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Veit T, Barnikel M, Kneidinger N, Munker D, Arnold P, Barton J, Crispin A, Milger K, Behr J, Neurohr C, Leuschner G. Clinical Impact of Physical Activity and Cough on Disease Progression in Fibrotic Interstitial Lung Disease. J Clin Med 2023; 12:jcm12113787. [PMID: 37297982 DOI: 10.3390/jcm12113787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Physical activity limitations and cough are common in patients with interstitial lung disease (ILD), potentially leading to reduced health-related quality of life. We aimed to compare physical activity and cough between patients with subjective, progressive idiopathic pulmonary fibrosis (IPF) and fibrotic non-IPF ILD. In this prospective observational study, wrist accelerometers were worn for seven consecutive days to track steps per day (SPD). Cough was evaluated using a visual analog scale (VAScough) at baseline and weekly for six months. We included 35 patients (IPF: n = 13; non-IPF: n = 22; mean ± SD age 61.8 ± 10.8 years; FVC 65.3 ± 21.7% predicted). Baseline mean ± SD SPD was 5008 ± 4234, with no differences between IPF and non-IPF ILD. At baseline, cough was reported by 94.3% patients (mean ± SD VAScough 3.3 ± 2.6). Compared to non-IPF ILD, patients with IPF had significantly higher burden of cough (p = 0.020), and experienced a greater increase in cough over six months (p = 0.009). Patients who died or underwent lung transplantation (n = 5), had significantly lower SPD (p = 0.007) and higher VAScough (p = 0.047). Long-term follow up identified VAScough (HR: 1.387; 95%-CI 1.081-1.781; p = 0.010) and SPD (per 1000 SPD: HR 0.606; 95%-CI: 0.412-0.892; p = 0.011) as significant predictors for transplant-free survival. In conclusion, although activity didn't differ between IPF and non-IPF ILD, cough burden was significantly greater in IPF. SPD and VAScough differed significantly in patients who subsequently experienced disease progression and were associated with long-term transplant-free survival, calling for better acknowledgement of both parameters in disease management.
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Affiliation(s)
- Tobias Veit
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Michaela Barnikel
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Paola Arnold
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Jürgen Barton
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Alexander Crispin
- IBE-Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian University, 81377 Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, 81377 Munich, Germany
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
| | - Claus Neurohr
- Department of Pneumology and Respiratory Medicine, Hospital Schillerhoehe, Academic Teaching Hospital of the University of Tuebingen, 70376 Gerlingen, Germany
| | - Gabriela Leuschner
- Comprehensive Pneumology Center (CPC-M), German Center for Lung Research, 81377 Munich, Germany
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2
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Kreuter M, Behr J, Bonella F, Costabel U, Gerber A, Hamer OW, Heussel CP, Jonigk D, Krause A, Koschel D, Leuschner G, Markart P, Nowak D, Pfeifer M, Prasse A, Wälscher J, Winter H, Kabitz HJ. [Consensus guideline on the interdisciplinary diagnosis of interstitial lung diseases]. Pneumologie 2023; 77:269-302. [PMID: 36977470 DOI: 10.1055/a-2017-8971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
The evaluation of a patient with interstitial lung disease (ILD) includes assessment of clinical, radiological, and often histopathological data. As there were no specific recommendations to guide the evaluation of patients under the suspicion of an ILD within the German practice landscape, this position statement from an interdisciplinary panel of ILD experts provides guidance related to the diagnostic modalities which should be used in the evaluation of ILD. This includes clinical assessment rheumatological evaluation, radiological examinations, histopathologic sampling and the need for a final discussion in a multidisciplinary team.
