Der Internist
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Non-invasive ventilation is a technique to ventilate patients without endotracheal intubation and analgosedation. Pressure tight masks allow the ventilation of patients with severe respiratory or ventilatory insufficiency. ⋯ The typical indications are hypoxaemic respiratory failure in pneumonia or cardiogenic pulmonary edema, and hypercapnic ventilatory insufficiency in severe chronic obstructive pulmonary disease, neuromuscular disorders, or advanced kyphoscoliosis. The physiological background, technical aspects of performing non-invasive ventilation, and typical indications are discussed.
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Chronic obstructive pulmonary disease (COPD) is often associated with comorbidities. Cardiovascular diseases, weight loss, loss of fat free mass combined with muscle dysfunction, osteoporosis and depression are the main comorbidities in COPD. ⋯ Thus, the extrapulmonary manifestations are meaningful parameters of clinical assessment. Systemic inflammation is probably the key to the extrapulmonary signs of COPD.
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Bronchial asthma, with a prevalence in Germany of 5% among adults and 10% among children, remains a frequent disease. Newer cell biological data show a separate regulation of the allergy (interleukin 4, IL-4, pathway) and of the eosinophilic inflammation in asthma (IL-5 pathway). Both conditions require a therapeutic approach. ⋯ New medications are intended to overcome any remaining therapeutic weak points. Antileukotrienes and anti-IgE antibodies can contribute to reducing the necessary corticosteroids. Pharmaceutical agents that intervene in the IL-4 or IL-5 regulation or prevent remodeling are being developed.
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Even methodological sound guidelines will only achieve their goals when the recommendations are transferred into practice. Guideline introduction and dissemination must therefore be accompanied by active implementation measures. ⋯ Considering them is of major help to assure that the content of clinical pathways is in accordance with evidence. The article highlights methodological requirements in guideline and pathway development and gives prospects on how both tools can be used together.