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Tobias Boeselt,1 Johannes Kroenig,1 Theresa-Sophie Lueders,1 Niklas Koehler,2 Bjoern Beutel,1 Olaf Hildebrandt,1 Ulrich Koehler,1 Regina Conradt1 1Department of Internal Medicine, Division of Pneumology, Intensive Care and Sleep Medicine, Philipps-University Marburg, Marburg, Germany; 2Thora Tech GmbH, Clinical Research Department, Gießen, GermanyCorrespondence: Tobias Boeselt, Department of Internal Medicine, Division of Pneumology, Intensive Care and Sleep Medicine, Philipps-University Marburg, Baldingerstrasse 1, Marburg, 35033, Germany, Email tobias.boeselt@uni-marburg.deIntroduction: In clinical practice, wheezing and coughing represent a worsening of the respiratory situation of COPD patients and should be monitored long-term during and after an Acute Exacerbation of COPD (AECOPD) to observe the therapy. We investigated if overnight monitoring of wheezing and coughing is feasible during AECOPD and whether automatic long - term monitoring enables an objective assessment during and after an AECOPD.Methods: In 14 patients (age: 56– 80 years) with pre-existing COPD (stages B-D) nighttime wheezing and coughing events were monitored for a period of three weeks. The portable LEOSound® monitor recorded three nights into AECOPD (nights 1, 3 and 6) during the hospital stay, and the 20th night post- AECOPD ambulatory. Before each recording the subjective symptom severity was assessed by a COPD Assessment Test (CAT) and a Modified British Medical Research Council (MMRC) dyspnoea index questionnaire.Results: In all 14 patients, lung sounds were recorded in good quality during each of the 4 recording nights. Wheezing ranged between 5% and 90% (79 − 539.5 minutes) of the recording time on the first night. All patients showed some coughs, in four patients coughing was particularly pronounced and largely receding over the total investigation period. As group, the percentages of wheezing and the number of coughs did not show significant differences between the four recording times. The CAT scores (p< 0.001) declined over the course of investigation period, suggesting a subjective improvement of symptoms.Conclusion: The observational study showed that standardized long-term recording can be performed in high-quality during acute COPD exacerbation as it does not require the patient’s cooperation. The good-quality data of coughs and wheezing were analyzed qualitatively and quantitatively. The long-term presentation of respiratory symptoms during an AECOPD offers the opportunity to evaluate factors that influence exacerbations and therapeutic approaches.Keywords: COPD, wheezing, cough, long term monitoring of respiratory sounds, CAT, exacerbation

Patrick Fischer,1 Volker Gross,1 Johannes Kroenig,2 Andreas Weissflog,3 Olaf Hildebrandt,2 Keywan Sohrabi,1,4 Ulrich Koehler2 1Faculty of Health Sciences, University of Applied Sciences, Giessen, Germany; 2Department of Pneumology, Intensive Care and Sleep Medicine, University Hospital of Marburg and Giessen, Marburg, Germany; 3Clinical Research Department, Thora Tech GmbH, Giessen, Germany; 4Institute for Medical Informatics, Justus-Liebig-University Giessen, Giessen, Germany Purpose: Chronic cough is one of the main symptoms of COPD. Ambulatory objective monitoring provides novel insights into the determinants and characteristics of nighttime cough in COPD.Materials and methods: Nighttime cough was monitored objectively by LEOSound lung sound monitor in patients with stable COPD II–IV. In 30 patients, with 10 patients in each stage group, nighttime cough was analyzed for epoch frequency, epoch severity (epoch length and coughs per epoch), and pattern (productive or nonproductive).Results: Cough was found in all patients ranging from 1 to 294 events over the recording period. In 29 patients, cough epochs were monitored, ranging from 1 to 75 epochs. The highest amount of cough epochs was found in patients with COPD stage III. Active smokers had significantly more productive cough epochs (61%) than nonsmokers (24%).Conclusion: We found a high rate of nighttime cough epochs in patients with COPD, especially in those in stage III. Productive cough was predominantly found in patients with persistent smoking. LEOSound lung sound monitor offers a practical and valuable opportunity to evaluate cough objectively. Keywords: cough, COPD, nighttime, cough-monitor, lung sound, cough epochs

