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Advanced age is not an obstacle to carring out a lung function test. In most cases a lung function test is necessary due to the fact that about 20% of older persons are affected by an obstructive respiratory disorder. Standard values for the lung function test are available up to advanced ages. The experience of the examiner and a calm environment for the lung function test have an impact on the quality of the measurement results. Severe cognitive impairments and severe immobility make the performance of a lung function test impossible. Simple geriatric assessments can help to reliably identify these patients. Alternative lung function test procedures have to be validated in order to adequately diagnose this vulnerable subgroup of patients at risk.Höheres Lebensalter ist kein Argument gegen die Durchführung einer Lungenfunktionsprüfung. Die Notwendigkeit einer Lungenfunktionsprüfung ergibt sich allein aufgrund der mit über 20 % hohen Prävalenz einer obstruktiven Ventilationsstörung bei älteren Menschen. Normwerte für die Lungenfunktionsprüfung sind bis ins hohe Lebensalter verfügbar. Erfahrung des Untersuchers und eine ruhige Umgebung beeinflussen das Messergebnis. Ausgeprägte Hirnleistungsstörungen und schwere Immobilität machen eine Lungenfunktionsprüfung unmöglich. Einfache Assessments helfen, diese Patienten verlässlich zu identifizieren. Um diese gefährdete und vulnerable Subgruppe adäquat behandeln zu können, müssen alternative Untersuchungsverfahren entwickelt und validiert werden.

Spirometry in the Medical Practice - Part 2: Interpretation

Spirometry in the Medical Practice - Part 1: Measuring

Bronchiolitis obliterans (BO) is a rare and severe pulmonary disease which can occur due to airway infection or as a result of stem cell or lung transplantation. Our goal was to study the lung function and airway inflammation among BO patients. Furthermore, we examined the potential of the lung clearance index (LCI) for BO diagnostics among that group. 16 BO patients (age: 16.7; 9.6 - 25.3 years) and 17 healthy controls (age: 16.6; 7.6 - 25.0 years) participated in the study. Lung function parameters (FVC, FEV BO patients had significantly lower FVC, FEV In BO patients, lung function in childhood and adolescence is severely impaired. Furthermore, we were able to demonstrate the sensitivity and reproducibility of LCI and its value for the evaluation of small airway obstruction. In induced sputum, a neutrophil-dominated airway inflammation is detectable. Die Bronchiolitis obliterans (BO) ist eine sehr seltene, chronische Lungenerkrankung, die vereinzelt nach schweren Atemwegsinfektionen oder als Folge von Stammzell- und Lungentransplantation auftritt. Ziel der Arbeit war es, die Lungenfunktion und die bronchiale Entzündung bei BO-Patienten im Jugend- und Kindesalter zu untersuchen. Zudem sollte das Potenzial des LCI in der Diagnostik dieser Patienten untersucht werden. Es wurden 16 BO-Patienten (Alter: Median 16,7; 9,6 – 25,3 Jahre) und 17 gesunde Probanden (Alter: Median 16,6; 7,6 – 25,0 Jahre) untersucht. Neben der Untersuchung der Lungenfunktion (FVC, FEV FVC, FEV Die Lungenfunktion ist bei Kindern und Jugendlichen mit BO stark eingeschränkt. Zudem erwies sich der LCI als sensitiver und reproduzierbarer Marker zur Beurteilung der obstruktiven Beeinträchtigung der kleinen Atemwege. Im induzierten Sputum ist eine von Neutrophilen dominierte bronchiale Entzündung nachweisbar.

