[Exercise testing in respiratory medicine].

This document replaces the DGP recommendations published in 1998. Based on recent studies and a consensus conference, the indications, choice and performance of the adequate exercise testing method in its necessary technical and staffing setting are discussed. Detailed recommendations are provided: for arterial blood gas analysis and right heart catherterization during exercise, 6-minute walk test, spiroergometry, and stress echocardiography.

[Differential diagnosis of restrictive lung diseases: utility of cardiopulmonary exercise testing].

Exercise dyspnea is a common symptom of restrictive lung diseases. Not only from the clinical perspective but also from the pathophysiological point of view, restrictive lung disorders represent a very heterogeneous group of diseases. Exercise testing is mandatory because pulmonary function tests at rest are not reliable for the diagnostic evaluation and functional characterisation of these patients.

[Asthma and COPD - dosing recommendations at beginning and end of treatment].

In the treatment of asthma and COPD for two drug classes slowly increasing starting doses or tapering at the end of therapy is required: In the case of allergen specific immunotherapy (desensitisation) with allergen extracts gradual increases of doses are necessary to prevent allergic shock. In the case of prolonged systemic treatment of asthma or COPD with glucocorticoids tapering is necessary to avoid symptoms of adrenal gland insufficiency after drug withdrawal or exacerbation of the underlying disease. In the short term treatment of asthma exacerbations with systemic glucocorticoids tapering is not necessary, for COPD suitable studies are still lacking.

Treatment with sequential intravenous or oral moxifloxacin was associated with faster clinical improvement than was standard therapy for hospitalized patients with community-acquired pneumonia who received initial parenteral therapy.

Background: Although third-generation cephalosporins, such as ceftriaxone (CTRX), and pneumococcal fluoroquinolones, such as moxifloxacin (MXF), are currently recommended first-line antibiotics for empirical treatment of inpatients with community-acquired pneumonia, CTRX and MXF have never undergone a head-to-head comparison. We therefore compared the efficacy, safety, and speed and quality of defervescence of sequential intravenous or oral MXF and high-dose CTRX with or without erythromycin (CTRX+/-ERY) for patients with community-acquired pneumonia requiring parenteral therapy.

Methods: In this prospective, multicenter, randomized, controlled, nonblinded study, 397 patients were randomly assigned to receive either MXF (400 mg once daily intravenously, possibly followed by oral tablets) or CTRX (2 g intravenously once daily) with or without ERY (1 g intravenously every 6-8 h) for 7-14 days.

Cost-effectiveness of formoterol and salbutamol as asthma reliever medication in Sweden and in Spain.

This study aimed to evaluate the cost-effectiveness of formoterol (Oxis) Turbuhaler 4.5 microg and salbutamol 200 microg as reliever medications in Sweden and Spain. The study used data on effectiveness (exacerbations and symptom-free days) and resource utilisation from an open, 6-month, parallel-group, multicentre randomised trial with 18,124 asthma patients in 24 countries.

Formoterol as relief medication in asthma: a worldwide safety and effectiveness trial.

The aim of the study was to compare the safety and effectiveness of as-needed formoterol with salbutamol in a large international real-life asthma study. Children and adults (n=18,124) were randomised to 6 months as-needed treatment with open-label formoterol 4.5 microg Turbuhaler or salbutamol 200 microg pressurised metered dose inhaler or equivalent.

A prospective, randomized, multicenter comparative study of clinafloxacin versus a ceftriaxone-based regimen in the treatment of hospitalized patients with community-acquired pneumonia.

In an open-label, phase 3, randomized, multicenter study, clinafloxacin (200 mg/d) was compared to ceftriaxone (2 g/d; with or without erythromycin) in 527 patients with acute community-acquired bacterial pneumonia (CAP). Primary efficacy parameters were clinical cure rate and microbiologic eradication rates (by pathogen and by patient) determined 5-9 d post-therapy (test of cure; TOC). Clinical cure rates at TOC for the 2 treatment groups were equivalent in the intention-to-treat (clinafloxacin 79.

A comparative study of levofloxacin and ceftriaxone in the treatment of hospitalized patients with pneumonia.

A multinational, multicentre, open, randomised study in hospitalised patients with pneumonia compared levofloxacin 500 mg twice daily with ceftriaxone 4 g i.v. once daily.

Protein profile in bronchoalveolar lavage fluid from patients with sarcoidosis and idiopathic pulmonary fibrosis as revealed by SDS-PAGE electrophoresis and western blot analysis.

So far bronchoalveolar lavage (BAL)-protein in interstitial lung disease (ILD) is evaluated by measuring concentrations of single proteins. Due to the high dilution of most proteins in BAL, analysis of protein profile has been disappointing. This study describes a new method to overcome this problem and to reveal a highly differentiated picture of BAL proteins.

B-lymphocyte response in peripheral blood of patients with pulmonary sarcoidosis.

