Helgo Magnussen

Pulmonary Research Institute at Lungclinic Grosshansdorf

Background The 2017 ATS/ERS technical standard for measuring the single-breath diffusing capacity (DLCO) proposed the “rapid-gas-analyzer” (RGA) or, equivalently, “total-breath” (TB) method for the determination of total lung capacity (TLC). In this study, we compared DLCO and TLC values estimated using the TB and conventional method, and how estim...

Background Subjects with obesity show an increased prevalence of airway obstruction but it is not clear in each case whether this reflects genuine lung disease. Via intentional increase in end-expiratory lung volume we studied the detection of obesity-induced airway obstruction in lung-healthy obese subjects. Methods The primary study population c...

Background Lung emphysema is an important phenotype of chronic obstructive pulmonary disease (COPD), and CT scanning is strongly recommended to establish the diagnosis. This study aimed to identify criteria by which physicians with limited technical resources can improve the diagnosis of emphysema. Methods We studied 436 COPD patients with prospec...

Background Inhaled corticosteroids (ICS) are indicated for prevention of exacerbations in patients with COPD, but they are frequently overprescribed. ICS withdrawal has been recommended by international guidelines in order to prevent side effects in patients in whom ICS are not indicated. Method Observational comparative effectiveness study aimed...

Purpose In the Withdrawal of Inhaled Steroids during Optimized Bronchodilator Management (WISDOM) trial, inhaled corticosteroid (ICS) withdrawal in patients with chronic obstructive pulmonary disease receiving triple therapy (long-acting β2-agonist+long-acting muscarinic antagonist+ICS) did not change moderate/severe exacerbation risk. However, man...

Background: Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow limitation and chronic inflammation. Predicting exacerbations of COPD, which contribute to disease progression, is important to guide preventative treatment and improve outcomes. Blood eosinophils are a biomarker for patient responsiveness to inhaled c...

The Global Initiative for Asthma (GINA) report was primarily intended as a strategy document and not a clinical guideline. However, the 2014 update moved the report towards a "practical, clinical practice‐centred document", and has in many countries formed a basis for national guidelines. A possible limitation of the GINA report is its primary focu...

Background Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with loss of lung function and poor outcomes for patients. However, there are limited data on the time course of changes in forced expiratory volume in 1 s (FEV1) preceding the first reported symptom and after the start of an exacerbation. Methods WISDOM was a...

Background: Little is known about physical activity in daily life among patients with sarcoidosis. Fatigue is a frequent and disabling symptom that might negatively affect physical activity levels. Methods: In patients with sarcoidosis, we measured physical activity (steps per day) by accelerometry (SenseWear Armband) for 1 week. We assessed lun...

Triple inhaled therapy for chronic obstructive pulmonary disease (COPD) consists of an inhaled corticosteroid (ICS), a long-acting β2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) taken in combination. Triple therapy is recommended by the Global initiative for Chronic Obstructive Lung Disease (GOLD) for patients who experience recur...

We described physical activity measures and hourly patterns in patients with chronic obstructive pulmonary disease (COPD) after stratification for generic and COPD-specific characteristics and, based on multiple physical activity measures, we identified clusters of patients. In total, 1001 patients with COPD (65% men; age, 67 years; forced expirato...

Background: Dyspnea is the impairing cardinal symptom in COPD, but the underlying brain mechanisms and their relationships to clinical patient characteristics are widely unknown. This study compared neural responses to the perception and anticipation of dyspnea between patients with stable moderate-to-severe COPD and healthy controls. Moreover, ass...

Background Physical activity (PA) is associated with disease severity in idiopathic pulmonary fibrosis (IPF), but longitudinal studies evaluating its prognostic value and changes over time are lacking. Methods We measured PA (steps per day, SPD) in a cohort of 46 IPF-patients (mean age, 67 years; mean FVC, 76.1%pred.) by accelerometry at baseline,...

