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Objectives: To estimate the treatment incidence of post-COVID syndrome (postinfectious sequelae present at least 12 weeks following infection) in the context of ambulatory care in Bavaria, Germany, and to establish whether related diagnoses occur more frequently than in patients with no known history of COVID-19., Design: Retrospective cohort analysis of routinely collected claims data., Setting: Ambulatory care in Bavaria, Germany, observed from January 2020 to March 2022 (data accessed May 2022)., Participants: 391 990 patients with confirmed COVID-19 diagnosis, 62 659 patients with other respiratory infection and a control group of 659 579 patients with no confirmed or suspected diagnosis of COVID-19., Primary and Secondary Outcome Measures: Primary outcome is diagnosis of post-COVID syndrome documented in ambulatory care. Secondary outcomes are: chronic fatigue syndrome, psychological disorder, fatigue, mild cognitive impairment, disturbances of taste and smell, dyspnoea, pulmonary embolism and myalgia., Results: Among all patients with confirmed COVID-19, 14.2% (95% CI 14.0% to 14.5%) received a diagnosis of a post-COVID syndrome, and 6.7% (95% CI 6.5% to 6.9%) received the diagnosis in at least two quarterly periods during a 2-year follow-up. Compared with patients with other respiratory infections and with controls, patients with COVID-19 more frequently received a variety of diagnoses including chronic fatigue syndrome (1.6% vs 0.6% and 0.3%, respectively), fatigue (13.3% vs 9.2% and 6.0%), dyspnoea (9.9% vs 5.1% and 3.2%) and disturbances of taste and smell (3.2% vs 1.2% and 0.5%). The treatment incidence of post-COVID syndrome was highest among adults aged 40-59 (19.0%) and lowest among children aged below 12 years (2.6%)., Conclusions: Our results demonstrate a moderately high incidence of post-COVID syndrome 2 years after COVID-19 diagnosis. There is an urgent need to find efficient and effective solutions to help patients with dyspnoea, fatigue, cognitive impairment and loss of smell. Guidelines and treatment algorithms, including referral criteria, and occupational and physical therapy, require prompt and coherent implementation., Competing Interests: Competing interests: ED, MT and RG are employees of the Association of Statutory Health Insurance Physicians of Bavaria. AS received fees from the Association of Statutory Health Insurance Physicians of Bavaria for lectures on post-COVID syndrome., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

