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Holtfreter B, Stubbe B, Gläser S, Trabandt J, Völzke H, Ewert R, Kocher T, Ittermann T, Schäper C. Periodontitis Is Related to Exercise Capacity: Two Cross-sectional Studies. J Dent Res 2021; 100:824-832. [PMID: 33655783 DOI: 10.1177/0022034521995428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although a potential link between periodontitis and cardiorespiratory fitness might provide a reasonable explanation for effects of tooth-related alterations seen on cardiometabolic diseases, evidence is currently limited. Thus, we investigated the association between clinically assessed periodontitis and cardiopulmonary exercise testing (CPET). Data from 2 independent cross-sectional population-based studies (5-y follow-up of the Study of Health in Pomerania [SHIP-1; N = 1,639] and SHIP-Trend-0 [N = 2,439]) were analyzed. Participants received a half-mouth periodontal examination, and teeth were counted. CPET was based on symptom limited-exercise tests on a bicycle ergometer. Associations of periodontitis parameters with CPET parameters were analyzed by confounder-adjusted multivariable linear regression. In the total sample, mean pocket probing depth (PPD), mean clinical attachment levels, and number of teeth were consistently associated with peak oxygen uptake (peakVO2) and exercise duration in both studies, even after restriction to cardiorespiratory healthy participants. Statistically significant associations with oxygen uptake at anaerobic threshold (VO2@AT), slope of the efficiency of ventilation in removing carbon dioxide, and peak oxygen pulse (VÉ/VCO2 slope) occurred. Further, interactions with age were identified, such that mainly older individuals with higher levels of periodontal disease severity were associated with lower peakVO2. Restricted to never smokers, associations with mean clinical attachment levels and the number of teeth mostly diminished, while associations of mean PPD with peakVO2, VO2@AT, VÉ/VCO2 slope, and exercise duration in SHIP-1 and SHIP-Trend-0 were confirmed. In SHIP-1, mean peakVO2 was 1,895 mL/min in participants with a mean PPD of 1.6 mm and 1,809 mL/min in participants with a mean PPD of 3.7 mm. To conclude, only mean PPD reflecting current disease severity was consistently linked to cardiorespiratory fitness in 2 cross-sectional samples of the general population. If confirmed in well-designed large-scale longitudinal studies, the association between periodontitis and cardiorespiratory fitness might provide a biologically plausible mechanism linking periodontitis with cardiometabolic diseases.
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Affiliation(s)
- B Holtfreter
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - B Stubbe
- Department of Internal Medicine B, Cardiology, Pneumology, Weaning, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
| | - S Gläser
- Department of Internal Medicine, Vivantes Kliniken Berlin, Neukölln, Germany
| | - J Trabandt
- Department of Internal Medicine, Vivantes Kliniken Berlin, Neukölln, Germany
| | - H Völzke
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - R Ewert
- Department of Internal Medicine B, Cardiology, Pneumology, Weaning, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
| | - T Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - T Ittermann
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Medicine Greifswald, Greifswald, Germany
| | - C Schäper
- Department of Internal Medicine B, Cardiology, Pneumology, Weaning, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Greifswald, Germany
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Bollmann T, Ittermann T, Gläser S, Völzke H, Doerr M, Habedank D, Obst A, Ewert R, Schäper C, Stubbe B. Reference Values for Pulmonary Single-Breath Diffusing Capacity - Results of the "Study of Health in Pomerania". Pneumologie 2020; 75:268-275. [PMID: 32820488 DOI: 10.1055/a-1234-7151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The assessment of pulmonary single-breath diffusing capacity is a frequently performed diagnostic procedure and considered as an important tool in medical surveillance examinations of pulmonary diseases.The aim of this study was to establish reference equations for pulmonary single-breath diffusing capacity parameters in a representative adult-population across a wide age range and to compare the normative values from this sample with previous ones. METHODS Diffusing capacity measurement was carried out in 3566 participants (1811 males) of a cross-sectional, population-based survey ("Study of Health in Pomerania - SHIP"). RESULTS Individuals with cardiopulmonary disorders and current smoking habits were excluded, resulting in 1786 healthy individuals (923 males), aged 20 - 84 years. Prediction equations for both sexes were established by quantile regression analyses, taking into consideration the influence of age, height, weight and former smoking. CONCLUSION The study provides a novel set of prediction equations for pulmonary single-breath diffusing capacity in an adult Caucasian population. The results are comparable to previously reported equations, underline their importance and draw attention to the need for up-to-date reference equations that adequately take into account both the subjects' origin, age, anthropometric characteristics and the equipment used.
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Affiliation(s)
- T Bollmann
- Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Germany
| | - T Ittermann
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Greifswald, Germany
| | - S Gläser
- Vivantes Hospital Berlin-Neukölln
| | - H Völzke
- Institute for Community Medicine, SHIP/Clinical-Epidemiological Research, University Greifswald, Germany
| | - M Doerr
- Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Germany
| | | | - A Obst
- Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Germany
| | - R Ewert
- Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Germany
| | - C Schäper
- Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Germany
| | - B Stubbe
- Department of Internal Medicine B, Cardiology, Pneumology, Infectious Diseases, Intensive Care Medicine, University Medicine Greifswald, Germany
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Schäper C, Bollmann T, Ittermann T, Gläser S, Felix SB, Völzke H, Ewert R, Stubbe B. Referenzwerte für Parameter der pulmonalen Diffusion – Ergebnisse der Study of Health in Pomerania (SHIP). Pneumologie 2018. [DOI: 10.1055/s-0037-1619174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - T Ittermann
