Sports Preparticipation Evaluation for Healthy Adults: A Consensus-Based German Guideline.

The benefits of physical activity are undisputed. However, adverse events can occur in rare cases, particularly during high-intensity or prolonged exercise. During physical activity, at-risk patients can experience major cardiac events, whereas adverse events affecting the musculoskeletal system are more common but less severe.

Characteristics of Older Individuals with Asthma Being Treated with Biologics.

Purpose: Biologic (antibody) therapy is a safe, effective, and guideline-recommended treatment for patients with severe and otherwise uncontrolled asthma. The number of older individuals with asthma is increasing but there is a lack of data on the use of biologics in this cohort. Therefore, this study reports the characteristics of older individuals receiving biologic therapy for severe asthma.

German National Guideline for Treating Chronic Respiratory Failure with Non-Invasive Ventilation.

The german guideline on non-invasive ventilation offers comprehensive recommendations for the treatment of chronic respiratory failure in various underlying conditions, such as COPD, thoraco-restrictive diseases, obesity-hypoventilation syndrome, and neuromuscular diseases. The aim of the guideline is to improve the treatment of patients with chronic respiratory insufficiency using non-invasive ventilation and to make the indications and therapy recommendations accessible to all involved in the treatment process. It is based on the latest scientific evidence and replaces the previous guideline from 2017.

[Bronchiectasis disease].

Bronchiectasis is a worldwide inflammatory disease with different epidemiology and heterogenous etiology. The disease burden is high for patients and economic costs can be immense. So far there are no special disease modifying drugs available for patients with bronchiectasis other than cystic fibrosis.

[Prognostic parameters in patients with prolonged weaning from mechanical ventilation: a retrospective analysis].

Weaning from mechanical ventilation of patients treated in an intensive care unit can be difficult and requires transfer to a specialised weaning unit. So far, only limited data are available on parameters associated with survival and successful weaning in this patient group.A retrospective analysis of patients (n=659) treated in the specialised weaning unit at the University Hospital RWTH Aachen during a time period of 8 years was conducted.

Implementation and One-Year Evaluation of Proenkephalin A in Critical Care.

Proenkephalin A 119-159 (PENK) is a promising functional kidney biomarker, evaluated in various clinical settings. In critical care medicine, early diagnosis of acute kidney injury (AKI) is crucial; however, to date, the diagnosis and the assessment of kidney function is still based on serum creatinine (sCr) and urine output, both associated with several limitations. Between November 2020 and March 2022, we implemented PENK in our daily practice on our intensive care units (ICU).

The role of vascularity and the fibrovascular interface in interstitial lung diseases.

Interstitial lung disease (ILD) is a clinical term that refers to a diverse group of non-neoplastic lung diseases. This group includes idiopathic and secondary pulmonary entities that are often associated with progressive pulmonary fibrosis. Currently, therapeutic approaches based on specific structural targeting of pulmonary fibrosis are limited to nintedanib and pirfenidone, which can only slow down disease progression leading to a lower mortality rate.

Randomised, Placebo-Controlled, Double-Blind Trial to Assess Efficacy and Safety of ELOM-080 in Outpatients with COVID-19.

Introduction: Incidences of infections with Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) are still high and treatment guidelines lack specific recommendations for outpatients with Coronavirus-induced disease 2019 (COVID-19). Phytomedicine ELOM-080, an enhancer of mucociliary clearance (MCC), showed benefits as add-on therapy in hospitalised COVID-19 patients.

Methods: This randomised, double-blind, placebo-controlled proof-of-concept study investigated whether outpatients with mild to moderate acute symptomatic COVID-19 would benefit from a 14-day treatment with ELOM-080 with regard to potential early treatment effects on cough and further typical COVID-19 symptoms.

Poor Correlation between Diaphragm Ultrasound and Invasive Gold Standard Technique Derived Respiratory Muscle Strength Assessment in Patients after Hospitalisation for COVID-19.