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Affiliation(s)
- Michael Kreuter
- Universitäres Lungenzentrum Mainz, Abteilungen für Pneumologie, ZfT, Universitätsmedizin Mainz und Pneumologie, Beatmungs- und Schlafmedizin, Marienhaus Klinikum Mainz
- Zentrum für interstitielle und seltene Lungenerkrankungen, Thoraxklinik, Universitätsklinikum Heidelberg und Klinik für Pneumologie, Klinikum Ludwigsburg
- Deutsches Zentrum für Lungenforschung
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München
- Deutsches Zentrum für Lungenforschung
| | - Francesco Bonella
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Ulrich Costabel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Alexander Gerber
- Rheumazentrum Halensee, Berlin und Institut für Arbeits- Sozial- und Umweltmedizin, Goetheuniversität Frankfurt am Main
| | - Okka W Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg und Abteilung für Radiologie, Klinik Donaustauf, Donaustauf
| | - Claus Peter Heussel
- Diagnostische und interventionelle Radiologie, Thoraxklinik Heidelberg, Universitätsklinikum Heidelberg
- Deutsches Zentrum für Lungenforschung
| | - Danny Jonigk
- Institut für Pathologie, Medizinische Hochschule Hannover und Institut für Pathologie, RWTH Universitätsklinikum Aachen
- Deutsches Zentrum für Lungenforschung
| | - Andreas Krause
- Abteilung für Rheumatologie, klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin
| | - Dirk Koschel
- Abteilung für Innere Medizin und Pneumologie, Fachkrankenhaus Coswig, Lungenzentrum, Coswig und Bereich Pneumologie der Medizinischen Klinik, Carl Gustav Carus Universitätsklinik, Dresden
| | - Gabriela Leuschner
- Medizinische Klinik und Poliklinik V, LMU Klinikum der Universität München
- Deutsches Zentrum für Lungenforschung
| | - Philipp Markart
- Medizinische Klinik V, Campus Fulda, Universitätsmedizin Marburg und Medizinische Klinik und Poliklinik, Universitätsklinikum Gießen
- Deutsches Zentrum für Lungenforschung
| | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU Klinikum, München
| | - Michael Pfeifer
- Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg
| | - Antje Prasse
- Klinik für Pneumologie und Infektionsmedizin, Medizinische Hochschule Hannover und Abteilung für Fibroseforschung, Fraunhofer ITEM
- Deutsches Zentrum für Lungenforschung
| | - Julia Wälscher
- Zentrum für interstitielle und seltene Lungenerkrankungen, Ruhrlandklinik, Universitätsmedizin Essen
| | - Hauke Winter
- Abteilung für Thoraxchirurgie, Thoraxklinik, Universität Heidelberg, Heidelberg
- Deutsches Zentrum für Lungenforschung
| | - Hans-Joachim Kabitz
- II. Medizinische Klinik, Pneumologie und Internistische Intensivmedizin, Klinikum Konstanz, GLKN, Konstanz
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3
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Nowak D, Ochmann U, Mueller-Lisse UG. Berufskrankheiten der Atemwege und der Lunge. PNEUMO NEWS 2022; 14:28-41. [PMID: 36281236 PMCID: PMC9581555 DOI: 10.1007/s15033-022-3415-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dennis Nowak
- Inst. u. Poliklinik f. Arbeits-u. Umweltmedizin LMU München, Ziemssenstr. 1, 80336 München, Deutschland
| | - Uta Ochmann
- Klinikum Innenstadt der LMU, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Ziemssenstr. 1, 80336 München, Deutschland
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4
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Schreiber T, Hagmeyer L, Randerath WJ. [Hypersensitivity Pneumonitis - an important differential diagnosis of infiltrative lung diseases]. Dtsch Med Wochenschr 2021; 146:1392-1398. [PMID: 34670281 DOI: 10.1055/a-1275-6734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hypersensitivity pneumonitis (HP) is an inflammatory and/or fibrotic disease of the lung parenchyma and terminal bronchioles caused by an allergic reaction to inhaled antigens. The immune response following antigen exposure results in lymphocytic inflammation as well as granuloma formation.The typical histologic pattern of HP consists of cellular interstitial pneumonia, cellular bronchiolitis, and epithelioid cell granulomas. The additional presence of fibrosis has a significant impact on the course as well as the prognosis of the disease and represents a therapeutic approach. Therefore, a classification into a non-fibrotic and a fibrotic phenotype is proposed.The diagnosis of HP is made by high-resolution computed tomography (HRCT) of the lung, evaluation of possible antigen exposure, and bronchoscopy with bronchoalveolar lavage and, if necessary, forceps biopsy. If the diagnosis is inconclusive, transbronchial cryobiopsy or surgical lung biopsy may need to follow. A multidisciplinary board is critical in making the diagnosis.
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Preisser AM, Koschel D, Merget R, Nowak D, Raulf M, Heidrich J. Workplace-related inhalation test - Specific inhalation challenge: S2k Guideline of the German Society for Occupational and Environmental Medicine e.V. (DGAUM), the German Society for Pneumology and Respiratory Medicine e.V. (DGP) and the German Society for Allergology and Clinical Immunology e.V. (DGAKI). Allergol Select 2021; 5:315-334. [PMID: 34646977 PMCID: PMC8507414 DOI: 10.5414/alx02280e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/01/2021] [Indexed: 11/25/2022] Open
Abstract
Not available.
