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Zusammenfassung Hintergrund Diese Studie untersucht aktuelle Bedürfnisse und Belastungen von ambulanten Krebspatienten im Rahmen der COVID-19-Pandemie. Material und Methoden Zwischen 11/2020 und 02/2021 wurden 122 ambulante Krebspatientinnen und -patienten des Comprehensive Cancer Center München in die Studie eingeschlossen und anhand eines standardisierten, halbstrukturierten Interviews zu Wissensstand und Informationsbedürfnissen in Bezug auf COVID-19, Risikowahrnehmung und Sorgen hinsichtlich der ambulanten Krebsbehandlung, COVID-19-spezifischen Belastungen sowie zum Vertrauen in das Gesundheitssystem und der Impfbereitschaft befragt. Zusätzlich wurde psychosozialer Distress anhand des Distress-Thermometers (DT) erhoben. Ergebnisse Über ein Drittel der Krebspatienten (34,2 %, n = 41/120) hatte noch Informationsbedarf hinsichtlich der Auswirkungen des Coronavirus auf ihre Erkrankung oder Behandlung. 17,2 % (n = 21/122) waren von Veränderungen der laufenden oder geplanten Krebstherapie betroffen. Bei n = 42/121 (34,7 %) der Patienten zeigte sich ein erhöhter psychosozialer Distress (DT ≥ 5). Die häufigste Corona-spezifische Belastung war die Angst vor einer Überlastung des Gesundheitssystems (77,9 %, n = 95/122), gefolgt von der Befürchtung, dass sich Angehörige noch größere Sorgen um die betroffenen Patienten machen (56,2 %, n = 68/121). 71,2 % (n = 74/104) der Patienten sind bereit, sich impfen zu lassen; 60 % (n = 18/30) der zum Zeitpunkt der Untersuchung Unentschlossenen oder Ablehner wünschen sich vor einer endgültigen Entscheidung für die Impfung ein Informationsgespräch mit ihrem Onkologen/ihrer Onkologin. Schlussfolgerung Corona-spezifische Belastungen von Krebspatienten betreffen insbesondere den Verlauf der Therapie, aber auch eine mögliche Überlastung des Gesundheitssystems. Onkologische Behandler-Teams sollten Fragen ihrer Patienten Raum geben, mögliche Unsicherheiten anerkennen, emotionale Unterstützung leisten und auf valide Informationsquellen aufmerksam machen.

This study investigates current needs and psychosocial burden of out-patients with cancer during the COVID-19-Pandemic.Between 11/2020 and 02/2021 122 cancer patients who underwent out-patient treatment at the Comprehensive Cancer Center Munich participated in the study. Based on a standardized, semi-structured interview, participants were asked about their knowledge and informational needs related to COVID-19, risk perception and concerns regarding continuing out-patient treatment, COVID-19 related distress, confidence in the national health system, and their readiness to get vaccinated against COVID-19. Additionally, patients filled out the distress thermometer (DT).More than a third of the patients (34,2 %, n = 41/120) wanted to receive more information about the effects of the coronavirus on their cancer and their treatment. 17,2 % (n = 21/122) had faced changes concerning their current or planned treatment. 42/121 (34,7 %) of the patients were clinically distressed (DT ≥ 5). A possible overload of the health care system was the most commonly reported COVID-related concern (77,9 %, n = 95/122), followed by being concerned that their family members might be additionally worried about them (56,2 %, n = 68/121). 71,2 % (n = 74/104) of the patients are willing to be vaccinated; 60 % (n = 18/30) of those undecided or refusing at the time of the survey expressed a desire to have a consultation with an oncologist before giving their final consent to vaccination.Corona-specific distress of cancer patients relates in particular to the course of therapy, but also to a possible overload of the health care system. Oncology care teams should allow space for questions from their patients, acknowledge possible uncertainties, provide emotional support, and draw attention to reliable sources of information.Diese Studie untersucht aktuelle Bedürfnisse und Belastungen von ambulanten Krebspatienten im Rahmen der COVID-19-Pandemie.Zwischen 11/2020 und 02/2021 wurden 122 ambulante Krebspatientinnen und -patienten des Comprehensive Cancer Center München in die Studie eingeschlossen und anhand eines standardisierten, halbstrukturierten Interviews zu Wissensstand und Informationsbedürfnissen in Bezug auf COVID-19, Risikowahrnehmung und Sorgen hinsichtlich der ambulanten Krebsbehandlung, COVID-19-spezifischen Belastungen sowie zum Vertrauen in das Gesundheitssystem und der Impfbereitschaft befragt. Zusätzlich wurde psychosozialer Distress anhand des Distress-Thermometers (DT) erhoben.Über ein Drittel der Krebspatienten (34,2 %, n = 41/120) hatte noch Informationsbedarf hinsichtlich der Auswirkungen des Coronavirus auf ihre Erkrankung oder Behandlung. 17,2 % (n = 21/122) waren von Veränderungen der laufenden oder geplanten Krebstherapie betroffen. Bei n = 42/121 (34,7 %) der Patienten zeigte sich ein erhöhter psychosozialer Distress (DT ≥ 5). Die häufigste Corona-spezifische Belastung war die Angst vor einer Überlastung des Gesundheitssystems (77,9 %, n = 95/122), gefolgt von der Befürchtung, dass sich Angehörige noch größere Sorgen um die betroffenen Patienten machen (56,2 %, n = 68/121). 71,2 % (n = 74/104) der Patienten sind bereit, sich impfen zu lassen; 60 % (n = 18/30) der zum Zeitpunkt der Untersuchung Unentschlossenen oder Ablehner wünschen sich vor einer endgültigen Entscheidung für die Impfung ein Informationsgespräch mit ihrem Onkologen/ihrer Onkologin.Corona-spezifische Belastungen von Krebspatienten betreffen insbesondere den Verlauf der Therapie, aber auch eine mögliche Überlastung des Gesundheitssystems. Onkologische Behandler-Teams sollten Fragen ihrer Patienten Raum geben, mögliche Unsicherheiten anerkennen, emotionale Unterstützung leisten und auf valide Informationsquellen aufmerksam machen.

