Medical vulnerability
Zusammenfassung der Projektergebnisse
The objective of the research module “Medical vulnerability” was to identify factors impairing health and furthering disease progression in patients exposed to heat stress and to develop a range of measures for management of chronic diseases with respect to reduction of heat stress. Our research on outdoor climate and disease progression showed a negative effect of high temperatures and elevated air humidity on the disease status of patients with chronic respiratory diseases. An analysis of intrinsic risk factors revealed that patients admitted to a hospital during summer time are younger than patients hospitalized during the colder seasons. Patients admitted during hot summer periods suffered more often from a myocardial infarction comorbidity. Peripheral arterial obstructive disease and tumors occurred more frequently in patients with COPD exacerbations during “cold” summers. We identified active smoking as extrinsic risk factor for disease exacerbation under heat stress. First results on heat stress and medication prompted us to start further studies on the effects of long-acting beta2-agonists (LABA), long-acting muscarinic antagonists (LAMA), and inhaled corticosteroids (ICS) on disease status during periods of heat stress. After we overcame all technical and administrative difficulties with the installment of air convection free patient room climatization, a prospective clinical trial showed that by providing a constant room temperature of 23°C, patients with chronic respiratory diseases were discharged 1.5 days earlier from hospital than patients treated in conventional patient rooms without climate control. An analysis of the mean daily physical activity revealed significantly more movements by patients hospitalized in climatecontrolled rooms than by patients in standard rooms. This points at a beneficial effect of air-convection free climate control on the early mobilization of patients. In addition, patients in standard rooms developed a significantly higher heart rate, decreased heart rate variability, increased respiration rate as well as an increased cardiorespiratory coupling during their stay in the hospital. Patients in climatecontrolled rooms did not show this behavior. These results indicate that heat stress leads to a sympathetic overactivation with tachycardia, tachypnea, and an increased cardiorespiratory coupling in COPD patients. This pathomechanism reduces the ability to compensate heat stress and could contribute to disease exacerbation. Our research results showed that water-cooling ceilings in patient rooms are a suitable adaptation strategy to reduce heat stress, especially in view of the ongoing climate change to warmer temperatures. Prof. Dr. Witt gave over 20 interviews to scientific and general media reporters (print, radio, and television) about the clinical climate impact research of the UCaHS project. The general media reported on our findings for example in the article “Zu heiß”, published by the Süddeutsche Zeitung on 28.07.2017, and the documentary “Cooler Kollaps”, broadcasted by 3sat on 25.06.2015. Two interviews were published in the Deutsches Ärzteblatt (16.03.2017 and Dtsch Arztebl 2015; 112(39)). The chief editor Prof. Dr. Baethge invited Prof. Dr. Witt to publish further results on the effects of patient room climatization in the Deutsches Ärzteblatt. We will continue our investigations concerning the effects of climate-controlled patient rooms with respect to healthcare costs. Our research on climate and chronic respiratory disease progression will be expanded to include interactions of heat and air pollution.
Projektbezogene Publikationen (Auswahl)
- Tele-monitoring reduces exacerbation of COPD in the context of climate change - a randomized controlled trial. J Environ Health. 2013 Nov 21;12:99
Jehn M, Donaldson G, Kiran B, Liebers U, Mueller K, Scherer D, Endlicher W, Witt C
(Siehe online unter https://doi.org/10.1186/1476-069X-12-99) - Heat stress in chronic obstructive pulmonary disease: Is there a vulnerable phenotype for climate associated exacerbations? Eur Respir J. 2014; 44: Suppl. 58, P3210
M. Hanisch, J. Heinsohn, M. Jehn, U. Liebers, D. Scherer, W. Pankow, A. Holzgreve, C. Witt
- Heat stress is associated with reduced health status in pulmonary arterial hypertension: a prospective study cohort. Lung. 2014 Aug; 192(4):619-24
Jehn M, Gebhardt A, Liebers U, Kiran B, Scherer D, Endlicher W, Witt C
(Siehe online unter https://doi.org/10.1007/s00408-014-9587-4) - Notfallaufnahmen von COPD-Patienten bei urbanem Hitzestress – Gibt es einen vulnerablen Phänotyp? Pneumologie 2015; 69 - P530
U. Liebers, M. Hanisch, J. Heinsohn, M. Jehn, W. Pankow, A. Holzgreve, D. Scherer, C. Witt
(Siehe online unter https://doi.org/10.1055/s-0035-1544724) - Novel climatisation model in hospital improves the reconvalescence of urban heat-stress related lung disease progression. Discussion C 104 Indoor and Outdoor Pollution: Epidemiology and Mechanisms. ATS, Denver 2015
N. Omid, U. Liebers, A.J. Schubert, M. Jehn, W. Endlicher, D. Scherer, C. Witt
- Strahlungskonvektive Krankenzimmer-Klimatisierung zur Beeinflussung des Hospitalisierungsverlaufes hitzestress-vulnerabler Patienten mit chronischer Lungenkrankheit – Adapatation an den Klimawandel? Pneumologie 2015; 69 - P322
N. Omid, U. Liebers, R. Ehrlich, J. Heinsohn, M. Jehn, W. Endlicher, D. Scherer, C. Witt
(Siehe online unter https://doi.org/10.1055/s-0035-1544786) - The Effects of Climate Change on Patients With Chronic Lung Disease. A Systematic Literature Review. Dtsch Arztebl Int. 2015 Dec 21;112(51-52):878-83
Witt C, Schubert AJ, Jehn M, Holzgreve A, Liebers U, Endlicher W, Scherer D
(Siehe online unter https://doi.org/10.3238/arztebl.2015.0878) - More heat stress and air pollution for the lungs in view of climate change. MMW Fortschr Med. 2017 Jul;159(13):42-45
Witt C, Liebers U, Dostal V, Heinsohn JB, Hanisch M, Drozdek M, Schubert A, Scherer D
(Siehe online unter https://doi.org/10.1007/s15006-017-9900-2)