Based on a case report an overview on the differential diagnostic considerations with respect to blood hypereosinophilia (HE) and hypereosinophilic syndromes (HES) in childhood is given. A 13-year-old boy was admitted for the clarification of an asthma. In the blood count an increased HE with 3 500/µl (30%) was found along with elevated total serum IgE and IL-5 level (2 000 IU/ml and 17 pg/ml). Lung function showed an obstruction (FEV1 38%). Radiologically the picture of bronchiectasis and mucus pluggine appeared. In the BAL a HE (76%) with raised IL-5 level was apparent. Histologically asthma was diagnosed with mucostasis, hypertrophy of the bronchial wall musculature and a lung HE. Differential-diagnostically an ABPA, a Churg-Strauss-Syndrome, a parasitosis, drug associated HE, allergies and malignant disease could be excluded. An aberrant T-cell clone in peripheral blood was detected by flow cytometry and T-cell receptor clonal rearrangements by PCR, leading to the diagnosis of a lymphoid variant of HES (L-HES). Failure to detect the FIP1L1-PDGFRA gene fusion and a normal bone marrow examination could exclude a neoplastic HES (HESN). After steroid initiation, prompt decrease of blood eosinophilia with resolution of symptoms was observed. Steroid discontinuation led to eosinophilia recurrence associated with disease symptoms. As steroid-sparing agent the immunosuppressive azathioprine was additionally given; steroid doses could be decreased and stopped in the course. This case demonstrated the range of HE evaluation in infancy. With asthma one should also consider the possibility of a L-HES.

Prognostic factors for clinical failure of acute exacerbation in patients with COPD (AECOPD) are of special importance in order to choose an adequate therapy and resources during inpatient treatment. Our database was analyzed to identify predictors for a negative outcome.In a retrospective analysis medical records of 616 patients (299 women; 317 men) hospitalized for AECOPD between January 2011 and January 2016 were analyzed in order to evaluate demographic and clinical parameters leading to adverse events. Only the first admission was considered. Logistic regression analysis was performed to determine the relative risk (odds ratio (OR) leading to severe adverse events such as intensive care unit (ICU) admission, mechanical ventilation (invasive or noninvasive), early readmission to ICU and hospital and death).An increased risk of an ICU admission was found for patients with a coronary heart disease (OR = 5.734; p = 0.009) and for patients requiring an antibiotic therapy (OR = 11.721; p = 0.003). An increased risk for rehospitalisation and mortality was found for age (OR = 1.034; p = 0.028) and a longer duration of the hospital stay (OR = 1.063; p = 0.042). A lower C‑reactive protein (CRP) level was associated with a lower risk of readmission to the hospital (OR = 0.991; p = 0.03). An increased risk of ventilator therapy was found for patients with chronic heart failure (OR = 6.166; p = 0.02) and sleep apnea syndrome (OR = 6.698; p = 0.003), diabetes (OR = 3.754; p = 0.041) and a long stay in the ICU (OR = 2.018; p = 0.000).Comorbidities in patients with AECOPD were found to be a major risk factor for ICU admission and mechanical ventilation. Elderly patients and patients with prolonged hospital stay showed a higher risk for readmission and mortality. Patients with a low CRP blood level seemed to have a lower risk for rehospitalisation.

Spirometry is an important diagnostic tool, which, with correct implementation, detects possible obstructive or restrictive lung diseases. However, it is important to note that only part of the lung function is measured by spirometry. For instance, total lung volume and residual volume, both useful in detecting pulmonary emphysema, are not measured. Therefore, in case of pathological spirometry or suspected restrictive lung disease, further tests such as body plethysmography with diffusion measurement should be carried out.

A hallmark of the newly published GLI (Global Lungs Initiative) spirometric reference values is their "all-age" (3-95yr) predictive power, accomplished by incorporating non-linear age dependencies into modelling parameters. This modelling strategy is especially promising for the age range of puberty; however, the performance of GLI-values for adolescents is currently unknown. We calculated GLI-based z-scores for children/adolescents without apparent respiratory diseases from two different German studies, LUNOKID (N = 1943, 4-19 years) and GINIplus (N = 1042, 15 years) and determined the goodness of fit for specific age groups. We defined fit sufficient if the absolute mean of z-scores was

