Search

Background: Asthma is one of the most common chronic diseases in both children and adults. Asthma first occurring in adulthood (adult-onset asthma, AOA) is associated with poorer prognosis compared to childhood-onset asthma (COA), which urgently calls for more research in this area. The aim of this work was to analyze the data on asthma collected in the German National Cohort and compare it with the German Health Interview and Examination Survey for Adults (DEGS), in particular regarding AOA., Material and Methods: Our analysis was based on the dataset of the main questionnaire at mid-term of the German National Cohort baseline examination, comprising 101,723 participants. Variables considered in the analyses were self-reported diagnosis of asthma, age at first diagnosis, asthma treatment in the past 12 months, age, and sex., Results: In the midterm dataset, 8.7% of women and 7.0% of men in the German National Cohort reported that they had ever been diagnosed with asthma. Approximately one third of participants with asthma received their initial diagnosis before their 18th birthday. COA affected 2.2% of women and 2.8% of men, whereas AOA affected 6.5% of women and 4.2% of men. During the previous 12 months, 33% of COA cases and 60% of AOA cases were medically treated., Conclusion: The proportion of persons affected by asthma in the German National Cohort, as well as observed patterns regarding age and gender, corresponds to other data sources such as DEGS. However, in our analysis, the proportion of individuals with AOA was higher than described in the literature. The increase in cumulative asthma diagnoses with age is markedly steeper in younger participants, indicating a rising trend over time.

Asthma is a heterogeneous inflammatory airway disease that causes relevant morbidity across individuals of all age cohorts. In recent years, advances in the understanding of asthma pathophysiology have led to the development of treatments tailored to specific pheno- and endotypes of the disease. This has significantly changed asthma management, especially for patients with severe disease. These new treatment options offer individuals with asthma access to personalized and disease-modifying therapies. The present paper is a comprehensive overview of recent clinical studies and of German and international guideline updates on asthma management., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Asthma is a heterogeneous inflammatory airway disease that causes relevant morbidity across individuals of all age cohorts. In recent years, advances in the understanding of asthma pathophysiology have led to the development of treatments tailored to specific pheno- and endotypes of the disease. This has significantly changed asthma management, especially for patients with severe disease. These new treatment options offer individuals with asthma access to personalized and disease-modifying therapies. The present paper is a comprehensive overview of recent clinical studies and of German and international guideline updates on asthma management., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has stated that pulmonary rehabilitation (PR) is the most effective therapeutic intervention to reduce dyspnoea and to improve physical performance and quality of life for patients with obstructive lung disease.New innovative studies raised in the area of PR:1) Pulmonary fibrosis & asthma bronchiale - While PR is recommended for chronic respiratory diseases other than COPD (chronic obstructive pulmonary disease) in the respective disease-specific treatment guidelines, PR in some pathologies is underrated. For example, there is a growing body of evidence showing the effectiveness of structured and multidisciplinary PR programs in pulmonary fibrosis and asthma bronchial patients;2) Coronavirus SARS-CoV-2 - There is preliminary evidence that COVID-19 patients can benefit from a PR program. The current COVID-19 position paper of the German Respiratory Society e. V. (DGP) regarding PR recommendations suggests that early rehabilitative therapies are already indicated during hospitalisation on the normal or intensive care unit and that rehabilitative interventions should be continued after discharge as a follow-up treatment in PR centres in order to reduce long-term consequences of COVID-19 disease;3) Telehealth meets PR - To further improve the effectiveness of PR in COPD patients using recent technologies, a supplementary "digital exercise program" can contribute to greater benefits compared to PR alone., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Particularly in young children the diagnosis of asthma is difficult and mostly based on clinical symptoms like wheezing, cough and dyspnea. Children with nocturnal wheezing often suffer from a low quality of sleep and impaired sense of well-being during the day. Physicians recommend that parents record the frequency of asthma attacks or symptoms to help manage their children's disease. The lack of an appropriate method for standardized and objective monitoring makes asthma management difficult. The aim of this paper is to present a new method for automated wheeze and cough detection and analysis. The mobile LEOSound recording and analysing system described here should help improve diagnosis and monitoring of asthma symptoms in children., (© Georg Thieme Verlag KG Stuttgart · New York.)

