[Bronchial asthma and chronic obstructive pulmonary disease with acute exacerbation: preclinical differential diagnostic and emergency treatment]. / Asthma bronchiale und chronisch obstruktive Lungenerkrankung mit akuter Exazerbation: Präklinische Differenzialdiagnostik und Notfalltherapie.

Chronic obstructive pulmonary disease (COPD) and bronchial asthma are the most common causes of obstructive pulmonary diseases and acute dyspnoea. In the preclinical emergency situation a distinction between bronchial asthma and exacerbated COPD is difficult because symptoms are similar. Although the preclinical measures differ only marginally, a differential diagnosis from other causes of respiratory obstruction and acute dyspnoea, such as cardiac decompensation, anaphylaxis, aspiration of foreign bodies, tension pneumothorax and inhalation trauma is necessary because alternative treatment options are required. In the treatment of COPD and bronchial asthma inhalative bronchodilatory beta(2)-mimetics are the first choice especially for serious obstructive emergencies because there is an unfavorable relationship between effect and side-effects for the intravenous route. Dosable aerosols, nebulization and if necessary, continuous nebulization, are appropriate application forms even for serious obstructive crises with the need of a respirator. In these cases a minimal inspiratory flow in patients is not required. Theophylline only plays a minor role to beta(2)-mimetics and anticholinergics as a bronchodilator in asthma and COPD guidelines, even in serious obstructive diseases. For severe asthma attacks the administration of magnesium is a possible additional option. Systemic intravenous administration of steroids has an anti-inflammatory effect and for this reason is the second column of treatment for both diseases. Invasive ventilation remains a last resort to ensure respiratory function and indications for this are given in patients with clinical signs of impending exhaustion of breathing.

Dicarboxylic acids affect the growth of dermatophytes in vitro.

Azelaic acid is a dicarboxylic acid with known antimycotic activity. In this study we have used an agar dilution technique to test the effect of six other dicarboxylic acids (sebacic, undecanedioic, dodecanedioic, tridecanedioic, tetradecanedioic and hexadecanedioic acid, 10(-4)-10(-2) mol/l, pH 5.5) on in vitro growth of Trichophyton (T.) rubrum, T. mentagrophytes and Microsporum (M.) canis. Furthermore, the fungicidal activity of 10(-2) mol/l undecanedioic and sebacic acid was tested using a T. rubrum growth assay. Undecanedioic acid proved fungistatic at 10(-2) mol/l for all species and fungicidal for T. rubrum. A minor fungistatic effect on T. rubrum and T. mentagrophytes was also seen with the other acids at this concentration. M. canis was inhibited only by high concentrations of four acids, whereas low concentrations of all six agents resulted in enlarged thallus diameters. We conclude that among dicarboxylic acids fungistatic activity is not limited to azelaic acid. Undecanedioic acid appears promising for further investigations.