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Raveling T, Vonk JM, Hill NS, Gay PC, Casanova C, Clini E, Köhnlein T, Márquez-Martin E, Schneeberger T, Murphy PB, Struik FM, Kerstjens HA, Duiverman ML, Wijkstra PJ. Home noninvasive ventilation in severe COPD: in whom does it work and how? ERJ Open Res 2024; 10:00600-2023. [PMID: 38348241 PMCID: PMC10860207 DOI: 10.1183/23120541.00600-2023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/26/2023] [Indexed: 02/15/2024] Open
Abstract
Background Not all hypercapnic COPD patients benefit from home noninvasive ventilation (NIV), and mechanisms through which NIV improves clinical outcomes remain uncertain. We aimed to identify "responders" to home NIV, denoted by a beneficial effect of NIV on arterial partial pressure of carbon dioxide (PaCO2), health-related quality of life (HRQoL) and survival, and investigated whether NIV achieves its beneficial effect through an improved PaCO2. Methods We used individual patient data from previous published trials collated for a systematic review. Linear mixed-effect models were conducted to compare the effect of NIV on PaCO2, HRQoL and survival, within subgroups defined by patient and treatment characteristics. Secondly, we conducted a causal mediation analysis to investigate whether the effect of NIV is mediated by a change in PaCO2. Findings Data of 1142 participants from 16 studies were used. Participants treated with lower pressure support (<14 versus ≥14 cmH2O) and with lower adherence (<5 versus ≥5 h·day-1) had less improvement in PaCO2 (mean difference (MD) -0.30 kPa, p<0.001 and -0.29 kPa, p<0.001, respectively) and HRQoL (standardised MD 0.10, p=0.002 and 0.11, p=0.02, respectively), but this effect did not persist to survival. PaCO2 improved more in patients with severe dyspnoea (MD -0.30, p=0.02), and HRQoL improved only in participants with fewer than three exacerbations (standardised MD 0.52, p=0.03). The results of the mediation analysis showed that the effect on HRQoL is mediated partially (23%) by a change in PaCO2. Interpretation With greater pressure support and better daily NIV usage, a larger improvement in PaCO2 and HRQoL is achieved. Importantly, we demonstrated that the beneficial effect of home NIV on HRQoL is only partially mediated through a reduction in diurnal PaCO2.
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Affiliation(s)
- Tim Raveling
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Groningen Research Institute of Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Judith M. Vonk
- Groningen Research Institute of Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nicholas S. Hill
- Division of Pulmonary, Critical Care and Sleep Medicine, Tufts University Medical Center Boston, Boston, MA, USA
| | - Peter C. Gay
- Department of Pulmonary and Critical Care Medicine and the Center for Sleep Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ciro Casanova
- Department of Pulmonary, Research Unit, Hospital Universitario La Candelaria, Universidad de La Laguna, Tenerife, Spain
| | - Enrico Clini
- Respiratory Diseases Unit, Dept of Medical and Surgical Sciences SMECHIMAI, University Hospital of Modena Policlinico, University of Modena Reggio-Emilia, Modena, Italy
| | | | - Eduardo Márquez-Martin
- Medical–Surgical Unit of Respiratory diseases, University Hospital Virgen del Rocío, Seville, Spain
- CIBER-ES, Instituto de Salud Carlos III, Madrid, Spain
| | - Tessa Schneeberger
- Department of Pulmonary Rehabilitation, Philipps-University of Marburg, Marburg, Germany
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, Germany
| | - Patrick B. Murphy
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Fransien M. Struik
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Huib A.M. Kerstjens
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Groningen Research Institute of Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marieke L. Duiverman
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Groningen Research Institute of Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Peter J. Wijkstra
- Department of Pulmonary Diseases and Home Mechanical Ventilation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Groningen Research Institute of Asthma and COPD, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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2
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Wollsching-Strobel M, Butt U, Majorski DS, Mathes T, Stachwitz P, Hagen J, Kroppen D, Köhnlein T, Windisch W, Schwarz SB. [The digitalization of pneumology and the role of medical societies]. Pneumologie 2022; 76:560-567. [PMID: 35948017 DOI: 10.1055/a-1866-2507] [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: 10/15/2022]
Abstract
BACKGROUND Medicine is becoming increasingly digitalized. Digital applications are finding their way into health care. The aim of the study was to record the attitudes of members of the German Respiratory Society (DGP) towards digitalization. METHODS The study was conducted in cooperation with the DGP, the German Respiratory League and the Health Innovation Hub (HIH) of the German Federal Ministry of Health. Data were gathered with the help of an online questionnaire (July/August 2021), analyzed descriptively and supplemented with a subgroup comparison regarding proactivity of the members. RESULTS 284 questionnaires were complete and included in the analysis (31% female); 76.4% believed that digitalization would change their daily professional life within five years. 47.2% had prescribed or planned to prescribe Digital Health Applications (DiGA). Lack of technology skills of patients and the time required for health professionals were seen as critical (49.3 and 47.5%). Regarding DiGA, scientific proof of efficacy (48.9%) and ease of use for patients (47.9%) were rated as most important. The subgroup comparison showed that 42.7% actively informed themselves about digital medicine and that this group saw more opportunities for meaningful use of DiGA. CONCLUSION The members of the DGP have mostly a positive view about the profound changes expected from digital medicine. The more active the role of DGP members and other professional societies, the more digital elements can add value to practice.
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Affiliation(s)
- Maximilian Wollsching-Strobel
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., Berlin, Deutschland, Köln, Deutschland.,Deutsche Atemwegsliga e.V., Bad Lippspringe, Deutschland.,Department für Humanmedizin, Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Universität Witten/Herdecke, Fakultät für Gesundheit, Köln, Deutschland
| | - Uta Butt
- Deutsche Atemwegsliga e.V., Bad Lippspringe, Deutschland
| | - Daniel Sebastian Majorski
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., Berlin, Deutschland, Köln, Deutschland.,Deutsche Atemwegsliga e.V., Bad Lippspringe, Deutschland.,Department für Humanmedizin, Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Universität Witten/Herdecke, Fakultät für Gesundheit, Köln, Deutschland
| | - Tim Mathes
- Department für Humanmedizin, Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Universität Witten/Herdecke, Fakultät für Gesundheit, Köln, Deutschland.,Medizinische Statistik, Institut für medizinische Statistik, Georg-August-Universität Göttingen, Göttingen, Deutschland
| | - Philipp Stachwitz
- health innovation hub (hih) des Bundesministeriums für Gesundheit, Berlin, Deutschland.,Deutsche Schmerzgesellschaft e. V
| | - Julia Hagen
- health innovation hub (hih) des Bundesministeriums für Gesundheit, Berlin, Deutschland
| | - Doreen Kroppen
- Department für Humanmedizin, Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Universität Witten/Herdecke, Fakultät für Gesundheit, Köln, Deutschland
| | - Thomas Köhnlein
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., Berlin, Deutschland, Köln, Deutschland.,Deutsche Atemwegsliga e.V., Bad Lippspringe, Deutschland
| | - Wolfram Windisch
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., Berlin, Deutschland, Köln, Deutschland.,Deutsche Atemwegsliga e.V., Bad Lippspringe, Deutschland.,Department für Humanmedizin, Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Universität Witten/Herdecke, Fakultät für Gesundheit, Köln, Deutschland
| | - Sarah Bettina Schwarz
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V., Berlin, Deutschland, Köln, Deutschland.,Department für Humanmedizin, Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Universität Witten/Herdecke, Fakultät für Gesundheit, Köln, Deutschland
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3
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Köhnlein T, Wilkens M, Eydt K. [Impact of COVID-19 pandemic on information management and adherence to replacement therapy with AAT of patients with alpha-1 antitrypsin deficiency (AATM)]. Pneumologie 2022; 76:494-498. [PMID: 35724679 DOI: 10.1055/a-1845-0160] [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: 10/18/2022]
Abstract
METHODS In March 2021, a 19-item survey was sent to 420 patients with AATD who were being treated with AAT replacement therapy (prolastin) and who participated in the German AlphaCare patient program. RESULTS The majority of the respondents (55.9%; 138) had been diagnosed with AATD ≥10 years prior to the survey and most (93.5%; 231) felt adequately informed about their disease through their physician, AlphaCare and Alpha1 Deutschland. The majority of respondents were concerned/very concerned about acquiring COVID-19. Only 1.2% of the respondents reported having been infected with SARS-CoV-2, less than the infection rate in the general population at that time (3.4%). Almost all of the respondents fully agreed/agreed that they had restricted their social contacts due to the pandemic. A substantial percentage of the responding patients fully agreed/agreed that they were concerned about being infected with COVID-19 during a visit at their doctor's office or clinic. Regarding AAT augmentation therapy, only 18 respondents reported discontinuing therapy during the pandemic, but most of these discontinuations were short-term - one was permanent. CONCLUSIONS These survey results suggest that AATD patients are well-informed about the risks of COVID-19 with their condition and practised self-protection measures. This may have resulted in an COVID-19 infection rate lower than the general population. Although respondents were concerned about exposure to COVID-19 in their doctor's office or clinic, very few discontinued therapy even temporarily.