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Affiliation(s)
- Alexandra M. Preisser
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg
- Mandated representative of the German Society for Occupational and Environmental Medicine e. V. (DGAUM)
- Coordinator of the guideline
| | - Dirk Koschel
- Department of Internal Medicine and Pneumology, Fachkrankenhaus Coswig, Lung Center, Coswig, Division of Pneumology, Medical Department I, University Hospital Carl Gustav Carus, Dresden
- Mandated representative of the German Society for Allergology and Clinical Immunology (DGAKI)
| | - Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, and
- Mandated representative of the German Society for Occupational and Environmental Medicine e. V. (DGAUM)
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, CPC Comprehensive Pneumology Center Munich, DZL, Deutsches Zentrum für Lungenforschung Munich, Germany
- Mandated representative of the German Society for Pneumology and Respiratory Medicine e. V. (DGP) , and
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, and
- Mandated representative of the German Society for Allergology and Clinical Immunology (DGAKI)
| | - Jan Heidrich
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg
- Coordinator of the guideline
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Nowak D, Ochmann U, Mueller-Lisse UG. [Occupational diseases of the airways and the lungs]. Internist (Berl) 2021; 62:906-920. [PMID: 34387701 PMCID: PMC8361830 DOI: 10.1007/s00108-021-01109-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 11/10/2022]
Abstract
The attributable proportion of occupation-related influences on airway and lung diseases is 10-30%. In patients with obstructive airway diseases it is extremely important to sufficiently document findings during the period of activities burdening the airway as compared to periods off work. Chronic obstructive pulmonary disease (COPD) can have a work-related (partial) cause even in smokers. Regarding occupational infectious diseases, the main cause up to 2019 was tuberculosis but the corona pandemic has led to coronavirus disease 2019 (COVID-19) being the most frequent occupational disease. For the occupational medical assessment of interstitial and malignant pulmonary diseases, checklists can be helpful to support the medical history.
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Affiliation(s)
- Dennis Nowak
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, LMU Klinikum, Ziemssenstr. 1, 80336, München, Deutschland.
- Comprehensive Pneumology Center (CPC) München, Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland.
| | - Uta Ochmann
- Institut und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, LMU Klinikum, Ziemssenstr. 1, 80336, München, Deutschland
- Comprehensive Pneumology Center (CPC) München, Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland
| | - Ullrich G Mueller-Lisse
- Klinik und Poliklinik für Radiologie, LMU Klinikum, München, Deutschland
- Comprehensive Pneumology Center (CPC) München, Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland
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7
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Microbial contamination in water-based metalworking fluid as trigger for occupational hypersensitivity pneumonitis - development of specific IgG tools for a suspected clinical case. Allergol Select 2020; 4:110-117. [PMID: 33326510 PMCID: PMC7734872 DOI: 10.5414/alx02124e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/19/2020] [Indexed: 11/18/2022] Open
Abstract
Microbially contaminated metal-working fluid (MWF) can cause respiratory symptoms in exposed workers in the form of exogenous allergic alveolitis/hypersensitivity pneumonitis (HP). The diagnosis of HP is based, among others, on the identification of the culprit and the detection of corresponding specific IgG antibodies (sIgG) in the patient's serum. Commercial antigen tools for the detection of these HP triggers are rarely available; therefore, antigens from contaminated MWF workplace samples were isolated exemplarily for diagnosis of a suspected HP case. Various MWF-specific bacteria were identified in the workplace samples, including Pseudomonas oleovorans, Pseudomonas alcaliphila, Pseudomonas spec., Paenibacillus glucanolyticus, and Corynebacterium amycolatum. The sIgG antigen binding, detected by ImmunoCAP system against MWF antigens from workplace samples and against the identified bacterial antigens, was much stronger in the patient serum compared to selected reference sera. The highest sIgG concentrations in the patient's serum could be determined against Pseudomonas antigens. Inhibition tests showed cross-reactions of MWF and Pseudomonas antigens, whereby the Pseudomonas antigens cross-reacted less with each other. For in-vitro diagnosis in case of suspected HP caused by contaminated MWF, workplace-related antigens are now available.