In lung disease, physical activity improves lung function and reduces morbidity. However, healthy populations are not well studied. We estimate the relationship between spirometric indices and accelerometric physical activity in lung-healthy adolescents.895 nonsmoking German adolescents without chronic lung disease (45% male, mean±sdage 15.2±0.26 years) from the GINIplus and LISAplus cohorts completed questionnaires, spirometry, 7-day accelerometry and an activity diary. Physical activity was measured as minutes, quintiles and regularity of daily moderate, vigorous and moderate-to-vigorous physical activity (MVPA), participation in sport and active commuting to school. Primary outcomes were forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC and forced expiratory flow at 25–75% of FVC; they were separately correlated with physical activity and adjusted for confounders of respiratory function, including early-life exposures.Adolescents averaged 40 min MVPA per day, typical for European youth. 79% participated in sports and 51% commuted actively. An association was suggested between 3% higher FVC (∼100 mL) and either extreme MVPA quintile or percentage of days with >30 min MVPA (pSpirometric indices were not significantly associated with active lifestyle or measures of activity in lung-healthy adolescents after adjustment for confounding and multiple-comparison artefacts.

The new lung function reference values of the global lung initiative (GLI) are recommended by most health societies. The aim of this study was to analyze FEV1- and FEV1/FVC-values from a German and Austrian patient group applying old and new reference values.A total of 215 Caucasian children (aged 5-17 years) were included. FEV1-values were significantly lower applying GLI reference values compared to Zapletal values (median 96.9 % pred. (87.3-105.2) versus 100.6 % pred. (quartile 91.5-111.4), p = 0.000), the median difference was 4.9 % (range -12.9 to 27.5) % pred. Differences correlated significantly with age and FEV1 in % predicted (Zapletal), p = 0.000 17/70 (24 %) patients with cystic fibrosis had FEV1-values80% pred. applying Zapletal, in 25 (36 %) patients FEV1 was abnormal (z-score1645) using GLI values; 3/145 asthmatics (2 %) had FEV1-Werte80 % d.S. (Zapletal), 7/145 (5 %) z-scores1645 (GLI).Differences between GLI-and Zapletal-reference values were considerable in pediatric asthma and CF-patients.

Preschool children often show total expiration times of less than one second in pulmonary function tests. Therefore, FEV1 cannot be used for evaluation of obstructive pulmonary diseases in small children. Aex, the area under the expiratory flow-volume loop, does not depend on the expiration time. The Aex value varies according to the convex or concave shape of the flow volume loop, can be quantified and is a valuable parameter in the diagnosis of obstructive airway diseases.In this study FEV1 und Aex values of 19882 flow-volume loops were measured and compared. The comparison shows a very high correlation coefficient of r = 0.99.The changes of both parameters in an individual after provocation or bronchospasmolysis also demonstrate a strong correlation. A 20 % change of FEV1 equals an Aex change of 36 %.We conclude that measuring Aex is a good alternative to measuring FEV1 especially if the FEV1 cannot be obtained due to short expiration times.

COPD is not a homogenous disease but consists of at least four different phenotypes: Emphysema, COPD with chronic bronchitis, asthma-COPD overlap syndrome (ACOS), and COPD with recurrent exacerbations. With differentiation, treatment can be designed phenotype-specific. Some modern drugs are not indicated in all phenotypes.COPD stellt kein homogenes Krankheitsbild dar. Mindestens vier häufigere klinische Phänotypen lassen sich differenzieren: COPD mit Emphysem, COPD vom bronchitischen Typ, Asthma-COPD-Overlap-Syndrome (ACOS) und COPD mit häufigen Exazerbationen. Die Festlegung des Phänotyps erlaubt eine Typ-spezifische Behandlung. Manche Therapieformen eignen sich nur für einzelne Phänotypen.La BPCO n'est pas une maladie homogène. Quatre différents phénotypes peuvent être différentiés: BPCO avec emphysème, BPCO avec bronchite chronique, l'asthme-BPCO overlap syndrome (ACOS) et la BPCO avec des exacerbations fréquentes. Avec la différentiation du type la thérapie devient phénotype-spécifique. Quelques médicaments modernes ne sont pas indiqués que dans certains phénotypes.