Sarcoidosis is a granulomatous disorder which can be characterized by various immunologic abnormalities including lymphocyte dysfunctions. The purpose of this study was to investigate the B-lymphocyte reactivity in the peripheral blood of 29 various patients with pulmonary sarcoidosis. A significant decrease in the production of IgG, IgM and IgA in supernatants of cultivated sarcoidosis B-cells both after stimulation with a T-cell dependent polyclonal B-cell activator (pokeweed mitogen) and with a T-cell independent polyclonal B-lymphocyte activator (Klebsiella pneumoniae) was seen, which suggested a disturbance in the B-cell differentiation of sarcoidosis patients.

Recovery of proteins from the broncho-alveolar lavage fluid proposal for a standardisation.

In this study various precipitation methods have been used to concentrate the proteins from broncho-alveolar-lavages. The highest percentage of proteins was recovered from the broncho-alveolar-lavages using the method of Wessel & Flügge (Anal. Biochem.

Increased expression of growth factor genes for macrophages and fibroblasts in bronchoalveolar lavage cells of a patient with pulmonary histiocytosis X.

Pulmonary histiocytosis X is the local manifestation of a systemic disorder of unknown cause characterised by infiltration of Langerhans cell like histiocytes and parenchymal fibrosis. In a male smoker with histologically proved histiocytosis X and functional impairment bronchoalveolar lavage showed an increase in CD-1/OKT-6 antigen positive histiocytes to 8%. Northern blot analysis of RNA from bronchoalveolar lavage cells showed an exaggerated expression of the M-CSF gene and of the c-fms gene encoding for the corresponding receptor.

[Bronchoalveolar lavage in Wegener's granulomatosis].

Bronchoalveolar lavage was performed in 14 patients suffering from histologically confirmed Wegener's granulomatosis who also showed x-ray signs of lung involvement. Cell distribution and immunophenotypical characterisation of lymphocytes and alveolar macrophages of patients suffering from Wegener's granulomatosis were compared with the findings obtained from 10 controls. The bronchoalveolar lavage of the granulomatosis patients showed a significant increase of the total cell count, signalling inflammatory involvement of the lung.

Ofloxacin in lower respiratory tract infections.

In order to determine the efficacy and safety of the new quinolone ofloxacin in the treatment of chronic lower respiratory disease, 674 patients (353 with chronic bronchitis, 212 with community-acquired pneumonia and 109 with hospital-acquired pneumonia) were treated with ofloxacin 200 mg twice a day. In total, 627 patients (93%) showed a satisfactory clinical response, and 47 patients (7%) had no change or deterioration. Neither severe side effects nor interactions between ofloxacin and coadministered theophylline were seen.

[Bronchoalveolar lavage in diseases of rheumatic origin].

The cells recovered by bronchoalveolar lavage reflect the cellular composition of the interstitial lung tissue. Inflammatory and fibrosing interstitial lung disorders, often accompanying rheumatic diseases, can be detected by this diagnostic procedure.

Proliferation, macrophage colony-stimulating factor, and macrophage colony-stimulating factor-receptor expression of alveolar macrophages in active sarcoidosis.

Alveolar macrophages (AM) in sarcoidosis display an enhanced mitotic activity. Immunocytochemical detection of the proliferation-associated Ki-67 antigen revealed significant increase in the number of proliferating AM in active sarcoidosis as compared with inactive stages of disease. Macrophage proliferation may provide an additional marker of disease activity.

[Bronchoalveolar lavage in cytostatic drug-induced lung changes].

Fibrosing alveolitides are associated with a characteristic cellular pattern in the BAL fluid. In contrast, acute interstitial fibrosing pulmonary changes in patients receiving cytostatic drug treatment cannot be detected in the BAL fluid, since the direct influence of cytostatic agents on the cellular constitution of the BAL fluid predominates.

[Interstitial lung fibrosis in rheumatoid arthritis--comparison of lung function and bronchoalveolar lavage].

In fibrosing alveolitides that are associated with rheumatoid arthritides, the BAL fluid reveals a characteristic cell pattern. These cellular changes occur at an earlier date than do the radiological signs of pulmonary fibrosis. Together with a measurement of the CO diffusion capacity, BAL is a suitable monitoring parameter for fibrosing alveolitides in rheumatoid arthritis.

[Interleukin 1 secretion from alveolar macrophages in pulmonary sarcoidosis].

Alveolar macrophages obtained from 28 patients with pulmonary sarcoidosis were investigated to determine their ability spontaneously to release interleukin 1. In 14 of these patients, a significant spontaneous liberation of interleukin 1 was observed; the BAL parameters of these patients pointed to an elevated activity of the disease.

[Functional and morphological characterization of alveolar macrophages from patients with pulmonary sarcoidosis].

Bronchoalveolar lavage was performed in 28 patients with pulmonary sarcoidosis. Enzyme cytochemical staining with the tartrate-resistant acid phosphatase revealed a significantly increased portion of sarcoidosis macrophages showing a monocyte-like phenotype. Immunocytochemical staining with the proliferation-associated monoclonal antibody Ki-67 showed an increase of proliferating monocyte/macrophages related to disease activity in sarcoidosis.