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  1. Article ; Online: Criteria for evaluation of response to biologics in severe asthma - the Biologics Asthma Response Score (BARS).

    Milger, Katrin / Korn, Stephanie / Feder, Claudia / Fuge, Jan / Mühle, Andreas / Schütte, Wolfgang / Skowasch, Dirk / Timmermann, Hartmut / Suhling, Hendrik

    Pneumologie (Stuttgart, Germany)

    2023  

    Abstract: Background:  The introduction of monoclonal antibodies (biologics) has revolutionized the therapy of severe asthma. Even though there is a response in the majority of patients, the degree of response varies. To date criteria for assessment of response ... ...

    Title translation Kriterien zur Evaluation des Ansprechens auf Biologika bei schwerem Asthma – der Biologics Asthma Response Score (BARS).
    Abstract Background:  The introduction of monoclonal antibodies (biologics) has revolutionized the therapy of severe asthma. Even though there is a response in the majority of patients, the degree of response varies. To date criteria for assessment of response to biologics are not consistently defined.
    Aim:  To define criteria for evaluation of response to biologics that are precise, simple and suitable for daily use in order to guide decision-making regarding continuation, switching or stopping of biological therapy.
    Methods:  8 physicians with large experience in this indication, supported by a data-scientist, developed a consensus on criteria to evaluate response to biologics in patients with severe asthma.
    Result:  We developed a combined score based on current literature, own experience and practicability. It uses the main criteria exacerbations, oral corticosteroid (OCS) therapy and asthma control (asthma control test, ACT). We defined thresholds for "good response", "response" and "insufficient response" rated with a score of "2", "1" and "0" respectively: annual exacerbations ("0 or reduction ≥ 75 %", "reduction 50-74 %", "reductio < 50 %"), daily OCS dose ("stopping or reduction ≥ 75 %", "reduction 50-74 %", "reduction < 50 %"), asthma control ("ACT increase ≥ 6 or ≥ 3 with result ≥ 20", "ACT increase 3-5 with result < 20", "ACT increase < 3"). Additional individual criteria like lung function and comorbidities may be important for evaluation of response. We propose 3, 6 and 12 months timepoint for assessment of tolerability and response. Using the combined score, we developed a scheme to guide the decision whether switching the biologic should be considered.
    Conclusion:  The Biologic Asthma Response Score (BARS) serves as objective and simple tool to evaluate response to biologic therapy using the three main criteria exacerbations, OCS use and asthma control. A validation of the score was initiated.
    Language English
    Publishing date 2023-08-25
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 607630-0
    ISSN 1438-8790 ; 0934-8387
    ISSN (online) 1438-8790
    ISSN 0934-8387
    DOI 10.1055/a-2102-8128
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Kriterien zur Evaluation des Ansprechens auf Biologika bei schwerem Asthma – der Biologics Asthma Response Score (BARS).

    Milger, Katrin / Korn, Stephanie / Feder, Claudia / Fuge, Jan / Mühle, Andreas / Schütte, Wolfgang / Skowasch, Dirk / Timmermann, Hartmut / Suhling, Hendrik

    Pneumologie (Stuttgart, Germany)

    2023  Volume 77, Issue 4, Page(s) 220–232

    Abstract: Background:  The introduction of monoclonal antibodies (biologics) has revolutionized the therapy of severe asthma. Even though there is a response in the majority of patients, the degree of response varies. To date criteria for assessment of response ... ...