When caring for patients with respiratory diseases, always think of the heart! This is especially important for COPD patients, but also for a variety of other disorders of the respiratory system. At the workshop "Luftschlösser", held once more at Wiesbaden, Germany in February 2019 the many and important interactions of the lungs and the heart as well as the therapeutic implications were discussed. Based on pathophysiology, the psycho-social consequences of dyspnea, the leading symptom in patients with lung and heart disease became apparent. A particularly demanding diagnostic and therapeutic situation occurs in patients suffering simultaneously of lung and heart disease. It has been shown how frequently the diagnosis myocardial infarction is missed in COPD patients - and vice versa. Surprisingly, this is also the case in asthmatics with coronary heart disease or heart failure, a fact not readily known in clinical practice. In patients with emphysema and no apparent heart disease, hyperinflation leads to significantly restricted heart function. Reducing hyperinflation by inhaling broncholytics thus improves heart function. Biomarkers are increasingly being used for diagnostic purposes. Their role is being investigated in the large German COPD cohort COSYCONET. Lung patients suffering from more severe heart diseases pose a challenge for therapy in intensive care, especially when ventilated, and weaning from the ventilator is prolonged. Lung vessel diseases are "classic" examples of the intimate interaction of the lungs and the heart. In pulmonary arterial hypertension as well as in chronic thrombo-embolic pulmonary hypertension the lag time between the first symptoms and the definite diagnosis is often unacceptably long. For both diseases of the lung vessels therapeutic options have improved significantly over the last years. Pulmonologists should take care of this increasingly important patient group. Sleep-related breathing disorders and heart function are closely intertwined. Both conditions need special attention after the results of the SERVE-HF trial have been published. But there is no doubt that obstructive sleep apnea represents an independent and important risk factor for cardiovascular disease and needs to be treated according to existing guidelines.This workshop demonstrated impressively the multiple interactions of the respiratory system with cardiac function, resulting diagnostic and therapeutic problems, and means to overcome these problems. Guidelines for respiratory diseases should appropriately address cardiac comorbidity., Competing Interests: B. Jany erhielt Vortragshonorare und Reisekostenerstattung von Boehringer Ingelheim.R. Bals erhielt Forschungsmittel oder persönliche Bezüge von AstraZeneca, CSL Behring, Boehringer Ingelheim, Novartis, German Federal Ministry of Education and Research (BMBF), Competence Network Asthma and COPD (ASCONET), persönliche Bezüge von GlaxoSmithKline, Grifols. Weitere Förderung außerhalb dieser Publikation erfolgte durch die Wilhelm-Sander Stiftung, die Schwiete Stiftung, die Deutsche Krebshilfe und den Mukoviszidose e. V. M. Dreher erhielt Vortragshonorare von Actelion, Astra Zeneca, Bayer, Berlin Chemie, Boehringer, Chiesi, Hamilton, Heinen und Löwenstein, Intermune, Linde, Novartis, Pfizer, Philips Respironics, ResMed, Roche und Weinmann, Beraterhonorare von Almirall, Boehringer, Hamilton, Linde, Novartis, Pfizer, Philips Respironics, ResMed und Roche, Forschungsmittel von Linde, Philips Respironics und ResMed.M. Held gibt an Vortrags- und Beraterhonorare von folgenden Firmen erhalten zu haben: Actelion, Astra Zeneca, Bayer Healthcare, BMS, Boehringer Ingelheim, Berlin Chemie, Daichii Sanyo, MSD, OMT, Pfizer und Forschungsbeihilfen von der Firma Actelion.R. Koczulla hat Honorare von Grifols, CSL, Novartis, Roche, GSK, Boehringer, Astra Zeneca, Berlin Chemie, TEVA, Sanofi, Mundipharma, GSK, Chiesi erhalten.W. Randerath erhielt Vortragshonorare und Reisekosten der Firmen Boehringer Ingelheim, Berlin Chemie, Bayer, Novartis und Roche.H. Watz erhielt Honorare für Vortrags- und Beratungstätigkeit sowie die Durchführung von klinischen Studien und Reisekostenerstattungen von den Firmen AstraZeneca, Bayer, Boehringer Ingelheim, BerlinChemie, Chiesi, Novartis, GlaxoSmithKline, Takeda und SanofiAventis.H. Wilkens erhielt Honorare für Vorträge und/oder Beratertätigkeiten von Actelion, Bayer Health Care, Boehringer Ingelheim, MSD, Pfizer und Roche.G. Steinkamp erhielt Honorare für Medizinisch-wissenschaftliches Publizieren von Boehringer Ingelheim, Gilead Sciences, InfectoPharm, Novartis, Pari GmbH und Alpha1 Deutschland e. V. L. Jany und M. Pfeifer geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: In light of overall increasing healthcare expenditures, it is mandatory to study determinants of future costs in chronic diseases. This study reports the first longitudinal results on healthcare utilization and associated costs from the German chronic obstructive pulmonary disease (COPD) cohort COSYCONET., Material and Methods: Based on self-reported data of 1904 patients with COPD who attended the baseline and 18-month follow-up visits, direct costs were calculated for the 12 months preceding both examinations. Direct costs at follow-up were regressed on baseline disease severity and other co-variables to identify determinants of future costs. Change score models were developed to identify predictors of cost increases over 18 months. As possible predictors, models included GOLD grade, age, sex, education, smoking status, body mass index, comorbidity, years since COPD diagnosis, presence of symptoms, and exacerbation history., Results: Inflation-adjusted mean annual direct costs increased by 5% (n.s., €6,739 to €7,091) between the two visits. Annual future costs were significantly higher in baseline GOLD grades 2, 3, and 4 (factors 1.24, 95%-confidence interval [1.07-1.43], 1.27 [1.09-1.48], 1.57 [1.27-1.93]). A history of moderate or severe exacerbations within 12 months, a comorbidity count >3, and the presence of dyspnea and underweight were significant predictors of cost increase (estimates ranging between + €887 and + €3,679, all p <0.05)., Conclusions: Higher GOLD grade, comorbidity burden, dyspnea and moderate or severe exacerbations were determinants of elevated future costs and cost increases in COPD. In addition we identified underweight as independent risk factor for an increase in direct healthcare costs over time., Competing Interests: Johanna I Lutter reports grants from German Federal Ministry of Education and Research during the conduct of the study. Stefan Karrasch reports grants from German Federal Ministry of Education and Research (BMBF) during the conduct of the study. Holger Schulz report grants from German Federal Ministry of Education and Research (BMBF), during the conduct of the study. Claus Vogelmeier report grants and personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, personal fees from CSL Behring, personal fees from Chiesi, grants and personal fees from GlaxoSmithKline, grants and personal fees from Grifols, personal fees from Menarini, personal fees from Mundipharma, grants and personal fees from Novartis, personal fees from Teva, personal fees from Cipla, grants from Bayer Schering Pharma AG, grants from MSD, and grants from Pfizer outside the submitted work. Rolf Holle report grants from German Federal Ministry of Education and Research, during the conduct of the study. The authors report no other conflicts of interest in this work.