Introduction Plasminogen activator inhibitor-1 (PAI-1), a major inhibitor of fibrinolysis, is associated with thrombosis, obesity, insulin resistance, dyslipidemia, and premature aging, which all are coexisting conditions of chronic obstructive pulmonary disease (COPD). The role of PAI-1 in COPD with respect to metabolic and cardiovascular function...

Introduction Predire le risque d’exacerbation est un enjeu de la prise en charge de la BPCO. Objectif Identifier les facteurs de risque d’exacerbation en utilisant une analyse multivariee des donnees issues de l’etude Wisdom (Fig. 1). Methodes L’etude Wisdom a permis de recruter (NCT00975195 ; 12 mois, randomisee, en groupes paralleles) des patient...

Introduction La mesure du nombre d’eosinophiles circulant a ete associee a la survenue d’exacerbations plus frequentes au cours de l’histoire naturelle de la BPCO. Objectif Au cours de l’etude Wisdom, on a apprecie si les patients avec un nombre d’eosinophiles different presentaient plus ou moins d’exacerbation de BPCO a l’arret de la corticotherap...

Background Sleep disturbances are common in patients with chronic obstructive pulmonary disease (COPD) with a considerable negative impact on their quality of life. However, factors associated with measures of sleep in daily life have not been investigated before nor has the association between sleep and the ability to engage in physical activity o...

Rationale The WISDOM study (NCT00975195) showed no increased risk of exacerbation when inhaled corticosteroid (ICS) was withdrawn stepwise in patients with severe COPD on LAMA+LABA maintenance therapy versus continued LAMA+LABA+ICS.¹ Daily home spirometry measured the time course of lung-function changes throughout the study. The aim of this post h...

Introduction The coexistence of chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) is frequent and might be inter-related through inflammation-related processes reflected by specific markers. Here, we studied angiopoietin-like protein 4 (ANGPTL4), an upcoming cardiovascular marker, in stable COPD, and its relationship to...

BACKGROUND: The observed coexistence of COPD and cardiovascular disease (CVD) may be interrelated through inflammatory processes. Here we investigated the relationship between angiopoietin-like protein 4 (ANGPTL4), an acute phase protein, and cardiovascular function in patients with COPD. METHODS: In a cohort study we assessed serum levels of ANGP...

Introduction: Treatment management and patient outcomes could be improved by identifying patients with severe COPD who are at increased risk of exacerbations. Aim: To identify factors associated with exacerbation risk using a multivariate analysis of data from the WISDOM study. Methods: In WISDOM ([NCT00975195][1]; 12-month, randomised, parallel-...

Background: Aclidinium bromide 400 µg (AB) is known to improve lung function and symptoms in moderate to severe COPD; however, sleep disturbances are common in patients with COPD. Aim: This study investigated the effects of AB on symptoms and sleep quality. Methods: This was a Phase IV, 21-day, randomized, double-blind, placebo (PBO)-controlled, tw...

Introduction: Blood eosinophil counts may predict response to inhaled corticosteroids (ICS) in patients with COPD with a history of exacerbations. Aim: To investigate if higher screening blood eosinophil counts were associated with more exacerbations after ICS withdrawal in the WISDOM study. Methods: In WISDOM (NCT00975195; 12-month, randomised, pa...

The WISDOM study (NCT0975195) reported a change in lung function following withdrawal of fluticasone propionate in patients with severe to very severe COPD treated with tiotropium and salmeterol. However, little is known about the validity of home-based spirometry measurements of lung function in COPD. Therefore, as part of this study, following su...

Rationale: Knowledge about the prevalence of objectively assessed peripheral artery disease (PAD) and its clinical relevance in patients with COPD is scarce. Objectives: We aimed (1) to assess the prevalence of PAD in COPD compared to distinct control groups and (2) to study the association between PAD and functional capacity as well as health s...