    Title translation Criteria for evaluation of response to biologics in severe asthma - the Biologics Asthma Response Score (BARS).
    Abstract Background:  The introduction of monoclonal antibodies (biologics) has revolutionized the therapy of severe asthma. Even though there is a response in the majority of patients, the degree of response varies. To date criteria for assessment of response to biologics are not consistently defined.
    Aim:  To define criteria for evaluation of response to biologics that are precise, simple and suitable for daily use in order to guide decision-making regarding continuation, switching or stopping of biological therapy.
    Methods:  8 physicians with large experience in this indication, supported by a data-scientist, developed a consensus on criteria to evaluate response to biologics in patients with severe asthma.
    Result:  We developed a combined score based on current literature, own experience and practicability. It uses the main criteria exacerbations, oral corticosteroid (OCS) therapy and asthma control (asthma control test, ACT). We defined thresholds for "good response", "response" and "insufficient response" rated with a score of "2", "1" and "0" respectively: annual exacerbations ("0 or reduction ≥ 75 %", reduction 50-74 %", "reductio  < 50 %"), daily OCS dose ("stopping or reduction ≥ 75 %", "reduction 50-74 %", "reduction < 50 %"), asthma control (ACT increase ≥ 6 or ≥ 3 with result ≥ 20", "ACT increase 3-5 with result < 20", "ACT increase < 3"). Additional individual criteria like lung function and comorbidities may be important for evaluation of response. We propose 3, 6 and 12 months timepoint for assessment of tolerability and response. Using the combined score, we developed a scheme to guide the decision whether switching the biologic should be considered.
    Conclusion:  The Biologic Asthma Response Score (BARS) serves as objective and simple tool to evaluate response to biologic therapy using the three main criteria exacerbations, OCS use and asthma control. A validation of the score was initiated.
    MeSH term(s) Humans ; Anti-Asthmatic Agents/therapeutic use ; Asthma/diagnosis ; Asthma/drug therapy ; Biological Products/therapeutic use ; Adrenal Cortex Hormones
    Chemical Substances Anti-Asthmatic Agents ; Biological Products ; Adrenal Cortex Hormones
    Language German
    Publishing date 2023-02-16
    Publishing country Germany
    Document type English Abstract ; Journal Article
    ZDB-ID 607630-0
    ISSN 1438-8790 ; 0934-8387
    ISSN (online) 1438-8790
    ISSN 0934-8387
    DOI 10.1055/a-2014-4350
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    ab Jg. 2022: Lesesaal (EG)
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  3. Book ; Online ; Thesis: Zur Wertigkeit der Spiroergometrie bei der Charakterisierung und Schweregradbeurteilung von Patienten mit chronisch obstruktiver Lungenerkrankung (COPD)

    Mühle, Andreas

    2013  

    Abstract: Spiroergometrie, COPD ... Summary Chronic obstructive pulmonary disease (COPD) is a complex and very heterogeneous disease with multiple clinical phenotypes. Exertional intolerance as a main symptom of COPD results from individual different alterations in ... ...

    Author's details von Andreas Mühle
    Abstract Spiroergometrie, COPD

    Summary Chronic obstructive pulmonary disease (COPD) is a complex and very heterogeneous disease with multiple clinical phenotypes. Exertional intolerance as a main symptom of COPD results from individual different alterations in pulmonary ventilation, gas exchange, circulation and muscular function. COPD complexity is not adequately described with resting spirometric measurements. Cardiopulmonary exercise testing (CPET) is regarded as the gold standard assessment for evaluating exercise capacity and the causes of exercise limitation. The aim of the present investigations was to evaluate whether CPET can provide valuable functional and prognostic information in patients with moderate, severe and very severe COPD. 64 COPD patients stages II, III and IV according to the GOLD classification were examined by means of spirometry, body plethysmography, measurement of the diffusion capacity by the single-breath method, blood-gas analysis, MMRC dyspnea scale, echocardiography, six min walk test and symptom-limited exercise testing (cycle ergometer) with the ramp protocol of the SHIP study (Koch et al. 2009). All examinations were performed according to recognized national and international guidelines. CPET allowed a valid evaluation of exercise capacity and the mechanisms limiting exercise tolerance in all patients. There were no indications for terminating the exercise test before achieving the truly maximal effort. We have found one or more definite criteria of maximal effort in ...
    Language German
    Size Online-Ressource (PDF-Datei: 230 S., 2244 KB), graph. Darst.
    Publisher Universitätsbibliothek
    Publishing place Greifswald
    Document type Book ; Online ; Thesis
    Thesis / German Habilitation thesis Univ., Diss.--Greifswald, 2013
    Database Former special subject collection: coastal and deep sea fishing

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  4. Book ; Online ; Thesis: Zur Wertigkeit der Spiroergometrie bei der Charakterisierung und Schweregradbeurteilung von Patienten mit chronisch obstruktiver Lungenerkrankung (COPD)

    Mühle, Andreas [Verfasser]

    2013  

    Author's details Andreas Mühle
    Keywords Medizin, Gesundheit ; Medicine, Health
    Subject code sg610
    Language German
    Publisher Universitätsbibliothek Greifswald
    Publishing place Greifswald
    Document type Book ; Online ; Thesis
    Database Digital theses on the web

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  5. Article: Kriterien zur Evaluation des Ansprechens auf Biologika bei schwerem Asthma – der Biologics Asthma Response Score (BARS)

    Milger, Katrin / Korn, Stephanie / Feder, Claudia / Fuge, Jan / Mühle, Andreas / Schütte, Wolfgang / Skowasch, Dirk / Timmermann, Hartmut / Suhling, Hendrik

    Pneumologie

    2023  Volume 77, Issue 04, Page(s) 220–232

    Abstract: Hintergrund: Die Einführung monoklonaler Antikörper (Biologika) hat die Therapie des schweren Asthmas revolutioniert. Auch wenn die Mehrheit der Patienten ein Ansprechen zeigt, kann dieses unterschiedlich ausgeprägt sein. Bislang sind Kriterien zur ... ...