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Affiliation(s)
- Thomas Köhnlein
- Pneumologisches Facharztzentrum Teuchern und Mitteldeutsche Fachklinik für Schlafmedizin, Teuchern, Germany
| | | | - Katharina Eydt
- Scientific & Medical Affairs, Grifols Deutschland GmbH, Frankfurt, Germany
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4
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Köhnlein T, Schwarz SB, Nagel S, Windisch W. Home Non-Invasive Positive Pressure Ventilation in Chronic Obstructive Pulmonary Disease: Why, Who, and How? Respiration 2022; 101:709-716. [PMID: 35717945 DOI: 10.1159/000525015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/25/2022] [Indexed: 11/19/2022] Open
Abstract
Advanced chronic obstructive pulmonary disease (COPD) might result in chronic hypercapnic ventilatory failure. Similar to neuromuscular and restrictive chest wall diseases, long-term non-invasive positive pressure ventilation (NPPV) is increasingly used in chronic hypercapnic COPD. This review describes the methods, patient selection, ventilatory strategies, and therapeutic effects of long-term Home-NPPV based on randomized controlled clinical trials published since 1985 in English language retrieved from the databases PubMed and Scopus. Long-term NPPV is feasible and effective in stable, non-exacerbated COPD patients with daytime hypercapnia with arterial pressure of carbon dioxide (PaCO2) levels ≥50 mm Hg (6.6 kPa), if the applied ventilatory pressures and application times improve baseline hypercapnia by at least 20%. Patients who survived an acute hypercapnic exacerbation might benefit from long-term NPPV if hypercapnia persists 2-4 weeks after resolution of the exacerbation. Pressure-controlled ventilation or pressure-support ventilation with adequate minimum backup breathing frequencies, in combination with nasal masks or oronasal masks have been successfully used in all larger clinical trials. Ventilatory strategies with mean inspiratory pressures of up to 28 cm H2O are well-tolerated by patients, but limitations exist in patients with impaired cardiac performance. Home-NPPV with a PaCO2-reductive approach might be considered as an additional treatment option in patients with stable chronic hypercapnic COPD.
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Affiliation(s)
- Thomas Köhnlein
- Facharztzentrum Teuchern und Mitteldeutsche Fachklinik für Schlafmedizin, Teuchern, Germany
| | - Sarah Bettina Schwarz
- Department of Pneumology, Kliniken der Stadt Köln GmbH, University of Witten/Herdecke, Cologne, Germany
| | - Stephan Nagel
- Klinikum St. Georg, Robert-Koch-Klinik, Respiratory Medicine, Leipzig, Germany
| | - Wolfram Windisch
- Department of Pneumology, Kliniken der Stadt Köln GmbH, University of Witten/Herdecke, Cologne, Germany
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5
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Hoheisel A, Vogt G, Nagel S, Bonitz A, Müller C, Köhnlein T, Hoheisel G. [MDR tuberculosis, Alpha-1-anti-trypsin Deficiency, Cough in a Geriatric Nurse]. Pneumologie 2021; 75:971-980. [PMID: 34233361 DOI: 10.1055/a-1493-1206] [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: 10/20/2022]
Abstract
Multidrug-resistant tuberculosis (MDR-TB) is of low proportion in comparison to the total number of TB patients, however, due to the necessity of a complex medication with potentially severe and life threatening adverse reactions, long term sequelae, and unfavorable outcome special attention is essential. We report the case of a 30-year-old geriatric nurse with a history of chronic cough and hereditary alpha-1-anti-trypsin deficiency (AATD), who suffered from MDR-TB and experienced a number of severe adverse reactions.
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Affiliation(s)
- Andreas Hoheisel
- Universitätsspital Basel, Bereich für Pneumologie, Basel, Schweiz
| | - Geert Vogt
- Robert-Koch-Klinik, Klinikum Sankt Georg, Leipzig, Deutschland
| | - Stephan Nagel
- Robert-Koch-Klinik, Klinikum Sankt Georg, Leipzig, Deutschland
| | - Andreas Bonitz
- Praxis für Pneumologie/Allergologie, Leipzig, Deutschland
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6
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Herkenrath SD, Dreher M, Gompelmann D, Held M, Koczulla AR, Köhnlein T, Rohde G, Wälscher J, Watz H, Randerath WJ. Technical Innovations in Pneumology: E-Health, Screening, Diagnostics, and Therapy. Respiration 2021; 100:1009-1015. [PMID: 33965942 DOI: 10.1159/000516335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 11/19/2022] Open
Abstract
At the 2020 "Luftschlösser" (castles in the air) conference, experts from a wide range of pneumological fields discussed technical innovations in pneumology, which can be seen in many different areas of the field, including e-health, screening, diagnostics, and therapy. They contribute to substantial advancements ranging from the innovative use of diagnostic tools to novel treatments for chronic lung diseases. Artificial intelligence enables broader screening, which can be expected to have beneficial effects on disease progression and overall prognosis. There is still a high demand for clinical trials to investigate the usefulness and risk-benefit ratio. Open questions remain especially about the quality and utility of medical apps in an inadequately regulated market. This article weighs the pros and cons of technical innovations in specific subspecialties of pneumology based on the lively exchange of ideas among various pneumological experts.
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Affiliation(s)
- Simon Dominik Herkenrath
- Institute of Pneumology at the University of Cologne, Clinic of Pneumology and Allergology, Bethanien Hospital, Solingen, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Daniela Gompelmann
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Matthias Held
- Department of Internal Medicine, Respiratory Medicine and Ventilatory Support, Medical Mission Hospital, Central Clinic Würzburg, Academic Teaching Hospital of the Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Andreas Rembert Koczulla
- Institute for Pulmonary Rehabilitation Research, Schoen Klinik Berchtesgadener Land, Teaching Hospital of Philipps-University of Marburg, Marburg, Germany
| | | | - Gernot Rohde
- Department of Respiratory Medicine, Medical Clinic 1, University Hospital, Frankfurt, Germany
| | - Julia Wälscher
- Department of Pneumology, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Henrik Watz
- Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Winfried Johannes Randerath
- Institute of Pneumology at the University of Cologne, Clinic of Pneumology and Allergology, Bethanien Hospital, Solingen, Germany
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7
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Dellweg D, Lepper PM, Nowak D, Köhnlein T, Olgemöller U, Pfeifer M. [Statement of the German Society for Pulmonology and Respiratory Medicine Regarding the Regulation to Use FFP and Surgical Masks in the General Population]. Pneumologie 2021; 75:181-186. [PMID: 33598902 DOI: 10.1055/a-1375-6717] [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: 10/22/2022]
Abstract
On January 19, 2021, a new regulation on the mask requirement was issued in an initiative by the federal and state governments. This regulation obliges citizens to wear medical masks on public transport and in shops. In its statement, the German Society for Pneumology and Respiratory Medicine (DGP) describes the technical background of the various medical masks and explains their functionality using the associated standards. The DGP comes to the conclusion that FFP masks of the EN 149 standard were designed for the self-protection of the wearer and ensure this if the mask is worn properly and closes tightly to the face. Incorrect use must be avoided at all costs. Surgical masks in accordance with the EN 14683 standard were designed to protect against bacteria-carrying aerosols and, due to their design, have a rather low self-protection component. Community masks are not yet subject to any official standard. Community masks with electrostatic properties and high filtration performance could represent a reusable alternative in the future. Depending on the severity of their illness, patients with heart and/or lung diseases require a stress test with a mask to minimize medical risks.
