[Investigation of the Filter Performance in a Sample of Standardised Particle-filtering Half Masks]. / Stichprobenuntersuchung der Filterleistung von normierten partikelfilternden Halbmasken.

BACKGROUND: Thanks to a simplified special approval process that was valid until October 1st, 2020, a large number of particle-filtering half masks have come onto the German market. When caring for SARS-CoV-2 infected patients, the RKI recommends wearing particle-filtering half masks with a filter performance of at least 94 %, which corresponds to FFP class 2 according to EN 149:2001+A1:2009. We have examined 15 particle-filtering half masks with different specifications for their filter performance METHOD: The masks were clamped in a jig in an airtight test box. Radioactive particles with a size of 0.6 ±â€Š0.4 µm were nebulized into the box and sucked into a filter through the port of the jig and an unfiltered reference port using an artificial lung. The activity deposited on the filter was measured by means of a gamma camera. The filter performance was calculated from this. RESULTS: Five of the 15 masks tested had a filter performance of less than 94 % and therefore do not meet the FFP2 standard. The filter performance of these masks was 71.8 ±â€Š2.3 %, 73.2 ±â€Š2.3 %, 78.2 ±â€Š6.7 %, 92.2 ±â€Š0.5 % and 85.9 ±â€Š1.6 %. CONCLUSION: One third of the examined masks did not meet the recommended FFP2 standard, which is recommended for the care of SARS-CoV-2 infected patients. A comprehensive review of already approved products by the supervisory authorities is advisable.

[Guideline for the Diagnosis and Treatment of Asthma - Addendum 2020 - Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology]. / S2k-Leitlinie zur Diagnostik und Therapie von Patienten mit Asthma ­ Addendum 2020.

The present addendum of the guideline for the diagnosis and treatment of asthma (2017) complements new insights into the diagnosis and management of asthma as well as for the newly approved drugs for the treatment of asthma. Current, evidence-based recommendations on diagnostic and therapeutic approaches are presented for children and adolescents as well as for adults with asthma.

[Guideline for Long-Term Oxygen Therapy - S2k-Guideline Published by the German Respiratory Society]. / Leitlinie zur Langzeit-Sauerstofftherapie.

Long-term oxygen therapy is of great importance both for reducing mortality and for improving performance in patients with chronic lung diseases. The prerequisites for Long-term oxygen therapy are adequate diagnostics and clearly defined indication. A causal distinction into chronic hypoxaemic and hypercapnic respiratory failure is reasonable, from which the differential indication for non-invasive ventilation results.The revised guideline covers the diagnostics and indication of chronic lung and heart diseases, the role of oxygen in terminal illness and gives a detailed description of available oxygen devices. The guideline is intended to help avoid undersupply, oversupply and false prescriptions. Furthermore, the chapter "Postacute Oxygen Therapy" discusses the procedure, relevant in everyday life, but not yet clearly defined, for prescribing oxygen therapy for the home at the end of an inpatient stay. Another important point, the correct prescription of mobile oxygen systems, is also presented in the guideline. This document is a revised version of the guideline for longterm oxygen therapy and replaces the version of 2008.

[Survey of Specialist Pulmonary Medicine Health Care Structures for Patients with Interstitial Lung Disease in Nordrhein-Westfalen, Germany - A Pilot Project of the Western German Respiratory Society (WdGP)]. / Erfassung der pneumologisch-fachärztlichen Versorgungsstrukturen für Patienten mit interstitiellen Lungenerkrankungen in Nordrhein-Westfalen.

AIM OF THE STUDY: Survey of specialist pulmonary medicine health care structures for patients with interstitial lung disease (ILD) in Nordrhein-Westfalen, Germany. METHODS: The Western German Respiratory Society initiated a voluntary registration of ILD expert centers. Structural quality and processes were evaluated by questionnaire. RESULTS: 49 centers were registered, 46 allowed analysis of their center data (15 pulmonology specialist practices, 34 hospital pulmonology departments). Specialist practices saw a median of 360 ILD patients per year (26 % first diagnosis), hospital departments a median of 105 ILD patients per year (63 % first diagnosis). 10 centers diagnose more than 100 new ILD cases per year. Specialist practices report median 50 bronchoscopies per year, hospital departments median 1396. 78 % of the centers participate in a multidisciplinary ILD case conference. CONCLUSION: Several ILD expert centers were identified in Nordrhein-Westfalen. Outpatient care mainly involves the monitoring of ILD patients, inpatient services focus on complex initial diagnostics or cases with unusual disease behaviour. ILD centers meeting regional health care needs should be supported in their development.

[Guideline for the Diagnosis and Treatment of Asthma - Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology]. / S2k-Leitlinie zur Diagnostik und Therapie von Patienten mit Asthma.

