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ZusammenfassungAsthma und COPD sind die häufigsten obstruktiven Atemwegserkrankungen. Die chronische Inflammation bedingt eine Induktion von proinflammatorischen Zytokinkaskaden. Neben der systemischen Inflammation tragen Hypoxämie, Hyperkapnie, eine katabole Stoffwechsellage, eine gonadale oder eine Schilddrüsendysfunktion, eine muskuloskelettale Dysfunktion und Inaktivität sowie Vitamin D‑Mangel zu einem erhöhten Knochenbruchrisiko bei. Iatrogene Ursachen der Osteoporose sind die zum Teil langjährigen Anwendungen von inhalativen oder systemischen Glukokortikoiden (GC). Die inhalative GC Applikation bei Asthma ist oft schon im Kindes- und Jugendalter indiziert, aber auch interstitielle Lungenerkrankungen wie die chronisch organisierende Pneumonie, die Sarkoidose oder rheumatische Erkrankungen mit Lungenbeteiligung werden mit inhalativen oder oralen GC behandelt. Bei PatientInnen mit zystischer Fibrose kommt es durch die Malabsorption im Rahmen der Pankreasinsuffizienz, durch Hypogonadismus und chronische Inflammation mit erhöhter Knochenresorption zu einer Abnahme der Knochenstruktur. Nach Lungentransplantation ist die Immunsuppression mit GC ein Risikofaktor.Die pneumologischen Grunderkrankungen führen zu einer Veränderung der trabekulären und kortikalen Mikroarchitektur des Knochens und zu einer Verminderung von osteologischen Formations- und Resorptionsmarkern. Hyperkapnie, Azidose und Vitamin D‑Mangel können diesen Prozess beschleunigen und somit das individuelle Risiko für osteoporotische Fragilitätsfrakturen erhöhen.Eine Knochendichtemessung mit einem T‑Score −2,5 auf. Eine niedrig-traumatische Fraktur in der Anamnese indiziert eine osteologische Therapie.Neben der Optimierung des Vitamin D‑Spiegels sind sämtliche in Österreich zur Behandlung der Osteoporose zugelassenen antiresorptiv oder anabol wirksamen Medikamente auch bei pneumologischen PatientInnen mit einem erhöhten Knochenbruchrisiko entsprechend der nationalen Erstattungskriterien indiziert.

Die pneumologische Rehabilitation ist ein wesentlicher Bestandteil der Therapie bei Patienten mit chronischen Lungenerkrankungen. Sie fuhrt zu einer Verbesserung der Leistungsfahigkeit und der Lebensqualitat, sowie zu einer Abnahme der Anzahl und Dauer der Spitalsaufenthalte bei Patienten mit COPD und Reduktion der Gesundheitskosten.

Chronic obstructive pulmonary disease (COPD) represents a major global health problem; however, there are no data regarding clinical phenotypes of these patients in Austria. This was an analysis from the Austrian cohort of the cross-sectional Phenotypes of COPD in Central and Eastern Europe (POPE) study, which was offered to patients with stable COPD in a real-life setting. Patients were recruited at 5 different outpatient facilities in 3 different provinces in Austria. All consecutive patients aged ≥40 years with a diagnosis of COPD confirmed by a post-bronchodilator forced expired volume in 1 s/forced vital capacity (FEV1/FVC) ratio