BackgroundPoor medication-adherence is common in chronic lung patients, resulting in reduced health-outcomes and increased healthcare-costs. This study aimed to investigate the impact of an acoustic reminder and support calls on adherence to inhaled therapy in asthma and COPD patients and to determine their effect on exacerbations.MethodsThis single-blinded randomized controlled trial investigated asthma and COPD patients during 6 months in an ambulatory setting. The intervention consisted of daily alarm clock and support phone calls, whenever use of rescue medication doubled or inhaled medication was not taken as prescribed. Primary outcome was time to next exacerbation. Frequency of exacerbations, adherence to inhaled medication and quality of life scores were secondary outcomes. Cox and Poisson regression were used to determine intervention effect on time to exacerbation and frequency of exacerbations, respectively.ResultsSeventy-five participants were assigned to the intervention group and 74 to usual follow-up care. During a median follow-up of 6.2 months, 22 and 28% in the intervention and control groups respectively, experienced at least one exacerbation. Intervention had no effect on time to first exacerbation (HR 0.65, 95% CI 0.21 to 2.07,P = .24), but showed a trend toward a 39% decreased frequency of exacerbations (RR = 0.61, 95% CI 0.35 to 1.03,P = .070) for the adjusted models, respectively. The intervention group had significantly more days with 80–100% taking adherence regarding puff inhalers (82 ± 14% vs. 60 ± 30%,P P = .01). Timing adherence in participants using puff inhalers was higher in the intervention group (69 ± 25% vs. 51 ± 33%,P ConclusionParticipants assigned to the intervention group had significantly better taking and timing adherence of inhaled medication resulting in a trend towards a decreased frequency of exacerbations. However, no effect on time to next exacerbation was observed.Trial registrationClinicalTrials.gov:NCT02386722, Registered 14 February 2014.

Despite important advances in diagnosis and medical therapy of heart failure (HF), disease monitoring and therapy guidance remains to be based on clinical signs and symptoms. NT-proBNP was repeatedly demonstrated to be a strong and independent predictor of morbidity and mortality in patients with HF. Only few - and conflicting - data are available on the efficacy of serial measurement of NT-proBNP as a tool for treatment monitoring in HF. These data are limited to the outpatient setting. Currently, no data are available on the effects of this approach in patients hospitalized for acute decompensated HF. The goal of this study is to explore whether the availability of serial NT-proBNP measurements may influence treatment decisions in patients with acute decompensated HF, and whether this leads to more rapid dose adjustments of prognostically beneficial medical therapies and earlier hospital discharge. In the intervention group, serial measurements of NT-proBNP every second business day are performed and made available to the treating physician, while no serial measurements are available in control group. HF therapy is left at the discretion of the treating physician. The primary endpoints are defined as the effects of monitoring NT-proBNP on medical HF therapy decisions, including type and dosing of medical therapies and the rapidity of adjustments, length of hospital stay, and evaluation of the changes in NT-proBNP values. Additional secondary endpoints include incidence of electrolyte imbalances and renal failure, changes in NYHA functional class, vital signs, body weight, quality of life, incidence of adverse events, transfer to Intensive Care Units, and mortality.

