378 results on '"Kenn Klaus"'
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2. Pneumologische Erkrankungen (Asthma, COPD, dysfunktionelle respiratorische Symptome)
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Jarosch, Inga, Kenn, Klaus, and Joisten, Christine, editor
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- 2023
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3. Grundlagen der nichtmedikamentösen Therapie
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Koczulla, Andreas R., Kenn, Klaus, Jarosch, Inga, Kreuter, Michael, editor, Costabel, Ulrich, editor, Herth, Felix JF, editor, and Kirsten, Detlef, editor
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- 2022
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4. Vocal Cord Dysfunction
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Koczulla, Andreas R., Kenn, Klaus, Kreuter, Michael, editor, Costabel, Ulrich, editor, Herth, Felix JF, editor, and Kirsten, Detlef, editor
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- 2022
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5. Psychosomatik - neurobiologisch fundiert und evidenzbasiert
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Steel, Jennifer, primary, Klimecki, Olga, additional, Ditzen, Beate, additional, Nater, Urs M., additional, Schweinberger, Stefan R., additional, Stangier, Ulrich, additional, Rose, Matthias, additional, Schächinger, Hartmut, additional, Schmidt, Charlotte Lisa, additional, Maercker, Andreas, additional, Templin, Christian, additional, Otte, Christian, additional, Ehlert, Ulrike, additional, Noser, Emilou, additional, Friederich, Hans-Christoph, additional, Schmidt, Jennifer, additional, Mehnert-Theuerkauf, Anja, additional, Rauers, Antje, additional, Knoll, Nina, additional, Briken, Peer, additional, Hecker, Tobias, additional, Binder, Elisabeth, additional, Froböse, Ingo, additional, Häuser, Winfried, additional, Hilbert, Anja, additional, Rufer, Michael, additional, Lutz, Wolfgang, additional, Horn, Andrea, additional, Kruse, Johannes, additional, Gaab, Jens, additional, Keller, Peter Fritz, additional, Schäfert, Rainer, additional, Derra, Claus, additional, Martin, Alexandra, additional, Smith, Ryan, additional, Herpertz-Dahlmann, Beate, additional, Knop, Andrea, additional, Reich, Günter, additional, Jacobi, Frank, additional, Kosciusko, Rachel, additional, Leithäuser, Boris, additional, Widder, Bernhard, additional, Daubländer, Monika, additional, Leweke, Frank, additional, de Zwaan, Martina, additional, Jordan, Jochen, additional, Siegrist, Johannes, additional, Köllner, Volker, additional, Konturek, Peter C., additional, Schauenburg, Henning, additional, Peters, Achim, additional, Wormit, Alexander, additional, von Moreau, Dorothee, additional, Hillecke, Thomas, additional, Bengel, Jürgen, additional, Landolt, Hans-Peter, additional, Ritter, Viktoria, additional, Franz, Matthias, additional, Kahaly, George J., additional, Crönlein, Tatjana, additional, Gündel, Harald, additional, Roelcke, Volker, additional, Ladwig, Karl-Heinz, additional, von Känel, Roland, additional, Ballach, Sarah T., additional, Entringer, Sonja, additional, Fromm, Bernd, additional, Peters, Eva, additional, Egloff, Niklaus, additional, Oddo-Sommerfeld, Silvia, additional, Gold, Stefan, additional, Lane, Richard D., additional, Ritz, Thomas, additional, Langner, Peter, additional, Lenski, Denise, additional, Nolte, Tobias, additional, Sommerlad, Sarah, additional, Strauman, Timothy J., additional, Zipfel, Stephan, additional, Winter, Sibylle Maria, additional, Erim, Yesim, additional, Lozza-Fiacco, Serena, additional, Mernone, Laura, additional, Fischer, Susanne, additional, Gerlach, Alexander L., additional, Slotta, Timo, additional, Pohl, Anna, additional, Anderegg, Laura, additional, Aybek, Selma, additional, Bär, Karl-Jürgen, additional, Bittmann, Cornelia, additional, Bosch, Jessica, additional, Brindley, Emily, additional, Brockmeyer, Timo, additional, Cammann, Victoria Lucia, additional, Cheng, Hannah, additional, Di Chiara, Marianna, additional, Dammering, Felix, additional, Dorr, Florence, additional, Ecker-Egle, Marie-Luise, additional, Epel, Elissa, additional, Faller, Hermann, additional, Feneberg, Anja C., additional, Fischer, Felix, additional, Flatscher-Thöni, Magdalena, additional, von Franqué, Fritjof, additional, Geigges, Werner, additional, Geuter, Ulfried, additional, Gieler, Uwe, additional, Gitzen, Ute Katharina, additional, Hasler, Gregor, additional, Heidenreich, Thomas, additional, Holst, Sebastian C., additional, Koch, Anna Katharina, additional, Koenig, Julian, additional, Konnopka, Alexander, additional, Koops, Thula, additional, Kreuzer, Peter M., additional, Lampe, Astrid, additional, Langheim, Eike, additional, Lazarides, Claudia, additional, Lehnen, Nadine, additional, Lendt, Claas, additional, Lukaschek, Karoline, additional, Michalak, Johannes, additional, Pathak, Ritambhara, additional, Prem, Roman, additional, Radziej, Katharina, additional, Rajput, Meera, additional, Röhricht, Frank, additional, Schecklmann, Martin, additional, Schick, Maren, additional, Schoch-Ruppen, Jessica, additional, Simon, Joe, additional, Szawan, Konrad Andreas, additional, Templin-Ghadri, Jelena, additional, Vielsmeier, Veronika, additional, Vogel, Heiner, additional, Wang, Isi, additional, Welte-Jzyk, Claudia, additional, Werner-Felmayer, Gabriele, additional, Werth, Esther, additional, Wilke, Christiane, additional, Wischmann, Tewes, additional, Langguth, Berthold, additional, Langhorst, Jost, additional, Bingel, Ulrike, additional, Cattapan, Katja, additional, Chae, Woo Ri, additional, de Punder, Karin, additional, Elsenbruch, Sigrid, additional, Finke, Johannes B., additional, Frommberger, Ulrich, additional, Icenhour, Adriane, additional, Kenn, Klaus, additional, König, Hans-Helmut, additional, Petrowski, Katja, additional, Rief, Winfried, additional, Rohleder, Nicolas, additional, Schwab, Nathalie, additional, Spiller, Tobias Raphael, additional, Spitzer, Carsten, additional, Stieglitz, Rolf-Dieter, additional, and Zacher, Magdalena, additional
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- 2024
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6. Benefits of pulmonary rehabilitation in COPD patients with mild cognitive impairment – A pilot study
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Andrianopoulos, Vasileios, Gloeckl, Rainer, Schneeberger, Tessa, Jarosch, Inga, Vogiatzis, Ioannis, Hume, Emily, Koczulla, Rembert A., and Kenn, Klaus
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- 2021
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7. High-intensity non-invasive ventilation during exercise-training versus without in people with very severe COPD and chronic hypercapnic respiratory failure: a randomised controlled trial
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Schneeberger, Tessa, primary, Dennis, Clancy John, additional, Jarosch, Inga, additional, Leitl, Daniela, additional, Stegemann, Antje, additional, Gloeckl, Rainer, additional, Hitzl, Wolfgang, additional, Leidinger, Maximilian, additional, Schoenheit-Kenn, Ursula, additional, Criée, Carl-Peter, additional, Koczulla, Andreas Rembert, additional, and Kenn, Klaus, additional
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- 2023
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8. Whole-body vibration training versus conventional balance training in patients with severe COPD—a randomized, controlled trial
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Gloeckl, Rainer, Schneeberger, Tessa, Leitl, Daniela, Reinold, Tobias, Nell, Christoph, Jarosch, Inga, Kenn, Klaus, and Koczulla, Andreas R.