HINTERGRUND: Ziel unserer Studie war es, den Effekt von einem Jahr ambulanter wohnortnaher Rehabilitation auf funktionelle Parameter sowie auf die Lebensqualitat und Exazerbationsrate bei Patienten mit COPD zu untersuchen. METHODIK: Wir inkludierten 100 Patienten in ein multidisziplinares Rehabilitationsprogramm, welches sowohl Ausdauer-, Kraft- und inspiratorisches Atemmuskeltraining beinhaltet. Wir fuhrten folgende Messungen vor der Rehabilitation sowie nach sechs und 12 Monaten durch: Spiroergometrie, modifizierter Bruce Test, Kraft der Arme und Beine sowie inspiratorische Atemmuskelkraft. Zusatzlich wurde der Saint Georges Respiratory Questionnaire und die Exazerbationstage ein Jahr vor sowie wahrend der Rehabilitation erhoben. ERGEBNISSE: 100 Patienten (42 f/58 m) mit COPD (COPD IV – N = 36, COPD III – N = 42, COPD II – N = 22), einem mittleren Alter von 60,5 ± 9,6 Jahren, einem BMI von 25,8 ± 6,0 begannen ein pneumologisches Rehabilitationsprogramm uber einen Zeitraum von einem Jahr. Die Spiroergometrie (VO2max von 1,1 auf 1,3 l/Min, P < 0.05), der modifizierte Bruce Test (von 13 ± 7 Min auf 18 ± 9 Min; P < 0.001), die Kraft der Arme (von 39,9 ± 3 auf 52,9 ± 8 kg; P < 0.001) und Beine verbesserten sich (von 85,3 ± 45 auf 131,5 ± 57 kg; P < 0.001). Der Maximal inspiratorische Druck stieg von 81,1 auf 108,8 mbar (P < 0.0001). Es kam zu keinen Veranderungen in der FEV1 oder FEV1/FVC, jedoch der Saint Georges Respiratory Questionnaire (Gesamtscore) verbesserte sich von 37,2 ± 3,6 auf 26,5 ± 2,8; P < 0.001. Auch kam es zu einer Reduktion der Exazerbationsraten von 2,8 im Jahr vor der Rehabilitation auf 0,8; P = 0.006) sowie der Hospitalisationstage (von 27,3 auf 3,3, P < 0.001). FOLGERUNGEN: Ein Jahr ambulanter pneumologischer Rehabilitation fuhrt zu einer deutlichen Verbesserung der korperlichen Leistungsfahigkeit und der gesundheitsbezogenen Lebensqualitat, weiters konnen die Anzahl der Exazerbationen sowie die Hospitalisationstage reduziert werden.

The aim of our study was to determine the effect of one year of pulmonary rehabilitation (PR) on functional parameters and exacerbation rates in patients with chronic obstructive pulmonary disease (COPD).A total of 100 patients were enrolled in a multidisciplinary PR program. PR included endurance, resistance and respiratory muscle training. We performed spiroergometry, a modified Bruce Test and measurements of upper and lower limb contractility as well as inspiratory muscle strength before, six and 12 months after beginning rehabilitation. Additionally, we assessed the quality of life and the number of exacerbations and exacerbation days one year before and after starting rehabilitation.100 patients (42 female/58 male) with COPD (COPD IV-N=36, COPD III-N=42, COPD II-N=22), a mean age of 60.5+/-9.6 years, BMI 25.8+/-6.0 attended a rehabilitation training program over a time period of one year. Spiroergometry (VO2max from 1.1 to 1.3 l/min, P0.05), modified Bruce Test (from 13+/-7 Min to 18+/-9 Min; P0.001), upper limb (from 39.9+/-3 to 52.9+/-8 kg; P0.001) and lower limb strength increased significantly (from 85.3+/-45 to 131.5+/-57 kg; P0.001). The maximal inspiratory pressure rose from 81.1 mbar to 108.8 mbar (p0.001). There was no improvement in FEV1 or FEV1/FVC but Saint Georges Respiratory Questionnaire (total score) improved from 37.2+/-3.6 to 26.5+/-2.8; P0.001. The same was true for exacerbation rates (they dropped from 2.8 to 0.8; P=0.006) and the number of hospitalization days (from 27.3 to 3.3, P0.001).One year of outpatient pulmonary rehabilitation is an effective intervention leading to a significant improvement in exercise tolerance and quality of life in patients with COPD also reducing COPD exacerbation rates and hospitalizations.