Introduction: Chronic obstructive pulmonary disease (COPD) is a widely spread chronic disease. In Switzerland, it is estimated that 400’000 patients suffer from COPD and 65million worldwide. Aims and Objectives: The Swiss COPD Cohort Study (SCCS) was established in 2006 to asses COPD management in primary care. To date little is known about factors associated with changes in COPD therapy. Therefore, we evaluated determinants for therapy change. We hypothesized that exacerbations and a high burden of symptoms would be predictive. Method: The SCCS is an ongoing questionnaire-based study. General practitioners recruited patients with a spirometrically diagnosed COPD. Every 6 months information about symptoms, exacerbations, treatment and comorbidities were collected. Data of patients included from 2015-2019 were used and screened for therapy change. A logistic mixed model was performed to detect predictors. Results: 195 patients with 690 visits were included. The mean age was 68.1 (37-90) years, 35.4% were female, the mean FEV1 was 60.9 (±18.13) and most patients had COPD GOLD A or B (81.5%). 69% of the visits were without therapy changes. In 31%, a treatment adjustment was detected, whereof 34% presented a step-up in therapy, 32% a step-down and 34% a step-up and step-down in one visit. Exacerbation, GOLD stage C, D and severe airway obstruction GOLD 3-4 were associated with treatment changes. If comorbidities were present, therapy changes were less likely. Conclusion: This analysis demonstrates that in most visits there were no therapy changes. If adjustments were made, they were linked to exacerbation, GOLD stage and severity of airflow limitation. Comorbidities showed a negative association with therapy changes.

Background: Poor medication-adherence is common in chronic lung patients, resulting in reduced health-outcomes and increased healthcare-costs. Objective: To investigate the impact of an acoustic reminder and support calls on adherence to inhaled therapy in asthma and COPD patients and to determine their effect on exacerbations. Methods: This single-blinded randomized trial investigated patients during 6 months. Exacerbations were recorded and adherence to inhaled medication was monitored using electronic data capture devices. Cox and Poisson regression were used to determine intervention effect on time to exacerbation and frequency of exacerbations, respectively. Results: Of 149 eligible patients, 75 participants were assigned to the intervention group and 74 to usual follow-up care. During follow-up, 22% and 28% in the intervention and control groups respectively, experienced at least one exacerbation. Intervention had no effect on time to first exacerbation (HR 0.62, 95% CI 0.20 to 1.91, p=.20), but showed a trend toward a 39% decreased frequency of exacerbations (RR=0.61, 95% CI 0.35 to 1.03, p=.070). The intervention group had significantly more days with 80-100% taking adherence regarding puff inhalers (82±14% vs. 60±30%, p Conclusion: Patients in the intervention group had significantly better taking and timing adherence of inhaled medication resulting in a trend towards a decreased frequency of exacerbations. However, no effect on time to next exacerbation was observed.

Background: Prevalence and impact of chronic rhinosinusitis (CRS) in chronic obstructive pulmonary disease (COPD) remain unclear. We hypothesized that CRS is more frequent in patients with COPD compared to controls and we aimed to evaluate the odds of CRS in both groups. Methods: We recruited patients with COPD and a healthy control group in a tertiary referral hospital in Switzerland. Diagnosis of CRS was defined according to published guidelines and supported by computed tomography (CT) findings. Sino-nasal-outcome-test-20 (SNOT-20) and sino-nasal-outcome-test-primary-nasal-symptom-score (SNOT-PNS-score) were self-assessed with a cut-off for abnormality of >12. Results: Data from 83 COPD patients (35 females, age: 67 years ± 10) and 34 controls (18 females, age: 67 years ± 12) were analyzed. In the COPD group 14 out of 83 (20.3%) fulfilled the diagnosis of CRS compared to only 1 out of 34 (3%) in the control group (OR 6.7; 95% CI 0.84-53.10; p = 0.064). Forty-eight COPD patients (59%) and 14 controls (41%) had an abnormal SNOT-20 score (OR 1.96; 95% CI 0.87-4.40; p=0.10), with a median score of 16.0 (ICR 21) in COPD patients compared to a median score of 8.0 (ICR 13) in controls (p=0.001). The SNOT-PNS-score was abnormal in 49 COPD patients (59%) and in 9 controls (26%) (OR 4.00; 95% CI 1.66-9.64; p=0.001). Abnormal findings of the upper airways did not correlate with COPD severity or smoking status. Conclusions: CRS was a frequent diagnosis in patients with COPD. CRS reduces quality of life in this patient group.

Background: The Swiss COPD cohort was established in 2006 to collect data in a primary care setting. The objective of this study was to evaluate possible predictive factors for exacerbation and re-exacerbation. Methods: In order to predict exacerbation until the next visit based on the knowledge of exacerbation since the last visit, a multistate model described by Therneau and Grambsch was performed. Results: Data of 1,247 patients (60.4% males, 46.6% current smokers) were analyzed, 268 (21.5%) did not fulfill spirometric diagnostic criteria for COPD. Data of 748 patients (63% males, 44.1% current smokers) were available for model analysis. In order to predict exacerbation an extended Cox Model was performed. Mean FEV1/FVC-ratio was 53.1% (±11.5), with a majority of patients in COPD GOLD classes 2 or 3. Hospitalization for any reason (HR1.7; P = 0.04) and pronounced dyspnea (HR for mMRC grade four 3.0; P < 0.001) at most recent visit as well as prescription of short-acting bronchodilators (HR1.7; P < 0.001), inhaled (HR1.2; P = 0.005) or systemic corticosteroids (HR1.8; P = 0.015) were significantly associated with exacerbation when having had no exacerbation at most recent visit. Higher FEV1/FVC (HR0.9; P = 0.008) and higher FEV1 values (HR0.9; P = 0.001) were protective. When already having had an exacerbation at the most recent visit, pronounced dyspnea (HR for mMRC grade 4 1.9; P = 0.026) and cerebrovascular insult (HR2.1; P = 0.003) were significantly associated with re-exacerbation. Physical activity (HR0.6; P = 0.031) and treatment with long-acting anticholinergics (HR0.7; P = 0.044) seemed to play a significant protective role. In a best subset model for exacerbation, higher FEV1 significantly reduced and occurrence of sputum increased the probability of exacerbation. In the same model for re-exacerbation, coronary heart disease increased and hospitalization at most recent visit seemed to reduce the risk for re-exacerbation. Conclusion: Our data confirmed well-established risk factors for exacerbations whilst analyzing their predictive association with exacerbation and re-exacerbation. This study confirmed the importance of spirometry in primary care, not only for diagnosis but also as a risk evaluation for possible future exacerbations. Trial registration: Our study got approval by local ethical committee in 2006 (EK Nr. 170/06) and was registered retrospectively on ClinicalTrials.gov (NCT02065921, 19th of February 2014).