Chronic obstructive pulmonary disease (COPD) and asthma share common clinical characteristics such as cough and dyspnea. Therefore both diseases are sometimes difficult to distinguish clinically but extended medical history and diagnostic tests usually allow their differentiation. This is important because the therapeutic approach differs between the two diseases. In many cases spirometric testing including bronchodilatation is useful to differentiate between COPD and Asthma and can also be performed by the general practitioner. Apart from spirometry, additional diagnostic tests are presented that facilitate differentiation between COPD and Asthma.Die chronisch obstruktive Lungenerkrankung (COPD) und das Asthma bronchiale weisen Gemeinsamkeiten in der Symptomatik auf wie z. B. Husten und Atemnot. Die klinische Unterscheidung ist daher nicht immer leicht, jedoch helfen sowohl die weiterführende Anamnese als auch diagnostische Tests erheblich bei der Differenzierung. Diese ist überaus wichtig, da sich die therapeutischen Ansätze der beiden Erkrankungen unterscheiden. Die Spirometrie inklusive Bronchodilatation ist in vielen Fällen der geeignete Test für die Unterscheidung zwischen Asthma und COPD und kann auch in der Hausarztpraxis einfach durchgeführt werden. Neben der Spirometrie werden im folgenden Artikel weitere diagnostische Tests vorgestellt, mit deren Hilfe Merkmale der jeweiligen Erkrankung objektiviert werden können, die die Unterscheidung erleichtern.

Roflumilast is a new drug with innovative pharmacodynamic properties for use in patients with chronic obstructive pulmonary disease (COPD). By selective inhibition of phosphodiesterase-4 roflumilast targets inflammatory processes in COPD, with beneficial effects on smoking-induced bronchial inflammation, fibrotic remodeling, mucociliary malfunction and oxidative stress.

Chronic obstructive pulmonary disease (COPD), a complex disease triggered mostly by exposure to cigarette smoke, is a leading cause of morbidity and mortality worldwide, leading not only to pulmonary damage but also to systemic impairment. There is growing awareness of systemic inflammation and cardiovascular, neurologic, psychiatric, and endocrine comorbidities associated with COPD. The diagnosis of CODP is based upon the clinical presentation, measurement of the pulmonary function, investigation of comorbidities and exclusion of differential diagnoses. COPD is a heterogeneous disease including various phenotypes. A number of drugs reduce or alleviate symptoms, increase exercise capacity, or reduce the number and severity of exacerbations. Non-pharmacologic measures such as smoking cessation, nutritional support, long term oxygen therapy, physiotherapy, rehabilitation, lung volume reduction and lung transplantation may be available for appropriate patients and can improve health status.

A 46-year-old patient was frequently seen with a medically treated Anti-Jo-1 syndrome. The patient had already been treated with azathioprine and oral corticosteroids on account of decreasing lung function, dyspnoea, fatigue, and beginning signs of myositis. Although high doses of steroids and azathioprine were administered, the muscleskeletal syndromes increased steadily. The patient used to be an active long-distance runner (20 km), but now was unable to perform that kind of physical exercise. It was decided to start a treatment with the GalileoTM training device for active muscle training of the lower extremities. Before and after three months of training the following assessment was performed: measurement of health-related quality of life (St. Georges respiratory questionnaire, SGRQ), ultrasound measurement of the cross-sectional area of the quadriceps muscle, 6 minute walk test (6 MWT), lung function testing, and assessment of serum markers of inflammation (TNF-alpha, interleukin-8, CRP, CK, myoglobin). After only two months, training with the GalileoTM five times a week has improved the patient's conditions dramatically. The training will be continued.