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Veit T, Barnikel M, Crispin A, Kneidinger N, Ceelen F, Arnold P, Munker D, Schmitzer M, Barton J, Schiopu S, Schiller HB, Frankenberger M, Milger K, Behr J, Neurohr C, Leuschner G. Variability of forced vital capacity in progressive interstitial lung disease: a prospective observational study. Respir Res 2020; 21:270. [PMID: 33076914 PMCID: PMC7574190 DOI: 10.1186/s12931-020-01524-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 09/25/2020] [Indexed: 11/28/2022] Open
Abstract
Background Fibrotic interstitial lung disease (ILD) is often associated with poor outcomes, but has few predictors of progression. Daily home spirometry has been proposed to provide important information about the clinical course of idiopathic pulmonary disease (IPF). However, experience is limited, and home spirometry is not a routine component of patient care in ILD. Using home spirometry, we aimed to investigate the predictive potential of daily measurements of forced vital capacity (FVC) in fibrotic ILD. Methods In this prospective observational study, patients with fibrotic ILD and clinical progression were provided with home spirometers for daily measurements over 6 months. Hospital based spirometry was performed after three and 6 months. Disease progression, defined as death, lung transplantation, acute exacerbation or FVC decline > 10% relative was assessed in the cohort. Results From May 2017 until August 2018, we included 47 patients (IPF n = 20; non-IPF n = 27). Sufficient daily measurements were performed by 85.1% of the study cohort. Among these 40 patients (IPF n = 17; non-IPF n = 23), who had a mean ± SD age of 60.7 ± 11.3 years and FVC 64.7 ± 21.7% predicted (2.4 ± 0.8 L), 12 patients experienced disease progression (death: n = 2; lung transplantation: n = 3; acute exacerbation: n = 1; FVC decline > 10%: n = 6). Within the first 28 days, a group of patients had high daily variability in FVC, with 60.0% having a variation ≥5%. Patients with disease progression had significantly higher FVC variability than those in the stable group (median variability 8.6% vs. 4.8%; p = 0.002). Cox regression identified FVC variability as independently associated with disease progression when controlling for multiple confounding variables (hazard ratio: 1.203; 95% CI:1.050–1.378; p = 0.0076). Conclusions Daily home spirometry is feasible in IPF and non-IPF ILD and facilitates the identification of FVC variability, which was associated with disease progression.
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Affiliation(s)
- Tobias Veit
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Michaela Barnikel
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Alexander Crispin
- IBE - Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilian University Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Felix Ceelen
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Paola Arnold
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Magdalena Schmitzer
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Barton
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Sanziana Schiopu
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Herbert B Schiller
- Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Marion Frankenberger
- Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.,Department of Pneumology, Asklepios Fachkliniken Muenchen-Gauting, Academic Teaching Hospital of the University of Munich, Gauting, Germany
| | - Claus Neurohr
- Department of Pneumology and Respiratory Medicine, Hospital Schillerhoehe, Academic Teaching Hospital of the University of Tuebingen, Gerlingen, Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, Ludwig-Maximilian University Munich, Marchioninistrasse 15, 81377, Munich, Germany. .,Comprehensive Pneumology Center (CPC-M), Ludwig-Maximilian University, and Helmholtz Center Munich, Member of the German Center for Lung Research (DZL), Munich, Germany.
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Raulf M, Joest M, Sander I, Hoffmeyer F, Nowak D, Ochmann U, Preisser A, Schreiber J, Sennekamp J, Koschel D. Update of reference values for IgG antibodies against typical antigens of hypersensitivity pneumonitis. ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1917-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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10
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Wiesmüller GA, Heinzow B, Aurbach U, Bergmann KC, Bufe A, Buzina W, Cornely OA, Engelhart S, Fischer G, Gabrio T, Heinz W, Herr CEW, Kleine-Tebbe J, Klimek L, Köberle M, Lichtnecker H, Lob-Corzilius T, Merget R, Mülleneisen N, Nowak D, Rabe U, Raulf M, Seidl HP, Steiß JO, Szewzyk R, Thomas P, Valtanen K, Hurrass J. Kurzfassung der AWMF-Leitlinie medizinisch klinische Diagnostik bei Schimmelpilzexposition in Innenräumen. ALLERGO JOURNAL 2017. [DOI: 10.1007/s15007-017-1382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kouranos V, Jacob J, Nicholson A, Renzoni E. Fibrotic Hypersensitivity Pneumonitis: Key Issues in Diagnosis and Management. J Clin Med 2017; 6:jcm6060062. [PMID: 28617305 PMCID: PMC5483872 DOI: 10.3390/jcm6060062] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 11/23/2022] Open
Abstract
The diagnosis of hypersensitivity pneumonitis (HP) relies on the clinical evaluation of a number of features, including a history of significant exposure to potentially causative antigens, physical examination, chest CT scan appearances, bronchoalveolar lavage lymphocytosis, and, in selected cases, histology. The presence of fibrosis is associated with higher morbidity and mortality. Differentiating fibrotic HP from the idiopathic interstitial pneumonias can be a challenge. Furthermore, even in the context of a clear diagnosis of fibrotic HP, the disease behaviour can parallel that of idiopathic pulmonary fibrosis in a subgroup, with inexorable progression despite treatment. We review the current knowledge on the diagnosis, management, and prognosis of HP with particular focus on the fibrotic phenotype.
