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Daten uber die klinische Prasentation der chronisch-obstruktiven Lungenerkrankung (COPD) haben zu einer neuen Klassifikation der Erkrankung gefuhrt. Auser der spirometrischen Schweregradeinteilung werden das Ausmas der Symptome sowie die Exazerbationsrate berucksichtigt. Die Standardtherapie der stabilen COPD befindet sich im Umbruch, da in naher Zukunft Fixkombinationen aus langwirksamen Betamimetika und langwirksamen Anticholinergika eingesetzt werden konnen. Damit wird der Stellenwert von inhalativen Steroiden neu zu bewerten sein. Die Zulassung von Roflumilast hat die medikamentose Therapie um eine Option erweitert, mit Hilfe derer bei Patienten mit schwerer Obstruktion (FEV1

Die haufigsten Diagnosen bei Patienten mit Dyspnoe sind Asthma, chronisch obstruktive Lungenerkrankung, interstitielle Lungenerkrankung und Herzinsuffizienz. Akute Dyspnoe, definiert als Atemnot, die innerhalb von Minuten oder wenigen Stunden entsteht, wird im Allgemeinen von einer begrenzten Zahl von Grunderkrankungen verursacht und kann Ausdruck einer lebensbedrohlichen Situation sein, die dann einer akuten zielgerichteten Diagnostik mit konsekutiver lebensrettender Therapie nach den Leitlinien der verursachenden Grunderkrankung bedarf.

Data about the clinical presentation of chronic obstructive pulmonary disease (COPD) have resulted in a new classification of the disease. The degree of airflow limitation has been amended by symptoms and exacerbation rate. The standard pharmacotherapy of stable COPD is in transition, as fixed combinations of long acting beta agonists and long acting anticholinergics are in the late stages of clinical development. On this background inhaled corticosteroids will need to be re-evaluated. Roflumilast is a recently approved therapeutic option that primarily diminishes exacerbation frequency in patients with chronic bronchitis and severe airflow obstruction (FEV(1)50%). In COPD patients with acute exacerbations procalcitonin levels can be used to guide antibiotic therapy. Comparable clinical outcomes can be achieved while using significantly less amounts of antibiotics.

Allergic diseases of the lungs may affect the airways, the pulmonary parenchyma and the pulmonary vessels. The most relevant representatives are allergic asthma, hypersensitivity pneumonitis, bronchopulmonary aspergillosis and the Churg-Strauss syndrome. The type of allergic reaction and the pathophysiological consequences vary considerably between these entities. New drugs target specific mechanisms based on new insights into the pathogenetic processes of the underlying disease.

Acute respiratory failure and the "acute respiratory distress syndrome" (ARDS) are frequent medical conditions in critically ill patients. Various causes can potentially result in the development of ARDS. Two cases are presented, in which malignant diseases were identified as causes of the respiratory failure. The first patient was diagnosed with an acute myeloic leukemia M5 (FAB). In the second patient, lung histology revealed an adenocarcinoma of the lung. These case reports show that in addition to the classical causes of ARDS, specific disease entities can mimic this form of respiratory failure. Beside solid cancers and lymphomas, acute and progressive forms of inflammatory, parenchymal lung diseases (such as acute interstitial pneumonitis, acute eosinophilic pneumonia, diffuse alveolar hemorrhagia, and acute hypersensitivity pneumonitis) can manifest with this picture. As a consequence, the diagnostic workup of respiratory failure of unknown cause should include these entities.

Dyspnoea is a very subjective phenomenon based on the variation in severity for a given degree of functional impairment. It is difficult to grade dyspnoea. Dyspnoea is caused by a variety of physiological, pathophysiological, psychological and environmental factors. The mechanisms leading to dyspnoea are not completely understood. It is known that mechanical reasons like ventilation disturbances (obstruction, restriction), impairment of the ventilation muscles, skeletal deformation and many other reasons can cause dyspnoea. Every pulmonary or cardiac disease may induce dyspnoea depending on the progression of the underlying disease. The aim of this article is to give an overview of basic pathophysiological mechanisms, diagnostic procedures and considerations with regard to possible differential diagnoses.

It is currently believed that the most important factor in the pathogenesis of chronic obstructive pulmonary disease (COPD) is inflammation of the small airways caused by inhaled particles and gases. In this context, a disturbance of the physiological balance between proteases and antiproteases develops that may cause lung emphysema. Moreover, oxidative stress seems to be important, as it may enhance the inflammatory reaction. The development of emphysema may also involve a loss of alveolar cells by apoptosis. Finally, several studies have indicated that a systemic inflammation is induced by COPD that may be of relevance to the development of systemic components that are observed in COPD patients.

The chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. Recently, international guidelines for diagnosis, prevention and therapy have been published. Now also a modified German version of these guidelines is available. The diagnosis and the severity of the disease is established on the basis of spirometric findings. All stages of COPD are treated with bronchodilators (beta 2-sympathomimetics and anticholinergics). In addition, in stage II and III theophylline and inhaled corticosteroids may be used. Systemic steroids should be restricted to acute exacerbations. For patients with advanced COPD long-term oxygen therapy and in selected cases surgical procedures may be indicated. Rehabilitation measures are of high value. Strategies for primary prevention and smoking cessation programs are extremely important. To get to the diagnosis of COPD as early as possible, all smokers with cough and phlegm should undergo spirometry.