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Affiliation(s)
- D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg Grafschaft
| | - P M Lepper
- Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - D Nowak
- Klinikum der Universität München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), München
| | - T Köhnlein
- Pneumologisches Facharztzentrum Teuchern, Teuchern
| | - U Olgemöller
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg.,Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf.,Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
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8
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Randerath W, Dreher M, Gompelmann D, Held M, Koczulla R, Köhnlein T, Rohde G, Wälscher J, Watz H, Steinkamp G. [Technological Innovations in Pulmonology - Examples from Diagnostics and Therapy]. Pneumologie 2020; 74:585-600. [PMID: 32663891 DOI: 10.1055/a-1186-7333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A significant proportion of the current technological developments in pneumology originate from the various areas of information technology. The spectrum ranges from smartphone apps to be used in daily life or in patient care to the use of artificial intelligence in screening and early detection of diseases. The diagnostic accuracy of apps for symptom analysis is currently very limited. Research projects are performed on the integration of symptoms and functional parameters into early detection, but also on mobility measurements as a prognostic marker in COPD. Lung cancer screening using computed tomography represents a major challenge. Here, artificial intelligence can help radiologists to cope with huge amounts of data. However, the quality of the software depends on the sufficient training of the system. Technological developments shape all fields of pneumology. For diagnostic and interventional endoscopy, they offer improved biopsy techniques and microstructural imaging. Advances in lung function measurements allow the differentiated analysis of respiratory mechanical disorders, and they could be transferred to ventilation technology. The translation of basic findings about the lung microbiome into patient care may perspectively help to better understand and treat COPD exacerbations.
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Affiliation(s)
- W Randerath
- Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien, Solingen
| | - M Dreher
- Klinik für Pneumologie und Internistische Intensivmedizin, Medizinische Klinik V, Universitätsklinikum Aachen
| | - D Gompelmann
- Klinische Abteilung für Pulmologie, Universitätsklinik Innere Medizin II, Wien
| | - M Held
- Missioklinik, Klinikum Würzburg Mitte, Zentrum für Thoraxmedizin Würzburg, Medizinische Klinik mit Schwerpunkt Pneumologie und Beatmungsmedizin
| | - R Koczulla
- Fachzentrum für Pneumologie, Schön Klinik Berchtesgadener Land und Universitätsklinikum Marburg
| | - T Köhnlein
- Pneumologisches Facharztzentrum Teuchern
| | - G Rohde
- Pneumologie/Allergologie, Medizinische Klinik 1, Universitätsklinikum Frankfurt
| | - J Wälscher
- Pneumologie, Ruhrlandklinik, Universitätsmedizin Essen
| | - H Watz
- Pneumologisches Forschungsinstitut an der LungenClinic Großhansdorf, Airway Research Center North (ARCN), Deutsches Zentrum für Lungenforschung (DZL)
| | - G Steinkamp
- Medizinisch-wissenschaftliches Publizieren, Schwerin
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9
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Dellweg D, Lepper PM, Nowak D, Köhnlein T, Olgemöller U, Pfeifer M. [Position Paper of the German Respiratory Society (DGP) on the Impact of Community Masks on Self-Protection and Protection of Others in Regard to Aerogen Transmitted Diseases]. Pneumologie 2020. [PMID: 32455450 DOI: 10.1055/a-1184-7263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg Grafschaft
| | - P M Lepper
- Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - D Nowak
- Klinikum der Universität München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), München
| | | | - U Olgemöller
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg.,Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf.,Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
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10
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Dellweg D, Lepper PM, Nowak D, Köhnlein T, Olgemöller U, Pfeifer M. [Position Paper of the German Respiratory Society (DGP) on the Impact of Community Masks on Self-Protection and Protection of Others in Regard to Aerogen Transmitted Diseases]. Pneumologie 2020; 74:331-336. [PMID: 32434252 PMCID: PMC7362397 DOI: 10.1055/a-1175-8578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg Grafschaft
| | - P M Lepper
- Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - D Nowak
- Klinikum der Universität München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), München
| | | | - U Olgemöller
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
- Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
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Dreher M, Neuzeret PC, Windisch W, Martens D, Hoheisel G, Gröschel A, Woehrle H, Fetsch T, Graml A, Köhnlein T. Prevalence Of Chronic Hypercapnia In Severe Chronic Obstructive Pulmonary Disease: Data From The HOmeVent Registry. Int J Chron Obstruct Pulmon Dis 2019; 14:2377-2384. [PMID: 31695357 PMCID: PMC6805244 DOI: 10.2147/copd.s222803] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/23/2019] [Indexed: 12/12/2022] Open
Abstract
Background Non-invasive ventilation (NIV) has been shown to improve survival and quality of life in COPD patients with chronic hypercapnic respiratory failure. However, the proportion of COPD patients with chronic hypercapnia is not yet known and clinical data enabling better identification of patients are scarce. The HOmeVent registry was initiated to determine the prevalence of chronic hypercapnia in COPD in an outpatient setting and to evaluate the predictors of hypercapnia. Methods HOmeVent is a multicenter, prospective, observational, non-interventional patient registry that includes COPD patients in GOLD stage 3 or 4. Eligible patients were identified and enrolled in an outpatient setting during routine clinic visits. Assessments included blood gas analyses, pulmonary function testing and quality of life assessment. Results Ten outpatient clinics in Germany enrolled 231 COPD patients in the registry (135 in GOLD stage 3 (58%) and 96 in GOLD stage 4 (42%)). Arterial carbon dioxide pressure (PaCO2) was ≥45 mmHg in 58 patients (25%); of these, 20 (9%) had PaCO2 ≥50 mmHg. The prevalence of hypercapnia at both cut-off values was numerically higher for patients in GOLD stage 4 versus 3. An increased body mass index, a decreased forced vital capacity and an increased bicarbonate level were significant independent predictors of hypercapnia. The proportion of patients who received NIV was 6% overall and 22% of those with hypercapnia. Conclusion A relevant proportion of COPD patients in GOLD stage 3 and 4 exhibits chronic hypercapnia and might, therefore, be candidates for long-term domiciliary NIV treatment.
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Affiliation(s)
- Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany
| | | | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken Der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany
| | | | | | | | - Holger Woehrle
- Sleep and Ventilation Center Blaubeuren, Respiratory Center Ulm, Ulm, Germany
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Fawzy El-Sayed K, Graetz C, Köhnlein T, Mekhemar M, Dörfer C. Effect of total sonicated Aggregatibacter actinomycetemcomitans fragments on gingival stem/progenitor cells. Med Oral Patol Oral Cir Bucal 2018; 23:e569-e578. [PMID: 30148477 PMCID: PMC6167108 DOI: 10.4317/medoral.22661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/16/2018] [Indexed: 01/24/2023] Open
Abstract
Background Aggregatibacter-actinomycetemcomitans (A.actinomycetemcomitans) are strongly associated with localized-aggressive-periodontitis (LAgP). The study’s aim was to test for the first time the effect of total sonicated A.actinomycetemcomitans-bacterial-fragments on gingival mesenchymal stem/progenitor cells’ (G-MSCs) proliferation and regenerative gene expression in-vitro. Material and Methods G-MSCs were isolated, characterized, expanded and stimulated by total sonicated A.actinomycetemcomitans-bacterial-fragments (0 (negative-control), 15, 60, 120 and 240µg/ml; serovar-b; n=6/group). Cellular proliferation and NF-κβ (NFKB1), Alkaline Phosphatase (ALPL), Collagen-I (COL1A1), Collagen-III (COL3A1), Osteonectin (SPARC) and Osteopontin (SPP1) m-RNA expression were assessed via reverse-transcription-polymerase-chain-reaction (RT-PCR) at 24, 48 and 72 hours and CFUs-ability evaluated at twelve days. Results G-MSCs demonstrated stem/progenitor cells’ characteristics. A.actinomycetemcomitans-bacterial-fragments (up to 72 hours) resulted in marked G-MSCs’ proliferation over-time (p<0.001) and elevated NFKB1 (p=0.017), COL1A1 (p=0.025), SPARC (p=0.025), decreased ALPL (p=0.017), with no significant differences for COL3A1 and SPP1 expression or stimulation times (p>0.05; Friedman-test). Longer-term stimulation for twelve days reduced G-MSCs’ CFUs. Conclusions Sonicated A.actinomycetemcomitans-bacterial-fragments’ exert beneficial short-term effects on G-MSCs’ proliferative and non-mineralized tissue forming aptitude. Results shed new light on the importance of periodontal treatment for LAgP patients, using power driven sonic/ultrasonic devices, which, in addition to reducing the subgingival microbial load, produces cell-stimulatory A.actinomycetemcomitans-bacterial-fragments, with positive attributes on tissue reparative/regenerative responses of tissue resident stem/progenitor cells in their niche. Key words:Ultrasonic, Aggregatibacter actinomycetemcomitans, stem cells, gingiva, Aggressive periodontitis.