Cystic fibrosis (CF) is a chronic, life-shortening disease of multiple organ systems. Guidelines recommend that patients should be treated in specialised CF centres with multi-professional teams. We describe the organisation of medical care at the CF centre of Innsbruck University as well as results of treatment.Procedures and delivery of multi-professional care have been elaborated and structured. Since 2006 the Centre has been repeatedly certified according to DIN ISO 9001:2000. The patient database is being used during the doctor's consultation and for the continuous monitoring of treatment results.In 2010, 71 of the 148 patients (48%) were between 18 and 56 years old. The total number of patients has doubled and the proportion of adults tripled since 1995. Nevertheless, median FEV1 remained stable (80% of predicted) during the last 15 years. Compared with 18 CF centres of the German Benchmarking Group, patients treated in Innsbruck had favourable FEV1 values: 52% of adults had a normal FEV1 (80% pred.) and only 23% an FEV150% of predicted.A structured programme of multi-professional care was associated with favourable treatment results, both longitudinally and in comparison to other CF centres.

Workers exposed to dust have to undergo medical check-ups every 2 years including lung function testing. Here we report on the routine lung function data (FVC, FEV1, MEF50) of 994 workers from Austria. Lung function data were compared to the Austrian standard values that are based on routine testing of healthy volunteers. For all parameters the workers' values were significantly poorer than the Austrian standards (FVC: -0.4 l; FEV1: -0.5 l; MEF50: -0.9 l/s). The difference from the standard increased with increasing duration of the dust exposure. This increase was significant for the total group for MEF50 even after controlling for smoking. About half of the workers were exposed to quartz dust and had poorer lung function values (p = 0.02 for MEF50) than the other workers. Smoking significantly reduced all 3 lung function parameters with a significant interaction between strong smoking (compared to non-smokers) and quartz exposure (compared to all other exposures). Current Austrian limit values are not protective against chronic damage of the respiratory system. The combined impact of cigarette smoke and high concentration of mineral dust (quartz) is especially dangerous.

The question about the repeatability of forced expiratory manoeuvres in childhood lung function testing is of scientific and clinical interest. The following study investigated to what extent children ≥ 4 to 7 years of age with intermittent bronchial asthma are able to produce reproducible lung function measurements on the one hand in the healthy status and on the other hand in an exacerbated status.64 children at the age of ≥ 4 to 7 years with intermittent preschool bronchial asthma performed lung function measurements in the healthy status and again in an exacerbated status. FEV (1) values from the measurements were analysed according to ATS/ERS guidelines concerning repeatability.According to the new ATS/ERS guidelines 74.6 % of the children could perform at least 2, and 59.3 % could perform 3 repeatable measurements in the healthy status. In the exacerbated status this was 87.5 % and 68.8 %, respectively. There were no significant differences between the healthy and the exacerbated status and between the age groups. Compared to former repeatability criteria, children of this age group can perform significantly more reproducible measurements (p 0.0001).The ATS/ERS guidelines from 2007 simplify the repeatability of forced expiratory manoeuvres in children at ≥ 4 to 7 years of age compared to the former criteria. Repeatability is not reduced in the exacerbated status. 74.6 % of children in this age group can produce repeatable lung function measurements.

Preoperative evaluation of patients undergoing lung resection remains an interdisciplinary challenge. Despite substantial progress in anesthesiology, intensive care medicine and surgery, mortality of patients undergoing pneumonectomy remains high at 5-9%. Guidelines were developed to identify patients with an increased perioperative risk for morbidity and mortality. These guidelines are focused around the forced expiratory capacity (FEV) measured by spirometry, following further investigations in patients with limited FEV(1). Extended testing includes measurement of the diffusion capacity, calculation of postoperative predicted values of lung function and spiroergometry to determine maximal oxygen uptake. In this article the methods to measure parameters of lung function and gas exchange are described and evaluated in the context of the current guidelines.

Several national and international studies on the care of asthma patients delivered by community pharmacists have shown that pharmacist interventions help to improve patient parameters like, for example, the patient's quality of life, self-management skills, compliance and optimization of drug therapy. These results have led to pharmacists' involvement in national asthma guidelines, e.g., in the UK and the United States. Pharmacists have now also been involved in the revised version of the German national guidelines on asthma. In this paper we will present the existing evidence in Germany on how pharmacists add value to the care of asthma patients. Furthermore, the involvement of pharmacists in the German National Disease Management Guideline for Asthma will be discussed.

