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Milger K, Skowasch D, Hamelmann E, Mümmler C, Idzko M, Gappa M, Jandl M, Körner-Rettberg C, Ehmann R, Schmidt O, Taube C, Holtdirk A, Timmermann H, Buhl R, Korn S. Bronchodilator Reversibility in the GAN Severe Asthma Cohort. J Investig Allergol Clin Immunol 2023; 33:446-456. [PMID: 36000830 DOI: 10.18176/jiaci.0850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Positive bronchodilator reversibility (BDR) is a diagnostic criterion for asthma. However, patients with asthma may exhibit a negative BDR response. Aim: To describe the frequency of positive and Negative BDR response in patients with severe asthma and study associations with phenotypic characteristics. METHODS A positive BDR response was defined as an increase in FEV1 >200 mL and >12% upon testing with a short-acting ß-agonist. RESULTS BDR data were available for 793 of the 2013 patients included in the German Asthma Net (GAN) severe asthma registry. Of these, 250 (31.5%) had a positive BDR response and 543 (68.5%) a egative BDR response. Comorbidities significantly associated with a negative response were gastroesophageal reflux disease (GERD) (28.0% vs 40.0%, P<.01) and eosinophilic granulomatosis with polyangiitis (0.4% vs 3.0%; P<.05), while smoking history (active: 2.8% vs 2.2%; ex: 40.0% vs 41.7%) and comorbid chronic obstructive pulmonary disease (COPD) (5.2% vs 7.2%) were similar in both groups. Patients with a positive BDR response had worse asthma control (median Asthma Control Questionnaire 5 score, 3.4 vs 3.0, P<.05), more frequently reported dyspnea at rest (26.8% vs 16.4%, P<.001) and chest tightness (36.4% vs 26.2%, P<.001), and had more severe airway obstruction at baseline (FEV1% predicted, 56 vs 64, P<.001) and higher fractional exhaled nitric oxide (FeNO) levels (41 vs 33 ppb, P<0.05). There were no differences in diffusion capacity of the lung for carbon monoxide, single breath (% pred, 70% vs 71%). Multivariate linear regression analysis identified an association between positive BDR response and lower baseline FEV1% (P<.001) and chest tightness (P<.05) and a negative association between BDR and GERD (P<.05). CONCLUSION In this real-life setting, most patients with severe asthma had a negative BDR response. Interestingly, this was not associated with smoking history or COPD, but with lower FeNO and presence of GERD.
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Affiliation(s)
- K Milger
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany
| | - D Skowasch
- Department of Internal Medicine II - Pneumology/Cardiology, University Hospital Bonn, Bonn, Germany
| | - E Hamelmann
- University Hospital for Pediatrics and Adolescent Medicine, Children´s Center Bethel, University of Bielefeld, Bielefeld, Germany
| | - C Mümmler
- Department of Medicine V, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany
| | - M Idzko
- Department of Pulmonary Medicine, Medical University of Vienna, Vienna, Austria
| | - M Gappa
- Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - M Jandl
- Hamburger Institut für Therapieforschung, Hamburg, Germany
| | | | - R Ehmann
- Ambulante Pneumologie Stuttgart, Stuttgart, Germany
| | - O Schmidt
- Pneumologische Gemeinschaftspraxis Koblenz, Koblenz, Germany
| | - C Taube
- Department of Pulmonary Medicine, University Hospital - Ruhrlandklinik, Essen, Germany
| | | | | | - R Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - S Korn
- IKF Pneumologie Mainz, Mainz, Germany
- Thoraxklinik Heidelberg, Heidelberg, Germany
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Schlierenkamp S, Diekmann S, zur Nieden P, Lux G, Walendzik A, Abels C, Wasem J, Best D, Klipker K, Marschall U, Schaff C, Timmermann H, Neusser S. Arztkontakte vor und nach der Strukturreform der
Psychotherapie-Richtlinie: eine Analyse von Routinedaten der gesetzlichen
Krankenversicherung im Projekt Eva PT-RL (Evaluation der
Psychotherapie-Richtlinie). Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753660] [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: 12/12/2022]
Affiliation(s)
- S Schlierenkamp
- Essener Forschungsinstitut für Medizinmanagement GmbH, Essen,
Deutschland
| | - S Diekmann
- Essener Forschungsinstitut für Medizinmanagement GmbH, Essen,
Deutschland
| | - P zur Nieden
- Essener Forschungsinstitut für Medizinmanagement GmbH, Essen,
Deutschland
| | - G Lux
- Essener Forschungsinstitut für Medizinmanagement GmbH, Essen,
Deutschland
| | - A Walendzik
- Universität Duisburg-Essen, Lehrstuhl für
Medizinmanagement, Essen, Deutschland
| | - C Abels
- Universität Duisburg-Essen, Lehrstuhl für
Medizinmanagement, Essen, Deutschland
| | - J Wasem
- Universität Duisburg-Essen, Lehrstuhl für
Medizinmanagement, Essen, Deutschland
| | - D Best
- Deutsche Psychotherapeuten Vereinigung, Berlin,
Deutschland
| | - K Klipker
- AOK-Bundesverband GbR, Berlin, Deutschland
| | | | - C Schaff
- Berufsverband für Kinder- und Jugendpsychiarie, Psychosomatik
und Psychotherapie in Deutschland e.V. (BKJPP), Mainz, Deutschland
| | - H Timmermann
- Vereinigung Analytischer Kinder- und Jugendlichen-Psychotherapeuten in
Deutschland e.V. (VAKJP), Berlin, Deutschland
| | - S Neusser
- Essener Forschungsinstitut für Medizinmanagement GmbH, Essen,
Deutschland
