ABSTRACT
BACKGROUND: Ambroxol has been established for decades in the treatment of acute and chronic respiratory diseases. In 2015, the European Medicines Agency reassessed the clinical benefit-risk ratio of the drug. OBJECTIVE: What new scientific data on ambroxol, which are relevant to the treatment of bronchopulmonary diseases, are available? METHOD: The review is based on a systematic literature research in medline with the search term "ambroxol" during the publication period 2006-2015. Non-relevant publications were excluded manually. RESULTS AND CONCLUSIONS: Ambroxol is still intensively researched. The traditional indication as an expectorant is confirmed. But there is also an ever better understanding of the various mechanisms of action as well as the ever more exact modeling of the structures under investigation. New fields of application are conceivable, e. g. in patients with severe pulmonary disease who undergo surgery or who are in intensive care, as an adjuvant in anti-infective therapies, especially in infections with biofilm-producing pathogens, or in rare diseases such as lysosomal storage diseases. However, final evidence of the clinical relevance in these fields of application is still missing.
Subject(s)
Ambroxol/therapeutic use , Expectorants/therapeutic use , Lung Diseases/drug therapy , Clinical Trials as Topic , Humans , Publications/statistics & numerical dataSubject(s)
Diagnosis-Related Groups/economics , Diagnosis-Related Groups/legislation & jurisprudence , Healthcare Common Procedure Coding System/economics , Healthcare Common Procedure Coding System/legislation & jurisprudence , National Health Programs/economics , National Health Programs/legislation & jurisprudence , Ultrasonography/economics , Contrast Media/administration & dosage , Costs and Cost Analysis , Diagnosis, Differential , Echocardiography, Doppler, Color/economics , Echocardiography, Stress/economics , Germany , Humans , Insurance Coverage/economics , Insurance Coverage/legislation & jurisprudenceSubject(s)
Diagnosis-Related Groups/standards , Documentation/standards , Methicillin-Resistant Staphylococcus aureus , National Health Programs , Staphylococcal Infections/diagnosis , Diagnosis-Related Groups/economics , Documentation/economics , Fee Schedules , Germany , Humans , International Classification of Diseases , National Health Programs/economics , Reimbursement Mechanisms/economics , Staphylococcal Infections/microbiology , Staphylococcal Infections/therapy , Time FactorsSubject(s)
Abdominal Pain/etiology , Adipose Tissue/blood supply , Appendicitis/diagnosis , Appendix/blood supply , Torsion Abnormality/diagnosis , Typhlitis/diagnosis , Acute Disease , Adult , Appendicitis/surgery , Appendix/pathology , Diagnosis, Differential , Female , Humans , Laparoscopy , Necrosis , Sensitivity and Specificity , Torsion Abnormality/surgery , Ultrasonography , Ultrasonography, Doppler, ColorSubject(s)
Arrhythmias, Cardiac/diagnosis , Depressive Disorder, Major/diagnosis , Diagnosis-Related Groups/classification , International Classification of Diseases , National Health Programs , Panic Disorder/diagnosis , Somatoform Disorders/diagnosis , Female , Germany , Guidelines as Topic , Humans , Middle AgedSubject(s)
Cheyne-Stokes Respiration/classification , Diagnosis-Related Groups/economics , Sleep Apnea Syndromes/classification , Cheyne-Stokes Respiration/diagnosis , Cheyne-Stokes Respiration/economics , Diagnosis, Differential , Germany , Humans , Obesity Hypoventilation Syndrome/classification , Obesity Hypoventilation Syndrome/diagnosis , Obesity Hypoventilation Syndrome/economics , Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/economicsSubject(s)
Current Procedural Terminology , Diagnosis-Related Groups/economics , Hospital Costs/statistics & numerical data , Length of Stay/economics , National Health Programs/economics , Aftercare/economics , Cost Savings , Germany , Humans , Magnetic Resonance Imaging/economics , Patient Discharge/economicsSubject(s)
Alcohol Withdrawal Delirium/rehabilitation , Alcoholism/rehabilitation , Diagnosis-Related Groups/classification , International Classification of Diseases/classification , National Health Programs , Alcohol Withdrawal Delirium/diagnosis , Alcoholism/diagnosis , Comorbidity , Germany , Humans , Psychoses, Alcoholic/diagnosis , Psychoses, Alcoholic/rehabilitation , Relative Value ScalesABSTRACT