The assessment of lung function with spirometry is a frequently performed diagnostic procedure and is considered an important tool in medical monitoring of pulmonary diseases. This study aimed at establishing current reference standards, derived from a representative population sample in West Pomerania of Germany and to compare them to existing data.Standardized spirometric function tests were performed - 1sec forced respiratory volume (FEV1) and forced vital capacity (FVC) - on 1,809 participants (885 men, 924 women) of a cross-sectional epidemiological survey, called Study of Health in Pomerania ( SHIP).All persons with cardiac disorders, current smokers and those who were on specific medication which could influence lung functions were excluded, leaving a total of 904 healthy subjects (439 men, 465 women, aged 25-85 years. The results were analysed by quantile regression.The study provides a representative, gender specific set of predictive equations for lung function parameters by spirometry. Comparison to existing prediction equations revealed a consistent underestimation in the current population. The results help to interpret the results of lung function tests: it is therefore recommended that the existing prediction equations be revised.

A complete removal of the larynx has profound consequences for a patient. Since laryngectomy involves the separation of the upper airway from the lower airway, it not only implies a loss of the voice organ but also leads to chronic lung problems such as increased coughing, mucus production and expectoration. In addition, laryngectomees complain of fatigue, sleeping problems, a reduced sense of smell and taste, and a loss of social contact. A heat and moisture exchanger (HME) cassette can replace a function of the upper airway which consists in conditioning inspired air. It can improve pulmonary symptoms in three ways. 1. An HME cassette heats and moisturises inhaled air and thus creates nearly physiological conditions in the region of the deep airway. 2. The use of an HME cassette leads to an increase in breathing resistance, thereby reducing dynamic airway compression and improving lung ventilation. 3. An HME cassette acts as a filter and removes larger particles from incoming air. This review examines the current understanding of lung physiology after laryngectomy and assesses the effects of HME cassettes on the conditioning of respiratory air, lung function and psychosocial problems.

The question whether patients suffering from end-stage emphysema who are candidates for lung transplantation should be treated with a single lung or with a double lung transplantation is still unanswered.We reviewed 24 consecutive lung transplant procedures, comparing the results of 6 patients with an unilateral and 17 with a bilateral transplantation.After bilateral transplantation the patients showed a trend towards better blood gas exchange with shorter time on ventilator and intensive care compared patients after unilateral procedure. Three-year-actuarial survival was higher in the group after bilateral transplantation (83% versus 67%). There was a continuous improvement in pulmonary function in both groups during the first months after transplantation. Vital capacity and forced exspiratory ventilation therapies during the first second were significantly higher in the bilateral transplant group.Both unilateral and bilateral transplantation are feasible for patients with end-stage emphysema. Bilateral transplantation results in better pulmonary reserve capacity and faster rehabilitation.

The antileukotrienes (anti-LT), consisting of synthesis inhibitors and leukotriene receptor antagonists, represent a new direction in targeted drug therapy for asthma. In the present article, the anti-inflammatory properties of anti-LT are briefly summarized. Orally administered anti-LT inhibit the allergen-induced early and late asthmatic reactions and may attenuate the allergen-associated hyperresponsiveness. They also have a remarkable inhaled steroid-sparing effect. In chronic asthma, anti-LT may exert significant therapeutic benefit. In addition to their properties as relievers, anti-LT may have properties as controllers of asthma.

Physical activity is an important parameter related to morbidity and mortality in cardiovascular disease, metabolic syndrome/diabetes, mental disorders, cancer, and chronic obstructive pulmonary disease (COPD). In COPD, lower levels of physical activity as reported by the patients are associated with a faster annual lung function decline, increased number of hospitalizations, and higher risk of mortality. Self-reported physical activity, however, correlates only poorly with objectively quantified physical activity in patients with COPD. Recent data show that physical activity can reliably be measured in a substantial number of patients with COPD. Extrapulmonary effects of COPD are associated with reduced physical activity. Clinical characteristics commonly used to assess disease severity like the forced expiratory volume in 1 s or the 6-min walk distance only incompletely reflect the physical activity of patients with COPD.