In Germany as well as internationally, evidence-based asthma guidelines were developed as a decision aid for diagnosis and therapy. However, adherence to recommendations is usually less than optimal. The authors explore potential implementation barriers: knowledge gaps, practical presentation of guidelines, and attitudes of doctors and patients. In this paper, we compare results of our knowledge survey of family doctors and trainees with results of similar national and international studies. In all studies, all surveyed groups of physicians revealed considerable knowledge gaps. Many physicians in our own study erroneously preferred mucolytics and antibiotics to treat acute or subacute asthma symptoms though these drugs are not or only exceptionally indicated. The inflammatory character of asthma often goes unrecognized, as well as the importance of inhaled (and systemic) corticosteroids in long term treatment (or treatment of exacerbations)., (© Georg Thieme Verlag KG Stuttgart · New York.)

According to the international guidelines of COPD (GOLD) and asthma (GINA) diagnosis and treatment of both diseases necessitate spirometry in the private practice as well as in hospital setting. However today, spirometry is not sufficiently used in Switzerland. This paper intends to give an easy overview how spirometry is performed and spirometric values can be interpreted.

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The further increase of allergies in industrialized countries demands evidence-based measures of primary prevention. The recommendations as published in the guideline of 2004 were updated and consented on the basis of a systematic literature search. Evidence from the period February 2003-May 2008 was searched in the electronic databases Cochrane and MEDLINE as well as in reference lists of recent reviews and by contacting experts. The retrieved citations were screened for relevance first by title and abstract and in a second step as full paper. Levels of evidence were assigned to each included study and the methodological quality of the studies was assessed as high or low. Finally the revised recommendations were formally consented (nominal group process) by representatives of relevant societies and organizations including a self-help group. Of originally 4556 hits, 217 studies (4 Cochrane Reviews, 14 meta-analyses, 19 randomized controlled trials, 135 cohort and 45 case-control studies) were included and critically appraised. Grossly unchanged remained the recommendations on avoiding environmental tobacco smoke, breast-feeding over 4 months (alternatively hypoallergenic formulas for children at risk), avoiding a mold-promoting indoor climate, vaccination according to current recommendations, and avoidance of furry pets (especially cats) in children at risk. The recommendation on reducing the house dust mite allergen exposure as a measure of primary prevention was omitted and the impact of a delayed introduction of supplementary food was reduced. New recommendations were adopted concerning fish consumption (during pregnancy / breast-feeding and as supplementary food in the first year), avoidance of overweight, and reducing the exposure to indoor and outdoor air pollutants. The revision of this guideline on a profound evidence basis led to (1) a confirmation of existing recommendations, (2) substantial revisions, and (3) new recommendations. Thereby it is possible to give evidence-based and up-to-date recommendations on primary prevention of allergies.

Several national and international studies on the care of asthma patients delivered by community pharmacists have shown that pharmacist interventions help to improve patient parameters like, for example, the patient's quality of life, self-management skills, compliance and optimization of drug therapy. These results have led to pharmacists' involvement in national asthma guidelines, e.g., in the UK and the United States. Pharmacists have now also been involved in the revised version of the German national guidelines on asthma. In this paper we will present the existing evidence in Germany on how pharmacists add value to the care of asthma patients. Furthermore, the involvement of pharmacists in the German National Disease Management Guideline for Asthma will be discussed.

Allergic diseases represent a major health problem in Europe. They are increasing in prevalence, severity and costs. GA2LEN (Global Allergy and Asthma European Network), an FP6 Network of Excellence, was created in 2005 as a vehicle to ensure excellence in research bringing together research and clinical institutions to combat fragmentation in the European research area and to tackle allergy as a whole. GA2LEN benefited greatly from the voluntary efforts of researchers who are strongly committed to this model of pan-European collaboration. The network was organized in order to increase networking for scientific projects in allergy and asthma around Europe and to make GA2LEN the world leader in the field. Besides these activities, research has been jointly made and the first papers are being published. GA2LEN achievements in general can be grouped as those for a durable infrastructure built up during the project phase those which are project-related work based on these novel infrastructures, and the development and implementations of guidelines. The major achievements of GA2LEN are reported in this paper.

