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Based on real-life data for the stage distribution of COPD patients (GOLD) and the actual stage-related treatment costs in a large nationwide cohort study (COSYCONET) 1, the influence of the reduced smoking rate on treatment costs was determined for the scenario of a reduction in the smoking rate of 26 % in this patient group by 10 percentage points to 16 %. The assumption was made that with a reduced smoking rate, lower stages (I/II) will be more strongly represented, while higher and more cost-intensive stages (III/IV) will be proportionally reduced. The intervention to achieve tobacco abstinence was calculated for the rough model calculations with the typical costs of a guideline-compliant treatment by a behavioral therapy group cessation program and the parallel use of medication support 2 3. The result showed a potential reduction of case costs by 10.5 %, not including reduction in costs associated with treatment of comorbidities., Competing Interests: Thomas Hering erhielt in den letzten 3 Jahren Honorare für Beratung und Vorträge von AstraZeneca GmbH, Berlin-Chemie, GSK, Mylan Pharma, Novartis GmbH, Pfizer Pharma GmbH, Sanofi-Aventis, Takeda, bytes4business, Carepath Technologies. Er betreibt die gemeinwohlorientierte Vermittlungsplattform www.rauchfrei-in-berlin.de und ist Autor der Programmes „Mein Nichtraucherprogramm (Entwöhnungsprogramm des Bundesverbandes der Pneumologen – BdP).Anil Batra hat in den letzten 3 Jahren einschlägige Förderungen durch die Bundeszentrale für gesundheitliche Aufklärung (BZgA) e. V., die Deutsche Krebshilfe und das BMBF erhalten. AB betreibt das Tabakentwöhnungsprogramm „Nichtraucher in sechs Schritten“ und führt regelmäßig Fortbildungen zu diesem Thema durch.Stephan Mühlig hatte in den letzten 3 Jahren wirtschaftliche oder persönliche Verbindungen zur AOKPLUS, der Deutschen Krebshilfe, dem Sächsischen Staatsministierium für Soziales und Gesundheit, der BZgA, dem Bundesgesundheitsministerium, den Firmen Pfizer, Johnson & Johnson.Dennis Nowak erhielt Vortragshonorare von Bristol MyersSquibb, Berlin Chemie, Boehringer Ingelheim, GSK, Mundipharma, Novartis, Hexal, Lilly. Er ist im Advisory Board Raucherentwöhnung der Firma Pfizer tätig.Tobias Rüther erhielt in den letzten drei Jahren Beratungs- und Vortragshonorare von Pfizer Pharma GmbH, Johnson & Johnson, Sanofi und Servier und Berlin Chemie.Larissa Schwarzkopf hatte keinerlei finanzielle, persönliche oder sonst wie geartete Konflikte., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

New patients in the secondary respiratory care require more time for the first consultation and place a higher diagnostic and therapeutic demand if compared to patients already in chronic care. More diagnostic procedures and patient's education by the team are required. No such burden is observed regarding differential degrees of severity of respiratory diseases, e. g. COPD. The overall demands add up to twice the demands of patients already in care. Thus the time required for the treatment of 50 new patients allows consultations for 100 patients already known in the office.As additional time and effort for new patients is not adequately represented in the German medical tax (EBM) a trend to risk selection and a preference for control patients is observed. In contrast incentives to foster treatment of new patients could be an effective measure to dramatically reduce waiting time for visits with pulmonologists. This should be achieved by changes in the German medical tax (EBM)., Competing Interests: A. Hellmann ist Vorsitzender des Bundesverbandes der Pneumologen, Schlaf- und Beatmungsmediziner (BdP); Vorträge für Novartis und Allergopharma.T. Hering ist stellv. Vorsitzender des BdP.J. Andres ist Geschäftsführer der medWIss GmbH, Auftragnehmer des BdP., (© Georg Thieme Verlag KG Stuttgart · New York.)

Exacerbations determine the disease process in COPD often decisively, whereas their detection and documentation has not been established satisfactory yet. For this purpose, a simple short Patient Questionnaire with a maximum of five positive answers was developed and evaluated. Values of 2 or more positive responses amplify the signal for an exacerbation, while with the presence of only 1 positive response a potential, but not a likely exacerbation must be considered. The MEP is well suited for a continuous documentation in computer-based administration systems., (© Georg Thieme Verlag KG Stuttgart · New York.)