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Affiliation(s)
- Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, Sydney Street, SW3 6NP London, UK.
| | - Joseph Jacob
- Department of Radiology, Royal Brompton Hospital, London, UK.
| | - Andrew Nicholson
- Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College, London, UK.
| | - Elizabetta Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, Sydney Street, SW3 6NP London, UK.
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Wiesmüller GA, Heinzow B, Aurbach U, Bergmann KC, Bufe A, Buzina W, Cornely OA, Engelhart S, Fischer G, Gabrio T, Heinz W, Herr CEW, Kleine-Tebbe J, Klimek L, Köberle M, Lichtnecker H, Lob-Corzilius T, Merget R, Mülleneisen N, Nowak D, Rabe U, Raulf M, Seidl HP, Steiß JO, Szewszyk R, Thomas P, Valtanen K, Hurraß J. Abridged version of the AWMF guideline for the medical clinical diagnostics of indoor mould exposure: S2K Guideline of the German Society of Hygiene, Environmental Medicine and Preventive Medicine (GHUP) in collaboration with the German Association of Allergists (AeDA), the German Society of Dermatology (DDG), the German Society for Allergology and Clinical Immunology (DGAKI), the German Society for Occupational and Environmental Medicine (DGAUM), the German Society for Hospital Hygiene (DGKH), the German Society for Pneumology and Respiratory Medicine (DGP), the German Mycological Society (DMykG), the Society for Pediatric Allergology and Environmental Medicine (GPA), the German Federal Association of Pediatric Pneumology (BAPP), and the Austrian Society for Medical Mycology (ÖGMM). ALLERGO JOURNAL INTERNATIONAL 2017; 26:168-193. [PMID: 28804700 PMCID: PMC5533814 DOI: 10.1007/s40629-017-0013-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This article is an abridged version of the AWMF mould guideline "Medical clinical diagnostics of indoor mould exposure" presented in April 2016 by the German Society of Hygiene, Environmental Medicine and Preventive Medicine (Gesellschaft für Hygiene, Umweltmedizin und Präventivmedizin, GHUP), in collaboration with the above-mentioned scientific medical societies, German and Austrian societies, medical associations and experts. Indoor mould growth is a potential health risk, even if a quantitative and/or causal relationship between the occurrence of individual mould species and health problems has yet to be established. Apart from allergic bronchopulmonary aspergillosis (ABPA) and mould-caused mycoses, only sufficient evidence for an association between moisture/mould damage and the following health effects has been established: allergic respiratory disease, asthma (manifestation, progression and exacerbation), allergic rhinitis, hypersensitivity pneumonitis (extrinsic allergic alveolitis), and increased likelihood of respiratory infections/bronchitis. In this context the sensitizing potential of moulds is obviously low compared to other environmental allergens. Recent studies show a comparatively low sensitizing prevalence of 3-10% in the general population across Europe. Limited or suspected evidence for an association exist with respect to mucous membrane irritation and atopic eczema (manifestation, progression and exacerbation). Inadequate or insufficient evidence for an association exist for chronic obstructive pulmonary disease, acute idiopathic pulmonary hemorrhage in children, rheumatism/arthritis, sarcoidosis and cancer. The risk of infection posed by moulds regularly occurring indoors is low for healthy persons; most species are in risk group 1 and a few in risk group 2 (Aspergillus fumigatus, A. flavus) of the German Biological Agents Act (Biostoffverordnung). Only moulds that are potentially able to form toxins can be triggers of toxic reactions. Whether or not toxin formation occurs in individual cases is determined by environmental and growth conditions, above all the substrate. In the case of indoor moisture/mould damage, everyone can be affected by odour effects and/or mood disorders. However, this is not a health hazard. Predisposing factors for odour effects can include genetic and hormonal influences, imprinting, context and adaptation effects. Predisposing factors for mood disorders may include environmental concerns, anxiety, condition, and attribution, as well as various diseases. Risk groups to be protected particularly with regard to an infection risk are persons on immunosuppression according to the classification of the German Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, KRINKO) at the Robert Koch- Institute (RKI) and persons with cystic fibrosis (mucoviscidosis); with regard to an allergic risk, persons with cystic fibrosis (mucoviscidosis) and patients with bronchial asthma should be protected. The rational diagnostics include the medical history, physical examination, and conventional allergy diagnostics including provocation tests if necessary; sometimes cellular test systems are indicated. In the case of mould infections the reader is referred to the AWMF guideline "Diagnosis and Therapy of Invasive Aspergillus Infections". With regard to mycotoxins, there are currently no useful and validated test procedures for clinical diagnostics. From a preventive medicine standpoint it is important that indoor mould infestation in relevant dimension cannot be tolerated for precautionary reasons. With regard to evaluating the extent of damage and selecting a remedial procedure, the reader is referred to the revised version of the mould guideline issued by the German Federal Environment Agency (Umweltbundesamt, UBA).