In a multicenter study (7 participating centres) 132 patients with bronchial asthma (grade II or III) and sensitization to storage mites (SM) and/or house dust mites (HSM) were screened and asked to undergo further allergological evaluation. 90 patients agreed. In addition to routine skin prick tests and RAST, quantitative skin prick tests (QSPT) and bronchial provocation tests (BPT) were also performed with the suspected mite allergens. The results were correlated with aspects of the domestic and working environments. Furthermore we questioned whether the outcome of BPT could be predicted from the results of the routine skin tests/RAST and QSPT respectively. Out of a total of 145 BPTs there were 79 positive results with SM and/or HSM. Three patients were mono-allergic to SM. The correlation with the domestic environment was unremarkable. Correlation with occupational factors revealed a strong predominance of farmers (42 of 90) and suggested the same for professions involved in work in dust-laden environments like bakers (5 of 90) and workers in wood- and paper industry (7 of 90). This also means, that SM-allergy occurs in persons not occupationally exposed to dust. A prediction as to the allergological relevance of SM-allergen was not possible from viewing the routine skin prick test however positive RAST data showed a significant correlation with positive BPT to SM Lepidoglyphus. Similarly it was possible to draw an inference from QSPT as to the relevant allergy. With a positive QSPT to the SM Lepidoglyphus destructor a positive result with a BPT was highly probable. Due to small numbers it is not possible to make a similar statement for the other SM species (Acarus and Tyrophagus).

The National Disease Management Program (NDM Program) represents the basic content of structured, cross-sectoral healthcare. In particular, the NDM Program is directed towards coordinating different disciplines and areas of healthcare. The recommendations are developed through interdisciplinary consensus of the scientific medical societies on the basis of the best available evidence. Within this scope the scientific medical societies concerned with the prevention, diagnosis, therapy and rehabilitation of asthma consented upon a National Disease Management Guideline for Asthma in 2005. Among other things, the following cornerstones of asthma prevention were agreed upon: Breastfeeding and non-smoking were suggested as primary prevention measures for (expectant) parents. With respect to secondary prevention, recommendations have been made for allergen avoidance, active/passive smoking and immunotherapy. Regarding tertiary prevention, position statements on vaccination and specific immunotherapy are developed. The present paper presents both the original texts of the recommendations and the evidence underlying them.

In the past clinical guidelines were mainly developed by experts and in everyday clinical practice almost exclusively used by clinical experts, while issues that were relevant from the patients' (consumers') point of view tended to be neglected. But then, the majority of patient information has not been perceptibly connected to clinical guidelines. Connecting the development of clinical guidelines with the development of patient information publications would make good sense for both products, though. On the one hand, evidence-based treatment guidelines could be made available to the actual target group of the clinical care process--i.e. the patients or consumers--and on the other hand, patient experiences and competencies (social evidence) might inform the production of guidelines. Such a procedure demands the cooperation of clinical experts and patients. So far there are no generally accepted methods in Germany for the practical implementation of consumer involvement on both the organizational and content level with the aim of involving patients in the development process of guidelines as well as the production of the respective patient information versions. Such a methodology shall be established as part of the National Program for Disease Management Guidelines. For the first time in this program, patient involvement is being exercised within the scope of the National Disease Management Guideline for Asthma (NDM Asthma). Here, patients are involved in the NDM development process by providing the opportunity to comment on the consented guideline draft and to participate in the translation of the NDM Asthma into a patient version. The present paper is a background report describing the current state of work and indicating consequences for some future developments.

Copyright of Praxis (16618157) is the property of Aerzteverlag medinfo AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Geographical Information Systems (GIS) are increasingly applied as modern tools for analysis and visualization of health-related spatial data, especially in epidemiological research. GIS are used by medical researchers and executives in the public health service. A community-based survey was conducted according to the phase II protocol of the International Study of Asthma and Allergies in Childhood (ISAAC) in Munich. The spatial patterns of disease incidence were analysed and related to exposure data by GIS. The prevalence study on fourth-grade pupils (n = 3354) and school beginners (n = 2890) was conducted during the school term 1995/96 in Munich. Parental questionnaires and measurements of lung function and immunological parameters were used. The questionnaire data were integrated in a GIS database. In this paper we discuss methodological aspects of GIS-based spatial analysis related to epidemiological data. In addition, we investigate whether there were spatial clusters of children with wheeze in the last 12 months of a magnitude unlikely to occur by chance and which could indicate local health risks. The study was based on permutation tests where global and local methods were applied. No spatial clusters of children with asthma symptoms were identified in the city of Munich.