    Abstract Hintergrund: Die Einführung monoklonaler Antikörper (Biologika) hat die Therapie des schweren Asthmas revolutioniert. Auch wenn die Mehrheit der Patienten ein Ansprechen zeigt, kann dieses unterschiedlich ausgeprägt sein. Bislang sind Kriterien zur Beurteilung des Ansprechens auf Biologika nicht einheitlich definiert.
    Ziel: Definition von konkreten, einfachen und praxistauglichen Kriterien zur Bewertung des Ansprechens auf Biologika bei Patienten mit schwerem Asthma, um eine Entscheidungshilfe bzgl. Fortführung, Umstellung oder Beendigung der Therapie zu geben.
    Methoden: 8 Ärztinnen und Ärzte mit umfangreicher Erfahrung in dieser Indikation, unterstützt durch einen Data Scientist, erarbeiteten einen Experten-Konsens hinsichtlich Kriterien zur Evaluation des Ansprechens auf Biologika-Therapien bei Patienten mit schwerem Asthma.
    Ergebnis: Auf Basis aktueller Literatur, eigener Erfahrungen und Praktikabilität wurde ein kombinierter Score entwickelt. Dieser berücksichtigt als Hauptkriterien Exazerbationen, Dauertherapie mit oralen Steroiden (OCS) und Asthmakontrolle (Asthma Control Test, ACT). Schwellenwerte für die Einschätzung „gutes Ansprechen“, „Ansprechen“ und „unzureichendes Ansprechen“ wurden definiert und mit „2“, „1“ bzw. „0“ Punkten bewertet: jährliche Exazerbationen („0 oder Reduktion ≥ 75 %“, „Reduktion 50–74 %“, „Reduktion < 50 %“), Tagesdosis OCS („Absetzen oder Reduktion ≥ 75 %“, „Reduktion 50–74 %“, „Reduktion < 50 %“), Asthmakontrolle („ACT Anstieg ≥ 6 oder ≥ 3 mit Endwert ≥ 20“, „ACT Anstieg 3–5 mit Endwert < 20“, „ACT Anstieg < 3“). Zusätzliche individuelle Kriterien, wie Lungenfunktion und Komorbiditäten, können für die Bewertung des Therapieansprechens wichtig sein. Verträglichkeit und Ansprechen sollten nach 3, 6 und 12 Monaten erfasst werden. Anhand des Scores wurde ein praxisnahes Schema für die Entscheidung erarbeitet, ob ein Wechsel des Biologikums erwogen werden sollte.
    Schlussfolgerung: Der
    Biologics Asthma Response Score: dient zur objektiven und einfachen Einschätzung des Ansprechens auf Therapie mit Biologikum auf Grundlage einer strukturierten Bewertung der drei Hauptkriterien Exazerbationen, oraler Steroidverbrauch und Asthmakontrolle. Eine Validierung des Scores wurde initiiert.
    Keywords schweres Asthma ; Biologika ; Ansprechen ; Kriterien ; Score ; Umstellung ; severe asthma ; biologics ; response ; criteria ; score ; switching
    Language German
    Publishing date 2023-02-16
    Publisher Georg Thieme Verlag KG
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 607630-0
    ISSN 1438-8790 ; 0934-8387
    ISSN (online) 1438-8790
    ISSN 0934-8387
    DOI 10.1055/a-2014-4350
    Database Thieme publisher's database

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    Uh II Zs.142: Show issues Location:
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  6. Article: Criteria for evaluation of response to biologics in severe asthma – the Biologics Asthma Response Score (BARS)

    Milger, Katrin / Korn, Stephanie / Feder, Claudia / Fuge, Jan / Mühle, Andreas / Schütte, Wolfgang / Skowasch, Dirk / Timmermann, Hartmut / Suhling, Hendrik

    Pneumologie

    2023  

    Abstract: Background: The introduction of monoclonal antibodies (biologics) has revolutionized the therapy of severe asthma. Even though there is a response in the majority of patients, the degree of response varies. To date criteria for assessment of response to ...

