Multidrug-resistant tuberculosis (MDR-TB) is of low proportion in comparison to the total number of TB patients, however, due to the necessity of a complex medication with potentially severe and life threatening adverse reactions, long term sequelae, and unfavorable outcome special attention is essential. We report the case of a 30-year- old geriatric nurse with a history of chronic cough and hereditary alpha1- anti-trypsin deficiency (AATD), who suffered from MDRTB and experienced a number of severe adverse reactions.

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases associated with high mortality. Previous studies suggested a prognostic role for peak oxygen uptake (VO2peak) assessed during cardiopulmonary exercise testing (CPET) in patients with COPD. However, most of these studies had small sample sizes or short follow-up periods, and despite their relevance, CPET parameters are not included in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) tool for assessment of severity. Objectives: We therefore aimed to assess the prognostic value of CPET parameters in a large cohort of outpatients with COPD. Methods: In this retrospective, multicentre cohort study, medical records of patients with COPD who underwent CPET during 2004–2017 were reviewed and demographics, smoking habits, GOLD grade and category, exacerbation frequency, dyspnoea score, lung function measurements, and CPET parameters were documented. Relationships with survival were evaluated using Kaplan-Meier analysis, Cox regression, and receiver operating characteristic (ROC) curves. Results: Of a total of 347 patients, 312 patients were included. Five-year and 10-year survival probability was 75% and 57%, respectively. VO2peak significantly predicted survival (hazard ratio: 0.886 [95% confidence interval: 0.830; 0.946]). The optimal VO2peak threshold for discrimination of 5-year survival was 14.6 mL/kg/min (area under ROC curve: 0.713). Five-year survival in patients with VO2peak <14.6 mL/kg/min versus ≥ 14.6 mL/kg/min was 60% versus 86% in GOLD categories A/B and 64% versus 90% in GOLD categories C/D. Conclusions: We confirm that VO2peak is a highly significant predictor of survival in COPD patients and recommend the incorporation of VO2peak into the assessment of COPD severity.

1Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany; 2ResMed, Martinsried, Germany; 3Department of Pneumology, Cologne Merheim Hospital, Kliniken Der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany; 4Studienzentrum, Leipzig, Germany; 5Mvz Aaz, Aachen, Germany; 6Sleep and Ventilation Center Blaubeuren, Respiratory Center Ulm, Ulm, Germany; 7The Clinical Research Institute, Munich, Germany; 8Facharztzentrum Teuchern, Teuchern, Germany Background: Non-invasive ventilation (NIV) has been shown to improve survival and quality of life in COPD patients with chronic hypercapnic respiratory failure. However, the proportion of COPD patients with chronic hypercapnia is not yet known and clinical data enabling better identification of patients are scarce. The HOmeVent registry was initiated to determine the prevalence of chronic hypercapnia in COPD in an outpatient setting and to evaluate the predictors of hypercapnia. Methods: HOmeVent is a multicenter, prospective, observational, non-interventional patient registry that includes COPD patients in GOLD stage 3 or 4. Eligible patients were identified and enrolled in an outpatient setting during routine clinic visits. Assessments included blood gas analyses, pulmonary function testing and quality of life assessment. Results: Ten outpatient clinics in Germany enrolled 231 COPD patients in the registry (135 in GOLD stage 3 (58%) and 96 in GOLD stage 4 (42%)). Arterial carbon dioxide pressure (PaCO2) was ≥45 mmHg in 58 patients (25%); of these, 20 (9%) had PaCO2 ≥50 mmHg. The prevalence of hypercapnia at both cut-off values was numerically higher for patients in GOLD stage 4 versus 3. An increased body mass index, a decreased forced vital capacity and an increased bicarbonate level were significant independent predictors of hypercapnia. The proportion of patients who received NIV was 6% overall and 22% of those with hypercapnia. Conclusion: A relevant proportion of COPD patients in GOLD stage 3 and 4 exhibits chronic hypercapnia and might, therefore, be candidates for long-term domiciliary NIV treatment.

Background:Non-invasive ventilation (NIV) has been shown to improve survival and quality of life in COPD patients with chronic hypercapnic respiratory failure. However, the proportion of COPD patients with chronic hypercapnia is not yet known and clinical data enabling better identification of patients are scarce. The HOmeVent registry was initiated to determine the prevalence of chronic hypercapnia in COPD in an outpatient setting and to evaluate the predictors of hypercapnia.Methods:HOmeVent is a multicenter, prospective, observational, non-interventional patient registry that includes COPD patients in GOLD stage 3 or 4. Eligible patients were identified and enrolled in an outpatient setting during routine clinic visits. Assessments included blood gas analyses, pulmonary function testing and quality of life assessment.Results:Ten outpatient clinics in Germany enrolled 231 COPD patients in the registry (135 in GOLD stage 3 (58%) and 96 in GOLD stage 4 (42%)). Arterial carbon dioxide pressure (PaCO2) was ≥45 mmHg in 58 patients (25%); of these, 20 (9%) had PaCO2 ≥50 mmHg. The prevalence of hypercapnia at both cut-off values was numerically higher for patients in GOLD stage 4 versus 3. An increased body mass index, a decreased forced vital capacity and an increased bicarbonate level were significant independent predictors of hypercapnia. The proportion of patients who received NIV was 6% overall and 22% of those with hypercapnia.Conclusion:A relevant proportion of COPD patients in GOLD stage 3 and 4 exhibits chronic hypercapnia and might, therefore, be candidates for long-term domiciliary NIV treatment.