- Institut Für Community Medicine, Ship/Klinisch-Epidemiologische Forschung, Ernst-Moritz-Arndt Universität Greifswald
| | - S Gläser
- Klinik für Innere Medizin – Pneumologie, Vivantes Klinikum Spandau
| | - SB Felix
- Klinik Für Innere Medizin B, Ernst-Moritz-Arndt Universität Greifswald
| | - H Völzke
- Institut Für Community Medicine, Ship/Klinisch-Epidemiologische Forschung, Ernst-Moritz-Arndt Universität Greifswald
| | - R Ewert
- Zentrum für Innere Medizin; Klinik für Innere B; Bereich Pneumologie, Universitätsmedizin Greifswald
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Müller-Heinrich A, Warnke C, Heine A, Bollmann T, Boesche M, Schäper C, Stubbe B, Friesecke S, Felix SB, Gläser S, Obst A, Ewert R. Das Weaningzentrum an der Universitätsmedizin Greifswald – Strukturen und Ergebnisse über 10 Jahre. Pneumologie 2018. [DOI: 10.1055/s-0037-1619304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Müller-Heinrich
- Klinik für Innere Medizin B, Pneumologie, Intensivmedizin, Universitätsmedizin Greifswald
| | - C Warnke
- Klinik für Innere Medizin B, Pneumologie, Intensivmedizin, Universitätsmedizin Greifswald
| | - A Heine
- Klinik für Innere Medizin B, Pneumologie, Intensivmedizin, Universitätsmedizin Greifswald
| | - T Bollmann
- Klinik für Innere Medizin B, Pneumologie, Intensivmedizin, Universitätsmedizin Greifswald
| | - M Boesche
- Klinik für Innere Medizin B, Pneumologie, Intensivmedizin, Universitätsmedizin Greifswald
| | - C Schäper
- Klinik für Innere Medizin B, Pneumologie, Intensivmedizin, Universitätsmedizin Greifswald
| | | | - S Friesecke
- Klinik für Innere Medizin B, Pneumologie, Intensivmedizin, Universitätsmedizin Greifswald
| | - SB Felix
- Klinik für Innere Medizin B, Pneumologie, Intensivmedizin, Universitätsmedizin Greifswald
| | - S Gläser
- Klinik für Innere Medizin, Pneumologie, Vivantes Klinikum Spandau
| | - A Obst
- Klinik für Innere Medizin B, Pneumologie, Intensivmedizin, Universitätsmedizin Greifswald
| | - R Ewert
- Klinik für Innere Medizin B, Pneumologie, Intensivmedizin, Universitätsmedizin Greifswald
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Bönsel K, Ewert R, Obst A, Felix SB, Walther D, Penzel T, Fietze I, Völzke H, Gläser S, Schäper C, Stubbe B. Kardiorespiratorische Polysomnografie bei Patienten mit Herzinsuffizienz oder chronisch obstruktiver Lungenerkrankung im Vergleich zu Probanden einer Bevölkerungsstichprobe (SHIP-TREND). Pneumologie 2018. [DOI: 10.1055/s-0037-1619291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - R Ewert
- Bereich Pneumologie, Klinik für Innere Medizin B, Zentrum für Innere Medizin, Universitätsmedizin Greifswald K. ö. R
| | - A Obst
- Bereich Pneumologie, Klinik für Innere Medizin B, Zentrum für Innere Medizin, Universitätsmedizin Greifswald K. ö. R
| | - SB Felix
- Klinik für Innere Medizin B, Ernst-Moritz-Arndt Universität Greifswald
| | | | - T Penzel
- Klinik für Kardiologie und Angiologie, Interdisziplinäres Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin
| | - I Fietze
- Klinik für Kardiologie und Angiologie, Interdisziplinäres Schlafmedizinisches Zentrum, Charité-Universitätsmedizin Berlin
| | - H Völzke
- Institut für Community Medicine, Ship/Klinisch-Epidemiologische Forschung, Ernst-Moritz-Arndt Universität Greifswald
| | - S Gläser
- Klinik für Innere Medizin – Pneumologie, Vivantes Klinikum Spandau
| | - C Schäper
- Pneumologie, Universitätsmedizin Greifswald
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Müller-Heinrich A, Warnke C, Heine A, Bollmann T, Boesche M, Schäper C, Stubbe B, Friesecke S, Felix SB, Gläser S, Obst A, Ewert R. [Weaning Unit of the University Medicine Greifswald - Institutional Structure and Weaning Results from Prolonged Ventilation over 10 Years]. Pneumologie 2017; 71:514-524. [PMID: 28505685 DOI: 10.1055/s-0043-103094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The increasing importance of intensive care medicine including mechanical ventilation has been accompanied by the demand of weaning opportunities for patients undergoing prolonged mechanical ventilation. Consequently, specialised clinical institutions, focusing on the weaning from mechanical ventilation, have been established since the 1980 s.The present article illustrates the structural development and results of such a specialised institution at the University Medicine Greifswald, using data of 616 patients collected within the past ten years (2006 - 2015). Across the years, a shift in the underlying disease leading to mechanical ventilation can be found, with rising numbers of patients suffering from pneumonia/sepsis and declining numbers of patients who underwent cardiac surgery in advance. The days with mechanical ventilation outside (p = 0.004) and within the investigated institution (p = 0.02) are significantly declining. The percentage of successfully weaned patients increased from 62.7 % (2006 - 2010) to 77.3 % (2011 - 2015), p < 0.001. Consecutively, the percentage of patients who remained mechanically ventilated decreased from 16.4 % to 9.6 % (p < 0.001) and the share of in-hospital deceased patients significantly declined from 20.9 % to 13.0 % (p < 0.001). Furthermore, the one-year-survival after hospital discharge in successful weaned patients was 72 percent. The present data, collected at the University Medicine Greifswald are quite comparable to data of other German institutions that are specialised on weaning from mechanical ventilation.
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Affiliation(s)
| | - C Warnke
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B.,BDH-Klinik Greifswald GmbH
| | - A Heine
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - T Bollmann
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - M Boesche
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - C Schäper
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B.,Kreiskrankenhaus Demmin, Klinik für Innere Medizin
| | - B Stubbe
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - S Friesecke
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - S B Felix
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - S Gläser
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B.,Vivantes Klinikum Berlin Spandau, Klinik für Innere Medizin - Pneumologie
| | - A Obst
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - R Ewert
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