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- 2021
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9. Transplantation
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Gloeckl, Rainer, Schneeberger, Tessa, Jarosch, Inga, Kenn, Klaus, Clini, Enrico, editor, Holland, Anne E., editor, Pitta, Fabio, editor, and Troosters, Thierry, editor
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- 2018
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10. Comparison of supplemental oxygen delivery by continuous versus demand based flow systems in hypoxemic COPD patients – A randomized, single-blinded cross-over study
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Gloeckl, Rainer, Jarosch, Inga, Schneeberger, Tessa, Fiedler, Claudia, Lausen, Melody, Weingaertner, Julian, Hitzl, Wolfgang, Kenn, Klaus, and Koczulla, Andreas Rembert
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- 2019
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11. A new instrument to assess disease-related fears in Interstitial Lung Disease (ILD): The ILD-Anxiety-Questionnaire (IAQ)
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Piel, Nina, primary, Kreuter, Michael, additional, Kenn, Klaus, additional, and Stenzel, Nikola, additional
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- 2023
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12. Vocal Cord Dysfunction
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Kenn, Klaus, Kreuter, Michael, editor, Costabel, Ulrich, editor, Herth, Felix, editor, and Kirsten, Detlef, editor
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- 2016
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13. Grundlagen der nichtmedikamentösen Therapie
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Kenn, Klaus, Jarosch, Inga, Kreuter, Michael, editor, Costabel, Ulrich, editor, Herth, Felix, editor, and Kirsten, Detlef, editor
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- 2016
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14. What's the secret behind the benefits of whole-body vibration training in patients with COPD? A randomized, controlled trial
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Gloeckl, Rainer, Jarosch, Inga, Bengsch, Ulrike, Claus, Magdalena, Schneeberger, Tessa, Andrianopoulos, Vasileios, Christle, Jeffrey W., Hitzl, Wolfgang, and Kenn, Klaus
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- 2017
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15. Benefits of pulmonary rehabilitation in patients with advanced lymphangioleiomyomatosis (LAM) compared with COPD – a retrospective analysis
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Gloeckl, Rainer, Nell, Christoph, Schneeberger, Tessa, Jarosch, Inga, Boensch, Martina, Watz, Henrik, Wirtz, Hubert, Welte, Tobias, Kenn, Klaus, and Koczulla, Andreas Rembert
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- 2020
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16. Sarcopenic Obesity, Functional Outcomes, and Systemic Inflammation in Patients With Chronic Obstructive Pulmonary Disease
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Joppa, Pavol, Tkacova, Ruzena, Franssen, Frits M.E., Hanson, Corrine, Rennard, Stephen I., Silverman, Edwin K., McDonald, Merry-Lynn N., Calverley, Peter M.A., Tal-Singer, Ruth, Spruit, Martijn A., Kenn, Klaus, Wouters, Emiel F.M., and Rutten, Erica P.A.
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- 2016
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17. Pulmonary rehabilitation in patients with mustard gas lung disease: a study protocol for a randomized controlled trial
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Sedighi Moghadam, Mohamad Reza, Ghanei, Mostafa, Kenn, Klaus, and Hopkinson, Nicholas S.
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- 2019
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18. Transplantation
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Gloeckl, Rainer, primary, Schneeberger, Tessa, additional, Jarosch, Inga, additional, and Kenn, Klaus, additional
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- 2017
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19. Illness perceptions predict exercise capacity and psychological well-being after pulmonary rehabilitation in COPD patients
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Zoeckler, Natalie, Kenn, Klaus, Kuehl, Kerstin, Stenzel, Nikola, and Rief, Winfried
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- 2014
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20. Integrierte Versorgung bei Asthma bronchiale und COPD
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Kenn, Klaus, Lingner, Heidrun, editor, Schwartz, Friedrich-Wilhelm, editor, and Schultz, Konrad, editor
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- 2007
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21. The association of cognitive functioning as measured by the DemTect with functional and clinical characteristics of COPD: results from the COSYCONET cohort
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von Siemens, Sarah Marietta, Perneczky, Robert, Waschki, Benjamin, Lutter, Johanna I, Welte, Tobias, Jörres, Rudolf A, Kahnert, Kathrin, group, COSYCONET study, Andreas, Stefan, Bals, Robert, Behr, Jürgen, Vogelmeier, Claus F, Bewig, Burkhard, Buhl, Roland, Ewert, Ralf, Stubbe, Beate, Gogol, Manfred, Grohé, Christian, Hauck, Rainer, Held, Matthias, Jany, Berthold, Henke, Markus, Herth, Felix, Höffken, Gerd, Katus, Hugo A, Kirsten, Anne-Marie, Watz, Henrik, Koczulla, Rembert, Kenn, Klaus, Kronsbein, Juliane, Kropf-Sanchen, Cornelia, Lange, Christoph, Kauffmann-Guerrero, Diego, Zabel, Peter, Pfeifer, Michael, Randerath, Winfried J, Seeger, Werner, Studnicka, Michael, Taube, Christian, Teschler, Helmut, Timmermann, Hartmut, Virchow, J Christian, Vogelmeier, Claus, Alter, Peter, Wagner, Ulrich, Wirtz, Hubert, Trudzinski, Franziska C, and Söhler, Sandra
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Male ,medicine.medical_specialty ,epidemiology [Cognitive Dysfunction] ,psychology [Pulmonary Disease, Chronic Obstructive] ,Medizin ,Comorbidity ,Cohort Studies ,03 medical and health sciences ,FEV1/FVC ratio ,Pulmonary Disease, Chronic Obstructive ,0302 clinical medicine ,Cognition ,epidemiology [Pulmonary Disease, Chronic Obstructive] ,Surveys and Questionnaires ,medicine ,Dementia ,Humans ,COPD ,Cognitive Dysfunction ,ddc:610 ,Cognitive skill ,Path analysis (statistics) ,Aged ,lcsh:RC705-779 ,business.industry ,Research ,physiology [Cognition] ,diagnosis [Pulmonary Disease, Chronic Obstructive] ,lcsh:Diseases of the respiratory system ,Middle Aged ,medicine.disease ,Mental Status and Dementia Tests ,humanities ,Cross-Sectional Studies ,Cognitive impairment ,diagnosis [Cognitive Dysfunction] ,030228 respiratory system ,Cohort ,Physical therapy ,Female ,psychology [Cognitive Dysfunction] ,business ,030217 neurology & neurosurgery ,Cognitive load - Abstract
Alterations of cognitive functions have been described in COPD. Our study aimed to disentangle the relationship between the degree of cognitive function and COPD characteristics including quality of life (QoL).Data from 1969 COPD patients of the COSYCONET cohort (GOLD grades 1–4; 1216 male/ 753 female; mean (SD) age 64.9 ± 8.4 years) were analysed using regression and path analysis. The DemTect screening tool was used to measure cognitive function, and the St. George‘s respiratory questionnaire (SGRQ) to assess disease-specific QoL.DemTect scores were =60 years of age. For statistical reasons, we used the average of both algorithms independent of age in all subsequent analyses. The DemTect scores were associated with oxygen content, 6-min-walking distance (6-MWD), C-reactive protein (CRP), modified Medical Research Council dyspnoea scale (mMRC) and the SGRQ impact score. Conversely, the SGRQ impact score was independently associated with 6-MWD, FVC, mMRC and DemTect. These results were combined into a path analysis model to account for direct and indirect effects. The DemTect score had a small, but independent impact on QoL, irrespective of the inclusion of COPD-specific influencing factors or a diagnosis of cognitive impairment.We conclude that in patients with stable COPD lower oxygen content of blood as a measure of peripheral oxygen supply, lower exercise capacity in terms of 6-MWD, and higher CRP levels were associated with reduced cognitive capacity. Furthermore, a reduction in cognitive capacity was associated with reduced disease-specific quality of life. As a potential clinical implication of this work, we suggest to screen especially patients with low oxygen content and low 6-MWD for cognitive impairment.
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- 2022
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22. Cerebral oxygen availability during exercise in COPD patients with cognitive impairment
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Andrianopoulos, Vasileios, Vogiatzis, Ioannis, Gloeckl, Rainer, Bals, Robert, Koczulla, Rembert A., and Kenn, Klaus
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Pulmonary rehabilitation ,Chronic obstructive pulmonary disease ,Cognitive function ,Cerebral blood flow ,Exercise ,Comorbidities - Published
- 2022
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23. Automatic oxygen titration versus constant oxygen flow rates during walking in COPD: a randomised controlled, double-blind, crossover trial.
