{"id":3198,"date":"2019-09-30T14:21:17","date_gmt":"2019-09-30T12:21:17","guid":{"rendered":"https:\/\/www.alpha1-deutschland.org\/?page_id=3198"},"modified":"2023-08-24T14:38:06","modified_gmt":"2023-08-24T12:38:06","slug":"infektionspraevention","status":"publish","type":"page","link":"https:\/\/alpha1-deutschland.org\/en\/infektionspraevention","title":{"rendered":"Infection prevention"},"content":{"rendered":"
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Infection and infection prevention in alpha-1 antitrypsin deficiency<\/span><\/h1>\n
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Below you will find the latest articles on the topic of infection prevention:<\/p>\n<\/div>\n<\/div>\n\n\n\n\n\t\t\t<\/div> \n\t\t<\/div>\n\t<\/div> \n\n\t

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infection<\/a><\/div><\/div>
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01\/2024: Autumn newsletter. Vaccination recommendations, helpful coughing techniques and more!<\/span><\/a>

01\/2024: Autumn newsletter. Vaccination recommendations, helpful coughing techniques and more!<\/span><\/h3>November 4, 2024<\/span><\/span><\/div><\/div><\/div><\/div>
\"M\u00f6gliche<\/div><\/div><\/div>
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Hepatitis A and B vaccination in Alpha1 antitrypsin deficiency \u2013 why this can be beneficial<\/span><\/a>

Hepatitis A and B vaccination in Alpha1 antitrypsin deficiency \u2013 why this can be beneficial<\/span><\/h3>October 13, 2023<\/span><\/span><\/div><\/div><\/div><\/div>
\"Impfung<\/div><\/div><\/div>
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Which vaccinations make sense for Alphas now?<\/span><\/a>

Which vaccinations make sense for Alphas now?<\/span><\/h3>December 19, 2020<\/span><\/span><\/div><\/div><\/div><\/div>
\"Computergenerierte<\/div><\/div><\/div>
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How can I protect myself from infections?<\/span><\/a>

How can I protect myself from infections?<\/span><\/h3>September 30, 2019<\/span><\/span><\/div><\/div><\/div><\/div><\/div><\/div>\n\t\t\t<\/div> \n\t\t<\/div>\n\t<\/div> \n<\/div><\/div>\n\t\t
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Significance of exacerbation for the course of COPD<\/span><\/h2>\n<\/div>\n\n\n\n\n\t\t\t<\/div> \n\t\t<\/div>\n\t<\/div> \n\n\t
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Author<\/h4><\/span><\/span>\n<\/div>\n
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Prof. Tobias Welte<\/strong>, MHH<\/p>\n<\/div>\n\n\n\n

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Alpha-1 antitrypsin deficiency (AATD) is a specific form of chronic obstructive pulmonary disease (COPD). While treatment for AATD focuses heavily on managing the progression of emphysema, infections and acute exacerbations, which are crucial for the course of the disease, receive insufficient attention.<\/p>\n

A study by European pulmonologists in 13 countries evaluated 16,000 COPD patients who required hospitalization due to an acute exacerbation. The three-month follow-up of these patients revealed that 111,000 of all patients died during this period. This is a significant proportion. It also demonstrates that hospitalization for a COPD exacerbation can be more dangerous than a heart attack, which has a mortality rate of only 21,000. Severely ill patients died even more frequently; patients in stage IV disease requiring non-invasive ventilation had a mortality rate of 351,000.<\/p>\n

Another large international COPD study found that exacerbations are a marker for the further course of the disease. According to the ECLIPSE study, those hospitalized once in the first year had a high risk of being hospitalized again in subsequent years, as 651 of these patients were readmitted in the second year of the study. Mortality was also significantly higher among hospitalized patients. Several years ago, researchers calculated the average life expectancy after a COPD exacerbation: only half of these patients were still alive after 3.6 years. This figure is alarming and similar to that of people with malignant cancers.<\/p>\n<\/div>\n\n\n\n\n\t\t\t<\/div> \n\t\t<\/div>\n\t<\/div> \n\n\t

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Exacerbation in AATM patients<\/span><\/h2>\n

The situation for those with AATD is worse than that of the overall group of COPD patients. More than half (541,000) of AATD patients experience an exacerbation within a year, and 181,000 even experience three or more exacerbations per year. On average, there are 1.2 exacerbations per person per year in AATD. Unsurprisingly, quality of life suffers when frequent exacerbations occur. Frequent exacerbations also determine the prognosis in AATD. Considering the decline in the lung function value FEV1, frequent exacerbations are clearly associated with a more rapid decline in lung function.<\/p>\n

It's common knowledge that infections are more frequent during the winter months from October to March. In AATD, exacerbations often last twice as long as in other COPD patients. Importantly, exacerbations are particularly common in patients with chronic sputum production. This is also related to the increased inflammatory processes occurring in the bronchi. This affects not only the well-known inflammatory marker CRP, but also the marker interleukin-8. Interleukin-8 attracts neutrophils in particular, which play a crucial role in the disease process in AATD because they release the dangerous proteases.<\/p>\n<\/div>\n\n\n\n\n\t\t\t<\/div> \n\t\t<\/div>\n\t<\/div> \n\n\t

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The COPD Dilemma<\/span><\/h2>\n

