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G Schultze-Werninghaus

Publications and source records attributed to G Schultze-Werninghaus.

At least 19 recordsLinked to original sources
PubMed2006

[Treatment of bronchial asthma with consideration also of the upper airway].

Asthma is chronic inflammatory disease of the lower airway. In many cases, it is accompanied by allergic or non-allergic upper airway disease. While the treatment of the lower airway in bronchial asthma has been largely standardized based on diverse guidelines, for the simultaneous treatment of the upper airway, different strategies are in use. On the basis of collected study data, it has been shown that simultaneous pharmacotherapy of the upper airway comorbidities also has a positive effect on asthma. It has been shown that, when applied in good time, specific immunotherapy can prevent the development of asthma in some cases. This means that in patients with airway pathology, simultaneous treatment of the other level (upper or lower) should be considered.

Anti-Allergic Agents↗
PubMed2006

[Long-term compliance of cpap-therapy--update, predictors and interventions].

CPAP (continuous positive airway pressure) is the therapy of choice for obstructive sleep apnea syndrome (OSAS). About 70 % of patients on CPAP use their device for at least 70 % of nights with an application-time of at least 4 hours per night. Severity of breathing disorder respectively disturbance of sleep architecture, degree of daytime sleepiness and patients' satisfaction with diagnostic and therapeutic procedures are good predictors of long-term CPAP-compliance. CPAP-compliance can be increased by intensive patient education. Alternative devices like for example Bilevel or auto-CPAP respectively cannot augment CPAP compliance.

Continuous Positive Airway Pressure↗
PubMed2006

[Cognitive deficits in patients with chronic obstructive pulmonary disease (COPD)].

INTRODUCTION: Patients with COPD present with impairments of their cognitive performance. The present study compares intelligence and memory performance as well as different aspects of attention in COPD patients and healthy controls. Additionally, potential factors influencing daytime performance are analyzed. PATIENTS AND METHODS: Neuropsychological testing was performed in 32 patients with COPD and 10 normal controls. The following aspects were evaluated: memory, intelligence, simple, selective and divided attention, sustained attention under stress and under monotonous conditions. RESULTS: There were no differences between COPD patients and normals with regard to divided attention, vigilance and memory. Patients with COPD demonstrated significantly worse results in terms of intelligence (p < 0.01) as well as simple (p < 0.01), selective (p < 0.05) and sustained attention (p < 0.01). No correlation existed between the severity of the disease (lung function, blood gas analysis, nocturnal oxygen saturation) and neuropsychological findings. Merely a relationship between memory function and slow-wave sleep or REM sleep was demonstrated. CONCLUSION: Impairments of cognitive performance in patients with COPD cannot be predicted on the basis of the severity of the disease. Therefore neuropsychological testing is recommended, especially when impairment of daytime function has to be quantified.

Adult↗
PubMed2005

Relevance of human metapneumovirus in exacerbations of COPD.

BACKGROUND AND METHODS: Human metapneumovirus (hMPV) is a recently discovered respiratory virus associated with bronchiolitis, pneumonia, croup and exacerbations of asthma. Since respiratory viruses are frequently detected in patients with acute exacerbations of COPD (AE-COPD) it was our aim to investigate the frequency of hMPV detection in a prospective cohort of hospitalized patients with AE-COPD compared to patients with stable COPD and to smokers without by means of quantitative real-time RT-PCR. RESULTS: We analysed nasal lavage and induced sputum of 130 patients with AE-COPD, 65 patients with stable COPD and 34 smokers without COPD. HMPV was detected in 3/130 (2.3%) AE-COPD patients with a mean of 6.5 x 10(5) viral copies/ml in nasal lavage and 1.88 x 10(5) viral copies/ml in induced sputum. It was not found in patients with stable COPD or smokers without COPD. CONCLUSION: HMPV is only found in a very small number of patients with AE-COPD. However it should be considered as a further possible viral trigger of AE-COPD because asymptomatic carriage is unlikely.

Adult↗
PubMed2005

[Driving simulator performance in patients with obstructive sleep apnea syndrome: what consequences for driving capability?].

