Pneumologie最新文献

DGP pneumologists advocate measures for adaptation, prevention and the implementation of sustainable health care. To protect patients and mitigate the health threat posed by climate change, resilient systems should be built. To protect lung health, they call for action to counteract rising temperatures and the development of extreme weather events, and for further reductions in air pollution. They point out particularly vulnerable population groups that need to be protected.

Students' experiences in medical school may have a significant influence on their later choice of medical specialty, but so far, there has been a lack of objective data on how the subject of pneumology is perceived at German medical schools and where there may be potential for improvement.From July to November 2022, we conducted an online survey among final-year students at German medical schools, as well as chief physicians in the field of pneumology. Students were invited to participate by e-mail via their faculties and the survey was further advertised by the Federal Representation of Medical Students in Germany (BVMD). Chief physicians were contacted via the mailing list of the German Respiratory Society (DGP).We received n=279 responses from students (from 95% of German medical faculties) and n=53 responses from chief physicians in pneumology. Both groups considered pneumology to be rather underrepresented or underrepresented compared to other specialties in the medical curricula (62% of students, 89% of chief physicians). Students attributed the greatest influence on their career aspirations by far to theoretical knowledge, practical experience during internships, clinical traineeships and the final (practical) year of medical school (89% of responses), with value being attributed to good and appreciative supervision and the opportunity to work independently. In a regression analysis, practical learning experience in the field of pneumology during the final year of medical school was particularly associated with students' later career choice for pneumology. From the students' perspective, practical teaching (91% of responses) as well as other courses requiring personal attendance (51%) should be strengthened. Chief physicians described difficulties recruiting junior staff into the field of pneumology and highlighted the need to stress the importance of the subject and the financing of teaching at medical schools.Implementation of a more comprehensive, practice-oriented training in respiratory medicine seems essential for promoting the recruitment of the next generation of physicians into the field of pneumology. The results presented in this paper form a basis for giving more weight to pneumology in medical school curricula and serve as an aid for decision-makers at medical faculties and teaching hospitals in Germany.

The aim of the guideline on climate-conscious prescribing of inhaled medicines is to reduce the carbon footprint of the healthcare system. Chronic respiratory diseases such as asthma and COPD are at risk by climate change. At the same time while inhalants are used to treat these diseases, their use contributes to global warming in several ways. Metered-dose inhalers (MDIs) contain propellants that are potent greenhouse gases, while powder inhalers (DPIs) are considered a more environmentally friendly alternative.Factors such as individual preferences, abilities and skills play a decisive role in the individual selection of the most suitable inhalation system. The guideline provides assistance and recommendations for selecting the most suitable products, taking into account the environmental footprint of the available products.The guideline recommends inhaled therapy, preferably with DPI, for adolescents over the age of 12 and adults with obstructive pulmonary disease. The aim is to enable and inform a climate-conscious choice of therapy in order to reduce the use of emission-intensive DA. When prescribing DA, a preparation with a counter should be selected.A therapy review is required if patients require a prescription for short-acting β-mimetics (SABA) more than twice a year, as this indicates inadequate asthma control.Decision aids explain the differences between DA and DPI to find the optimal therapy. It also emphasises the importance of training for children and adolescents, as their ability to use inhalers varies.The implementation of the guideline is supported by various materials (slide sets, short version, information for patients, https://register.awmf.org/de/leitlinien/detail/053-059).

Background:  Nosocomial pneumonia, encompassing hospital-acquired (HAP) and ventilator-associated pneumonia (VAP), remains a major cause of morbidity and mortality in hospitalized adults. In response to evolving pathogen profiles and emerging resistance patterns, this updated S3 guideline (AWMF Register No. 020-013) provides an evidence-based framework to enhance the diagnosis, risk stratification, and treatment of nosocomial pneumonia.

Methods:  The guideline update was developed by a multidisciplinary panel representing key German professional societies. A systematic literature review was conducted with subsequent critical appraisal using the GRADE methodology. Structured consensus conferences and external reviews ensured that the recommendations were clinically relevant, methodologically sound, and aligned with current antimicrobial stewardship principles.

Results:  For the management of nosocomial pneumonia patients should be divided in those with and without risk factors for multidrug-resistant pathogens and/or Pseudomonas aeruginosa. Bacterial multiplex-polymerase chain reaction (PCR) should not be used routinely. Bronchoscopic diagnosis is not considered superior to non-bronchoscopic sampling in terms of main outcomes. Combination antibiotic therapy is now reserved for patients in septic shock and high risk for multidrug-resistant pathogens, while select patients may be managed with monotherapy (e. g., meropenem). In clinically stabilized patients, antibiotic therapy should be de-escalated and focused, as well as duration shortened to 7-8 days. In critically ill patients, prolonged application of suitable beta-lactam antibiotics should be preferred. Patients on the intensive care unit (ICU) are at risk for invasive pulmonary aspergillosis (IPA). Diagnostics for Aspergillus should be performed with an antigen test from bronchial lavage fluid.

Conclusion:  This updated S3 guideline offers a comprehensive, multidisciplinary approach to the management of nosocomial pneumonia in adults. By integrating novel diagnostic modalities and refined therapeutic strategies, it aims to standardize care, improve patient outcomes, and enhance antimicrobial stewardship to curb the emergence of resistant pathogens.

