[Guideline for the Diagnosis and Treatment of Asthma - Addendum 2020 - Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology]. / S2k-Leitlinie zur Diagnostik und Therapie von Patienten mit Asthma ­ Addendum 2020.

The present addendum of the guideline for the diagnosis and treatment of asthma (2017) complements new insights into the diagnosis and management of asthma as well as for the newly approved drugs for the treatment of asthma. Current, evidence-based recommendations on diagnostic and therapeutic approaches are presented for children and adolescents as well as for adults with asthma.

German Respiratory Society guidelines for diagnosis and treatment of adults suffering from acute, subacute and chronic cough.

The present 2019 S2k consensus guideline of the German Respiratory Society was written for pneumologists - in contrast to the more general predecessor's S3 guidelines from 2004 to 2010 -, since 2014 the German College of General Practitioners and Family Physicians (DEGAM) published their own cough guidelines. The guidelines contain 48 recommendations agreed upon the consensus and 16 statements, which are explained in the background text in the following nine chapters: epidemiology, physiology, classification, acute, subacute or chronic cough, diagnostics and therapy; an extra chapter was dedicated to chronic idiopathic/refractory cough. Further emphasis of the guidelines is the physiology of cough in anticipation of the introduction of new drugs, as well as detailed treatment for cough triggered by affectations of the upper respiratory tract or gastroesophageal reflux. The guideline should provide the pneumologist with the latest knowledge for neighboring disciplines required for diagnosis and therapy of cough. The clinical chapters also contain a short summary, practical recommendations and a bibliography of their own. Three new simplified algorithms for acute, subacute and chronic cough, round off the diagnostics chapter.

[Guidelines of the German Respiratory Society for Diagnosis and Treatment of Adults Suffering from Acute, Subacute and Chronic Cough]. / Leitlinie der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin zur Diagnostik und Therapie von erwachsenen Patienten mit Husten.

The present 2019 S2k consensus guideline of the German Respiratory Society was written - in contrast to the predecessor more general S3 guidelines from 2004 and 2010 - for pneumologists, since 2014 the German College of General Practitioners and Family Physicians (DEGAM) published his own cough guidelines.The guideline contains 48 recommendations agreed by consensus and 16 statements, which are explained in the background text in the following nine chapters: epidemiology, physiology, classification, acute, subacute or chronic cough, diagnostics and therapy; an extra chapter was dedicated to chronic idiopathic cough. Further emphasis of the guideline is the physiology of cough in anticipation of the introduction of new drugs, as well as detailed treatises on cough triggered by affections in the upper respiratory tract or by gastroesophageal reflux. The guideline should provide the pneumologist with the latest knowledge from neighboring disciplines required for diagnosis and therapy of cough. The clinical chapters also contain a short summary, practical recommendations and a bibliography of their own. Three new, simplified algorithms for acute, subacute and chronic cough round off the Diagnostics chapter.

[Inhaled Triple Therapy in Severe Chronic Obstructive Pulmonary Disease (COPD)]. / Dreifachfixkombinationen (LAMA/LABA/ICS) zur inhalativen Dauertherapie der schwergradigen COPD.

COPD (chronic obstructive pulmonary disease) is characterised by persistent airflow obstruction caused by exposure to irritants including cigarette smoke dust, and fumes. Long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) in fixed-dose combination inhalers are the pillars of modern COPD therapy. LABA/inhaled corticosteroids (ICS) inhalers have been proved to be particularly efficient in patients with ≥ 2 exacerbations per year. Until recently, although recommended in guidelines for severe and unstable COPD patients, the clinical usefulness of the LABA/LAMA/ICS combination was a matter of debate. Recent trials with fixed-dose combination inhalers containing fluticasonfuroate/vilanterol/umeclidinium or beclometasone/formoterol/glycopyrronium significantly reduced exacerbation rates and dyspnea scores and improved lung function as well as quality of life better than the LABA/ICS, LABA/LAMA comparators or the single compounds in selected COPD trial patients. Beclometasone/formoterol/glycolpyrronium and fluticasonfuroate/umeclidinium/vilanterol are the first triple combination therapies approved in a fixed-dose inhaler for COPD patients. The domains of triple fixed-dose formulations are COPD patients in groups C and D.

[Massive Morgagni Hernia as a Reason for Lung Function Impairment]. / Morgagni-Hernie als Ursache einer restriktiven Ventilationsstörung.

