V. Gross

Combined lung-sound and reflux-monitoring: a pilot study of a novel approach to detect nocturnal respiratory symptoms in gastro-oesophageal reflux disease.

Aliment Pharmacol Ther 2011; 33: 592–600

Nächtliche Langzeitregistrierung von Lungengeräuschen bei Patienten mit gastroösophagealem Reflux

Gastro-oesophageal reflux disease (GERD) is one of the most common clinical conditions in the developed countries. Particular interest in pulmonary manifestations of this disease has arisen over the last few years. Although the high coincidence between reflux and chronic cough is unquestioned, the proof of a causal correlation is still lacking. In this paper we present the Marburger Lung-Sound-Monitoring as a new method for the detection of nocturnal respiratory symptoms such as cough, wheezing and throat clearing and their temporal correlation with reflux. This method will in future allow us to precisely record and to evaluate the extent and duration of reflux events and their correlation with respiratory symptoms.

Was ist für die Diagnostik und Therapieverlaufskontrolle von chronischem Husten wichtig

Within the last years there has been significant progress in the field of chronic cough. So far, the analysis and evaluation of chronic cough was done mainly on the basis of subjective methods such as manual counts of cough events, questionnaires and diaries. Testing cough hypersensitivity and monitoring 24 h cough represent objective criteria. Validated questionnaires on cough frequency and quality of life represent the impact of chronic cough. Cough frequency monitoring, the preferred tool to objectively assess cough, should be used as primary end-point in clinical trials. It will also be possible to discriminate between productive and non-productive cough. The relationship with subjective measures of cough is weak. In the future, cough and its therapy should therefore be assessed with a combination of subjective and objective tools.

Quantification of nasal respiratory flow by tracheal sound analysis

By now the pneumotachograph is the gold standard for quantitative measurement of the respiratory flow. However, for continuous quantitative monitoring of airflow or measuring flow within non-invasive ventilated patients an ideal solution is still missing. In this study we made an attempt to detect the nasal breathing with our newly developed system of measurement. This method allows the detection of nasal airflow by means of a sensor, which is placed on the trachea. In 20 pulmonary healthy male subjects the airflow was measured by a pneumotachograph. At the same time tracheal breathing sounds were recorded by a sensor placed paralaryngeal. Using a newly developed analysis system, tracheal breathing sounds can be transformed and the real respiratory flow curve can be calculated. For inspiration, as well as expiration, the estimated airflow showed a highly significant correlation (pearson correlation coefficient, r = 0.89 up to 0.92 with p< 0.01). The presented method is still being tested but has the potential to be applicable in polysomnography.

Home monitoring of nocturnal cough in COPD patients

Abstract Telemedicine approaches in the treatment of COPD can be useful for the detection of upcoming exacerbations. Specifically productive cough can serve as an effective monitoring parameter. By using modern technologies, we developed a smartphone application to record and analyze nocturnal cough in an outpatient environment. All results will be displayed through a web interface by patients, physicians and relatives. Monitoring cough could lead to an individual therapy and an increased quality of life.

Evaluation of an app-based stress protocol

Abstract Stress is a major influence on the quality of life in our fast-moving society. This paper describes a standardized and contemporary protocol that is capable of inducing moderate psychological stress in a laboratory setting. Furthermore, it evaluates its effects on physiological biomarkers. The protocol called “THM-Stresstest” mainly consists of a rest period (30 min), an app-based stress test under the surveillance of an audience (4 min) and a regeneration period (32 min). We investigated 12 subjects to evaluate the developed protocol. We could show significant changes in heart rate variability, electromyography, electro dermal activity and salivary cortisol and α-amylase. From this data we conclude that the THM-Stresstest can serve as a psychobiological tool for provoking responses in the cardiovascular-, the endocrine and exocrine system as well as the sympathetic part of the central nervous system.