Introduction: Non-invasive ventilation (NIV) significantly improves survival and quality of life in COPD patients with chronic hypercapnic respiratory failure. However, the proportion of patients with chronic hypercapnia is unknown. Aim: The HOmeVent registry aims to determine the prevalence of chronic hypercapnic COPD patients in an outpatient setting. Methods: A multicentre, prospective, observational, non-interventional medical device registry was developed for COPD patients in GOLD stage 3 or 4. Participants were identified and enrolled in an outpatient setting during routine visits for COPD. The registry was approved by all local ethic committees and patients provided written informed consent. Results: 8 outpatient clinics were enrolled. To date, 109 COPD patients have been included (63.4% male; mean age 67.7±8.9 years; mean body mass index 25.4±5.2; 53.2% and 46.8% in GOLD stage 3 and 4, respectively). PaCO2 was ≥45 mmHg in 31 patients (28.4%); of these, 20 (18.3%), 6 (5.5%) and 5 (4.6%) had PaCO2 <50, 50 to <55 and ≥55 mmHg, respectively. In the group with PaCO2 ≥45 mmHg (n=31), 11 were in GOLD stage 3 and 20 were in GOLD stage 4; for the 11 patients with PaCO2 ≥50 mmHg, 5 and 6 were in GOLD stage 3 and 4, respectively. Conclusion: A high proportion of COPD patients in GOLD stage 3 and 4 exhibit chronic hypercapnia and might therefore be candidates for NIV treatment.

Abstract Early non-invasive detection of lung cancer is a precondition for enabling better prognosis supported by new innovative therapy regimes. The aim of our study was to evaluate angiogenic and inflammatory proteins in exhaled breath condensate (EBC) as markers for lung cancer. Our report presents a diagnostic study of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and tumor necrosis factor-α (TNF-α) in EBC of 300 individuals, 84 patients with lung cancer, 111 patients with stable chronic obstructive pulmonary disease (COPD), and in 105 healthy controls. Detection of VEGF and bFGF in EBC was applicable to discriminate cancer patients from COPD patients as well as from healthy volunteers. Especially VEGF seems to be suitable to discriminate between non-small cell lung cancer (NSCLC) patients and control groups with highest VEGF values in EBC of patients with progressive NSCLC. The concentration of angiogenic factors correlated with disease progression as well as higher tumor stage. This study supports cytokine analysis in EBC as a suitable noninvasive diagnostic screening method for lung cancer detection and monitoring.

Background: Many mediators in pleural effusions give diagnostic information. This study therefore aimed to find out whether the repeated determination of interleukin (IL)-6, IL-15, vascular endothelial growth factor (VEGF), and tissue inhibitors of metalloproteinase (TIMP)-2 would confirm previous results and, furthermore, whether a combination of these parameters could achieve a higher diagnostic yield.Methods: Two consecutive groups of patients with pleural effusions were included. The underlying disease entities in series I vs. series II were: 12 vs. 0 tuberculosis (TB), 19 vs. 30 primary lung cancer, 7 vs. 14 secondaries to the lung, 5 vs. 13 congestive heart failure, and 2 vs. 7 para-pneumonic effusion.Results: VEGF could not differentiate values of series I to the same degree as in series II. For IL-15, totally deviating levels were obtained in series II. IL-6, however, showed comparable results in both series. Values of TIMP-2 were generally higher in series II. The diagnostic accuracies of VEGF and IL-6 were comparable. With logistic regression, the data of VEGF and IL-6 could be used as a classifying tool when TB cases were excluded. The classifying tool based on the data of series I showed a high degree of diagnostic accuracy (area under the curve, AUC=0.94) in contrast to the calculation based on the data of series II (AUC=0.56). Combining both series, VEGF was superior.Conclusions: VEGF was confirmed as a valid marker for malignant diseases. VEGF in combination with IL-6 could serve as a classifying tool. TB cases, however, should be excluded. The previously proposed relevance of TIMP-2 as a diagnostic parameter could, similarly to IL-15, not be confirmed.

