Background:Real-world evidence concerning the cardiovascular (CV) risk of umeclidinium (UMEC) monotherapy or UMEC/vilanterol (VI) is scarce. This real-world study investigated CV risk in new users of UMEC or UMEC/VI versus new users of tiotropium (TIO) in patients with chronic obstructive pulmonary disease (COPD). Methods:This prospective, observational, multinational, cohort study enrolled patients ≥18 years with COPD who initiated UMEC, UMEC/VI or TIO between 2 February 2016 and 31 January 2023. Noninferiority (95% confidence interval upper bound <2.0) of UMEC and UMEC/VI to TIO was compared for the time-to-first event (hazard ratio (HR) over 24 months) of a composite CV end-point of myocardial infarction, stroke, heart failure or sudden cardiac death. Stabilised inverse probability of treatment weighting adjusted for differences in baseline covariate balance between groups. Incidence rates for the composite CV end-point were calculated. Results:In total, 6606 patients were enrolled; 6165 were included in the analysis. Both UMEC (n=1246) and UMEC/VI (n=2448) were noninferior to TIO (n=2471) for the risk of the composite CV end-point (adjusted HR (95% CI): UMEC versus TIO: 1.254 (0.830-1.896); UMEC/VI versus TIO: 1.352 (0.952-1.922)). Unadjusted composite CV incidence rates were low across cohorts (incidence rate (95% CI) per 100 person-years: UMEC: 1.157 (0.814-1.594); UMEC/VI: 1.287 (1.034-1.584); TIO: 0.924 (0.716-1.174)). Conclusions:Both UMEC and UMEC/VI were noninferior to TIO for composite CV risk, suggesting that physicians may consider escalating patients to dual bronchodilator therapy if COPD symptoms are not effectively managed with monotherapy.

Abstract:Here we summarize the most important new scientific developments in the field of chronic cough (CC). Many have been already considered in the new German Cough Guidelines published 2025. We explain the difference between chronic cough on the one hand as a symptom of almost all respiratory and other diseases and on the other, cough as a disease on its own right: refractory chronic cough and unexplained chronic cough (RCC/UCC). In the German version of ICD 10 a new code was introduced for these entities: U69.6. Every patient with CC should undergo a basic diagnostic procedure including history, physical exam, a chest X-ray and a lung function test. According to a detailed history checking for typical features of a symptomatic CC or RCC/UCC many patients may need further targeted, "personalized" often multidisciplinary diagnosis including all clinically suspected potential causes. We highlight the benefits and a range of possible practical applications of objective cough monitoring with special smartphone and "cough watch" software. We discuss peripheral and central neuronal hypersensitivity of the cough reflex and hence, the scientific base of RCC/UCC. This central neuronal hypersensitivity may also be responsible for a high placebo effect in CC drug trials. Thus, it may be difficult to prove the therapeutic effect of a new drug, i.e. Gefapixant, the first recently approved treatment for RCC/UCC. We discuss the different CC phenotypes and endotypes, they will require development of new differentiated therapies. Finally, we discuss some new pipeline drugs in development.

BackgroundChronic obstructive pulmonary disease (COPD) is a global health concern, characterised by exacerbations, worsening outcomes and increasing costs. Real-world studies are essential for understanding treatment regimens and long-term outcomes.ObjectiveTETRIS focused on the impact of triple therapy in managing COPD.Trial DesignTETRIS was a prospective, observational study that enrolled 1,196 patients with COPD from 134 centres who were on triple therapy for at least 2-48 weeks prior to inclusion.MethodsThe primary objectives were to quantify the proportion of patients continuously receiving triple therapy at 6, 12 and 24 months and assess time to discontinuation using Kaplan-Meier methodology. Clinical outcomes and therapy changes were evaluated overall and in subgroups by dosing regimen (once-daily [OD] vs. twice-daily [BID]) and specific single-inhaler triple therapies.ResultsPersistence with triple therapy was 92.5%, 84.4% and 38.5% at 6, 12 and 24 months, respectively. Only 10% of patients changed therapy over 24 months. At 24 months, the mean change in CAT sum score since baseline was -4.4 among patients on OD triple therapy (FF/UMEC/VI OD). The overall CAT responder rate was 50.1%. Exacerbation and hospitalisation rates remained low throughout the study. The composite endpoint of clinically important deterioration occurred in 53.6% of patients, with lower rates of 45.9% among patients receiving FF/UMEC/VI OD.ConclusionIn this real-world cohort, 38.5% of patients remained on triple therapy at 24 months, and most patients did not require a change in their initial therapy. The steep drop at 24 months was mostly because only few patients remained under observation since the protocol permitted study completion at 18 months, and any patient who dropped out from the study was not censored but counted as patient no longer on continuous triple therapy. These findings support the effectiveness and stability of triple therapy in routine practice and highlight the value of OD single-inhaler regimens in optimising COPD management.Registrationhttps://clinicaltrials.gov/study/NCT04657211.