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Ewert R, Ittermann T, Bollmann T, Spielhagen T, Dörr M, Schäper C, Warnke C, Obst A, Friedrich N, Felix S, Markus M, Piontek M, Penzel T, Fietze I, Glos M, Stubbe B, Desole S, Kaczmarek S, Schmidt C, Völzke H, Gläser S. Pneumologisch relevante Daten aus der „Study of Health in Pomerania“ (SHIP) – eine Übersicht zu den Kohorten, Methoden und ersten Ergebnissen. Pneumologie 2017; 71:17-35. [DOI: 10.1055/s-0042-117461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- R. Ewert
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - T. Ittermann
- Universitätsmedizin Greifswald, Institut für Community Medizin
| | - T. Bollmann
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | | | - M. Dörr
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - C. Schäper
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - C. Warnke
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - A. Obst
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - N. Friedrich
- Universitätsmedizin Greifswald, Institut für Klinische Chemie und Laboratoriumsmedizin
| | - S. Felix
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - M. Markus
- Universitätsmedizin Greifswald, Institut für Community Medizin
| | - M. Piontek
- Universitätsmedizin Greifswald, Institut für Community Medizin
| | - T. Penzel
- Universitätsmedizin Berlin, Charité, Medizinische Klinik für Kardiologie und Angiologie
| | - I. Fietze
- Universitätsmedizin Berlin, Charité, Medizinische Klinik für Kardiologie und Angiologie
| | - M. Glos
- Universitätsmedizin Berlin, Charité, Medizinische Klinik für Kardiologie und Angiologie
| | - B. Stubbe
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - S. Desole
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - S. Kaczmarek
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
| | - C. Schmidt
- Universitätsmedizin Greifswald, Institut für Community Medizin
| | - H. Völzke
- Universitätsmedizin Greifswald, Institut für Community Medizin
| | - S. Gläser
- Universitätsmedizin Greifswald, Klinik für Innere Medizin B
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Stubbe B, Obst A, Fietze I, Penzel T, Schäper C, Gläser S, Ewert R. Schlafassoziierte Atmungsstörungen als Komorbidität der COPD. Pneumologie 2016. [DOI: 10.1055/s-0036-1571963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bollmann T, Schmidt CO, Albers M, Völzke H, Markus MR, Westphal S, Obst A, Schäper C, Ewert R, Gläser S. Lungenfunktionsdiagnostik in großen Kohortenstudien – Bedeutung innovativer Qualitätssicherung zur Detektion methodischer Fehlerquellen. Pneumologie 2014. [DOI: 10.1055/s-0034-1367876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Boesche M, Schäper C, Obst A, Röser I, Ewert R. Deskription von Patienten mit neudiagnostiziertem Lungenkarzinom im Flächenland Mecklenburg-Vorpommern – Eine 5 Jahres-Auswertung der Universitätsmedizin Greifswald mittels Daten des Klinischen Krebsregisters. Pneumologie 2014. [DOI: 10.1055/s-0034-1367959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bollmann T, Ittermann T, Gläser S, Ewert R, Schäper C. Arterieller Hypertonus und antihypertensive Therapie – besteht ein Einfluss auf Lungenfunktionsparameter? Pneumologie 2014. [DOI: 10.1055/s-0034-1368077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Koch B, Schmidt CO, Albers M, Penzel T, Fietze I, Garcia C, Völzke H, Felix SB, Gläser S, Schäper C, Obst A, Ewert R. Kardiorespiratorische Polysomnografie in einer epidemiologischen Studie – Chancen und Herausforderungen. Pneumologie 2014. [DOI: 10.1055/s-0034-1367935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schöpf H, Obst A, Boesche M, Hoffmann W, Röser I, Schäper C, Ewert R, Felix SB, Gläser S. Prognostische Prädiktoren bei Patienten mit Bronchialkarzinom unter besonderer Berücksichtigung lungenfunktioneller und spiroergometrischer Parameter. Pneumologie 2014. [DOI: 10.1055/s-0034-1367952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Koch B, Schipf S, Schäper C, Felix SB, Nauck M, Völzke H, Wallaschofski H, Ewert R, Ittermann T, Gläser S. Untersuchung des Zusammenhanges zwischen Typ-1-Diabetes mellitus, Lungenfunktion und kardiopulmonaler Leistungsfähigkeit - Ergebnisse der Study of Health in Pomerania. Pneumologie 2013. [DOI: 10.1055/s-0033-1345064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Koch B, Schipf S, Schäper C, Felix SB, Nauck M, Völzke H, Wallaschofski H, Gläser S, Ittermann T, Ewert R. Untersuchung des Zusammenhanges zwischen Typ-1-Diabetes mellitus und eingeschränkter Lungenfunktion - Ergebnisse der Study of Health in Pomerania (SHIP). Pneumologie 2013. [DOI: 10.1055/s-0033-1334505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bollmann T, Obst A, Heine A, Gläser S, Schäper C, Christian W, Koch B, Ewert R. Kinetik von hämodynamischen Parametern während des Belastungsrechtsherzkatheters - wann soll gemessen werden? Pneumologie 2013. [DOI: 10.1055/s-0033-1334594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Czekay S, Bollmann T, Obst A, Kähler C, Gläser S, Schäper C, Warnke C, Ewert R. Korreliert die Höhe des mPAP/CO-slope unter fahrradergometrischer Belastung mit prognoserelevanten Parametern der Ruhehämodynamik? Pneumologie 2013. [DOI: 10.1055/s-0033-1334606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gläser S, Ittermann T, Schäper C, Obst A, Dörr M, Spielhagen T, Felix SB, Völzke H, Bollmann T, Opitz CF, Warnke C, Koch B, Ewert R. [The Study of Health in Pomerania (SHIP) reference values for cardiopulmonary exercise testing]. Pneumologie 2012; 67:58-63. [PMID: 23247595 DOI: 10.1055/s-0032-1325951] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The interpretation of gas exchange measured by cardiopulmonary exercise testing (CPET) depends on reliable reference values. Within the population based Study of Health in Pomerania (SHIP) CPET was assessed in 1706 volunteers. The assessment based on symptom limited exercise tests on a bicycle in a sitting position according to a modified Jones protocol. CPET was embedded in an extensive examination program. After the exclusion of active smokers and volunteers with evidence of cardiopulmonary and musculoskeletal disorders the reference population comprised 616 healthy subjects (333 women) aged 25 to 85 years. Reference equations including upper and/or lower limits based on quantile regression were assessed. All values were corrected for the most important influencing factors.This study provides reference equations for gas exchange and exercise capacity assessed within a population in Germany.
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Affiliation(s)
- S Gläser
- Klinik für Innere Medizin B - Kardiologie, Pneumologie/Infektiologie Intensivmedizin und Weaningzentrum, Universitätsmedizin Greifswald.