Background: Little is known about the consequences of idiopathic pulmonary fibrosis (IPF) for physical activity (PA). Objectives: We aimed to investigate levels of PA in IPF and to study associations of PA with lung function, exercise capacity, symptoms, and quality of life. Methods: In stable patients with IPF we measured PA (steps per day, S...

Background: Blood eosinophil counts might predict response to inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) and a history of exacerbations. We used data from the WISDOM trial to assess whether patients with COPD with higher blood eosinophil counts would be more likely to have exacerbations if ICS treat...

Rationale Sporadic lymphangioleiomyomatosis (LAM) is an orphan lung disease for which daily physical activity has not been studied so far and it is unclear whether a disease-specific impact beyond airflow limitation exists. Clinical correlates indicating reduced physical activity in addition to established parameters like airflow limitation and hyp...

During the 2015 European Respiratory Society Congress, a symposium was held on ‘Current thinking and new paradigm for COPD’. Through a combination of plenary lectures and interactive panel discussions, experts discussed the recent evidence for chronic obstructive pulmonary disease (COPD) treatment and how this evidence can be applied in clinical pr...

Die aktuelle S3-Leitlinie Palliativmedizin widmet sich vier Symptomen, die unheilbar kranke Krebspatienten besonders häufig beeinträchtigen: Atemnot, Tumorschmerz, Obstipation und Depression. Wie können Sie diese Symptome erfassen und behandeln?

The combination of an inhaled long-acting β2-agonist with an inhaled corticosteroid (ICS) is widely used in the management of chronic obstructive pulmonary disease (COPD), primarily to prevent exacerbations [1]. Concerns about the increased risk of pneumonia, even with newer ICS [2], have generated interest in whether the ICS can be safely withdraw...

Introduction: The WISDOM study (NCT00975195) showed that in patients with severe to very severe COPD receiving tiotropium + salmeterol, risk of moderate or severe exacerbations was non-inferior in patients discontinuing inhaled corticosteroids (ICS) compared to those continuing ICS. However, patients in the ICS-withdrawal arm had a small reduction...

Background: COPD is characterized by exercise intolerance, muscle depletion, and physical inactivity. The aim of this study was to analyze the role of sustained physical inactivity for changes in exercise capacity and skeletal muscle mass in the course of COPD. Methods: In this cohort study, we measured physical activity level (PAL; total daily ene...

Patients with COPD suffer from chronic dyspnea. Previous studies on the neural mechanisms underlying dyspnea perception were investigated in healthy volunteers only. We tested whether COPD patients compared to healthy controls show different neural responses while anticipating and perceiving dyspnea, and whether neural responses correlate with dise...

COPD is characterized by neutrophilic airway inflammation. Neutrophil extracellular trap formation (NETosis), which consists of extracellular neutrophilic DNA, histones and granule enzymes, such as neutrophil elastase may regulate innate immune responses and potentially contribute to neutrophil-associated diseases. The presence of NETosis in sputum...

Introduction Chronic obstructive pulmonary disease (COPD) is characterized by neutrophilic airway inflammation. Neutrophil extracellular trap (NET) formation - a meshwork of neutrophil DNA components and neutrophil enzymes are involved in innate immunity and inflammation. Little is known about the presence of these structures in induced sputum from...

The diagnostic pathway for the evaluation of patients with dyspnea requires a thorough history taking and physical examination. Based on the results of these basic steps a broad variety of additional diagnostic tests are available. Each test can contribute valuable information when correctly indicated and performed. Among these are electrocardiogra...

Patients with Chronic Obstructive Pulmonary Disease (COPD) suffer from chronic dyspnea, which is commonly perceived as highly aversive and threatening. Moreover, COPD is often accompanied by disease-specific fears and avoidance of physical activity. However, little is known about structural brain changes in COPD patients and respective relations wi...

Little is known about the role of physical activity in the course of COPD. The aim of this study was to assess changes in physical activity in COPD in relation to severity stages and changes in other disease components, and to evaluate the longitudinal association between sustained physical inactivity and disease progression. In this prospective co...