Introduction: Individuals who survive acute coronavirus disease 2019 (COVID-19) might experience diaphragm muscle weakness. Diaphragm ultrasound may be an easy-to-obtain bedside tool for determining diaphragm function. However, twitch transdiaphragmatic pressure (twPdi) following magnetic stimulation (MS) of the phrenic nerves is the gold standard for non-volitional assessment of diaphragm strength.

[S3 Guideline: Treating Chronic Respiratory Failure with Non-invasive Ventilation].

The S3 guideline on non-invasive ventilation as a treatment for chronic respiratory failure was published on the website of the Association of the Scientific Medical Societies in Germany (AWMF) in July 2024. It offers comprehensive recommendations for the treatment of chronic respiratory failure in various underlying conditions, such as COPD, thoraco-restrictive diseases, obesity-hypoventilation syndrome, and neuromuscular diseases. An important innovation is the separation of the previous S2k guideline dating back to 2017, which included both invasive and non-invasive ventilation therapy.

[Prolonged weaning after long-term ventilation due to SARS-CoV-2 infection: a multicenter retrospective analysis].

Unlabelled: Some of the patients with SARS-CoV-2 infection (COVID-19) received invasive ventilation during inpatient care. Weaning from ventilation was difficult for some patients (so-called prolonged weaning).

Patients: Patients (n=751) with prolonged weaning (reason for ventilation "pneumonia" and "acute respiratory failure") from four centers for the period 2011-23 from the "WeanNet" registry were used as a matched group.

Potential Diaphragm Muscle Weakness-related Dyspnea Persists 2 Years after COVID-19 and Could Be Improved by Inspiratory Muscle Training: Results of an Observational and an Interventional Clinical Trial.

Diaphragm muscle weakness might underlie persistent exertional dyspnea, despite normal lung and cardiac function in individuals who were previously hospitalized for acute coronavirus disease (COVID-19) illness. The authors sought, first, to determine the persistence and pathophysiological nature of diaphragm muscle weakness and its association with exertional dyspnea 2 years after hospitalization for COVID-19 and, second, to investigate the impact of inspiratory muscle training (IMT) on diaphragm and inspiratory muscle weakness and exertional dyspnea in individuals with long COVID. Approximately 2 years after hospitalization for COVID-19, 30 individuals (11 women, 19 men; median age, 58 years; interquartile range [IQR] = 51-63) underwent comprehensive (invasive) respiratory muscle assessment and evaluation of dyspnea.

Diaphragm ultrasound in patients with prolonged weaning from mechanical ventilation.

Background: Several publications have examined diaphragmatic ultrasound using two-dimensional (2D) parameters in the context of weaning from mechanical ventilation (MV) and extubation. However, the studied cohorts had rather short duration of ventilation. Examinations on patients with prolonged weaning after long-term ventilation were missing.

Persistence of Diffusion Capacity Impairment and Its Relationship with Dyspnea 12 Months after Hospitalization for COVID-19.

: Dyspnea is a common persistent symptom after acute coronavirus disease 2019 illness (COVID-19). One potential explanation for post-COVID-19 dyspnea is a reduction in diffusion capacity. This longitudinal study investigated diffusion capacity and its relationship with dyspnea on exertion in individuals previously hospitalized with COVID-19.

Definition of the Post-COVID syndrome using a symptom-based Post-COVID score in a prospective, multi-center, cross-sectoral cohort of the German National Pandemic Cohort Network (NAPKON).

Purpose: The objective examination of the Post-COVID syndrome (PCS) remains difficult due to heterogeneous definitions and clinical phenotypes. The aim of the study was to verify the functionality and correlates of a recently developed PCS score.

Methods: The PCS score was applied to the prospective, multi-center cross-sectoral cohort (in- and outpatients with SARS-CoV-2 infection) of the "National Pandemic Cohort Network (NAPKON, Germany)".

Effective non-invasive ventilation reduces muscle sympathetic nerve activity in patients with stable hypercapnic COPD.