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Schneeberger, Tessa, Jarosch, Inga, Leitl, Daniela, Gloeckl, Rainer, Hitzl, Wolfgang, Dennis, Clancy John, Geyer, Tatjana, Criée, Carl-Peter, Koczulla, Andreas Rembert, and Kenn, Klaus
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CROSSOVER trials ,CHRONIC obstructive pulmonary disease ,VOLUMETRIC analysis ,BLOOD lactate ,HYPOVENTILATION - Published
- 2023
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24. Effects of whole body vibration in patients with chronic obstructive pulmonary disease – A randomized controlled trial
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Gloeckl, Rainer, Heinzelmann, Inga, Baeuerle, Sandra, Damm, Eva, Schwedhelm, Anna-Lena, Diril, Merve, Buhrow, David, Jerrentrup, Andreas, and Kenn, Klaus
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- 2012
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25. Perceptions of NIV During Exercise in NIV-Naïve Patients With COPD
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Dennis, Clancy J, primary, Menadue, Collette, additional, Schneeberger, Tessa, additional, Leitl, Daniela, additional, Schoenheit-Kenn, Ursula, additional, Harmer, Alison R, additional, Barnes, David J, additional, Koczulla, Andreas R, additional, Kenn, Klaus, additional, and Alison, Jennifer A, additional
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- 2022
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26. Associations of oxygenated hemoglobin with disease burden and prognosis in stable COPD: Results from COSYCONET
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Trudzinski, F.C., Jörres, R.A., Alter, P., Kahnert, K., Waschki, B., Herr, C., Kellerer, C., Omlor, A., Vogelmeier, C.F., Fähndrich, S., Watz, H., Welte, T., Jany, B., Söhler, S., Biertz, F., Herth, F., Kauczor, H.-U., Bals, R., Andreas, Stefan, Behr, Jürgen, Bewig, Burkhard, Buhl, Roland, Ewert, Ralf, Stubbe, Beate, Ficker, Joachim H., Gogol, Manfred, Grohé, Christian, Hauck, Rainer, Held, Matthias, Henke, Markus, Höffken, Gerd, Katus, Hugo A., Kirsten, Anne-Marie, Koczulla, Rembert, Kenn, Klaus, Kronsbein, Juliane, Kropf-Sanchen, Lange, Christoph, Zabel, Peter, Pfeifer, Michael, Randerath, Winfried J., Seeger, Werner, Studnicka, Michael, Taube, Christian, Teschler, Helmut, Timmermann, Hartmut, Virchow, J. Christian, Wagner, and Wirtz, Hubert
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Adult ,Male ,medicine.medical_specialty ,Exacerbation ,Medizin ,lcsh:Medicine ,Severity of Illness Index ,Gastroenterology ,Article ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,Medical research ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Signs and symptoms ,lcsh:Science ,Survival rate ,Aged ,Oxygen saturation (medicine) ,Aged, 80 and over ,Inflammation ,COPD ,Oxygenated Hemoglobin ,Multidisciplinary ,Proportional hazards model ,business.industry ,Hazard ratio ,lcsh:R ,Middle Aged ,Prognosis ,medicine.disease ,Comorbidity ,Survival Rate ,Risk factors ,030228 respiratory system ,Oxyhemoglobins ,Female ,lcsh:Q ,Blood Gas Analysis ,business ,Biomarkers - Abstract
We studied whether in patients with stable COPD blood gases (BG), especially oxygenated hemoglobin (OxyHem) as a novel biomarker confer information on disease burden and prognosis and how this adds to the information provided by the comorbidity pattern and systemic inflammation. Data from 2137 patients (GOLD grades 1–4) of the baseline dataset of the COSYCONET COPD cohort were used. The associations with dyspnea, exacerbation history, BODE-Index (cut-off ≤2) and all-cause mortality over 3 years of follow-up were determined by logistic and Cox regression analyses, with sex, age, BMI and pack years as covariates. Predictive values were evaluated by ROC curves. Capillary blood gases included SaO2, PaO2, PaCO2, pH, BE and the concentration of OxyHem [haemoglobin (Hb) x fractional SaO2, g/dL] as a simple-to-measure correlate of oxygen content. Inflammatory markers were WBC, CRP, IL-6 and -8, TNF-alpha and fibrinogen, and comorbidities comprised a broad panel including cardiac and metabolic disorders. Among BG, OxyHem was associated with dyspnoea, exacerbation history, BODE-Index and mortality. Among inflammatory markers and comorbidities, only WBC and heart failure were consistently related to all outcomes. ROC analyses indicated that OxyHem provided information of a magnitude comparable to that of WBC, with optimal cut-off values of 12.5 g/dL and 8000/µL, respectively. Regarding mortality, OxyHem also carried independent, additional information, showing a hazard ratio of 2.77 (95% CI: 1.85–4.15, p 8000/µL was 2.33 (95% CI: 1.60–3.39, p 2. It thus appears well suited for clinical use with minimal equipment, especially for GPs.
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- 2020
27. Bilevel Noninvasive Ventilation During Exercise Reduces Dynamic Hyperinflation and Improves Cycle Endurance Time in Severe to Very Severe COPD
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Dennis, Clancy J., primary, Menadue, Collette, additional, Schneeberger, Tessa, additional, Leitl, Daniela, additional, Schoenheit-Kenn, Ursula, additional, Hoyos, Camilla M., additional, Harmer, Alison R., additional, Barnes, David J., additional, Koczulla, Andreas R., additional, Kenn, Klaus, additional, and Alison, Jennifer A., additional
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- 2021
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28. Pulmonary Rehabilitation Improves Exercise Capacity And Molecular Skeletal Muscle Adaptation In Pulmonary Emphysema Patients: 2972 Board #37 June 3, 3: 30 PM - 5: 00 PM
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Gehlert, Sebastian, Jarosch, Inga, Jacko, Daniel, Witte, Niklas, Clever, Axel, Borowik, Sergej, Wingels, Christian, Kenn, Klaus, and Bloch, Wilhelm
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- 2016
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29. Pneumologische Rehabilitation
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Kenn, Klaus, primary and Glöckl, Rainer, additional
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- 2015
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30. Automatic oxygen titration versus constant oxygen flow rates during walking in COPD: a randomised controlled, double-blind, crossover trial
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Schneeberger, Tessa, primary, Jarosch, Inga, additional, Leitl, Daniela, additional, Gloeckl, Rainer, additional, Hitzl, Wolfgang, additional, Dennis, Clancy John, additional, Geyer, Tatjana, additional, Criée, Carl-Peter, additional, Koczulla, Andreas Rembert, additional, and Kenn, Klaus, additional
- Published
- 2021
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31. Relationship between body composition, exercise capacity and health-related quality of life in idiopathic pulmonary fibrosis
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Machado, Felipe V C, primary, Bloem, Ada E M, additional, Schneeberger, Tessa, additional, Jarosch, Inga, additional, Gloeckl, Rainer, additional, Winterkamp, Sandra, additional, Franssen, Frits M E, additional, Koczulla, Andreas R, additional, Pitta, Fabio, additional, Spruit, Martijn A, additional, and Kenn, Klaus, additional
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- 2021
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32. Comprehensive pulmonary rehabilitation (PR) decreases frailty in lung transplant recipients – a prospective observational study
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Schneeberger, Tessa, primary, Gaida, Maximilian, additional, Jarosch, Inga, additional, Leitl, Daniela, additional, Gloeckl, Rainer, additional, Kenn, Klaus, additional, and Koczulla, Andreas Rembert, additional
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- 2021
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33. Benefits of pulmonary rehabilitation in COVID-19 – a prospective observational cohort study
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Gloeckl, Rainer, primary, Leitl, Daniela, additional, Jarosch, Inga, additional, Schneeberger, Tessa, additional, Nell, Christoph, additional, Stenzel, Nikola, additional, Vogelmeier, Claus, additional, Kenn, Klaus, additional, and Koczulla, Rembert, additional
- Published
- 2021
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34. Predictors of Success for Pulmonary Rehabilitation in Patients Awaiting Lung Transplantation
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Kenn, Klaus, Gloeckl, Rainer, Soennichsen, Andreas, Sczepanski, Bernd, Winterkamp, Sandra, Boensch, M., and Welte, Tobias
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- 2015
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35. Pulmonary Rehabilitation and Noninvasive Ventilation in Patients with Hypercapnic Interstitial Lung Disease
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Dreher, Michael M., Ekkernkamp, Emelie E., Schmoor, Claudia C., Schoenheit-Kenn, Ursula U., Winterkamp, Sandra S., and Kenn, Klaus K.