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Affiliation(s)
- K Fawzy El-Sayed
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian Albrechts-Universität zu Kiel, Arnold-Heller-Str. 3, Haus 26, 24105 Kiel, Germany,
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13
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Dreher M, Neuzeret PC, Busam D, Hoheisel G, Gröschel A, Woehrle H, Ortner K, Graml A, Windisch W, Köhnlein T. HomeVent Register – Prävalenz von chronischer Hyperkapnie bei COPD-Patienten und deren Behandlungspfade. Pneumologie 2018. [DOI: 10.1055/s-0037-1619142] [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)
- M Dreher
- Sektion Pneumologie, Medizinische Klinik I, Medizinische Fakultät der RWTH Aachen
| | | | | | | | | | | | - K Ortner
- The Clinical Research Institute, München
| | | | | | - T Köhnlein
- Klinikum St. Georg, Robert-Koch-Klinikum, Leipzig
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Stegemann A, Schneeberger T, Schönheit-Kenn U, Glöckl R, Jarosch I, Köhnlein T, Koczulla AR, Kenn K. Nächtliche nicht-invasive Beatmung bei COPD Patienten on top eines 3-wöchigen pneumologischen Rehabilitationprogramms – eine randomisierte, kontrollierte Studie. Pneumologie 2018. [DOI: 10.1055/s-0037-1619406] [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)
| | - T Schneeberger
- Schön Klinik Berchtesgadener Land; Philipps-Universität Marburg
| | | | - R Glöckl
- Schön Klinik Berchtesgadener Land; Klinikum Rechts der Isar, Technische Universität München (TUM)
| | | | - T Köhnlein
- Klinikum St. Georg gGmbH; Robert-Koch-Klinik, Leipzig
| | - AR Koczulla
- Schön Klinik Berchtesgadener Land; Philipps-Universität Marburg
| | - K Kenn
- Schön Klinik Berchtesgadener Land; Philipps-Universität Marburg
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15
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Windisch W, Dreher M, Geiseler J, Siemon K, Brambring J, Dellweg D, Grolle B, Hirschfeld S, Köhnlein T, Mellies U, Rosseau S, Schönhofer B, Schucher B, Schütz A, Sitter H, Stieglitz S, Storre J, Winterholler M, Young P, Walterspacher S. [Guidelines for Non-Invasive and Invasive Home Mechanical Ventilation for Treatment of Chronic Respiratory Failure - Update 2017]. Pneumologie 2017; 71:722-795. [PMID: 29139100 DOI: 10.1055/s-0043-118040] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Today, invasive and non-invasive home mechanical ventilation have become a well-established treatment option. Consequently, in 2010 the German Society of Pneumology and Mechanical Ventilation (DGP) has leadingly published the guidelines on "Non-Invasive and Invasive Mechanical Ventilation for Treatment of Chronic Respiratory Failure". However, continuing technical evolutions, new scientific insights, and health care developments require an extensive revision of the guidelines.For this reason, the updated guidelines are now published. Thereby, the existing chapters, namely technical issues, organizational structures in Germany, qualification criteria, disease specific recommendations including special features in pediatrics as well as ethical aspects and palliative care, have been updated according to the current literature and the health care developments in Germany. New chapters added to the guidelines include the topics of home mechanical ventilation in paraplegic patients and in those with failure of prolonged weaning.In the current guidelines different societies as well as professional and expert associations have been involved when compared to the 2010 guidelines. Importantly, disease-specific aspects are now covered by the German Interdisciplinary Society of Home Mechanical Ventilation (DIGAB). In addition, societies and associations directly involved in the care of patients receiving home mechanical ventilation have been included in the current process. Importantly, associations responsible for decisions on costs in the health care system and patient organizations have now been involved.The currently updated guidelines are valid for the next three years, following their first online publication on the home page of the Association of the Scientific Medical Societies in German (AWMF) in the beginning of July 2017. A subsequent revision of the guidelines remains the aim for the future.
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Affiliation(s)
- W Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln.,Universität Witten/Herdecke, Fakultät für Gesundheit/Department für Humanmedizin
| | - M Dreher
- Medizinische Klinik I - Sektion Pneumologie, Universitätsklinikum Aachen, Aachen
| | - J Geiseler
- Medizinische Klinik IV, Paracelsus-Klinik Marl, Marl
| | - K Siemon
- Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg
| | - J Brambring
- Heimbeatmungsservice Brambring Jaschke GmbH, Unterhaching
| | - D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg
| | - B Grolle
- Lufthafen, AKK Altonaer Kinderkrankenhaus gGmbH, Hamburg
| | - S Hirschfeld
- Querschnittgelähmtenzentrum, Berufsgenossenschaftliches Unfallkrankenhaus Hamburg, Hamburg
| | - T Köhnlein
- Klinik für Pneumologie und Intensivmedizin, Klinikum St. Georg, Leipzig
| | - U Mellies
- Klinik für Kinderheilkunde III, Universitätsklinikum Essen, Essen
| | - S Rosseau
- Pneumologisches Beatmungszentrum, Ernst von Bergmann Klinik gGmbH, Bad Belzig
| | - B Schönhofer
- Klinik für Pneumologie, KRH Klinikum Siloah-Oststadt-Heidehaus, Hannover
| | - B Schucher
- Zentrum für Pneumologie und Thoraxchirurgie, Krankenhaus Großhansdorf, Großhansdorf
| | | | - H Sitter
- Institut für theoretische Chirurgie, Universitätsklinikum Giessen und Marburg GmbH, Marburg
| | - S Stieglitz
- Medizinische Klinik I, Petrus Krankenhaus, Wuppertal
| | - J Storre
- Intensiv-, Schlaf- und Beatmungsmedizin, Asklepios Fachkliniken München-Gauting, Gauting.,Klinik für Pneumologie, Universitätsklinikum Freiburg, Freiburg i. Br
| | - M Winterholler
- Klinik für Neurologie, Krankenhaus Rummelsberg gGmbH, Schwarzenbruck
| | - P Young
- Klinik für Schlafmedizin und neuromuskuläre Erkrankungen, Universitätsklinikum Münster, Münster.,Klinik für Beatmungs- und Schlafmedizin, Clemenshospital Münster, Münster
| | - S Walterspacher
- Universität Witten/Herdecke, Fakultät für Gesundheit/Department für Humanmedizin.,II. Medizinische Klinik, Klinikum Konstanz, Konstanz
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16
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Conrad A, Janciauskiene S, Köhnlein T, Fuge J, Ivanyi P, Tudorache I, Gottlieb J, Welte T, Fuehner T. Impact of alpha 1-antitrypsin deficiency and prior augmentation therapy on patients' survival after lung transplantation. Eur Respir J 2017; 50:50/3/1700962. [PMID: 28890438 DOI: 10.1183/13993003.00962-2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 06/30/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Anton Conrad
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Sabina Janciauskiene
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,These authors contributed equally
| | - Thomas Köhnlein
- Dept of Respiratory Medicine, Klinikum St. Georg gGmbH (Robert-Koch-Klinikum), Leipzig, Germany
| | - Jan Fuge
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Philipp Ivanyi
- Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Dept of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jens Gottlieb
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Tobias Welte
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Thomas Fuehner
- Dept of Respiratory Medicine, Hannover Medical School, Hannover, Germany .,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,These authors contributed equally
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17
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Lorenz J, Bals R, Ewert R, Jany B, Koczulla AR, Köhnlein T, Randerath WJ, Steinkamp G, Watz H, Welte T. [Expert Meeting on COPD: Personalized Treatment of COPD - Wishful Thinking or Reality?]. Pneumologie 2016; 70:638-650. [PMID: 27723914 DOI: 10.1055/s-0042-112044] [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: 10/20/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is considered to be a complex and heterogeneous disease comprising multiple components. Its clinical presentation, pattern of functional disturbance, disease presentation and pathology varies tremendously between individuals despite the common feature of incompletely reversible airflow obstruction. It is therefore widely accepted that COPD is characterized by discriminable phenotypes that represent specific patterns of these disease features. COPD phenotypes are believed to correlate with outcome parameters such as severity of symptoms, exacerbations, functional loss or death and to require different treatment algorithms.This survey is the result of presentations that were given during an expert conference. It highlights the significance of major comorbidities, genetic, morphologic and inflammatory COPD-phenotypes and their impact on disease progression and treatment modalities.
