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The objective is to provide a comprehensive overview of the rapidly developing field of the current state of research on use of hypochlorous acid (HOCl) to aid infection prevention and control, including naso-pharyngeal, alveolar, topical, and systemic HOCl applications. Also, examples are provided of dedicated applications in COVID-19. A brief background of HOCl’s biological and chemical specifics and its physiological role in the innate immune system is provided to understand the effect of applications in the context of the body’s own physiological defense mechanisms.

Hintergrund: Anhaltende Symptome nach akuter Coronavirus-Krankheit-2019 (COVID-19) sind häufig und es besteht kein signifikanter Zusammenhang mit der Schwere der akuten Erkrankung. Bei Long COVID (anhaltende Symptome > 4 Wochen nach akuter COVID-19) treten häufig respiratorische Symptome auf, aber Lungenfunktionstests zeigen nur leichte Veränderungen, die die Symptome nicht erklären. Obwohl COVID-19 zu einer Beeinträchtigung des peripheren Nervensystems und der Skelettmuskulatur führen kann, wurde die Funktion der Atemmuskulatur in diesem Zusammenhang nicht untersucht. Methoden: In dieser Studie haben wir den Schweregrad der Dyspnoe (NYHA-Funktionsklasse) bei Long-COVID-Patienten untersucht und analysierten dessen Zusammenhang mit dem Body-Mass-Index (BMI), der Einsekundenkapazität (FEV1), der forcierten Vitalkapazität, anderen Parametern der Bodyplethysmographie, der Diffusionskapazität für Kohlenmonoxid (DLCO), den arteriellen Blutgasen und der Funktion der Atemmuskulatur, die anhand des Atemwegsokklusionsdrucks (P0,1) und des maximalen Inspirationsdrucks (PImax) in 2 Atemwegskliniken in Deutschland zwischen Oktober 2020 und August 2021 gemessen wurde. Ergebnisse: Insgesamt wurden 116 Patienten in die Studie aufgenommen. Das Durchschnittsalter betrug 50,2 ± 14,5 Jahre, BMI 26,7 ± 5,87 kg/m2, NYHA-Klasse I 19%, II 27%, III 41% und IV 14%. Während die Lungenfunktionswerte und die Computertomografie oder die konventionelle Röntgenaufnahme des Brustkorbs im normalen Bereich lagen, war die Funktion der Atemmuskulatur deutlich beeinträchtigt. Der P0,1 war auf 154 ± 83% des Sollwerts erhöht und der PImax war auf 41 ± 25% des Sollwerts reduziert. Die PImax-Reduktion war stark mit dem Schweregrad der Dyspnoe verbunden, aber nicht abhängig vom BMI, der Zeit nach der akuten COVID-19 und den meisten anderen Parametern. Schlussfolgerungen: Diese Studie zeigt, dass die Atemwegssymptome bei Patienten mit Long COVID hauptsächlich durch eine verminderte Inspirationsmuskelkraft verursacht sein können. Die Bewertung von PImax und P0,1 könnte eine Dyspnoe besser erklären als klassische Lungenfunktionstests und die DLCO. Eine prospektive Studie ist erforderlich, um diese Ergebnisse zu bestätigen. [ABSTRACT FROM AUTHOR]

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Copyright of Deutsches Ärzteblatt International is the property of Deutscher Aerzte-Verlag GmbH 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.)