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- 2015
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36. Kurzfristige Effekte einer Sauerstoffsubstitution unter Belastung bei Patienten mit idiopathische pulmonaler Fibrose (IPF)
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Schneider, Christoph and Kenn, Klaus (Prof.)
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carbon dioxi ,Sauerstofftherapie ,training ,exercise ,Sauerstoffsättigung ,ESWT ,oxygen therapy ,dyspnoea ,idiopatische pulmonale Fibrose ,Belastung ,idiopathic pulmonary fibrosis ,oxygen saturation ,SpO2 ,Lungenfibrose ,IPF ,Dyspnoe ,Medical sciences, Medicine ,Kohle ,ddc:610 ,endurance shuttle walk test ,Medizin, Gesundheit - Abstract
Background: National and international guidelines recommend a supplemental oxygen therapy during exercise for patients with idiopathic pulmonary fibrosis (Behr et al., 2013; Magnussen et al., 2008; Raghu et al., 2011). There is a lack of studies supporting this suggestion. Dowman et al. demonstrate an improvement of exercise capacity in IPF Patients while breathing supplemental oxygen (Dowman et al., 2017). Nishiyama et al. did not find an enhancement of exercice capacity in 6-minute walking test for those Patients under oxygen therapy (Nishiyama et al., 2008). A retrospective analysis does find an improvement in walking distance in 6-minute walking test for IPF Patients breathing oxygen (Frank et al., 2012). These studies are restricted by a limited number of cases and yield different results. The present study aimed to examine the short-term effects of supplemental oxygen therapy in a larger group of IPF Patients. We expected those Patients to increase exercise capacity and SpO2 when being treated with oxygen. We also investigated the effects of oxygen therapy on breathing frequency, heart rate and partial pressure of carbon dioxide. Methods: 40 Patients (age: 68.98 ± 7.31 years, 39 male, 1 female) diagnosed with idiopathic pulmonary fibrosis and hypoxemia during exercise were included in this study. All were participating in an inpatient pulmonary rehabilitation programm at m Schön Klinik Berchtesgadener Land. Body plethysmography, diffusing capacity, bioelectrical impedance analysis and capillary bloodgas testing were conducted in all patients. ISWT was used to determine peak walking speed. ESWT was performed by all patients at 85% of peak walking speed. Study protocol included one ESWT applying room air, one ESWT applying 2 L O2/min and one ESWT applying 4 L O2/min. Tests were conducted in randomised order and double blinding was used to reduce bias. Patients were instructed to maintain predetermined speed for as long as possible. Primary endpoint was the exercise capacity (in seconds) until a patient had to stop walking. SpO2, breathing frequency, heart rate and tcpCO2 were measured condinuously during ESWT. We used results at isotime (duration of the shortest ESWT of one patient) to sustain comparability of measurements in between tests of different length. Dyspnea was inquired using modified borg-scale at the end of every ESWT. Results: We found a significant improvement in exercise capacity in IPF patients breathing oxygen compared to room air. Patients could maintain predetermined walking speed significantly longer at a rate of 2 L O2/min (p=0.003) and 4 L O2/min (p, Hintergrund: Bei hypoxischen Patienten mit idiopathischer pulmonaler Fibrose (IPF) wird in den nationalen und internationalen Leitlinien eine Sauerstofftherapie unter Belastung empfohlen (Behr et al., 2013; Magnussen et al., 2008; Raghu et al., 2011). Behr et al. sprechen eine starke Empfehlung bei sehr geringer Evidenz aus. Dowman et al. konnten eine Verbesserung der körperlichen Ausdauerleistung und SpO2 unter Sauerstofftherapie nachweisen (Dowman et al., 2017). Nishiyama et al. fanden keine Leistungssteigerung von IPF Patienten im 6-Minuten Gehtest unter Sauerstofftherapie (Nishiyama et al., 2008). In einer retrospektiven Analyse zeigte sich bei diesen Patienten hingegen eine Verbesserung der Gehstrecke unter Sauerstofftherapie (Frank et al., 2012). Die Aussagekraft dieser Studien ist durch geringe Fallzahlen limitiert und sie zeigen widersprüchliche Ergebnisse. Ziel der vorliegenden Studie war es, die kurzfristigen Effekte einer Sauerstofftherapie bei einer größeren Gruppe von IPF Patienten zu untersuchen. Es wurde erwartet, dass diese Patienten ihre Ausdauer und SpO2 bei Belastung durch eine Sauerstofftherapie verbessern können. Es sollten außerdem die Effekte einer solchen Therapie auf die Atemfrequenz, Herzfrequenz und den Kohlenstoffdioxidpartialdruck der Patienten untersucht werden. Methodik: Im Rahmen der pneumologischen Rehabilitation an der Schön Klinik Berchtesgadener Land nahmen 40 Patienten mit idiopathischer pulmonaler Fibrose (Alter: 68.98 ± 7.31 Jahre, 39 männlich, 1 weiblich) und Belastungshypoxie (im 6-Minuten Gehtest) an dieser prospektiven Studie teil. Als Basisuntersuchungen wurden eine Lungenfunktion, eine Diffusionsmessung, eine Bioimpedanzanalyse und eine Blutgasanalyse durchgeführt. Jeder Patient absolvierte einen ISWT zur Bestimmung der maximalen Gehgeschwindigkeit. Jeder Patient absolvierte 3 ESWTs bei 85% dieser Gehgeschwindkeit. Dabei wurde jeweils ein Gehtest unter Raumluft, einer unter 2 L O2/min und einer unter 4 L O2/min durchgeführt. Die Anwendung der Atemgase erfolgte in randomisierter Reihenfolge und unter doppelter Verblindung. Die Patienten wurden angewiesen, die extern vorgegebene Geschwindigkeit so lange wie möglich durchzuhalten. Primärer Endpunkt der Studie war die Gehdauer (in Sekunden) bis zum Abbruch des ESWT durch den Patienten. Die SpO2, AF, HF und tcpCO2 wurden während des ESWT kontinuierlich aufgezeichnet. Um eine Vergleichbarkeit dieser Messparameter zu erreichen, wurde aus jedem Gehtest der Messwert bei Isotime (kürzeste Gehdauer eines Patienten in den 3 ESWTs) verwendet. Am Ende jedes Gehtests wurde die Dyspnoe des Patienten auf der modifizierten Borg-Skala erhoben. Ergebnisse: Es zeigte sich eine signifikante Verlängerung der Gehdauer im ESWT unter Sauerstofftherapie gegenüber Raumluft. Unter 2 L O2/min (p=0.003) und unter 4 L O2/min (p
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37. Benefits of an Oxygen Reservoir Cannula versus a Conventional Nasal Cannula during Exercise in Hypoxemic COPD Patients: A Crossover Trial
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Gloeckl, Rainer, Heinzelmann, Inga, Matthaei, Maximilian, Seeberg, Stella, Damisch, Thomas, Jerrentrup, Andreas, and Kenn, Klaus
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- 2014
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38. Vocal Cord Dysfunction (VCD)
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Kenn, Klaus, primary
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- 2014
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39. Influence of an Acute Exacerbation During Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease Awaiting Lung Transplantation
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Gloeckl, Rainer, primary, Jarosch, Inga, additional, Leitl, Daniela, additional, Schneeberger, Tessa, additional, Nell, Christoph, additional, Langer, Daniel, additional, Koczulla, Andreas R., additional, and Kenn, Klaus, additional
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- 2021
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40. Pulmonary rehabilitation in long COVID: more than just natural recovery!?
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Gloeckl, Rainer, primary, Leitl, Daniela, additional, Jarosch, Inga, additional, Schneeberger, Tessa, additional, Nell, Christoph, additional, Stenzel, Nikola, additional, Daher, Ayham, additional, Dreher, Michael, additional, Vogelmeier, Claus F., additional, Kenn, Klaus, additional, and Koczulla, Andreas R., additional
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- 2021
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41. Psychopneumologie: Bedeutung und Potenzial einer neuen Betrachtungsweise für Forschung und Praxis
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Stenzel, Nikola M. and Kenn, Klaus
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- 2024
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42. Additional file 1 of Whole-body vibration training versus conventional balance training in patients with severe COPD—a randomized, controlled trial
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Gloeckl, Rainer, Schneeberger, Tessa, Leitl, Daniela, Reinold, Tobias, Nell, Christoph, Jarosch, Inga, Kenn, Klaus, and Koczulla, Andreas R.
