Pneumologie
-
Review Meta Analysis
[Prognostic factors for COPD patients with chronic hypercapnic respiratory failure and home ventilation].
The prevalence of patients with severe COPD and chronic hypercapnic respiratory failure (CHRF) receiving non-invasive home ventilation has greatly increased. With regard to disease severity, a multidimensional assessment seems indicated. Base excess (BE), in particular, reflects the long-term metabolic response to chronic hypercapnia and thus constitutes a promising, easily accessible, integrative marker of CHRF. ⋯ Accordingly, in view of the patients' individual risk profile, the decision about the initiation of NIV should probably not rely solely on symptoms and chronic persistent hypercapnia but include a spectrum of factors that specifically reflect disease severity. Owing to the physiologically positive effects of NIV and according to retrospective data, patients with COPD and recurrent hypercapnic respiratory decompensation and patients with prolonged mechanical ventilation and/or difficult weaning could also be considered for long-term non-invasive ventilation. This, however, has to be corroborated in future prospective trials.
-
Idiopathic pulmonary fibrosis (IPF) is a chronic condition of unknown etiology with an life-limiting outcome. An excess of profibrotic and proinflammatory mediators as well as reactive oxygen species, resulting in progressive fixed tissue fibrosis, architectural distortion and loss of lung function making it plausible to inhibit these processes therapeutically. In this review new treatment options are discussed including substances with antiinflammatory properties which inhibit cytokines, eicosanoids or oxidants, drugs with antifibrotic efficacy as well as anticoagulative compounds. ⋯ Unfortunately most studies still failed to meet their primary end-points. Marginal trends or statistically significant differences between treatment groups were only apparent in subgroups or exploratory end-points of post-hoc analysis. Regardless of numerous trails published in recent years and per se promising new drugs, a change in current recommendations in the management of IPF is not warranted at present.