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Affiliation(s)
- Gerhard A. Wiesmüller
- Institute for Occupational Medicine and Social Medicine, University Hospital, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Infection Control and Environmental Hygiene, Cologne Health Authority, Neumarkt 15–21, 50667 Cologne, Germany
| | - Birger Heinzow
- Formerly: Regional Social Security Authorities (LAsD) for Schleswig-Holstein, Kiel, Germany
| | - Ute Aurbach
- Department of Microbiology and Mycology, Dr. Wisplinghoff Laboratory, Cologne, Germany
| | | | - Albrecht Bufe
- Experimental Pneumology, Ruhr University, Bochum, Germany
| | - Walter Buzina
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Oliver A. Cornely
- Department I for Internal Medicine and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Steffen Engelhart
- Institute for Hygiene and Public Health, Bonn University Hospital, Bonn, Germany
| | - Guido Fischer
- Baden-Württemberg Regional Health Authorities at the Regional Council Stuttgart, Stuttgart, Germany
| | - Thomas Gabrio
- Formerly: Baden-Württemberg Regional Health Authorities at the Regional Council in Stuttgart, Stuttgart, Germany
| | - Werner Heinz
- Medical Clinic and Outpatient Clinic II with Special Focus on Infectiology, Würzburg University Hospital, Würzburg, Germany
| | - Caroline E. W. Herr
- Bavarian Office for Health and Food Safety, Munich, Germany
- Adj. Prof. “Hygiene and Environmental Medicine”, Ludwig-Maximilian University, Munich, Germany
| | | | - Ludger Klimek
- Wiesbaden Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - Martin Köberle
- Clinic and Outpatient Clinic for Dermatology and Allergology am Biederstein, Technical University of Munich, Munich, Germany
| | - Herbert Lichtnecker
- Medical Institute for Environmental and Occupational Medicine MIU GmbH, Erkrath, Germany
| | | | - Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | | | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Member of the German Centre for Lung Research, Munich University Hospital, Munich, Germany
| | - Uta Rabe
- Centre for Allergology and Asthma, Johanniter Hospital im Fläming Treuenbrietzen GmbH, Treuenbrietzen, Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Hans Peter Seidl
- Formerly: Chair of Microbiology and Clinic and Outpatient Clinic for Dermatology and Allergology am Biederstein, Technical University of Munich, Munich, Germany
| | - Jens-Oliver Steiß
- Centre for Pediatric and Adolescent Medicine, University Hospital Gießen and Marburg GmbH, Gießen, Germany
- Specialist Practice for Allergology and Pediatric Pneumology, Fulda, Germany
| | - Regine Szewszyk
- FG (specialist field) II 1.4 Microbiological Risks, Federal Environmental Agency, Berlin, Germany
| | - Peter Thomas
- Department and Outpatient Clinic for Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Kerttu Valtanen
- FG (specialist field) II 1.4 Microbiological Risks, Federal Environmental Agency, Berlin, Germany
| | - Julia Hurraß
- Department of Infection Control and Environmental Hygiene, Cologne Health Authority, Neumarkt 15–21, 50667 Cologne, Germany
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Piel S, Kreuter M, Herth F, Kauczor HU, Heußel CP. Diagnostik granulomatöser Erkrankungen mit Lungenbefall. PNEUMO NEWS 2017; 9:40-50. [PMID: 32288858 PMCID: PMC7140243 DOI: 10.1007/s15033-017-0557-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Granulome als Zeichen der spezifischen Entzündung im Lungengewebe treten bei vielen Erkrankungen auf. Das radiologische Standardverfahren bei pulmonalen Granulomatosen ist meistens die Dünnschichtcomputertomografie. Bei klinischem Verdacht und entsprechenden Hinweisen in der Thoraxübersicht sind eine Dünnschicht-CT und die interdisziplinäre Diskussion der Befunde zu empfehlen.
