Uta Liebers

Segmental volume reduction using thermal vapour ablation in patients with severe emphysema: 6-month results of the multicentre, parallel-group, open-label, randomised controlled STEP-UP trial.

BACKGROUND Lung volume reduction of emphysematous lobes results in clinical improvement for patients with severe emphysema. However, some segments within a lobe are often substantially more diseased than others, thereby warranting a more targeted approach of the emphysematous parts of a lobe. We therefore did a study to assess whether or not selective sequential treatment of the more diseased upper lobe segments with bronchoscopic vapour ablation led to clinical improvement. METHODS For the multicentre, parallel-group, randomised, controlled, open-label Sequential Staged Treatment of Emphysema with Upper Lobe Predominance (STEP-UP) trial, adult patients aged 45-75 years with severe, upper lobe-predominant emphysema with a forced expiratory volume in 1 s (FEV1) between 20% and 45%, substantial hyperinflation, and post-rehabilitation 6-min walk test (6MWT) greater than 140 m were enrolled from 13 hospital sites in Europe (ten sites) and Australia (three sites). A computer-generated blocked randomisation scheme (block size three per site based on a random table from an independent biostatistician) stratified by site was used to randomly assign enrolled patients 2:1 to segmental vapour ablation (treatment group) or standard medical management (control group). Patients and investigators were not masked to group assignment. The primary efficacy endpoints were statistically significant changes in FEV1 and St Georges Respiratory Questionnaire (SGRQ-C) scores between trial groups at 6 months, analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01719263. FINDINGS Between June 30, 2013, and Oct 1, 2014, 134 patients were screened and 70 were enrolled and randomly assigned: 46 to the treatment group and 24 to the control group. One patient in the treatment group did not receive treatment because of physician decision post-randomisation; this patient is excluded from all analyses. The mean relative improvement in FEV1 between the treatment group versus the control group was 14·7% (95% CI 7·8-21·5%; p<0·0001) and in SGRQ-C was -9·7 points (95% CI -15·7 to -3·7; p=0·0021). COPD exacerbation was the most common serious adverse event, occurring in 11 (24%) of 45 patients in the treatment group and one (4%) of 24 in the control group. One exacerbation resulted in a patient death 84 days after treatment; this was judged by the data and safety monitoring board to be possibly related to treatment. No pneumothorax occurred within 30 days of treatment. INTERPRETATION Compared with standard medical management, targeted thermal vapour ablation of more diseased segments and preservation of less diseased segments resulted in clinically meaningful and statistically significant improvements in lung function and quality of life at 6 months, with an acceptable safety profile. FUNDING Uptake Medical.

The Effects of Climate Change on Patients With Chronic Lung Disease. A Systematic Literature Review.

BACKGROUND Ever since higher overall mortality rates due to heat stress were reported during the European heat waves of 2003 and 2006, the relation between heat waves and disease-specific events has been an object of scientific study. The effects of heat waves on the morbidity and mortality of persons with chronic lung disease remain unclear. METHODS We conducted a systematic search using PubMed, the Cochrane Library, and Google Advanced Search to identify relevant studies published between 1990 and 2015. The reference lists of the primarily included articles were searched for further pertinent articles. All articles were selected according to the PRISMA guidelines. The heat-wave-related relative excess mortality was descriptively expressed as a mean daily rate ratio ([incidence 1]/[incidence 2]), and the cumulative excess risk (CER) was expressed in percent. RESULTS 33 studies with evaluable raw data concerning the effect of heat waves on patients with chronic lung disease (chronic obstructive pulmonary disease, bronchial asthma, pulmonary arterial hypertension, and idiopathic pulmonary fibrosis) were analyzed in this review. By deriving statistics from the overall data set, we arrived at the conclusion that future heat waves will-with at least 90% probability-result in a mean daily excess mortality (expressed as a rate ratio) of at least 1.018, and-with 50% probability-in a mean daily excess mortality of at least 1.028. These figures correspond, respectively, to 1.8% and 2.8% rises in the daily risk of death. CONCLUSION Heat waves significantly increase morbidity and mortality in patients with chronic lung disease. The argument that the excess mortality during heat waves is compensated for by a decrease in mortality in the subsequent weeks/months (mortality displacement) should not be used as an excuse for delay in implementing adaptive strategies to protect lung patients from this risk to their health.