Copyright of Der Hautarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Public Health (09431853) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Medical guidelines provide boundaries that are established for the medical community, within which clinical practice is considered to be acceptable. The main purpose for such guidelines is to improve the quality of care for patients. This can only be accomplished, however, if these documents are accepted and used effectively. In turn, acceptance of therapy guidelines essentially depends on both the structure and the presentation of the contents. GUIDELINES FOR THE TREATMENT OF ASTHMA were first issued in 1994 by the Deutsche Atemwegsliga. Since then, almost 4 years have passed, and our knowledge of the pathogenesis of asthma and drug efficacy has improved significantly. In addition, new classes of antiasthmatic drugs will be soon available. These developments make it necessary to adapt the guidelines to current knowledge., Proposals for Improvement: The paper proposes several aspects on improving the present guidelines and aims at fueling future discussions.

Patients with asthma often suffer from multiple allergies at the same time. Additionally many patients show a specific constellation of the interaction visible in the individual history, and at the same time in the actual doctor-patient relationship as well. In this short paper we will summarize the actual knowledge about the etiology of the disease, and also delineate the possible factors involved in producing the typical asthma attack. In the second part the most important therapeutic strategies are shown, with emphasis on psychosocial elements.

Systematic training of children and adolescents to cope with asthma has been practised in Germany for long years parallel to the development of training for adult asthmatics. An analysis conducted in mid-1992 revealed a considerable gap between the actual need for such training and the available training facilities. The analysis covered asthma training both for outpatients and inpatients including those referred to rehabilitation hospitals. The analysis revealed that there have been some achievements in the topics that were analysed (general framework of conditions for training, target groups of patients, agreement on the direction in which to proceed with regard to scope and aims, follow-up and aftercare, interdisciplinary exchange of ideas and actions, financing and government-piloted sponsorship by the compulsory health insurance bodies, qualification of the asthma pupils and evaluation), whereas in many cases these achievements are in the nature of a pilot study or of a matured model without meeting as yet the essential conditions for a full-range and adequate asthma training offer that can be realised in a sufficiently large area. However, a general consensus has been reached recently on medical contents of the training, on problems of methods and didactic approach and also on standards of evaluation. The paper expressing this general consensus was passed on the occasion of the 3rd Annual General Meeting of the Work Team for Asthma Training in Childhood and Adolescence. This means that the essential prerequisites for expanding the training programme from a local to a large-area programme have now been created.

Churg-Strauss syndrome has three main criterions: 1) severe asthma with fever attacks, 2) extra- and intravascular granulomatous proliferations of epitheloid and giant cells, 3) inflammatory infiltrates rich in eosinophilic leukocytes. All these features were given in the case of a 19-year-old woman, who died suddenly. This paper deals with the morphological findings of the forensic autopsy.

Copyright of Zeitschrift für Rechtsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The regression in morbidity of tuberculosis has changed the profile of the chest hospital. The number of patients with chronic obstructive lung diseases increased considerably. Special efforts are necessary for their diagnosis, therapy and assessment. Therefore it is favourable to concentrate patients with bronchial asthma in special departments and to qualify the medical staff in these special problems. In this paper a report is given on our own experience with such a special department for bronchial asthma in the last eight years.

The bronchodilation in childhood asthma bronchiale was studied by means of the suitable form of administration for that age, the paediatric syrup. We have chosen as active substance the hexoprenaline which has a long standing as a modern beta-2-selective bronchodilator. 2 different doses confirm a good effect and provide some margin, which is highly welcome, especially so in paediatry. The paper corroborates the importance of the measurement of the obstruction even in this age to confirm the diagnosis and the proposed therapy, we have used the optimal body plethysmography for that purpose. The plotting of the obstruction-pressure curve, which is a prerequisite for the calculation of the resistance, however, presents some methodical difficulties in infantile patients. The former statement of a possible sole information on the obstruction via the beta-flow curve was confirmed in a regression equation, it allows an about 80% significant determination of the resistance even without the alpha-curve.

The diagnosis of bronchial asthma is difficult because dyspnea as the leading symptom is ambiguous. Often other diseases with dyspnea are called asthma. For long term treatment it is necessary to know the pathogenesis of asthma and the factors triggering attacks. This in many cases needs special investigations. In the present paper some proposals are given to make a preliminary diagnosis on the basis of history and simple clinical findings, giving the indication for consecutive investigations respectively referring the patient to a specialist.