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Bollmann T, Schäper C, Walther D, Puls R, Vogelgesang S, Ewert R, Felix S. Progrediente klinische Verschlechterung bei ausgeprägter intra- und retroperitonealer Lipomatose - ein Fallbericht. Pneumologie 2012. [DOI: 10.1055/s-0032-1309182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Koch B, Penzel T, Fietze I, Garcia C, Zimmermann S, Völzke H, Gläser S, Schäper C, Obst A, Ewert R. Polysomnografie in einer populationsbasierten Studie – Ergebnisse der Study of Health in Pomerania. Pneumologie 2012. [DOI: 10.1055/s-0032-1302780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bollmann T, Schäper C, Walther D, Puls R, Vogelgesang S, Ewert R, Felix S. Progrediente klinische Verschlechterung bei ausgeprägter intra- und retroperitonealer Lipomatose – ein Fallbericht. Pneumologie 2012. [DOI: 10.1055/s-0032-1302688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schäper C, Gläser S, Koch B, Bollmann T, Warnke C, Müller-Heinrich A, Herberg M, Puls R, Ewert R. Akute Atemnot nach Imprägnierung von Kleidung im Haushalt – ein Fallbericht. Pneumologie 2012. [DOI: 10.1055/s-0032-1302611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Henkel B, Obst A, Halank M, Schäper C, Opitz C, Grieger A, Koch B, Warnke C, Bruch L, Felix SB, Ewert R, Gläser S. Nicht-invasive Prädiktoren einer pulmonalen Hypertonie bei Patienten mit idiopathischer Lungenfibrose. Pneumologie 2012. [DOI: 10.1055/s-0032-1302690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Koch B, Lau K, Ittermann T, Völzke H, Felix S, Ewert R, Schäper C, Gläser S. Spiroergometrische Referenzwerte für Parameter der Atemmechanik - Ergebnisse der Study of Health in Pomerania. Pneumologie 2011. [DOI: 10.1055/s-0031-1272228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Walther D, Schäper C, Velikovska A, Bollmann T, Rosenberg C, Warzok R, Ewert R. Bronchiolithiasis als seltene Ursache von Hämoptysen. Pneumologie 2011. [DOI: 10.1055/s-0031-1272076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gläser S, Ittermann T, Koch B, Völzke H, Wallaschofski H, Nauck M, Warnke C, Ewert R, Schäper C. Lungenvolumina, Atemwegsobstruktion und systemische Inflammation - Ergebnisse der Study of Health in Pomerania. Pneumologie 2011. [DOI: 10.1055/s-0031-1272023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Walter D, Schäper C, Velikovska A, Bollmann T, Rosenberg C, Warzok R, Ewert R. Bronchiolithiasis als seltene Ursache von Hämoptysen. Pneumologie 2011. [DOI: 10.1055/s-0031-1272075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schäper C, Noga O, Koch B, Ewert R, Felix SB, Gläser S, Kunkel G, Gustavus B. Anti-inflammatory properties of montelukast, a leukotriene receptor antagonist in patients with asthma and nasal polyposis. J Investig Allergol Clin Immunol 2011; 21:51-58. [PMID: 21370724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Leukotrienes, especially LTC4, are important inflammatory mediators in allergic and nonallergic inflammation of the entire airways. Of particular interest are numerous theories regarding the pathogenesis of aspirin intolerance with subsequent hyperproduction of leukotrienes and inhibition of cyclooxygenase. OBJECTIVE To examine the influence of the cysteinyl-leukotriene receptor antagonist montelukast on clinical symptoms and inflammatory markers in nasal lavage fluid in patients with bronchial asthma and nasal polyps, and determine its dependency on aspirin sensitization. METHODS Twenty-four patients (7 women, 17 men; median age, 55.5 years) with nasal polyps and controlled asthma (n=12 with aspirin intolerance) were treated with 10 mg montelukast once daily for 6 weeks in a blinded, placebo-controlled fashion. The placebo phase was randomly assigned 4 weeks before (n=12) or after treatment (n=12). Symptom score, rhinoendoscopy, rhinomanometry, smears for eosinophils, and nasal lavages for the determination of different mediators were performed. RESULTS Compared to placebo, there were significant improvements in the nasal symptom score and airflow limitation as well as a reduction in the inflammatory mediators in nasal lavage fluid after treatment. Furthermore, reduced eosinophils in nasal smears and peripheral blood were observed 2 and 6 weeks after treatment. CONCLUSION Leukotriene 1 receptor blockade led to a significant decrease in eosinophil inflammation accompanied by a reduction in other mediators such as neurokinin A and substance P in the nasal lavage fluid of patients with nasal polyps and asthma, with or without aspirin intolerance.
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Affiliation(s)
- C Schäper
- Department of Internal Medicine B-Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, Greifswald, Germany
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Schäper C, Gläser S, Wolff B, Koch B, Vietzke G, Felix S, Kleber F, Opitz C, Ewert R. Resting Alveolar Gas Tensions as a Mortality Prognosticator in Chronic Heart Failure. Transplant Proc 2010; 42:2681-6. [DOI: 10.1016/j.transproceed.2010.05.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 04/25/2010] [Accepted: 05/12/2010] [Indexed: 01/02/2023]
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Spitzer C, Koch B, Grabe HJ, Ewert R, Barnow S, Felix SB, Ittermann T, Obst A, Völzke H, Gläser S, Schäper C. Association of airflow limitation with trauma exposure and post-traumatic stress disorder. Eur Respir J 2010; 37:1068-75. [PMID: 20729219 DOI: 10.1183/09031936.00028010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Trauma exposure and post-traumatic stress disorder (PTSD) are associated with self-reported asthma and chronic obstructive pulmonary disease. However, these conditions have not yet been related to objective measures of lung function. 1,772 adults from the general population were assessed regarding their medical histories and spirometric lung function. Additionally, they were administered a PTSD interview, and assigned to three groups: no trauma; trauma, but no PTSD; and trauma with PTSD. Adjusting for sociodemographic, clinical and lifestyle factors, subjects with PTSD had significantly higher odds ratios for most asthma-related symptoms than PTSD-negative participants (OR 3.2-8.8). The mean ratio of forced expiratory volume in 1 s (FEV₁) to forced vital capacity (FVC) was lowest in the PTSD group and highest in those without trauma exposure. Traumatic stress was independently associated with FEV₁ and FEV₁/FVC. Participants with PTSD, compared with those without, had a significantly increased risk for airflow limitation independent of its definition (OR 4.2-7.8). This is the first study relating traumatic stress and PTSD, respectively, to objective parameters of lung function. Our findings suggest an association of trauma exposure and PTSD with airflow limitation, which may be mediated by inflammatory processes.
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Affiliation(s)
- C Spitzer
- Dept of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany.
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Koch B, Gläser S, Friedrich N, Völzke H, Felix S, Ewert R, Schäper C. Referenzwerte für die Bodyplethysmografie bei Erwachsenen – Ergebnisse der Study of Health in Pomerania (SHIP). Pneumologie 2010. [DOI: 10.1055/s-0030-1251306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gläser S, Schäper C, Warnke C, Obst A, Felix S, Opitz C, Ewert R, Koch B. Endothelfunktion: ein peripher messbares Surrogat für Gasaustauscheffizienz und kardiopulmonale Belastbarkeit? Pneumologie 2010. [DOI: 10.1055/s-0030-1251114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schäper C, Gläser S, Obst A, Schmidt C, Völzke H, Felix SB, Ewert R, Koch B. Prävalenz von Asthma und Asthmasymptomen in Mecklenburg-Vorpommern – longitudinale Ergebnisse aus der SHIP Studie. Pneumologie 2010. [DOI: 10.1055/s-0030-1251192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schäper C, Gustavus B, Koch B, Ewert R, Felix SB, Kunkel G, Noga O, Gläser S. Effect of fluticasone on neuropeptides in nasal lavage in persistent allergic rhinitis. J Investig Allergol Clin Immunol 2010; 20:214-221. [PMID: 20635787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVE Recent guidelines reveal that allergic rhinitis impairs quality of life. Neuropeptides play a central role in allergy-related nasal inflammation. The objective of this study was to analyze the release of neuropeptides (substance P, neurokinin A, and vasoactive intestinal peptide) in nasal lavage and their modification by intranasal fluticasone propionate as an established therapy in patients with allergic rhinitis. METHODS Eleven patients with proven allergic rhinitis induced by house dust mite were challenged before and after administration of fluticasone propionate nasal spray. Nasal lavage samples were collected after allergen challenge, and neuropeptides were measured using enzyme-linked immunosorbent assay. Values for histamine, protein, and human serum albumin were also recorded. Eight healthy individuals were included as nonatopic controls. RESULTS The neuropeptides investigated were detectable in nasal lavage fluid in both patients and controls. Treatment with fluticasone propionate significantly decreased clinical response to allergen challenge (P < .01) compared with the controls and led to a decrease in values for substance P, neurokinin A, vasoactive intestinal peptide, histamine release, human serum albumin, and total protein after allergen challenge (P < .01). CONCLUSIONS The demonstration of proinflammatory neuropeptides in NAL and suppression of their release after allergen challenge caused by a topical corticosteroid suggest a role for neuropeptides in allergic inflammation. Diminished release of neuropeptides induced b fluticasone propionate was accompanied by an improvement in the clinical symptoms of patients with persistent allergic rhinitis.
