Hintergrund: Es existieren nur wenige Daten, die die häusliche Versorgung von Patient:innen in der außerklinischen Intensivpflege darstellen.

Background and Methods:Constant-minute-volume and constant-bolus devices serve as two different means of portable oxygen conservation. A prospective randomised crossover study was conducted in COPD GOLD IV patients to investigate the effect of these two devices on dyspnea, oxygenation and 6-minute walking test (6MWT) distance. The primary endpoint was the final operating level required (operating level range 1-5 for both devices) by either device to meet the success criteria for mobile oxygen therapy, as outlined in the British Thoracic Society guidelines (SpO2 ≥90% throughout 6MWT; ≥10% increase in walking distance from baseline; improvement in BORG of at least 1 point from baseline). Results:Twenty-five patients were enrolled in the study and randomly assigned to one of two sequences involving the use of each type of portable oxygen conservation device. 14 female, 67.9 years (±7.8); FEV1: 27.3%pred. (±8.4); PaO2 at rest without oxygen: 50.3mmHg (±5.9). For both systems, 24/25 patients (96%) were successfully recruited. The mean operating-level difference when success criteria were met was -0.58 in favor of the constant bolus device (95% CI: -0.88 to -0.28, P <0.001). Secondary endpoints (walking distance, respiratory rate and BORG dyspnea) showed no statistically significant or clinically relevant differences. An algorithm created especially for this study showed a high success rate in terms of titration for the required operating level. Conclusion:Both portable oxygen-conserving devices met the success criteria in 96% of patients in the 6MWT when they were titrated to the correct level. The constant-bolus device required a significantly lower operating level to achieve the success criteria, hereby reducing energy consumption. Individual titration of the respective device is recommended, which can be facilitated by the novel titration algorithm described here.

Hintergrund Die Messung der Therapieadhärenz bei Patienten mit COPD ist komplex. Es müssen die inhalative, die apparative und die Therapie in Tablettenform berücksichtigt werden. Folgen mangelnder Adhärenz sind ungenügende Therapieeffekte und eine fortschreitende COPD. Ziel der Studie war es unterschiedliche Patient:innengruppen hinsichtlich ihrer Therapieadhärenz zu identifizieren und Zusammenhänge zu anderen Risikofaktoren zu untersuchen.

Background: Measuring medication adherence in patients with COPD is complex. Different forms of therapy and devices must be considered. Consequences of poor adherence are insufficient treatment effects, and frequent exacerbations. The aim of this study was to identify different patient groups regarding their adherence to therapy and to investigate correlations to other risk factors. Methods: The modified Stendal Adherence with Medication Score (SAMS) was used to assess adherence. In addition to demographic data, the St. George Respiratory Questionnaire (SGRQ), GOLD stage, inhalation device handling errors, and comorbidities were assessed. Preliminary descriptive analysis was performed (mean±SD or median (IQR). Results: 137 patients (40.9% female, 67.5±9.9 years) with COPD (79.6% GOLD D, 2.5±2.2 exacerbations in the last year) were included. 26.3% were classified as non-adherent, 43.8% as moderately adherent, and 29.9% as fully adherent (SAMS Score: 7.2±8.1, cut-off 12 points). The overall inhalation device handling error rate was 3 (4-1) out of 10 errors. The critical error/total error rate was 33.3% (50-0%) per patient. The updated Charlson Comorbidity Index was 2.2±2.0 and 26.3% had a history of comorbid bronchial asthma. The SGRQ was 60.6±16.4 points. Conclusion: Approximately two-thirds of patients were classified as moderate or non-adherent with over a quarter of patients making ≥4 errors in device use and the individual rate for critical device handling errors being ≥50%. The planned analysis of the preliminary data presented here will address relationships between exacerbation frequency, device handling error rates, and predictors of non-adherence in a multiple regression analysis model.