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Data_FILES - Abstract
Additional file 1. Additional tables and figures.
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- 2021
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43. Additional file of Whole-body vibration training versus conventional balance training in patients with severe COPD—a randomized, controlled trial
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Gloeckl, Rainer, Schneeberger, Tessa, Leitl, Daniela, Reinold, Tobias, Nell, Christoph, Jarosch, Inga, Kenn, Klaus, and Koczulla, Andreas R.
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education ,macromolecular substances - Abstract
Additional file of Whole-body vibration training versus conventional balance training in patients with severe COPD—a randomized, controlled trial
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- 2021
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44. Whole-body vibration training versus conventional balance training in patients with severe COPD_a randomized, controlled trial
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Gloeckl, Rainer, Schneeberger, Tessa, Leitl, Daniela, Reinold, Tobias, Nell, Christoph, Jarosch, Inga, Kenn, Klaus, and Koczulla, Andreas R.
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Research ,Chronic obstructive pulmonary disease ,Pulmonary rehabilitation ,Exercise ,Neuromuscular power ,Force measurement platform ,Vibration platform ,ddc - Published
- 2020
45. Effekte der zusätzlichen Sauerstoffzufuhr über ein Demandsystem im Vergleich zum Dauerflusssystem bei körperlicher Belastung hypoxämischer COPD-Patienten
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Böttge, Melody M. and Kenn, Klaus (Prof. Dr.)
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Obstruktive Ventilationsstörung ,Pneumologie ,COPD ,Sauerstoffzufuhrsystem ,Medizin, Gesundheit ,Medical sciences, Medicine ,ddc:610 - Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable pulmonary disease which is associated with not fully reversible, progressive respiratory symptoms, and airflow limitation. It is one of the leading causes of morbidity and mortality and is projected to be the third leading cause of death by 2020. A premature therapeutic treatment is essential, as it alleviates symptoms, improves the quality of life, and slows down the progression of the disease. Long-term oxygen therapy is a recommended therapy option for hypoxemic COPD patients and improves the chances of survival significantly. Patients with chronic hypoxemia and chronic respiratory insufficiency of stage IV benefit from 16 – 24 hours long-term oxygen therapy per day as it increases lifespan and improves exercise intensity and duration. In clinical practice, two different oxygen-delivery systems are used for long-term oxygen therapy: a continuous-oxygen-flow system and a demand-oxygen-delivery system. Both systems are small, handy, portable, and allow good mobility for the patients. The continuous-oxygen-flow system is associated with higher consumption of oxygen because oxygen is supplied continuously during both inspiration and expiration. The demand-oxygen-delivery system delivers a bolus of oxygen during early inspiration and needs to be triggered by the patient’s inspiratory effort, but no oxygen is supplied during expiration. There is, however, a lack of evidence with respect to which oxygen-delivery system is most suitable during exercise. In fact, there are various studies that have already examined the effect of a continuous-oxygen-flow system during exercise. However, there is no study that compared the effects of the continuous-oxygen-flow system and the demand-oxygen-delivery system using a standardized, externally paced walk-test procedure in a sufficiently large sample of hypoxemic patients. This is the first study which examines the effects of supplemental oxygen delivery with a demand-oxygen-delivery system compared to a continuous-oxygen-flow system during a standardized, externally paced walk-test procedure in form of an Endurance Shuttle Walking Test at isotime in a large sample of hypoxemic COPD patients. Compared to the 6-minute walk test the Endurance Shuttle Walking Test provides a better standardization, is well validated, and offers high reliability for measuring endurance-walk capacity in COPD patients. It is therefore comparable to the intensity of typical daily activities. In total, 77 hypoxemic COPD patients with long-term oxygen therapy were enrolled in the monocentric, randomized, single-blinded, controlled crossover trial that was conducted during a three-week inpatient pulmonary rehabilitation program at the Schön Klinik Berchtesgadener Land in Schönau am Königssee, Germany. Out of the initial 77 participants, 70 hypoxemic COPD patients were included in the analysis. For this study, an Incremental Shuttle Walking Test was initially performed by the patients. At least 24 hours thereafter, patients participated in two additional walking tests (Endurance Shuttle Walking Test) with two oxygen-delivery systems in randomized order. There was a wash-out phase of 24 hours between these two Endurance Shuttle Walking Tests. The primary outcome was the oxygen saturation during the exercise at isotime. Secondary outcomes were transcutaneous partial pressure of carbon dioxide, breathing frequency, and pulse rate, as well as dyspnea and walking distance. Furthermore, patients were analyzed with respect to secondary target parameters (gender, BMI, and use of a rollator) in order to identify potential predictors for the use of a specific oxygen-delivery system. The results of this study show that under these standardized workload conditions, there are neither statistically significant nor clinically relevant differences between the continuous-oxygen-flow system and the demand-oxygen-delivery system concerning oxygen saturation in hypoxemic COPD patients during the entire exercise. A separate subgroup analysis merely reveals a general trend in which more patients benefited from oxygen saturation using the continuous-oxygen-flow system since some of these patients had a significantly higher oxygen saturation (up to 13 %) and the difference in oxygen saturation between the continuous-oxygen-flow system and the demand-oxygen-delivery system reached the required clinical-relevance level of 4 %. However, the majority of participants in this subgroup analysis did not show any clinically relevant difference in oxygen saturation at isotime. Additionally, the results of the analysis identifying potential predictors did not show any statistically significant differences between the continuous-oxygen-flow system and the demand-oxygen-delivery system with respect to oxygen saturation at isotime. In summary, no clinically relevant differences in primary and secondary outcomes could be identified when comparing the scrutinized oxygen-delivery systems among hypoxemic COPD patients, and thus both may be considered equivalent with respect to the physiological impact. From a practical point of view, the demand-oxygen-delivery system used in this study offers a bigger advantage compared to the continuous-oxygen-flow system as it is smaller and lighter and has a longer operating life. Based on the results analyzed in this present study, hypoxemic COPD patients are advised to individually adapt to one of these oxygen-delivery systems in order to evaluate and configure the type of oxygen delivery as well as the oxygen-flow adjustment for each patient. Only this way efficiency and the intended levels of oxygen saturation can be