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Competing Interests: T. Greulich erhielt Kongressunterstützung durch AstraZenca, Boehringer-Ingelheim, Chiesi, CSL-Behring, Grifols, GSK, Mundopharma, Novartis sowie Forschungsunterstützung durch CSL-Behring und Grifols. C. Clarenbach erhielt Honorare für Beratertätigkeit von Roche, Novartis, Boehringer, GSK, Astra Zeneca, Sanofi, Vifor und Mundipharma. D. Skowasch erhielt Honorare für Beratertätigkeiten/Vorträge und Kongressteilnahmeunterstützung von Grifols. R. Bals berichtet über persönliche Zahlung (advisory boards) von AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Grifols, Novartis und CSL Behring. Forschung von Prof. Bals wird unterstützt von: Bundesministerium für Bildung und Forschungskompetenznetzwerk (BMBF) Asthma und COPD (ASCONET), Sander Stiftung, Schwiete Stiftung, Boehringer Ingelheim, Novartis und Mukoviszidose e. V. A. R. Koczulla: Vorträge, Advisory Board für CSL und Grifols, Forschungsunterstützung von Grifols und CSL.S. Fähndrich, W. Gleiber, H. Hautmann, R. Heine, M. Idzko, K. Schmidt-Scherzer und R. Wiewrodt geben an, dass kein Interessenkonflikt besteht.

Objectives: Bronchoscopy is an integral part of pulmonary medicine. In recent years, a series of new technologies have evolved. It is to assume that significant changes have also occurred in clinical practice. We conducted a nationwide survey to evaluate the current status of care and to compare it with earlier reports., Methods: A standard questionnaire was sent to 1875 institutions to assess the clinical practice of bronchoscopy in Germany with respect to general issues, education, sedation/anaesthesia and technical aspects., Results: The returned questionnaires cover 301,965 bronchoscopies, performed by 2158 physicians over 12 months, making it the largest survey to date. The proportion of rigid bronchoscopies has decreased and amounts to 7.3% at present. Atropine as a premedication is hardly used any more. Sedation is routinely applied in 88% of flexible bronchoscopies, for which a combination of propofol and midazolam is preferred by most institutions (41.3%), followed by propofol monotherapy (28.3%). 74.4% of institutions accept aspirin for transbronchial biopsy, 8.1% dual platelet inhibition. 62.4% of all institutions perform airway recanalisation, favouring cryotherapy and argon plasma coagulation. 9.1% of bronchoscopies are supported by endobronchial ultrasound., Conclusion: Compared to preceding surveys, the experience of bronchoscopists, especially regarding interventional procedures, has increased. Endobronchial ultrasound has become a standard of care, as has patient sedation with propofol., (© Georg Thieme Verlag KG Stuttgart · New York.)

Flexible bronchoscopy is a standard examination today and is conducted not only in nearly every hospital but also in privately owned practices. The vast majority of patients want sedation for this examination. Such a procedure is nearly always necessary in complex and interventional procedures, irrespective of the patient's wish. The recommendation at hand to use sedation measures for flexible bronchoscopy is based on the results of numerous clinical studies and also takes account of individual experiences in this area. The structural and procedural requirements and the requirements for staff training are defined and should describe the minimum standard when it comes to conducting a bronchoscopy under sedation. Furthermore the drugs recommended for sedation are discussed and their methods of application shown. Finally the recommendations also include suggestions for patient clarification, monitoring and discharge. They should provide the examiner with concrete operating options and therefore above all increase patient safety., (© Georg Thieme Verlag KG Stuttgart · New York.)

Bronchoscopic training courses are an essential part of the education in bronchoscopy for all kinds of specialisations and professions performing such investigations. All aspects of the application should be mentioned during a course. These recommendations are necessary because the number of bronchoscopies performed in the last years has increased due to the increasing number of patients, improved equipment and better availability. Courses should provide the basic knowledge including main points of indications, preconditions for the procedure and decisions of consequence after bronchoscopy. Participants should be trained in the skills of correct handling and performing flexible bronchoscopies in training dummies. Necessary competence requirements on the course instructor are adequate professional qualifications, paedagogic skills and the availability of appropriate teaching material. Quality assurance of the course should be achieved by consequent evaluation. A widely spread field of bronchoscopic applications can improve patient care in many medical specialisations., (© Georg Thieme Verlag KG Stuttgart · New York.)