Otto Chris Burghuber

Target lobe volume reduction and COPD outcome measures after endobronchial valve therapy.

Endobronchial valve (EBV) therapy may be associated with improvements in chronic obstructive pulmonary disease-related outcomes and may therefore be linked to improvements in the body mass index, airflow obstruction, dyspnoea, exercise capacity (BODE) index. Data from 416 patients with advanced emphysema and hyperinflation across Europe and USA, who were randomised to EBV (n=284) or conservative therapy (n=132) were analysed. Quantitative image analysis was used to compare the volume of the targeted lobe at baseline and at 6 months to determine target lobe volume reduction (TLVR). 44% of patients receiving EBV therapy (versus 24.7% of controls) had clinically significant improvements in the BODE index (p<0.001). BODE index was significantly reduced by mean±sd 1.4±1.8, 0.2±1.3 and 0.1±1.3 points in patients with TLVR >50%, 20%–50% and <20%, respectively (intergroup differences p<0.001), but increased by 0.3±1.2 points in controls. Changes in BODE were predicted by baseline BODE and correlated significantly with lobar exclusion and lung volumes at 6 months. A greater proportion of patients in the treatment group than in the control group achieved a clinically meaningful improvement in BODE index; however, the likelihood of benefit was less than half in both groups. Patients in whom TLVR was obtained had greater improvements in clinical outcomes. Patients treated with EBV were more likely to have a significantly reduced BODE score (44% treated versus 25% controls) http://ow.ly/qXRUy

Prevalence and prognosis of COPD in critically ill patients between 1998 and 2008

The epidemiology of chronic obstructive pulmonary disease (COPD) in critically ill patients is largely unknown. The aims of the study were: 1) to determine whether COPD, either as the cause of intensive care unit (ICU) admission or as a comorbid condition, is an independent risk factor for increased morbidity and mortality; and 2) to investigate time trends in proportion and outcome of acute respiratory failure in patients with COPD admitted to ICUs. Prospectively recorded data from 194 453 adults consecutively admitted to 87 Austrian ICUs over a period of 11 years (1998–2008) were retrospectively analysed. COPD was present in 8.6% of all patients. The risk-adjusted mortality of patients with COPD was higher than in patients without COPD. The presence of COPD was an independent risk factor for increased mortality and was associated with prolonged mechanical ventilation and prolonged weaning. During the course of the 11 years, the proportion of acute respiratory failure due to COPD increased by about two-thirds, and the use of noninvasive ventilation within the COPD cohort more than doubled. Simultaneously, the risk-adjusted mortality of patients with COPD improved. In critically ill patients, the presence of COPD is increasing and is an independent risk factor for mortality and morbidity.

Österreichische Gesellschaft für Lungenerkrankungen und Tuberkulose: Konsensus zum Management der chronisch obstruktiven Lungenerkrankungen (COPD)

Seit der Publikation der Konsensusempfehlungen der Österreichischen Gesellschaft für Lungenerkrankungen und Tuberkulose (ÖGLUT) zur Diagnostik und Therapie der COPD 1999 wurde das Management der Erkrankung durch zahlreiche große Studien im Hinblick auf seine Effektivität überprüft. Die Ergebnisse prospektiver, kontrollierter Studien führten zur Erstellung neuer Behandlungskonzepte bezogen auf den Schweregrad der Erkrankung. Epidemiologische Studien wiesen auf die dramatische Bedeutung der COPD hin und führten zu einer weltweiten Initiative zur Bekämpfung der COPD (Global Initiative for Chronic Obstructive Lung Disease, GOLD). Die Österreichische Konsensusempfehlung orientiert sich im Hinblick auf Wertigkeit der Behandlungsstrategien an den Evidenzgraden gemäß Evidence Based Medicine (EBM) der GOLD-Guidelines, die Sinnhaftigkeit eigener österreichischer Empfehlungen besteht in der Berücksichtigung nationaler Bedürfnisse und Versorgungsstrukturen. Die Empfehlungen enthalten zum ersten Mal nicht nur medikamentöse Therapiekonzepte, sondern auch Maßnahmen zur Rehabilitation und Schulung von COPDPatienten. Die Österreichische Gesellschaft für Lungenerkrankungen und Tuberkulose möchte mit diesen Konsensusempfehlungen das Bewusstsein für die Bedeutung der COPD in Österreich fördern und allen mit der Behandlung der COPD Befassten eine Hilfestellung für das bestmögliche, medizinisch gesicherte Management der Erkrankung geben.