Purpose: Description of the perfusion of pulmonary metastasis by contrast-enhanced ultrasound (CEUS) and their correlation with vascularization patterns represented by immunohistochemical CD34 endothelial staining., Patients and Methods: The data of 54 patients with histologic proven peripheral pulmonary metastasis, investigated between 2004 and 2023 by CEUS. These CEUS parameters were evaluated: time to enhancement (TE), categorized as early pulmonary-arterial (PA) or delayed bronchial-arterial (BA) patterns; extent of enhancement (EE), either marked or reduced; homogeneity of enhancement (HE), homogeneous or inhomogeneous; and decrease of enhancement (DE), rapid washout (<120 s) or late washout (≥120 s). Additionally, tissue samples in 45 cases (83.3%) were stained with CD34 antibody for immunohistochemical analysis., Results: In total, 4 lesions (7.4 %) exhibited PA enhancement, and 50 lesions (92.6%) demonstrated BA enhancement. Furthermore, 37 lesions (68.5%) showed marked enhancement, while 17 lesions (31.5%) exhibited reduced enhancement. The enhancement was homogeneous in 28 lesions (51.86%) and inhomogeneous in 26 lesions (48.14%). Additionally, 53 lesions (98.1%) displayed a rapid washout. A chaotic vascular pattern indicative of a bronchial arterial blood supply was identified in all cases (45/45, 100%), including all 4 lesions with PA enhancement., Conclusion: Pulmonary metastases in CEUS predominantly reveal bronchial arterial enhancement and a rapid washout. Regarding EE and HE, pulmonary metastases show heterogeneous perfusion patterns. A PA enhancement in CEUS does not exclude BA neoangiogenesis.

Competing Interests: C. Görg received funding from Bracco Imaging. Bracco Imaging supported the CEUS workshops at the University Hospital Marburg.

Due to their often peripheral pleural-based location, pneumonias can be visualised by B-mode ultrasound. Therefore, sonography can be used as an alternative imaging modality to chest X-ray in suspected cases of pneumonia. Depending on the clinical background of the patient, and various underlying pathological mechanisms, a heterogeneous pattern of pneumonia is seen in both B-mode lung ultrasound and contrast-enhanced ultrasound. Here, we describe the spectrum of sonographic manifestations of pneumonic/inflammatory consolidation on B-mode lung ultrasound and contrast-enhanced ultrasound., Competing Interests: C. Görg received funding from Bracco Imaging. Bracco Imaging supported CEUS workshops at the University Hospital Marburg., (© 2023 The Authors. Australasian Journal of Ultrasound in Medicine published by John Wiley & Sons Australia, Ltd on behalf of Australasian Society for Ultrasound in Medicine.)

In pneumology, preventive check-ups have played a subordinate role so far. Current research results could change this. In the following article the focus is on lung cancer and COPD, diseases that have a considerable influence on mortality and morbidity in modern society. Approaches will be discussed that will allow earlier diagnosis of COPD or identify patients at risk. In particular Capture, a questionnaire that significantly increases the pre-test probability in COPD diagnostics, should be mentioned here. Lung carcinoma screening is a controversial topic in Germany. In an American study, the relative mortality rate from lung cancer was significantly reduced by CT screening. Results of a European study (Nelson trial) are still pending. A high pre-test probability will also be decisive for lung cancer screening. In this way, the cost-benefit ratio could be optimized. Since COPD patients have a significantly increased risk of lung cancer, there might be overlaps in the screening procedures., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