Background The burden of asthma and COPD among patients is high and people affected are frequently hospitalized due to exacerbations. There are numerous reasons for the lack of disease control in asthma and COPD patients. It is associated with non-adherence to guidelines on the part of the health care provider and with poor inhalation technique and/or non-adherence to the prescribed treatment plan by the patient. This study aims to present data on inhaler technique and its impact on quality of life (QoL) and symptom control in a typical population of patients with chronic lung disease from a randomized controlled trial on medication adherence. Methods For this cross-sectional analysis, 165 asthma and COPD patients were analyzed. Correct application of inhaler devices was tested using pre-defined checklists for each inhaler type. QoL and symptom control were investigated using COPD Assessment Test (CAT) and Asthma Control Test (ACT). Spirometry was used to measure forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Results Overall, incorrect inhalation technique ranged from 0 to 53% depending on the type of inhaler. COPD patients with incorrect device application had a higher CAT sum score compared to those with a correct device application (P = .02). Moreover, COPD patients with incorrect device application were more likely to suffer from cough (P = .03) and were more breathless while walking uphill or a flight of stairs (P = .02). While there was no significance found in asthma patients, COPD patients who used their devices correctly had a significantly better mean FEV1% predicted at baseline compared to those who applied their devices incorrectly (P = .04). Conclusions Correct inhalation of prescribed medication is associated with improved health status and lung function. These findings should encourage health professionals to provide instructions on correct inhalation technique and to regularly re-evaluate the patients’ inhalation technique. Trial registration ClinicalTrials.gov: NCT0238672, Registered 14 February 2014.

Background Some sleep disorders are known risk factors for occupational injuries (OIs). This study aimed to compare the prevalence of obstructive sleep apnea syndrome (OSAS) in a population of patients with OIs admitted to the emergency room (ER) with hospital outpatients as controls. Methods Seventy-nine patients with OIs and 56 controls were recruited at the University Hospital of Basel, Switzerland between 2009 and 2011. All patients completed a questionnaire and underwent a full-night attended polysomnography (PSG). We considered an apnea–hypopnea index (AHI) > 5 as an abnormal finding suggestive of a diagnosis of OSAS. Results Patients with OIs did not differ from controls regarding sex, age, body mass index, and job risk of OI. Patients with OIs tended to have an abnormal AHI (n = 38 [48%] vs. n = 16 [29%], odds ratio [OR] = 2.32 [95% confidence interval (CI):1.05–5.13]), and a higher AHI (8.0 vs. 5.6 events/h; Cohen’s d 0.28, p = 0.028) compared with controls. Patients with OIs also had abnormal limb movement index, arousal index, and signs of sleep bruxism compared with controls. Compared with 36 controls (66%), 70 patients with OIs (89%) had either excessive daytime sleepiness (EDS), and/or an abnormal finding during PSG (OR = 4.32, 95% CI:1.65–11.52). However, patients with OIs did not differ from controls regarding EDS or oxygen desaturation index. Conclusions Patients treated in the ER for OI had more abnormal findings suggestive of OSAS or other sleep disorders compared with a control group of hospital outpatients. Screening for these conditions should be part of the postaccident medical investigation.

