COPD – eine unterschätzte Erkrankung

COPD - An Underestimated Disease Abstract: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition with a complex clinical picture. The diagnosis is not easy to make because COPD can develop insidiously and remain unnoticed for a long time. Therefore, general practitioners play a central role in the early detection of the disease. Suspected COPD can be confirmed by special examinations in collaboration with pulmonologists. The new GOLD guideline defines three COPD risk groups (A-B-E) which should guide the personalized treatment concept. A short- or long-acting bronchodilator (SAMA/SABA or LAMA/LABA) is recommended for group A, and a dual long-acting bronchodilator therapy (LABA+LAMA) is recommended for group B and E. In case of blood eosinophilia (≥300 cells/µl) and/or recent hospitalization for COPD exacerbation, triple therapy (LABA+LAMA+ICS) is recommended. General practitioners are important in implementing non-pharmacological measures (smoking cessation, regular exercise, vaccinations, patient selfmanagement education). However, this also underlines the high demands of the implementation of the GOLD guideline in daily practice.COPD ist eine heterogene Erkrankung mit komplexem Krankheitsbild. Die Diagnose ist nicht einfach zu stellen, denn COPD kann sich schleichend entwickeln und lange unbemerkt bleiben. Hausärztinnen und -ärzten kommt daher für die Früherkennung eine zentrale Rolle zu. Der COPD-Verdacht kann in Zusammenarbeit mit Pneumologen durch spezielle Untersuchungen abgesichert werden als Voraussetzung für das medikamentöse Therapiekonzept. Die neue GOLD-Guideline definiert drei COPD-Risikogruppen (A-B-E). Für Gruppe A wird ein kurz- oder langwirksamer Bronchodilatator (SAMA/SABA bzw. LAMA/LABA) empfohlen. Für Gruppe B und E wird eine Kombinationstherapie LABA+LAMA empfohlen. Bei Bluteosinophilie (≥ 300 Zellen/μl) und/oder kürzlicher Hospitalisierung aufgrund einer COPD-Exazerbation wird eine Dreifachtherapie (LABA+LAMA+ICS) empfohlen. Hausärztinnen und -ärzte sind wichtig bei der Umsetzung therapiebegleitender Massnahmen (Coaching von Patientinnen und Patienten, Impfungen, Rauchstopp, regelmässige Bewegung). Dies unterstreicht aber auch die hohen Anforderungen der Umsetzung der GOLD-Guideline in den Praxisalltag

Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86–1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91–1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. Funding: UK Medical Research Council and Health Technology Assessment Programme

Hamburg auf dem Weg ins Dritte Reich Entwicklungsjahre 1931-1933

SIGLEFES Bonn(Bo133)-A83-4492 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Neues in der Asthma-Grundversorgung

Zusammenfassung. Für die Allgemeinpraktikerin und den Allgemeinpraktiker gibt es wichtige Neuerungen in der Asthmabehandlung, da sich die internationalen Empfehlungen auf Basis der Global Initiative for Asthma (GINA) geändert haben. Für die Stufe 1 wird der alleinige Einsatz kurzwirksamer β2-Agonisten (SABA) ohne inhalatives Kortikosteroid (ICS) aufgrund der mangelnden Wirksamkeit und Sicherheit nicht mehr empfohlen, sondern stattdessen niedrig dosiertes ICS-Formoterol bei Bedarf. Bei schwerem, unkontrolliertem Asthma der Stufe 5 wird der Einsatz von biologischen Therapien, wie z.B. Interleukin-Antikörpern, empfohlen. Weisen Asthma-Kranke gleichzeitig auch Symptome einer chronisch-obstruktiven Lungenkrankheit (COPD) auf, sollten sie mit einer ICS-enthaltenden Therapie behandelt werden. Die Empfehlungen der GINA bleiben auch während der Corona-Pandemie unverändert gültig. Aktuelle Verschreibungsdaten der Schweiz belegen, dass sowohl SABA als auch orale Kortikosteroide (OCS) noch eine grosse Rolle in der Asthmabehandlung spielen und die GINA-Empfehlungen noch nicht ausreichend umgesetzt wurden. Novelties in the Treatment of Asthma Abstract. For general practitioners there have been important novelties in the treatment of asthma due to recent modifications of the international guidelines from Global Initiative for Asthma (GINA). Step 1 no longer recommends the use of short-acting β2-agonists (SABA) without concomitant inhaled corticosteroids (ICS) as a controller because of the lack of efficacy and for safety reasons. Instead, low dose ICS-formoterol as needed is recommended. GINA step 5 recommends targeted biologic therapies like interleukin antibodies in patients with severe uncontrolled asthma. Asthma patients presenting simultaneously with symptoms of chronic obstructive pulmonary disease (COPD) should receive treatment containing ICS. Independent of the current corona pandemic, GINA recommendations stay in place. Recent data on prescriptions of SABA and oral corticosteroids (OCS) in Switzerland indicate that they still play an important role in asthma management and that GINA recommendations have not yet been sufficiently implemented into practice. Résumé. L’évolution récente des recommandations internationales GINA (Global Initiative for Asthma) entraîne des changements majeurs de la prise en charge des patients asthmatiques pour le médecin de premier recours. Dans l’asthme léger (palier GINA 1), l’utilisation de bronchodilatateurs β2-agonistes à courte durée d’action (SABA) seuls comme traitement de secours n’est plus recommandée; il est désormais plutôt proposé de prescrire une association de corticostéroides inhalés (CSI) faiblement dosés avec un bronchodilatateur à longue durée d’action à début d’action rapide (formoterol) en traitement au besoin chez ces patients. Dans l’asthme sévère non contrôlé (palier 5 GINA), l’objectif est d’éviter la corticothérapie orale (OCS) au profit de l’utilisation de thérapies biologiques ciblées (par exemple anticorps anti-interleukine). Un traitement contenant des CSI doit être maintenu chez les patients asthmatiques même si une bronchopneumopathie chronique obstructive (BPCO) est associée. Les recommandations de traitement GINA ne sont pas modifiées par les conditions actuelles de pandémie. Des données récentes sur les prescriptions de SABA et de corticostéroïdes oraux (OCS) indiquent qu’ils jouent toujours un rôle important en Suisse dans la prise en charge de l’asthme; ces pratiques doivent évoluer à la lumière des nouvelles recommandations GINA

[Novelties in the Treatment of Asthma].

For general practitioners there have been important novelties in the treatment of asthma due to recent modifications of the international guidelines from Global Initiative for Asthma (GINA). In Step 1, use of short-acting beta2-agonists (SABA) without concomitant inhaled corticosteroids (ICS) as controller is no longer recommended for lack of efficacy and safety reasons. Instead, low dose ICS-formoterol as needed is recommended. In Step 5, in patients with severe uncontrolled asthma GINA recommends targeted biologic therapies like interleukin antibodies. Asthma patients presenting simultaneously with symptoms of chronic obstructive pulmonary disease (COPD) should receive treatment containing ICS. Independent of the current corona pandemic, GINA recommendations stay in place

[COPD : a still neglected condition].

Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung disorder with a complex clinical picture. The diagnosis may be difficult at times, as COPD may develop insidiously and remain unnoticed for a long time. Therefore, general practitioners play a central role in early detection of disease. Suspected COPD may be confirmed by further investigations in collaboration with a pulmonologist. The most recent GOLD guideline defines three COPD risk groups (A-B-E) which should guide the personalized treatment concept. General practitioners are crucial for implementing non-pharmacological measures such as smoking cessation, regular exercise, vaccinations, and patient self-management education. However, this also underlines the challenges to implement the GOLD recommendations in daily practice