Lars Christian Huber

Background/Objectives: Acute cor pulmonale is a critical clinical condition often encountered in acute care settings. Optimal management demands coordinated, interdisciplinary care. The aim of this study was to assess the current knowledge and management strategies for acute cor pulmonale among different groups of physicians involved in acute care in Switzerland. Methods: A structured questionnaire, extrapolated from the Acute Cardiovascular Care Association of the European Society of Cardiology clinical consensus statement on the diagnosis and treatment of cor pulmonale, was distributed among physicians of four specialties. Results: A total of 110 physicians participated in this multicenter survey, including 15 “experts,” 71 “generalists” (internal and emergency medicine), and 24 “specialists” (cardiology and intensive care). Experts validated 29 out of 40 questionnaire items (Fleiss Kappa 0.63), which were then used for analysis. Overall, there was substantial agreement with the experts’ answers among non-experts, with most correct response rates exceeding 60%. Significant differences were observed for only two items: experts more frequently recognized the prognostic value of clinical models (87% vs. 59%, p = 0.046) and the correct indications for systemic thrombolysis (100% vs. 76%, p = 0.037). Between generalists and specialists, differences in knowledge were minimal. Specialists more accurately identified the role of repeated arterial blood gas analysis, while generalists showed better awareness of clinical prognostic models. Conclusions: The study highlights a sound knowledge of acute cor pulmonale among acute care physicians, regardless of specialty. Despite comparable levels of knowledge, some variations reflect their clinical roles and information sources. The results emphasize the value of existing educational efforts and support the need for comprehensive, accessible guidelines to standardize care in complex conditions like acute cor pulmonale.

In this retrospective, single‐center data analysis, we audited our clinical practice to treat Stenotrophomonas maltophilia in asymptomatic lung transplant recipients (LTRs). Eighteen LTRs with confirmed isolation of S. maltophilia were identified. Twelve of these LTRs have been treated with antibiotics, while 6 were managed without treatment. Treatment was based on antibiograms (trimethoprim/sulfamethoxazole [TMP/SMX] (8/12), levofloxacin (1/12), or both (3/12). Clearance (12/12 vs 6/6), eradication (10/12 vs 3/6, P=.27), and freedom from S. maltophilia recurrence (83%±11% vs 40%±22% after one year, log‐rank P=.09) were not found to differ significantly between treated and untreated patients. None of the patient groups showed significant changes in lung function or biochemical variables. Creatinine levels at the end of the study period were found to be higher in treated patients compared to the untreated group (P=.049). De novo acquired TMP/SMX resistance in S. maltophilia strains was not observed. These results indicate no evidence that antibiotic treatment for S. maltophilia in asymptomatic LTRs alters lung function or the clinical outcome.

Diagnosis of acute lung allograft rejection is currently based on transbronchial lung biopsies. Additional methods to detect acute allograft dysfunction derived from plasma and bronchoalveolar lavage samples might facilitate diagnosis and ultimately improve allograft survival. This review article gives an overview of the cell profiles of bronchoalveolar lavage and plasma samples during acute lung allograft rejection. The value of these cells and changes within the pattern of differential cytology to support the diagnosis of acute lung allograft rejection is discussed. Current findings on the topic are highlighted and trends for future research are identified.

The development of chronic lung allograft dysfunction (CLAD) is one of the major obstacles following lung transplantation and limits patients’\ud long-term outcome. Within the group of emerging CLAD phenotypes, bronchiolitis obliterans syndrome is the most common form\ud and observed in up to 75% of lung transplant recipients 10 years after transplantation. Therapeutic options to address BOS are limited and,\ud at our center, include modification of immunosuppression, immunomodulation using macrolide antibiotics, the use of statins, leukotriene\ud receptor antagonists, and extracorporeal photopheresis. The evidence for most of these therapy options is derived from case reports or\ud small, descriptive studies, whereas controlled trials are yet to be conducted. In the context of an illustrative case report, we review hereby\ud the current literature regarding these different treatment options

Pulmonary capillary hemangiomatosis (PCH) is a rare histological substrate within the spectrum of pulmonary arterial hypertension that possibly represents an unusual manifestation of pulmonary veno-occlusive disease (PVOD). One of the histological hallmarks of PCH is the proliferation of pulmonary capillaries in the alveolar septa that infiltrate adjacent structures such as bronchioles, vessels, and visceral pleura. The hyperplastic process involving the smallest vessels of the pulmonary vascular bed might reflect uncontrolled angiogenesis, but whether this vascular proliferation is idiopathic or, conversely, a reactive process remains to be elucidated. Here we discuss the pathogenesis of PCH exemplified by the first reported case of a young patient with repaired scimitar syndrome that developed unilateral PCH. Pulmonary capillary hemangiomatosis (PCH) is a rare histological substrate within the spectrum of pulmonary arterial hypertension that possibly represents an unusual manifestation of pulmonary veno-occlusive disease (PVOD). One of the histological hallmarks of PCH is the proliferation of pulmonary capillaries in the alveolar septa that infiltrate adjacent structures such as bronchioles, vessels, and visceral pleura. The hyperplastic process involving the smallest vessels of the pulmonary vascular bed might reflect uncontrolled angiogenesis, but whether this vascular proliferation is idiopathic or, conversely, a reactive process remains to be elucidated. Here we discuss the pathogenesis of PCH exemplified by the first reported case of a young patient with repaired scimitar syndrome that developed unilateral PCH.