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Affiliation(s)
- C Schäper
- Department of Internal Medicine B--Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, Universität Greifswald, Greifswald, Germany.
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Koch B, Schäper C, Ittermann T, Völzke H, Felix S, Ewert R, Gläser S. Referenzwerte für die Spirometrie bei Erwachsenen. Dtsch Med Wochenschr 2009; 134:2327-32. [DOI: 10.1055/s-0029-1242688] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Walther D, Schäper C, Heine A, Gläser S, Ewert R. Asthma als Vorbote einer Vaskulitis. Pneumologie 2009. [DOI: 10.1055/s-0029-1213899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Warnke C, Pusch R, Walther D, Bollmann T, Gläser S, Schäper C, Ewert R. 3 Jahre Weaningstation am Universitätsklinikum Greifswald – Methoden und Ergebnisse. Pneumologie 2009. [DOI: 10.1055/s-0029-1213819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Koch B, Schäper C, Ittermann T, Spielhagen T, Dörr M, Völzke H, Opitz C, Ewert R, Gläser S. Reference Values for Cardiopulmonary Exercise Testing in Obese Individuals – Results from the SHIP Study. Pneumologie 2009. [DOI: 10.1055/s-0029-1213993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schnell M, Jantzen F, Koch B, Gläser S, Schäper C, Felix S, Ewert R, Landsberger M. ET-1-induzierte Expression von LOX-1 in Fibroblasten und venösen Endothelzellen der Lunge: Effekte von Bosentan in vitro. Pneumologie 2009. [DOI: 10.1055/s-0029-1214128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schäper C, Gustavus B, Koch B, Ewert R, Hanf G, Kunkel G, Noga O, Gläser S. Effects of fexofenadine on inflammatory mediators in nasal lavage fluid in intermittent allergic rhinitis. J Investig Allergol Clin Immunol 2009; 19:459-464. [PMID: 20128420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Allergic rhinitis, a disease that impairs quality of life, is characterized by inflammation due to an allergic reaction. Fexofenadine is a second-generation histamine receptor blocker well known for its potent interaction with this inflammatory process. The main aim of this study was to further clarify the anti-inflammatory effects exerted by fexofenadine in patients with intermittent allergic rhinitis. METHODS Twenty patients with intermittent allergic rhinitis due to birch and mugwort pollen were enrolled. Fexofenadine was administered once a day at a dose of 120 mg. Clinical improvement was assessed by a symptom score, and nasal airway flows were measured by anterior rhinomanometry at baseline and after 2 weeks of treatment with fexofenadine. Nasal smears were tested for eosinophils and nasal lavage fluid were examined for histamine, cysteinyl leukotrienes, soluble intercellular adhesion molecule-1, eosinophil cationic protein, and albumin by enzyme-linked immunosorbent assay. All the tests were performed during the pollen season. RESULTS Fexofenadine induced a significant improvement in nasal and ocular symptoms (P < .001), nasal edema and secretion (P < .001), and nasal airway flow (P < .001). The clinical improvement was related to a significant reduction in all inflammatory mediators (P < .01 in all cases). CONCLUSION This study demonstrates that fexofenadine is able to mediate significant changes in different nasal lavage markers from patients with intermittent allergic rhinitis. The changes observed in the markers analyzed in both nasal secretions and serum are attributable to the anti-inflammatory effects of fexofenadine in vivo.
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Affiliation(s)
- C Schäper
- Division of Cardiology and Pneumology, Universität Greifswald, Greifswald, Germany.
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Abstract
Despite recent remarkable efforts in the medical treatment options of patients with pulmonary arterial hypertension (PAH) a considerable number of patients need escalations to improve disease related symptoms and pulmonary hemodynamics. Most of the pulmonary vascular vasodilators have been approved in its potency as an initial and sole medical option. However, there is increasing scientific evidence on the reliability, safety and effectiveness of possible combinations. This paper reviews the current scientific literature about medical escalations and combination therapy in patients with PAH.
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Affiliation(s)
- R Ewert
- Bereich Pneumologie/Infektiologie, Klinik und Poliklinik für Innere Medizin B, Universität Greifswald.
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Gläser S, Meyer R, Schäper C, Heinrich A, Koch B, Bollmann T, Warnke C, Walther D, Hetzer R, Ewert R. Histomorphologische pulmonal-interstitielle und -vaskuläre Veränderung als Ursache von Diffusionsstörungen nach Herztransplantation. Pneumologie 2008. [DOI: 10.1055/s-2008-1074404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gläser S, Noga O, Koch B, Schäper C, Schmitt B, Bollmann T, Opitz C, Ewert R. Fortgeschrittene interstitielle Lungenerkrankungen und pulmonale Hypertonie: Einfluss der pulmonal-arteriellen Hypertonie auf Gasaustausch, Atemeffizienz, Dyspnoe und Belastungsfähigkeit. Pneumologie 2008. [DOI: 10.1055/s-2008-1074130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Binder D, Hackenthal M, Graseck L, Schweisfurth H, Schäper C, Krüll M, Temmesfeld-Wollbrück B, Suttorp N, Beinert T, Hellriegel K. Efficacy and tolerability of a weekly schedule of docetaxel-cisplatin as first-line treatment for advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.18159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18159 Background: Docetaxel-cisplatin, administered every 3 weeks, is an effective first-line chemotherapy for locally advanced or metastatic NSCLC. However, this regimen is commonly associated with neutropenia and neutropenic infections. Moreover, the extensive hydration required with cisplatin given every 3 or 4 weeks makes outpatient treatment difficult. We assessed the efficacy and tolerability of weekly docetaxel-cisplatin, which may be better tolerated than the standard regimen. Methods: Patients (pts) with histologically confirmed stage UICC IIIB (malignant effusion) or IV NSCLC were treated with docetaxel (35 mg/m2, 30 min. infusion) and cisplatin (25 mg/m2, 30-min. infusion) on Days 1, 8, and 15, every 4 weeks for 4–6 cycles. Pts received ondansetron 8 mg iv and dexamethasone 8 mg iv preceding every day of chemotherapy and oral dexamethasone 2 x 4 mg daily from the day before until the day after chemotherapy. NK1-antagonists were given at the investigator’s discretion. On each day of therapy, 2750 mL of fluid was infused over 3.5 h. Most pts were treated in an outpatient department. Safety was assessed using CTCAE v3.0. The primary endpoint was response rate (RECIST). Results: 45 pts were enrolled; efficacy and tolerability data were available for 43 pts. 12/45 pts achieved an objective response (11 partial; 1 complete; ITT response rate 27%). Median time to progression was 3.9 months. Pts received a median of 3 full cycles. 4 pts (9%) required dose reductions. No cases of neutropenic fever/infections or grade 2–4 thrombocytopenia were observed. Only 2 pts (5%) had grade 3 neutropenia. One pt (2%) experienced grade 3–4 nausea/vomiting. 5 pts died during therapy for reasons not unequivocally attributable to tumor progression (bacterial meningitis with normal neutrophil counts [n=1], pneumonia with normal neutrophil counts [n=1], pulmonary arterial embolism [n=1], unknown [n=2]). Conclusions: Docetaxel-cisplatin administered weekly was well tolerated. Hematologic toxicity and neutropenic fever were uncommon. Docetaxel-cisplatin can be safely administered with relatively low hydration volumes in an outpatient setting. Survival data will be presented. No significant financial relationships to disclose.
