Neue internationale Diagnoseleitlinien zur Diagnose der exogen-allergischen Alveolitis

Zeitschrift für Pneumologie - Tập 20 Số 6 - Trang 313-324 - 2023
Koschel, Dirk1,2,3
1Abteilung Innere Medizin und Pneumologie, Fachkrankenhaus Coswig, Lungenzentrum, Coswig, Deutschland
2Ostdeutsches Lungenzentrum, Coswig-Dresden, Deutschland
3 Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland

Tóm tắt

In den letzten Jahren wurden 2 internationale Leitlinien für die Diagnostik der exogen-allergischen Alveolitis (EAA) publiziert. Es erfolgt die Bewertung der beiden neuen internationalen EAA-Leitlinien bezüglich Stärken und Schwächen insbesondere im Hinblick auf Praktikabilität im klinischen Alltag und auch unter Berücksichtigung arbeitsmedizinischer Aspekte im Berufskrankheitenverfahren. Es erfolgte eine Analyse der beiden internationalen EAA-Leitlinien und deren Empfehlungen mit anschließender Diskussion. In beiden Leitlinien wurden wichtige diagnostische Fragestellungen nach dem GRADE-System mit entsprechender Graduierung einer Empfehlung (schwach bis stark) beantwortet. Eine in beiden Publikationen empfohlene alleinige Unterteilung der EAA in nichtfibrotischen und fibrotischen Verlauf hat zwar Vorteile für die Prognosebewertung und Therapiewahl, aber dadurch wird nicht adäquat zwischen akuten und chronisch nichtfibrotischen Verläufen unterschieden. Die Differenzierung der EAA-Diagnose in mehrere Konfidenzstufen erscheint insbesondere für die Patientenkommunikation oder auch im Berufskrankheitenrecht problematisch. Die Notwendigkeit einer invasiven Diagnostik mittels BAL (bronchoalveoläre Lavage) bzw. BAL und Lungenbiopsie für die Diagnose einer EAA mit hoher Konfidenz bzw. definitive Diagnose einer EAA ist v. a. bei akuten nichtfibrotischen Verläufen nicht gerechtfertigt. Beide internationale Leitlinien zur Diagnostik der EAA geben einen sehr guten Überblick über die vorhandene Evidenz einzelner diagnostischer Verfahren. Eine an das deutsche Gesundheitssystem angepasste deutsche Leitlinienmodifikation ist notwendig.

Tài liệu tham khảo

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