BACKGROUND AND OBJECTIVE: Patients with obstructive sleep apnea (OSA) have an increased accident risk. The German Society of Sleep Research and Sleep Medicine (DGSM) recommends for patients with OSA and daytime sleepiness that their driving ability should be re-established 6 weeks after the initiation of CPAP (continuous positive airway pressure), with documentation of therapeutic effects on daytime symptoms and performance. The present study was conducted to investigate whether an improvement of driving ability can be documented in neuropsychological tests and a simulated driving situation 14 days after the initiation of CPAP. PATIENTS AND METHODS: Driving simulation and neuropsychological tests of vigilance were conducted in 36 patients (36 males, aged 54 9 years) with OSAS before and 2 (n=23), 14 (n=18) and 42 days (n=17) after initiation of CPAP. RESULTS: Vigilance tests showed only slight changes under CPAP. Frequency of accidents during driving simulation was reduced after 14 days of CPAP, but a statistically remarkable decrease was achieved only on day 42. In contrast, concentration faults were reduced after 2 and 14 days of CPAP. CONCLUSIONS: In OSA-patients improvement of daytime performance in a simulated driving situation can be documented 14 days after initiation of CPAP. There is need for investigating larger cohorts of patients so that current recommendations for driving licensing can be modified and permission to drive can be given earlier.

Automobile Driving↗
PubMed2005

[Antioxidant treatment with N-acetylcysteine and vitamin C in patients with chronic bronchitis].

BACKGROUND AND OBJECTIVE: N-acetylcysteine (NAC) is known to have direct antioxidant properties due to its thiol-group on the one hand as well as indirect antioxidant capacity as cysteine-donor to cellular glutathione-synthesis on the other hand. Therefore NAC appears to be attractive in antioxidant therapy of inflammatory disorders of the lung. This study aimed to investigate the use of antioxidant therapy with NAC in chronic bronchitis. PATIENTS AND METHODS: In this randomized, double-blinded and placebo-controlled trial 100 patients divided into four groups were observed over a period of 3 months. The treatment consisted of either 600 mg NAC bid, 500 mg Vitamin C bid, a combination of those two substances using the same dosage or a placebo-preparation. The release of reactive oxygen species from isolated neutrophilic granulocytes and mononuclear cells was quantified before treatment and after three months using chemiluminescence (primary outcome parameter). Furthermore cellular glutathione content of these inflammatory cells was quantified spectrometrically. In addition, leukocyte-count and erythrocyte sedimentation rate as well as spirometry and a standardized symptom-based questionnaire were used to monitor the clinical efficacy. RESULTS: None of the above substances were able to significantly reduce the release of reactive oxygen species from the examined population of inflammatory cells. They also failed to increase intracellular glutathione-levels. Concordantly, no changes in spirometry and the results of the symptom-based questionnaire were found. CONCLUSION: In summary NAC, Vitamin C and the NAC/ Vitamin C-combination did neither enhance antioxidant protection in the blood nor is it of any clinical benefit in chronic bronchitis. Possible reasons may be a lack of antioxidant deficiency in these patients and negative feedback mechanisms of the glutathione-system.

Acetylcysteine↗
PubMed2005

Association of interleukin-8 receptor alpha polymorphisms with chronic obstructive pulmonary disease and asthma.

Chronic obstructive pulmonary disease (COPD) and asthma are common complex diseases characterized by airflow obstruction and inflammatory processes in the small airways. lnterleukin 8 (IL-8) is a potent proinflammatory cytokine which interacts with the IL-8 receptor alpha (IL8RA, CXCR1) and beta (IL8RB, CXCR2), leading to activation and migration of leukocytes. In order to evaluate the role of the IL8RA gene in the pathogenesis of COPD and asthma, we screened the coding region of IL8RA for mutations by means of single-strand conformation polymorphism analysis in 50 COPD patients and identified three exchanges (M31R, S276T and R335C). These three polymorphisms were subsequently genotyped in 182 adult patients with COPD, 68 adult patients and 130 children with asthma as well as 454 healthy controls. The frequencies of the IL8RA 31R and 335C alleles were significantly increased in patients with COPD and in children with asthma compared to healthy controls (P=0.0073 and 0.023, respectively). Thus, these polymorphisms may play a role in the pathogenesis of COPD and asthma.

Amino Acid Substitution↗
PubMed2005

[Inhalation therapy with Respimat soft inhaler in patients with COPD and asthma].

