Abstract:PRiVENT (Prevention of Invasive Ventilation through Early Identification and Early Intervention in Patients at Risk) is a cross-sectoral care model developed within the framework of the Innovation Fund of the German Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA). The aim of the project was to identify patients at increased risk of prolonged mechanical ventilation at an early stage and to promote successful weaning from mechanical ventilation through the early involvement of certified weaning centres and structured, interprofessional interventions. By doing so, the project seeks to prevent long-term invasive mechanical ventilation, tracheostomy, and the need for long-term out-of-hospital intensive care.Based on the initial positive results of the Innovation Fund project, a selective integrated care contract pursuant to § 140a of the German Social Code Book V (SGB V) was developed in collaboration with AOK Baden-Württemberg. The objective of this contract was to sustainably transfer the care structures established during the project into routine clinical care and to make them available throughout Baden-Württemberg for insured members of AOK Baden-Württemberg.The core components of the PRiVENT care pathway are the Weaning Board and the Weaning Consultation, both of which are conducted by an interprofessional team consisting of at least a pulmonologist and a respiratory therapist from a certified specialised weaning centre. Consultations may be performed via telemedicine, in a hybrid format, or entirely on site. The following section describes the healthcare services provided within the PRiVENT selective care contract under § 140a SGB V.
Abstract:The journal "Der Tuberkulosearzt" was first published in October 1947; following two name changes - to "Praxis der Pneumologie" in 1964 and "Praxis und Klinik der Pneumologie" in 1977 - it has been known to its readership as "Pneumologie" since 1989. After briefly reviewing the historical context at the time of the journal's inaugural issue, this paper presents a bibliometric analysis of articles related to occupational medicine published over the 80-year history of the journal now known as "Pneumologie". Subsequently, the first three articles dedicated to occupational medicine topics are presented as case studies, and the relevance of their content is discussed from a modern perspective.
Zusammenfassung Im Oktober 1947 erschien erstmalig die Zeitschrift „Der Tuberkulosearzt“, die nach zwei Namenswechseln – 1964 zu „Praxis der Pneumologie“ und 1977 zu „Praxis und Klinik der Pneumologie“ – seit 1989 als „Pneumologie“ der Leserschaft bekannt ist. Nach einer geschichtlichen Einordnung der Situation zum Zeitpunkt des Erscheinens der ersten Ausgabe der Zeitschrift folgt eine bibliometrische Analyse der in den 80 Jahren des Bestehens der heutigen „Pneumologie“ veröffentlichten Artikel mit einem arbeitsmedizinischen Bezug. Im Anschluss werden die ersten drei Beiträge, die sich arbeitsmedizinischen Themen widmeten, exemplarisch vorgestellt und die Relevanz deren Inhalte aus der heutigen Perspektive diskutiert.
Abstract:Systemic corticosteroids are no longer recommended for the treatment of severe, uncontrolled asthma. Instead, various biologics are available. When prescribing these, it is important to ensure the correct indication, select the appropriate biologic and apply the correct ICD coding.
Abstract:Bronchoalveolar lavage (BAL) is a minimally invasive procedure frequently used in the evaluation of pulmonary diseases. The primary indications for its use include the diagnosis of inflammation, infection, and interstitial lung diseases. Additionally, BAL plays a role in tumor diagnostics, detection of rejection following lung transplantation, and the diagnosis of occupational lung diseases (e.g., berylliosis, asbestosis).Although BAL alone mostly does not enable a definitive diagnosis, analysis of the BAL fluid provides important findings that are essential when interpreted in the clinical context. Successful analysis and interpretation require careful sample collection and rapid processing. Sample preparation is technically straightforward, and routine staining (Giemsa) is uncomplicated. BAL is widely available, cost-effective, and an indispensable tool in the diagnostic workup of pulmonary diseases.
History:A 77-year-old man was admitted due to radiologic suspicion of right hilar tumor progression and newly developed right-sided pleural effusion. He had known NSCLC of the left lower lobe (keratinizing squamous cell carcinoma), initially staged T4N1M1c (contralateral lesion and hepatic metastasis), stage IVb. Comorbidities included COPD II, peripheral arterial disease, coronary artery disease, hypertension, and type 2 diabetes. Current oncologic therapy consisted of carboplatin, paclitaxel, and pembrolizumab.The patient presented with exertional dyspnea and reduced breath sounds with dullness to percussion at the right lung base. Bronchoscopic re-biopsy (EBUS-TBNA and transbronchial biopsy) was performed. Pleural cytology was negative for malignancy; therefore, thoracoscopy was conducted, revealing chronic pleuritis without malignant involvement. Findings:Histology showed no metastatic disease but demonstrated diffuse alveolar damage (DAD), consistent with immune-related pneumonitis. A pronounced sarcoid-like granulomatous reaction was observed, also involving the pleura. Diagnosis:Immune-related pneumonitis and pleuritis under PD-1 inhibitor therapy. Discussion:Immune-related pneumonitis occurs in approximately 1-5% of patients receiving immune checkpoint inhibitors. Imaging often shows bilateral ground-glass opacities. Histologically, organizing pneumonia is most common; DAD is less frequent. Diagnosis is made by excluding infection and tumor progression.Pleural effusion in oncologic patients is usually interpreted as tumor progression. Immune-mediated pleural involvement is rare and reported only in isolated cases. PD-1 blockade enhances T-cell activation and IFN-γ release, which may promote granuloma formation.Treatment consists of systemic glucocorticoids.
Zusammenfassung Die S3-Leitlinie beschreibt evidenz- und konsensbasierte Empfehlungen zur strukturierten Nachsorge erwachsener Patient*innen nach Lungentransplantation. Ziel ist die Standardisierung der Langzeitbetreuung zur Optimierung von Überleben, Funktionsstatus und Lebensqualität. Die Leitlinie richtet sich an pneumologische, internistische, chirurgische und hausärztliche Fachkreise sowie an Transplantationszentren und stationäre Einrichtungen in den deutschsprachigen Ländern Deutschland, Österreich und der Schweiz. Die Federführung hat die Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP). Methodisch basiert sie auf systematischen Literaturrecherchen und GRADE-basierter Evidenzbewertung; und der Entwicklung eines interdisziplinär und multiprofessionellen Konsens unter Beteiligung von Patientenvertretern. Die Leitlinie betont ein lebenslanges, individualisiertes Nachsorgekonzept, das auf enger Kooperation zwischen Transplantationszentrum, niedergelassenen Ärztinnen und Patientinnen beruht. Zentrale Inhalte der Leitlinie umfassen die Immunsuppression mit Auswahl, Kombination und Monitoring von Calcineurininhibitoren, Antimetaboliten und mTOR-Inhibitoren. Außerdem berücksichtigt sie Strategien zur Minimierung von Nebenwirkungen und Nephrotoxizität. Kerngebiete sind auch die Vorbeugung und Behandlung von Infektionen wie die Prävention opportunistischer Infektionen (CMV, Aspergillus, Pneumocystis jirovecii u. a.) und zur Impfstrategie. Die Leitlinie gibt Empfehlung zur standardisierten Überwachung von Patienten mittels Bronchoskopien, Biopsien und Spirometrie mit strukturierten Visitenintervallen eines Nachsorgekonzeptes inklusive Vorsorgeuntersuchungen. Die Themen akuter zellulärer Abstoßung, mangelnde Therapietreue und chronisches Transplantatversagen werden ebenfalls behandelt. Komorbiditäten wie Diabetes, chronische Nierenkrankheit, Osteoporose und Tumorprävention werden ebenfalls berücksichtigt.