achieved. Based on this study, additional, comprehensive comparisons with other existing portable oxygen-delivery systems should be investigated under standardized and uniform workload conditions. Here, not only the oxygen saturation, but also other outcomes should be considered and analyzed at rest, during exercise, and during sleep., Die chronisch obstruktive Atemwegserkrankung (Chronic Obstructive Pulmonary Disease, COPD) ist eine vermeidbare und behandelbare Erkrankung, die mit nicht vollständig reversibler, progredient verlaufender Atemwegsobstruktion einhergeht. Sie ist eine der führenden Ursachen für Morbidität und Mortalität und wird laut Prognosen im Jahr 2020 die dritthäufigste Todesursache weltweit sein. Eine frühzeitige therapeutische Behandlung ist essentiell, da somit die Symptome gelindert, die Lebensqualität deutlich verbessert und die Krankheitsprogression verlangsamt wird. Zu den apparativen Therapieformen zählen neben der nicht-invasiven Beatmung auch die Langzeitsauerstofftherapie. Patientinnen und Patienten mit chronischer Hypoxämie und chronischer respiratorischer Insuffizienz im Stadium IV profitieren von einer Langzeitbehandlung mit Sauerstoff bei einer Anwendung von 16 – 24 Stunden pro Tag. Sie verlängert die Überlebenszeit und verbessert die Belastungsintensität bzw. -dauer. In der klinischen Praxis werden für die Langzeitsauerstofftherapie zwei unterschiedliche Sauerstoffzufuhrsysteme verwendet: das Dauerfluss- und das Demandsystem. Beide Formen ermöglichen Patientinnen und Patienten durch ihre kleine, leichte und handliche Ausführung eine gute Mobilität. Das Dauerflusssystem geht mit erheblich höherem Verbrauch von Sauerstoff einher, weil der Sauerstoff sowohl während der Ein- als auch während der Ausatmung freigesetzt wird. Das Demandsystem, welches nur nach inspiratorisch nasaler Triggerung durch die Personen einen Sauerstoffbolus freisetzt, spart Sauerstoff ein und kann zu einer vergleichbaren Sauerstoffsättigung bei COPD-Patientinnen und -Patienten in Ruhe führen.Welches tragbare Sauerstoffzufuhrsystem allerdings unter Belastung in der Praxis am geeignetsten ist, wurde noch nicht ausreichend untersucht. Es gibt bereits einige Studien bei COPD-Patientinnen und -Patienten, in denen der Effekt des Dauerflusssystems unter Belastung untersucht wurde. Jedoch gibt es noch keine Studie, in der diese beiden Sauerstoffzufuhrsysteme bei einem geeigneten Kollektiv mit ausreichender Fallzahl unter standardisierten Testbedingungen analysiert wurden. In dieser Studie wurden zum ersten Mal die Effekte der zusätzlichen Sauerstoffzufuhr über ein Demandsystem im Vergleich zum Dauerflusssystem während eines standardisierten Gehtests in Form eines Endurance Shuttle Walking Tests mit vorgegebener Geschwindigkeit und unter Verwendung der Isotime in einer großen Kohorte hypoxämischer COPD-Patientinnen und -Patienten untersucht. Der Shuttle Walking Test stellt im Vergleich zum 6-Minuten-Gehtest eine bessere Standardisierung und einen guten Vergleich der Belastungsintensität der alltäglichen Aktivität dar. Insgesamt wurden 77 hypoxämische COPD-Patientinnen und -Patienten mit Langzeitsauerstofftherapie für die monozentrische, randomisierte, einfach verblindete, kontrollierte Crossover-Studie im Rahmen ihres dreiwöchigen, multidisziplinären Rehabilitationsprogramms in der Schön Klinik Berchtesgadener Land in Schönau am Königssee rekrutiert. Davon wurden 70 Personen in die Analyse eingebunden. Zunächst erfolgte ein Incremental Shuttle Walking Test. Nach frühestens 24 Stunden nahmen sie an zwei weiteren Belastungsgehtests (Endurance Shuttle Walking Test) mit zwei Sauerstoffzufuhrsystemen in randomisierter Reihenfolge und im zeitlichen Abstand von 24 Stunden teil. Primäre Zielgröße war die Sauerstoffsättigung während des Verlaufs der Belastung zur Isotime. Sekundäre Zielgrößen waren transkutaner Kohlendioxidpartialdruck, Atemfrequenz und Pulsfrequenz sowie Dyspnoe und Gehstrecke. Ebenso wurde die gesamte Stichprobengröße im Hinblick auf Nebenzielparameter (Geschlecht, BMI und Verwendung eines Rollators) unterteilt und gesondert analysiert, um mögliche Prädiktoren für die Benutzung eines bestimmten Sauerstoffgeräts zu identifizieren. Die Ergebnisse zeigen, dass unter diesen standardisierten und einheitlichen Belastungsbedingungen zu allen Messzeiten weder statistisch signifikante noch klinisch relevante Unterschiede zwischen Dauerflusssystem und Demandsystem hinsichtlich der Sauerstoffsättigung bei hypoxämischen COPD-Patientinnen und -Patienten erkennbar sind. In einer gesonderten Subgruppenanalyse zeigte sich lediglich ein genereller Trend, dass im Hinblick auf die Sauerstoffsättigung die Benutzung eines Dauerflusssystems für mehr Patientinnen und Patienten von Vorteil war, da bei einigen dieser Personen eine deutlich höhere Sauerstoffsättigung (bis zu 13 %) zu verzeichnen war und die Differenzen bezogen auf die Sauerstoffsättigung zwischen beiden Geräten die geforderte klinische Relevanz von 4 % erfüllten. Die Mehrheit der Personen dieser Subgruppenanalyse zeigte allerdings zum Zeitpunkt der Isotime keinen klinisch relevanten Unterschied in der Sauerstoffsättigung. Die Untersuchung möglicher Prädiktoren zeigte zur Isotime keine statistisch signifikanten Unterschiede zwischen Dauerflusssystem und Demandsystem hinsichtlich der Sauerstoffsättigung. Insgesamt ergibt sich, dass die beiden untersuchten Sauerstoffzufuhrsysteme im Hinblick auf primäre als auch sekundäre Zielgrößen unter Belastung hypoxämischer COPD-Patientinnen und -Patienten keine klinisch relevanten Unterschiede aufweisen und somit bezogen auf den physiologischen Einfluss als gleichwertig anzusehen sind. Aus praktischer Sicht bietet das hier verwendete Demandsystem den Vorteil, dass es im Vergleich zum Dauerflusssystem kleiner, leichter und somit handlicher ist und zusätzlich eine längere Nutzungsdauer hat. Im Zusammenhang mit den analysierten Ergebnissen ist für hypoxämische COPD-Patientinnen und -Patienten eine individuelle Anpassung der Sauerstoffzufuhrsysteme zu empfehlen, bei der die Art des Geräts als auch die Einstellung des Sauerstoffflusses für jede Person evaluiert und konfiguriert werden sollte. Nur so kann die Wirksamkeit und die Effizienz gewährleistet und die angestrebten Sauerstoffsättigungswerte erreicht werden. Basierend auf dieser Studie sollten zusätzliche, umfangreiche Untersuchungen mit verschiedenen portablen Sauerstoffzufuhrsystemen unter standardisierten und einheitlichen Belastungsbedingungen erfolgen, bei denen die individuelle Sauerstoffsättigung und weitere Zielgrößen unter anderem in Ruhe, unter Belastung und im Schlaf bei hypoxämischen COPD-Patientinnen und -Patienten analysiert und verglichen werden.
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- 2020
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46. Increased asthma control after a 3-week inpatient pulmonary rehabilitation program
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Schneeberger, Tessa, Jarosch, Inga, Moll, Johanna, Gloeckl, Rainer, Boensch, Martina, Hitzl, Wolfgang, Idzko, Marco, Taube, Christian, Kenn, Klaus, and Koczulla, Andreas Rembert
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- 2020
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47. Perceptions of Noninvasive Ventilation During Exercise in Noninvasive Ventilation-Naïve Patients With COPD.
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Dennis, Clancy J., Menadue, Collette, Schneeberger, Tessa, Leitl, Daniela, Schoenheit-Kenn, Ursula, Harmer, Alison R., Barnes, David J., Koczulla, Andreas R., Kenn, Klaus, and Alison, Jennifer A.