After bronchoscopic lung-volume reduction (LVR) improvement in pulmonary function and exercising tolerance can be achieved in patients with severe heterogeneous lung emphysema. Feasibility and safety for one-way valve placement in homogeneous emphysema were evaluated.Ten patients entered this prospective study. In all cases a homogeneous distribution was confirmed by computer analysis of the CT-scans. We performed unilateral LVR and occluded the lobe with the lowest perfusion, measured by nuclear scintigraphy. Endpoints of the study were changes in lung function test, quality of life and 6-minutes-walk-test (6-MWT) at day 30 and 90 and the safety of the procedure.Preoperative mean forced expiratory volume in 1 second (FEV1) was 0.93 l (range 0.55 - 1.35 l), mean residual volume was 5.23 l (3.55 - 8.24 l) and 6-MWT was 325 m ( 150 - 480 m). Improvement of dyspnoe and exercising tolerance was reported in 7 cases. No major changes in lung function were evident at days 30 and 90. A trend towards improvement was observed in 6-MWT (DeltaMW + 10.4 +/- 9.8 %). One pneumothorax was noticed, in one case the valves were removed after 90 days because of recurrent infections.This study shows that bronchoscopic LVR in patients with severe homogeneous emphysema is feasible and seems to be safe. In contrast to surgical LVR patients may have a cinical benefit by bronchoscopic treatment. Longtime follow -up and patient selection criteria have to be examined in larger trials.

A standard outcome parameter for pharmacological trials in COPD has not yet been defined. Therefore, it is the aim of this review to evaluate frequently used parameters for their eligibility as assessment and outcome parameters in COPD.A review of the actual scientific literature was performed.It is recommended to continue to rely primarily on the FEV (1), which has been used as a primary variable in the vast majority of trials. In addition, further parameters, such as FVC and IC/TLC should be determined. If available, additional information is provided by RV/TLC, K (co), PaO (2) and PaCO (2). FEV (1) is not a surrogate parameter for dyspnoea, quality of life, and exercise tolerance, which should therefore be assessed separately. Frequency and severity of exacerbations and mortality are important outcome parameters in long-term trials. Complex indices, such as the BODE index, may be superior to single variables.No single additional parameter has been evaluated sufficiently in order to substitute FEV (1) as the standard parameter for the assessment and outcome in COPD.

There is overwhelming evidence from large-scale placebo-controlled trials but also from epidemiologic COPD (chronic obstructive pulmonary disease) studies and meta-analyses supporting FEV(1) (forced expiratory volume in 1 s) as a strong diagnostic and prognostic marker that predicts future morbidity and mortality. Specifically, attenuation of reduced FEV(1) is a powerful indicator of successful medical intervention and vice versa. FEV(1) decline indicates an increasing risk for advanced disease stage eventually leading to further deterioration. However, it remains to be determined whether reducing the frequency of exacerbations or pharmacological improvement of FEV(1) can help to slow lung function decline and consequently improve clinical outcome in these patients. All in all, FEV(1) and its change over time are essential parameters in the assessment of COPD progression and efficacy of therapeutic intervention.

In the treatment of asthma and COPD for two drug classes slowly increasing starting doses or tapering at the end of therapy is required: In the case of allergen specific immunotherapy (desensitisation) with allergen extracts gradual increases of doses are necessary to prevent allergic shock. In the case of prolonged systemic treatment of asthma or COPD with glucocorticoids tapering is necessary to avoid symptoms of adrenal gland insufficiency after drug withdrawal or exacerbation of the underlying disease. In the short term treatment of asthma exacerbations with systemic glucocorticoids tapering is not necessary, for COPD suitable studies are still lacking.