{"title":"Dupilumab bei Asthma mit Typ-2-Inflammation","authors":"","doi":"10.1159/000531827","DOIUrl":"https://doi.org/10.1159/000531827","url":null,"abstract":"","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117083915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
André Roque, Luis Tarboda-Barata, Álvaro A. Cruz, Giovanni Viegi, Tiago Maricoto
Einleitung: Die chronisch-obstruktive Lungenerkrankung (COPD) ist weltweit eine der Hauptursachen für Tod und Behinderung. Inzwischen gibt es zahlreiche Behandlungsmöglichkeiten, aber die Kriterien für die Auswahl inhalativer Bronchodilatatoren und inhalativer Kortikosteroide sind weiterhin in der Diskussion. Neue Studien haben die Rolle von Patientencharakteristika wie Eosinophilenzahl und Exazerbationsverlauf bei der Auswahl der wirksamsten personalisierten Behandlungsoption hervorgehoben. Methoden: In dieser konzeptionellen Übersichtsarbeit wird eine ausführliche Begründung mit einem integrativen Ansatz für die COPD-Behandlung entwickelt, wobei Daten aus den wichtigsten bisher durchgeführten klinischen Studien gesammelt werden, die die aktuellen GOLD-2023-Empfehlungen unterstützen können. Ergebnisse: Je nach Charakteristika und Profil des Patienten werden verschiedene Behandlungsoptionen, darunter Mono-, Zweifach- und Dreifachtherapien, in einer Diagrammmatrix dargestellt und ihre Wirksamkeit in Bezug auf die Verringerung von Exazerbationen und des Sterberisikos verglichen.
{"title":"COPD-Behandlung – eine konzeptionelle Überprüfung auf der Grundlage kritischer Endpunkte","authors":"André Roque, Luis Tarboda-Barata, Álvaro A. Cruz, Giovanni Viegi, Tiago Maricoto","doi":"10.1159/000531608","DOIUrl":"https://doi.org/10.1159/000531608","url":null,"abstract":"Einleitung: Die chronisch-obstruktive Lungenerkrankung (COPD) ist weltweit eine der Hauptursachen für Tod und Behinderung. Inzwischen gibt es zahlreiche Behandlungsmöglichkeiten, aber die Kriterien für die Auswahl inhalativer Bronchodilatatoren und inhalativer Kortikosteroide sind weiterhin in der Diskussion. Neue Studien haben die Rolle von Patientencharakteristika wie Eosinophilenzahl und Exazerbationsverlauf bei der Auswahl der wirksamsten personalisierten Behandlungsoption hervorgehoben. Methoden: In dieser konzeptionellen Übersichtsarbeit wird eine ausführliche Begründung mit einem integrativen Ansatz für die COPD-Behandlung entwickelt, wobei Daten aus den wichtigsten bisher durchgeführten klinischen Studien gesammelt werden, die die aktuellen GOLD-2023-Empfehlungen unterstützen können. Ergebnisse: Je nach Charakteristika und Profil des Patienten werden verschiedene Behandlungsoptionen, darunter Mono-, Zweifach- und Dreifachtherapien, in einer Diagrammmatrix dargestellt und ihre Wirksamkeit in Bezug auf die Verringerung von Exazerbationen und des Sterberisikos verglichen.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"52 1-4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123458380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bronchiektasen werden oft als progressiv und irreversibel angesehen, sodass Fälle von Rückbildung oder Umkehr ein wichtiger Schritt zum Verständnis der zugrunde liegenden pathophysiologischen Mechanismen sind. Mukoviszidose (cystic fibrosis, CF), die durch pathogene Varianten des Gens CFTR (cystic fibrosis transmembrane conductance regulator) verursacht wird, ist eine Erfolgsgeschichte der personalisierten Medizin. Die jüngste Entwicklung von CFTR-Modulatortherapien hat die Behandlung revolutioniert. Innerhalb weniger Wochen wurde eine dramatische Verbesserung der Lungenfunktion, der Sputumproduktion, der Tagesform und der Lebensqualität beobachtet. Die Auswirkungen einer Langzeitbehandlung mit Elexacaftor + Tezacaftor + Ivacaftor (ETI) auf strukturelle Anomalien sind derzeit jedoch nicht bekannt. In dieser Fallserie werden 3 erwachsene Mukoviszidosepatienten beschrieben, bei denen sich die zylindrischen, varikösen und vor allem zystischen Veränderungen der Bronchiektasen nach längerer ETI-Behandlung zunehmend besserten. Dies wirft die interessante Frage nach der Reversibilität der Bronchiektasie sowie nach den Mechanismen auf, die an der Aufrechterhaltung und Progression der Bronchiektasie bei CF beteiligt sind.
