germany
| | - A M Preisser
- Division of Clinical Occupational Medicine, Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, 10 Seewartenstraße, 20459, Hamburg, Germany
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Bittner C, Preisser AM, Harth V. Asthma bronchiale als Berufskrankheit infolge einer Nahrungsmittelallergie bei einem madagassischen Koch. Pneumologie 2017. [DOI: 10.1055/s-0037-1598521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C Bittner
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin; Universitätsklinikum Hamburg-Eppendorf
| | - AM Preisser
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin; Universitätsklinikum Hamburg-Eppendorf
| | - V Harth
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin; Universitätsklinikum Hamburg-Eppendorf
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Kraft A, Bittner C, Harth V, Preisser AM. Asthma bronchiale als Berufskrankheit infolge einer Allergie auf Fische und Krustentiere – verzögerte Diagnostik mit anaphylaktischer Reaktion. Pneumologie 2017. [DOI: 10.1055/s-0037-1598522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A Kraft
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - C Bittner
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - V Harth
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - AM Preisser
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf
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Preisser AM, Harth V. Allergische bronchopulmonale Aspergillose in der Müllentsorgung – verzögerte Diagnose mit langwierigen Folgen. Pneumologie 2017. [DOI: 10.1055/s-0037-1598412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- AM Preisser
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf
| | - V Harth
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf
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Velasco Garrido M, Bittner C, Harth V, Preisser AM. Gesundheitsbezogene Lebensqualität bei berufsbedingtem Asthma bronchiale – eine systematische Übersichtsarbeit. Pneumologie 2016. [DOI: 10.1055/s-0036-1572262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Preisser AM, Velasco Garrido M, Bittner C, Hampel E, Harth V. Stufen- und Rampenbelastung am Fahrradergometer: Sind die Ergebnisse vergleichbar? Pneumologie 2014. [DOI: 10.1055/s-0034-1367879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Velasco Garrido M, Bittner C, Münster TV, Harth V, Preisser AM. Atemwegsprobleme bei Mitarbeitern der Müllentsorgung und Straßenreinigung. Pneumologie 2014. [DOI: 10.1055/s-0034-1367878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Preisser AM, Velasco Garrido M, Bittner C, Hampel E, Harth V. Gradual Versus Continuous Increase of Load in Ergometric Tests: Are the Results Comparable? Body Metabolism and Exercise 2014; 840:51-8. [DOI: 10.1007/5584_2014_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Karabin-Kehl B, Harth V, Preisser AM. [Epidemiological and occupational medicine aspects of pleural mesothelioma]. Pneumologie 2013; 67:209-18. [PMID: 23580457 DOI: 10.1055/s-0032-1326061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Malignant mesothelioma of the pleura represents a signal tumour for (occupational) exposure to asbestos. Almost 20 years after the ban of asbestos in Germany, incident cases are still occurring due to the long latency period between the initial exposure to asbestos and the onset of the tumour. Of particular interest is the development of mesothelioma epidemiology. In Germany, it is extensively discussed whether the incidence of malignant pleura mesothelioma continues to rise, has already reached a plateau or is expected to decline in the next few years. The development is predominantly caused by the total asbestos use, its application and the gradual substitution of asbestos. The prevention of asbestos-related diseases due to former exposures, but also due to existing asbestos contaminations and their restoration is still a hot topic in occupational medicine. It is thus of major importance to ensure an adequate occupational safety and to care for asbestos-exposed workers - even after cessation of their exposure - with effective and efficient measures of early detection. New technologies, such as nanotechnology with carbon nanotubes, represent new potential health hazards.
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Affiliation(s)
- B Karabin-Kehl
- Institut und Hochschulambulanz für Arbeitsmedizin, Umweltmedizin und Public Health (IAUP) und Präventivmedizinisches Zentrum für arbeits- und umweltbedingte Erkrankungen, Germany
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Meyer FJ, Borst MM, Buschmann HC, Ewert R, Friedmann-Bette B, Ochmann U, Petermann W, Preisser AM, Rohde D, Rühle KH, Sorichter S, Stähler G, Westhoff M, Worth H. [Exercise testing in respiratory medicine]. Pneumologie 2013; 67:16-34. [PMID: 23325729 DOI: 10.1055/s-0032-1325901] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This document replaces the DGP recommendations published in 1998. Based on recent studies and a consensus conference, the indications, choice and performance of the adequate exercise testing method in its necessary technical and staffing setting are discussed. Detailed recommendations are provided: for arterial blood gas analysis and right heart catherterization during exercise, 6-minute walk test, spiroergometry, and stress echocardiography. The correct use of different exercise tests is discussed for specific situations in respiratory medicine: exercise induced asthma, monitoring of physical training or therapeutical interventions, preoperative risk stratification, and evaluation in occupational medicine.
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Affiliation(s)
- F J Meyer
- Klinik für Pneumologie, Gastroenterologie, Internistische Intensiv- und Beatmungsmedizin, Städtisches Klinikum Harlaching, München.
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Abstract
Medical expert opinion by occupational physicians and pneumologists has two main objectives: making a diagnosis with probability bordering on certainty and clarifying a causal relationship to a present or former occupational exposure to irritant toxic, allergenic or fibrosing dusts, gases, welding fumes or mineral fibres. Especially for conditions that are associated with exertional dyspnea, the diagnosis at rest using spirometry, body plethysmography, pulmonary function test, blood gas analysis, electrocardiogram and echocardiography is of limited use. This paper identifies the indications for cardiopulmonary exercise testing (CPET) in occupational medicine, explains the related measurements and their differential diagnostic value with special consideration of the flow-volume curve under exercise as well as the alveolar-arterial oxygen gradient. Diagnostic statements on the relevance of oxygen uptake measured at continuous and peak load compared to the wattage ascertained on the bicycle ergometer are presented. Characteristic CPET findings are explained in terms of their differential diagnostic significance. Furthermore, the importance of CPET for the assessment of occupational disease-related functional loss (clinical proportions in the reduction of working capacity) is shown.
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Affiliation(s)
- A M Preisser
- Universitätsklinikum Hamburg-Eppendorf, Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Klinische Arbeitsmedizin, Hamburg.
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Affiliation(s)
- A M Preisser
- Universitätsklinikum Hamburg-Eppendorf, Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Klinische Arbeitsmedizin.
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