[Pneumological Assessment with Regard to Performance Demands - Concept: "Load to Capacity"]. / Pneumologische Bewertung und Begutachtung im Spiegel von Beanspruchungskriterien.

Professional opinions on and assessments of physical performance must be oriented to the individual capacity of the person in question. Moreover, this performance has to be correlated with the expected physical load at work, sports activities or operative stress. This "Load to Capacity Concept" is already a part of an integrative medical assessment, based on clinical experience and common sense, rather than on diagnostic numerical values. An evaluation of work intensity in the context of socio-medical assessment ("light - moderate - severe - very severe", German Statutory Pension Insurance, based on the German REFAClassification) can now be complemented by well accessible and valid data based on measurements of real-life and professional activities. Also the ratio of continuous power in view of the maximal power output (V'O2 peak) and the power at the aerobic-anaerobic threshold (V'O2 at VT1) is well established. This information is gained by ergospirometry (CPET - Cardio Pulmonary Exercise Testing). The focus while interpreting the performance lies on Watt as a physical parameter and on O2-consumption (V'O2 L/min) as the crucial biological correlate. V'O2 is presented as a direct value (L/min) or in complex values like MET (Metabolic Equivalent of Task) and calories (kcal).Recent studies can take advantage of technical progress in this field: rapid sensory measurement, convenient display in graphs and tables. In earlier literature there is ample information on working demands and energy expenditure, supplemented by V'O2-data and MET (see Ainsworth et al.). These studies are helpful for orientation. However, it has to be kept in mind that these studies were done with technical possibilities available then, mostly in a laboratory setting, not under real-life conditions. Portable ergospirometry was not available at that time. Ergospirometry has already proved to be a useful tool in cases where expert opinion is required on compensation claims or questions of early retirement. Positive results of our study on "Occupational Activity of Cleaning Personnel in Clinics" are also reported here.

Oxygen Consumption (V'O2) and physical Strainas measured by the occupational activity of cleaning personnel.

BACKGROUND: The aim of the study was to determine the physical effort and energy expenditure needed over a working period of 45-60 min, specifically for the occupational activity of cleaning. The effort was demonstrated in absolute terms (V'O2), in relation to the involved person's maximum physical capacity (peak V'O2) and in relation to the individual aerobic-anaerobic threshold (V'O2 at VT1, the point when lactate starts to accumulate but can be cleared). In addition to this, the aim was to verify the suitability of portable ergospirometry in determining the occupational workload in a real-life setting. METHODS: Thirty-five cleaners performed a bicycle ergospirometry to determine their maximum physical capacity (peak V'O2 = L/min) and their aerobic-anaerobic threshold (V'O2 at the Ventilatory Threshold 1 [VT1]). This was followed by portable ergospirometry lasting 45-60 min while pursuing regular cleaning activities. RESULTS: Performance V'O2 (the average oxygen consumption over 45-60 min of work- time) was 1.06 L/min or 4.4 METs. This was scarcely lower than the individual V'O2 at VT1 and approached 45% of the maximum physical capacity (peak V'O2). In addition, there was positive feedback regarding the wearability of the portable device. The dropout rate was low. CONCLUSION: The occupational activity of cleaning was defined as a "committed activity", performed close to the upper limit of the continuous physical capacity (approaching V'O2 at VT1). The positive feedback and a low dropout rate proved good acceptance of portable ergospirometry in this field of work over a 45-60 min period.

[Bronchial asthma due to storage mite allergy]. / Asthma bronchiale bei Allergie gegen Vorratsmilben.