Developing more effective and convenient inhalation devices for the treatment of obstructive pulmonary diseases is at least as important as designing new drugs. In recent years, existing inhalation systems have undergone many technical modifications and there have also been many new developments. All of these systems have their own particular attributes and characteristics. Two fundamentally different modes of operation are represented by propellant-driven metered-dose inhalers (pMDI) on the one hand and dry powder inhalers (DPI) on the other. However, none of the systems developed so far can be considered ideal. The Respimat Soft Inhaler (Respimat SI) was developed in the light of experience with previous systems and was launched in Germany at the beginning of 2004. The aim in developing this new type of inhaler was to avoid the well-known drawbacks typically associated with pMDI and DPI. The Respimat SI requires neither a chemical propellant nor batteries. The active ingredients are dissolved in water and the solution is atomised using mechanical energy only imparted by a spring which, when released, provides the power to force the solution through an extremely fine nozzle system. Two fine jets of liquid are produced. They converge at an optimised angle and the resulting impact generates a fine mist which is slow-moving and lasts for about 1.5 seconds; moreover, a high proportion of the droplets fall into the fine particle fraction. All of these features allow excellent lung deposition and reduced oropharyngeal deposition. Coordination between actuation and inhalation is less critical as compared with pMDI due to the fact that the mist is both slow-moving and long-lasting. A further advantage is that the mist is generated independently of the patient's inspiratory flow. The Respimat SI meets the requirements for an ideal inhaler better than any other previous device and must therefore be regarded as a significant new development.

Asthma↗
PubMed2005

[Non-passable tumor-associated stenosis of trachea and stent-implantation -- an indication for Virtual CT-bronchoscopy].

We report about a male 50-year-old patient with known non-small cell lung cancer and tumor-associated stenosis of the right main bronchus already treated with Neodym-YAG-laser coagulation. Eight months later the patient was readmitted to hospital and revealed complete occlusion of the right main bronchus and subtotal stenosis of the distal trachea and the left main bronchus. Conventional tracheobronchoscopy failed to visualize the post-stenotic parts of the left main bronchus due to the length and degree of stenosis. Multidetector-CT-generated virtual tracheobronchoscopy was able to demonstrate complete intraluminal tumor extent thus making precise pre-interventional measurements for stent implantation possible. Furthermore, post-interventional re-evaluation by virtual tracheobronchoscopy confirmed correct position and patency of the stent located within the distal trachea and the left main bronchus. Our case report demonstrates a non-invasive and easy approach for evaluating the tracheobronchial system in a patient with tumor-associated airway stenosis including the possibility for viewing beyond post-stenotic segments.

Bronchoscopy↗
PubMed2005

Driving simulator and neuropsychological [corrected] testing in OSAS before and under CPAP therapy.

Patients with obstructive sleep apnoea syndrome (OSAS) have an increased car accident rate. Investigations on accident frequency are based on case history, insurance reports and driving simulator studies. The present study combines neuropsychological testing of different attention aspects engaged in driving a car and driving simulation to evaluate a suitable instrument for assessing therapeutic effects of continuous positive airway pressure (CPAP). Driving simulator investigation and neuropsychological testing of alertness, vigilance and divided attention were performed in 31 patients with polysomnographically confirmed OSAS (apnoea-hypopnoea index 24.8+/-21.5.h(-1)) before, and 2 and 42 days after initiation of CPAP. Divided attention and alertness improved significantly during CPAP, whereas vigilance remained unchanged. However, accident frequency (OSAS before therapy: 2.7+/-2.0; 2 days after CPAP: 1.5+/-1.4; 42 days after CPAP: 0.9+/-1.3) and frequency of concentration faults (OSAS before therapy: 12.4+/-5.1; 2 days after CPAP: 6.5+/-3.9; 42 days after CPAP: 4.9+/-3.3) decreased in the simulated driving situation after 2 and 42 days of therapy. There was no relation between accident frequency, concentration faults and daytime sleepiness, as measured by the Epworth Sleepiness Scale, and polysomnographic or neuropsychological findings, respectively. In conclusion, the present results suggest that driving simulation is a possible benchmark parameter of driving performance in obstructive sleep apnoea syndrome patients.

