Diagnosis, Prevention and Treatment of Stable COPD and Acute Exacerbations of COPD: The Swiss Recommendations 2018.

The Swiss National Guidelines 2013 for chronic obstructive pulmonary disease have been revised in order to acknowledge recent progress in diagnosis and management of this disease. The resulting new Swiss recommendations are based on best evidence from the literature, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2018 report and other published national guidelines. Misdiagnosis of chronic obstructive pulmonary disease is common and means that patients do not always receive optimal treatment. To improve the management of patients with chronic obstructive pulmonary disease in Switzerland, these recommendations encourage a more comprehensive assessment of patients, based on the combined assessment of symptoms, degree of airflow limitation, risk of exacerbation and the presence of comorbidities. Recommendations for evidence-based preventive measures, as well as pharmacological and non-pharmacological strategies for the management of both stable and acute exacerbations of chronic obstructive pulmonary disease are provided in this update.

Treatment of COPD Exacerbation in Switzerland: Results and Recommendations of the European COPD Audit.

BACKGROUND: The European COPD Audit initiated by the European Respiratory Society (ERS) evaluated the management of hospital admissions due to exacerbation of chronic obstructive pulmonary disease (COPD) in several European countries. Data on the treatment of severe acute exacerbations of COPD (AECOPDs) in Switzerland are scarce. OBJECTIVES: In light of the GOLD 2010 guidelines, this work aims to examine the quality of care for AECOPD and to provide specific recommendations for the management of severe AECOPD in Switzerland. METHODS: A total of 295 patients requiring hospital admission to 19 Swiss hospitals due to exacerbation of COPD during a predefined 60 days in 2011 were included in the study. We compared the Swiss data to the official GOLD 2010 recommendations and to the results of the other European countries. RESULTS: Approximately 43% of the Swiss patients with severe AECOPD were current smokers at hospital admission, compared to 33% of the patients in other European countries (p < 0.001). In Switzerland and in Europe, spirometry data were not available for most patients at hospital admission (65 and 60%, respectively; p = 0.08). In comparison to other European countries, antibiotics were prescribed 14% less often in Switzerland (p < 0.001). Only 79% of the patients in the Swiss cohort received treatment with a short-acting bronchodilator at admission. CONCLUSIONS: Considering the overall high standard of health care in Switzerland, in light of the GOLD 2010 guidelines we are able to make 7 recommendations to improve and standardize the management of severe AECOPD for patients treated in Switzerland.

Average volume-assured pressure support in obesity hypoventilation: A randomized crossover trial.

BACKGROUND: Average volume-assured pressure support (AVAPS) has been introduced as a new additional mode for a bilevel pressure ventilation (BPV) device (BiPAP; Respironics; Murrysville, PA), but studies on the physiologic and clinical effects have not yet been performed. There is a particular need to better define the most efficient ventilatory treatment modality for patients with obesity hypoventilation syndrome (OHS). METHODS: In OHS patients who did not respond to therapy with continuous positive airway pressure, the effects of BPV with the spontaneous/timed (S/T) ventilation mode with and without AVAPS over 6 weeks on ventilation pattern, gas exchange, sleep quality, and health-related quality of life (HRQL) assessed by the severe respiratory insufficiency questionnaire (SRI) were prospectively investigated in a randomized crossover trial. RESULTS: Ten patients (mean [+/- SD] age, 53.5 +/- 11.7 years; mean body mass index, 41.6 +/- 12.1 kg/m2; mean FEV1/FVC ratio, 79.4 +/- 6.5%; mean transcutaneous P(CO2) [PtcCO2], 58 +/- 12 mm Hg) were studied. PtcCO2 nonsignificantly decreased during nocturnal BPV-S/T by -5.6 +/- 11.8 mm Hg (95% confidence interval [CI], -14.7 to 3.4 mm Hg; p = 0.188), but significantly decreased during BPV-S/T-AVAPS by -12.6 +/- 12.2 mm Hg (95% CI, -22.0 to -3.2 mm Hg; p = 0.015). Pneumotachographic measurements revealed a higher individual variance of peak inspiratory pressure (p < 0.001) and a trend for lower leak volumes but also for higher tidal volumes during BPV-S/T-AVAPS. The SRI summary scale score improved from 63 +/- 15 to 78 +/- 14 during BPV-S/T (p = 0.004) and to 76 +/- 16 during BPV-S/T-AVAPS (p = 0.014). Sleep quality and oxygen saturation also comparably improved following BPV-S/T and BPV-S/T-AVAPS. CONCLUSION: BPV-S/T substantially improved oxygenation, sleep quality, and HRQL in patients with OHS. AVAPS provided additional benefits on ventilation quality, thus resulting in a more efficient decrease of PtcCO2. However, this did not provide further clinical benefits regarding sleep quality and HRQL.

Reliability and validity of a German asthma quality of life questionnaire.

The Asthma Quality of Life Questionnaire (University of Sydney [AQLQ-Sydney]) is a self-administered questionnaire that has been developed in Australia and validated in different languages in Australia, the USA and Spain. We developed a German translation of this questionnaire by applying a sequential forward and backward translation approach. The objective of this study was to validate a German translation of the AQLQ-Sydney questionnaire in an outpatient population of asthmatic patients in Switzerland. Outpatients were assessed for a diagnosis of asthma and those who consented were selected for the validation study. All patients had spirometry, methacholine challenge testing, fractional exhaled nitric oxide recorded and answered the German AQLQ-Sydney. A subgroup of 17 patients answered the questionnaire for a second time after receiving asthma treatment with combined steroids and bronchodilators for two months. Test-retest-reliability was tested in 12 stable asthmatic patients without treatment modification. Of 90 patients assessed, 57 were diagnosed with asthma and participated in the validation study. The total score did not significantly correlate with any of the objective measures of severity of asthma. However, the "Breathlessness" subscale score correlated weakly with PD20 methacholine. Internal consistency was high with Cronbach's alpha of 0.97 for the total score and 0.91-0.97 for the subscale scores. Test-retest reliability was also high for the total score and the subscale scores. The questionnaire detected a significant improvement in total quality of life score and "Breathlessness" and "Mood" subscale scores after a period of combined treatment with inhaled steroids and long acting bronchodilators. The German translation of the AQLQ-Sydney had a good internal consistency and test-retest-reliability in stable asthmatic patients. It shows responsiveness to treatment. Some correlations with objective markers were detected.

Mechanical versus manual chest compression CPR under ground ambulance transport conditions.

BACKGROUND: Novel mechanical chest compression devices offer the possibility to transport cardiac arrest patients with ongoing CPR and might shorten significantly the time delay to post-resuscitation care. METHODS: We simulated an eight-minute cardiac resuscitation situation during ambulance transport using CPR training manikins. We compared teams consisting of two experienced resuscitators with the performance of a mechanical chest compression device (LUCAS). RESULTS: CPR-performance by two experienced resuscitators demonstrated ambivalent results. Whereas mean compression rate was within the recommended range (103/min, 95% CI: 93-113/min), mean compression depth was closely below the actually recommended compression depth of >5 cm (49.7 mm, 95% CI: 46.1-53.3mm). Nevertheless, only a mean of two thirds (67%) of all compressions were classified as manually correct (defined as sternal compression depth >5 cm). In contrast, the LUCAS device showed a constant and reliable CPR performance (99.96% correctly applied chest compressions correctly applied within the device programmed parameters, P = 0.0162) with almost no variance between the different sequences. CONCLUSION: The LUCAS CPR device represents a reliable alternative to manual CPR in a moving ambulance vehicle during emergency evacuation. Furthermore, it needs less human resources and is safer for the EMS personnel.