Increased sympathetic drive is of prognostic significance in chronic obstructive pulmonary disease (COPD) but its determinants remain poorly understood. One potential mechanism may be chemoreflex-mediated adrenergic stimulation caused by sustained hypercapnia. This study determined the impact of non-invasive ventilation (NIV) on muscle sympathetic nerve activity (MSNA) in patients with stable hypercapnic COPD.

GLI-12 Reference Values versus Fixed 0.7 Ratio for the Detection of Airflow Obstruction in the Presence of Lung Hyperinflation.

Introduction: Airflow obstruction (AO) is evidenced by reduced forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) with the threshold for diagnosis often being set at <0.7. However, currently the ATS/ERS standards for interpretation of lung function tests recommend the lower limit of normal (LLN), calculated by reference equations of the Global Lung Initiative from 2012 (GLI-12), as a threshold for AO diagnosis.

Effects of structured protocolized physical therapy on the duration of mechanical ventilation in patients with prolonged weaning.

Purpose: 20% of patients with mechanical ventilation (MV) have a prolonged, complex weaning process, often experiencing a condition of ICU-acquired weakness (ICUAW), with a severe decrease in muscle function and restricted long-term prognosis. We aimed to analyze a protocolized, systematic approach of physiotherapy in prolonged weaning patients and hypothesized that the duration of weaning from MV would be shortened.

Methods: ICU patients with prolonged weaning were included before (group 1) and after (group 2) introduction of a quality control measure of a structured and protocolized physiotherapy program.

Stepwise management of COPD: What is next after bronchodilation?

Inhaled bronchodilator therapy with long-acting muscarinic antagonists (LAMAs) and long-acting β-agonists (LABAs) in combination is currently the mainstay of treatment for chronic obstructive pulmonary disease (COPD). Treatment guidelines recommend the addition of inhaled corticosteroids (ICS) to LABA/LAMA only in patients with a history of frequent/severe exacerbations and high blood eosinophil counts, or in those with concomitant asthma. Despite this, real-world data suggest that clinicians are not adhering to this guidance and that ICS are frequently overused.

Supplemental oxygen therapy in chronic obstructive pulmonary disease: is less is more? How much is too much?

Purpose Of Review: Currently available evidence supporting the use of supplemental oxygen therapy (SOT) in chronic obstructive pulmonary disease (COPD) is complex, and data on the mortality reduction associated with SOT usage in patients with severe daytime resting hypoxemia have not been updated since the development of other treatments.

Recent Findings: No reduction in mortality was found when SOT was used in patients with moderate resting daytime, isolated nocturnal, or exercise-induced hypoxemia. However, some of these patients obtain other significant benefits during SOT, including increased exercise endurance, and a mortality reduction is possible in these 'responders'.

Significance of Hypocapnia in the Risk Assessment of Patients with Pulmonary Hypertension.

Blood gas analysis is part of the diagnostic work-up for pulmonary hypertension (PH). Although some studies have found that the partial pressure of carbon dioxide (PaCO) is an independent marker of mortality in individuals with pulmonary arterial hypertension (PH Group 1), there is a lack of data regarding the significance of PaCO in individuals with different types of PH based on the new 2022 definitions. Therefore, this study analyzed data from 157 individuals who were undergoing PH work-up, including right heart catheterization, using PH definitions from the 2022 European Society of Cardiology/European Respiratory Society guidelines.

[Non-invasive Mechanical Ventilation in Acute Respiratory Failure. Clinical Practice Guidelines - on behalf of the German Society of Pneumology and Ventilatory Medicine].

The guideline update outlines the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.Non-invasive ventilation (NIV) has a high value in therapy of hypercapnic acute respiratory failure, as it significantly reduces the length of ICU stay and hospitalization as well as mortality.Patients with cardiopulmonary edema and acute respiratory failure should be treated with continuous positive airway pressure (CPAP) and oxygen in addition to necessary cardiological interventions.