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Affiliation(s)
- Stella Piel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Michael Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universität Heidelberg und Translational Lung Research Center (TLRC), Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Felix Herth
- Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universität Heidelberg und Translational Lung Research Center (TLRC), Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Hans-Ulrich Kauczor
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, und Translational Lung Research Center (TLRC), Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Claus Peter Heußel
- Abteilung für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik, Universität Heidelberg und Translational Lung Research Center (TLRC), Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Iberl G, Schellenberg M. Krankheitsbilder. PFLEGEWISSEN PNEUMOLOGIE 2017. [PMCID: PMC7123638 DOI: 10.1007/978-3-662-52667-5_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Das Spektrum der pneumologischen Krankheitsbilder ist groß und oft fächerübergreifend. Neben den häufigsten Erkrankungen wie COPD, Asthma bronchiale oder Tumoren des Thorax werden hier weitere häufige und seltene Erkrankungen dargestellt, die im Alltag das Bild einer pneumologischen Station prägen. Die führende Symptomatik, der diagnostische Weg und auch therapeutische Vorgehensweisen werden verständlich erörtert, um so den Umgang mit pneumologischen Erkrankungsbildern zu erleichtern.
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Affiliation(s)
- Gabriele Iberl
- Universitätsklinikum Heidelberg, Thoraxklinik Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Mavi Schellenberg
- Universitätsklinikum Heidelberg, Thoraxklinik Universitätsklinikum Heidelberg, Heidelberg, Germany
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Piel S, Kreuter M, Herth F, Kauczor HU, Heußel CP. [Pulmonary granulomatous diseases and pulmonary manifestations of systemic granulomatous disease : Including tuberculosis and nontuberculous mycobacteriosis]. Radiologe 2016; 56:874-884. [PMID: 27638826 PMCID: PMC7095880 DOI: 10.1007/s00117-016-0165-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CLINICAL/METHODICAL ISSUE Granulomas as signs of specific inflammation of the lungs are found in various diseases with pulmonary manifestations and represent an important imaging finding. STANDARD RADIOLOGICAL METHODS The standard imaging modality for the work-up of granulomatous diseases of the lungs is most often thin-slice computed tomography (CT). There are a few instances, e. g. tuberculosis, sarcoidosis and silicosis, where a chest radiograph still plays an important role. METHODICAL INNOVATIONS Further radiological modalities are usually not needed in the routine work-up of granulomatous diseases of the chest. In special cases magnetic resonance imaging (MRI) and positron emission tomography (PET)-CT scans play an important role, e. g. detecting cardiac sarcoidosis by cardiac MRI or choline C‑11 PET-CT in diagnosing lung carcinoma in scar tissue after tuberculosis. PERFORMANCE The accuracy of thin-slice CT is very high for granulomatous diseases. ACHIEVEMENTS In cases of chronic disease and fibrotic interstitial lung disease it is important to perform thin-slice CT in order to diagnose a specific disease pattern. Thin-slice CT is also highly sensitive in detecting disease complications and comorbidities, such as malignancies. Given these indications thin-slice CT is generally accepted in the routine daily practice. PRACTICAL RECOMMENDATIONS A thin-slice CT and an interdisciplinary discussion are recommended in many cases with a suspected diagnosis of pulmonary granulomatous disease due to clinical or radiographic findings.
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Affiliation(s)
- S Piel
- Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universität Heidelberg, Heidelberg, Deutschland.