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Affiliation(s)
- D. Binder
- Charite, Berlin, Germany; Vivantes-Klinikum Am Urban, Berlin, Germany; Carl Thiem Klinikum, Cottbus, Germany; Klinik Wartenberg, Wartenberg, Germany
| | - M. Hackenthal
- Charite, Berlin, Germany; Vivantes-Klinikum Am Urban, Berlin, Germany; Carl Thiem Klinikum, Cottbus, Germany; Klinik Wartenberg, Wartenberg, Germany
| | - L. Graseck
- Charite, Berlin, Germany; Vivantes-Klinikum Am Urban, Berlin, Germany; Carl Thiem Klinikum, Cottbus, Germany; Klinik Wartenberg, Wartenberg, Germany
| | - H. Schweisfurth
- Charite, Berlin, Germany; Vivantes-Klinikum Am Urban, Berlin, Germany; Carl Thiem Klinikum, Cottbus, Germany; Klinik Wartenberg, Wartenberg, Germany
| | - C. Schäper
- Charite, Berlin, Germany; Vivantes-Klinikum Am Urban, Berlin, Germany; Carl Thiem Klinikum, Cottbus, Germany; Klinik Wartenberg, Wartenberg, Germany
| | - M. Krüll
- Charite, Berlin, Germany; Vivantes-Klinikum Am Urban, Berlin, Germany; Carl Thiem Klinikum, Cottbus, Germany; Klinik Wartenberg, Wartenberg, Germany
| | - B. Temmesfeld-Wollbrück
- Charite, Berlin, Germany; Vivantes-Klinikum Am Urban, Berlin, Germany; Carl Thiem Klinikum, Cottbus, Germany; Klinik Wartenberg, Wartenberg, Germany
| | - N. Suttorp
- Charite, Berlin, Germany; Vivantes-Klinikum Am Urban, Berlin, Germany; Carl Thiem Klinikum, Cottbus, Germany; Klinik Wartenberg, Wartenberg, Germany
| | - T. Beinert
- Charite, Berlin, Germany; Vivantes-Klinikum Am Urban, Berlin, Germany; Carl Thiem Klinikum, Cottbus, Germany; Klinik Wartenberg, Wartenberg, Germany
| | - K. Hellriegel
- Charite, Berlin, Germany; Vivantes-Klinikum Am Urban, Berlin, Germany; Carl Thiem Klinikum, Cottbus, Germany; Klinik Wartenberg, Wartenberg, Germany
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Binder D, Schweisfurth H, Grah C, Schäper C, Temmesfeld-Wollbrück B, Siebert G, Suttorp N, Beinert T. Docetaxel/gemcitabine or cisplatin/gemcitabine followed by docetaxel in the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC): results of a multicentre randomized phase II trial. Cancer Chemother Pharmacol 2006; 60:143-50. [PMID: 17031643 DOI: 10.1007/s00280-006-0358-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Accepted: 09/14/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Most patients (pts) with metastatic non-small cell lung cancer (NSCLC) receive either single agents or chemotherapy doublets. Recent studies have demonstrated that triple-agent therapies may improve the response rate, but are associated with significant toxicity, and frequently do not prolong survival. A sequential triple-agent schedule may combine acceptable tolerability and good efficacy. We therefore conducted a multicentre, prospectively randomized study that evaluates a sequential three-drug schedule and a platinum-free doublet regimen. PATIENTS AND METHODS The pts with union international contre le cancer (UICC) stage IV NSCLC were randomized to one of two schedules: in arm Doc-Gem, they received gemcitabine (900 mg/m(2), 30 min infusion) on days 1 and 8, and docetaxel (75 mg/m(2), 1 h infusion) on day 1, repeated every 3 weeks up to six cycles. In arm Cis-Gem-->Doc, gemcitabine (900 mg/m(2), days 1 and 8) and cisplatin (70 mg/m(2), 1 h infusion, day 1) were given for three cycles, followed by three cycles of docetaxel (100 mg/m(2), day 1, repeated every 3 weeks). RESULTS One hundred and thirteen pts were randomized to arms Doc-Gem (55 pts) and Cis-Gem-->Doc (58 pts). With Doc-Gem, 20.4% of pts responded to the treatment whereas 31.0% responded in arm Cis-Gem-->Doc (overall response, intent-to-treat, difference not significant). The median time to progression was 3.6 months in arm Doc-Gem [95% confidence interval (CI) 1.4, 5.9] and 5.2 months in arm Cis-Gem-->Doc (95% CI 3.1, 7.3). The median survival was 8.7 months with treatment Doc-Gem (95% CI 5.7, 11.6) and 9.4 months with treatment Cis-Gem-->Doc (95% CI 7.8, 11.0). The 1-year survival rates were 34 and 35%, respectively. Mild to moderate leukopenia was frequently seen with both schedules. Other common adverse events (AE) were nausea/vomiting, thrombocytopenia, anaemia, diarrhoea, and infections. No significant differences in AEs were observed between the schedules except for nausea/vomiting, which occurred more frequently with Cis-Gem-->Doc. CONCLUSION The sequential therapy comprising cisplatin, gemcitabine, and docetaxel demonstrated promising tumour control whereas the platinum-free combination (docetaxel/gemcitabine) was very well tolerated. However, the schedules resulted in comparable survival to recent large trials in pts with advanced NSCLC. The present results do not justify further phase III investigation.