This is the 4 th edition of the Cough Guidelines of the German Respiratory Society written by respiratory, gastroenterology, ear-nose-throat specialists, including respiratory physiotherapists and speech pathology specialists; importantly, a patient representative was also involved. Compared with earlier versions we used a new methodology: after discussion in the guidelines group, we asked and answered the 12 most important and most frequent "key" questions regarding the clinical practice. The extent of the guideline could thus be significantly reduced. We added a short scientific background to each of the answers including the most recent references. The recommendations and statements were created in consensus and graded as strong, or weak. If sufficient literature was not available, we suggested discussing joint decisions with the patient.

Acute respiratory infections are highly prevalent and significantly impair quality of life and productivity. Despite their impact, they are often not managed according to best medical practice. A lack of knowledge about symptomatic therapies leads to mis- and under-treatment. Thus, this narrative expert opinion paper aims to highlight the importance of appropriate and early symptomatic treatment in order to assist informed therapeutic decision making and advance efforts to reduce antibiotics misuse. Clinical and mechanistic evidence supports the use of several herbal and synthetic non-antibiotic treatment options. While acute respiratory infections are usually self-limiting, treatment alleviates symptom severity, reducing the risk of inflammatory escalation. Timing of the intervention is crucial, as early initiation shortens illness duration. In conclusion, optimizing the management of acute respiratory infections could relieve the individual and societal burden of illness and slow the increase in antimicrobial resistances.

This is the 4th edition of the Cough Guidelines of the German Respiratory Society (DGP), written by and for respiratory, internal medicine, allergy, ear-nose-throat, gastroenterology specialists, speech therapists, and physiotherapists. In a modified Delphi process, the authors developed 12 key questions on classification, common causes of acute, subacute, and chronic cough: both as a symptom of respiratory diseases including the upper airways, reflux, and drug-related cough, and as a primary disease, i.e., unexplained chronic cough and refractory chronic cough due to hypersensitivity of the cough reflex. An in-person guideline conference followed to find evidence-based answers and recommendations, which were graded as strong, weak, or insufficient evidence for recommendation. A brief scientific background to the respective questions was then compiled by expert groups of authors. Diagnostic algorithms were created for acute, subacute, and chronic cough and reflux-related cough. The significantly reduced scope and improved overview make it easy to use it in daily practice. The guideline is available in digital form as a smartphone application (currently only in German): https://www.leila.de/de/.

Chronic cough is a common clinical problem which is burdensome for patients and can be difficult to treat. Individual centres of cough expertise have been set up in countries across Europe but to date there has been no means to collate and analyse clinical data from such sites to gain a more comprehensive understanding of cough phenotypes, disease burden and the natural history of this condition. The NEw Understanding in the tReatment Of COUGH (NEuroCOUGH) registry is the first pan-European prospective observational study of adult patients referred for evaluation of chronic cough. Patients (≥18 years old) with a cough lasting more than 8 weeks with no chest radiology findings to explain the cough will be recruited. Key exclusion criteria include current or recent (<12 months) smoking, significant smoking history (≥20 pack-years) and obstructive spirometry (forced expiratory volume in 1 s/forced vital capacity ratio <0.6). The study aims to recruit 2500 patients across 13 European sites by 2026 and participants will be followed up at 12-monthly intervals for 36 months. The registry comprises comprehensive clinical, physiological and biological data on chronic cough, along with data on the impact and longitudinal outcome of chronic cough. The NEuroCOUGH registry has been established at a time of considerable advance in the field of cough. It will serve as a valuable clinical and research resource which will extend our current understanding of this difficult to treat condition. The initiative is also intended to encourage the establishment of new specialist cough clinics, thus creating much needed clinical trial infrastructure throughout Europe to ultimately improve patient care.