OBJECTIVE: The objective of our study was to determine whether transbronchial bronchoscopic biopsy of solitary pulmonary nodules under CT guidance using a low-dose protocol can increase diagnostic yield in patients who had undergone unsuccessful conventional bronchoscopic biopsy. SUBJECTS AND METHODS: We included 33 consecutive patients (25 men; mean age +/- SD, 64 +/- 9.6 years) with solitary pulmonary nodules at different sites and with a lesion-to-pleura distance of at least 2 cm who previously underwent conventional bronchoscopy that did not result in histologic diagnosis. All patients were prospectively investigated with transbronchial bronchoscopic biopsy under MDCT guidance. Examinations were performed with the patient in conscious sedation using a low-dose protocol (80 kV, 20 mAs, 5-mm collimation, 10-mm slices). The position of the tip of the biopsy device was confirmed and documented before biopsies were performed. All specimens were examined by standard histopathologic techniques. The effective radiation dose was calculated for every patient. RESULTS: The diagnostic yield was 24 in 33 selected patients (overall accuracy, 72.7%): 13 (54%) had primary lung cancer and 11 (46%) had benign diagnoses. The formal operative characteristics were sensitivity, 59%; specificity, 100%; positive predictive value, 100%; and negative predictive value, 55%. The final diagnoses of the remaining nine patients in whom transbronchial bronchoscopic biopsy was not diagnostic were non-small cell lung cancer (n = 3); small cell lung cancer (n = 3); and alveolar carcinoma, carcinoid tumor, and hemorrhaged bulla (n = 1 each). All nonmalignant diagnoses were confirmed by 6 months radiographic and clinical follow-up. The mean duration of the procedure was 39 +/- 15 minutes, and the average effective dose was 0.7 mSv (range, 0.5-1.1 mSv). One case of pulmonary hemorrhage (3%) occurred after the procedure. CONCLUSION: MDCT-guided transbronchial bronchoscopic biopsy is a promising and safe tool for the diagnostic pathway of solitary pulmonary nodules in previously undiagnosed patients. Image quality was sufficient with low-dose protocols, which resulted in low radiation exposure for patients and personnel.
Subject(s)
Biopsy, Needle/methods , Lung Neoplasms/diagnosis , Lung/pathology , Radiography, Interventional , Solitary Pulmonary Nodule/diagnosis , Tomography, X-Ray Computed , Bronchoscopy , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Radiation Dosage , Sensitivity and SpecificitySubject(s)
Comorbidity , Diagnosis-Related Groups , International Classification of Diseases , National Health Programs , Diabetes Mellitus/diagnosis , Diabetes Mellitus/therapy , Germany , Humans , Hypoglycemia/diagnosis , Hypoglycemia/therapy , Medical Staff, Hospital , Patient Admission , Urinary Tract Infections/diagnosis , Urinary Tract Infections/therapySubject(s)
Diagnosis-Related Groups/legislation & jurisprudence , Insurance, Health, Reimbursement/legislation & jurisprudence , International Classification of Diseases/legislation & jurisprudence , Length of Stay/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Patient Readmission/legislation & jurisprudence , Cost Control/legislation & jurisprudence , Diagnosis-Related Groups/economics , Germany , Humans , Insurance, Health, Reimbursement/economics , International Classification of Diseases/economics , Length of Stay/economics , National Health Programs/economics , Patient Readmission/economics , Patient Transfer/economics , Patient Transfer/legislation & jurisprudenceABSTRACT
BACKGROUND AND PURPOSE: Obstructive sleep apnea syndrome (OSAS) is regarded as a cardiovascular risk factor. Therefore, cardiopulmonary exercise capacity in patients with OSAS before and under treatment with continuous positive airway pressure (CPAP) was investigated. PATIENTS AND METHODS: Cardiopulmonary exercise capacity was investigated in 36 patients with untreated OSAS using spiroergometry. A follow-up after at least 6 months was performed in 17 of these patients being treated with CPAP and in eight CPAP-neglecting patients, who served as controls. RESULTS: Maximum oxygen uptake (