A case of primary tularemic pneumonia presenting with necrotizing mediastinal and hilar lymph nodes

ZusammenfassungDie Tularämie ist eine seltene Erkrankung hervorgerufen durch den gram-negativen BacillusFrancisella tularensis. Das klinische Erscheinungsbild solcher Patienten hängt von der Infektionsroute ab. Neben den klassischen Manifestationen einer ulceroglandulären und typhoidalen Tularämie gibt es auch einzelne Fälle mit primärer oder sekundärer pulmonaler Beteiligung. Symptome, laborchemische Parameter und radiologische Veränderungen einer Infektion in der Lunge sind unspezifisch. Die Diagnose stützt sich auf klinischen Verdacht und dem Nachweis erhöhter Antikörpertiter gegenüberF. tularensis (> 1∶128) im Agglutinationstest.Im Folgenden berichten wir über einen Patienten mit pneumonischer Infiltration verbunden mit mediastinaler und hilärer Lymphknotenvergösserung als Folge einer primär tularämischen Pneumonie. Die Diagnose wurde serologisch gestellt und eine Antibiotikatherapie mit Doxyzyklin und Streptomycin führte zur Verbesserung klinischer Symptomatik und zur Rückbildung der radiologischen Veränderungen. Wir empfehlen die primär pneumonische Tularämie in der Differentialdiagnose unklarer pneumonischer Infiltrationen mit mediastinaler und/oder hilärer Lymphadenopathie mit einzubeziehen.SummaryTularemia is an unusual disease caused by the gram-negative coccobacillusFrancisella tularensis. The clinical features of the disease depend on the route of inoculation. Ulceroglandular and typhoidal forms have been recognized as occurring in tularemia, however primary or secondary pneumonic infections have also been reported. Symptoms, laboratory markers and radiological features are non-specific in tularemic pneumonia. Diagnosis is made on clinical grounds and evidence of elevated agglutinating antibodies toF. tularensis (> 1∶128).We report a case of primary tularemic pneumonia presenting with pulmonary infiltrates and necrotizing mediastinal and hilar lymph nodes in an otherwise healthy subject from a non-endemic area. Diagnosis of tularemia was obtained serologically, and antibiotic therapy with doxycycline and streptomycin resolved symptoms and radiological abnormalities. We suggest that tularemia should be considered in the differential diagnosis of pneumonia with mediastinal and/or hilar lymphadenopathy.

Spontaneous bilateral diaphragmatic paralysis: a rare cause of respiratory failure.

SummaryBilateral diaphragmatic paralysis (BDP) can occur in the course of motor neuron disease, myopathy, or from mechanical damage or the use of “ice slush” during cardiac surgery. BDP has been observed during and after infections, associated with systemic lupus erythematosus and mediastinal tumors, or may have idiopathic etiology. It is a serious and life-threatening condition.A 62-yr-old man presented with slowly progressive dyspnoea that worsened in the supine position and on bending forward.Chest X-rays, fluoroscopy, lung-function parameters and blood-gas analysis revealed respiratory failure. BDP was confirmed from a phrenic nerve stimulation test and measurement of transdiaphragmatic pressure (Pdi). Since there was no evidence of an obvious etiology, BDP was considered idiopathic. Other muscles were not involved. The pathological basis was probably focal demyelination in segments of the phrenic nerve.Because of increasing diaphragmatic muscle fatigue, the patient was treated with a nasal mask providing bi-level positive airway pressure (BiPAP) ventilation during the night.Clinical suspicion of BDP should always be raised in patients suffering slowly progressive dyspnoea without any obvious cardiac, metabolic or traumatic predisposing factors, and orthopnoea and dyspnoea on bending forward. Electromyographic tests and measurement of Pdi can reveal the correct diagnosis.

Clinical highlights from the 2011 ERS Congress in Amsterdam.