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Affiliation(s)
- J Lorenz
- Klinik für Pneumologie und Internistische Intensivmedizin, Klinikum Lüdenscheid
| | - R Bals
- Pneumologie, Allergologie, Beatmungsmedizin, Universitätsklinikum des Saarlandes
| | - R Ewert
- Innere Medizin, Pneumologie, Internistische Intensivmedizin, Universitätsmedizin Greifswald
| | - B Jany
- Innere Medizin, Missionsärztliche Klinik Würzburg
| | - A R Koczulla
- Klinik für Innere Medizin, Schwerpunkt Pneumologie, Universitätsklinikum Marburg
| | - T Köhnlein
- Klinik für Pneumologie und Intensivmedizin, Klinikum St. Georg, Leipzig
| | - W J Randerath
- Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien, Solingen
| | - G Steinkamp
- Medizinisch-wissenschaftliches Publizieren, Schwerin
| | - H Watz
- Pneumologisches Forschungsinstitut an der LungenClinic Großhansdorf
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover
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18
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Fuchs SI, Schwerk N, Pittschieler K, Ahrens F, Baden W, Bals R, Fähndrich S, Gleiber W, Griese M, Hülskamp G, Köhnlein T, Reckling L, Rietschel E, Staab D, Gappa M. Lung clearance index for monitoring early lung disease in alpha-1-antitrypsin deficiency. Respir Med 2016; 116:93-9. [PMID: 27296827 DOI: 10.1016/j.rmed.2016.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 03/23/2016] [Accepted: 04/26/2016] [Indexed: 11/28/2022]
Abstract
Patients with alpha-1-antitrypsin deficiency (AATD) and a PI-ZZ genotype are at high risk to develop severe emphysema during adulthood. However, little is known about early stages of emphysema and disease manifestation in other PI-types. Spirometry is commonly used for monitoring although early manifestation of emphysema is suspected within the peripheral airways that are not accessible by forced expiratory manoeuvres. We hypothesized that the Lung Clearance Index (LCI) derived from multiple breath nitrogen-washout (N2-washout) is useful to bridge this diagnostic gap. Patients from age 4 years onward and different PI-types performed N2-washout and spirometry. Results were compared to controls. 193 patients (4-79 years, 75% PI-ZZ) and 33 controls (8-60 years) were included. Mean (SD) LCI in patients was 9.1 (3.1) and 6.3 (0.6) in controls (p ≤ 0.001). 47% of adult patients with other than PI-ZZ genotypes and 39% of all patients with normal spirometry had abnormal LCIs. The LCI measured by N2-washout discriminates between patients with AATD and controls, reflects AATD related lung disease in all stages and appears to identify early peripheral lung changes in younger age than spirometry. We conclude that a normal spirometry does not exclude presence of AATD related lung disease even in genotypes other than PI-ZZ.
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Affiliation(s)
- Susanne I Fuchs
- Department of Paediatrics and Research Institute, Marien Hospital Wesel, Germany.
| | - Nicolaus Schwerk
- Paediatric Pulmonology, Allergology and Neonatology, Medical University Hannover, Germany
| | | | | | | | - Robert Bals
- Department 5, University of Saarland, Homburg, Germany
| | | | | | - Matthias Griese
- Dr. von Haunersches Kinderspital, Medical University Munich, Germany
| | - Georg Hülskamp
- Department of Paediatrics, Clemenshospital Münster, Germany
| | | | | | - Ernst Rietschel
- Cystic Fibrosis Centre, University Hospital of Cologne, Germany
| | - Doris Staab
- Paediatric Pulmonologie and Allergology, Charité Berlin, Germany
| | - Monika Gappa
- Department of Paediatrics and Research Institute, Marien Hospital Wesel, Germany
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Köhnlein T, Buhl R, Tetzlaff K, Korducki L, Vogelmeier C, McGarvey L. Pooled Safety Analysis Of Adjudicated Serious Adverse Events With The Fixed-Dose Combination Of Tiotropium + Olodaterol. Pneumologie 2016. [DOI: 10.1055/s-0036-1572050] [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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20
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Westhoff M, Schönhofer B, Neumann P, Bickenbach J, Barchfeld T, Becker H, Dubb R, Fuchs H, Heppner HJ, Janssens U, Jehser T, Karg O, Kilger E, Köhler HD, Köhnlein T, Max M, Meyer FJ, Müllges W, Putensen C, Schreiter D, Storre JH, Windisch W. [Noninvasive Mechanical Ventilation in Acute Respiratory Failure]. Pneumologie 2015; 69:719-756. [PMID: 26649598 DOI: 10.1055/s-0034-1393309] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The non-invasive ventilation (NIV) is widespread in the clinical medicine and has attained meanwhile a high value in the clinical daily routine. The application of NIV reduces the length of ICU stay and hospitalization as well as mortality of patients with hypercapnic acute respiratory failure. Patients with acute respiratory failure in context of a cardiopulmonary edema should be treated in addition to necessary cardiological interventions with continuous positive airway pressure (CPAP) or NIV. In case of other forms of acute hypoxaemic respiratory failure it is recommended the application of NIV to be limited to mild forms of ARDS as the application of NIV in severe forms of ARDS is associated with higher rates of treatment failure and mortality. In weaning process from invasive ventilation the NIV reduces the risk of reintubation essentially in hypercapnic patients. A delayed intubation of patients with NIV failure leads to an increase of mortality and should therefore be avoided. With appropriate monitoring in intensive care NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency. Furthermore NIV can be useful within palliative care for reduction of dyspnea and improving quality of life. The aim of the guideline update is, taking into account the growing scientific evidence, to outline the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.
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Affiliation(s)
| | | | - P Neumann
- Evangelisches Krankenhaus Göttingen-Weende gGmbH, Göttingen
| | | | - T Barchfeld
- Knappschaftskrankenhaus Dortmund, Klinikum Westfalen GmbH, Dortmund
| | - H Becker
- Asklepios Klinikum Barmbeck, Hamburg
| | - R Dubb
- Klinikum Stuttgart, Katharinenhospital, Stuttgart
| | - H Fuchs
- Uniklinik Freiburg, Freiburg
| | - H J Heppner
- Geriatrische Klinik, HELIOS Klinikum Schwelm, Schwelm
| | - U Janssens
- St.- Antonius-Hospital Eschweiler, Akad. Lehrkrankenhaus der RWTH Aachen, Eschweiler
| | - T Jehser
- Gemeinschaftskrankenhaus Havelhöhe, Berlin
| | - O Karg
- Asklepios Fachkliniken München-Gauting, Gauting
| | - E Kilger
- Ludwig-Maximilians-Universität, München
| | - H-D Köhler
- Fachkrankenhaus Klostergrafschaft, Schmallenberg
| | | | - M Max
- Centre Hospitalier de Luxembourg, Luxemburg
| | - F J Meyer
- Klinikum Harlaching, Städtisches Klinikum München, München
| | - W Müllges
- Universitätsklinikum Würzburg, Würzburg
| | | | - D Schreiter
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden
| | - J H Storre
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln
| | - W Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln
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22
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Eberlein CK, Frieling H, Köhnlein T, Hillemacher T, Bleich S. Suicide attempt by poisoning using nicotine liquid for use in electronic cigarettes. Am J Psychiatry 2014; 171:891. [PMID: 25082494 DOI: 10.1176/appi.ajp.2014.14030277] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Köhnlein T, Windisch W, Köhler D, Drabik A, Geiseler J, Hartl S, Karg O, Laier-Groeneveld G, Nava S, Schönhofer B, Schucher B, Wegscheider K, Criée CP, Welte T. Non-invasive positive pressure ventilation for the treatment of severe stable chronic obstructive pulmonary disease: a prospective, multicentre, randomised, controlled clinical trial. Lancet Respir Med 2014; 2:698-705. [PMID: 25066329 DOI: 10.1016/s2213-2600(14)70153-5] [Citation(s) in RCA: 429] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Evidence is weak for the ability of long-term non-invasive positive pressure ventilation (NPPV) to improve survival in patients with stable hypercapnic chronic obstructive pulmonary disease (COPD). Previous prospective studies did not target a reduction in hypercapnia when adjusting ventilator settings. This study investigated the effect of long-term NPPV, targeted to markedly reduce hypercapnia, on survival in patients with advanced, stable hypercapnic COPD. METHODS This investigator-initiated, prospective, multicentre, randomised, controlled clinical trial enrolled patients with stable GOLD stage IV COPD and a partial carbon dioxide pressure (PaCO2) of 7 kPa (51.9 mm Hg) or higher and pH higher than 7.35. NPPV was targeted to reduce baseline PaCO2 by at least 20% or to achieve PaCO2 values lower than 6.5 kPa (48.1 mm Hg). Patients were randomly assigned (in a 1:1 ratio) via a computer-generated randomisation sequence with a block size of four, to continue optimised standard treatment (control group) or to receive additional NPPV for at least 12 months (intervention group). The primary outcome was 1-year all-cause mortality. Analysis was by intention to treat. The intervention was unblinded, but outcome assessment was blinded to treatment assignment. This study is registered with ClinicalTrials.gov, number NCT00710541. FINDINGS Patients were recruited from 36 respiratory units in Germany and Austria, starting on Oct 29, 2004, and terminated with a record of the vital status on July 31, 2011. 195 patients were randomly assigned to the NPPV group (n=102) or to the control group (n=93). All patients from the control group and the NPPV group were included in the primary analysis. 1-year mortality was 12% (12 of 102 patients) in the intervention group and 33% (31 of 93 patients) in the control group; hazard ratio 0.24 (95% CI 0.11-0.49; p=0.0004). 14 (14%) patients reported facial skin rash, which could be managed by changing the type of the mask. No other intervention-related adverse events were reported. INTERPRETATION The addition of long-term NPPV to standard treatment improves survival of patients with hypercapnic, stable COPD when NPPV is targeted to greatly reduce hypercapnia. FUNDING German Lung Foundation; ResMed, Germany; Tyco Healthcare, Germany; and Weinmann, Germany.