Am 25. April 2014 feierte Professor Joachim Schauer seinen 75. Geburtstag, zu dem wir ihm gratulieren. Wir freuen uns, dass unser verehrter Hochschullehrer und früherer Chef bei guter Gesundheit sein darf. Wer erwartet hätte, dass er nur noch seinen Leidenschaften frönt, Gespräche über Musik (bei bekannter Vorliebe für Wagner und Mahler) bei einem Glas guten Rotwein führt und über die alten Zeiten philosophiert – hat weit gefehlt! Professor Schauer ist nach wie vor sehr engagiert in der Patientenbetreuung, bringt seine Erfahrung im Kollegenkreis ein und ist dank seiner langjährigen Expertise als gefragter Gutachter tätig. Als Ehrenpräsident der von ihm mitbegründeten Mitteldeutschen Gesellschaft für Pneumologie (MDGP) und als früherer Präsident der Sächsischen Gesellschaft für Innere Medizin besucht und moderiert er auch heute noch Tagungen und ist dabei weiterhin angesehener Diskussionspartner. Seine Gabe, teils gänzlich unterschiedliche Positionen integrativ und produktiv zusammenzufügen, waren ihm – gepaart mit Optimismus, Willensstärke und visionärer Kraft – in den schwierigen Jahren nach der politischen Wende in unserem Land und der damit verbundenen Umgestaltung auch der Universität Leipzig als gewählter Klinikdirektor und Prodekan und später als Medizinischer Vorstand des Universitätsklinikums eine große Hilfe. Er war der richtige Mann am richtigen Ort! Die Abteilung Pneumologie an der Medizinischen Klinik wurde unter seiner Leitung zu einem der führenden Zentren für Pulmonale Hypertonie Mitteldeutschlands und beherbergt eines der ersten Schlaflabore Sachsens. Die ihm anvertraute Organisation und Gestaltung des 39.Kongresses der Deutschen Gesellschaft für Pneumologie in Leipzig im März 1998 waren für ihn und seine Mitarbeiter ein besonderes Anliegen. Professor Nikolaus Konietzko schrieb später darüber: „Es war ein glanzvoller Kongress, erstmals im Osten unserer Republik veranstaltet und erstmals unter voller Einbeziehung der neu strukturierten wissenschaftlichen Sektionen durchgeführt. Die Tagung in Leipzig war perfekt organisiert, eingebettet in eine kühle ästhetische Architektur und eine warme menschliche Atmosphäre. Ihr Tagungspräsident, Joachim Schauer, hat damals Maßstäbe gesetzt“ [1]. Durch diesen Kongress zur Integration der in beiden Teilen unseres Landes unterschiedlich gewachsenen pneumologischen Landschaften beigetragen zu haben, war für ihn eine Ermutigung von besonders hohemWert. Trotz seiner administrativen Kompetenzen und akademischen Meriten bewahrte sich Professor Schauer seine Bodenständigkeit, seine zwischenmenschliche Empathie und Güte. Er ist als Internist im allerbesten Sinne auch Generalist – uns als Arzt und Mensch ein Vorbild. Er förderte seine Mitarbeiter, gewährte ihnen Freiräume zur Profilierung auf nationaler und internationaler Ebene. Viele seiner Schüler und Mitarbeiter gestalten heute das Fachgebiet der Pneumologie nicht nur in Sachsen mit. Wir wünschen ihm von Herzen ein Minimum an Sorgen und Beschwerden und ein Maximum an fortwährender Kreativität, Lebensfreude und Schaffenskraft im Kreis seiner Familie, Freunde und Kollegen.

Cardiopulmonary exercise testing (CPET) allows a valid evaluation of cardiopulmonary function capability and the recognition of existing limitations in COPD patients. Whereas the measurement of the different parameters of CPET and the evaluation of the results are standardised, this does not apply to the protocols chosen. The aim of this study was to evaluate whether the results of two different exercise protocols were comparable in an outpatient multicentre setting. Ninety COPD patients stages II-IV according to the Gold classification were examined by means of symptom-limited exercise testing on a bicycle with two different ramp protocols (10 Watts vs. 16 Watts/min) within seven days. The results show that a higher acceleration rate of the load was associated with shorter exercise duration and higher achieved exercise capacity. Gas exchange and ventilatory parameters did not show significant differences on comparing both protocols. In pulmonary practices COPD patients of the Gold stages II-IV can be examined safely and with validity by means of CPET. The application of a ramp protocol with a stepwise increase of 16 Watts/minute can be recommended, particularly as for this regimen standardised normal values are available.

