Guidelines updated in collaboration with ARCN physicians

Physicians of ARCN help to guarantee optimal diagnosis and therapy of in lung diseases by keeping guidelines up to date. Already last year, guidelines for asthma as well as for tuberculosis in adults have been refreshed. In the first quarter of 2018, the guideline for nosocomial pneumonia and the “Updated Recommendation for Treatment of Metastatic Non-Small Cell Lung Cancer” were added. The new guidelines for COPD and lung cancer will be published within a short time. ARCN physicians are also involved here.

Medical guidelines are intended to support physicians in treating their patients. Guidelines describe the state of the art of evidence-based research. Therefore, they represent an important interface between science and clinical practice. Since 1995 the Association of the Scientific Medical Societies in Germany (AWMF, ‚Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften‘) coordinates the accurately defined process of guideline production. Below, three guidelines and one therapy recommendation will be presented which were published recently in collaboration with ARCN physicians.

The updated asthma guideline defines the disease and describes the most important diagnostic methods and therapeutic interventions. Further chapters deal with comorbidities, prevention, occupational asthma as well as asthma during pregnancy. The guideline was developed in collaboration of the German and Austrian Societies together with the Society for Pediatric Pneumology and the Deutsche Atemwegsliga. Therefore, it encompasses recommendations for children as well as adults. From DZL site ARCN, Prof. Klaus F. Rabe (LungenClinic Grosshansdorf) was involved – next to colleagues from DZL sites UGMLC and CPC-M. The article was published in the December 2017 edition of Pneumologie, the organ of DZL and DGP.

The ‘Updated Recommendation for Treatment of Metastatic Non-Small Cell Lung Cancer’ was published in January in Pneumologie. The first part gives an overview of current diagnostic methods. An important feature in this context is the detection of driver mutations: in case of a positive result a patient could receive a targeted therapy. If PD-L1 expression is detected, a therapy with monoclonal antibodies should be considered. The second part of the article deals with different treatment options and schemes. In particular, patients with gene mutations can be treated with newly approved targeted first-line medications, i.e. EGFR tyrosine kinase inhibitors, ALK tyrosine kinase inhibitors and the combination trametinib/dabrafenib for patients with BRAF-V600E mutation. In case of a relapse, therapy with osimertinib (in patients with resistance due to T900M mutation who already received EGFR-TKI treatment) or immunotherapy as first- or second-line are options. The authors – including ARCN oncologist Prof. Martin Reck (LungenClinic Grosshansdorf) and PD Dr. Niels Reinmuth of DZL site CPC-M – present their personal view which is nevertheless based on the guidelines of the Medical Society. Thus, their recommendations don’t have the rank of a guideline, “but they present the most current state of research to our readers, because we portray and discuss the most recently available (and approved) therapies”, says Martin Reck. Guidelines cannot have this state of currency.

There is also a new guideline for tuberculosis in adults which was developed with the collaboration of Prof. Roland Diel (LungenClinic Grosshansdorf and UKSH, Campus Kiel). It includes expanded chapters on drug-resistant tuberculosis, HIV coinfection and pharmacologic management.

Prof. Klaus Dalhoff (UKSH, Campus Lübeck) lead the commission on the updated guideline on ‘Epidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia‘. New recommendations for diagnostic tools, on prolonged infusion with antibacterial drugs, and improved therapy concepts have been added. Also in this case, authors from further DZL sites – BREATH, UGMLC and TLRC – were involved.

Further information:

• Deutsche Gesellschaft für Arbeitsmedizin und Umweltmedizin e. V., Deutsche Gesellschaft für Rehabilitationswissenschaften e V, und Deutsche Gesellschaft für Gynäkologie und Geburtshilfe e. V., Buhl R, Bals R, Baur X, Berdel D, Criée CP, Gappa M, Gillissen A, Greulich T, Haidl P, Hamelmann E, Kardos P, Kenn K, Klimek L, Korn S, Lommatzsch M, Magnussen H, Nicolai T, Nowak D, Pfaar O, Rabe KF, Riedler J, Ritz T, Schultz K, Schuster A, Spindler T, Taube C, Taube K, Vogelmeier C, von Leupold A, Wantke F, Weise S, Wildhaber J, Worth H, Zacharasiewicz A (2017) [Guideline for the Diagnosis and Treatment of Asthma – Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology]. Pneumologie 71: 849-919 (ARCN, CPC-M, UGMLC) External link to the article [in German]

• Reinmuth N, Gröschel A, Schumann C, Sebastian M, Wiewrodt R, Reck M (2018) [Updated Recommendation for Treatment of Metastatic Non-Small Cell Lung Cancer]. Pneumologie 72: 138-154 (ARCN, CPC-M) External link to the article [in German]

• Schaberg T, Bauer T, Brinkmann F, Diel R, Feiterna-Sperling C, Haas W, Hartmann P, Hauer B, Heyckendorf J, Lange C, Nienhaus A, Otto-Knapp R, Priwitzer M, Richter E, Rumetshofer R, Schenkel K, Schoch OD, Schönfeld N, Stahlmann R (2017) [Tuberculosis Guideline for Adults – Guideline for Diagnosis and Treatment of Tuberculosis including LTBI Testing and Treatment of the German Central Committee (DZK) and the German Respiratory Society (DGP)]. Pneumologie 71: 325-397 (ARCN) External link to the article [in German]

• Dalhoff K, Abele-Horn M, Andreas S, Deja M, Ewig S, Gastmeier P, Gatermann S, Gerlach H, Grabein B, Heussel CP, Höffken G, Kolditz M, Kramme E, Kühl H, Lange C, Mayer K, Nachtigall I, Panning M, Pletz M, Rath PM, Rohde G, Rosseau S, Schaaf B, Schreiter D, Schütte H, Seifert H, Spies C, Welte T, in collaboration with the following scientific Societies and institutions: Deutsche Gesellschaft für Chirurgie, Deutsche Gesellschaft für Innere Medizin e. V., Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin, Deutsche Sepsis-Gesellschaft e. V., and Robert Koch-Institut (2018) [Epidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia – Update 2017 – S3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy, the German Radiological Society and the Society for Virology]. Pneumologie 72: 15-63 (ARCN, BREATH, TLRC, UGMLC) External link to the article [in German]

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