The present guideline is a new version and an update of the guideline for the diagnosis and treatment of asthma, which replaces the previous version for german speaking countries from the year 2006. The wealth of new data on the pathophysiology and the phenotypes of asthma, and the expanded spectrum of diagnostic and therapeutic options necessitated a new version and an update. This guideline presents the current, evidence-based recommendations for the diagnosis and treatment of asthma, for children and adolescents as well as for adults with asthma.

[Standardization of spirometry: 2015 update. Published by German Atemwegsliga, German Respiratory Society and German Society of Occupational and Environmental Medicine]. / Leitlinie zur Spirometrie. Leitlinie der Deutschen Atemwegsliga, der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Gesellschaft für Arbeitsmedizin und Umweltmedizin zur Spirometrie.

Spirometry is a simple test and considered the gold standard in lung function. An obstructive ventilatory defect is a disproportionate reduction of maximal airflow from the lung in relation to the maximal volume that can be displaced from the lung. It implies airway narrowing and is defined by a reduced FEV1/FVC ratio below the 5th percentile of the predicted value (lower limit of normal, LLN). A restrictive disorder may be suspected when vital capacity (FVC) is reduced and FEV1/FVC is normal. It is definitely proven, however, only by a decrease in TLC below the 5th percentile of predicted value (LLN). The measurement of TLC by body plethysmography is necessary to confirm or exclude a restrictive defect or hyperinflation of the lung when FVC is below the LLN. 2012 a task force of the ERS published new reference values based on 74,187 records from healthy non-smoking males and females from 26 countries. The new reference equations for the 3-95 age range are now available that include appropriate age-dependent mean values and lower limits of normal (LLN). This presentation aims at providing the reader with recommendations dealing with standardization and interpretation of spirometry.

[Effect of Inhalation of Tobramycin for 12 Months on Reduction of Hospitalisation Rate in Severe COPD]. / Inhalation von Tobramycin über 12 Monate zur Senkung der Hospitalisationsrate bei schwerer COPD mit gehäuften Hospitalisationen.

INTRODUCTION: Bacterial colonisation in stable disease of severe COPD and bronchiectasis can cause recurrent hospital treatment, which has a negative impact on the patient's prognosis. A multicentre study has investigated if daily inhalation of tobramycin for one year would lower the number of hospitalisations in severe COPD. METHODS: 44 patients with severe COPD [FEV1 % of predicted value: 42.8 ± 7,1 tobramycin group (T) and 33.5 ± 10.3 placebo group (P)] and a minimum of two hospitalisations in the year before inclusion were randomly assigned to inhale twice daily for 12 months 80 mg tobramycin or isotonic saline (placebo). Concomitant therapy was according to the GOLD guidelines. Primary end point was the number of hospitalisations in the period of study, secondary end points were pulmonary function test and 6 MWD. RESULTS: Inhalation of T changed the number of hospitalisations from 2.8 ± 0.5 per year to 3.5 ± 2.7, P from 3.0 ± 1,4 to 2.3 ± 2.2. These differences and the results for secondary endpoints did not reach significance. The dropout rate was high, only 6 patients (T) and 14 patients (P) finished the study per protocol. CONCLUSION: Inhalation with 160 mg tobramycin by means of a nebuliser over a 12-month period did not reduce the number of hospitalisations for patients with severe COPD and a minimum of two hospitalisations compared to placebo. The severity of the disease was the main reason for the high dropout rate.

[Bronchiolitis]. / Bronchiolitis.

Due to the variability in respect to aetiology, histopathology, lung function, imaging and clinical presentation, as well as overlapping parenchymal processes, bronchiolar disorders are generally difficult to diagnose. Thus, diseases of the small airways should generally be considered in the differential diagnostic approach to respiratory conditions. The diagnostic approach can be devided into several steps: in steps 1 (history and physical examination) and 2 (plain chest radiographs and pulmonary function tests) may point towards a bronchiolar pulmonary process. High-resolution CT (HR-CT) scanning of the chest provides three distinct HR-CT patterns (tree-in-bud sign, ill-defined centrilobular ground-glass nodules and/or pattern of mosaic attenuation, especially visible on expiratory images) which confirm a bronchiolic involvement and help to narrow down a likely diagnosis or more specific bronchiolitic diseases. In inconclusive cases, a histological diagnosis may be required. The paper presents a clinically useful algorithmic approach to diagnosis and differential diagnosis of bronchiolar disorders.

[Bronchiolitis. Part 1--anatomic features, classification, clinical presentation and imaging]. / Bronchiolitis. Teil 1--Anatomische Grundlagen, Klassifikation, klinische Präsentation und Bildgebung.