Malignant primary tracheal tumours are rare. The most common histological subtypes are squamous cell carcinoma and adenoid cystic carcinoma. These two entities have different prognoses and growth patterns. Tracheobronchoscopy and thoracic sectional imaging are standard diagnostic tools for tumour staging and local evaluation. Complete surgical resection of the affected tracheal segment is the treatment of choice for limited disease without distant metastases. Incomplete gross tumour resection with additional irradiation is an acceptable therapeutic option for adenoid cystic carcinoma. Interventional endoscopy with tumour debulking or tracheal stenting and/or definitive mediastinal radiotherapy are treatment alternatives in either a locally advanced or palliative setting., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction:  The ambulantization of patient care that were previously provided as inpatient service is one of the goals of the current reform in the German healthcare system. In pulmonology, this particularly applies to endoscopic procedures. However, the real costs of endoscopic services, which form the basis for the calculation of a future so called hybrid DRG or in the AOP catalog, are unclear., Methods:  After selection of use cases including endoscopic procedures which can be performed on an outpatient basis by a committee of experts the appropriate DRGs were identified from the § 21-KHEntgG data for 2022 published by the Institute for the Hospital Remuneration System (InEK). The costs were calculated from the respective InEK cost matrix added by the calculated material costs., Results:  The use cases suitable for outpatient treatment were systematic endobronchial ultrasound (EBUS) with transbronchial needle aspiration (calculated costs € 2,175.60 without or € 3,315.60 including PET/CT), navigation-assisted bronchoscopy for peripheral lesions (depending on the methodology € 2,870.23 to €4,120.23) and diagnostic (flexible) bronchoscopy (€ 1,121.02)., Conclusion:  Outpatient treatment of endoscopic procedures that were previously performed inpatient is possible and necessary, and the costs calculated in this publication can form a reliable basis for appropriate reimbursement. Together with a structural quality that has been transformed to outpatient service and cross-sector cooperation, continued high-quality care for pneumological patients can be ensured., Competing Interests: Keiner der Autoren erklärte einen Interessenkonflikt. Die inspiring-health GmbH (M. Rathmayer, M. Tiefgraber, M. Wilke) hat als Berater für die Moderation der Arbeitsgruppensitzungen und die Durchführung der Kostenkalkulationen ein Beratungshonorar von der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e. V. erhalten., (Thieme. All rights reserved.)

Background: The PRiVENT project aims to improve the care of invasively ventilated patients and to reduce the number of out-of-hospital long-term ventilated patients. PRiVENT offers intensive care units the opportunity to exchange information with experts from specialized weaning centers in interprofessional weaning boards and weaning consults and to exploit the full weaning potential of the patients. In the context of the accompanying process evaluation, the PRiVENT intervention components will be examined for sustainability, scalability and effectiveness, and the interprofessional collaboration between intensive care units and the responsible weaning centers will be investigated in order to identify potentials for the care of invasively managed patients., Methods: In a qualitative cross-sectional study, semistructured, problem-oriented interviews were conducted with care providers of participating ICUs. The data were digitally recorded, pseudonymized and verbatim transcribed. Data analysis was based on Brown and Clarke's Thematic Analysis and the Consolidated Framework for Implementation Research. MAXQDA 2020 software was used to organize the data., Results: Fourteen interviews were conducted with ICU care providers. The early transfer of patients to a weaning center and the integration of pulmonary expertise into routine care were identified as positively perceived potentials of the weaning boards and weaning consults. Especially in critically ill, multimorbid patients suffering from COVID-19, the expertise of the weaning centers was considered helpful. Due to heavy workloads, nurses were unable to participate in weaning boards and weaning consults., Conclusion: Interprofessional collaboration between weaning centers and ICUs in weaning boards and weaning consults can improve the care of invasively ventilated patients. Strategies to promote the involvement of nurses should be discussed and developed., Competing Interests: Joachim Szecsenyi ist Gründer des aQUA Institutes. Franziska Trudzinski gibt folgende Interessenkonfilkte an: 1. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Grifols, Novartis, CSL Behring, Streamed up RG Gesellschaft für Information und Organisation mbH. 2. Participation on a Data Safety Monitoring Board or Advisory Board: CSL Behring, GlaxoSmithKline., (Thieme. All rights reserved.)

