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Abstract: Objective: To determine the diagnostic accuracy and diagnostic patterns of clinical symptoms in patients suspected to suffer from obstructive airway diseases (OADs) within different health care sectors. Study Design and Setting: Ten general practices (219 patients), one practice of pneumologists (259 patients) and one specialist hospital (300 patients). Sensitivities, specificities, positive (LR+), and negative (LR−) likelihood ratios of clinical symptoms were compared with lung function testing. Results: Thirty-one percent had chronic obstructive pulmonary disease (COPD), 21% had asthma. Sensitivities increased and specificities decreased from outpatient to hospital setting. The multivariate model of adjusted likelihood ratios for COPD showed LR+=4.86 (95% confidence interval [CI]=2.09–11.29) and LR−=0.07 (95% CI=0.01–0.43) of the combination “wheezing,” “dyspnea when going upstairs,” “smoking” in general practice. In hospital, the combination “dyspnea when going upstairs,” “dyspnea during minimal exercise,” and “smoking” showed LR+=3.34 (95% CI=2.08–5.31) and LR−=0.02 (95% CI=0.01–0.12). The combination “no coughing,” “dyspnea attacks,” and “no smoking” showed LR+=4.08 (95% CI=1.67–10.4) and LR−=0.24 (95% CI=0.12–0.58) for asthma in general practice. The combination “dyspnea attacks” and “no dyspnea when walking” showed LR+=6.48 (95% CI=1.01–40.94) and LR−=0.28 (95% CI=0.11–0.75) for asthma in hospital. Conclusion: Clinical decision rules for OAD need to be derived from original studies in their respective settings or assessed on their transferability to other settings. [Copyright &y& Elsevier]

Summary: The increasing panel of systemic therapies enables the individual management of cancer patients, even in advanced stages. However, diagnostic tools indicating early the efficacy of therapy are still needed. In prospectively collected sera of 161 patients with recurrent non-small cell lung cancer (NSCLC) receiving second-line chemotherapy, the courses of nucleosomes, cytokeratin-19 fragments (CYFRA 21-1), carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and progastrin-releasing peptide (ProGRP) were investigated and correlated with therapy response. At high specificity for detection of progressive disease, most sensitive biomarkers were identified and included in a combination model. High levels and insufficient decreases of nucleosomes and CYFRA 21-1 during the first cycle of therapy indicated poor outcome. Combination of nucleosome concentrations at day 8 and CYFRA 21-1 before start of the second cycle enabled the early detection of progressive disease with a sensitivity of 34.4% at 95% specificity (AUC 0.79) prior to imaging techniques. When cutoffs were fixed at the 90th percentile of responding patients, the combination model achieved sensitivities of 19% at 100% specificity and of 52% at 88% specificity. Thus, nucleosomes and CYFRA 21-1 showed to be valuable for the individual management of patients with recurrent NSCLC. [Copyright &y& Elsevier]