{"title":"Mukoviszidose-Modulatortherapie kann zystische Bronchiektasen rückgängig machen","authors":"P. G. Middleton, N. J. Simmonds","doi":"10.1159/000531804","DOIUrl":"https://doi.org/10.1159/000531804","url":null,"abstract":"Bronchiektasen werden oft als progressiv und irreversibel angesehen, sodass Fälle von Rückbildung oder Umkehr ein wichtiger Schritt zum Verständnis der zugrunde liegenden pathophysiologischen Mechanismen sind. Mukoviszidose (cystic fibrosis, CF), die durch pathogene Varianten des Gens CFTR (cystic fibrosis transmembrane conductance regulator) verursacht wird, ist eine Erfolgsgeschichte der personalisierten Medizin. Die jüngste Entwicklung von CFTR-Modulatortherapien hat die Behandlung revolutioniert. Innerhalb weniger Wochen wurde eine dramatische Verbesserung der Lungenfunktion, der Sputumproduktion, der Tagesform und der Lebensqualität beobachtet. Die Auswirkungen einer Langzeitbehandlung mit Elexacaftor + Tezacaftor + Ivacaftor (ETI) auf strukturelle Anomalien sind derzeit jedoch nicht bekannt. In dieser Fallserie werden 3 erwachsene Mukoviszidosepatienten beschrieben, bei denen sich die zylindrischen, varikösen und vor allem zystischen Veränderungen der Bronchiektasen nach längerer ETI-Behandlung zunehmend besserten. Dies wirft die interessante Frage nach der Reversibilität der Bronchiektasie sowie nach den Mechanismen auf, die an der Aufrechterhaltung und Progression der Bronchiektasie bei CF beteiligt sind.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125145773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hintergrund: Die chronisch-obstruktive Lungenerkrankung (COPD) ist eine häufige Atemwegserkrankung, die durch eine anhaltende Einschränkung des Luftstroms gekennzeichnet ist. Berichte über eine Infektion mit Mycobacterium tuberculosis oder Nocardia bei COPD-Patienten liegen vor, eine Co-Infektion mit Mycobacterium tuberculosis und Nocardia ist jedoch selten. Hier beschreiben wir einen solchen Fall einer COPD-Patientin im Krankenhaus sowie das Diagnoseverfahren. Falldarstellung: Eine 79-jährige Landwirtin mit COPD wurde seit dem 10. Januar 2022 nacheinander in 2 Krankenhäuser eingeliefert. Ihre Hauptbeschwerden waren ein sich verschlimmernder Husten, Auswurf und Schnappatmung. Die mikrobiologische Untersuchung wurde im ersten Krankenhaus aus unbekannten Gründen nicht durchgeführt, die empirische Antibiotikabehandlung war nicht wirksam. Die Patientin wurde anschließend in unser Krankenhaus überwiesen. Nach der Untersuchung auf die Infektionsquelle und den Erreger wurde in ihrem Fall Tuberkulose diagnostiziert. Die Tuberkulosebehandlung brachte der Patientin keinen Nutzen, eine Remission der Atemwegssymptome blieb aus. Proben von Rückenmarksflüssigkeit und bronchoalveolärer Lavage-Flüssigkeit wurden im Anschluss für eine mikrobiologische Untersuchung eingeschickt. Die Ergebnisse wiesen auf Mycobacterium tuberculosis und Nocardia spp. hin. Nach 4-tägiger Bakterienkultur ergab sich das Wachstum von Nocardia spp. im Medium; Nocardia farcinica wurde durch MALDI-TOF-Massenspektrometrie und 16S-RNA identifiziert. Der Patientin wurden zur Behandlung der Co-Infektion Trimethoprim und Sulfamethoxazol (TMP/SMX) in Kombination mit Antituberkulotika verschrieben. Ihr Zustand verbesserte sich allmählich, sodass sie am 19. Februar 2022 aus dem Krankenhaus entlassen wurde. Die Ergebnisse der Nachbeobachtung waren allerdings unklar. Schlussfolgerungen: Eine Co-Infektion mit Nocardia und Mycobacterium tuberculosis sollte bei COPD-Patienten in Betracht gezogen werden. Wiederholte mikrobiologische und mikroskopische Untersuchungen sind in allgemeinen Krankenhäusern unerlässlich.
