[Gender-Specific Differences in Obstructive Lung Diseases]. / Genderaspekte obstruktiver Atemwegserkrankungen.

Asthma is a common disease with increasing prevalence worldwide. Sex differences in asthma vary with age. The prevalence of chronic obstructive pulmonary disease (COPD) in females appears to be increasing.There is increasing clinical evidence for sex differences in incidence, morbidity, and mortality of obstructive lung disease. The purpose of this review is to define sex differences in epidemiology, symptom profiles, and management. This provides valuable information which could aid the management of asthma and COPD. There is still a high amount of research in gender medicine to do.

Sleep apnoea in heart failure.

Studies from the USA have reported that sleep apnoea is common in congestive heart failure (CHF), with Cheyne-Stokes respiration (CSR) being the most frequent type of sleep-disordered breathing (SDB) in these patients. Within the present study, the authors sought to assess the prevalence and type of SDB among CHF patients in Germany. A total of 203 CHF patients participated in this prospective multicentre study. All patients were stable in New York Heart Association classes II and III and had a left ventricular ejection fraction (LVEF)<40%. The patients were investigated by polygraphy and all data were centrally analysed. Patient enrolment was irrespective of sleep-related symptoms. The majority of patients were male with a mean age of 65 yrs and hospitalised. Of the 203 patients, 145 (71%) had an apnoea/hypopnoea index>10.h(-1), obstructive sleep apnoea (OSA) occurred in 43% (n=88) and CSR in 28% (n=57) of patients. The prevalence of sleep-disordered breathing is high in patients with stable severe congestive heart failure from a European population. As sleep-disordered breathing may have a negative impact on the prognosis of congestive heart failure, a sleep study should be performed in every patient with congestive heart failure and a left ventricular ejection fraction of <40%. This diagnostic approach should probably be adopted for all of these patients irrespective of the presence of sleep-related symptoms.

Dynamics from picoseconds to nanoseconds of trehalose in aqueous solutions as seen by quasielastic neutron scattering.

We present a study of the dynamical behavior of trehalose, a cryoprotecting agent, in concentrated aqueous solutions. Dynamics in a wide time range from picoseconds to nanoseconds has been observed using both neutron time of flight and neutron spin-echo techniques. Fast dynamics has been described using a simple diffusion model, while dynamical processes at longer times show a more complex behavior, described by a stretched exponential decay. Obtained relaxation times show a good agreement with data from viscosity measurements on aqueous trehalose solutions by Magazu et al. [Branca, Magazu, Maisano et al., J. Phys.: Condens. Matter 11, 3823 (1999)]. Experimental data provide us with some insight into the cryoprotecting properties and processes of trehalose. We conclude that an increase of the solvent viscosity in embedded biological material due to the production or the presence of trehalose might prevent biomolecules from damage.

[Therapy of nocturnal asthma: salmeterol versus nocturnal administration of retard theophylline--comparison of effectiveness and tolerance]. / Therapie des nächtlichen Asthmas: Salmeterol versus abendliche Einnahme von retardiertem Theophyllin--Vergleich der Wirksamkeit und der Verträglichkeit.

The aim of the present study was to compare the efficacy and the tolerability of salmeterol and theophylline in patients with nocturnal asthma. 16 patients were entered into a randomized, double-blind, crossover trial. Using a double-dummy technique, salmeterol (50 micrograms b.i.d. by MDI) or theophylline (Uniphyllin; 600 mg nocte orally) were given for periods of 7 days with a wash-out period of 7 days between treatment periods. With salmeterol the number of nights with an overnight fall in peak expiratory peak flow rate (PEFR) of at least 20% was reduced by about 20% compared to about 10% with theophyllin (p < 0.05 for the difference between salmeterol and theophylline). With respect to nocturnal symptoms 62.6% of the patients had rare or non symptoms without and 84.7% with salmeterol, compared to 46.5% without and 67.3% with theophylline (p < 0.05). With respect to the improvement of early morning symptoms, the increase of nights with none or rare symptoms was 46.2% with salmeterol compared to 25.8% with theophylline. The overall parameter of efficacy defined as a) the number of nights with an overnight fall in PEFR or less than 20% als well as b) none or rare nocturnal symptoms and c) none or rare early morning symptoms increased from 23.4% at baseline to 75.1% during treatment with salmeterol compared to an increase from 24.5% at baseline with 54.8% during treatment with theophylline (p < 0.05). 12 patients preferred salmeterol over theophylline (p < 0.05). 3 patients had gastrointestinal disturbances during theophylline treatment. It can be concluded that both salmeterol and theophylline are effective in the treatment of nocturnal asthma. With respect to the overall efficacy and the tolerability salmeterol is superior to theophylline.

[Therapy of bronchial asthma during pregnancy]. / Therapie des Asthma bronchiale in der Schwangerschaft.

Asthma has been reported to occur in 0.4-1% of pregnant women. A number of clinical studies have attempted to clarify the effect of pregnancy on the course of asthma. Taken together, there is little consistent evidence that pregnancy profoundly influences the severity of asthma, except in occasional individuals. The goals of therapy in managing asthma in a pregnant women are identical to those in a nonpregnant woman with asthma. Management of pregnant women with asthma aims at preventing recurrent attacks of wheezing, acute severe asthmatic attacks, and respiratory failure. Recent studies suggest that inflammation in the airway walls may play an important role in the pathogenesis of asthma. It is increasingly apparent that several different cells, particularly eosinophils, lymphocytes, macrophages, produce a variety of mediators that interact in a complex way to produce a number of pathologic effects. Therefore, the primary treatment should involve antiinflammatory drugs. At present, inhaled corticosteroids appear to be the most effective therapy. Cromolyn sodium may also have an antiinflammatory effect. On the other hand, beta 2-sympathomimetics are the most effective bronchodilators available, followed by theophylline. None of these anti-asthma drugs is harmful in usual doses, to either woman or fetus.