Background/Objective: Breathlessness is a highly prevalent and distressing symptom in patients with cancer and advanced chronic diseases. Symptom management is often overlooked. We explored the experiences of patients, caregivers, and health care providers (HCPs) and their expectations for future service developments. Design: This is a multiperspective qualitative study drawing on semistructured interviews. Setting/Subjects: Participants were recruited from palliative, respiratory, and cardiology departments of the Munich University Hospital and from a chronic obstructive pulmonary disease (COPD) patient group. Measurements: Interviews were analyzed using qualitative content analysis. Subcategories used the directional views of participants (positive, negative, and indifferent). The coding tree identified three categories: (1) attributes of symptom management, (2) practice pattern gaps, and (3) components of good practice. Results: Ten patients (5 female, 65.2 median age; COPD n  = 3, cancer n  = 3, chronic heart failure n  = 2, and lung fibrosis n  = 2), 3 caregivers (2 female, 53.6 median age), and 10 HCPs were interviewed. Patients and caregivers felt stressed and frustrated due to a lack of awareness regarding the symptom burden and little support from HCPs. HCPs pointed to a lack of therapeutic concepts and unclear assumptions of responsibilities. Specialist breathlessness services are perceived as addressing important gaps in professional practice from the viewpoint of all stakeholders. Accessibility and collaboration with other local health care services are important features of such specialist services. Conclusions: Chronic refractory breathlessness in advanced disease is managed insufficiently for most patients, caregivers, and HCPs. Increased knowledge about effective interventions and availability of skills-based training for patients, caregivers, and HCPs would help in breathlessness management.

Background: Cough is one of the most common symptoms in general and pulmonary medicine with profound negative impact on health-related quality of life (HRQL). The Leicester Cough Questionnaire (LCQ) is a validated HRQL questionnaire, yet a validated German version of the LCQ is not available and it has never been tested in a cohort with sarcoidosis., Objectives: To translate the LCQ into German and determine its psychometric properties., Methods: The LCQ was translated in a forward-backward approach. Structured interviews in sarcoidosis patients were performed. Subsequently, sarcoidosis patients were asked to answer the German LCQ and comparative questionnaires. Distribution properties, item difficulty, concurrent validity, Rasch model fit and internal consistency of the German LCQ were determined., Results: 200 patients with sarcoidosis were included. We provide evidence for reliability, unidimensionality and internal consistency. However, only a moderate correlation with general and respiratory-specific HRQL questionnaires, no Rasch model fit could be shown. Skewed responses caused by floor effects were detected., Conclusion: We demonstrate that the German LCQ is valid and reliable and its psychometric properties fulfil the standards required for its use in clinical settings as well as in interventional trials., Competing Interests: The authors have declared that no competing interests exist.