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OBSTRUCTIVE lung disease diagnosis ,STATISTICS ,NASAL cannula ,CONTINUOUS positive airway pressure ,HUMAN comfort ,SENSORY perception ,INTERVIEWING ,ARTIFICIAL respiration ,RANDOMIZED controlled trials ,EXERCISE ,PULMONARY function tests ,SCALE analysis (Psychology) ,DESCRIPTIVE statistics ,STATISTICAL sampling ,DATA analysis - Abstract
BACKGROUND: The perceptions of using noninvasive ventilation (NIV) during exercise in patients with COPD who are naïve to NIV is unknown. The present study aimed to examine the perceptions of using NIV during exercise in people with COPD and to determine the relationship between patient perceptions with both baseline patient characteristics and exercise outcomes. METHODS: During a trial examining the effect of NIV during exercise on dynamic hyperinflation in people with COPD who were naïve to NIV, participants completed a 5-point Likert scale questionnaire (scored strongly disagree -2 to strongly agree +2) before and after using NIV during exercise and a semi-structured interview after using NIV during exercise. RESULTS: Eighteen participants, mean age (SD) 69 (7) y, FEV
1 /FVC 0.44 (0.08), FEV1 39 (7)% predicted, completed the study. Prior to exercise with NIV, participants were neutral about NIV, (mean [SD]) (0.67[0.84]). After exercise with NIV, participants felt that NIV made breathing easier (1.00 [0.77]) and that it helped exercise (1.06 [0.64]). There were moderate correlations between feeling that NIV was comfortable or effective and a change in exercise endurance time (q = - 0.588, P = .02), isotime inspiratory capacity (q = 0.488, P = .03), and measures of resting hyperinflation (q = 0.603, \P = .02). Interviews revealed that despite feeling comfortable using NIV during exercise, NIV might be too complicated for patients to manage outside a supervised environment. CONCLUSIONS: Individuals with COPD, naïve to NIV, and using NIV during exercise for the first time reported a positive effect of NIV on breathlessness and exercise performance. Participants' perceived benefit of NIV correlated moderately with increased endurance time and resting hyperinflation and with a reduction in dynamic hyperinflation during exercise, suggesting that patient reports could also aid selection of those who will benefit from NIV during exercise. [ABSTRACT FROM AUTHOR]- Published
- 2022
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48. Protocol for an observational study to identify potential predictors of an acute exacerbation in patients with chronic obstructive pulmonary disease (the PACE Study)
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Kenn, Klaus, primary, Gloeckl, Rainer, additional, Leitl, Daniela, additional, Schneeberger, Tessa, additional, Jarosch, Inga, additional, Hitzl, Wolfgang, additional, Alter, Peter, additional, Sczepanski, Bernd, additional, Winterkamp, Sandra, additional, Boensch, Martina, additional, Schade-Brittinger, Carmen, additional, Skevaki, Chrysanthi, additional, Holz, Olaf, additional, Jones, Paul W, additional, Vogelmeier, Claus F, additional, and Koczulla, Andreas R, additional
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- 2021
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49. Relationship between clinical and radiological signs of bronchiectasis in COPD patients: Results from COSYCONET
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Kirsten Anne-Marie, Anne Wirz, Erich Traugott, Ficker Joachim H, Bertram J. Jobst, Vivien Janke, Stubbe Beate, Johanna I. Lutter, Barbara Ziss, Franziska C. Trudzinski, Patricia Berger, Henrik Watz, Gogol Manfred, Thomas Bahmer, Beate Polte, Kronsbein Juliane, Campus Kiel, Lange Christoph, Martina Seibert, Rudolf A. Jörres, Pfeifer Michael, Timmermann Hartmut, Grohé Christian, Tobias Welte, Studnicka Michael, Petra Hundack-Winter, Jana Graf, Jürgen Behr, Diana Schottel, Buhl Roland, Virchow J. Christian, Bewig Burkhard, Ruhrlandklinik gGmbH. Essen, Wirtz Hubert, Rosalie Untsch, Birte Struck, Peter Alter, Kathrin Kahnert, Gudrun Hübner, Vogelmeier Claus, Sabine Michalewski, Kropf-Sanchen Cornelia, Kenn Klaus, Pontus Mertsch, Sonja Rohweder, Hauck Rainer, Andreas Stefan, Ilona Kietzmann, Zabel Peter, Michaela Schrade-Illmann, Höffken Gerd, Julia Tobias, Frank Biertz, Seeger Werner, Manuel Klöser, Kahnert Kathrin, Teschler Helmut, Anita Reichel, Gina Spangel, Ulrike Rieber, Randerath Winfried J, Julia Teng, Tanja Lucke, Herth Felix, Jeanette Pieper, Lenka Krabbe, Taube Christian, Jürgen Biederer, Wagner Ulrich, Doris Lehnert, Claus Vogelmeier, Katrin Schwedler, Henke Markus, Jany Berthold, Katus Hugo A, Bals Robert, Zaklina Hinz, Cornelia Böckmann, Ellen Burmann, Margret Gleiniger, Behr Jürgen, Britta Markworth, Ewert Ralf, Gertraud Weiß, Katrin Wons, Barbara Arikan, Watz Henrik, Beate Schaufler, Lena Sterk, Robert Bals, Hans-Ulrich Kauczor, Koczulla Rembert, Held Matthias, and Welte Tobias
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Copd patients ,Medizin ,Comorbidity ,Severity of Illness Index ,Pulmonary Disease, Chronic Obstructive ,Medicine ,Humans ,In patient ,Lung ,Aged ,Aged, 80 and over ,COPD ,Bronchiectasis ,business.industry ,Phlegm ,Middle Aged ,medicine.disease ,Radiological weapon ,Clinical diagnosis ,Cohort ,Female ,Radiography, Thoracic ,Radiology ,medicine.symptom ,business ,Tomography, X-Ray Computed - Abstract
Bronchiectasis (BE) might be frequently present in COPD but masked by COPD symptoms. We studied the relationship of clinical signs of bronchiectasis to the presence and extent of its radiological signs in patients of different COPD severity. Visit 4 data (GOLD grades 1-4) of the COSYCONET cohort was used. Chest CT scans were evaluated for bronchiectasis in 6 lobes using a 3-point scale (0: absence, 1: ≤50%, 2: >50% BE-involvement for each lobe). 1176 patients were included (61%male, age 67.3y), among them 38 (3.2%) with reported physicians' diagnosis of bronchiectasis and 76 (6.5%) with alpha1-antitrypsin deficiency (AA1D). CT scans were obtained in 429 patients. Within this group, any signs of bronchiectasis were found in 46.6% of patients, whereby ≤50% BE occurred in 18.6% in ≤2 lobes, in 10.0% in 3-4 lobes, in 15.9% in 5-6 lobes; >50% bronchiectasis in at least 1 lobe was observed in 2.1%. Scores ≥4 correlated with an elevated ratio FRC/RV. The clinical diagnosis of bronchiectasis correlated with phlegm and cough and with radiological scores of at least 3, optimally ≥5. In COPD patients, clinical diagnosis and radiological signs of BE showed only weak correlations. Correlations became significant with increasing BE-severity implying radiological alterations in several lobes. This indicates the importance of reporting both presence and extent of bronchiectasis on CT. Further research is warranted to refine the criteria for CT scoring of bronchiectasis and to determine the relevance of radiologically but not clinically detectible bronchiectasis and their possible implications for therapy in COPD patients.
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- 2020
50. Effekte zweier Sauerstoffsysteme (Flüssigsauerstoff versus Konzentrator) auf die Oxygenierung in Ruhe und während Belastung bei hypoxämischen COPD-Patienten
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Weingaertner, Julian and Kenn, Klaus (Prof. Dr. med.)
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Flüssigsauerstoff ,Effekte ,demand ,liquid oxygen ,Konzentrator ,oxygenation ,Demand ,LOD ,Dauerfluss ,Portible oxygen concentrator ,Belastung ,Liquid oxygen devic ,continous flow ,POC ,oxygen delivery systems ,concentrator ,Oxygenierung ,Ruhe ,Sauerstoffsysteme ,Medizin, Gesundheit ,Vergleich ,Medical sciences, Medicine ,ddc:610 - Abstract