BACKGROUND Obstructive sleep apnea syndrome (OSAS) is common in adults. People with OSAS have a higher risk of experiencing traffic accidents and occupational injuries (OIs). We aimed to clarify the diagnostic performance of a three-channel screening device (ApneaLinkTM) compared with the gold standard of full-night attended polysomnography (PSG) among hospital outpatients not referred for sleep-related symptoms. Furthermore, we aimed to determine whether manual revision of the ApneaLinkTM autoscore enhanced diagnostic performance. METHODS We investigated 68 patients with OI and 44 without OI recruited from the University Hospital Basel emergency room, using a cross-sectional study design. Participating patients spent one night at home with ApneaLinkTM and within 2 weeks slept for one night at the sleep laboratory. We reanalyzed all ApneaLinkTM data after manual revision. RESULTS We identified significant correlations between the ApneaLinkTM apnea-hypopnea index (AHI) autoscore and the AHI derived by PSG (r = 0.525; p

With respect to the overweight epidemic, this study aimed to investigate the association between domain-specific physical activity and body composition measures in Swiss male employees.; A total of 192 healthy male adults in full-time employment were investigated. Height, weight, and waist circumference were measured and body mass index was calculated. Relative fat mass and relative muscle mass were determined by bioelectric impedance analysis. Physical activity was assessed by the validated International Physical Activity Questionnaire.; In multiple linear regressions, leisure-time activity showed an inverse association with waist circumference and relative fat mass and a positive correlation with relative muscle mass. Work activity was positively related to waist circumference and body mass index.; This study shows that leisure-time activity may be the most effective physical activity domain for body composition. Work activity does not seem to be protective against overweight.

In the therapy of chronic obstructive pulmonary disease (COPD), it is a major goal to improve health-related quality of life (HRQOL). Patients with COPD often suffer from exertional dyspnea and adopt a sedentary lifestyle, which could be associated with poorer HRQOL. The aim of this study was to investigate the independent association of objectively measured daily physical activity and functional capacity with HRQOL in patients with COPD.In this cross-sectional study conducted at the University Hospital Basel, Switzerland, 87 stable patients (58.6% male, mean age: 67.3 ± 9.6 yrs) with COPD in GOLD grades I (n = 23), II (n = 46), III (n = 12) and IV (n = 6) were investigated. To assess HRQOL, the COPD assessment test (CAT) was completed. Patients performed spirometry and 6-min walk test. Physical activity was measured by the SenseWear Mini Armband on 7 consecutive days. By performing a multiple linear regression analysis, independent predictors of CAT score were identified.Age (β = -0.39, p = 0.001), average daily steps (β = -0.31, p = 0.033) and 6-min walk distance (β = -0.32, p = 0.019) were found to be independent predictors of CAT score, whereas physical activity duration above 3 METs (p = 0.498) and forced expiratory volume in 1 s in% of predicted (p = 0.364) showed no significant association.This study showed that average daily steps and functional capacity are independent determinants of HRQOL in patients with COPD. This emphasizes the importance to remain active and mobile, which is associated with better HRQOL.

Background: Existing prediction models for mortality in chronic obstructive pulmonary disease (COPD) patients have not yet been validated in primary care, which is where the majority of patients receive care. Objectives: Our aim was to validate the ADO (age, dyspnoea, airflow obstruction) index as a predictor of 2-year mortality in 2 general practice-based COPD cohorts. Methods: Six hundred and forty-six patients with COPD with GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I-IV were enrolled by their general practitioners and followed for 2 years. The ADO regression equation was used to predict a 2-year risk of all-cause mortality in each patient and this risk was compared with the observed 2-year mortality. Discrimination and calibration were assessed as well as the strength of association between the 15-point ADO score and the observed 2-year all-cause mortality. Results: Fifty-two (8.1%) patients died during the 2-year follow-up period. Discrimination with the ADO index was excellent with an area under the curve of 0.78 [95% confidence interval (CI) 0.71-0.84]. Overall, the predicted and observed risks matched well and visual inspection revealed no important differences between them across 10 risk classes (p = 0.68). The odds ratio for death per point increase according to the ADO index was 1.50 (95% CI 1.31-1.71). Conclusions: The ADO index showed excellent prediction properties in an out-of-population validation carried out in COPD patients from primary care settings.

Aim: The aim of this study is to investigate the effects of an acoustic reminder on medication adherence in lung patients. Methods: In this on-going prospective single-blind randomized controlled trial, in- and outpatients from several hospitals around Basel diagnosed with asthma or COPD and with prescribed inhalative medication were recruited. They must have experienced at least one exacerbation in the previous 12 months. The intervention group is provided with an acoustic reminder for inhalation and receives support calls when the medication is not taken as prescribed.In both groups, adherence was measured with electronic devices, which record date and time of each actuation. We present preliminary data of the first 54 patients (154 patients are planned to enroll) recruited since 2014. Adherence was defined as percentage of days with correct dosing (correct number of prescribed inhalations). Results: Of the 54 (76% male, 67.9±9.1 yrs) patients, 42 (78%) had COPD, 8 (15%) asthma and 4 (7%) asthma-COPD overlap syndrome. Adherence to puff inhalers was higher in the intervention compared to control group (80±19% vs. 51±21%; p Conclusion: These results suggest a beneficial effect of regular reminder on the adherence of lung patients. Adherence to once-daily dosage and powder capsules regimens appears to be better.