Radiologic manifestations of bronchoscopic lung volume reduction in severe chronic obstructive pulmonary disease

OBJECTIVE. Bronchoscopic lung volume reduction promises to become an effective treatment option in severe chronic obstructive pulmonary disease. Several techniques are currently being investigated, including implantation of devices into the lung and instillation of hot water vapor or polymer. This article reviews the spectrum of radiologic manifestations on chest radiography and CT that occur after the intervention. CONCLUSION. Familiarity with the intended effects and adverse events will aid the radiologist in supporting bronchoscopic lung volume reduction.

Interventional Pneumology in Pulmonary Bleeding; A Review: From the Bronchus to the Vessel

Interventional pneumology includes both bronchological and vascular methods of diagnosis and therapy, especially in emergency situations such as pulmonary hemorrhage. In massive pulmonary hemorrhage bronchological diagnosis is required to determine the site and extent of bleeding, as well as angiography of bronchial arteries, and of pulmonary arteries. Bronchus occlusion by aid of balloon catheter or double lumen tube are holding measures until definitive surgery or embolization of bronchial or pulmonary arteries can be performed. The paper suggests a close relationship between bronchoscopic and angiographic diagnosis and therapy in case of severe pulmonary bleeding.

Stadtluft im Klimawandel — „Dusty and Hot“

Die gesundheitlichen Risiken der Luftverschmutzung werden besonders in Innenstädten in Zeiten des Klimawandels verstärkt. Gefährdete Bevölkerungsgruppen wie Patienten mit Asthma bronchiale oder COPD müssen durch geeignete Strategien geschützt werden. Vier Maßnahmen werden hier vorgestellt.

Mehr Hitzestress und Schadstoff-Belastung für die Lungen

Patienten mit chronischen Lungenerkrankungen sind vom Klimawandel besonders betroffen. Hitzestress und Luftverschmutzung in Großstädten, höhere Pollenbelastung und neue Krankheitserreger tragen dazu bei. Höchste Zeit, geeignete Anpassungsstrategien zu entwickeln!

Novel water born cooling system enables early mobilization of patients hospitalized for urban heat stress related chronic lung disease progression

Introduction: The aim of this study was to investigate whether climate controlled patient rooms support earlier mobilization of patients admitted for exacerbation of chronic lung disease. Methods: This randomized clinical trial conducted summer 2014, branched into conventional patient rooms without climatization G2 (T mean 24.9°C, max. T 30.5 °C) versus patient rooms equipped with capillary tube mats G1 (set point temperature 23 °C (Clina Cooling Inc.)). 32 patients (mean age 67 years, COPD 76 %, 12 % PAH and 12 % Asthma) were eligible for data analyses. In order to acquire mobility data a validated activity tracker (Withings pulse, Aipermon 440) was attached to the patients and movements were continuously detected during stay in hospital. The results from activity tracking were correlated to patient continuous sheets documented 6- Minutes- Walking- Test (6-MWT). Results: Patients enrolled in the radiant climate controlled rooms group G1 had a 20.3 % higher mean daily move count - 884 (CI 95%, 453- 1314, p<0.05) versus patients in control rooms G2 - 734 (CI 95%, 340 – 1128, p<0.05). The same applied to 6-MWT, where G1 came up with 16.9% higher mean values (G1: 186.9 m, 95% CI 76-623, p<0.05 versus G2: 159.2 m, 95% CI 143.4- 230.4, p<0.05 ). Moreover, since patients in the climate controlled rooms stayed compared to control group mean 3,07 days less in hospital the maximum activity rate on discharge was obtained earlier and at a higher positive slope in G1. Conclusion: Hospital room equipped with innovative water born cooling system supports earlier mobilization in heat stress impaired patients suffering from chronic lung disease.