COSYCONET 1 is the only German COPD cohort which is large enough to be internationally comparable. The recruitment, which started in 2010 and ended in December 2013, comprised 2741 patients with the diagnosis of COPD who were subsequently investigated in regular follow-up visits. All visits included a comprehensive functional and clinical characterisation. On the basis of this detailed data set, it was possible to address a large number of clinical questions. These questions ranged from the prescription of medication, the detailed analysis of comorbidities, in particular cardiovascular disease, and biomarker assessment to radiological and health-economic aspects. Currently, more than 60 publications of COSYCONET data are internationally available. The present overview provides a description of all the results that were obtained, focussing on the relationship between different clinical and functional aspects as well as their potential practical consequences. In addition, information on the follow-up study COSYCONET 2 is given., Competing Interests: Kathrin Kahnert berichtet persönliche Einnahmen über Vortragstätigkeiten der Fa. Astra Zeneca und GSK, welche nicht in Zusammenhang mit der COSYCONET-Studie stehen. Carolina Fischer, Jürgen Behr, Rudolf Jörres, Felix, Herth, Sandra Söhler, Henrik Watz, Inge Kokot, Peter Alter berichten keine Interessenskonflikte. Klaus Rabe berichtet persönliche Einnahmen für Vortragstätigkeiten von Astra Zencea, Boehringer Ingelheim, Chiesie Pharmaceuticals, Novartis, Sanofi & Regeneron, GlaxoSmithKline, Berlin Chemie, Roche Pharma sowie die Teilnahme an Advisory Boards bei Astra Zeneca, Boerhinger Ingelheim und Sanofi & Regeneron, welche nicht in Zusammenhang mit der COSYCONET-Studie stehen. Claus Vogelmeier berichtet über Verträge zwischen dem BMBF, Astra Zeneca, Boehringer Ingelheim, Chiesie, CSL Behring, GlaxoSmithKline, Grifols, Novartis und der Philipps-Universität Marburg, zudem persönliche Einnahmen über Vortragstätigkeiten/Beratungen bei den Firmen Aerogen, Astra Zeneca, Boehringer Ingelheim, CSL Behring, Chiesi, GlaxoSmithKline, Insmed Menarini, Novartis, Nuvaira, Insmed Menarini, außerhalb der vorliegenden Arbeit. Franziska Trudzinski berichtet persönliche Einnahmen über Vortragstätigkeiten der Fa. Boehringer Ingelheim, Chiesie, GlaxoSmithKline, Grifols, Novartis, CSL Behring, welche nicht in Zusammenhang mit der COSYCONET-Studie stehen. Tobias Welte berichtet über Verträge zwischen dem BMBF, GSK, Novartis, Astra Zeneca, Boehringer Ingelheim und der Medizinischen Hochschule Hannover, zudem persönliche Einnahmen über Vortragstätigkeiten/Beratungen für Astra Zeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesie, GSK, Novartis außerhalb der vorliegenden Arbeit. Hans-Ulrich Kauczor berichtet Unterstützung der Fa. Bayer an die Universität Heidelberg (Verbrauchsmaterial), Verträge zwischen den Fa. Philips, Siemens und Boehringer Ingelheim zu der Universität Heidelberg, ferner persönliche Einnahme über Vortrags- und Beratertätigkeiten bei Siemens, Philips, Boehringer Ingelheim, MSD, Sanofi außerhalb der hier eingereichten Arbeit. Robert Bals berichtet persönliche Einnahmen über Vortrags- und Beratertätigkeiten von AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Grifols, Novartis, CSL Behring sowie Fördermittel für das Institut des BMBF, des Competence Network Asthma and COPD (ASCONET), Sander Stiftung, Schwiete Stiftung, Krebshilfe, Mukoviszidose e.V. außerhalb der eingereichten Arbeit., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Substantial new data on the early detection of lung cancer with low-dose CT has become available since the last joint statement of the German Radiological Society and the German Respiratory Society was published in 2011. The German S3 guideline on lung cancer was revised in 2018 and now contains a weak recommendation regarding the early detection of lung cancer with low-dose CT in a quality-assured early detection program. These new developments required a change in the position of the involved professional societies. This joint statement describes the main features of a quality-assured program for the early detection of lung cancer with low-dose CT in Germany. KEY POINTS::   · New study data on early detection of lung cancer with low-dose CT and the new German S3 guideline on lung cancer required a new positioning of the involved professional societies.. · The involved professional societies strongly recommend that low-dose CT examinations for early detection of lung cancer should only be performed within a quality-assured program.. · The article describes some fundamentals of such a quality-assured early detection program.. CITATION FORMAT: · Wormanns D, Kauczor H, Antoch G et al. Joint Statement of the German Radiological Society and the German Respiratory Society on a Quality-Assured Early Detection Program for Lung Cancer with Low-Dose CT. Fortschr Röntgenstr 2019; 191: 993 - 997., Competing Interests: The authors declare that they have no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Advanced emphysema and asthma constitute major health burden worldwide and are associated with significant morbidity and mortality. Pharmacological options are limited. Researches are being carried out aiming to modify the natural course of both the diseases. Lung volume reduction surgeries are performed in advanced emphysema but are associated with significant morbidity and prolonged hospital stay. Various minimally invasive bronchoscopic methods have been developed with the goal of achieving clinical benefits of volume reduction surgery but lower complications. Bronchial thermoplasty is a bronchoscopic method of delivering controlled heat in the airways to reduce airway smooth muscle mass, thereby reducing bronchoconstriction in patients with severe asthma who remain uncontrolled despite optimal medical therapy. Various randomised controlled trials have been performed to evaluate the safety and efficacy of various endoscopic treatments like valves, coils, use of sclerosants and targeted lung denervation for severe emphysema and bronchial thermoplasty in severe asthma. The current review summaries the clinical trial evidence available for lung volume reduction in emphysema and thermoplasty in asthma and provide guidance for optimal patient selection for various therapies available.