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Affiliation(s)
- D Binder
- Medizinische Klinik m. S. Infektiologie und Pneumologie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Binder D, Hackenthal M, Graseck L, Schweisfurth H, Schäper C, Temmesfeld-Wollbrück B, Suttorp N, Beinert T, Hellriegel K. Tolerability of a weekly schedule of docetaxel-cisplatin as first-line treatment in patients with stage IIIB/IV non-small cell lung cancer (NSCLC). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17112 Background: Recent trials have shown that the combination docetaxel-cisplatin is an effective first-line treatment in locally advanced or metastatic NSCLC. However, the regimen can be associated with a marked rate of neutropenia. The present study tests the efficacy and tolerability of a weekly schedule of docetaxel and cisplatin. Methods: Patients (pts) with histologically confirmed NSCLC stages UICC IIIB (malignant effusion) or IV were treated with docetaxel (35 mg/m2, 30 min. infusion) and cisplatin (25 mg/m2, 30 min. infusion) on days 1, 8 and 15 repeated every 4 weeks for 4 to 6 cycles. This phase II study is scheduled to include 50 pts and primary endpoint is tumour response rate. Pts received 8 mg of ondansetron and 8 mg of dexamethasone i.v. preceding every day of therapy and oral dexamethasone 2 × 4 mg from the day before until the day after chemotherapy. NK1-antagonists were given at discretion of the investigator. In total, 2750 ml of volume were infused on each day of therapy. Most of the pts were treated in an outpatient department. Safety was assessed via common terminology criteria for adverse events v3.0 (CTCAE 3.0). Interim tolerability data is presented. Results: Currently, 28 pts were evaluable for this interim tolerability analysis. Pts received a median of 3 full cycles. There were no treatment-related deaths. Dose reductions of docetaxel and cisplatin due to poor tolerability were necessary in 3 pts (11%). No pts suffered from neutropenic fever while grade 3 neutropenia occurred in only 2 pts (7%). There was no grade 2/3/4 thrombocytopenia. 5 pts (18%) had grade 2 anemia, and 2 pts (7%) had an elevation of the plasma creatinine (both grade 1). Other toxicities were non-neutropenic infections (5/1/1 pts with grade 2, 3, 4, respectively), diarrhea (3 pts [11%] with grade 3), constipation (5 pts [18%] with grade 2) and mucositis (4 pts [14%] with grade 2/3). There was no grade 3/4 nausea or vomiting; 3 pts [11%] had grade 2 nausea/vomiting. Conclusions: In the present study, the combination of docetaxel and cisplatin appears well tolerated. It was associated with a very low frequency of severe hematologic toxicity or neutropenic fever. With relatively low hydration volumes it can be safely administered in an outpatient setting. [Table: see text]
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Affiliation(s)
- D. Binder
- Med. Klinik m. S. Infektiologie und Pneumologie, Charite - Universitätsmedizin, Berlin, Germany; Klinik f. Innere Medizin Hämatologie und Onkologie, Vivantes-Klinikum Am Urban Berlin, Germany; Medizinische Klinik, Carl-Thiem-Klinikum, Cottbus, Germany; Hämatologie und Internistische Onkologie, Klinik Wartenberg, Germany
| | - M. Hackenthal
- Med. Klinik m. S. Infektiologie und Pneumologie, Charite - Universitätsmedizin, Berlin, Germany; Klinik f. Innere Medizin Hämatologie und Onkologie, Vivantes-Klinikum Am Urban Berlin, Germany; Medizinische Klinik, Carl-Thiem-Klinikum, Cottbus, Germany; Hämatologie und Internistische Onkologie, Klinik Wartenberg, Germany
| | - L. Graseck
- Med. Klinik m. S. Infektiologie und Pneumologie, Charite - Universitätsmedizin, Berlin, Germany; Klinik f. Innere Medizin Hämatologie und Onkologie, Vivantes-Klinikum Am Urban Berlin, Germany; Medizinische Klinik, Carl-Thiem-Klinikum, Cottbus, Germany; Hämatologie und Internistische Onkologie, Klinik Wartenberg, Germany
| | - H. Schweisfurth
- Med. Klinik m. S. Infektiologie und Pneumologie, Charite - Universitätsmedizin, Berlin, Germany; Klinik f. Innere Medizin Hämatologie und Onkologie, Vivantes-Klinikum Am Urban Berlin, Germany; Medizinische Klinik, Carl-Thiem-Klinikum, Cottbus, Germany; Hämatologie und Internistische Onkologie, Klinik Wartenberg, Germany
| | - C. Schäper
- Med. Klinik m. S. Infektiologie und Pneumologie, Charite - Universitätsmedizin, Berlin, Germany; Klinik f. Innere Medizin Hämatologie und Onkologie, Vivantes-Klinikum Am Urban Berlin, Germany; Medizinische Klinik, Carl-Thiem-Klinikum, Cottbus, Germany; Hämatologie und Internistische Onkologie, Klinik Wartenberg, Germany
| | - B. Temmesfeld-Wollbrück
- Med. Klinik m. S. Infektiologie und Pneumologie, Charite - Universitätsmedizin, Berlin, Germany; Klinik f. Innere Medizin Hämatologie und Onkologie, Vivantes-Klinikum Am Urban Berlin, Germany; Medizinische Klinik, Carl-Thiem-Klinikum, Cottbus, Germany; Hämatologie und Internistische Onkologie, Klinik Wartenberg, Germany
| | - N. Suttorp
- Med. Klinik m. S. Infektiologie und Pneumologie, Charite - Universitätsmedizin, Berlin, Germany; Klinik f. Innere Medizin Hämatologie und Onkologie, Vivantes-Klinikum Am Urban Berlin, Germany; Medizinische Klinik, Carl-Thiem-Klinikum, Cottbus, Germany; Hämatologie und Internistische Onkologie, Klinik Wartenberg, Germany
| | - T. Beinert
- Med. Klinik m. S. Infektiologie und Pneumologie, Charite - Universitätsmedizin, Berlin, Germany; Klinik f. Innere Medizin Hämatologie und Onkologie, Vivantes-Klinikum Am Urban Berlin, Germany; Medizinische Klinik, Carl-Thiem-Klinikum, Cottbus, Germany; Hämatologie und Internistische Onkologie, Klinik Wartenberg, Germany
| | - K. Hellriegel
- Med. Klinik m. S. Infektiologie und Pneumologie, Charite - Universitätsmedizin, Berlin, Germany; Klinik f. Innere Medizin Hämatologie und Onkologie, Vivantes-Klinikum Am Urban Berlin, Germany; Medizinische Klinik, Carl-Thiem-Klinikum, Cottbus, Germany; Hämatologie und Internistische Onkologie, Klinik Wartenberg, Germany
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Binder D, Temmesfeld-Wollbrück B, Wurm R, Woiciechowsky C, Schäper C, Schürmann D, Suttorp N, Beinert T. [Brain metastases of lung cancer]. Dtsch Med Wochenschr 2006; 131:165-71. [PMID: 16429340 DOI: 10.1055/s-2006-924941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cerebral metastases are a frequent complication of lung cancer. They often determine patients' prognosis and need urgent therapeutic intervention. Based on histologic type, former therapies, age and performance of the patient, the number of cerebral lesions and the extracerebral tumour activity, individualized treatments are applied. For patients who suffer from non-small cell lung cancer and a single CNS lesion the best results can be achieved if they are surgically resected or receive radiosurgery. Their survival time can be markedly increased in comparison to patients who undergo whole brain irradiation. If multiple metastases are seen in CT or MRI, whole brain irradiation is the therapy to choose. Furthermore it should be initiated if small cell lung cancer metastasizes to the brain. More aggressive local treatment options appear promising, but a clear role for them has not yet been defined. Systemic chemotherapy gains more attention in the treatment of small and non-small cell lung cancer with brain metastases. How to increase the efficacy through simultaneous application of chemo- and radiotherapy is tested in current trials. This article gives an overview on clinical presentation and diagnosis of cerebral metastases in lung cancer and reviews current treatment options.