Background: The treatment of patients with COPD and chronic hypercapnic respiratory failure using non-invasive home ventilation (NIV) is well established. A "deventilation syndrome" (DVS) has been described as dyspnea after cessation of NIV therapy. Methods: A systematic scoping review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews searching Embase was conducted. A final manual search followed in February 2023. Literature synthesis was blinded using Rayyan by three different reviewers. Results: A total of 2009 studies were screened. 5 studies met the eligibility criteria. 4 articles presented original data. 3 articles examined treatment options. 3 studies were prospective; none were randomized. A total of 122 patients were included. DVS was defined differently in all studies. 74 patients had DVS (48 controls). Patients were evaluated by blood gas analysis, transcutaneous PCO2, spirometry, body plethysmography, respiratory muscle assessments, diaphragmatic EMG and ultrasound, 6-minute walk test, polysomnography, and questionnaires. Treatment approaches included minimization of patient ventilator asynchrony (PVA) and use of pursed lip breathing ventilation. Pathophysiologic mechanisms discussed were PVA, high IPAP, hyperinflation and respiratory muscle impairment. Compared with controls, patients with DVS suffered from more severe airway obstruction, hyperinflation, and PaCO2 retention, worse exercise test scores and poorer quality of life. Conclusion: The available evidence does not allow for definite conclusions about pathophysiological mechanisms, ethology, or therapeutic options.

Scientifically validated web-based training videos for proper inhalation technique were increasingly used by an international audience during the pandemic. Translations into additional languages would support a larger patient population. https://bit.ly/3lYQwsD.

Hintergrund Die nicht-invasive Beatmung (NIV) hat sich als die am besten geeignete Therapie für COPD-Patienten mit chronisch hyperkapnischem Atemversagen erwiesen. Während physiologische Parameter und das Langzeitüberleben häufig als primäre Endpunkte dienten, haben sich nur wenige Studien mit den Auswirkungen der NIV-Einleitung auf die Schlafqualität beschäftigt.

Background: Non-invasive ventilation (NIV) has been shown to be the most appropriate therapy for COPD patients with chronic respiratory failure. While physiological parameters and long-term outcome frequently serve as primary outcomes, very few studies have primarily addressed the impact of NIV initiation on sleep quality in COPD. Methods: This single-center prospective cohort study comprised NIV-naïve patients with COPD. All patients underwent polysomnographic evaluation both at baseline and at 3 months follow-up, accompanied by the assessment of health-related quality of life (HRQL) using the Severe Respiratory Insufficiency Questionnaire (SRI) and the Epworth Sleepiness Scale (ESS). A subgroup evaluation was performed to address the impact of comorbid obstructive sleep apnea syndrome (OSAS). Results: Forty-six patients were enrolled and twenty-five patients completed the follow-up period (66.7 ± 7.4 years). NIV resulted in an increase in slow-wave sleep (+2% (−3.5/7.5), p = 0.465) and rapid eye movement sleep (+2.2% (−1.0/5.4), p = 0.174), although no statistical significance could be detected. ESS (−1.7(−3.6/0.1), p = 0.066) also showed a positive trend. Significant improvements in the Respiratory Disturbance Index (RDI) (−12.6(−23.7/−1.5), p = 0.027), lung function parameters, transcutaneous PCO2 and the SRI summary scale (4.5(0.9/8), p = 0.016) were observed. Conclusion: NIV therapy does not decrease sleep quality and is even capable of improving HRQL, transcutaneous PaCO2, daytime sleepiness and RDI, and the latter especially holds true for patients with comorbid OSAS.

Hintergrund Bei portablen Demand-Sauerstoffkonzentratoren (Engl. portable Oxygen-Conserving-Device=pOCD) gibt es unterschiedliche Technologien: constant-minute-volume devices (cmvD) und constant-bolus-devices (cbD). Diese werden in der vorliegenden Studie bei COPD-Patient:innen mit schwerer respiratorischer Insuffizienz während eines 6-Minuten-Gehtests (6MWT) verglichen.

