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Polysomnographic measurements were performed in 210 indoor patients (age mean = 49.7 +/- 8.9 years, Broca mean = 126.0 +/- 20.7% FEV1%p mean = 79.9 +/- 23.9) of a pneumological rehabilitation centre who had a suspicious history or clinical symptoms of obstructive sleep apnoea. 72 had neither an airway obstruction nor a pathological apnoea index. 58 patients only suffered from airway obstruction and 42 had only a pathological apnoea index. In 38 patients, a pathological apnoea index and also airway obstructions were seen. For the last three groups we calculated the mean of the SaO2-values for an 8 hour night time period with and without n-CPAP-therapy. In both groups with only one disease a typical pattern of the SaO2-values during sleep could be demonstrated. The patients with overlap syndrome (SAS + COB) showed a superposition of both single disease SaO2-time courses even with much lower initial SaO2-values. During n-CPAP-therapy in all groups a reduction of the variations of SaO2 induced by sleep pattern and circadian rhythm are evident.
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An analysis of the situation in respect of the activity of the Working Group "Patient Training" of the German Society of Pneumology reveals that the development has been a positive one. During the period under scrutiny (1988-1990) the patient training measures were markedly broadened for patients suffering from obstructive airway diseases. A significant increase took place in specialised hospitals and in the medical practices of physicians. Patients suffering from asthma, chronic obstructive bronchitis and pulmonary emphysema were trained both for coping with their individual diseases and with subsequent and concomitant diseases. On the whole, about 18,000 patients were trained in Germany. Both own material and in an increasing measure material supplied by the pharmaceutical industry was successfully employed. Although most of the trainers are physicians, these are being increasingly joined by nurses and physiotherapists. In the consulting-rooms of practising physicians, patient training is performed mainly up to two hours after consulting hours, especially in the evening. Preferred subjects are technique of inhalation, problems of therapy and causes of airway diseases. Second in importance after the individual talk with the patient is the group discussion. To spread patient training it will be necessary to set up pilot units: however, the medical professional organisations should also help in translating the project into reality. Standardisation of training measures for clinic and practice is planned and will be a future target for the working group. The aim is to officially integrate training measures into the therapeutic concept in obstructive airway disease also for practising physicians.
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Data concerning the occurrence of chronic-obstructive pulmonary disease (COPD) in patients with obstructive sleep apnea syndrome (OSAS) vary between 11 and 20% due to the underlying definition of COPD. We investigated the frequency of COPD in 202 patients with OSAS. The obstructive pattern was defined by bodyplethysmography (Rt > 0.35 kPa x 1(-1) x s(-1)), flow-volume-curve (MEF50 < 50% pred.), Tiffeneau-index (FEV1/IVC < 70% pred.) and anamnesis (cough and/or sputum). Prevalence of COPD in our 202 patients with OSAS was 16.3%. Patients with OSAS and COPD had a higher body-mass-index (BMI), lower PaO2 and spent more time in an oxygen saturation < or = 90% in relation to total recording time (t90). Polysomnographically there was no difference between the two groups with regard to the ventilatory parameters apnea-index (AI) and apnea-hypopnea-index (AHI). As there is a high risk of developing hypercapnia, pulmonary arterial hypertension and cor pulmonale in patients with OSAS and COPD there is need for early diagnosis of the combination of both diseases.
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As a part of the Davoser-Reha-Study, the significance of psychosocial aspects on the course of chronic pulmonary disease has been investigated on 414 patients (mean age = 47.1 years) with COPD (mean duration = 16 years) and a high percentage of multimorbidity (75%). Of special interest was the question, what kind of impact coping strategies do have on certain aspects of quality of life, in the sense of outcome criterias of the medical rehabilitation. Also it is not possible for the moment to draw final conclusions, because the knowledge about coping strategies and their adaptability is still very limited, the current study indicates, that some coping strategies are more supportive for adaptation than others. Positive for adaptation are strategies, which can be described as active exposition with the disease (fighting spirit, information seeking and active problem solving). Depressive coping strategies and the tendency to deny the disease seem to have a negative effect. All in all the results verify the strong necessity of taking psychosocial aspects into account for the complete treatment of chronically ill patients with COPD.
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After the stabilization of the obstructive airways disease 14 patients performed 4 times exercise-tests of 6 minutes at a bicycle during one week. The basic values of the lung function showed with FEV1 of 66%, Rt of 5,74 hPa/l/s and IGV of 155% a strong disturbance of the mechanical features of the lung. At the mean during the exercise tests the PO2a remained with 69 Torr constant. PC2a increases at the same time for 3 Torr. After the exercise test a significant increase of PO2a of 11.4 Torr takes place. At the individual patients there was a great variability of the results between the different tests. Only three patients showed always a decrease of PO2a-values. The reason for this variability is the ventilation/perfusion inhomogeneity, which changes between the investigations. There are significant multilinear correlations between the FEV1%- as the IGV%-values and PO2a for the values at rest, during exercise as 5 min after the end of exercise. The exercise tests show at the PO(2a)-values the variability of the ventilation/perfusion inhomogeneity which dominates the bloodgas values. The important increase of the PO2a after the exercise test even at this patients can be of importance. The duration of this effect after multiple loads and the dependence of the workload should be investigated.
UNLABELLED: GOAL OF THE INVESTIGATION: It was investigated (1) whether guidelines for the treatment of bronchial asthma and chronic obstructive pulmonary diseases (chronic obstructive bronchitis and lung emphysema) are distributed in Germany, (2) whether they are accepted by general practitioners and physicians for internal medicine without subspecialty, and (3) how much they are used. METHODS: (1) The mostly read medical journals have been screened. (2) 1200 physicians have been questioned with regard to the main criteria of these guidelines. (3) 600 physicians were asked to write a documentation for two patients each with bronchial asthma and chronic obstructive pulmonary disease. 344 of the questionnaires (28.7%) and 544 of the documentations could be analyzed (22.7%). RESULTS: Guidelines for the treatment of bronchial asthma are published in all leading journals. Substantially less references were found for the therapy of chronic obstructive bronchitis. The main concepts of training, diagnosis of the disease's severity, and physical therapy are all known by the practitioners. The training plays a sufficient role in only half of the questioned physicians. The self-measurement of the patient is not every where accepted. The treatment according to a stage by stage pharmacological therapy cannot be seen in one third of the questioned physicians. CONCLUSIONS: Differential diagnosis and therapy are not sufficiently emphasized in the current guidelines. Practitioners should participate in the development of guidelines, to include the aspects of realization.
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