In Germany, 10,000 cases of spontaneous pneumothorax are treated inpatient every year. The German Society for Thoracic Surgery (DGT), in co-operation with the German Society for Pulmonology (DGP), the German Radiological Society (DRG) and the German Society of Internal Medicine (DGIM) has developed an S3 guideline on spontaneous pneumothorax and postinterventional pneumothorax moderated by the German Association of Scientific Medical Societies (AWMF)., Method: Based on the source guideline of the British Thoracic Society (BTS2010) for spontaneous pneumothorax, a literature search on spontaneous pneumothorax was carried out from 2008 onwards, for post-interventional pneumothorax from 1960 onwards. Evidence levels according to the Oxford Center for Evidence-Based Medicine (2011) were assigned to the relevant studies found. Recommendations according to GRADE (A: "we recommend"/"we do not recommend", B: "we suggest"/"we do not suggest") were determined in three consensus conferences by the nominal group process., Results: The algorithms for primary and secondary pneumothorax differ in the indication for CT scan as well as in the indication for chest drainage application and video-assisted thoracic surgery (VATS). Indication for surgery is recommended individually taking into account the risk of recurrence, life circumstances, patient preferences and procedure risks. For some forms of secondary pneumothorax, a reserved indication for surgery is recommended. Therapy of postinterventional spontaneous pneumothorax is similar to that of primary spontaneous pneumothorax., Discussion: The recommendations of the S3 Guideline provide assistance in managing spontaneous pneumothorax and post-interventional pneumothorax. Whether this will affect existing deviant diagnostic and therapeutic measures will be demonstrated by future epidemiological studies., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart · New York.)

As is the case with younger patients, the treatment decisions for elderly patients with thoracic tumours are primarily based on the results of the usual routine diagnostics. Standardised assessments of existing comorbidities and geriatric assessments may provide information which are of particular relevance for intensive and/or complex therapy modalities and which may require early corresponding intervention or measures for support., (Copyright 2008 S. Karger AG, Basel.)

Through the introduction of new techniques, bronchoscopy, a standard tool for years, has made great strides within the last years. With the introduction of endobronchial ultrasound, staging can be improved considerably in patients with lung carcinoma, thereby also leading to a better estimate of the patient's prognosis. By means of navigation techniques it is possible today to biopsy even smaller coin lesions, so that the number of diagnostic operations should decline in the next years. Also in the therapy of lung emphysema, an endoscopic technique is now available as a further treatment option. There is a good chance that broader possibilities and fields of application of bronchoscopy will emerge.