| | - M Kreuter
- Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universität Heidelberg, Heidelberg, Deutschland
- Translational Lung Research Center (TLRC), Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - F Herth
- Zentrum für interstitielle und seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universität Heidelberg, Heidelberg, Deutschland
- Translational Lung Research Center (TLRC), Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - H-U Kauczor
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Translational Lung Research Center (TLRC), Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C-P Heußel
- Abteilung für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik, Universität Heidelberg, Heidelberg, Deutschland
- Translational Lung Research Center (TLRC), Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Exogen-allergische Alveolitis von inhalierten Schimmelpilzen bei beruflicher Zwiebel- und Kartoffel-Verarbeitung – Zwiebelsortierer- und Kartoffelarbeiter-Alveolitis. ALLERGO JOURNAL 2016. [DOI: 10.1007/s15007-016-1168-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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In-vitro-Serumdiagnostik. ALLERGOLOGIE 2016. [DOI: 10.1007/978-3-642-37203-2_51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Husten, Körpergewichtsabnahme und Abnahme der körperlichen Belastbarkeit. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-014-3165-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hagemeyer O, Bünger J, van Kampen V, Raulf-Heimsoth M, Drath C, Merget R, Brüning T, Broding HC. Occupational allergic respiratory diseases in garbage workers: relevance of molds and actinomycetes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 788:313-20. [PMID: 23835992 DOI: 10.1007/978-94-007-6627-3_42] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Exposures to molds and bacteria (especially actinomycetes) at workplaces are common in garbage workers, but allergic respiratory diseases due to these microorganisms have been described rarely. The aim of our study was a detailed analysis of mold or bacteria-associated occupational respiratory diseases in garbage workers. From 2002 to 2011 four cases of occupational respiratory diseases related to garbage handling were identified in our institute (IPA). Hypersensitivity pneumonitis (HP) was diagnosed in three subjects (cases 1-3, one smoker, two non-smokers), occupational asthma (OA) was diagnosed in one subject (case 4, smoker), but could not be excluded completely in case 2. Cases 1 and 2 worked in composting sites, while cases 3 and 4 worked in packaging recycling plants. Exposure periods were 2-4 years. Molds and actinomycetes were identified as allergens in all cases. Specific IgE antibodies to Aspergillus fumigatus were detected exclusively in case 4. Diagnoses of HP were essentially based on symptoms and the detection of specific IgG serum antibodies to molds and actinomycetes. OA was confirmed by bronchial provocation test with Aspergillus fumigatus in case 4. In conclusion, occupational HP and OA due to molds occur rarely in garbage workers. Technical prevention measures are insufficient and the diagnosis of HP is often inconclusive. Therefore, it is recommended to implement the full repertoire of diagnostic tools including bronchoalveolar lavage and high resolution computed tomography in the baseline examination.
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Affiliation(s)
- O Hagemeyer
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany,
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[Pulmonary allergic reactions]. Internist (Berl) 2013; 53:924-33. [PMID: 22806148 DOI: 10.1007/s00108-012-3059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Allergic diseases of the lungs may affect the airways, the pulmonary parenchyma and the pulmonary vessels. The most relevant representatives are allergic asthma, hypersensitivity pneumonitis, bronchopulmonary aspergillosis and the Churg-Strauss syndrome. The type of allergic reaction and the pathophysiological consequences vary considerably between these entities. New drugs target specific mechanisms based on new insights into the pathogenetic processes of the underlying disease.
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Abstract
BACKGROUND Feather duvet lung (FDL) is a rare subgroup of bird fancier's lung (BFL). We were interested in determining antigen-specific IgG antibodies in patients with FDL and comparing them with those with BFL. MATERIAL AND METHODS Specific IgG antibodies against goose and duck feathers, analysed with an automated fluorimetric enzyme immunoassay, were measured in healthy subjects (group A, n = 30), in patients with FDL (group B, n = 10) and with BFL (group C, n = 35); typical specific IgG antibodies of BFL in groups B and C. RESULTS An optimal threshold value for antibodies against goose or duck feathers to differentiate patients with either BFL or FDL from healthy subjects was determined at 10.85 mg L(-1) for goose feathers and at 8.81 mg L(-1) for duck feathers, respectively. Specific IgG antibodies against goose feathers were significantly higher in group B compared with group C. A ratio of specific IgG antibodies against goose feathers and budgerigar antigens with a threshold value of 0.91 could discriminate between patients with FDL and BFL with a specificity of 97% and a sensitivity of 90%. CONCLUSIONS We were able to demonstrate the significant difference in IgG antibodies in patients with FDL and BFL and their contribution to discriminate between these similar kinds of extrinsic allergic alveolitis.
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Affiliation(s)
- Dirk Koschel
- Department of Pulmonary Diseases, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany.
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Koschel D, Handzhiev S, Wiedemann B, Höffken G. Acute effects of NPPV in interstitial lung disease with chronic hypercapnic respiratory failure. Respir Med 2010; 104:291-5. [DOI: 10.1016/j.rmed.2009.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 09/21/2009] [Accepted: 09/22/2009] [Indexed: 10/20/2022]
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[Mold burden of interior rooms--report of findings, health evaluation and measures. Report of the "Methods and Quality Assurance in Environmental Medicine" Committee]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008; 50:1308-23. [PMID: 17924072 DOI: 10.1007/s00103-007-0339-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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