Background: The combination therapy for acute bronchitis with several plant extracts, such as Ivy and Thyme or Primrose and Thyme, is assumed to offer added benefit over single extract preparations. However, no clinical trials have yet demonstrated such a therapeutic advantage. Methods: In this three-arm, open-label, randomized clinical trial, patients with acute bronchitis were assigned to groups receiving Ivy extract EA 575 (Prospan® Cough Drops), Ivy/Thyme extract combination (Bronchipret® Drops), or Thyme/Primrose extract combination (Bronchicum® Drops) according to their respective labels. The primary endpoint was the assessment of non-inferiority, and the second endpoint was the assessment of superiority of Ivy vs. each of the two comparators (Ivy/Thyme and Thyme/Primrose) regarding the change in Bronchitis Severity Score between baseline and day 7. In total, 325 adult patients were considered for evaluation. Results: Non-inferiority of Ivy extract was statistically significant against both comparators (both p < 0.0001). Superiority of Ivy extract was statistically significant against Ivy/Thyme extract (p < 0.0001) but missed statistical significance against Thyme/Primrose extract (p < 0.0607). The incidence of adverse events was low and comparable between the groups. All adverse events were non-serious. Conclusions: these data revealed that Ivy extract EA 575 is non-inferior in acute bronchitis treatment compared to both comparators and superior to Ivy/Thyme.

BACKGROUND:Real-world cohorts provide a more universal understanding of the factors influencing treatment decision outcomes in patients with chronic obstructive pulmonary disease (COPD). METHODS:The objective of the TETRIS study is to elucidate influences on treatment decisions surrounding triple therapy (TT) in COPD patients over a 2-year follow-up period in a real-world setting in Germany. TETRIS included 1217 patients with COPD with/without asthma, already on TT for 2-48 weeks. Here, we report interim analyses of clinical endpoints at the 6-month and 1-year follow-up visits in subgroups of patients (n = 840) stratified based on single versus multiple-inhaler TT (SITT versus MITT), once versus twice-daily TT (OD versus BID) and different SITTs the patients were currently on. RESULTS:Mean number of hospitalisations due to exacerbations was significantly lower among the subgroup on fluticasone furoate, umeclidinium, and vilanterol administered OD (FF/UMEC/VI OD) versus budesonide, glycopyrrolate, and formoterol fumarate administered BID (BUD/GLY/FOR BID) subgroup at 6 months and 1-year (both, p < 0.0001) as well as among OD versus BID TT subgroups at 1-year (p = 0.02). The change in mean COPD assessment test sum score was significantly greater in the SITT versus MITT and OD versus BID TT subgroups at 6 months (p = 0.0018 and p = 0.0202, respectively) and 1-year (p = 0.0071 and p = 0.0002, respectively), and in the FF/UMEC/VI OD versus BUD/GLY/FOR BID subgroup at 1-year (p = 0.0004). CONCLUSION:Overall, SITT dosed OD, specifically FF/UMEC/VI is associated with a significant reduction in hospitalisations due to exacerbations and improvement in symptoms at the 6-month and 1-year follow-up visits. REGISTRATION:https://clinicaltrials.gov/study/NCT04657211.

Die Prävalenz des chronischen, d. h. über 8 Wochen anhaltenden Hustens liegt in verschiedenen europäischen Ländern zwischen 4 und 10,9

