Best Practices for the Management of Patients with Non-Tuberculous Mycobacterial Pulmonary Disease According to a German Nationwide Analysis of Expert Centers.

Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is a chronic inflammatory lung disease caused by infection with non-tuberculous mycobacteria (NTM). International guidelines provide evidence-based recommendations on appropriate diagnosis and treatment strategies, but there is a need for sharing day-to-day best practice between treatment centers to optimize patient care. This is particularly valuable for rare diseases like NTM-PD. In this cross-sectional analysis of NTM-PD management in Germany, medical and administrative staff from seven treatment centers were interviewed to identify best practice in the diagnosis, treatment, and ongoing management of patients with NTM-PD, including related hospital infrastructure and administration processes. A prioritization led to a collection of best practices for the management of patients with NTM-PD in Germany, which is presented here. Selected current best practices included performance of regular sputum tests for diagnosis, use of medical reports, and regular follow-up visits as well as increased interaction between physicians across different specialties. Future best practices that may be implemented to overcome current barriers comprised disease awareness activities, patient empowerment, and new approaches to enhance physician interaction. Challenges related to their implementation are also discussed and will help to raise disease awareness. The presented best practices may guide and optimize patient management in other centers.

Vitamin E intake in relation to allergic sensitization and IgE serum concentration.

BACKGROUND: A protective role of dietary vitamin E intake on disorders related to the immune system, such as allergic diseases, has been suggested. However, results from epidemiological studies are conflicting. OBJECTIVES: The aim of present study was to analyze whether dietary vitamin E intake is related to the prevalence of allergic sensitization and total serum IgE concentrations in adult subjects. METHODS: The present study population consisted of 366 adults aged 29 to 54 years participating in the German centers of the European Community Respiratory Health Survey (ECRHS) II, Erfurt and Hamburg. A validated food frequency questionnaire was used to gather information on dietary vitamin E intake. Total serum IgE concentrations and specific IgE to common allergens were analyzed by using the Pharmacia CAP System. Allergic sensitization was defined as specific serum IgE concentration > or = 0.35 kU/l. RESULTS: The risk for allergic sensitization was substantially decreased in the middle quartiles (aOR: 0.42; 95% CI: 0.22-0.81) and the highest quartile (aOR: 0.22; 95% CI: 0.08-0.60) of total dietary vitamin E intake, after adjustment for potential confounders. Total serum IgE concentration was not statistically significantly associated with dietary vitamin E intake. CONCLUSIONS: The findings of this study suggest that dietary vitamin E intake might play a protective role in the development of allergic sensitization.