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Affiliation(s)
- Thomas Köhnlein
- From the Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
| | - Wolfram Windisch
- Centre for Respiratory Medicine, Hospital Köln-Merheim, University of Witten/Herdecke, Cologne, Germany
| | - Dieter Köhler
- Department of Pneumology I, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, Germany
| | - Anna Drabik
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Geiseler
- Centre of Pneumology and Thoracic Surgery, Asklepios Hospital Gauting, Department of Intensive Care Medicine and Long-term Ventilation, Gauting, Germany
| | - Sylvia Hartl
- Department of Respiratory and Critical Care Medicine, and Ludwig Boltzmann Institute of COPD and Respiratory Epidemiology, Otto Wagner Hospital, Vienna, Austria
| | - Ortrud Karg
- Centre of Pneumology and Thoracic Surgery, Asklepios Hospital Gauting, Department of Intensive Care Medicine and Long-term Ventilation, Gauting, Germany
| | | | - Stefano Nava
- Department of Specialist, Diagnostic, and Experimental Medicine, School of Medicine, Università di Bologna, Bologna, Italy
| | - Bernd Schönhofer
- Department of Respiratory Medicine, Klinikum Oststadt-Heidehaus, Hannover, Germany
| | - Bernd Schucher
- LungenClinic Grosshansdorf, Center for Pneumology and Thoracic Surgery, Grosshansdorf, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Carl P Criée
- Department of Pneumology, Respiratory Care, and Sleep Medicine, Evangelisches Krankenhaus Göttingen-Weende, Bovenden-Lenglern, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Member of the German Centre for Lung Research
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Köhnlein T, Schmidt-Scherzer K, Greulich T, Bals R. [Expert statement for augmentation therapy in patients with alpha-1 antitrypsin deficiency]. Pneumologie 2014; 68:492-5. [PMID: 25006842 DOI: 10.1055/s-0034-1365802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Augmentation therapy in Alpha-1 Antitrypsin Deficiency aims to reduce the progression of lung emphysema, to reduce exacerbation frequency, and to improve quality of life. This expert statement briefly summarizes the most important treatment studies performed in patients with Alpha-1 Antitrypsin Deficiency and severe lung emphysema. Indications and contraindications for long-term intravenous augmentation therapy with human Alpha-1 Antitrypsin are derived from the available study results. Safety issues and the controversies of this topic are discussed in detail.
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Affiliation(s)
- T Köhnlein
- Klinikum St. Georg gGmbH Leipzig, Robert-Koch-Klinik
| | | | - T Greulich
- Universitätsklinikum Marburg, Klinik für Innere Medizin, Schwerpunkt Pneumologie
| | - R Bals
- Universitätsklinikum des Saarlandes, Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Homburg/Saar
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Fuchs S, Schwerk N, Pittschieler K, Ahrens F, Baden W, Bals R, Gleiber W, Griese M, Hülskamp G, Köhnlein T, Rietschel E, Staab D, Gappa M. Lung Clearance Index zur Früherkennung der Lungenerkrankung bei Patienten mit Alpha-1-Antitrypsinmangel und verschiedenen Genotypen. Pneumologie 2014. [DOI: 10.1055/s-0034-1367834] [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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Griese M, Kappler M, Eismann C, Ballmann M, Junge S, Rietschel E, van Koningsbruggen-Rietschel S, Staab D, Rolinck-Werninghaus C, Mellies U, Köhnlein T, Wagner T, König S, Teschler H, Heuer HE, Kopp M, Heyder S, Hammermann J, Küster P, Honer M, Mansmann U, Beck-Speier I, Hartl D, Fuchs C, Hector A. Inhalation treatment with glutathione in patients with cystic fibrosis. A randomized clinical trial. Am J Respir Crit Care Med 2013; 188:83-9. [PMID: 23631796 DOI: 10.1164/rccm.201303-0427oc] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
RATIONALE Glutathione is the major antioxidant in the extracellular lining fluid of the lungs and depleted in patients with cystic fibrosis (CF). OBJECTIVES We aimed to assess glutathione delivered by inhalation as a potential treatment for CF lung disease. METHODS This randomized, double-blind, placebo-controlled trial evaluated inhaled glutathione in subjects with CF 8 years of age and older and FEV1 of 40-90% of predicted. Subjects were randomized to receive 646 mg glutathione in 4 ml (n = 73) or placebo (n = 80) via an investigational eFlow nebulizer every 12 hours for 6 months. MEASUREMENTS AND MAIN RESULTS FEV1 (absolute values), both as pre-post differences (P = 0.180) and as area under the curves (P = 0.205), were the primary efficacy endpoints, and were not different between the glutathione group and the placebo group over the 6-month treatment period. Exploratory analysis showed an increase of FEV1 from baseline over placebo of 100 ml or 2.2% predicted; this was significant at 3 months, but not later. Subjects receiving glutathione had neither fewer pulmonary exacerbations, nor better scores for quality of life. Whereas increased glutathione and metabolites in sputum demonstrated significant delivery to the lungs, there was no indication of diminished oxidative stress to proteins or lipids, and no evidence for anti-inflammatory or antiproteolytic actions of glutathione supplemented to the airways. The adverse event incidence was similar between glutathione and placebo. CONCLUSIONS Inhaled glutathione in the dose administered did not demonstrate clinically relevant improvements in lung function, pulmonary exacerbation frequency, or patient-reported outcomes. Glutathione delivery to the airways was not associated with changes in markers of oxidation, proteolysis, or inflammation. Clinical trial registered with www.clinicaltrials.gov (NCT00506688) and https://eudract.ema.europa.eu/index.html (EudraCT 2005-003870-88).