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Affiliation(s)
- D Binder
- Medizinische Klinik m. S. Infektiologie und Pneumologie, Charité -- Universitätsmedizin Berlin.
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Binder D, Schweisfurth H, Grah C, Schäper C, Temmesfeld-Wollbrück B, Siebert G, Suttorp N, Beinert T. P-457 Docetaxel/gemcitabine vs. cisplatin/gemcitabine followed bydocetaxel in the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC): Results of a randomised phase II trial. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Binder D, Beinert T, Schweisfurth H, Grah C, Temmesfeld-Wollbrück B, Müller-Hagen G, Schäper C, Schürmann D, Suttorp N. Sequential cisplatin–gemcitabine–docetaxel vs docetaxel–gemcitabine in the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC): Interim results of an ongoing phase II trial. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D. Binder
- Medizinische Klinik m. S. Infektiologie, Berlin, Germany; Klinik Wartenberg, Wartenberg, Germany; III. Medizinische Klinik, Cottbus, Germany; Medizinische Klinik m. S. Kardiologie/Pneumologie, Berlin, Germany
| | - T. Beinert
- Medizinische Klinik m. S. Infektiologie, Berlin, Germany; Klinik Wartenberg, Wartenberg, Germany; III. Medizinische Klinik, Cottbus, Germany; Medizinische Klinik m. S. Kardiologie/Pneumologie, Berlin, Germany
| | - H. Schweisfurth
- Medizinische Klinik m. S. Infektiologie, Berlin, Germany; Klinik Wartenberg, Wartenberg, Germany; III. Medizinische Klinik, Cottbus, Germany; Medizinische Klinik m. S. Kardiologie/Pneumologie, Berlin, Germany
| | - C. Grah
- Medizinische Klinik m. S. Infektiologie, Berlin, Germany; Klinik Wartenberg, Wartenberg, Germany; III. Medizinische Klinik, Cottbus, Germany; Medizinische Klinik m. S. Kardiologie/Pneumologie, Berlin, Germany
| | - B. Temmesfeld-Wollbrück
- Medizinische Klinik m. S. Infektiologie, Berlin, Germany; Klinik Wartenberg, Wartenberg, Germany; III. Medizinische Klinik, Cottbus, Germany; Medizinische Klinik m. S. Kardiologie/Pneumologie, Berlin, Germany
| | - G. Müller-Hagen
- Medizinische Klinik m. S. Infektiologie, Berlin, Germany; Klinik Wartenberg, Wartenberg, Germany; III. Medizinische Klinik, Cottbus, Germany; Medizinische Klinik m. S. Kardiologie/Pneumologie, Berlin, Germany
| | - C. Schäper
- Medizinische Klinik m. S. Infektiologie, Berlin, Germany; Klinik Wartenberg, Wartenberg, Germany; III. Medizinische Klinik, Cottbus, Germany; Medizinische Klinik m. S. Kardiologie/Pneumologie, Berlin, Germany
| | - D. Schürmann
- Medizinische Klinik m. S. Infektiologie, Berlin, Germany; Klinik Wartenberg, Wartenberg, Germany; III. Medizinische Klinik, Cottbus, Germany; Medizinische Klinik m. S. Kardiologie/Pneumologie, Berlin, Germany
| | - N. Suttorp
- Medizinische Klinik m. S. Infektiologie, Berlin, Germany; Klinik Wartenberg, Wartenberg, Germany; III. Medizinische Klinik, Cottbus, Germany; Medizinische Klinik m. S. Kardiologie/Pneumologie, Berlin, Germany
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Kunkel G, Schäper C, Noga O, Schläfke S, Lemmnitz G, Köhler S. Efficacy, safety, and acceptance of beclomethasone dipropionate administered via a new dry powder Inhaler or a standard CFC metered-dose inhaler in asthma patients. Respiration 2004; 70:399-406. [PMID: 14512676 DOI: 10.1159/000072904] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2001] [Accepted: 05/15/2003] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/OBJECTIVES The mechanical aerosol generator, MAGhaler, is a new chlorofluorocarbon-free inhalation device. The objective of this trial was to show equivalent efficacy and safety of beclomethasone dipropionate (BDP) delivered via the MAGhaler and the metered-dose inhaler (MDI) in patients with mild to moderate bronchial asthma. Moreover, user-friendliness and acceptance of the two devices were compared. METHODS This was a double-blind, reference-controlled, 12-week trial in 171 patients with asthma receiving BDP (1,000 microg/day) delivered via either the MAGhaler or the conventional MDI. Respiratory function parameters, clinical symptoms, concomitant intake of salbutamol or fenoterol, adverse events (AEs), laboratory values, and concomitant medications and diseases were recorded. The primary efficacy parameter was mean forced expiratory volume in 1 s (FEV1), measured after 4, 8, and 12 weeks of therapy. RESULTS The equivalence of the two devices was confirmed (p = 0.003) on the basis of the ratios of the mean FEV1 in weeks 4 to 12. Mean (+/- SD) FEV1 (MAGhaler was 2.24 +/- 0.60 l (baseline), 2.61 +/- 0.90 litres (week 4), and 2.62 +/- 0.87 litres (weeks 4-12). Mean FEV1 (MDI) was 2.28 +/- 0.59 litres (baseline), 2.53 +/- 0.82 litres (week 4), and 2.56 +/- 0.77 litres (weeks 4-12). In total, 33 AEs occurred in 26 (30.2%) patients (MAGhaler) and 51 AEs in 36 (42.4%) patients (MDI). Most of the AEs were of mild or moderate intensity. The relationship to treatment could not be excluded for 11 AEs in 11 patients (MAGhaler) and 23 AEs in 18 patients (MDI). Three serious AEs, all unrelated to treatment, occurred in 3 patients (MAGhaler: 2, MDI: 1). There were no clinically relevant changes in other safety parameters. Most patients either preferred the MAGhaler or rated the two devices as equally acceptable. CONCLUSION The new MAGhaler was equivalent to the standard MDI in terms of the safety and efficacy of BDP. The improved user-friendliness and acceptance of the MAGhaler over the conventional MDI represent an important advance in the clinical management of bronchial asthma.
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Affiliation(s)
- G Kunkel
- Allergy and Asthma Clinic, Humboldt University Charité, Virchow-Klinikum, Berlin, Germany.
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