Spirometry is a simple test which is considered the gold standard in lung function. An obstructive ventilatory defect is a disproportionate reduction of maximal airflow from the lung in relation to the maximal volume that can be displaced from the lung. It implies airway narrowing and is defined by a reduced FEV1/FVC ratio below the 5th percentile...

Spirometry is a simple test and considered the gold standard in lung function. An obstructive ventilatory defect is a disproportionate reduction of maximal airflow from the lung in relation to the maximal volume that can be displaced from the lung. It implies airway narrowing and is defined by a reduced FEV1/FVC ratio below the 5th percentile of th...

Rationale: An antagonist (MK-7123) of the cytokine receptor CXCR2 reduces neutrophil chemotaxis and thus may alleviate airway inflammation in chronic obstructive pulmonary disease (COPD). Objectives: To assess the efficacy, safety, and tolerability of three dose levels of MK-7123, compared with placebo, in patients with moderate to severe COPD....

This study evaluated the effects of aclidinium bromide, a long-acting muscarinic antagonist indicated for maintenance treatment of chronic obstructive pulmonary disease (COPD), on exercise endurance, dyspnea, lung hyperinflation, and physical activity. In this randomized, double-blind, crossover study, patients with moderate-to-severe COPD received...

Asthma is an inflammatory disease of the airways, but in clinical practice inflammation is rarely monitored. The aim of this study was to assess the level of airway inflammation in steroid naive adult and pediatric patients with intermittent asthma over one year. 54 children and 50 adults with intermittent asthma (GINA step 1) were included. On up...

This European Respiratory Society (ERS) statement provides a comprehensive overview on physical activity in patients with chronic obstructive pulmonary disease (COPD). A multidisciplinary Task Force of experts representing the ERS Scientific Group 01.02 “Rehabilitation and Chronic Care” determined the overall scope of this statement through consens...

Indacaterol is a long-acting beta-2 agonist for once-daily treatment of COPD. We evaluated the effects of indacaterol 150 μg on lung hyperinflation compared with placebo and open-label tiotropium 18 μg. We measured physical activity during treatment with indacaterol 150 μg and matched placebo. We performed a randomized, three-period, cross-over stu...

Treatment with inhaled glucocorticoids in combination with long-acting bronchodilators is recommended in patients with frequent exacerbations of severe chronic obstructive pulmonary disease (COPD). However, the benefit of inhaled glucocorticoids in addition to two long-acting bronchodilators has not been fully explored. Methods In this 12-month,...

Background Treatment with inhaled glucocorticoids in combination with long-acting bronchodilators is recommended in patients with frequent exacerbations of severe chronic obstructive pulmonary disease (COPD). However, the benefit of inhaled glucocorticoids in addition to two long-acting bronchodilators has not been fully explored. Methods In this 1...

Rationale: Asthma is a chronic inflammatory airway disease of the whole bronchial tree. In this exploratory study we investigated the effects of beclomethasone/formoterol (becl/form) and budesonide/formoterol (bud/form) fixed combinations on lung function and airway inflammation in patients with mild to moderate asthma. Methods: 22 adult patient...

Although not yet widely implemented, fraction of exhaled nitric oxide (FeNO) has emerged in recent years as a potentially useful biomarker for the assessment of airway inflammation both in undiagnosed patients with non-specific respiratory symptoms and in those with established airway disease. Research to date essentially suggests that FeNO measure...

Ziel: Die Erstellung von evidenzbasierten und durch Experten konsentierten Empfehlungen im Rahmen von Leitlinien ist ein wichtiger Schritt zur Verbesserung der Qualitat der Versorgung von Patienten mit nicht heilbaren Krebserkrankungen. Darstellung der Ergebnisse, sowie der geplanten Implementierungsschritte ist das Ziel des Beitrages. Methodik: Zu...