Objective: The aim of this study is to describe the frequency of reasons for elderly patients visits to a general practice (GP) setting., Subjects and Methods: Cross-sectional data from 8,877 randomly selected patients were assessed during a 1-year period by 209 GPs in the German federal state of Saxony. The reasons for visits, performed procedures, and results of visits were documented. In this study, the data of patients aged 65 years and older are analyzed and the procedural and nonprocedural reasons for visits are described., Results: In all, 2,866 patients aged 65 years and older were included. The majority of patients (1,807) were female. A total of 4,426 reasons for visits were found, distributed on 363 International Classification of Primary Care-2 codes. In the mean, there were 1.5 reasons for a GP visit from each patient. The top five nonprocedural reasons for visiting the GP were: cough (1.8%), back complaints (1.6%), shoulder complaints (1.3%), knee complaints (1.1%), and dyspnea (1.0% of all reasons for visit). The top five procedural reasons for visiting the GP included follow-up investigations of cardiovascular or endocrine disorders and immunizations. The top 30 nonprocedural reasons for visits covered 21.9% of all reasons for visiting. The top 30 procedural reasons covered 54.3% of all reasons for visits., Conclusion: The current work indicates that people aged 65 years and older consult the GP more frequently for procedural than for nonprocedural reasons. The top 30 procedural and nonprocedural reasons for visits cover ~75% of all reasons for visits in these patients.

Background: Episodic breathlessness is one form of refractory breathlessness. Better understanding of the symptom is necessary for effective management., Aim: The aim was to describe the characteristics of episodic breathlessness in patients with advanced chronic obstructive pulmonary disease or lung cancer., Design: This is a longitudinal cohort study. Outcomes were assessed monthly by up to 13 telephone interviews: peak severity (modified Borg scale: 0-10), duration, frequency, and timing of breathlessness episodes. Data from each episode were pooled and analyzed using descriptive statistics. Associations between outcomes were explored by correlation coefficients., Setting/participants: Patients with chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease classification stage III or IV) or primary lung cancer (any stage) were recruited in two inpatient units (internal medicine) and two outpatient clinics in Oldenburg, Germany., Results: A total of 82 patients (50 chronic obstructive pulmonary disease, 32 lung cancer), mean age (standard deviation) 67 years (8 years) and 36% female, were included reporting on 592 breathlessness episodes (chronic obstructive pulmonary disease: 403, lung cancer: 189). Peak severity was perceived significantly higher in chronic obstructive pulmonary disease patients than in lung cancer patients (mean (standard deviation) Borg scale: 6.2 (2.1) vs 4.2 (1.9); p < 0.001). Episodes described by chronic obstructive pulmonary disease patients were longer than those described by lung cancer patients (median (range): 7 min (0-600) vs 5 min (0.3-120), p = 0.002)). Frequency was similar and most often daily in both groups. Severity and frequency of episodes were correlated in lung cancer patients (r = 0.324, p = 0.009)., Conclusion: Most breathlessness episodes are short (minutes) and severe with significant differences between chronic obstructive pulmonary disease and lung cancer patients. Effective management strategies are warranted to improve symptom relief and coping., (© The Author(s) 2015.)

Objectives: To evaluate the relationship between chief complaints and their underlying diseases and outcome in medical emergency departments (EDs)., Methods: All 34 333 patients who attended two of the EDs of the Charité Berlin over a 1-year period were included in the analysis. Data were retrieved from the hospital information system. For study purposes, the chief complaint (chest pain, dyspnoea, abdominal pain, headache or 'none of these symptoms') was prospectively documented in an electronic file by the ED-physician. Documentation was mandatory., Results: The majority of patients (66%) presented with 'none of these symptoms', 11.5% with chest pain, 11.1% with abdominal pain and 7.4% with dyspnoea. In total, 39.4% of all patients were admitted to the hospital. The leading diagnosis was acute coronary syndrome (50.7%) for chest pain in-patients and chronic obstructive pulmonary disease (16.5%) and heart failure (16.1%) for in-patients with dyspnoea. The causes of abdominal pain in in-patients were of diverse gastrointestinal origin (47.2%). In-hospital mortality of in-patients was 4.7%. Patients with chest pain had significantly lower in-hospital mortality (0.9%) than patients with dyspnoea (9.4%) and abdominal pain (5.1%)., Conclusion: The majority of emergency patients lack diagnosis-specific symptoms. Chief complaints help preselect patients but must not be mistaken as disease specific. Mortality largely differs depending on the chief complaint. In chest pain patients, standardized processes may be one factor that explains the low mortality in this group.