Chronic obstructive pulmonary disease (COPD) is, in a sense, a catch-all term encompassing various illnesses. Experts have not yet been able to adequately distinguish the different types and develop targeted therapies for them. In this respect, the results of COPD research are disappointing compared to asthma research. COPD comprises three main groups. For inflammation of the small and smallest airways, which plays a major role in asthma, there are highly effective, primarily anti-inflammatory treatments that mitigate the course of the disease and alleviate or even completely eliminate symptoms. These processes are insignificant for AATD (acute respiratory distress syndrome). The second group, emphysema with loss of lung tissue, particularly affects people with AATD. Current replacement therapy aims to slow the progression of emphysema. New research approaches aim to regenerate lost lung tissue. One approach could be to stimulate stem cells residing in the lungs to produce new, healthy tissue. This concept has already been successful in the liver, while it is still a thing of the future for the lungs.<\/p>\n

The third component of COPD is bronchiectasis, meaning the permanent dilation and remodeling of the bronchi. Here, too, tissue is destroyed, this time due to chronic inflammatory processes. Initially, the cleansing of the bronchi is impaired because the cilia on the mucous membrane surface are damaged and no longer function properly. Consequently, secretions, mucus, and inhaled particles can no longer be adequately transported out of the bronchi. They adhere to the bronchial wall in the mucus and form an ideal breeding ground for various pathogens. This leads to chronic infections and persistent inflammation.<\/p>\n<\/div>\n\n\n\n\n\t\t\t<\/div> \n\t\t<\/div>\n\t<\/div> \n\n\t

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AATM and bronchiectasis<\/span><\/h2>\n

Anyone with AATD should know whether or not they have bronchiectasis. Individuals with sputum, especially if it is yellowish or greenish, are at risk for bronchiectasis. A CT scan of the lungs can detect bronchiectasis and document its extent. If bronchiectasis is present, the next step is to check for a chronic respiratory infection, as this requires specific treatment.<\/p>\n

There are typical triggers for exacerbations. These include infections, mostly caused by viruses, but also by bacteria. Among non-infectious triggers, cigarette smoking plays a prominent role. Air pollutants can also be a problem. It is clear that people with AATD should absolutely not smoke.<\/p>\n<\/div>\n\n\n\n\n\t\t\t<\/div> \n\t\t<\/div>\n\t<\/div> \n\n\t

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Influenza, bronchiectasis registry, air pollutants<\/span><\/h2>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
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The influenza infection<\/span><\/h3>\n

The influenza virus, which causes the flu, is a true killer. It raged particularly fiercely in 2018. In Germany alone, there were 300,000 new cases in the eighth calendar week of last year. This exceptionally high level persisted for over six weeks. According to data from the Robert Koch Institute's influenza surveillance system, a total of two million people were infected. At least 1,600 people died directly from influenza. Of these, one-third were under 40 years old! The flu, therefore, also kills healthy young people.<\/p>\n

In addition to these officially documented deaths, many people suffer serious complications from influenza and die as a result. For example, the risk of a heart attack is more than six times higher during the first week of influenza. This is due to the massive inflammatory processes triggered by influenza. If complications are included, it can be assumed that there were 10,000 additional deaths due to influenza in 2018.<\/p>\n

This year was less dramatic. For one thing, far more people had been vaccinated against influenza, and with the more effective quadrivalent vaccine. Secondly, the current strain caused a less severe illness.<\/p>\n

Exactly 100 years ago, the Spanish flu raged. It is estimated that it claimed the lives of 25, or possibly even 50 million people worldwide. The H1N1 virus originally appeared in North America and was brought to Europe by traveling nurses. The first outbreak occurred in the French port city of Brest. In Spain, however, the flu arrived later. Therefore, the term "Spanish flu" is misleading.<\/p>\n

In a groundbreaking research project, tissue samples from 68 deceased soldiers who had died of the Spanish flu were examined. Microscopic examination of the tissue revealed, in addition to influenza viruses, a remarkably high number of pneumococcal bacteria, and to a lesser extent, other bacteria. Overall, more than half of the soldiers did not die directly from the influenza virus, but from the secondary bacterial infection. Unlike today, however, antibiotics were not available against bacteria 100 years ago.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n\n\t\t\t<\/div> \n\t\t<\/div>\n\t<\/div> \n\n\t

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\u201d<\/span>Left: Influenza wave in week 8 of 2018 in Germany compared to week 8 of 2019 (right). Source: https:\/\/influenza.rki.de\/MapArchive.aspx <\/p><\/div><\/blockquote>\n\t\t<\/div> \n\t<\/div>\n\t<\/div> \n<\/div><\/div>\n\t\t\t<\/div> \n\t\t<\/div>\n\t<\/div> \n\n\t

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Treatment of influenza<\/span><\/h3>\n

Medications against influenza viruses, such as oseltamivir (Tamiflu\u00ae), can reduce mortality. For oseltamivir to be effective, it must be taken within the first 72 hours of influenza. This is due to its mechanism of action: this neuraminidase inhibitor prevents the virus from entering the body's cells, where it multiplies and damages the body. Once the virus has entered the cells, which occurs within the first three days of illness, oseltamivir is no longer effective.<\/p>\n

Current research into influenza treatment is very active. At present, 15 different substances with novel mechanisms of action are being developed: they aim to reduce viral replication within cells. Baloxavir, a substance already approved in Japan and the USA, inhibits a protein essential for influenza virus replication. Consequently, the viral load decreases significantly after just one day of treatment, considerably faster than with oseltamivir. Approval of the drug in Europe is expected soon.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n\n\t\t\t<\/div> \n\t\t<\/div>\n\t<\/div> \n\n\t

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