Bestimmung der hyperkapnischen Atemantwort bei Patienten mit COPD

Previous studies showed a reduced hypercapnic ventilatory response (HCVR) in patients with COPD. However, the association between HCVR and COPD GOLD stages is unknown. The measurement of the HCVR is a methodological option to test the function of the breathing feedback cycle. The aim of this feasibility study was to present a new automatic and standardized device (MATAM) to measure and interpret the HCVR. This device determines if exposure to CO2 leads to an adequate increase in breathing frequency and tidal volume. Recordings are performed in a closed system that allows selective changes of each gas component. The minute ventilation (AMV) under hypercapnic stimulation is plotted against the end-tidal CO2 (ETCO2). The HCVR is defined as the linear regression line.28 patients (18 male; 10 female) with COPD GOLD stages 0 to IV were studied. The patients had a mean age of 57 ± 14 (standard deviation) years and a mean BMI of 32 ± 9 kg/m(2). We could show that the HCVR measurement in patients with COPD using MATAM was feasible. Patients with more severe COPD stages had a significantly more reduced HCVR. This could be an indication of reduced chemosensitivity due to a worsening of blood values (pH and pCO2) which affect the central chemoreceptors in the long term. Further studies will be needed to validate the MATAM device for healthy individuals and other patient groups, and for the investigation of standard values.

Ist die telemedizinische Versorgung von Patienten mit COPD sinnvoll

Berücksichtigt man den demografischen Wandel, die Zunahme älter werdender Menschen sowie den Anstieg chronischer Erkrankungen, wird klar, dass die Kosten im Gesundheitssystem zwangsläufig weiter steigen werden. Bereits heute sind etwa 75% der Ausgaben im Gesundheitswesen durch chronisch kranke Patienten verursacht. Die enorme sozioökonomische Bedeutung der chronischen Lungenerkrankungen, insbesondere der COPD, ist unbestritten. Die Prävalenz der chronischen Bronchitis wird bei der erwachsenen Bevölkerung in Deutschland auf 10 bis 15% geschätzt. Weltweit ist die COPD gegenwärtig die vierthäufigste Todesursache. Für die nächsten Jahrzehnte ist von einem weiteren Anstieg von Prävalenz, Morbidität und Mortalität der COPD auszugehen. Die jährlichen volkswirtschaftlichen Gesamtkosten der COPD werden auf 5,9 Mrd.€, die individuellen Kosten eines Patienten auf 3027 €/Patient geschätzt. Krankenhausaufenthalte stellen den bedeutendsten Kostenfaktor dar [1].

Bestimmung der Atemstromstärke mithilfe des ThorAKUSTIK-Verfahrens bei Mund- und Nasenatmung

BACKGROUND Respiratory flow detection with the aim of detecting sleep-related breathing disorders plays a major role in polysomnography. Due to the fact that pneumotachographs are too bulky and not suitable for measurements during sleep, the ThorAKUSTIK system has been developed. By attaching a noise sensor right next to larynx, it determines the respiratory flow in an acoustic way. METHODS The ThorAKUSTIK system as well as a pneumotachograph were applied simultaneously. The correlation between those two methods has been calculated. PATIENTS We investigated twenty male subjects. All of them were non-smokers. RESULTS The ThorAKUSTIK-System showed a highly positive correlation (r = 0.89 to 0.91; p < 0.01) and was able to measure the respiratory flow in a reliable way. CONCLUSIONS The ThorAKUSTIK-System allows a long-term live monitoring and has the potential to be used in several clinical departments. Larger studies are necessary to verify the application in the clinical routine.

Nasal long-term inhalation facilitates enhanced thoracic particle deposition

Sohrabi K., ThoraTech GmbH, Gießen, Germany Sohrabi A., Division of Respiratory and Critical Care Medicine, Philipps-University Marburg, Germany Librizzi D., Division of Nuclear Medicine, Philipps-University Marburg, Germany Mursina L., TH-Mittelhessen-University of Applied Sciences, Gießen, Germany Koehler U., Division of Respiratory and Critical Care Medicine, Philipps-University Marburg, Germany Gross V., TH-Mittelhessen-University of Applied Sciences, Gießen, Germany