Accidents, Traffic↗
PubMed2004

Evaluation of a real-time polymerase-chain reaction for severe acute respiratory syndrome (SARS) associated coronavirus in patients with hospitalised exacerbation of COPD.

One year after the first outbreak infections with SARS associated coronavirus were again reported and the clinical picture varied. Because health care facilities will have to initiate immediate preventive action in cases of probable SARS we tested the potential of PCR to exclude SARS associated coronavirus in patients hospitalized with respiratory symptoms. Based on primers published recently a real time Taqman PCR was established and evaluated. Lower respiratory tract specimens of patients with acute exacerbation of COPD were investigated. 141 patients with mild to moderate COPD were included. The assay was specific, sensitive, precise and reproducible and allowed absolute quantification without cross-reactivity to other respiratory viruses. None of the samples were positive for SARS associated coronavirus. Our RT-PCR for SARS associated coronavirus is a valid and practicable method to further exclude SARS in X-ray negative patients with respiratory symptoms, even in the presence of other respiratory RNA viruses.

Aged↗
PubMed2004

[Treatment for viral respiratory infections: Principles of action, strategies, and future prospects].

Pulmonary viral infections are associated with substantial morbidity and socioeconomic costs. Rhinovirus, influenza A and B, adenovirus, parainfluenza, respiratory syncytial virus (RSV), and coronavirus are etiologies most often associated with infections of the upper and lower respiratory tract. Therapy of viral infections in nonimmunocompromised hosts has only developed slowly during recent years, despite the enormous socioeconomic impact. This is in part due to the complex virus/host interactions and numerous and varying mechanisms of infection. Neuraminidase inhibitors have produced notable progress in the therapeutic approaches to influenza-associated pulmonary infections and are at least able to shorten the duration of symptoms in selected patients. However, neuraminidase inhibitors can only be applied in specific infections and the spectrum of agents with antiviral activity is broad. This article summarizes major principles of antiviral efficacy and reviews recent clinical trials.

Antiviral Agents↗
PubMed2004

[Acute severe asthma in older adults].

The underlying causes of acute severe or life threatening asthma are infections with respiratory viruses or Mycoplasma pneumoniae, rather than bacterial infections. In addition, exposure to various agents such as allergens, non-specific irritants or drugs, and inadequate long-term treatment may be responsible. High flow oxygen therapy, high dose topic beta(2)-agonists and systemic glucocorticosteroids should be used as baseline therapy in outpatients. In hospital, intravenous therapy-eventually including sedatives-can be administered under controlled or intensive care conditions. In patients with increasing respiratory pump weakness and alveolar hypoventilation, non-invasive and/or invasive mechanical ventilation may be required. In ventilated asthma patients permissive hypercarbia has been shown to reduce complications such as pneumothorax. Bronchoscopy and bronchial lavage are recommended for patients ventilated with increasing pressures or when atelectasis occurs.

Acute Disease↗
PubMed2004

[Does nCPAP-therapy change the lung function of patients with obstructive sleep apnea syndrome?].

BACKGROUND: nCPAP-therapy is standard for patients with obstructive sleep apnea syndrome (OSAS). This study investigated, if nCPAP changed the patients lung function. PATIENTS AND METHODS: Lung function of 228 OSAS patients without co-prevalent lung disease, who received nCPAP for the first time, was examined (whole body plethysmography, spirometry, and blood gas analysis). After 1, 2, and 3 years the results of the re-examined patients were compared with their individual starting results. RESULTS: The results of the patients in the basic and in the follow-up examinations was within standard range. During reexamination, an improvement of inspiratory vital capacity was registered repetitively, especially in smokers. On the other hand, MEF 50 decreased within the first two years and FEV (1) %VC, but not FEV (1), decreased after 2 and 3 years of reexamination. CONCLUSIONS: Neither obstructive nor restrictive lung diseases were diagnosed under nCPAP-therapy within three years. This study with a retrospective design showed significant improvements of vital capacity (VC) in patients with OSAS, especially in smokers, under nCPAP-therapy. This increase can be explained by an effect of practice in the examination and by recruitment of formerly hypoventilated lung areas. As MEF 50 and FEV (1) %VC depend on VC, the decrease of both parameters may be caused by the increase of VC. In summary, nCPAP did not cause negative effects of lung function in the investigated patients over a period of 3 years.

Continuous Positive Airway Pressure↗