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Kahnert K, Föhrenbach M, Lucke T, Alter P, Trudzinski FT, Bals R, Lutter JI, Timmermann H, Söhler S, Förderreuther S, Nowak D, Watz H, Waschki B, Behr J, Welte T, Vogelmeier CF, Jörres RA. The impact of COPD on polyneuropathy: results from the German COPD cohort COSYCONET. Respir Res 2020; 21:28. [PMID: 31959163 PMCID: PMC6971882 DOI: 10.1186/s12931-020-1293-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Peripheral neuropathy is a common comorbidity in COPD. We aimed to investigate associations between alterations commonly found in COPD and peripheral neuropathy, with particular emphasize on the distinction between direct and indirect effects. Methods We used visit 4 data of the COPD cohort COSYCONET, which included indicators of polyneuropathy (repeated tuning fork and monofilament testing), excluding patients with diabetes a/o increased HbA1c. These indicators were analysed for the association with COPD characteristics, including lung function, blood gases, 6-min walk distance (6-MWD), timed-up-and-go-test (TUG), exacerbation risk according to GOLD, C-reactive protein (CRP), and ankle-brachial index (ABI). Based on the results of conventional regression analyses adjusted for age, BMI, packyears and gender, we utilized structural equation modelling (SEM) to quantify the network of direct and indirect relationships between parameters. Results 606 patients were eligible for analysis. The indices of polyneuropathy were highly correlated with each other and related to base excess (BE), ABI and TUG. ABI was linked to neuropathy and 6-MWD, exacerbations depended on FEV1, 6-MWD and CRP. The associations could be summarized into a SEM comprising polyneuropathy as a latent variable (PNP) with three measured indicator variables. Importantly, PNP was directly dependent on ABI and particularly on BE. When also including patients with diabetes and/or elevated values of HbA1c (n = 742) the SEM remained virtually the same. Conclusion We identified BE and ABI as major determinants of peripheral neuropathy in patients with COPD. All other associations, particularly those with lung function and physical capacity, were indirect. These findings underline the importance of alterations of the micromilieu in COPD, in particular the degree of metabolic compensation and vascular status.
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Affiliation(s)
- K Kahnert
- Department of Internal Medicine V - Pulmonology, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M, member of German Center for Lung Research (DZL), Marchioninisr. 15, 81377 München, and Ziemssenstr. 1, 80336, Munich, Germany.
| | - M Föhrenbach
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M, member of German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - T Lucke
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M, member of German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - P Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany.,Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - F T Trudzinski
- Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - R Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424, Homburg, Germany
| | - J I Lutter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Ingolstädter Landstr. 1, 85764, Munich, Germany
| | - H Timmermann
- Hamburger Institut für Therapieforschung GmbH, Colonaden 72, 20354, Hamburg, Germany
| | - S Söhler
- ASCONET Study Coordination Office, University of Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - S Förderreuther
- Department of Neurology, Klinikum Innenstadt, Ludwig Maximilian University of Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - D Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M, member of German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - H Watz
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M, member of German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
| | - B Waschki
- LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany.,Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - J Behr
- Department of Internal Medicine V - Pulmonology, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M, member of German Center for Lung Research (DZL), Marchioninisr. 15, 81377 München, and Ziemssenstr. 1, 80336, Munich, Germany
| | - T Welte
- Department of Pneumology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - C F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043, Marburg, Germany
| | - R A Jörres
- Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M, member of German Center for Lung Research (DZL), University Hospital, LMU Munich, Ziemssenstr. 1, 80336, Munich, Germany
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Timmermann H, Mailänder C. Home Self-Administration of Biologics - A German Survey among Omalizumab-Treated Patients with Severe Asthma and their Treating Physicians. Pneumologie 2020; 74:103-111. [PMID: 31935761 DOI: 10.1055/a-1069-0900] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In the EU, five biologics have been approved as add-on therapy for patients with severe asthma. Until recently, none of the biologics was approved for home use and had to be administered under medical supervision, a time-consuming schedule for both patients and physicians, accompanied by greater expenditure. However, over the last year, four out of the five biologics have been granted approval for patient self-administration at home. The objective of this multiple-choice survey was to understand how patients with severe asthma treated with omalizumab and their treating physicians view the potential home use of biologics exemplified by omalizumab. The questionnaires were answered by 120 physicians and 432 patients (response rate: 51.7 % and 20.6 %, respectively). Overall, 44.7 % of patients were in favour of self-administration at home while 30.6 % opposed this method of administration and 23.8 % of patients were neutral. Especially teenagers and young adults had a positive attitude towards self-administration. 76.7 % of the questioned physicians were in favour of home use for certain patients. Time saving was the main advantage for self-administration mentioned by patients (53.2 %) as well as by physicians (72.5 %). The main concern for patients was 'making a mistake while injecting' (43.8 %) while 'forgetting to inject omalizumab' (73.3 %) was the main concern for physicians. 44.4 % of patients expressed a wish for individual training and 70.8 % of physicians agreed with this statement. The latter group also considered a starter kit including several information materials (54.2 %) as well as an electronic reminder system (50.8 %) as useful. In conclusion, self-administration of biologics has the potential to be timesaving for both patients and physicians.
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Affiliation(s)
| | - C Mailänder
- Novartis Pharma GmbH, Clinical Research Respiratory, Nuremberg
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