Zusammenfassung
Unter den nichtinvasiven Verfahren zur Erfassung einer Atemwegsentzündung werden zur Zeit nur für die Analyse des spontanen Sputums die Kosten von den Krankenkassen übernommen. Dieses Verfahren kann auch von niedergelassenen Pneumologen leicht für semiquantitative zytologische Analysen eingesetzt werden. Neuere Daten zeigen ebenfalls die Brauchbarkeit der Sputuminduktion, insbesondere für Diagnose und Therapiekontrolle eines Asthma, und belegen, dass hierdurch die Gesamtkosten pro Patient gesenkt werden können. Im Gegensatz zur Sputumanalyse liefert die Messung des ausgeatmeten Stickstoffmonoxids (NO) unmittelbar einen Wert. Vermöge seiner Assoziation mit Eosinophilen scheint NO ebenfalls für die Erfassung einer Atemwegentzündung geeignet. Die Zahl der Studien zur pathophysiologischen Bedeutung und zum klinischen Einsatz von NO ist weit größer als für andere Marker der Ausatemluft. Die Messungen sind einfach und schnell, doch stehen die hohen Investitionskosten dem Einsatz in der klinischen Praxis entgegen. Die Analyse anderer Komponenten der Ausatemluft, insbesondere solcher des Atemkondensats (EBC), bietet aufgrund der Vielfalt der im Prinzip messbaren Verbindungen faszinierende Perspektiven, bis hin zur Erstellung multivariater Markerprofile. Zum gegenwärtigen Zeitpunkt sind allerdings noch methodologische Fragen zu klären, und Daten über Nutzen und Kosten-Effizienz in der klinischen Praxis fehlen weitgehend. Verglichen mit NO ist der finanzielle Aufwand im klinischen Einsatz vor allem durch die Detektionsprozeduren pro Marker und Messung sowie die Kosten für Lagerung und Transport der Proben bestimmt. Möglicherweise stellt die direkte Messung des pH im Atemkondensat einen ersten Schritt zur Umgehung dieser Beschränkungen dar.
Abstract
Among the noninvasive procedures for the assessment of airway inflammation, the analysis of spontaneous sputum is currently the only method, the expenses of which are covered by health insurance in Germany. It can easily be used for semiquantitive cytological analyses by practising pneumologists. Recent data also indicate the usefulness of sputum induction, particularly in asthma diagnosis and therapy control, and demonstrate its capability of reducing total costs per patient. In contrast to sputum analysis, the measurement of exhaled nitric oxide (NO) yields a read-out without time delay. NO as associated with eosinophils also seems suitable for monitoring airway inflammation. The number of studies regarding NO, both its pathophysiological role and clinical use, is far greater than that regarding any other marker of exhaled air. Measurements are easy and fast, but the costs of analysers are still prohibitive in clinical practice. The analysis of other compounds of exhaled air, particularly those of exhaled breath condensate (EBC), offers fascinating perspectives, owing to the scope of markers that might be measured, and could enable the assessment of multivariate profiles that are useful for diagnosis and therapy control. Currently, however, the method still faces methodological questions, and data indicating its usefulness and cost-efficiency in clinical practice are scarce. Compared to NO, the expenses per measurement in clinical use are mainly due to the costs per marker detection after sampling, as well as storage and transport of samples. The on-site analysis of pH in the EBC could be a first step to circumvent this obstacle.
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Olaf Holz
Forschungslabor · Krankenhaus Großhansdorf · Zentrum für Pneumologie und Thoraxchirurgie
Wöhrendamm 80
22927 Großhansdorf
Email: o.holz@pulmoresearch.de; olaf.holz@t-online.de