Im medizinischen Alltag stehen für COPD-Patienten mit Indikation zur Langzeitsauerstofftherapie neben klassischen Flüssigsauerstoffsystemen (Liquid Oxygen Devices (LOD) mit Dauerfluss (CF) oder Demandsystem/Sparventil (DODS)) mittlerweile eine Vielzahl an mobilen Konzentratoren/POCs (Portable Oxygen Concentrators) als Applikationssysteme zur Verfügung. POCs konzentrieren akkubetrieben Sauerstoff aus der Umgebungsluft und können über eine herkömmliche Steckdose aufgeladen werden, weshalb sie eine größere Mobilität und Autonomie des Patienten versprechen. Hinsichtlich der Vergleichbarkeit der Effekte auf die Oxygenierung eines POCs mit denjenigen eines Flüssigsauerstoffgerätes sowie der korrekten Literkonversion von Flüssigsauerstoff (LOX / Liquid Oxygen) in die einzelnen Konzentratorstufen existieren aktuell nur wenige Studien. Aus diesem Grunde wurde in vorliegender randomisiert-kontrollierter cross-over Studie die Vergleichbarkeit des POCs (mit DODS) Activox™ 4L mit dem LOD (mit CF) Companion® 1000 bei 30 hypoxämischen COPD Patienten (Alter 65,6±8,2 Jahre; FEV1 35,2±10,4%; pO2 56,8±6,1mmHg; pCO2 38,3±4,9mmHg) unter Belastung und bei 15 hypoxämischen Patienten in Ruhe (Alter 65,5±7,6 Jahre; FEV1 31,5±7,3%; pO2 54,9±3,5mmHg; pCO2 40,2±3,3mmHg) untersucht. Es kam zu keinen Drop-outs. Untersuchung unter Belastung: Es wurde der Shuttlewalk als standardisierter Gehtest verwendet. Nach einem Einstufungstest (ISWT) folgten in den darauffolgenden zwei Tagen, in randomisierter Reihenfolge, jeweils ein Endurance Shuttle Walk Tests (ESWT) mit LOD und POC. Während der ESWTs wurde SpO2 als primärer Endpunkt sowie als Nebenzielparameter pCO2, Herzfrequenz, Atemfrequenz, inspiratorische Kapazität gemessen sowie Dyspnoe und körperliche Erschöpfung eruiert. SpO2 war vor als auch während des ESWTS mit dem LOD signifikant höher als mit dem POC (alle p-Werte ˂.001). Der durchschnittliche SpO2-Wert nahm während des ESWTs mit dem LOD von 95,3±2,4% auf 88,9±6,2%, mit dem POC von 93,6±2,9% auf 84,8±7% ab. Ein SpO2 von ˃90% konnte mit dem LOD länger gehalten werden, weshalb mit dem LOD durchschnittlich 108,3±138,0 Meter weiter und 123±160 Sekunden länger gelaufen wurde. Die Gehstrecke und -zeit insgesamt der ESWTs belief sich auf durchschnittlich 344,0±293,7 Meter bei 384±277 Sekunden (LOD) sowie 235,7±249,8 Meter bei 261±219 Sekunden (POC). Hinsichtlich der Nebenzielparameter ergaben sich keine statistisch relevanten Unterschiede. Untersuchung in Ruhe: An zwei Studientagen erhielten 15 Studienpatienten in randomisierter Reihenfolge im Sitzen und in Ruhe über einen Zeitraum von 40 Minuten Sauerstoff aus den Systemen. Die Durchflussrate wurde dabei mit 1l/min LOX (LOD) bzw. Stufe 1 (POC) begonnen und kontinuierlich alle 10 Minuten um eine weitere Stufe/Literflusszahl erhöht bis zur maximalen Stufe/Durchflussrate von Stufe 4 bzw. 4l/min LOX. Vor jeder Erhöhung wurde eine Blutgasanalyse durchgeführt und die Atemfrequenz gemessen. Es ergab sich ein statistisch signifikanter Unterschied zwischen beiden Geräten hinsichtlich des primären Endpunktes pO2 auf allen 4 Durchflussraten (alle p-Werte ˂.001). Mit dem POC nahm der durchschnittliche pO2 von 58,0±5,2mmHg (Stufe 1) auf 66,0±6,3mmHg (Stufe 4) und mit dem LOD von 63,8±6,5mmHg (1l/min LOX) auf 87,4±15,9mmHg (4l/min LOX) zu. Durchschnittlich lag der pO2 mit dem LOD auf allen Flusseinstellungen um 15,2±7,2mmHg höher. Die größte pO2-Mittelwertdifferenz berechnete sich mit 21,4±13,0mmHg bei maximaler Stufeneinstellung 4 und 4l/min LOX, wobei der durchschnittliche pO2 auf dieser Stufe mit dem POC im Vergleich um diesen Wert niedriger war. Auf Stufe 4 des POCs wiesen 14 der 15 Patienten einen niedrigeren pO2-Wert auf als bei ihnen mit 2l/min LOX gemessen worden war, fünf von ihnen lagen dabei unter ihrem Wert von 1l/min LOX. Hinsichtlich der Nebenzielparameter (pCO2, pH, AF) ergaben sich keine signifikanten Unterschiede. Der POC hatte pro Stufe einen ähnlichen Effekt auf die Oxygenierung der Patienten wie 0,304l/min LOX. Auf Stufe 4 erreichte der POC somit eine Flussäquivalenz von ca. 1,2l/min LOX. Für Patienten, die eine Durchflussrate größer als 2l/min LOX benötigten, konnte der POC selbst auf höchster Stufe somit keine gleichwertige Alternative zum Flüssigsauerstoffgerät darstellen. Unter Belastung konnte im Vergleich mit dem LOD annährend eine 1,5-fach längere Strecke zurückgelegt werden. Die niedrige Performance des POC Activox™ steht vermutlich mit technischen Spezifikationen, wie das in diesem Gerät verbaute DODS mit kleinem Bolusvolumen, in Zusammenhang., The two most common oxygen delivery systems for hypoxemic COPD patients available operate with liquid oxygen or by concentrating the ambient air (concentrators). The concentrator system is advantageous, because it is powered by an integrated battery and charged with a common electrical plug, which enables the patient to have a higher level of physical mobility and autonomy. There are limited publications, that explore if portable oxygen concentrators have a comparable efficiency on oxygen saturation to liquid oxygen devices with continuous flow (LOD). As of now there are no official recommendations on how to convert the oxygen flow rate for LOD (litre per minute) into the corresponding level of the POC; therefore, the aim of this randomized, controlled cross-over trial is to investigate the comparability of the portable oxygen concentrator Activox™ 4L (POC) to a liquid oxygen device Companion® (LOD) in 30 hypoxemic COPD patients during exercise (means: age 65,6±8,2 year, FEV1 35,2±10,4%, pO2 56,8±6,1mmHg, pCO2 38,3±4,9mmHg) and in 15 patients at rest (means: age 65,5±7,6 year; FEV1 31,5±7,3%, pO2 54,9±3,5mmHg; pCO2 40,2±3,3mmHg). No drop-outs occurred. As a baseline assessment all patients received a body plethysmography and a blood gas analysis without using supplemental oxygen. Examination during exercise: A Shuttle Walk was used as a standardized field walking test to simulate a cardiopulmonary exercise test with daily life relevance. Following an initial incremental shuttle walk test (ISWT), patients performed on two days in randomized order with each system one endurance shuttle walk test (ESWT). During the ESWT, breathing frequency, inspiratory capacity, SpO2, pCO2 and heart frequency were measured, as well as Dyspnoea and leg fatigue before and after the ESWT were evaluated. SpO2 was significantly higher before and during the ESWT with the LOD than with the POC (all p˂.005). The mean SpO2±SD dropped during the ESWT with the LOD from 95,3±2,4% to a mean SpO2 of 88,9±6,2% at the end of the walking test, while it was with the POC 93,6±2,9% (Start) and 84,8±7% SpO2 (End). Patients with the POC showed a lower pre-walk SpO2 and a faster decline of Oxygenation during the walking test. LOD supplied patients for a longer period of time with SpO2˃90% than with the POC. Therefore, patients were able to walk statistically significant (p˂.001) longer with the LOD during the ESWT. The mean distance and endurance with the LOD were 344,0±293,7 meter and 384±277 seconds, while with the POD it was with 235,7±249,8 meter and 261±219 seconds, consequently 108,3±138,0 meter and 123±160 seconds less than with the LOD. 24 of the 30 patients stopped the ESWT with the POC earlier than with the LOD. There was no significant statistical difference between the two devices regarding the second outcome parameters such as pCO2, breathing frequency, heart frequency, inspiratory capacity, as well as leg fatigue and dyspnoea (BORG-Scale). Examination at rest: The study was conducted during two consecutive days, where the 15 patients were connected in randomized order to one of the two systems via nasal cannula for a total time period of 40 minutes while remaining in a sitting position without speaking. The oxygen flow rate started at 1 liter/min (LOD) or Level 1 (POC) and increased every 10 minutes to the following level until it reached the maximum level at 4 (POC) or 4l/min (LOD). Blood gases (pO2, pCO2, pH) and breathing frequencies were measured at the end of each oxygen level. There was a significant difference between the two devices regarding the pO2 on all four flow rates (all p˂.001). On an average of all flow rates there was a 15,2±7,2mmHg higher pO2 measurable with the LOD. With an initial mean pO2 on level 1 of the POC with 58,0±5,2mmHg, the pO2 went up till 66,0±6,3mmHg on Level 4, reaching the maximum setting of oxygen flow of the POC. Patients with the LOD showed a mean pO2 with 1l/min-flowrate of 63,8±6,5mmHg and 87,4±15,9mmHg with a 4l/min flow. The maximum difference between the devices was reached on the maximum Level of the POC and 4l/min liquid oxygen with a 21,4±13,0mmHg lower oxygenation with the POC. On level 4, 14 of the 15 patients had a lower oxygenation than with the 2l/min liquid oxygen, 5 of these patients a lower pO2 than with 1l/min. Summarizing the POC had an effect per level on the patients pO2 as it had equivalent to 304ml/min liquid oxygen, reaching a maximum flow-capacity of the device on level 4 of 1,2l/min LOX. There was no significant difference between the two devices regarding the second outcome parameter such as pCO2, pH and breathing frequencies.
- Published
- 2020
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