Pneumologie最新文献

The determination of critical closing pressure (Pcrit) is the diagnostic gold standard for assessing the severity of pharyngeal instability. Pcrit measurements are typically performed during natural nocturnal sleep (NREM Stage 2) in combination with polysomnography. However, determining Pcrit during sleep is time-consuming and impractical for routine use. Alternatively, Pcrit measurements can also be done during drug-induced sleep. A disadvantage of this method is the varying doses of propofol needed to induce sleep, which can affect muscle tone differently. As an alternative to these methods, the application of negative pressure during wakefulness (NEP test) has proven effective. In this test, the patient is administered a subatmospheric pressure of -5 or -10 cmH₂O via mask at the beginning of expiration, and the change in expiratory airflow in the pharynx is measured. NEP test can be performed in both sitting and lying position. According to current knowledge, the NEP test appears to be a diagnostic procedure comparable to critical closing pressure (Pcrit) for assessing upper airway collapsibility.

Smoking of tobacco and cannabis is widespread in Germany. Preventing children and adolescents from starting to use these products is an important goal of prevention. The aim of the present study was to examine how often depiction or mention of cannabis and nicotine use occurs in German-language music videos, which can be seen as advertising for smoking.The sample, which comprised the population of all German-language music videos listed in the YouTube Top 100 Charts in 2023, included 600 music videos. Using a coding scheme, the music videos were categorised as 'smoke-free' or 'not smoke-free' and the depiction or mention of consumption was counted.Of the videos examined, 54.7% (n=328) contained at least one depiction or mention of cannabis or tobacco use; 31.7% of the videos (n=190) were exclusively about tobacco use, 12.5% of the videos (n=75) were exclusively about cannabis use, and 10.5% (n=63) were about both. While tobacco or cannabis use was shown or mentioned in 67.0% of the videos from the 'German rap' genre, the average for the other genres was 20.6% (OR=7.83; p<0.001). When considering cannabis use alone, the difference between the genres was even more pronounced. The proportion of videos in which cannabis was shown or mentioned was 29.7% in the 'German rap' genre and 4.4% in the other genres (OR=9.27; p<0.001). The 328 videos in which tobacco or cannabis use was shown received 3.2 billion clicks (64.5% of clicks). This means that these 328 videos generated a total of 9.7 trillion impressions. Of these, 5.8 trillion impressions were about nicotine use and 3.9 trillion about cannabis use.Music videos expose children and adolescents to a wide range of scenes of nicotine and cannabis use, which remains largely unregulated.

Globally, leptospirosis represents one of the most common zoonotic diseases, with approximately 1 million cases reported annually. It predominantly occurs in tropical and subtropical regions. In light of climate change, raising awareness of such diseases among clinicians in moderate climate zones might become increasingly important.We report the following case of a hybrid presentation of leptospirosis, characterized by predominant pulmonary involvement in the form of diffuse alveolar hemorrhage, as well as jaundice and nephritis.A 38-year-old patient presented one week after a summer riverside barbecue with fever and jaundice. Laboratory tests revealed elevated CRP and procalcitonin levels, direct hyperbilirubinemia and acute kidney injury. The following day he developed diffuse alveolar hemorrhage with rapidly progressive respiratory failure and the need for invasive ventilation. Serological testing for Leptospira was positive and the diagnosis was further confirmed by PCR.With supportive measures and anti-infective therapy with ceftriaxone the patient's condition progressively improved. After 8 days of invasive ventilation he was successfully extubated.This case highlights the importance of considering a broader differential diagnosis in complex and severe disease presentations. Despite the currently sporadic occurrence of this disease in Germany, leptospirosis should be considered in cases of pulmonary hemorrhage in conjunction with kidney failure and jaundice.