Background: Acute exacerbations are key events in COPD, associated with a decline in lung function, lower quality of life and increased mortality. Aims and objectives: The Swiss COPD cohort was established to collect spirometric and other data of patients treated in primary care. Our objective was to evaluate different potentially predictive factors for exacerbation and re-exacerbation. Methods: In order to predict exacerbation until the next visit based on the knowledge of exacerbation since the last visit, a multistate model described by Therneau and Grambsch was performed. Results: Data of 748 patients (63% males, 44.1% current smokers) were available for model analysis. Mean FEV1/FVC was 53.1% (±11.5). Hospitalisation for any reason (HR1.7; p0.04) and pronounced dyspnea (HR for mMRC grade 4 3.0; p When already having had an exacerbation at last visit, pronounced dyspnea (HR for mMRC grade 4 1.9; p0.026) and cerebrovascular insult (HR2.1; p0.003) were significantly associated with re-exacerbation. Physical activity (HR0.6; p0.031) and treatment with long-acting anticholinergics (HR0.7; p0.044) seemed to play a significant protective role. Conclusion: Our data confirmed well-established risk factors for exacerbations whilst analyzing their predictive association with exacerbation and re-exacerbation with a multistate model approach.

Background. Patients with Chronic Obstructive Pulmonary Disease (COPD) suffer from increased daytime sleepiness. The aim of this study was to identify potential predictors of subjective daytime sleepiness with special regard to sleep-related breathing disorder and nocturnal activity.Methods. COPD patients were recruited at the University Hospital Basel, Switzerland. COPD risk groups A–D were determined according to spirometry and COPD Assessment Test (CAT). Breathing disorder evaluation was performed with the ApneaLink device. Nocturnal energy expenditure was measured with the SenseWear Mini Armband. Subjective daytime sleepiness was recorded using the Epworth Sleepiness Scale (ESS).Results. Twenty-two patients (36%) were in COPD risk group A, 28 patients (45%) in risk group B, and 12 patients (19%) in risk groups C + D (n=62). Eleven patients (18%) had a pathological ESS ≥ 10/24. ESS correlated positively with CAT (r=0.386,p<0.01) and inversely with age (r=-0.347,p<0.01). In multiple linear regression age (β=-0.254,p<0.05), AHI (β=0.287,p<0.05) and CAT score (β=0.380,p<0.01) were independent predictors of ESS, while nocturnal energy expenditure showed no significant association (p=0.619).Conclusion. These findings provide evidence that daytime sleepiness in COPD patients may partly be attributable to nocturnal respiratory disturbances and it seems to mostly affect younger patients with more severe COPD symptoms.

The use of inhaled corticosteroids in mild to moderate COPD is controversial. The aim of this study was to determine whether airway hyperresponsiveness to mannitol might identify patients who are likely to respond to add-on inhaled corticosteroids.Ninety subjects with mild to moderate COPD were recruited and 68 subsequently randomized in a double-blind manner to receive inhaled budesonide (1,600 μg/d, n = 31) or placebo (n = 37) for 3 months. Thirty-eight subjects had airway hyperresponsiveness to mannitol (17 received budesonide, 21 placebo). All subjects received tiotropium throughout the study, including 4 weeks before randomization. Spirometry, quality of life (St. George Respiratory Questionnaire), degree of dyspnea, airway responsiveness to mannitol, and exhaled nitric oxide were assessed at week 0 (recruitment), week 4 (baseline prior to randomization), and week 16 (posttreatment).Compared with placebo, budesonide was associated with improved quality of life in subjects showing airway hyperresponsiveness to mannitol (difference of changes in quality of life score between randomization and study completion, −9.1; 95% CI, −15.8 to −2.3; P.01). Treatment with inhaled budesonide also led to a reduction in airway responsiveness to mannitol compared with placebo (difference in log10 response-dose ratio, −0.3; 95% CI, −0.6 to −0.04; P.01). However, postrandomization changes in FEV1 % predicted, quality of life, and exhaled nitric oxide showed no difference between budesonide and placebo.In subjects with mild to moderate COPD and airway hyperresponsiveness to mannitol, quality of life and airway responsiveness improved after treatment with inhaled corticosteroids added to long-acting bronchodilator therapy.

Background: COPD is known to be a progressive disease and a major burden in health system. Our objective was to analyze the progression of the disease and disease management under primary care setting over long term period. Methods: COPD patients were screened by GPS and enrolled into our cohort. Demographic data was collected; medical treatment, spirometric parameters, exacerbation history, treatment and disease progression were recorded every six months. Results: 1160 patients with chronic bronchitis (61% male, 47% current smoker) were screened at baseline. Only 60% of patients at baseline have COPD (50% in GOLD II and GOLD III). Most of the patients have combined therapy of min. 2 medication, ; fewer than 10% of the subjects have pulmonary rehab. The longest observation period lasted over 30 month. 51% of our patients have a medium risk for exacerbation. We registered 962 exacerbation and 36 death events 15 of them were due to an exacerbation. We recorded 456 events, which went from healthy to an exacerbation, besides more than 200 incidents the second exacerbation occurs immediately after the first one. Conclusion: our data shows that COPD is often under- and misdiagnosed in primary care and often treated poorly. This is probably due to poor knowledge of guidelines.