This review article discusses various forms of sleep disorders associated with musculoskeletal diseases (MD). It presents the pathophysiology and interaction of sleep-related disorders and MD and summarizes clinical symptoms and therapies from a somnological perspective. BACKGROUND: A large number of patients suffering from MD report fragmented sleep with poor overall sleep quality. Sleep disorders often lead to increased symptoms such as daytime fatigue, depression, or increased pain intensity. In contrast, the perception of pain worsens the quality of sleep. Sleep is a complex regulation of hormonal and neuromodulatory influences to maintain regenerative processes and signal processing. Furthermore, interleukins (e.g., IL-6 and TNFα), messenger substances, or inflammatory markers (e.g., CRP) may have a regulatory influence on sleep. THERAPY: Sleep disorders in MD can often be treated with behavioral therapies or drug approaches. Another and very important influence is physical activity. In combination with training, regular physical activity can lead, for instance, to improved sleep quality, endurance performance, and reduced inflammation values. The change of lifestyle with regard to activity and nutrition is another key concept in the optimal therapy of patients with MD., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Medication management of asthma is based on level of asthma control. GINA defined criteria for asthma control include asking about daytime symptoms, limitation of activity, nocturnal symptoms/awakenings and need for reliever treatment. Effective asthma control is necessary for preventing exacerbations and worsening of lung function. Standardized and validated questionnaires such as asthma control test (ACT) help to assess the level of asthma control. Asthma control is classified as controlled, partially controlled or uncontrolled. Multicenter studies like REALISE and AIRE give health care professionals information about effectiveness and adherence to medication over nearly 15 years. Asthma is still poorly controlled in more than 50 % of patients despite the availability of very effective drugs. Low adherence to the treatment, fear of systemic side effects related to long term treatment with inhaled corticosteroids, inadequate knowledge of the disease may be responsible factors for bad asthma control. Optimized tools for disease management and intensified education are necessary for therapeutic success., Competing Interests: U. Koehler gibt an, Vortragshonorare und Studienunterstützungen von Löwenstein Medical, GSK, Sanofi und Boehringer Ingelheim erhalten zu haben.K. Guenter, O. Hildebrandt, N. Koehler, T. Boeselt, J. Kroenig und C. Viniol geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Awareness of respiratory symptoms during day- and night-time is important for asthma control. Acoustic long-term recording offers a possibility to monitor symptoms objectively. In this prospective observational study frequency of night-time cough and wheezing was evaluated in patients with stable asthma., Methods: Night-time cough and wheezing were monitored by LEOSound lung sound monitor in 40 patients with stable asthma. Patients did not complain of respiratory problems during day- and nighttime, asthma control test was 23 points on average. FEV1 was 84 ± 15 %; MEF 50 71 ± 27 % and Rtot 0,48 ± 0,18 kPas/l. The age of the patients was 35 ± 11 years. All patients had an antiobstructive and/or anti-inflammatory medication. The present study focuses on description of frequency, severity and characteristics of night-time symptoms like cough and wheezing in patients with stable asthma and tries to depict differences in patients who present cough or wheezing., Results: Wheezing was monitored in 2 of the 40 patients. In the first patient duration of wheezing was 19 min, in the second 55 min. Lung function in patient 1 showed a moderate bronchial obstruction, he was still smoking. Patient 2 was a non-smoker with a significant bronchial obstruction (FEV1 49 %; MEF 50 27 % and Rtot 0,52 kPas/l). In 26 patients there was no coughing, 14 patients had 4 ± 3 (2 - 13) cough epochs during the night. By dividing the collective in two groups differentiated by the presence of cough/ no cough we found no significant differences regarding lung function and ACT-scores. Both patients with night-time wheezing presented low ACT- Scores (20 and 21 points)., Conclusions: Nocturnal wheezing and cough episodes were detectable in 2 respectively 14 patients with stable asthma. Long-term recording of normal and adventitious breath sounds offers a practical opportunity to evaluate night-time cough and wheezing objectively., Competing Interests: J. Kroenig erhielt Vortragshonorare von Löwenstein Medical.Dr. A. Weissflog ist Geschäftsführer der ThoraTech GmbH.Prof. Dr. U. Koehler gibt an, Vortragshonorare und Studienunterstützung von Löwenstein Medical erhalten zu haben.Die anderen Autoren geben keine Interessenkonflikte an., (© Georg Thieme Verlag KG Stuttgart · New York.)