Verlaufsuntersuchung von Patienten mit Asthma bronchiale unter besonderer Berücksichtigung der nächtlichen klinischen Symptomatik

Einleitung Die von der Global Initiative for Asthma definierten Kriterien für Asthmakontrolle bein-halten Fragen über Symptome während des Tags und der Nacht, Einschränkung der Tagesaktivitäten, Bedarf an Notfallmedikamenten und die Zufriedenheit des Patienten. Patienten mit nächtlichen Symptomen w...

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Bibliographic Details
Main Author: Dönges, Jonathan
Contributors: Koehler, Ulrich (Prof. Dr. med.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2022
Online Access:PDF Full Text
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Table of Contents: Introduction The Global Initiative for Asthma (GINA)-defined criteria for asthma control include questions about daytime symptoms, limitation of activity, nocturnal symptoms, need for reliever treatment and patients’ satisfaction. Patients with nocturnal symptoms like wheezing and cough often suffer from lower sleep quality and impaired daytime per-formance. The lack of an appropriate method for standardized and objective monitoring of respiratory symptoms leads to difficulties in asthma management. In this study, a new method for automated wheeze and cough detection during sleep is presented and used to reexamine patients with bronchial asthma. Methods Respiratory symptoms like wheezing and cough were recorded with the LEOSound-Monitor for one night in 55 asthmatic patients in their individual domestic setting. Be-fore, these patients’ lung function was evaluated. By their scaled obstructive parameters they were classified into 3 groups with no obstruction, only peripheral obstruction and central plus peripheral obstruction. The results of the acoustic long-term monitoring were contrasted with the three groups. The study consisted of 37 women and 18 men, with a mean age of 41 years, and a mean BMI of 27 kg/m2. Most of the patients had been tak-ing an ICS/LABA combination and would resort to a SABA as their rescue medication. Results 17 of the 55 asthma patients (30,9 %) showed no sign of obstruction in the lung func-tion evaluation, whereas 38 patients (69,1 %) a peripheral and/or central obstruction pre-sented. During sleep, wheezing was found in 8 patients (14.5%) with the LEOSound-Monitor. The median of the wheezing duration was 9 ½ min with a minimum of 4 min and a max-imum of 30 ½ min. Several obstruction-parameters of lung function showed a correla-tion with wheezing events. 6 of the 8 patients with wheezing were classified in the group with central/peripheral obstruction. Even though lung function showed no sign of obstruction, in 1 patient wheezing at night was also registered. During sleep, cough was detected in 30 patients (54.5 %). Contrary to the evaluation of wheezing, patients with cough were not related to the obstruction in lung function in evidence. Conclusion Respiratory symptoms like cough and wheezing directly affect the sleep quality in a negative way in patients with asthma bronchiale. Wheezing is seen as a clinical sign of lung obstruction and indicates a non-controlled asthma. However, patients are mostly unaware of their clinical symptoms during sleep and are not able to estimate their asth-matic status in an adequate way. LEOSound proved to be a useful tool in providing an objective evaluation of respiratory symptoms like coughing and wheezing. Lung ob-struction, defined by lung function analysis may be reflected in acoustic long-term mon-itoring, which therefore turns out to be helpful in examination of the disease process. In clinical practice, this may allow a profound improvement in asthma therapy by adjusting the treatment to respiratory symptoms.