{"title":"Co-Infektion mit Mycobacterium tuberculosisund Nocardia farcinica bei einer COPD-Patientin: ein Fallbericht","authors":"Ying Chen, Wei Hu","doi":"10.1159/000531609","DOIUrl":"https://doi.org/10.1159/000531609","url":null,"abstract":"Hintergrund: Die chronisch-obstruktive Lungenerkrankung (COPD) ist eine häufige Atemwegserkrankung, die durch eine anhaltende Einschränkung des Luftstroms gekennzeichnet ist. Berichte über eine Infektion mit Mycobacterium tuberculosis oder Nocardia bei COPD-Patienten liegen vor, eine Co-Infektion mit Mycobacterium tuberculosis und Nocardia ist jedoch selten. Hier beschreiben wir einen solchen Fall einer COPD-Patientin im Krankenhaus sowie das Diagnoseverfahren. Falldarstellung: Eine 79-jährige Landwirtin mit COPD wurde seit dem 10. Januar 2022 nacheinander in 2 Krankenhäuser eingeliefert. Ihre Hauptbeschwerden waren ein sich verschlimmernder Husten, Auswurf und Schnappatmung. Die mikrobiologische Untersuchung wurde im ersten Krankenhaus aus unbekannten Gründen nicht durchgeführt, die empirische Antibiotikabehandlung war nicht wirksam. Die Patientin wurde anschließend in unser Krankenhaus überwiesen. Nach der Untersuchung auf die Infektionsquelle und den Erreger wurde in ihrem Fall Tuberkulose diagnostiziert. Die Tuberkulosebehandlung brachte der Patientin keinen Nutzen, eine Remission der Atemwegssymptome blieb aus. Proben von Rückenmarksflüssigkeit und bronchoalveolärer Lavage-Flüssigkeit wurden im Anschluss für eine mikrobiologische Untersuchung eingeschickt. Die Ergebnisse wiesen auf Mycobacterium tuberculosis und Nocardia spp. hin. Nach 4-tägiger Bakterienkultur ergab sich das Wachstum von Nocardia spp. im Medium; Nocardia farcinica wurde durch MALDI-TOF-Massenspektrometrie und 16S-RNA identifiziert. Der Patientin wurden zur Behandlung der Co-Infektion Trimethoprim und Sulfamethoxazol (TMP/SMX) in Kombination mit Antituberkulotika verschrieben. Ihr Zustand verbesserte sich allmählich, sodass sie am 19. Februar 2022 aus dem Krankenhaus entlassen wurde. Die Ergebnisse der Nachbeobachtung waren allerdings unklar. Schlussfolgerungen: Eine Co-Infektion mit Nocardia und Mycobacterium tuberculosis sollte bei COPD-Patienten in Betracht gezogen werden. Wiederholte mikrobiologische und mikroskopische Untersuchungen sind in allgemeinen Krankenhäusern unerlässlich.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"194 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116688723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pathophysiologie der Sekretbildung bei COPD: Aktuelle Erkenntnisse zum mukoobstruktiven Phänotyp","authors":"G. Nilius","doi":"10.1159/000531610","DOIUrl":"https://doi.org/10.1159/000531610","url":null,"abstract":"","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127811898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Pulmonary rehabilitation (PR) improves physical and mental performance as well as quality of life in patients with chronic obstructive pulmonary disease (COPD). However, data on outcomes in very old patients are insufficient. We analyzed whether the elderly with COPD benefit in a similar way to younger patients from participation in an inpatient PR according to the assessments usually collected. Methods: Data from 3173 patients with COPD were retrospectively analyzed. Patients were referred to PR at the Zurich RehaZentren, Switzerland, between January 2013 and December 2019. PR was performed 6 days per week with an average duration of 18.85 days. Functional Independence Measurement (FIM), Feeling Thermometer (FT), and 6-Minute Walk Test (6MWT) were recorded on admission and discharge. Results: In all age groups, the 6MWT and FT improved significantly. FIM results also showed a significant increase. The results of the different age groups showed no significant differences in percentage improvements according to the assessments that were considered.