Hernia of Morgagni is the most rare of the four types of congenital diaphragmatic hernia (2 % - 3 % of all cases). In adults, it commonly presents with non-specific symptoms. In severe cases patients complain about shortness of breath and in lung function analysis a restrictive pattern can be observed. This paper presents a rare case of a massive diaphragmatic hernia of the right thorax which remained undiagnosed over many years and gives an up-to-date overview of the literature. The transabdominal approach using laparoscopic repair is favored in adults especially in non-acute cases. In our patient, the lung expanded postoperatively in most parts resulting in improvement of lung function and blood gas analysis.

[Guideline for the Diagnosis and Treatment of Asthma - Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology]. / S2k-Leitlinie zur Diagnostik und Therapie von Patienten mit Asthma.

The present guideline is a new version and an update of the guideline for the diagnosis and treatment of asthma, which replaces the previous version for german speaking countries from the year 2006. The wealth of new data on the pathophysiology and the phenotypes of asthma, and the expanded spectrum of diagnostic and therapeutic options necessitated a new version and an update. This guideline presents the current, evidence-based recommendations for the diagnosis and treatment of asthma, for children and adolescents as well as for adults with asthma.

[Unmet need in asthma management and future treatment options]. / Tatsächliche Güte der Asthmaeinstellung und Möglichkeiten der zukünftigen Therapieoptimierung.

Despite health initiatives and extensive guideline efforts for advancing the management of asthma, evidence from epidemiologic studies suggests, that many asthma patients still have uncontrolled disease. The percentage of the uncontrolled disease stage is highly prevalent and eventually succeeds the 50 % range depending on the disease severity. There is urgent need for improved care particularly in moderate as well as in severe asthma. Implementation of treatment plans, the focus on symptom control, better patient-caretaker communication and most importantly improvement of specific treatment options are the cornerstones for success. Tiotropium, the first long-term antimuscarinic compound, was approved for asthma treatment in 2014, new developed inhaled corticosteroids as well as ß2-mimetics and inhaler types will enhance the physician's armamentarium to treat this disease better. Agents aimed at inhibiting cytokines, such as mepoluzimab, daclizumab, reslizumab and others hold to various degree promise in the treatment of asthma. Other agents under investigation include phosphodiesterase type 4 inhibitors and oligonucleotides. In summary, there is future promise for substantial therapeutic advances in moderate and severe persistent asthma.

[Inhalation therapy, patient's perspective]. / Patientenpräferenz von Inhalern.

The cornerstone of drug application in obstructive pulmonary diseases is by inhalation as advocated by all treatment guidelines. Today, there exists an extensive choice of inhalers and new models. Numerous inhaler types are constantly being developed and introduced into the market making the "correct" selection a wearying task for the physician as well as for the patient. Improvement in the management of this aspect, which is often neglected in its importance in daily practice as well as in guidelines, is therefore reliant not only on the medications themselves but also on their effective delivery. Complicated inhaler mechanics and poor inhaler technique which do not meet the patient requirements and desires contribute to poor compliance eventually leading to poor disease control. In this review, the importance of inhaler acceptance and the degree of satisfaction with different inhaler types are discussed. This paper focuses on the behavioral and attitudinal evidence that the acceptance of the inhaler is linked to patient compliance, and its linkage on health and patient-reported outcomes.

[Epidemiology and costs of asthma in Germany - a systematic literature review]. / Epidemiologie und Kosten von Asthma bronchiale in Deutschland - eine systematische Literaturrecherche.

BACKGROUND: The aim of this study was to identify the prevalence and incidence as well as the health care costs of asthma specifically in the German setting. METHODS: Two systematic literature searches were conducted in PubMed in December 2012 (updated in March 2014). All publications in German and English were included. RESULTS: After review of title, abstracts and full publications, 17 relevant studies included information on the prevalence and incidence of asthma. The 12-month prevalence for adults ranges between 4.6 % and 6.34 % (children: 3.8 % - 11.8 %). At younger ages, asthma is more prevalent in boys. In adulthood, more women are affected. We identified seven cost-of-illness studies. The direct costs range between €â€Š690.4 m and 1.36 bn. The reported health care costs depend on the perspective, the severity of disease and the database, so that a comparison of results is difficult. CONCLUSION: All in all, this review underlines the epidemiological and health economic importance of asthma in Germany. Several studies on the prevalence of asthma are available, but there is little information on the current incidence of this disease. Further research is necessary for obtaining a comprehensive picture of the current health care costs.