Background: Measurement tools for Compliance with Non- invasive Ventilation are inevitably needed to Assess changes following specific treatment strategies. The aim of this Study was to develop a questionnaire to assess treatment adherence and comfort in patients with Non-invasive Ventilation. Methods: The topics of health impairment, handling, time of use, and aspects of ventilation were covered. These topics were predefined by an expert panel to ensure content validity. The expert panel consisted of physicians, respiratory therapists, critical care nurses, psychologists, and patient representatives. Second, all predefined topics were divided into items and rated by the expert panel using a 5-point Likert scale from "not at all relevant" (-2) to "absolutely relevant" (+2) to ensure content validity. Only relevant items (≥1 to +2) were used for item development, whereas nonrelevant items (<1) were not subject to item development Results: In total, the expert panel evaluated 37 items. 16 were deemed relevant for item development. 3 Experts merged the relevant items and formed the corresponding questions. The items are answered "yes" and "no" on a 2-point scale. The final NIV-Adherence and Comfort Questionnaire (NIV-ACQ) summary score contains 14 items and ranges from 0 (worst compliance) to 14 (best compliance). Conclusion: The NIV-ACQ is the first disease-specific treatment adherence questionnaire developed for patients on Non-invasive Ventilation. Further studies regarding validity and practicality have to follow.

Purpose: To professionally translate and validate an easy-to-use tool for assessing respiratory symptoms, sleep quality and side effects of the ventilator in patients undergoing long-term non-invasive ventilation (NIV) from the original French into German in order to broaden the area of operation for the S3-non-invasive ventilation (S3-NIV) questionnaire. Methods: In a prospective trial patients on long-term NIV were recruited. Professional translation and cultural adaptation was obtained via translation-back-translation using the ABC-Scheme, that compared each individual question and its language neutrality. Afterwards patients in a stable clinical state filled out the German S3-NIV questionnaire alongside the German St. Georges Respiratory Questionnaire to proof convergent validity via Spearman correlation. Internal Consistency was established using Cronbach´s α. Results: Sixty patients (female 56.6%) with long-term NIV for different underlying diseases were enrolled (COPD: n = 58, 96.6%; OHS: n = 2, 3.3%). Mean age was 65.3 years (SD: 8.5), mean body mass index (BMI) 29.4 kg/m2. Internal consistency was good (Cronbach´s α: summary score = 0.74; "respiratory symptoms" = 0.66; "sleep and side effects" = 0.69). Convergent validity in relation to the SGRQ was high (summary score: rho = −.61, p <0.001; "respiratory symptoms" rho = −.64, p <0.001). Exploratory factor analysis led to a variance of 39.51% and unveiled two components. Conclusion: The German version of the S3-NIV questionnaire is a valid, simple tool for assessing patient-centered outcomes in routine clinical care of patients undergoing long-term NIV.

Hintergrund Messinstrumente für die Compliance bei einer nicht-invasiven Beatmung werden zwangsläufig benötigt, um Veränderungen nach spezifischen Behandlungsstrategien zu bewerten. Das Ziel dieser Studie war die Entwicklung eines Fragenbogens zu Bewertung der Therapieadhärenz und -komfort bei Patient:innen mit einer nicht-invasiven Beatmung.

The path from first symptoms to initiation of allergen-specific immunotherapy (AIT) is too long in our survey, at just under 12 years. Even from diagnosis to AIT, it still takes 8.5 years. The reasons are manifold. The complaints are mostly sneezing (75

Hintergrund Ziel war zu untersuchen, ob und wie sich die Verwendung wissenschaftlich validierter, web-basierterer Schulungsvideos für die korrekte Anwendungen von Inhalationsdevices bei Patient:innen mit chronischen Atemwegserkrankungen in der breiten Bevölkerung durchgesetzt hat.