{"title":"COPD: Pulmonale Rehabilitation auch bei älteren Patienten über 80 sinnvoll","authors":"Julia Praxenthaler, A. Koczulla","doi":"10.1159/000531540","DOIUrl":"https://doi.org/10.1159/000531540","url":null,"abstract":"Background: Pulmonary rehabilitation (PR) improves physical and mental performance as well as quality of life in patients with chronic obstructive pulmonary disease (COPD). However, data on outcomes in very old patients are insufficient. We analyzed whether the elderly with COPD benefit in a similar way to younger patients from participation in an inpatient PR according to the assessments usually collected. Methods: Data from 3173 patients with COPD were retrospectively analyzed. Patients were referred to PR at the Zurich RehaZentren, Switzerland, between January 2013 and December 2019. PR was performed 6 days per week with an average duration of 18.85 days. Functional Independence Measurement (FIM), Feeling Thermometer (FT), and 6-Minute Walk Test (6MWT) were recorded on admission and discharge. Results: In all age groups, the 6MWT and FT improved significantly. FIM results also showed a significant increase. The results of the different age groups showed no significant differences in percentage improvements according to the assessments that were considered.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"181 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122095461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Maintaining correct inhaler technique is crucial in the management of chronic obstructive pulmonary disease (COPD). We aimed to investigate the inhaler technique in patients with COPD, to compare it immediately after and at 1 month after training, and to identify the predictors of incorrect inhaler use at 1 month after training. Methods: This prospective study was conducted at the COPD clinic of Siriraj Hospital (Bangkok, Thailand). Patients demonstrating improper inhaler use were trained face-to-face by pharmacists. Inhaler technique was re-assessed immediately after and at 1 month after training. The Montreal Cognitive Assessment (MoCA) score, pulmonary function tests, 6-min walk distance (6 MWD), modified Medical Research Council scale score, and COPD Assessment Test (CAT) score were evaluated. Results: Sixty-six patients with COPD who demonstrated at least one critical error during the use of any controller inhaler were enrolled. The mean age was 73.0 ± 9.0 years, and 75.8% patients had moderate/severe COPD. Immediately after training, all patients used dry powder inhalers correctly and 88.1% used pressurized metered-dose inhalers correctly. At 1 month, the number of patients demonstrating the correct technique decreased across all devices. Multivariable analysis revealed that MoCA score ≤ 16 was independently associated with a critical error at 1 month after training (adjusted odds ratio: 12.7, 95% confidence interval: 1.8-88.2, p = 0.010). At 1 month, CAT score (11.4 ± 8.9 vs. 8.4 ± 5.5, p = 0.018) and 6 MWD (351 ± 93 m vs. 372 ± 92 m, p = 0.009) had significantly improved in patients demonstrating the correct technique, and CAT score met the minimal clinically important difference.