The term "bronchiolitis" refers to a broad spectrum of common conditions related to the small airways associated with a miscellaneous aetiology, histology, clinical features and course. Due to their variability, bronchiolar disorders are generally difficult to diagnose. History (smoking, collagen vascular disease, inhalational injury, medication usage, and organ transplant) may point towards a bronchiolar process. In addition, signs of systemic and pulmonary infection and evidence of air trapping may provide diagnostic hints. Although clinical presentation, physical examination, pulmonary function tests (obstructive ventilatory defect), and plain chest radiographs may demonstrate abnormalities suggesting small airways involvement, they are often non-specific and rarely diagnostic. In contrast, the high-resolution CT (HR-CT) scanning of the chest provides three distinct HR-CT patterns that assist in the diagnosis and differential diagnosis of bronchiolar conditions: (i) a tree-in-bud pattern, (ii) ill-defined centrilobular ground-glass nodules, and (iii) a mosaic attenuation pattern (best visible on expiratory images). The present paper summarises the current knowledge, the classification, imaging, and the clinical presentation of bronchiolar disorders.

[Therapy for small airways disease: basic principles and therapeutic implications]. / Therapie der kleinen Atemwege: Grundlagen und Möglichkeiten.

This paper describes the possibility of targeting the small airways. In addition to aiding in the therapy for chronic obstructive lung diseases this may prove to be invaluable in the development of treatment strategies for diseases of the bronchioli. Essential factors in peripheral lung deposition include extra-fine particles, a slow and controlled inspiratory flow and an endexspiratory breathhold of 5 - 10 sec (especially for steroids). Due to methodological difficulties, clinical data comparing steroids with larger or extra-fine particles are limited in the field of asthma therapy. However, research suggests a trend for reduced symptoms, positively affected biomarkers and decreased lung hyperinflation when steroids with extra-fine particles are used.

[Lung function diagnostics for the small airways]. / Lungenfunktionsdiagnostik der kleinen Atemwege.

In the recent years growing interest has focused on the involvement of the distal airways (internal diameter < 2 mm) in obstructive lung diseases and other pulmonary conditions. Inflammation in the small airways seems to play a major role in severe and uncontrolled asthma as a major determinant of airflow obstruction. Thus, small airways represent an important target for inhalation therapy. Currently there is no accepted single lung function parameter to detect small airway dysfunction. Various invasive and non-invasive techniques have been described. In future, non-invasive lung function testing will gain more importance. Using spirometry or body plethysmography, lung function parameters such as the ratio of forced vital capacity to slow vital capacity (FVC/SVC) and the residual volume (RV) can provide information about air trapping in small airway disease. Recent data show that techniques such as impulse oscillometry, nitrogen washout testing and analysis of exhaled nitric oxide are promising tools to assess involvement of the small airways. Impulse oscillometry is a sensitive method to calculate peripheral airway resistance, nitrogen washout allows one to detect air trapping and inhomogeneous ventilation in the distal lung, and the alveolar nitric oxide concentration represents a marker of peripheral inflammation. Further studies are needed to validate these functional tests or their combination for diagnosis and assessment of treatment response in pulmonary diseases involving small airways.

[Perspectives in the inhalative administration of drugs]. / Perspektiven in der Inhalationstherapie.

Administration of drugs via the inhalation route will find new indications in the therapy for lung diseases. Furthermore, aerosolised drugs are of increasing interest for systemic treatment. The inhalation of antibiotics is already a well established therapy in cystic fibrosis. In bronchiectasis, severe COPD with bacterial airway colonisation and in mechanically ventilated patients, aerosolised aminoglycosides may provide benefit. Substitution of alpha1-antitrypsin in lung emphysema via inhalation seems to be superior to the intravenous administration. Inhaled insulin has currently been withdrawn from the market in spite of being approved by FDA and EMEA. However, intensive scientific research is still ongoing and many clinical studies are underway in the field of the inhalation of insulin, heparins and other systemic treatments.

[Cerebral arterial gas embolism as complication during the therapeutic endobronchial use of argon plasma coagulation]. / Zerebrale arterielle Gasembolie als Komplikation während einer therapeutischen endobronchialen Anwendung der Argon-Plasma-Koagulation.

In this case report, argon plasma coagulation (APC) was applied in a male individual to treat an occluding tumour of the right middle lobe bronchus with a post-stenotic atelectasis. During attempted recanalisation, the patient suffered a cerebral gas embolism as seen on CT scan, resulting in a distinct neurological deficit. We discuss the available data about cerebral gas embolism as a complication of APC and possibilities to avoid such complications.