While well validated algorithms exist for the diagnosis of patients with acute dyspnoea, such generally valid procedural instructions are lacking for patients with chronic dyspnoea. The diagnostic approach presented here is based on investigations of 246 patients with chronic dyspnoea recruited from two cardiological practices using a self-developed multi-level procedure. Besides anamnestic and clinical examinations, different diagnostic procedures, available in the ambulant range, are included. The results suggest that in over 50 % of the cases the cause of chronic dyspnoea can be determined from anamnestic and clinical examinations as well as from electrocardiogram and echocardiography. Additional inclusion of lung function and capillary blood gas analysis permitted a sufficient clarification in over 80 % of the cases. In a further step, cardiopulmonary exercise testing clarified the reasons for chronic dyspnoea in approximately 10 % of the remaining patients. Threshold values of lung function parameters as used for the differentiation of acute dyspnoea, do not seem suitable for the diagnosis of patients with chronic dyspnoea. By means of a simple step-wise diagnostic algorithm, applicable under ambulant conditions, the cause of chronic dyspnoea could sufficiently be clarified in more than 95 % of the cases., (© Georg Thieme Verlag KG Stuttgart · New York.)

In the second quarter 2011 the incidence of the symptoms "chronic dyspnea" among the patients in three specialist practices was determined by means of a self-developed questionnaire. 1286 anonymised questionnaires with full information could be evaluated. The proportion of the patients with a chronic dyspnea (inclusive "dyspnea and weakness feeling") in the practices amounted to between 15.3 and 57.7 %. An exclusive assessment of chronic dyspnea could be assigned to 10.4 to 31.4 % of the patients evaluated. From the view point of the treating physicians, the cause of the chronic dyspnea was sufficiently explained by the available information., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Heightened degrees of anxiety and depression are often found in patients suffering from sarcoidosis, but the reasons for that are unclear. Furthermore, age and gender differences of anxiety and depression in sarcoidosis have not been reported with reference to normative data., Objectives: The aim was to test age and gender differences of anxiety and depression in a large sample, and to examine the influence of affected organs, concomitant diseases and dyspnea., Methods: 1197 German patients diagnosed with sarcoidosis were examined, using the Hospital Anxiety and Depression Scale (HADS) and the MRC dyspnea scale., Results: Patients suffering from sarcoidosis were significantly more anxious and depressed than the general population. This effect was especially strong in young age groups. The number of affected organs, the number of concomitant diseases and the degree of dyspnea significantly predicted anxiety and depression scores in univariate analyses. Among the affected organs, muscles, nerves, and bones most significantly contributed to depression. Sleep apnea, restless legs syndrome, and arterial hypertension were associated with anxiety as well as depression. In multivariate analyses including age and gender, however, only dyspnea and the number of concomitant diseases remained predictors of anxiety and depression scores., Conclusions: The analysis of mental distress should take into account comparisons with normative values. Young patients deserve special social support. Dyspnea proved to be an important symptom in the prediction of anxiety and depression.