背景:维持正确的吸入器技术在慢性阻塞性肺疾病(COPD)的治疗中至关重要。我们的目的是研究COPD患者的吸入器技术，比较其在训练后1个月和训练后1个月的情况，并确定在训练后1个月不正确使用吸入器的预测因素。方法:本前瞻性研究在泰国曼谷Siriraj医院COPD门诊进行。药师对表现出吸入器使用不当的患者进行了面对面培训。在训练后立即和训练后1个月对吸入器技术进行重新评估。评估蒙特利尔认知评估(MoCA)评分、肺功能测试、6分钟步行距离(6mwd)、修订医学研究委员会量表评分和COPD评估测试(CAT)评分。结果:66例COPD患者在使用任何控制吸入器期间至少出现一次严重错误。平均年龄为73.0±9.0岁，75.8%为中/重度COPD。培训后，所有患者均正确使用干粉吸入器，88.1%的患者正确使用加压计量吸入器。在1个月时，所有器械中表现出正确技术的患者数量减少。多变量分析显示，MoCA评分≤16与训练后1个月的临界误差独立相关(校正优势比:12.7,95%可信区间:1.8-88.2,p = 0.010)。1个月时，采用正确技术的患者CAT评分(11.4±8.9对8.4±5.5,p = 0.018)和6 MWD(351±93 m对372±92 m, p = 0.009)显著改善，CAT评分达到最小临床重要差异。
{"title":"COPD: Konsequente Schulung älterer Patienten im Umgang mit ihrem Applikator etablieren","authors":"H. Frohnhofen","doi":"10.1159/000531539","DOIUrl":"https://doi.org/10.1159/000531539","url":null,"abstract":"Background: Maintaining correct inhaler technique is crucial in the management of chronic obstructive pulmonary disease (COPD). We aimed to investigate the inhaler technique in patients with COPD, to compare it immediately after and at 1 month after training, and to identify the predictors of incorrect inhaler use at 1 month after training. Methods: This prospective study was conducted at the COPD clinic of Siriraj Hospital (Bangkok, Thailand). Patients demonstrating improper inhaler use were trained face-to-face by pharmacists. Inhaler technique was re-assessed immediately after and at 1 month after training. The Montreal Cognitive Assessment (MoCA) score, pulmonary function tests, 6-min walk distance (6 MWD), modified Medical Research Council scale score, and COPD Assessment Test (CAT) score were evaluated. Results: Sixty-six patients with COPD who demonstrated at least one critical error during the use of any controller inhaler were enrolled. The mean age was 73.0 ± 9.0 years, and 75.8% patients had moderate/severe COPD. Immediately after training, all patients used dry powder inhalers correctly and 88.1% used pressurized metered-dose inhalers correctly. At 1 month, the number of patients demonstrating the correct technique decreased across all devices. Multivariable analysis revealed that MoCA score ≤ 16 was independently associated with a critical error at 1 month after training (adjusted odds ratio: 12.7, 95% confidence interval: 1.8-88.2, p = 0.010). At 1 month, CAT score (11.4 ± 8.9 vs. 8.4 ± 5.5, p = 0.018) and 6 MWD (351 ± 93 m vs. 372 ± 92 m, p = 0.009) had significantly improved in patients demonstrating the correct technique, and CAT score met the minimal clinically important difference.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116449577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The value of pre-booked repeated thoracentesis in patients with recurrent pleural effusion is reliant on the estimation of time to next drainage. Identifying factors associated with rapid pleural fluid recurrence could be supportive. Objective: We aimed to evaluate the ability of the patient and physician to predict the time to next therapeutic thoracentesis and to identify characteristics associated with rapid pleural fluid recurrence. Method: In a prospective, observational study, patients with recurrent unilateral pleural effusion and the physician were to predict the time to next symptom-guided therapeutic thoracentesis. Primary outcome was difference between days to actual thoracentesis and days predicted by the patient and the physician. Factors associated with pleural fluid recurrence within 60-day follow-up were assessed using Cox regression analysis. Results: A total of 98 patients were included, 71% with malignant pleural effusion. Patients’ and physicians’ predictions numerically deviated by 6 days from the actual number of days to re-thoracentesis (IQR 2–12 and 2–13, respectively). On multivariate analyses, factors associated with increased hazard of pleural fluid recurrence included daily fluid production (HR 1.35 [1.16–1.59], p > 0.001) and large effusion size (HR 2.76 [1.23–6.19], p = 0.01). Septations were associated with decreased hazard (HR 0.48 [0.24–0.96], p = 0.04).