Patients with interstitial lung disease (ILD) and especially with idiopathic pulmonary fibrosis(IPF) suffer from reduced survival expectation and risk of exacerbations. Lung cancer is a relevant comorbidity in ILD patients and associated with impaired survival.The most frequent ILD among patients with NSCLC (Non-small cell lung cancer) is idiopathic pulmonary fibrosis (IPF), which is associated with an greater decline in lung function and a higher risk of death.The prevalence of lung cancer in patients with ILD is up to 10% and in autopsy studies a prevalence up to 48% has been found.There are no guidelines for patients with lung cancer and ILD. Moreover, no adequate evidence is available.Therefore, we reviewed currently available literature to present an overview of the state of the art.In this review we focus on staging and treatment of the comorbidity of lung cancer and ILD.

The implementation of the requirements of the "Intensivpflege- und Rehabilitationsstärkungsgesetz (IPReG)" requires the establishment of new cross-sectoral care structures. As part of an online survey and a multi-professional panel discussion, which took place on April 27, 2024 at the Thorax Clinic of Heidelberg University, this topic was highlighted from various perspectives. Medical representatives from the fields of intensive care medicine and weaning, respiratory therapists and representatives of the WeanNet board, the AOK Baden-Württemberg and the head of an outpatient intensive care service took part in the discussion. The participants in the survey and the panel discussion still saw potential for optimisation in practical implementation to make the task of assessing weaning or decannulation potential more attractive for appropriately qualified doctors, as implementation currently depends very much on the motivation of individuals. Some patients and their relatives also have reservations about ventilator weaning and decannulation, as it often involves a change of care facility. Optimisation potential was seen mainly in including respiratory therapists and using telemedical options; furthermore, a structural, nationwide provision of care would be desirable, but this does not seem feasible everywhere from an infrastructural standpoint. Although telemedicine could be a good option to improve coverage, especially in more rural areas, the legal framework for this, as well as for potential assessment conduction by respiratory therapists, is not sufficient yet. These legal regulations need to be discussed and developed in constructive collaboration with all involved professions and patient representatives. In general, the law was seen as an opportunity to identify patients with weaning and decannulation potential and to improve the situation of patients with long-term ventilation in Germany due to its requirement of regular on-site visits by professionals with expertise in weaning.

This article summarises the highlights in the field of interventional pneumology from the congresses of the German Society of Pneumology (DGP) in March 2024 and the Austrian Society of Pneumology (ÖGP) in September 2024. Developments and numerous studies in the field of endoscopy and interventional pneumology were presented in the diverse programmes of these two congresses. New bronchoscopic techniques for the diagnosis of mediastinal lymphadenopathy were discussed, innovative navigation techniques and the use of new imaging techniques for the diagnosis of peripheral pulmonary nodules were presented and knowledge in the field of endoscopic lung volume reduction in emphysema patients was expanded.

Counseling and treatment of tobacco and nicotine users include classical behavioral therapy and cognitive-behavioral therapy methods. More than half of the quitters after an intervention relapsed into old behavior after 12 months. Discussions with experts have shown that evidence-based interventions are individually supplemented with treatment options without scientific evidence or with inconsistent efficacy. This study examined the use of adjuvant treatment options in the area of smoking cessation such as aromatherapy.The sample for our anonymous online survey (Sosci survey) consisted of 351 experts. All of them had registered with their contact data in a freely accessible database (https://www.anbieter-raucherberatung.de/anbieter.php). A total of 88 experts took part in the survey. Respondents were on average 53 years old, and 71% were female. They reported on average 14 years of experience in smoking cessation counseling. More than half of the participants (66.3%; n=57) had employed at least one adjuvant treatment option. Exercise (49.1%), hypnosis (34.5%) and acupuncture (27.3%) were mentioned most often.Adjuvant treatment options appear to be important in the counseling of tobacco and nicotine users and there should be more discussion on these options among experts. These should also considered in the development of curricula for counsellors on tobacco and nicotine cessation.

The Lungenemphysemregister e.V. (LE-Register) offers a specialized platform for the exchange of knowledge, the promotion of research and the improvement of the quality of care in interventional endoscopic and surgical therapies as well as the consideration of other socio-economic and health aspects of pulmonary emphysema. The current focus is primarily on endoscopic and surgical treatment approaches for patients. Through the networking of experts, the development of specific quality standards and the certification of centers, the LE Registry contributes to the evidence-based further development and optimization of these highly specialized therapies and with a focus on other aspects of health promotion in the future.

There is a high prevalence of dysphagia among patients with obstructive sleep apnea (OSA) and snoring. Swallowing is a complex process requiring fine-tuned neuromuscular coordination. Breathing and swallowing share a common passage in the pharynx. Swallowing process can be divided into an oral, pharyngeal and esophageal phase. When the swallowing reflex starts, hyoid and larynx are pulled up and the glottis covers the entrance to larynx. During swallowing apnea, which is a respiration pause for about 0.5-1.0 seconds, the bolus passes pharyngeal airway. Dysphagia is associated with severe complications such as aspiration and pneumonia. Although the pathophysiology of dysphagia in OSA-patients is not clearly understood, we assume that dysphagia is also a result of sensory and motor changes in the oropharynx caused by snoring vibrations.