    Abstract Background: The introduction of monoclonal antibodies (biologics) has revolutionized the therapy of severe asthma. Even though there is a response in the majority of patients, the degree of response varies. To date criteria for assessment of response to biologics are not consistently defined.
    Aim: To define criteria for evaluation of response to biologics that are precise, simple and suitable for daily use in order to guide decision-making regarding continuation, switching or stopping of biological therapy.
    Methods: 8 physicians with large experience in this indication, supported by a data-scientist, developed a consensus on criteria to evaluate response to biologics in patients with severe asthma.
    Result: We developed a combined score based on current literature, own experience and practicability. It uses the main criteria exacerbations, oral corticosteroid (OCS) therapy and asthma control (asthma control test, ACT). We defined thresholds for “good response”, “response” and “insufficient response” rated with a score of “2”, “1” and “0” respectively: annual exacerbations (“0 or reduction ≥ 75 %”, “reduction 50–74 %”, “reductio < 50 %”), daily OCS dose (“stopping or reduction ≥ 75 %”, “reduction 50–74 %”, “reduction < 50 %”), asthma control (“ACT increase ≥ 6 or ≥ 3 with result ≥ 20”, “ACT increase 3–5 with result < 20”, “ACT increase < 3”). Additional individual criteria like lung function and comorbidities may be important for evaluation of response. We propose 3, 6 and 12 months timepoint for assessment of tolerability and response. Using the combined score, we developed a scheme to guide the decision whether switching the biologic should be considered.
    Conclusion: The Biologic Asthma Response Score (BARS) serves as objective and simple tool to evaluate response to biologic therapy using the three main criteria exacerbations, OCS use and asthma control. A validation of the score was initiated.
    Keywords severe asthma ; biologics ; response ; criteria ; score ; switching ; schweres Asthma ; Biologika ; Ansprechen ; Kriterien ; Score ; Umstellung
    Language English
    Publishing date 2023-08-25
    Publisher Georg Thieme Verlag KG
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 607630-0
    ISSN 1438-8790 ; 0934-8387
    ISSN (online) 1438-8790
    ISSN 0934-8387
    DOI 10.1055/a-2102-8128
    Database Thieme publisher's database

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  7. Article ; Online: Value of Cardiopulmonary Exercise Testing in the Prognosis Assessment of Chronic Obstructive Pulmonary Disease Patients: A Retrospective, Multicentre Cohort Study.

    Ewert, Ralf / Obst, Anne / Mühle, Andreas / Halank, Michael / Winkler, Jörg / Trümper, Bernd / Hoheisel, Gerhard / Hoheisel, Andreas / Wiersbitzky, Mark / Heine, Alexander / Maiwald, Alexander / Gläser, Sven / Stubbe, Beate

    Respiration; international review of thoracic diseases

    2021  Volume 101, Issue 4, Page(s) 353–366

    Abstract: Introduction: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases associated with high mortality. Previous studies suggested a prognostic role for peak oxygen uptake (VO2peak) assessed during cardiopulmonary exercise ... ...

    Abstract Introduction: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases associated with high mortality. Previous studies suggested a prognostic role for peak oxygen uptake (VO2peak) assessed during cardiopulmonary exercise testing (CPET) in patients with COPD. However, most of these studies had small sample sizes or short follow-up periods, and despite their relevance, CPET parameters are not included in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) tool for assessment of severity.
    Objectives: We therefore aimed to assess the prognostic value of CPET parameters in a large cohort of outpatients with COPD.
    Methods: In this retrospective, multicentre cohort study, medical records of patients with COPD who underwent CPET during 2004-2017 were reviewed and demographics, smoking habits, GOLD grade and category, exacerbation frequency, dyspnoea score, lung function measurements, and CPET parameters were documented. Relationships with survival were evaluated using Kaplan-Meier analysis, Cox regression, and receiver operating characteristic (ROC) curves.
    Results: Of a total of 347 patients, 312 patients were included. Five-year and 10-year survival probability was 75% and 57%, respectively. VO2peak significantly predicted survival (hazard ratio: 0.886 [95% confidence interval: 0.830; 0.946]). The optimal VO2peak threshold for discrimination of 5-year survival was 14.6 mL/kg/min (area under ROC curve: 0.713). Five-year survival in patients with VO2peak <14.6 mL/kg/min versus ≥ 14.6 mL/kg/min was 60% versus 86% in GOLD categories A/B and 64% versus 90% in GOLD categories C/D.
    Conclusions: We confirm that VO2peak is a highly significant predictor of survival in COPD patients and recommend the incorporation of VO2peak into the assessment of COPD severity.
    MeSH term(s) Cohort Studies ; Exercise Test ; Humans ; Prognosis ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies
    Language English
    Publishing date 2021-11-19
    Publishing country Switzerland
    Document type Journal Article ; Multicenter Study
    ZDB-ID 206674-9
    ISSN 1423-0356 ; 0025-7931
    ISSN (online) 1423-0356
    ISSN 0025-7931
    DOI 10.1159/000519750
    Database MEDical Literature Analysis and Retrieval System OnLINE

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