背景:在反复胸腔积液患者中预先预约反复胸腔穿刺的价值取决于下次引流时间的估计。确定与快速胸腔积液复发相关的因素可能是支持性的。目的:我们旨在评估患者和医生预测下一次治疗性胸腔穿刺时间的能力，并确定与快速胸腔积液复发相关的特征。方法:在一项前瞻性观察研究中，反复发生单侧胸腔积液的患者和医生预测下一次症状引导的治疗性胸腔穿刺术的时间。主要结局是实际胸腔穿刺天数与患者和医生预测的天数之间的差异。采用Cox回归分析评估随访60天内胸腔积液复发相关因素。结果:共纳入98例患者，恶性胸腔积液占71%。患者和医生的预测与再次胸腔穿刺的实际天数有6天的数值偏差(IQR分别为2-12和2-13)。在多因素分析中，与胸膜积液复发风险增加相关的因素包括每日积液量(HR 1.35 [1.16-1.59]， p > 0.001)和大量积液(HR 2.76 [1.23-6.19]， p = 0.01)。分离与风险降低相关(HR 0.48 [0.24-0.96]， p = 0.04)。
{"title":"Pleuraerguss-Rezidive: Einschätzung und Planung sind durch Thoraxsonographie und Thorakozentese möglich","authors":"F. Stanzel","doi":"10.1159/000531410","DOIUrl":"https://doi.org/10.1159/000531410","url":null,"abstract":"Background: The value of pre-booked repeated thoracentesis in patients with recurrent pleural effusion is reliant on the estimation of time to next drainage. Identifying factors associated with rapid pleural fluid recurrence could be supportive. Objective: We aimed to evaluate the ability of the patient and physician to predict the time to next therapeutic thoracentesis and to identify characteristics associated with rapid pleural fluid recurrence. Method: In a prospective, observational study, patients with recurrent unilateral pleural effusion and the physician were to predict the time to next symptom-guided therapeutic thoracentesis. Primary outcome was difference between days to actual thoracentesis and days predicted by the patient and the physician. Factors associated with pleural fluid recurrence within 60-day follow-up were assessed using Cox regression analysis. Results: A total of 98 patients were included, 71% with malignant pleural effusion. Patients’ and physicians’ predictions numerically deviated by 6 days from the actual number of days to re-thoracentesis (IQR 2–12 and 2–13, respectively). On multivariate analyses, factors associated with increased hazard of pleural fluid recurrence included daily fluid production (HR 1.35 [1.16–1.59], p > 0.001) and large effusion size (HR 2.76 [1.23–6.19], p = 0.01). Septations were associated with decreased hazard (HR 0.48 [0.24–0.96], p = 0.04).","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132061481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To demonstrate the effects of rituximab (RTX) in patients with rheumatoid arthritis-related interstitial lung disease (RA-ILD). Methods: A total of 165 patients who used RTX for the management of rheumatoid arthritis were retrospectively scrutinised. Among these, 26 patients diagnosed with RA-ILD were analysed (61.5% male, mean age at RTX infusion 61.4 ± 6.5 years). To evaluate the efficacy of RTX on lung response, patients with pulmonary function test results and/or thorax computed tomography (chest-CT) of pre- and post-RTX were compared. Disease progression was defined as either a decline of ≥10% in forced vital capacity (FVC) and/or a decline of ≥15% in diffusion capacity of carbon monoxide (DLCO), or an increase of parenchymal involvement on chest-CT images according to the radiologists’ assessment. Results: Among 26 patients, the most common radiologic pattern was usual interstitial pneumonia (42.3%), followed by non-specific interstitial pneumonia (38.5%). Data for lung response was available in 20 patients. Median pre- and post-RTX DLCO values were 71.0% (60.0–77.0) and 63.0% (47.0–74.0), respectively (p = 0.06). Median pre- and post-RTX FVC values were 74.0% (61.0–99.0) and 84.0% (63.0–100.0), respectively (p = 0.28). Overall, stabilization or regression of RA-ILD was provided in 13 (65.0%) patients, whereas 7 patients had progressive RA-ILD. Post-RTX, 5 patients were diagnosed with RA-ILD.