[Frequency and influence of nosocomial pathogens on weaning outcome and in-hospital mortality in mechanically ventilated patients in a regional weaning centre in comparison of the years 2002 and 2006]. / Häufigkeit und Bedeutung von Bakterienisolaten bei langzeitbeatmeten Patienten und deren Einfluss auf das Weaning-Outcome und die Hospital-Letalität in einem überregionalen Weaningzentrum im Verlauf.

BACKGROUND: Patients with nosocomial infections in the intensive care unit (ICU) seem to have a poor prognosis. In this retrospective cohort study we investigated the relationship between weaning outcome, in-hospital mortality and the microbiological proof of nosocomial pathogens from secretions in mechanically ventilated patients in the years 2002 and 2006. PATIENTS AND METHODS: 311 patients with long term (> 14 days) invasive (tube or tracheostomy) mechanical ventilation (MV) were enrolled in to the study when they had failed at least two weaning attempts prior to transfer. Microbiological proof of nosocomial pathogens from secretions sampled by the bronchoscope and an X-ray of the chest on admission day (in the transferring ICU and in our ICU) was collected from all patients. RESULTS: There was a significant decline of the weaning success rate between 2002 and 2006 (p = 0.001). The In-hospital mortality was higher in 2006 (p = 0.03). The microbiological proof of nosocomial pathogens had no influence on the weanability (exception: MRSA patients in 2002). In both years, patients with infiltrates on X-ray of the chest showed no increased mortality. But in 2006 it took longer to liberate these patients from invasive MV. In 2002 microbiological proof of pathogens was related to higher in-hospital mortality. In 2006, there was no difference concerning mortality in both groups. CONCLUSIONS: Proof of nosocomial pathogens and infiltrates had no influence on the weanability of long-term mechanically ventilated patients. For in-hospital mortality, the results are contradictory.

Scintigraphy for evaluating early aspiration after oral feeding in patients receiving prolonged ventilation via tracheostomy.

OBJECTIVE: In tracheotomised patients the incidence of aspiration is difficult to determine because investigators often apply different criteria. In this study a scintigraphic method was used to visualise feeding aspiration directly and the results were compared with clinical evidence of aspiration. DESIGN: Prospective study in difficult-to-wean patients with tracheostomy. SETTING: Respiratory ICU. PATIENTS AND METHODS: The study population consisted of 62 consecutive patients (16 females, age: 64.1+/-11.1 years). All patients were tracheotomised and had previously been long-term ventilated in other ICUs due to weaning failure. The scintigraphic test was performed during spontaneous breathing. The standard nutrition consisted of a liquid, semi-liquid and solid meal which was labelled with 100 MBq 99mTc-human serum albumin. MEASUREMENTS AND RESULTS: Scintigraphic aspiration (SA) was defined as positive if radioactivity was detected in the bronchial system using a scintillation camera. Furthermore, aspiration was proven clinically (CA). CA and SA yielded identical results in 54 of the 62 patients [10 positive (16%) and in 44 negative (71%)]. CA, but not SA, was seen in 4/62 (6.5%) and SA, but not CA, was found in 4/62 (6.5%) patients. CONCLUSIONS: Our data re-emphasise that aspiration in tracheotomised patients is common (in our study approximately 30%). The scintigraphic method failed to identify all tracheotomised patients with clinically significant aspiration; however, it did suggest that some patients had subclinical aspiration.

[Daytime mechanical ventilation in chronic ventilatory insufficiency]. / Nichtinvasive Beatmung am Tag bei Patienten mit chronisch ventilatorischer Insuffizienz.

BACKGROUND: Nocturnal hypoventilation is associated with chronic ventilatory insufficiency (CVI). Noninvasive mechanical ventilation (NIV) performed overnight relieves symptoms of hypoventilation and improves daytime blood gases in CVI. In order to test whether the efficacy of NIV depends on its being applied during sleep we conducted a prospective case controlled study comparing daytime mechanical ventilation (DV) in awake patients with nocturnal mechanical ventilation (NV) given in equal quantities. PATIENTS AND METHODS: We enrolled 34 clinically stable patients (age: 56.1 +/- 12.1 years, 20 female) with CVI due to both restrictive lung and chest wall disorders and neuromuscular disease. Using a prospective case-control design, matched subjects were allocated alternately to DV and NV. RESULTS AND CONCLUSIONS: There were no significant differences between the groups in the improvement of the measured parameters; (e.g. PaCO2; DV: from 57.6 +/- 4.3 to 44.0 +/- 4.6 mm Hg, NV: from 55.5 +/- 3.5 to 45.0 +/- 4.1 mm Hg, p < 0.0001). We conclude that in many respects, when compared to NV, DV in awake patients is equally effective for the treatment of CVI.