Background: Against the background of an increasing prevalence of allergies, the epidemiology of asthma in relation to age is still a matter of debate. To further clarify the prevalence of asthma, asthmatic symptoms, and their change over time within a population sample, we analyzed longitudinal data from the Study of Health in Pomerania (SHIP)., Methods: Standardized questionnaires for asthma and asthmatic symptoms were available in 4310 individuals aged 20–79 years [corrected]. The population sample underwent a 5-year follow-up with 3300 subjects reexamined. The questionnaire evaluated estimates to describe the prevalence in wheeze, chest tightness, shortness of breath, coughing, nocturnal symptoms, and asthma attacks in the past 12 months, current medications, current asthma, and nasal allergies at baseline and its longitudinal net change., Results: The prevalence of current asthma at the baseline study was 1.8% [95% confidence interval (CI 1.4–2.2)], those of nasal allergies 16.7% (95% CI 15.6–17.9). Sixteen percent of asthmatic individuals were not medically treated. The net changes in asthmatic symptoms per 60 months of follow-up ranged between a decrease by 2.0% (chest tightness at night) and an increase by 1.2% (nocturnal attack of coughing). The proportions of subjects with current asthma remained unchanged. The prevalence of current asthma and symptoms was higher in young individuals, whereas the net change over time was slightly increasing at the age of 36 and above., Conclusion: Despite the fact of a high prevalence of subjects complaining of nasal allergies, the overall prevalence of current asthma remained low over time. The prevalence in asthma and asthmatic symptoms as well as its net changes over 5 years were age dependent.

Background: The Burden of Obstructive Lung Disease study showed that in Germany, to confirm the diagnosis of chronic obstructive lung disease (COPD) in one subject, eight people ≥ 40 years of age have to be screened. The number-needed-to-screen (NNS) increased to 18 for identifying a patient with COPD ≥ GOLD stage II. These high numbers limit the cost-effectiveness of COPD screening by population spirometry. We investigated in a primary care setting whether using two simple questions regarding smoking status and presence of cough and/or dyspnea may help to preselect patients for proper diagnosis of COPD., Methods: A total of 1088 patients aged ≥ 40 yrs without a history of chronic lung disease, who were either current or ex-smokers and complained of cough and/or dyspnea, were examined by respiratory physicians. Spirometry was carried out to confirm COPD diagnosis and severity., Results: A total of 61.6% of patients were male. Mean smoking history was 31.8 pack-yrs. In 516 patients (47.4%), a diagnosis of COPD was confirmed. Among these, 379 (34.8% of total) had at least GOLD stage II COPD, while 89 (8.2% of total) had advanced disease (GOLD stages III/IV). COPD prevalence was significantly associated with age and the extent of cigarette smoke exposure., Conclusions: Two questions regarding smoking status and presence of cough and/or dyspnea enabled general practitioners to select patients at risk for COPD for subsequent spirometry. This preselection reduced the NNS to 2.1 for identifying a COPD patient, and to 2.9 for identifying a patient of at least GOLD stage II.

Objective: Dyspnea is defined as an uncomfortable awareness of the need to breathe. Verbal report of dyspnea can be a valuable source of diagnostic information. However, little is known about the cognitive representation of respiratory sensations and about their affective evaluation in individuals not suffering from respiratory disease. Such knowledge would be important in evaluating the comparability of respiratory sensation report between healthy controls and patient groups., Method: Five hundred and eighty-two healthy individuals rated 20 descriptors of respiratory sensation with regard to frequency, valence, and situational incidence. Ratings were analysed on the level of subgroups of items found with cluster analysis and Multidimensional Scaling (MDS)., Results: Not all respiratory sensations commonly subsumed under dyspnea are perceived to be uncomfortable by healthy individuals. Two higher-order clusters were found, interpreted as (1) compensation of dyspnea and (2) breathing deficiencies. Breathing deficiencies were unknown by approximately 50% of participants and rated to be less frequent and more uncomfortable than compensation of dyspnea. Furthermore, three dimensions of respiratory sensations were found using MDS interpreted as (1) fit between need for air and actual breathing, (2) effort, and (3) attempt of voluntary control., Conclusion: The extent to which respiratory sensation ratings can be compared between patients and healthy individuals is limited. Latent dimensions of dyspnea might be less affected by differences in interpretation and evaluation of language descriptors of dyspnea and could help to assess comparability of sensation report between groups with different experiential background regarding breathlessness.