In a multicenter study (7 participating centres) 132 patients with bronchial asthma (grade II or III) and sensitization to storage mites (SM) and/or house dust mites (HSM) were screened and asked to undergo further allergological evaluation. 90 patients agreed. In addition to routine skin prick tests and RAST, quantitative skin prick tests (QSPT) and bronchial provocation tests (BPT) were also performed with the suspected mite allergens. The results were correlated with aspects of the domestic and working environments. Furthermore we questioned whether the outcome of BPT could be predicted from the results of the routine skin tests/RAST and QSPT respectively. Out of a total of 145 BPTs there were 79 positive results with SM and/or HSM. Three patients were mono-allergic to SM. The correlation with the domestic environment was unremarkable. Correlation with occupational factors revealed a strong predominance of farmers (42 of 90) and suggested the same for professions involved in work in dust-laden environments like bakers (5 of 90) and workers in wood- and paper industry (7 of 90). This also means, that SM-allergy occurs in persons not occupationally exposed to dust. A prediction as to the allergological relevance of SM-allergen was not possible from viewing the routine skin prick test however positive RAST data showed a significant correlation with positive BPT to SM Lepidoglyphus. Similarly it was possible to draw an inference from QSPT as to the relevant allergy. With a positive QSPT to the SM Lepidoglyphus destructor a positive result with a BPT was highly probable. Due to small numbers it is not possible to make a similar statement for the other SM species (Acarus and Tyrophagus).

[Guidelines for conducting provocation tests with allergens. German Society of Allergology and Clinical Immunology and German Society for Immunology]. / Leitlinie für die Durchführung bronchialer Provokationstests mit Allergenen - Deutsche Gesellschaft für Allergologie und klinische Immunologie und Deutsche Gesellschaft für Pneumologie -

Guidelines for bronchial allergen provocation tests, first published in 1984, are updated by this paper. This version has been compiled in repeated meetings of a panel of experts after evaluation of the publications available. Precise statements regarding indications, contraindications, after safety measures are given. Three evidence-based protocols are submitted in detail.

[Sensitization to storage mites--studies of the incidence of sensitivity to storage mites in comparison with house dust mites. Experiences in allergologic ambulatory care]. / Sensibilisierung gegen Vorratsmilben--Untersuchungen zur Häufigkeit der Sensibilisierung gegen Vorratsmilben im Vergleich zu Hausstaubmilben. Erfahrungen aus der allergologischen Ambulanz.

We examined the prevalence of sensitisation to storage mites and house dust mites in patients attending a pneumologist and allergologist in the office and clinical outpatient department. Our findings show sensitisations to storage mites up to 12%, to house dust mites in 26%. From a total of 3213 patients 914 patients (= 28%) showed positive skin reactions against at least one storage mite. There is a relationship of about 2:1 between house dust mites and storage mites in skin test results. From these data, safe conclusions as to the prevalence of storage mite sensitisation among the general population may not be drawn.

Clinical effects of benzyl benzoate in the prevention of house-dust-mite allergy. Results of a prospective, double-blind, multicenter study.

The efficacy of the acaricide benzyl benzoate as an additive to a chemically and technically defined cleaning substance (Acarosan) was tested in a multicentric, prospective, randomized, controlled study on 118 outpatients with bronchial asthma due to house-dust-mite allergy. Subjective reports from patients and doctors revealed an improvement in clinical complaints in more than 50%, with only small differences between the verum and the placebo group. Objective parameters such as titrated skin tests, RAST, and bronchial challenge tests with histamine and Dermatophagoides pteronyssinus (D. pt.) did not reveal any significant changes either during the year of testing or between the two groups. A clinical improvement as observed in either group could not be assessed by objective parameters. Additional questions as to the merits of the possible prophylactic use of benzyl benzoate over more than 1 year remain unanswered.

An unusual side effect on the skin under high dose D-penicillamin treatment.

An unusual side effect on the skin after one year's high dosage (3,0 g/die) of D-Penicillamin-treatment is reported. The skin showed double-pin-sized vesicles and laceration after minor injuries. After reduction of the dosage to 1,8 g/die and bathing the hands three times/day for 2 minutes in 1% Tannin solution the skin lesions and wounds healed eventually.