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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.

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).

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.

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.

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).

Health-related quality of life (HRQoL) denotes the patients' perception of well-being and function in physical, emotional, mental, social and everyday life areas. In adult medicine, HRQoL has been established as an outcome criterion to evaluate the quality and effect of different therapies. During the past 20 years, a multitude of instruments to assess HRQoL has been developed, mostly for adults, complying with psychometric standards concerning the reliability, validity and sensitivity of the scales. HRQoL research in children, however, is still in a developmental stage. The present paper describes challenges to the assessment of quality of life in children and adolescents: approaches to assess quality of life include patients' self-report versus report by other persons. Interviews, questionnaires and computer-assisted methods have been used. Generic and disease-specific (targeted) instruments can be applied. Frequently used generic measures are described and an international project to develop a set of quality of life instruments for children with chronic conditions is reported. The application of these measures in the research context using examples from a German prospective study in pediatric rehabilitation is exemplarily described and highlights the potential benefit of implementing these methods in epidemiologic and clinical studies.

The monoclonal anti-IgE antibody omalizumab is currently approved for the treatment of severe asthma. Randomized controlled trials for the indication atopic eczema have not yet been performed. This paper summarizes the current evidence on the effectiveness of omalizumab in atopic eczema. Using a systematic electronic search strategy, we identified three case series. These suggest that a subgroup of patients with extrinsic atopic eczema but only moderately elevated IgE levels might benefit most from omalizumab treatment. A randomized controlled trial should be performed to clarify the potential benefit of omalizumab for patients with atopic eczema. Additionally, such a study might help us to better understand the role of IgE in the pathogenesis of atopic eczema.

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.

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.

Successful allergen-specific immunotherapy (SIT) induces complex immunologic chan-ges resulting in reduced allergic inflammatory reactions. SIT has long-term effects in mild forms of inhalant allergies and is effective even when standard pharmacotherapy fails. Moreover, the risk to develop additional allergic sensitizations and the development of asthma is significantly reduced in children with allergic rhinitis. SIT is the treatment of choice in patients with systemic reactions to hymenoptera venoms. Although the exact effector mechanisms of SIT still have to be clarified, the most probable effect is a modulation of regulatory T cells associated with a switch of allergen-specific B-cells towards IgG4 production. The critical point to insure efficacy and safety is the selection of patients and allergens, task best performed by a specialist trained in allergology. Further details are available in the position papers of the German allergy societies - DGAI(Deutsche Gesellschaft fiir Allergologie und Klinische Immunologie) and ADA (Arzte-verband Deutscher Allergologen) - which can be found at www.dgaki.de.

It is increasingly suggested that there may be a connection between gastrooesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) and chronic sinusitis. We therefore wished to establish whether the literature contains sufficient evidence to support this assumption.We performed a search in Medline (PubMed) and EMBASE with the key words "GERD, GER, reflux, sinusitis, chronic sinusitis". The literature obtained was assessed with regard to the reported results and their evidence levels. The level of evidence was classified according to the usual levels I - IV, only levels Ia or Ib being considered sufficient evidence for a knowledge gain confirmed by therapeutic trials.A total of 77 references were found in Medline and 142 in EMBASE. A large number of these were narrative review articles addressing the connection between GERD or sinusitis and asthma or GERD or sinusitis and chronic cough. Only 12 papers and one case report dealt more or less directly with the question of a connection between chronic sinusitis and reflux. None of the studies could be classed as evidence level I (randomised controlled trials), ten were classed as level III studies, one as level IIb and one as level IV.The existing studies do not allow us to pinpoint LPR (and even less so GERD) as a clear-cut factor in the aetiopathogenesis of chronic sinusitis. However, despite all their deficiencies and limitations the studies nevertheless do show that reflux into the pharynx and nasopharynx is possible. This reflux (= LPR) can lead to chronic inflammation which can be successfully treated with antireflux therapy with proton pump inhibitors. Quantification of the association is not currently possible. An above-average proportion of the patients with chronic rhinosinusitis appear to have GERD/LPR. However the prevalence of GERD in the population is generally high. It has not yet been established with sufficient certainty whether the LPR must be regarded as a causative factor, whether it exacerbates or chronifies the disease or whether it is merely an epi-phenomenon which does not require specific treatment. To answer this important question we need prospective randomised controlled studies which will provide evidence of sufficient quality. These should be conducted with the help of standardised documentation.

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.

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.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.

The present paper focuses on the relation between control beliefs and the compliance of adolescents suffering from chronical diseases. It is assumed that the compliance will be high when the own behavior is regarded as most important for the improvement during illness (internal locus of control). A high compliance is also expected when the own state of health is seen as dependent from other persons, who are engaged in the therapeutic process (powerful others locus of control). Little compliance is expected when the state of health is regarded as dependent from fate or chance influences (chance locus of control). Thereover, it is assumed that the control beliefs are influenced by the specific disease of a patient, since diseases are controllable by the patients in different degrees and therefore should result in specific control beliefs. The theoretical assumptions were proved in an empirical study with 80 patients suffering from different diseases (Diabetes mellitus, Asthma bronchiale, Alopecia areata) and 366 healthy adolescents and adults. The results show a clear dependency of the control beliefs from the kind of disease of the patients. However, the relations between control beliefs and compliance are discrepant to the expectations which is shown mainly by null or negative correlations between internality and compliance. The empirical relations are explained by the self-reliant behavior of the internal patients which perhaps shows little compatibility to traditional concepts of compliance. The implications of the present results for the enhancement of compliance and for the definition of the compliance-concept are elaborated and discussed.

The radioallergosorbent test (RAST) has been used for in vitro diagnosis of asthma. The paper reports about 70 investigations in 40 patients with house dust and mite allergy. In 75 p. c. the test was positive, especially in mite allergy. On the other hand increased total IgE levels only in about 50 p.c. correlated with positive case history and skin test results. After hyposensitization indeed a better correlation was found. --In conclusion RAST seems to be no alternative but a useful completion to the traditional diagnostic methods as skin test and provocations test especially in mite allergy and analogous situations, where provocation test is not usual.

In contrast to the assessment of the vocational activity there are no fixed principles with regard to the application of defined methods of examination and the interpretation of its results. The assessment cannot be based only on the results of pulmonary function testing but has to take into consideration also the frequency and severity of the troubles, their dependence on vocational influence and their therapeutic management. The result of the function test using all given possibilities is essential. Sometimes are of decisive importance the arrangement of a mitable place of employment, the patient attitude to his disease and his vocational activities. In this paper proposals are given for a complex assessment of the physical capacity and invalidity in bronchial asthma.

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 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.

There are no fixed rules for the assessment of invalidity in chronic bronchitis and its complications. The methods of examination and the interpretation of the results are very different. The main cause of invalidity is diminished cardiopulmonary function. Therefore, lung function tests are of great importance. But some other important aspects have to be considered too, f.e. concomitant diseases, age and profession, possibilities to arrange a suitable place of employment, results of treatment. In this paper are discussed proposals for a complex assessment of invalidity including social and psychological aspects.