ObjectiveTo analyze prospectively the hypothalamic–pituitary–adrenal (HPA) axis and clinical outcome in patients treated with prednisone for exacerbated chronic obstructive pulmonary disease (COPD).DesignProspective observational study.Subjects and methodsPatients presenting to the emergency department were randomized to receive 40 mg prednisone daily for 5 or 14 days in a placebo-controlled manner. The HPA axis was longitudinally assessed with the 1 μg corticotropin test and a clinical hypocortisolism score at baseline, on day 6 before blinded treatment, at hospital discharge, and for up to 180 days of follow-up. Prednisone was stopped abruptly, irrespective of the test results. Patients discharged with pathological test results received instructions about emergency hydrocortisone treatment.ResultsA total of 311 patients were included in the analysis. Mean basal and stimulated serum total cortisol levels were highest on admission (496±398 and 816±413 nmol/l respectively) and lowest on day 6 (235±174 and 453±178 nmol/l respectively). Pathological stimulation tests were found in 63, 38, 9, 3, and 2% of patients on day 6, at discharge, and on days 30, 90, and 180 respectively, without significant difference between treatment groups. Clinical indicators of hypocortisolism did not correlate with stimulation test results, but cortisol levels were inversely associated with re-exacerbation risk. There were no hospitalizations or deaths as a result of adrenal crisis.ConclusionDynamic changes in the HPA axis occur during and after the treatment of acute exacerbations of COPD. In hypocortisolemic patients who were provided with instructions about stress prophylaxis, the abrupt termination of prednisone appeared safe.

Background: The Global Initiative for Chronic Obstructive Lung Disease proposed in 2011 a new system to classify chronic obstructive pulmonary disease (COPD) patients into risk groups A-D, which considers symptoms and future exacerbation risk to grade disease severity. The aim of this study was to investigate the agreement between COPD risk group classifications using COPD assessment test (CAT) or modified Medical Research Council (mMRC) and severity grades or past-year exacerbations. Furthermore, physical activity across risk groups was examined. Methods: 87 patients with stable COPD were classified into risk groups A-D. CAT and mMRC were completed. Severity grades I-IV were determined using spirometry and the number of past-year exacerbations was recorded. To test the interrater agreement, Cohen’s Kappa was calculated. Daily physical activity was measured by the SenseWear Mini armband. Results: Using CAT, 65.5% of patients were in high-symptom groups (B and D). With mMRC, only 37.9% were in B and D. Using severity grades, 20.7% of patients were in high-exacerbation risk groups (C and D). With past-year exacerbations, 9.2% were in C and D. Interrater agreement between CAT and mMRC (κ = 0.21) and between severity grades and past-year exacerbations (κ = 0.31) was fair. Daily steps were reduced in risk groups B and C + D compared to A (p < 0.01), using either classification. Conclusions: When classifying COPD patients into risk groups A-D, the use of CAT or mMRC and severity grades or past-year exacerbations does not provide equal results. Daily steps decreased with increasing COPD risk groups., BMC Research Notes, 7, ISSN:1756-0500

Background: The occurrence of both chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) in an individual patient has been described as ‘overlap syndrome', which has been associated with poor prognosis. Little is known about the possible predictors of the overlap syndrome and its association with comorbidities contributing to impaired outcome. Objectives: This study aimed to evaluate the prevalence and possible predictors of the overlap syndrome and its association with comorbidities in a cohort of COPD patients. Methods: Individuals with COPD (GOLD stages I-IV, risk groups A-D) were recruited from outpatient clinics. Information on age, gender, body mass index (BMI), smoking status, Epworth sleepiness scale (ESS), COPD assessment test, comorbidities, medications and exacerbations in the past year was collected and a spirometry was performed. Participants underwent a nocturnal polygraphy using the ApneaLink™ device at home. An apnea-hypopnea index (AHI) >10 per hour was considered to indicate OSA. Results: We enrolled 177 COPD patients (112 men) with a mean age of 64 years (range 42-90), of whom 35 (20%) had an ESS score above 10. During nocturnal polygraphy, 33 patients (19%) had evidence of OSA. In multivariate analysis, BMI and pack years were positively associated with AHI, independent of other significant AHI determinants from univariate analysis. Arterial hypertension and diabetes were more common in patients with the overlap syndrome. Conclusions: Almost 20% of COPD patients also have OSA. BMI and smoking history seem to be predictors of the overlap syndrome, and these patients may be more often affected by hypertension and diabetes.