{"title":"Behandlungserfahrungen mit Rituximab bei Patienten mit rheumatoider Arthritis-assoziierter interstitieller Lungenerkrankung in Ankara, Türkei","authors":"P. Xanthouli","doi":"10.1159/000531295","DOIUrl":"https://doi.org/10.1159/000531295","url":null,"abstract":"Objective: To demonstrate the effects of rituximab (RTX) in patients with rheumatoid arthritis-related interstitial lung disease (RA-ILD). Methods: A total of 165 patients who used RTX for the management of rheumatoid arthritis were retrospectively scrutinised. Among these, 26 patients diagnosed with RA-ILD were analysed (61.5% male, mean age at RTX infusion 61.4 ± 6.5 years). To evaluate the efficacy of RTX on lung response, patients with pulmonary function test results and/or thorax computed tomography (chest-CT) of pre- and post-RTX were compared. Disease progression was defined as either a decline of ≥10% in forced vital capacity (FVC) and/or a decline of ≥15% in diffusion capacity of carbon monoxide (DLCO), or an increase of parenchymal involvement on chest-CT images according to the radiologists’ assessment. Results: Among 26 patients, the most common radiologic pattern was usual interstitial pneumonia (42.3%), followed by non-specific interstitial pneumonia (38.5%). Data for lung response was available in 20 patients. Median pre- and post-RTX DLCO values were 71.0% (60.0–77.0) and 63.0% (47.0–74.0), respectively (p = 0.06). Median pre- and post-RTX FVC values were 74.0% (61.0–99.0) and 84.0% (63.0–100.0), respectively (p = 0.28). Overall, stabilization or regression of RA-ILD was provided in 13 (65.0%) patients, whereas 7 patients had progressive RA-ILD. Post-RTX, 5 patients were diagnosed with RA-ILD.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129825545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Medical thoracoscopy/pleuroscopy has become, after bronchoscopy, the second most commonly utilized endoscopic procedure in interventional pulmonology. Due to their common origin, medical thoracoscopy/pleuroscopy and video-assisted thoracic surgery (VATS) are quite similar procedures technically. In contrast to the prevailing attitude that it should predominantly be performed by interventional pulmonologists, we believe that, like all hybrid-in-nature techniques, it should be implemented as part of a combined specialist care service/team. Herewith, we describe our attempt to establish a multidisciplinary pleural disease program during a difficult economic period or our country, comprising thoracic surgeons, pulmonologists and anesthesiologists, all of whom brought in their experience, expertise and resources to establish and develop the service resulting in a hybridization of the technique, with, as reported, quite favorable results.
{"title":"Pleuraerkrankungen: Multidisziplinäre Teams aus Pneumologen und Thoraxchirurgen führen zu besserer Diagnose und Therapie","authors":"K. Hekmat","doi":"10.1159/000531411","DOIUrl":"https://doi.org/10.1159/000531411","url":null,"abstract":"Medical thoracoscopy/pleuroscopy has become, after bronchoscopy, the second most commonly utilized endoscopic procedure in interventional pulmonology. Due to their common origin, medical thoracoscopy/pleuroscopy and video-assisted thoracic surgery (VATS) are quite similar procedures technically. In contrast to the prevailing attitude that it should predominantly be performed by interventional pulmonologists, we believe that, like all hybrid-in-nature techniques, it should be implemented as part of a combined specialist care service/team. Herewith, we describe our attempt to establish a multidisciplinary pleural disease program during a difficult economic period or our country, comprising thoracic surgeons, pulmonologists and anesthesiologists, all of whom brought in their experience, expertise and resources to establish and develop the service resulting in a hybridization of the technique, with, as reported, quite favorable results.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128689174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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