This article reports on selected papers pertinent to the most important clinical problems in the field of respiratory medicine. Expert authors from the Clinical Assembly of the European Respiratory Society (ERS) have selected updated reports related to presentations given at the 2011 ERS Annual Congress, which was held in Amsterdam (the Netherlands) and attended by more than 20,000 participants. The hot topics and selected abstracts from the scientific groups of the Clinical Assembly are discussed here in the context of recent literature.

Diagnostik der COPD

SummaryLung function testing (spirometry) is crucial for the diagnosis of COPD, as irreversible airway obstruction is the main feature of chronic airway inflammation. Spirometry not only is essential in making the diagnosis but also in grading the disease according to FEV1 measurements. Therapeutic interventions and prognostic evaluations are made according to the grading of the disease. Diagnostic procedures aim to evaluate symptoms and disability in the course of COPD. The most important influence on the course of the disease are acute exacerbations. The diagnosis of acute exacerbations is based on clinical observations of sputum production, cough and dyspnoea. Grading of exacerbations according to the severity of symptoms is important for the treatment and in particular for the need of hospitalisation. Exclusion of other lung diseases with similar symptoms necessitates a number of other examinations. Optimal treatment of COPD needs clinical and objective documentation of the course of the disease. Not only spirometry but also quantification of clinical symptoms and exercise capacity measurements are appropriate approaches to follow this chronic disease.ZusammenfassungDie Diagnostik der COPD ist an den objektiven, reproduzierbaren Nachweis der Atemflussbehinderung gebunden. Die nicht reversible Obstruktion der Atemwege ist per definitionem das Kardinalsymptom der chronisch obstruktiven Lungenerkrankung. Sie ist mittels Spirometrie eindeutig feststellbar. Die Diagnostik muss den Schweregrad der Erkrankung feststellen, um eine stadienadaptierte Behandlung zu ermöglichen. Im Krankheitsverlauf sind wegen der Progression der Erkrankung regelmäßige lungenfunktionelle Stadienzuordnungen erforderlich. Die mangelnde Spezifität der Symptome, die in wechselnder Ausprägung vorliegen, erfordert eine exakte Differentialdiagnose. Den größten Einfluss auf die Prognose der Erkrankung und die Lebensqualität der Patienten haben intermittierende Verschlechterungen im Rahmen von akuten Exazerbationen. Die diagnostische Erfassung der akuten Exazerbation und deren Gewichtung in Bezug auf den Schweregrad hat daher im Behandlungsverlauf die größte Bedeutung. Sie ist durch die Lungenfunktionsprüfung nicht gut erfassbar und stützt sich in erster Linie auf klinische Beobachtungen. Die objektive Erfassung des Erkrankungsstadiums ist daher nur ein Teil der Diagnostik der COPD; ein großer Teil des diagnostischen Spektrums befasst sich mit der Dokumentation des Verlaufs der Symptome und deren Auswirkungen auf die Lebensqualität des Patienten. Der Versuch der Quantifizierung der Symptome ermöglicht die Vergleichbarkeit und damit die Dokumentation des therapeutischen Erfolges.

Taken to task : what is and is not an appropriate response to an ERS guidelines task force?

The European Respiratory Society (ERS) management group have discussed the worrying recent trend for outside interference by a small number of pharmaceutical and other companies in the Societys processes for generating, publishing, disseminating and/or implementing clinical practice guidelines. Recently, some companies have targeted their unwanted attentions very aggressively on particular individuals who are chairs or members of task forces developing guidelines. This is unacceptable, and the purpose of this manuscript is to remind all concerned of our guideline procedures, the proper way of responding and expressing comments, and how the Society will regard any future attempts to manipulate outcomes. Task forces use rigorous methodology, and the ERS will not tolerate interference with the processes by outsiders http://ow.ly/WwIe30cyhDO

The european respiratory society evaluates its 2013-2018 strategic plan implementation

In July 2013 the European Respiratory Society (ERS) developed its 2013–2018 strategic plan to serve its members better and achieve its mission objectives (table 1) [1]. The outcomes of the previous 2006–2007 Strategy Meeting [2] summarising the ERS pillars (figure 1) and the recently published ERS Presidential plans were used as background material [3–5]. Mid-term evaluation of the 2012–2018 European Respiratory Society strategy implementation http://ow.ly/WKhxk