Background and Objective: Surgery is an effective method to treat patients with morbid obesity. However health insurance companies frequently refuse to cover the costs for the procedure despite an existing DRG-code for this operation. Individual medical expertise are necessary to receive reimbursement. In the present study the acceptance of medical expertise to receive cost coverage was analysed in our patients of the years 2000-2003 eligible for obesity surgery., Patients and Methods: 617 medical expertise of patients eligible for obesity surgery in our hospital were reviewed and the acceptance rate was evaluated. Parameters such as body mass index, personal medical history, diets, comorbidity and prognosis were included. Expertise were submitted to the health care insurance companies and in case of acceptance the operation was performed., Results: The average age of our patients was 39.1 +/- 11.2 years, 72.1% were female, 27.9% male. The average BMI was 47.5 +/- 7.4 kg/m2. There was a high incidence of comorbidity in these patients (58.7% arterial hypertension, 38.6% diabetes mellitus, 95.8% dyspnoea, 96.1% arthropathy, 89.0% psychosocial disorders). The difference between accepted and non-accepted regarding these secondary complications was not significant. 209 patients (33.8%) were operated. 14 patients of these paid the costs themselves. Only in 195 cases (31.6%) the health care insurance company covered the costs for the operation., Conclusion: The high number of refusals of medical expertise is not justified in view of the strict criteria for indication, the high frequency of comorbidity and the good results after the operation.

Respiratory symptoms and lung function impairment as an expression of COPD are frequent in Germany. The symptoms, especially dyspnea, correlate only moderately with the degree of functional impairment. In contrast to the actual GOLD guidelines, in general practices the therapy is based on symptoms rather than on lung function, resulting in an undertreatment of asymptomatic patients. Therefore, increasing utilization of spirometry in practices is to demand; on the other hand respiratory symptoms should gain a greater significance in the GOLD guidelines, also against the background of disease-related costs.

This study aimed to establish epidemiological data on diving habits and outcome of subjects with respiratory diseases who are considered at increased risk for diving injuries. We conducted a cross-sectional demographics and prevalence study by distribution of an anonymous questionnaire with an issue of a widespread sport diving magazine. The questionnaire was designed to obtain medical and diving history data with an emphasis on respiratory diseases and complaints. The investigational population comprised sport scuba divers of any age and gender from Austria, Germany, and Switzerland. Two hundred and twenty-six male and 96 female divers sent completed questionnaires. Of the respondents 8.7 % indicated that they currently have asthma. Two thirds of asthmatics complained about regular dyspnoea. However, only 42.4 % used drugs relieving or controlling their symptoms regularly and 27.3 % used them in a prophylactic manner before diving. Five percent and 4.7 % of all divers reported a history of respiratory disease other than asthma or dyspnoea respectively. The divers with respiratory illness or complaints had logged a total of 17,386 dives. There were no cases of serious diving injuries. Despite the well-known limitations of postal surveys assessing self reported data, this study indicates that there is a population of subjects diving uneventfully with respiratory diseases that are considered medical contraindications to diving. These subjects deserve particular guidance on related risks and disease management.

Background: Plastic tracheostomy closure represents a safe surgical method with rare but potentially life-threatening complications such as dyspnea. Because of the general tendency to reduce hospital stay, the medically necessary time of hospitalization should be evaluated., Methods: Ninety-eight patients operated in succession were examined retrospectively for extent, time, and therapeutic procedures in cases of life-threatening dyspnea. Moreover, disorders of wound healing which had to be treated surgically were analyzed., Results: Of 98 patients 17% (17/98) developed dyspneas, 10% (10/98) up to the 3rd postoperative day, 2% (2/98) on the 6th postoperative day, and 5% (5/98) between the 17th and 92nd postoperative days; 13% (13/98) had to be treated because of extensive disorders of wound healing, 85% (11/13) up to the 3rd day., Conclusion: From the clinical and forensic viewpoint, a hospital stay for at least 3 postoperative days is necessary to record the majority of life-threatening complications after plastic tracheostomy closure.