Expertentreffen Obstruktive Atemwegserkrankungen: Targets und Methoden^[*]

Zusammenfassung

Zur Pathogenese und Klinik der chronisch obstruktiven Lungenerkrankung (COPD) und des Asthma bronchiale liegen zahlreiche neue Ergebnisse vor. Es wurden systematische Analysen von wohldefinierten und intensiv untersuchten Patientenkohorten publiziert, wie von der ECLIPSE-Kohorte in den USA und dem COSYCONet in Deutschland. Zentrale Publikationen des Jahres 2011 zur COPD und zum Asthma stellen bisherige Vorstellungen in Frage. Das pathogenetische Verhältnis von Parenchymdestruktion und bronchialer Obstruktion bei der COPD wird neu gesehen und die Bedeutung der kardiovaskulären Komorbidität neu bewertet. Die Bildgebung mit Computertomografie erlaubt die hochauflösende Darstellung der Lungenstruktur, und die MRT liefert zusätzlich funktionelle Informationen. Die Sicht der Patienten rückt stärker in den Fokus und wird mit Lebensqualitätsfragebögen, Dyspnoe-Skalen und dem COPD Assessment Test (CAT) dokumentiert. Das GOLD-Komitee unternimmt den Versuch, eine praktikable Klassifikation für die multiplen Facetten der COPD zu erarbeiten. Für die Therapie der COPD liegen Daten zu Betarezeptor-Antagonisten vor, ebenso wie zum Stellenwert der Anticholinergika für die Asthmatherapie. Diese Schwerpunkte waren Thema einer Expertentagung und werden im Übersichtsartikel zusammengefasst.

Abstract

New insights into the pathogenesis and clinical course of chronic obstructive pulmonary disease (COPD) and asthma have become available. Systematic analyses of well-defined and intensively monitored patient cohorts are being published, particularly from the ECLIPSE cohort in the USA and from the network COSYCONet in Germany. Important articles from 2011 on COPD and asthma put former concepts into question. There is a new understanding of the relationship between parenchymal destruction and bronchial obstruction in COPD as well as on the impact of cardiovascular comorbidity. Computed tomography allows high-resolution imaging of lung structures, and MRI delivers supplementary functional information. Researchers have also investigated the value of patient-reported outcomes, such as quality of life, dyspnoea, or the COPD assessment test (CAT). Members of the GOLD committee are trying to establish a feasible classification of the multiple facets of COPD. With respect to treatment, novel data on beta-adrenergic antagonists in COPD and on muscarinic antagonists in asthma have been published. These aspects were discussed during an expert meeting and are now summarised in the present review article.

^* Sponsor: Boehringer Ingelheim Pharma GmbH & Co KG

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