In contrast to humans, the location where sound is produced in birds is not the larynx, but rather the so-called "vocal box" (scientific term "Syrinx"). In some species the syrinx is located at the bifurcation point of the trachea into the two main bronchi (tracheal vocal head), while in some in the main bronchi (bronchial vocal head). During inspiration, part of the air flows into the lungs, and the part needed for singing flows into the air sacs adjacent to the lungs. During expiration, air leaves the air sacs and flows through the syrinx, where the song is created. When birds sing in two voices at the same time, individual sequences are formed simultaneously in the right and left parts of the syrinx.The song analysis is based on spectrograms (so-called sonagrams), which graphically represent the frequency spectrum of bird song.The song consists of one or more verses, which in turn consist of the variable or constant sequence of motives or syllables. Some songbirds have an enormous repertoire of syllables and verses (max. up to 7000 verses per day). In addition to singing, most bird species also have much simpler begging, contact, threatening, flight, alarm and copulation calls.Male birds sing primarily for two reasons: 1. They use song to woo a potential partner. This song provides the females with important information about the applicant's performance and health. 2. Singing serves to defend the territory.In around 40 % of songbird species, females also sing. Pairs of some species sing in perfect synchronization.A number of songbirds imitate both the voices of other songbirds and ambient noises, and many songbirds have regional dialects.Song development depends on genetics and other factors such as the environment, metabolism and hormonal influences. It proceeds step by step and initially includes relatively primitive sequences (so-called "subsongs"), then leads through more complex intermediate forms ("plastic songs") and finally to the completed singing pattern ("full songs").Young birds learn the song of their species at a time when they are not yet singing themselves, often as nestlings aged 10 to 50 days from older members of the species, usually from their fathers.The song of young birds develops, based on the template of adult song, in a network of sensory-motor neurons in the forebrain.Songbirds, especially the zebra finch, currently offer the best model for the neural basis of human language learning. In birds, the so-called "High Vocal Center" orchestrates all brain regions relevant to songs, with the neural control of song being sensitive to sex hormones.

Gaps in optimal COPD management have been identified in clinical practice, with discrepancies between guideline recommendations and routine care. The reasons for such discrepancies are incompletely understood. The ELETHON survey aimed to identify physicians' attitudes towards general concepts of COPD management and, in particular, initiation of inhaled triple therapies.ELETHON was a nationwide cross-sectional survey with general practitioners (GP) and pulmonary specialists (PS) working in the ambulatory outpatient setting in Germany, using a structured 17-item questionnaire (single or multiple choice questions) addressing the topics of secondary prevention, exacerbation detection, strategies for therapy escalation, choice of inhaled triple therapies and evaluation of treatment benefits.Questionnaires filled by n=2028 GPs and n=371 PS were analyzed. In both groups, secondary prevention was deemed important in COPD care (GP/PS 76.4%/90.6%), with inhalation technique, vaccination status, and appropriate inhaled pharmacotherapy as key components. Activity/rehabilitation was rarely mentioned by GPs (48.3% vs. 84.5%). Exacerbations and symptomatic worsening were the main triggers for therapy escalation, but were not recorded in a structured way. "Hospitalization" and "≥2 ambulatory exacerbations" were mentioned most frequently as thresholds. Neither GPs nor PS measured eosinophils in the majority of patients. Fixed triple combinations were preferred, with availability of different treatment steps in the same device as important decision aid. Treatment success was evaluated by exacerbations, quality of life, symptoms, lung function and rescue medication use, while COPD Assessment Test (CAT) score was rarely used by GPs and PS.The ELETHON survey identified gaps in COPD management in Germany. While secondary prevention is deemed important, escalation of inhaled therapy is undertaken rather late, the reported importance of vaccinations does not match current quota in German COPD patients, and non-pharmacological measures are often unused. Exacerbation and symptom documentation is rather subjective, validated questionnaires and blood eosinophils are of minor relevance. These results provide evidence of barriers and hidden potentials towards optimization of routine ambulatory care for COPD patients in Germany.