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Affiliation(s)
- Matthias Griese
- Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
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Knipel V, Köhnlein T, Greulich T, Windisch W. PiSMHeerlen - Seltene Variante eines Alpha1-Antitrypsin-Mangels. Pneumologie 2013. [DOI: 10.1055/s-0033-1334634] [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: 10/27/2022]
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Knipel V, Windisch W, Köhnlein T. Substitutionstherapie bei schwerem Alpha1-Antitrypsin-Mangel (FEV1 < 35% Soll). Pneumologie 2013. [DOI: 10.1055/s-0033-1334662] [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: 10/27/2022]
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Frenzel E, Korenbaum E, Hegermann J, Ochs M, Koepke J, Koczulla AR, Welte T, Köhnlein T, Janciauskiene S. Does augmentation with alpha1-antitrypsin affect neutrophil extracellular traps formation? Int J Biol Sci 2012; 8:1023-5. [PMID: 22904670 PMCID: PMC3421233 DOI: 10.7150/ijbs.4701] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 07/12/2012] [Indexed: 12/20/2022] Open
Affiliation(s)
- Eileen Frenzel
- Departments of Respiratory Medicine, Biophysical Chemistry and Anatomy, Hannover Medical School, Hannover, Germany
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Boedecker S, Rembe C, Schmid H, Hageney T, Köhnlein T. Calibration of the z-axis for large-scale scanning white-light interferometers. ACTA ACUST UNITED AC 2011. [DOI: 10.1088/1742-6596/311/1/012027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Steinkamp G, Köhnlein T, Ley-Zaporozhan J, Wegscheider K, Buhl R. Studienendpunkte beim Alpha-1-Antitrypsin-Mangel:[nl]Interdisziplinäre Aspekte. Pneumologie 2011. [DOI: 10.1055/s-0030-1256168] [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: 10/18/2022]
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Steinkamp G, Köhnlein T, Ley-Zaporozhan J, Wegscheider K, Buhl R. Studienendpunkte beim Alpha-1-Antitrypsin-Mangel:[nl]Interdisziplinäre Aspekte. Pneumologie 2011; 65:229-35. [DOI: 10.1055/s-0030-1256017] [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: 10/18/2022]
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Janciauskiene SM, Bals R, Koczulla R, Vogelmeier C, Köhnlein T, Welte T. The discovery of α1-antitrypsin and its role in health and disease. Respir Med 2011; 105:1129-39. [PMID: 21367592 DOI: 10.1016/j.rmed.2011.02.002] [Citation(s) in RCA: 217] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 01/24/2011] [Accepted: 02/07/2011] [Indexed: 01/08/2023]
Abstract
α1-Antitrypsin (AAT) is the archetype member of the serine protease inhibitor (SERPIN) supergene family. The AAT deficiency is most often associated with the Z mutation, which results in abnormal Z AAT folding in the endoplasmic reticulum of hepatocytes during biogenesis. This causes intra-cellular retention of the AAT protein rather than efficient secretion with consequent deficiency of circulating AAT. The reduced serum levels of AAT contribute to the development of chronic obstructive pulmonary disease (COPD) and the accumulation of abnormally folded AAT protein increases risk for liver diseases. In this review we show that with the discovery of AAT deficiency in the early 60s as a genetically determined predisposition to the development of early-onset emphysema, intensive investigations of enzymatic mechanisms that produce lung destruction in COPD were pursued. To date, the role of AAT in other than lung and liver diseases has not been extensively examined. Current findings provide new evidence that, in addition to protease inhibition, AAT expresses anti-inflammatory, immunomodulatory and antimicrobial properties, and highlight the importance of this protein in health and diseases. In this review co-occurrence of several diseases with AAT deficiency is discussed.
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Abstract
BACKGROUND Alpha-1 antitrypsin deficiency (AATD) is one of the most prevalent inherited diseases in Whites, but identification of affected patients and establishment of the diagnosis is still unsatisfactory. This study assessed the latencies and numbers of physicians involved in identifying AATD patients, and the importance of smoking, vaccination status, and specific augmentation therapy on the course of the disease. METHOD Patients from Germany and Austria underwent a single written interview with 28 items. Five hundred and ninety-six patients were addressed and 44.9% replied. RESULTS The age at symptom onset was 39.1±10.1 years, and the diagnosis was established at the age of 45.1±10.9 years. From the 6-year delay in establishing the diagnosis, 1.4±1.7 (range 0.5-10.5) years were due to patients' reluctance to seek medical attention. There were 3.2±2.4 (range 1-13) physicians involved in establishing the diagnosis. Smoking was associated with an earlier onset of respiratory symptoms and lower exercise capacity. Vaccination against pneumococci and/or influenza, and augmentation therapy resulted in significantly fewer exacerbations and fewer emergency room visits. Airway infections and passive smoking during childhood were not found to influence the onset of respiratory symptoms. CONCLUSIONS In conclusion, there is still a large delay between symptom onset and AATD diagnosis. Smoking history, vaccination status, and augmentation therapy have an important impact on the course of the disease.
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Affiliation(s)
- Thomas Köhnlein
- Hannover Medical School, Respiratory Medicine, Carl-Neuberg-Strasse 1, Hannover, Germany.
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Abstract
Alpha(1)-antitrypsin deficiency is characterized by a pathologic reduction of the serum concentration of alpha(1)-antitrypsin, the most important antiprotease in man. It is one of the most common hereditary diseases in Caucasians. Approximately 2% of obstructive airway diseases are caused by alpha(1)-antitrypsin deficiency. Patients above 35 years may develop lung emphysema, especially in the lower lobes. Symptoms are those of chronic obstructive pulmonary disease such as cough, sputum expectoration, and progressive dyspnoea. Patients with homozygous defect often develop cholestatic hepatitis in the neonatal period. However, only few adult patients develop chronic liver disease up to liver cirrhosis with an elevated risk for malignant liver tumors. The diagnostic hallmark is the reduced serum concentration of alpha(1)-antitrypsin while genetic testing proves the defect. An early recognition of the disease is decisive for prophylactic and therapeutic measures. Smoking should be stopped immediately. Treatment of lung disease includes physiotherapy, antiobstructive and antiinflammatory medication, augmentation with human alpha(1)-antitrypsin and lung surgery including lung transplantation. Liver toxins should be avoided. Besides experimental therapeutic approaches, liver disease can only be treated by liver transplantation.
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Affiliation(s)
- T Köhnlein
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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Windisch W, Brambring J, Budweiser S, Dellweg D, Geiseler J, Gerhard F, Köhnlein T, Mellies U, Schönhofer B, Schucher B, Siemon K, Walterspacher S, Winterholler M, Sitter H. Nichtinvasive und invasive Beatmung als Therapie der chronischen respiratorischen Insuffizienz. Pneumologie 2010; 64:207-40. [DOI: 10.1055/s-0029-1243978] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Köhnlein T. CPAP and/or NIV in cardiogenic pulmonary oedema. Breathe (Sheff) 2009. [DOI: 10.1183/18106838.0601.045] [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: 11/05/2022] Open
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Köhnlein T, Schönheit-Kenn U, Winterkamp S, Welte T, Kenn K. Noninvasive ventilation in pulmonary rehabilitation of COPD patients. Respir Med 2009; 103:1329-36. [DOI: 10.1016/j.rmed.2009.03.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 03/22/2009] [Accepted: 03/23/2009] [Indexed: 10/20/2022]
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Dierkesmann R, Gillissen A, Köhnlein T, Lorenz J, Magnussen H, Morr H, Pfeifer M, Schultze-Werninghaus G, Steinkamp G, Taube C, Teschler H, Vogelmeier C, Worth H. COPD und Begleiterkrankungen. Pneumologie 2009; 63:526-37. [DOI: 10.1055/s-0029-1214943] [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: 10/20/2022]
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Burkhardt O, Köhnlein T, Wrenger E, Lux A, Neumann KH, Welte T. Predicting outcome and survival in patients with Wegener's granulomatosis treated on the intensive care unit. Scand J Rheumatol 2009; 36:119-24. [PMID: 17476618 DOI: 10.1080/03009740600958611] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study was designed to search for risk factors predicting mortality of patients with Wegener's granulomatosis (WG) treated on the intensive care unit (ICU). METHODS Seventeen patients admitted to the ICU of an University Hospital for an acute illness related to WG were analysed retrospectively over 4 years. A variety of clinical and laboratory variables were recorded. Contingency table analyses, univariate logistic regression, and discriminate analysis were performed to determine which factors influenced a negative outcome. RESULTS Reasons for ICU admission were respiratory failure (n = 10), severe haemoptysis (n = 13), sepsis (n = 9), acute renal failure (n = 6), and gastrointestinal bleeding (n = 1). Patients were treated for a median of 6 days (range 4-121 days). During the stay in the ICU, five patients died within 24-121 days (overall mortality 29.4%). Causes of death were cerebral haemorrhage (n = 2), pulmonary embolism (n = 1), and sepsis (n = 2). Significantly associated with death were: Acute Physiology and Chronic Health Evaluation II (APACHE II) score>24 [p = 0.004, odds ratio (OR) 0.568, 95% confidence interval (CI) 0.327-0.989], period of time in the ICU>10 days (p = 0.001, OR 0.795, 95% CI 0.589-1.072), and treatment with cyclophosphamide during the stay in the ICU (p = 0.013, OR 0.799, 95% CI 0.651-0.980). No association was found for higher age, C-reactive protein (CRP), pulmonary involvement, serum creatinine, and requirement of haemodialysis. CONCLUSIONS The prognosis for WG patients in the ICU is serious, but the majority can survive. To achieve a more favourable outcome, patients should stay in the ICU for as short a time as possible. The occurrence of renal failure did not influence the outcome in our patients.