Levels of microRNAs (miRNAs) are increasingly assessed in biological fluids, for example, in samples obtained by bronchoalveolar lavage (BAL). “Post-collection kinetics” of miRNA expression levels, however, have not been investigated to date. In these experiments, we analyzed the dynamic expression profile of 5 different miRNAs (miR-17, miR-19b, miR-20b, miR-125a, and miR-223-3p) in BAL within the first 24 h following collection by routine bronchoscopy. miRNAs were quantified 0, 1, 4, 8, and 24 h after collection in samples that were kept at 4 °C or at room temperature. The expression of all five miRNAs was found to remain stable between the first 8 h after collection. 24 h after collection miRNAs faced substantial alterations in their expression profile. These data emphasize that BAL samples intended for further miRNA analysis can be handled at room temperature within the first 8 h after bronchoscopy.

Pulmonary hypertension (PH) due to COPD has dismal prognosis. We reviewed the long-term effect of PH-target therapy in severe PH-COPD. Patients attending our PH-clinic were reviewed for PH-COPD receiving PH-target therapy. Baseline characteristics, death/transplantation until 2014, therapy, NYHA functional class, 6 min walk distance (6MWD) and oxygen saturation (SpO₂) at baseline, 3, 6, 12 and 24 months were analysed. Of 48 PH-COPD identified 21 were excluded (insufficient data, comorbidity). 27 patients (7 females, 21 smokers, 23 emphysema) with median (quartiles) baseline age 70 (60; 76) years, FEV1 60 (46; 78) %, FEV1/FVC 57 (51; 64) %, DLCO 42 (36; 59) %, mean pulmonary artery pressure 39 (32;44) mmHg under inhaled iloprost (10), subcutaneous prostanoids (2), intravenous prostanoids (3), endothelin receptor antagonists (15) and phosphodiesterase-5-inhibitors (25) were included. Under therapy, NYHA functional class improved from 3.5 (3; 4) to 3 (2; 4) after 3 months and 3 (2; 3.5) after 6 months (p = .02 and .008). The 6MWD improved from 373 (236; 452) to 395 (339; 472), 414 (285; 492) and 396 (308; 497)m at 3, 6 and 12 months (p = .005, .006 and .011) with unchanged resting-SpO₂ but decreased peak-exercise SpO₂. During median follow-up of 5.9 (2.3; 8.4) years, 10 died, 2 were transplanted and 2 were lost to follow-up. Transplant-free survival at 1,2,3 years was 92,69,54 % and was similar for GOLD stages 1–4, but worse for patients with mPAP ≥40 mmHg (p = .026), 6MWD p = 0.008), resting SpO₂ p = 0.02) and peak-walk SpO₂ p = 0.012). PH-target vasodilator therapy improved NYHA functional class and 6MWD up to one year in highly selected patients with severe PH-COPD. Poor exercise capacity, low SpO₂ and high mean pulmonary artery pressure at baseline but not airflow obstruction were associated with unfavourable outcome.

Bronchiektasen bezeichnen irreversibel erweiterte Atemwege. Genaue epidemiologische Angaben zur Prävalenz von Bronchiektasen existieren nicht, sie sind aber häufig und werden zunehmend als solche erkannt. Eine Vielzahl von Erkrankungen und Auslöser können zu Bronchiektasen führen, häufig bleibt ihre Ätiologie unklar. Eine chronische pulmonale Infektion mit Pseudomonas aeruginosa ist mit einem schwereren klinischen Verlauf assoziiert und beeinflusst das therapeutische Management. Physiotherapie, mukoaktive Substanzen und Antibiotika sind die Eckpfeiler der Therapie von Bronchiektasen. Einen zunehmenden Stellenwert hat die immunmodulatorische Therapie mit Makroliden. In dieser Übersicht werden notwendige Abklärungen und neueste Entwicklungen hinsichtlich therapeutischer Ansätze bei Non-CF-Bronchiektasen diskutiert. Bronchiectasis is the term used for irreversibly dilated airways. Exact epidemiological information on the frequency of bronchiectasis is not available, but the morphological findings are increasingly detected and the associated syndrome is more frequently diagnosed due to improved imaging techniques and increased awareness among chest physicians. The workup of these patients includes a wide panel of investigations guided by patient history and clinical presentation. Despite thorough evaluation the aetiology frequently remains unclear. Chronic infection with Pseudomonas aeruginosa is associated with a severe course of the disease and its detection has impacts on the therapeutic management. Chest physiotherapy, mucoactive substances and antibiotics are the mainstay of therapy. In this review the evaluation of bronchiectasis and the recent therapeutic insights for non-cystic fibrosis bronchiectasis are discussed.