INTRODUCTION: Sleep problems present a risk for work injuries and are a major occupational health concern worldwide. Knowledge about the influence of sleep problems on work injury patterns is limited. Therefore, the aim of this study was to identify potential associations between different types of work injuries and sleep quality, sleep duration, and daytime sleepiness. METHODS: In this hospital-based study, 180 male and female patients with work injuries were recruited at the Emergency Department of the University Hospital Basel, Switzerland, from December 1st 2009 to June 30th 2011. The data on work injury characteristics, sleep problems, and potential confounders, such as demographic, health, lifestyle, occupational and environmental factors, were collected. Multivariable logistic regression analyses were performed to investigate the relationship between sleep problems and various types of work injury. RESULTS: Each dimension of sleep problems – sleep quality, sleep duration and daytime sleepiness – was a significant risk factor for at least one type of work injury. The strongest association was found for musculoskeletal injuries and falls with short sleep duration (odds ratio [OR] 5.41, 95% confidence interval [CI] 1.81–16.22). The standardised scores of the Pittsburgh sleep quality index (PSQI) and the Epworth sleepiness scale (ESS) did not discriminate between injury types. CONCLUSION: Employees with sleep problems were more likely to suffer from certain types of work injuries. This should be considered by employers monitoring work injuries and implementing prevention measures in the company’s health and safety management., Swiss Medical Weekly, 143, ISSN:1424-7860, ISSN:1424-3997

Background Despite the growing knowledge of the mechanisms of fracture healing, non-unions remain a substantial clinical problem. There is increasing interest in murine fracture models because they would allow studying molecular mechanisms of healing with the help of specific antibodies and gene-targeted animals. However, until now it has not been possible to reproducibly create non-unions in mice. Thus, the aim of this study was to develop a reliable non-union model in mice. Methods After creating segmental defects of 0.8 mm and 1.8 mm, mice femora were stabilized with a pin-clip fixation. Additionally, the influence of periosteal resection on the development of non-unions was studied. Histological and radiological healing was analyzed 5, 10, and 15 wk after surgery. Results After 10 wk all animals showed poor healing with predominantly atrophic non-unions. Whereas the 0.8 mm and the 1.8 mm gap with intact periosteum showed radiologically in 4/6 and 3/6 cases possible healing, only the gap of 1.8 mm with additional periosteal resection resulted in 100% (6/6) non-unions. The non-unions were confirmed also after 15 wk and appeared atrophic with typical histological and radiological features. These included lack of fracture bridging with abundant fibrous tissue in the gap, absence of callus formation, and rounded bone ends. Of interest, the non-unions were not avascular, but demonstrated a considerable vascularity within the fibrous tissue. Conclusion Taken together, we herein demonstrate for the first time a reliable non-union model in mice. This allows us to study molecular aspects of non-union formation and analyze different therapeutical strategies in these animals.

Importance International guidelines advocate a 7- to 14-day course of systemic glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease (COPD). However, the optimal dose and duration are unknown. Objective To investigate whether a short-term (5 days) systemic glucocorticoid treatment in patients with COPD exacerbation is noninferior to conventional (14 days) treatment in clinical outcome and whether it decreases the exposure to steroids. Design, Setting, and Patients REDUCE (Reduction in the Use of Corticosteroids in Exacerbated COPD), a randomized, noninferiority multicenter trial in 5 Swiss teaching hospitals, enrolling 314 patients presenting to the emergency department with acute COPD exacerbation, past or present smokers (≥20 pack-years) without a history of asthma, from March 2006 through February 2011. Interventions Treatment with 40 mg of prednisone daily for either 5 or 14 days in a placebo-controlled, double-blind fashion. The predefined noninferiority criterion was an absolute increase in exacerbations of at most 15%, translating to a critical hazard ratio of 1.515 for a reference event rate of 50%. Main Outcome and Measure Time to next exacerbation within 180 days. Results Of 314 randomized patients, 289 (92%) of whom were admitted to the hospital, 311 were included in the intention-to-treat analysis and 296 in the per-protocol analysis. Hazard ratios for the short-term vs conventional treatment group were 0.95 (90% CI, 0.70 to 1.29; P = .006 for noninferiority) in the intention-to-treat analysis and 0.93 (90% CI, 0.68 to 1.26; P = .005 for noninferiority) in the per-protocol analysis, meeting our noninferiority criterion. In the short-term group, 56 patients (35.9%) reached the primary end point; 57 (36.8%) in the conventional group. Estimates of reexacerbation rates within 180 days were 37.2% (95% CI, 29.5% to 44.9%) in the short-term; 38.4% (95% CI, 30.6% to 46.3%) in the conventional, with a difference of −1.2% (95% CI, −12.2% to 9.8%) between the short-term and the conventional. Among patients with a reexacerbation, the median time to event was 43.5 days (interquartile range [IQR], 13 to 118) in the short-term and 29 days (IQR, 16 to 85) in the conventional. There was no difference between groups in time to death, the combined end point of exacerbation, death, or both and recovery of lung function. In the conventional group, mean cumulative prednisone dose was significantly higher (793 mg [95% CI, 710 to 876 mg] vs 379 mg [95% CI, 311 to 446 mg], P Conclusions and Relevance In patients presenting to the emergency department with acute exacerbations of COPD, 5-day treatment with systemic glucocorticoids was noninferior to 14-day treatment with regard to reexacerbation within 6 months of follow-up but significantly reduced glucocorticoid exposure. These findings support the use of a 5-day glucocorticoid treatment in acute exacerbations of COPD. Trial Registration isrctn.org Identifier: ISRCTN19646069