COPD in Germany: Use of Diagnostic Measures Including Blood Eosinophil Counts in Daily Practice.

BACKGROUND: Accumulating evidence on the role of blood eosinophils as a biomarker prompted the Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee to refine the existing treatment algorithm by incorporating eosinophil counts into treatment recommendations. However, there is a lack of data on when, why and how frequently such blood tests and other measures are being performed by German private respiratory specialists. METHODS: A questionnaire evaluating doctors' opinions on the use of diagnostic measures at initial diagnosis and during follow-up, including blood eosinophil count in patients with COPD, was completed by 27 respiratory specialists. Medical records from the past 12 months of 251 patients treated by the same physicians were reviewed retrospectively to investigate the use of these measures. RESULTS: Body plethysmography (100 % of doctors) and chest X-ray (96.3 %) were the most commonly used measures according to the doctor's questionnaire; other measures were COPD assessment test (CAT; 85.2 %) and blood eosinophil count (81.5 %). The evaluation of patients' medical records revealed that body plethysmography was performed in 72.7 %, the CAT in 61.8 % and chest X-ray in 40.6 % of patients. Blood eosinophil count was measured in 7.2 %. CONCLUSIONS: In line with the GOLD recommendations, these results confirm that lung function, imaging and patient-reported outcome questionnaires play a crucial role in managing COPD. Our analyses reveal that measurement of the blood eosinophil count gained importance due to physicians' increased awareness of these cells as a useful biomarker. However, this test seems to be performed mainly for initial diagnosis and not on a regular basis.

[Modern therapy of sleep apnea]. / Moderne Therapie der Schlafapnoe.

There are different treatment options for obstructive sleep apnea, which are selectively used based on severity of sleep apnea, physical structure of the upper airway, and other medical aspects including co-morbidities. Weight loss as well as avoidance of alcohol and other CNS depressants is generally recommended. Positional training, oral appliances and surgery of the upper airways are used in selected cases. CPAP is the most effective method for treating obstructive sleep apnea irrespective of disease severity. In patients with central sleep apnea or Cheyne-Stokes respiration (CSA/CSR) diagnosis and treatment of the underlying cause is mandatory. Adaptive servo-ventilation appears to be an effective treatment modality for patients with complex sleep apnea and with CSA/CSR that is resistant to CPAP.

[Prevalence of sleep-related breathing disorders in ischemic and non-ischemic heart failure]. / Prävalenz schlafbezogener Atemstörungen bei ischämischer und nicht-ischämischer Herzinsuffizienz.

BACKGROUND AND OBJECTIVE: The prevalence of sleep-disordered breathing (SDB) in patients with chronic heart failure seems to be remarkably high, but existing studies are based on small cohorts of patients who were not receiving guideline-based drug treatment for heart failure. The aim of this study was to investigate the prevalence of SDB in patients with ischemic (ICM) or non-ischemic (DCM) cardiomyopathy. PATIENTS AND METHODS: A total of 647 consecutive patients (130 females, 517 males; mean age 63.23 10.4 years) in stable, symptomatic chronic heart failure (NYHA class at least II) and with impaired systolic left ventricular function (ejection fraction < or = 40%) were screened by cardiorespiratory polygraphy for the presence and type of SDB. Sleep apnea was classified as obstructive (OSA) or central (CSA) according to the majority of events, and as ICM or DCM according to the results of current left heart catheterization. SDB was defined according to the apnea-hypopnea index (AHI) as: no SDB: < or = 5/h, mild: 6 -14/h, moderate: 15-29/h, and severe > or = 30/h. RESULTS: Prevalence of SDB was 70% among DCM and 82% among ICM patients (p < 0.05). Central sleep apnea was found in 32% of DCM and 46% of ICM patients, obstructive sleep apnea in 38% of DCM and 36% of ICM patients. Moderate (15.7% vs. 9.9%, p < 0.05) and severe central sleep apnea (24.4% vs. 15.5%, p < 0.05) was documented more often in ICM than DCM patients. Severity of obstructive sleep apnea was similar in ICM and DCM patients. ICM patients were older than DCM patients (66.4 11 years vs. 66.0 9.0 years, p < 0.01) and in general presented with a greater impairment of cardiopulmonary function. CONCLUSIONS: There is a high prevalence of SDB in patients in chronic heart failure. Central sleep apnea can be documented particularly in ICM patients and seems to be a marker for the severity of heart failure. Because of their prognostic implications, risk stratification and identification of patients eligible for specific SDB treatment, screening for such disorders should be part of every heart failure work-up.

[Adaptive servoventilation: effect on Cheyne-Stokes-Respiration and on quality of life]. / Adaptive Servoventilation bei chronischer Herzinsuffizienz: Wirkung auf Cheyne-Stokes-Atmung und Lebensqualität.

BACKGROUND: Adaptive servo-ventilation (ASV) (AutoSetCS, ResMed) is a novel non-invasive ventilation modality for the treatment of Cheyne-Stokes-Respiration (CSR) in patients with heart failure. This study aimed to investigate the effect of ASV on sleep disordered breathing (SDB), afternoon nap duration, urine voidings, and quality of life. METHODS: 11 patients with CSR due to heart failure (EF < 40 %) were treated with ASV for a period of 6 weeks. Apnea-Hypopnoe-Index (AHI), Arousalindex (AI), duration of afternoon nap, number of voidings, and heart specific quality of life were assessed before and at the end of the treatment period. RESULTS: The average usage time of ASV was 5.8 +/- 2.1/h per day. With ASV the AHI was reduced from 48.2 +/- 11.6 to 6.4 +/- 8.3/h (p < 0.001) and the AI from 33.9 +/- 12.5 to 18.4 +/- 9.3 /h (p < 0.05). The afternoon nap duration was significantly less (1.4 +/- 0.6 vs. 0.7 +/- 0.4 hours per day; p = 0.004) as was the number of nocturnal voidings (2.9 +/- 0.7 vs. 1.1 +/- 0.3 per night; p = 0.007). There was a significant improvement in heart specific quality of life as measured with the Minnesota Living with heart failure questionnaire (43.5 +/- 21.1 vs. 27.6 +/- 15.7 (p = 0.02). CONCLUSION: ASV is well tolerated and improves SDB and quality of life of patients with heart failure with CSR.

[Experiences and results in hypertension screening in women between 20 and 65 years of age in Karl-Marx-City]. / Erfahrungen under Ergebnisse der Hypertoniesuche bei Frauen zwischen 20 und 65 Jahren in Karl-Marx-Stadt.

From 1975 to 1979 in the district of the City of Karl-Marx-Stadt 91,130 females at the age between 20 and 65 years were summoned to a gynaecologico-cardiological mass examination which was supported by computer. 56,460 females underwent the examination. According to the WHO-criteria two measurements of blood pressure were carried out, when increased blood pressure was present a third one and a fourth one by an examination group. A diagnostic standard programme was used. In the second measurement of blood pressure we established 19.8% of patients with hypertension and 28.6% patients with borderline values. 52.8% of the hypertensions were known. Of 10,685 females with known or established hypertension 10.1% underwent an optimum therapy. On the basis of these results a programme for the fight against hypertension was developed for the county Karl-Marx-Stadt.