[Medical clinical diagnostics for indoor mould exposure - Update 2023 (AWMF Register No. 161/001)].

This article is an abridged version of the updated AWMF mould guideline "Medical clinical diagnostics in case of indoor mould exposure - Update 2023", presented in July 2023 by the German Society of Hygiene, Environmental Medicine and Preventive Medicine (Gesellschaft für Hygiene, Umweltmedizin und Präventivmedizin, GHUP), in collaboration with German and Austrian scientific medical societies, and experts. Indoor mould growth is a potential health risk, even if a quantitative and/or causal relationship between the occurrence of individual mould species and health problems has yet to be established. There is no evidence for a causal relationship between moisture/mould damage and human diseases, mainly because of the ubiquitous presence of fungi and hitherto inadequate diagnostic methods.

[Diagnosis and Treatment of Hypersensitivity Pneumonitis - S2k Guideline of the German Respiratory Society and the German Society for Allergology and Clinical Immunology].

Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) in sensitized individuals caused by a large variety of inhaled antigens. The clinical form of acute HP is often misdiagnosed, while the chronic form, especially the chronic fibrotic HP, is difficult to differentiate from other fibrotic ILDs. The present guideline for the diagnosis and treatment of HP replaces the former German recommendations for the diagnosis of HP from 2007 and is amended explicitly by the issue of the chronic fibrotic form, as well as by treatment recommendations for the first time.

[Allergic bronchopullmonary aspergillosis (ABPA) - an Update].

Allergic bronchopulmonary aspergillosis (ABPA) is a regular occurrence in everyday pneumology. ABPA should be considered in patients with severe asthma, in mould allergic patients with very high serum IgE levels and in patients with cystic fibrosis. The aim should be to make the diagnosis as early as possible in the course of the disease to avoid late complications such as bronchiectasis and fibrotic lung remodelling.

Hospitalisation patterns in interstitial lung diseases: data from the EXCITING-ILD registry.

Background: Interstitial lung diseases (ILD) comprise a heterogeneous group of mainly chronic lung diseases with more than 200 entities and relevant differences in disease course and prognosis. Little data is available on hospitalisation patterns in ILD.

Methods: The EXCITING-ILD (Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases) registry was analysed for hospitalisations.

Risk Assessment for Patients with Chronic Respiratory Conditions in the Context of the SARS-CoV-2 Pandemic Statement of the German Respiratory Society with the Support of the German Association of Chest Physicians.

Assessing the risk for specific patient groups to suffer from severe courses of COVID-19 is of major importance in the current SARS-CoV-2 pandemic. This review focusses on the risk for specific patient groups with chronic respiratory conditions, such as patients with asthma, chronic obstructive pulmonary disease, cystic fibrosis (CF), sarcoidosis, interstitial lung diseases, lung cancer, sleep apnea, tuberculosis, neuromuscular diseases, a history of pulmonary embolism, and patients with lung transplants. Evidence and recommendations are detailed in exemplary cases.

Allergic bronchopulmonary aspergillosis (ABPA) in an atopic patient with difficult-to-expectorate airway secretions.

In the workup of a 55-year-old atopic patient with cough and viscous secretions, we diagnosed an allergic bronchopulmonary aspergillosis (ABPA) on the basis of common diagnostic criteria for adult asthma patients (Rosenberg-Patterson and ISHAM), supported by the use of IgE antibodies against the Aspergillus components Asp f 2, f 4, and f 6. Initial treatment with prednisolone and itraconazole led to remission. In the long-term follow-up, there were few relapses until 2015, which responded well to standard treatment with oral steroids, and since 2016 the patient is in stable remission.

Hypersensitivity pneumonitis of a bagpipe player: Fungal antigens as trigger?

Here we present a 79-year old man with chronic hypersensitivity pneumonitis probably caused by fungal contamination of a bagpipe. Several samples were taken from the patient's bagpipe. Four potential fungal antigens () as potential trigger of hypersensitivity pneumonitis were identified.

How to diagnose mould allergy? Comparison of skin prick tests with specific IgE results.

Background: Diagnosis of mould allergy is complicated due to the heterogeneity of the test material and the decrease in the number of commercial mould skin test solutions that are currently available.

Objectives: The aim of this study was to compare skin prick tests (SPT) from different manufacturers to one another and concurrently with sIgE tests for Aspergillus fumigatus (Asp f), Cladosporium herbarum (Cla h), Penicillium chrysogenum (Pen ch), Alternaria alternata (Alt a) and Aspergillus versicolor (Asp v) to ascertain a feasible diagnostic procedure for mould sensitization.

Methods: In this multi-centre study, 168 patients with mould exposure and/or mould-induced respiratory symptoms were included.

[Farmer's lung antigens in Germany].

Recent studies suggest that besides the long-known farmer's lung antigen sources Saccharopolyspora rectivirgula (Micropolyspora faeni), Thermoactinomyces vulgaris, and Aspergillus fumigatus, additionally the mold Absidia (Lichtheimia) corymbifera as well as the bacteria Erwinia herbicola (Pantoea agglomerans) and Streptomyces albus may cause farmer's lung in Germany. In this study the sera of 64 farmers with a suspicion of farmer's lung were examined for the following further antigens: Wallemia sebi, Cladosporium herbarum, Aspergillus versicolor, and Eurotium amstelodami. Our results indicate that these molds are not frequent causes of farmer's lung in Germany.

[Recent advances in extrinsic allergic alveolitis].

Extrinsic allergic alveolitis (hypersensitivity pneumonitis), especially humidifier lung, has been more frequently diagnosed over the last decades, whereas farmer's lung has decreased over the same time period. Today two types of the chronic course of extrinsic allergic alveolitis can be distinguished. The recurrent chronic course with a good prognosis may be differentiated from the insidious course with a poor prognosis by means of different histological patterns (UIP, NSIP, BOOP pattern).

[Sarcoidosis as a mimicry of haemangiotic carcinomatosis].

The radiologic work-up of a 67-year-old female patient for dyspnea revealed micronodular infiltrates in both lungs, which in combination with enlarged mediastinal and abdominal lymph-nodes were highly suspicious of sarcoidosis stage II. A bronchoscopic examination including transbronchial biopsy in another hospital was not diagnostic, so the patient was referred to us for surgical lung biopsy. A specimen from the right middle lobe showed massive haemangiotic carcinomatosis of a clear-cell carcinoma.

Renal handling of drugs in the healthy elderly. Creatinine clearance underestimates renal function and pharmacokinetics remain virtually unchanged.

Objective: It is commonly assumed that renal function, and in parallel the excretion of drugs, is considerably reduced in the elderly. Endogenous creatinine clearance or indirect estimates of this parameter are generally recommended for adapting drug dosage. The present study evaluates the validity of both assumptions.

Renal function in the elderly: impact of hypertension and cardiac function.

In senescence renal function is thought to decline markedly even in the absence of renal disease. It has also been proposed that the changes in renal function with age are not uniform and that confounding factors such as hypertension or atherosclerosis may play a role. We performed a comprehensive study to compare several aspects of renal function in four groups: (i) young healthy normotensive subjects (N = 24; 13 males; mean age 26 +/- 3 years); (ii) elderly healthy normotensive subjects (elderly NT; N = 29; 13 males; 68 +/- 7 years); (iii) elderly treated and untreated hypertensive patients (elderly HT; N = 25; 13 males; 70 +/- 6 years); and (iv) elderly patients with compensated mild to moderate heart failure (elderly HF; N = 14; 6 males; 69 +/- 6 years).