For more than 30 years the ascarid Toxocara canis, a parasite of the dog, has been considered a possible cause of allergic-pulmonal irritations (i.e. asthma bronchial) in man. According to a British study thousands of people are presumably suffering from asthma bronchial as a consequence of Toxocara infestations. The aim of our recent study was the assessment of the Toxocara seroprevalence in patients of varying bronchial reactivity and status of atopy suffering from respiratory disturbances. 191 serum samples from 59 male (mean age: 31.7 years) and 132 female patients (mean age: 36.6 years) with varying atopy status and degree of bronchial reactivity, living in or near Vienna, were examined for specific IgG antibodies against excretory-secretory (E/S) Toxocara canis antigen with enzyme-linked immunosorbent assay (TES-ELISA) and Western blot (TES-WB). In total a Toxocara seroprevalence of 9.4% could be assessed among these patients. 10% of the patients with and 7.8% of the patients without bronchial hyperreactivity were Toxocara-positive. Atopic patients were serologically positive in 7.1% of the cases tested whereas non-atopics showed an antibody prevalence of 14.3%. A comparison of Toxocara seroprevalence assessed within the recent study and in an earlier study among healthy pregnant women in Vienna did not show significant differences. The results of this study carried out in Vienna indicate that patients with bronchial hyper-reactivity or atopy show no higher seroprevalence than the normal population.

The sensitivity and specificity of Cyfra 21-1 as marker for lung cancer was evaluated in comparison with carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC) and neuron-specific enolase (NSE). Patients with histologically verified lung cancer and different groups without lung cancer were investigated. Sensitivity of Cyfra 21-1 (cut-off level 2.9 micrograms/l) was 40% for non-small cell lung cancer (NSCLC), 60% for rare histological types and 21% for small cell lung cancer (SCLC). In NSCLC sensitivity of Cyfra 21-1 was 35% for squamous cell carcinoma and 41% for adenomous carcinoma. The highest sensitivity for CEA was 45% in NSCLC, with 57% in the subtype of adenomous cell carcinoma; for SCC 30% was achieved in squamous cell carcinoma and for NSE 66% sensitivity was reached in SCLC. In our patients Cyfra 21-1 and CEA appeared equally useful for evaluating patients with NSCLC.

In the present study the incidence of bronchial asthma, airway complaints, and allergic rhinitis was investigated in a randomized population section including 3000 male and female inhabitants of Vienna (sex ratio 1:1), aged 20-44. Data on complaints in the respiratory tract were obtained from a total of 71% of the study population. Our results suggest that 14.7% of the entire population was suffering from allergic rhinitis (16.4% male versus 13.0% female; p0.05). Airway complaints such as wheezing, whistling, and feeling of tightness in the chest, awakening because of shortness of breath or cough were frequently reported, with no major differences between male and female subjects. The overall percentage of study subjects stating that they had suffered from airway complaints in the year before, i.e., the percentage of those giving affirmative answers to one of the questions, was 29%. Bronchial asthma was calculated to be present in 5.1% of the entire population (5.9 male versus 4.4 female). Attacks of asthma were reported by only 2.2% of the subjects, which gives an indication of the discrepancy between identified and unidentified bronchial asthma. Allergic rhinitis is correlated to, and constitutes a risk factor for the occurrence of complaints in the respiratory tract; public health policy should therefore be aimed at the prevention or early treatment of allergic rhinitis, and at reducing the proportion of cases suffering from unidentified bronchial asthma.

Obstructive sleep apnea is frequently found in middle-aged men. Usually, these patients are obese and therefore predisposed to hypertension. This study aimed to elucidate the relationships between hypertension, obesity and obstructive sleep apnea in 48 men suffering from sleep apnea. Hypertension was found in 39 of them (= 81%), 27 patients (= 56%) were morbidly obese (Broca index above 125%), 17 patients (= 36%) were moderately obese (Broca index between 100 and 125%) and 4 patients (= 8%) showed normal weight (Broca index below 100%). Severity of sleep apnea did not correlate with obesity or hypertension. Patients with sleep apnea who were hypertensive were significantly (p less than 0.025) more obese than those with normal blood pressure. Compared with an unselected population showing a similar degree of obesity, patients with obstructive sleep apnea showed a higher prevalence of hypertension and this is independent of age. These findings establish sleep apnea as a risk factor for hypertension.