The present article describes the 17-year success story of WeanNet, the Competence Network of Pulmonological Weaning Centers, from its founding and the development of a dedicated certification process to the establishment of a database now comprising more than 55.000 patients undergoing prolonged weaning. It discusses past evaluations of the database as well as an ongoing analysis currently in preparation.Due to the frequent successful weaning (approximately two-thirds of treated patients) WeanNet, alongside other organisations, has been actively involved in developing guidelines, laws and regulations for out-of-hospital intensive care, OPS codes, and further initiatives aimed at reducing the number of patients requiring invasive mechanical ventilation outside clinical settings. The guideline of prolonged weaning is currently being revised and, with the results of AI-supported data analysis, is expected to contribute to further quality improvements in the prolonged weaning process.

This is the 4^th edition of the Cough Guidelines of the German Respiratory Society written by respiratory, gastroenterology, ear-nose-throat specialists, including respiratory physiotherapists and speech pathology specialists; importantly, a patient representative was also involved.Compared with earlier versions we used a new methodology: after discussion in the guidelines group, we asked and answered the 12 most important and most frequent "key" questions regarding the clinical practice. The extent of the guideline could thus be significantly reduced.We added a short scientific background to each of the answers including the most recent references. The recommendations and statements were created in consensus and graded as strong, or weak. If sufficient literature was not available, we suggested discussing joint decisions with the patient.The 12 key questions are as follows:- Key question 1: The classification of cough (acute, i. e. up to three weeks duration; chronic, i. e. after 8 weeks duration and subacute in between) did not change, but we added "cough with or without expectoration as an additional classification aspect with therapeutic consequences.- Key question 2: Acute and subacute cough are mostly (but not exclusively) due to the common cold. They are the first or second most frequent symptom prompting patients to seek medical (or pharmacist's) care. Antibiotic therapy is strongly discouraged for common cold- Key question 3: We defined "Red flags" for mandatory immediate diagnostic for acute cough, which usually does not require such diagnostic procedures- Key question 4: Chronic cough overview of the most common causes for- Key question 5: Cough in acute SARS-CoV-2 infection and in long COVID - Key question 6: Refractory chronic cough and idiopathic chronic cough, two recently established entities were explained more in detail- Key question 7: To upper airway cough syndrome - Key question 8: Gastro-oesophageal-reflux-related cough - Key question 9: Cough-variant asthma and non-asthmatic eosinophilic bronchitis - Key question 10: Overview of drugs causing cough - Key question 11: Basic and personalized (due to the individual history) diagnostic procedures for patients with cough- Key question 12: Physiotherapy, speech therapy and pharmacotherapy for cough.

The lifetime risk of developing COPD is estimated to be between 25 and 30% (10% risk for COPD stage II or worse). It is projected that COPD will become the third leading cause of death within the next decade. COPD may be understood as a disease of accelerated lung ageing: The accumulation of senescent cells in the lungs results in the loss of repair ability and the release of inflammatory mediators. Geriatric patients typically present with multimorbidity, polypharmacy, restrictions in daily life, frailty and sarcopenia. Up to two-thirds of elderly patients with COPD have dysphagia, which leads to aspiration in 40% of cases and is prognostically unfavourable. Older patients with COPD are less likely to experience breathlessness than younger patients. In old patients with COPD, spirometry is the most important lung function test. FEV₆ instead of the FVC may be used. The clock test, mini-cog and the ability to draw two pentagons on top of each other are the best ways to screen patients with dementia to determine whether spirometry is feasible. Impulse oscillometry is a well investigated lung function test for elderly patients with COPD with the advantage not to require special cooperation. The 1-minute walking test or the 1-minute sit-to-stand test are good geriatric alternatives for the 6-minute walking test. The treatment is based on the current COPD guidelines. Substances with a long duration of action, such as fluticasone furoate, vilanterol and umeclidinium, are the best option. The capillary PO₂ is 6 mmHg higher than the arterial PO₂. The difference is even greater in heart failure. The ventilation-perfusion distribution disorder also increases with age, particularly when lying down. This is due to the increase in occlusion capacity, which causes the small airways to collapse earlier. It is essential to consider comorbidities and body position during blood gas sampling to avoid an oversupply of home oxygen therapy in old age.