COPD patients under shared treatment of general practitioners and pulmonologists were grouped in GOLD classification I-IV and A-D, respectively to find out whether the new A-D classification showed advantages concerning therapy decisions. As a result of CAT separation at 10 points (GOLD A-D rule) group C with higher risk and low symptoms was very small. It is described how CAT threshold values of 15 and 20 points would affect the size of the groups A-D in pulmonary practice. The new A-D classification showed better signals for exacerbations. Regardless of the classification I-IV or A-D respectively patients received a considerable amount of overtreatment (low degrees of severity) or undertreatment (higher degrees of severity). Only the application of prednisolone and of roflumilast, respectively, showed a noticeable relation to increased exacerbations in system A-D. A variety of reasons might cause that obviously the principles of both classifications are followed poorly. Higher attention for exacerbations may be considered as a progress resulting from the new a-d classification. Possible abrupt short term intraindividual changes of severity, inadequate to the global course of disease, are a possible disadvantage of the new A-D classification., (© Georg Thieme Verlag KG Stuttgart · New York.)

Chronic obstructive pulmonary disease (COPD), lung cancer, asthma and pulmonary tuberculosis are common pulmonary diseases that are caused or worsened by tobacco smoking. Growing observational evidence suggests that symptoms and prognosis of these conditions improve upon smoking cessation. Despite increasing numbers of (small) randomised controlled trials suggesting intensive smoking cessation treatments work in people with pulmonary diseases many patients are not given specific advice on the benefits or referred for intensive cessation treatments and, therefore, continue smoking.This is a qualitative review regarding smoking cessation in patients with COPD and other pulmonary disorders, written by a group of European Respiratory Society experts. We describe the epidemiological links between smoking and pulmonary disorders, the evidence for benefits of stopping smoking, how best to assess tobacco dependence and what interventions currently work best to help pulmonary patients quit. Finally, we describe characteristics and management of any "hardcore" smoker who finds it difficult to quit with standard approaches., (Copyright ©ERS 2015.)

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. Cigarette smoking is the main cause of COPD. Quitting smoking is thus the most effective treatment strategy and central in COPD prevention. A number of guidelines on prevention, diagnosis, therapy and rehabilitation of COPD have been published. To help implementing and standardizing smoking cessation in COPD a guideline was published 2008 in Germany focusing on this complex issue. The present guideline is an update of the 2008 guideline and has a high grade of evidence (S3 according to the AWMF; Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften). The guideline gives comprehensive and practical information on how to integrate smoking cessation as an central part of COPD therapy., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: As many as 50% of older smokers develop chronic obstructive pulmonary disease (COPD), and more than 80% of COPD-associated morbidity is caused by tobacco smoking. Despite the severe symptoms from which COPD patients suffer, they are often unable to quit smoking on their own., Methods: Experts from 9 medical societies, under the aegis of the German Society of Pulmonology and Respiratory Medicine (Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin), have developed an S3 guideline on smoking cessation in COPD. They took previously published guidelines into account, as well as more than 2000 initially surveyed publications, and created the new guideline in two consensus conferences followed by a Delphi process., Results: The following strongly evidence-based statements can be made: A smoking cessation strategy based on a combination of medication and psychosocial support has been found to be effective in COPD patients. Smoking cessation improves pulmonary function, alleviates dyspnea and cough, reduces the frequency of COPD exacerbations, and lowers mortality. Mere smoking reduction does not improve pulmonary function or alleviate symptoms. Smoking cessation is the most effective and least expensive single means of lowering the risk of developing COPD and of arresting its progression. Smoking cessation should therefore be strongly promoted at all levels of health care delivery., Conclusions: There is no question that smoking cessation ranks among the most effective medical interventions, yet the German health care system still does not assign it an adequate priority.

More than 30 % of the German population are regular smokers, over half of whom will eventually die of smoking-related diseases. Life expectancy is abridged by 10 years in smokers compared to non-smokers. Smoking tobacco is the main risk factor for lung cancer and chronic obstructive pulmonary disease (COPD) and predisposes to a number of other lung diseases. A smoking cessation programme including pharmacological as well as psychosocial support is highly effective in COPD Patients. Smoking cessation improves lung function, symptoms and mortality. In conclusion, smoking cessation services are among the most effective medical interventions. Thus, a sufficient supply of smoking cessation services on a population level must be ensured.