Cardiopulmonary exercise testing (CPET) allows a valid evaluation of cardiopulmonary function capability and the recognition of existing limitations in COPD patients. Whereas the measurement of the different parameters of CPET and the evaluation of the results are standardised, this does not apply to the protocols chosen. The aim of this study was to evaluate whether the results of two different exercise protocols were comparable in an outpatient multicentre setting. Ninety COPD patients stages II-IV according to the Gold classification were examined by means of symptom-limited exercise testing on a bicycle with two different ramp protocols (10 Watts vs. 16 Watts/min) within seven days. The results show that a higher acceleration rate of the load was associated with shorter exercise duration and higher achieved exercise capacity. Gas exchange and ventilatory parameters did not show significant differences on comparing both protocols. In pulmonary practices COPD patients of the Gold stages II-IV can be examined safely and with validity by means of CPET. The application of a ramp protocol with a stepwise increase of 16 Watts/minute can be recommended, particularly as for this regimen standardised normal values are available.

Early recognition of lung cancer is a prerequisite for any strategy to improve lung cancer treatment outcome. Here we report a cross-sectional study intended as a proof of principle investigation using breath based detection (exhaled breath condensate, EBC) of angiogenic markers (VEGF, bFGF, angiogenin), TNF-α and IL-8 to discriminate 74 individuals, with confirmed presence or absence (X-ray, CT) of non-small lung cancer (NSCLC). Levels of angiogenic markers bFGF, angiogenin and VEGF in EBC significantly discriminated between 17 individuals with newly detected NSCLC versus stable and exacerbated chronic obstructive pulmonary disease (COPD) patients as well as healthy volunteers. Levels of IL-8 and TNF-α in EBC indicated acute inflammation, e.g. in acute exacerbated COPD (AECOPD) and were not indicative of lung cancer. In a different group of patients that were already treated with two cycles of chemotherapy and who responded with at least a 25% reduction in primary tumor diameter, levels of angiogenic markers were lower compared to patients with newly diagnosed NSCLC. We suggest that breath based detection of angiogenic markers may help in the early detection of lung cancer.

Die Impulsoszillometrie (IOS) ist eine computergestützte Methode zur Messung komplexer mechanischer Eigenschaften der Atemwege. Ziel dieser Studiewardie IOS in derDiagnose obstruktiver Atemwegserkrankungen imHinblick auf die praktische Anwendbarkeit vergleichend zu den Standardverfahren Spirometrie, Pneumotachygrafie und Bodyplethysmografie zu evaluieren. Retrospektiv wurden 244 Patienten (Alter 61,5±13,6 J; 61% männlich) mit Asthma bronchiale (n = 65) und chronisch obstruktiver Lungenerkrankung (chronic obstructive pulmonary disease, COPD) (n = 179) untersucht. Mittels Bodyplethysmografie (SRtot > 120%SW)wurde bei 94% der Patienten eine Obstruktion diagnostiziert, mittels Pneumotachografie (FEV1 < 80%SW) bei 78% und mittels IOS je nach Parameter bei 87–94%. Leichtund mittelgradige Obstruktionen wurden durch alle IOS-Parameter außer R20 erfasst, schwere Obstruktionen jedoch besser durch die Frequenzabhängigkeit der Resistance FDR und die Reactance bei 5 Hz X5. Die Parameter R5, X5 und Zrs zeigten jedoch eine Tendenz zur Unterschätzung des Obstruktionsgrades. Eine bronchiale Obstruktion kanndurchdie IOS insgesamt sicherdiagnostiziert werden, sofern bei schwerer Obstruktion komplexe IOS-Parameter wie FDR und X5mit einbezogen werden. Die Parameter der Standardverfahren (Bodyplethysmografie und Pneumotachografie) zeigten aufgrund unterschiedlicher Messprinzipien insgesamt geringe statistische Korrelationen sowohl zur IOS, als auch im Vergleich untereinander. Zusammenfassend ist die IOS nach den Ergebnissen der Untersuchung eine patientenschonende und wenig kooperationsabhängige Methode zur Evaluierung obstruktiver Atemwegserkrankungen, welche bisherige Standardmethoden sinnvoll ergänzt und sichdarüber hinaus als sensitivesScreeninginstrument zur frühzeitigenErkennung einer Bronchialobstruktion eignet. Abstract !

Impulse oscillometry (IOS) is a computer supported method for the measurement of complex mechanical airway characteristics. Bronchial obstructions can reliably be diagnosed by IOS when more complex parameters such as frequency dependence of resistance (FDR) and lung reactance (X5) are evaluated in cases with more severe obstruction. Parameters of conventional methods like pneumotachography, spirometry, and bodyplethysmography show relatively low correlations due to the different measurement principles, not only in comparison to IOS, but also in between one another. The IOS is a convenient method for patients with a low dependency on cooperation for the evaluation of obstructive airway diseases complementary to the established standard methods. Furthermore, IOS may provide a sensitive screening tool for the early detection of bronchial obstructions not only in paediatrics but also in occupational medicine.