Pneumologie
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Inhaled corticosteroids (ICS) used in COPD (chronic obstructive pulmonary disease) are recommended only in combination with a long-acting beta2-agonist (LABA) in stage 3 and higher in COPD treatment guidelines. In comparison to placebo and the single components, a superior control by means of the ICS/LABA fixed combination therapy has been demonstrated for clinical improvement in the following parameters: reduction of exacerbation rate and hospitalisations, reduction of dyspnoea and improvement of forced expiratory volume in one second (FEV1). In contrast to data from database studies, the large prospective TORCH (Towards a Revolution in COPD Health) trial found in the ICS/LABA group a beneficial effect on the reduction of mortality only as a trend in the ICS/LABA group, which did not reach statistical significance. ⋯ ICS was associated with an excess risk of pneumonia, which doubles the pneumonia incidence in patients not receiving ICS. The probability of having pneumonia reported as an adverse event was 18-19 % in the ICS groups and resulted in a 1.7-2.2 elevated pneumonia risk. Because ICS therapy is recommended only in conjunction with a bronchodilator, fixed ICS/LABA combinations are a logical consequence for COPD long-term therapy.
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Tobacco abuse is especially a public health problem among children and teenagers in Germany. While the proportion of adolescents smoking regularly was 18% in 1997, this has increased to more than 30% in 2001. The high impact of peer groups in young people aggravates the development of smoking habits. ⋯ Exposure to cigarette smoke during pregnancy is directly correlated to premature rupture of the membranes, premature birth, delayed foetal development, and reduced lung function. Children are suffering from impairments of their health not only due to ETS exposure in utero but also after birth (e. g., diseases of upper and lower airways, delayed physical and mental development). Therefore, the prevention of active and passive smoking must be intensified and should consider the special situation of children and adolescents.
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Patients receiving mechanical ventilation and oxygen therapy frequently complain about the dryness of their airways. Humidifiers increase air humidity by generating water vapour and thus preventing the mucosa from desiccation. In this bench study, we compared the efficiency of several humidifiers. ⋯ Factors determinating the efficacy of humidifiers are the velocity of the airstream, the temperature of the water, the contact surface of the air and water compartments and the turbulence of the airstream. In vivo the amount of leakage is a very important determinant for the velocity of the airstream. In the care of mechanically ventilated patients one should have an approximate idea of the magnitude of the applied air flows. The limitations of some humidifiers should be known. The simple presence of a humidifier in combination with a respirator does not mean that the problem of dryness of the airway mucosa is eliminated.