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Affiliation(s)
- O Burkhardt
- Department of Pulmonary, Hannover Medical School, Hannover, Germany
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Welte T, Köhnlein T. Global and local epidemiology of community-acquired pneumonia: the experience of the CAPNETZ Network. Semin Respir Crit Care Med 2009; 30:127-35. [PMID: 19296412 DOI: 10.1055/s-0029-1202941] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Young children and the elderly are disproportionately affected by CAP. Lower respiratory tract infections (LRTIs), including CAP, were ranked third in a list of the 30 leading causes of death worldwide in 1990. Mortality rates are low (< 2%) in CAP patients treated as outpatients, but are higher (5 to 20%) among patients hospitalized for CAP, and are highest (up to 50%) in patients admitted to the intensive care unit. Several risk factors are known to be associated with increases in mortality, the most important of which are age > 65 years, male gender, and comorbidities such as chronic heart failure, advanced chronic obstructive pulmonary disease, neurological diseases, and liver cirrhosis. Patients living in nursing homes may have a special risk for multiresistant bacterial infection. The incidence of CAP varies worldwide by country, age, and gender. Further, data about epidemiology, etiology, morbidity, mortality, and economical burden of diseases differ between countries. In this review, we present recent data regarding the incidence, etiology, and rate of antibiotic resistance among CAP patients from the German Network for Community Acquired Pneumonia (CAPNETZ) registry and review data from several European countries.
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Affiliation(s)
- Tobias Welte
- Department of Pulmonary Medicine, Medizinische Hochschule Hannover, Hannover, Germany.
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Köhnlein T, Welte T. Klinischer Verlauf des Alpha-1 Antitrypsin-Mangels. Pneumologie 2009. [DOI: 10.1055/s-0029-1213810] [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: 10/21/2022]
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Hirche TO, Born T, Jungblut S, Sczepanski B, Kenn K, Köhnlein T, Hirche H, Wagner TO. Oxygen generation by combined electrolysis and fuel-cell technology: clinical use in COPD patients requiring long time oxygen therapy. Eur J Med Res 2008; 13:451-458. [PMID: 19008171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Oxy-Gen lite, a recently developed combined electrolysis and fuel cell technology, de-novo generates oxygen with high purity for medical use from distilled water and room air. However, its use in patients with chronic respiratory failure has never been evaluated. OBJECTIVES To test the clinical applicability and safety of Oxy-Gen lite technology, we enrolled 32 COPD patients with chronic hypoxemia and long-term oxygen therapy (LTOT) in a controlled, randomized, multicenter clinical trial. MATERIALS AND METHODS Standard continuous oxygen therapy with a maximal flow rate of 2 L/min was tested against pulsatile oxygen delivery by Oxy-Gen lite. Oxygen saturation at seated-rest was recorded over 30 min and used as a primary read-out parameter. Oxygen saturation was also recorded during mild physical strain (speaking out loud) or overnight's sleep. RESULTS Both methods of oxygen supply established oxygen saturations within the normal range (i.e., upper plateau of the sigmoid oxyhaemoglobin dissociation curve) compared to breathing room air (p<0.0001). Mean oxygen saturation under standard continuous oxygen flow or Oxy-Gen lite technology during rest, physical strain or sleep proved statistically equivalent (95%CI<2.5% of reference saturation). CONCLUSION The use of Oxy-Gen lite in COPD patients with hypoxemia and LTOT <or= 2 L/min is safe and results in oxygen saturation comparable to standard oxygen therapy. There is evidence that this form of oxygen supply is not only functional during rest but also during mild physical strain or overnight's sleep. Low noise, energy- and overhead-costs are particular advantages of this technology.
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Affiliation(s)
- T O Hirche
- Department of Pulmonary Medicine, University Hospital Frankfurt, Theodor Stern Kai 7, 60590 Frankfurt, Germany
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Hirche T, Wagner TOF, Born T, Jungblut S, Sczepanski B, Köhnlein T, Zuna I, Gunkel C, Hecker K. Erzeugung von Sauerstoff durch kombinierte Elektrolyse-Brennstoffzellentechnologie: Klinischer Einsatz bei Patienten mit chronischer respiratorischer Insuffizienz. Pneumologie 2008. [DOI: 10.1055/s-2008-1074327] [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: 10/21/2022]
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Köhnlein T, Welte T. Alpha-1 antitrypsin deficiency: pathogenesis, clinical presentation, diagnosis, and treatment. Am J Med 2008; 121:3-9. [PMID: 18187064 DOI: 10.1016/j.amjmed.2007.07.025] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Revised: 03/28/2007] [Accepted: 07/06/2007] [Indexed: 11/17/2022]
Abstract
Alpha-1 antitrypsin deficiency is an inherited disease affecting the lung and liver. The typical pulmonary manifestation is chronic obstructive pulmonary disease and emphysema. Severe chronic obstructive pulmonary disease may occur in young adulthood, and terminal respiratory insufficiency causes premature death in many patients. In the liver, alpha-1 antitrypsin deficiency may manifest as benign neonatal hepatitis syndrome; a small percentage of adults develop liver fibrosis, with progression to cirrhosis and hepatocellular carcinoma. The alpha-1 antitrypsin molecule is a serine protease inhibitor that is predominantly produced in the liver. Its most important physiologic functions are the protection of pulmonary tissue from aggressive proteolytic enzymes and regulation of pulmonary immune processes. Diagnosis of alpha-1 antitrypsin deficiency can be established by measurement of the serum alpha-1 antitrypsin concentration or by genetic analysis. Treatment is similar to the usual treatment for patients with chronic obstructive pulmonary disease. A further option is substitution therapy with human alpha-1 antitrypsin. The targets of treatment are the prevention of the accelerated decline of pulmonary function, reduction of lung infections, and improvements in exercise capacity.
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Affiliation(s)
- Thomas Köhnlein
- Hannover Medical School, Department of Respiratory Medicine, Hannover, Germany.
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Abstract
UNLABELLED Chronic severe heart failure is frequently associated with disturbances in the central control of breathing. During wakefulness, central breathing disorders could be ameliorated with beta-blocker treatment, but nothing is known about the effects of beta-blockers on the control of breathing during sleep. This study intends to determinate the prevalence and severity of nocturnal apnoeas and hypopnoeas in heart failure patients treated with or without metoprolol or carvedilol. Fifty consecutive patients with dilated cardiomyopathy in NYHA class II-IV with a left ventricular ejection fraction (LVEF) of 35% or below were studied with full polysomnography over one night. The mean Apnoea-Hypopnoea Index of beta-blocker free patients was 19.8+/-14.2 versus 7.4+/-8.5 (p<0.05) and 8.7+/-8.1 (p<0.05) in patients treated with metoprolol or carvedilol, respectively. The arousal index, sleep quality, and daytime sleepiness were improved in similar magnitude. CONCLUSION Long-term treatment of patients with advanced chronic heart failure with sufficient doses of metoprolol or carvedilol is associated with a lower prevalence and severity of central sleep apnoea (CSA).
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Affiliation(s)
- Thomas Köhnlein
- Department of Respiratory Medicine, Medizinische Hochschule Hannover (Hannover Medical School), Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany.
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Abstract
Non-invasive ventilation is a technique to ventilate patients without endotracheal intubation and analgosedation. Pressure tight masks allow the ventilation of patients with severe respiratory or ventilatory insufficiency. Non-invasive ventilation may be used as short-term treatment for patients with acute ventilatory decompensation, as well as for long-term therapy at home for patients with chronic respiratory diseases. The typical indications are hypoxaemic respiratory failure in pneumonia or cardiogenic pulmonary edema, and hypercapnic ventilatory insufficiency in severe chronic obstructive pulmonary disease, neuromuscular disorders, or advanced kyphoscoliosis. The physiological background, technical aspects of performing non-invasive ventilation, and typical indications are discussed.
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Affiliation(s)
- T Köhnlein
- Medizinische Hochschule Hannover, Abteilung Pneumologie.
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Köhnlein T, Welte T. Diagnostische Wertigkeit von Procalcitonin (PCT) bei Patienten mit Mukoviszidose. Pneumologie 2007. [DOI: 10.1055/s-2007-973255] [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: 10/21/2022]
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Burkhardt O, Köhnlein T, Pletz M, Welte T. Saccharomyces boulardii induced sepsis: successful therapy with voriconazole after treatment failure with fluconazole. ACTA ACUST UNITED AC 2005; 37:69-72. [PMID: 15764194 DOI: 10.1080/00365540510026454] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Saccharomyces boulardii is frequently used for prevention and treatment of all forms of diarrhoea. We report the case of a 19-y-old white male with an underlying severe neurological disease, who developed a fungal sepsis after prophylactic application of a drug containing S. boulardii. Initial treatment with fluconazole was not successful. After the application of voriconazole, the sepsis resolved completely. This is the first clinical report of a successful treatment of Saccharomyces sepsis with voriconazole.
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Affiliation(s)
- Olaf Burkhardt
- Department of Pulmonary and Critical Care Medicine, University Otto-von-Guericke, Magdeburg, Germany.
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