Die vorliegende 4. Ausgabe der deutschen fachärztlichen S2k-Leitlinie wurde im Auftrag der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin unter Teilnahme von – durch die jeweiligen Gesellschaften akkreditierten – Allergologen, HNO-Ärzten, Gastroenterologen, Internisten, Logopäden und Physiotherapeuten sowie eines Patientenvertreters unter Leitung eines Systematikers erstellt. Sie soll die S3-Husten-Leitlinie der Deutschen Gesellschaft für Allgemeinmedizin (DEGAM) im Hinblick auf spezielle Fragestellungen ergänzen. Sie hat gegenüber den früheren Versionen 1–3, die einen Monografie-Charakter hatten, ein völlig neues Konzept. In einem modifizierten Delphi-Verfahren erarbeiteten die Autoren 12 Schlüsselfragen, die in der Leitlinienkonferenz beantwortet und auf der Basis der vorliegenden Evidenz abgestimmt und nach Soll- (stark), Sollte- (schwache) oder Kann-Empfehlung (keine ausreichende Evidenz/Erfahrung) graduiert worden waren. Anschließend wurde ein kurzer wissenschaftlicher Hintergrund zu den jeweiligen Fragen durch sachverständige Gruppen der Autoren erarbeitet. Teilweise neue Diagnostik-Algorithmen wurden für den akuten, subakuten und chronischen Husten erstellt. Durch den deutlich reduzierten Umfang und bessere Übersicht ist die Leitlinie für die tägliche Praxis besser anwendbar. Sie wurde außerdem in die Smartphone App Leila Pro aufgenommen und ist mit den dortigen Komfortfunktionen abrufbar. Die Leitlinie enthält folgende Schlüsselfragen: 1. Wie wird Husten klassifiziert? 2. Was sind die häufigsten Ursachen für den akuten und subakuten Husten? 3. Welche Alarmzeichen („red flags“) erfordern eine unverzügliche ausführliche Diagnostik und ggf. Therapie? 4. Was sind häufige Ursachen für den chronischen Husten? 5. Ist die SARS-CoV-2-Infektion bei der Abklärung des Hustens relevant? 6. Was ist chronisch refraktärer oder chronisch idiopathischer Husten? 7. Können chronische Erkrankungen der oberen Atemwege chronischen Husten auslösen? 8. Kann gastroösophagealer Reflux chronischen Husten verursachen? 9. Kann eine bronchiale Hyperreagibilität (BHR) oder eine eosinophile Entzündung der Bronchien (NAEB) ohne klassisches Asthma für den chronischen Husten verantwortlich sein? 10. Gibt es Medikamente, die chronischen Husten verursachen können? 11. Welche Basisdiagnostik und personalisierte Diagnostik sind erforderlich, um den chronischen Husten abzuklären? 12. Welche nicht-medikamentösen und medikamentösen Therapien gibt es für den Husten?

BackgroundChronic cough (CC) is common in clinical practice, with refractory chronic cough (RCC) and unexplained chronic cough (UCC) being defined by guidelines from the European Respiratory Society, German Respiratory Society (DGP), and German Society of General Practice and Family Medicine (DEGAM) as separate entities. This study aimed to investigate the prevalence of RCC/UCC in an outpatient setting of pulmonologists.MethodsThis cross-sectional observational study was conducted in 16 pulmonologists’ offices in Germany. Adult patients with a specialist’s diagnosis of RCC or UCC and who provided informed consent were included. Active smokers were excluded.ResultsOf 22,140 consecutive out-patients screened, 421 were eligible for general analysis, and 226 met the RCC/UCC criteria per DGP guidelines for prevalence analysis. Among the 421 patients, 71.3% were female, 77.9% had therapy-resistant chronic cough (TRCC), and 22.1% had UCC. The main causes of TRCC were otherwise controlled asthma (59.1%) and gastroesophageal reflux disease (19.1%). Diagnosis had been established on average 6.4 ± 7.6 years prior. Common medications included inhaled corticosteroids (ICS/LABA: 45.6%, ICS mono: 26.8%), and herbal antitussives (23.3%). Codeine was used in 4.3% and morphine in 0.7%. Non-drug therapies like physiotherapy were infrequently used. Prevalence projections for RCC/UCC in Germany were 0.21 and 0.64%, based on different models.ConclusionThis study, the first in a secondary care setting in Germany to determine RCC/UCC prevalence in outpatients, found a higher prevalence in women and a long history of suffering. These findings underscore the need for improved diagnostic procedures and new therapeutic developments for RCC/UCC. Key limitations include the potential impact of the Covid-19 pandemic on data collection, a relatively small UCC sample, and potential referral bias due to the secondary care setting.

ZusammenfassungE-Zigaretten werden v. a. von Jugendlichen und jungen Erwachsenen konsumiert. Aromen in E-Zigaretten erhöhen deren Attraktivität und fördern den Einstieg von Jugendlichen und Erwachsenen in den Konsum. Dadurch werden insbesondere junge Menschen dem Risiko einer Nikotinabhängigkeit und vielfältigen toxischen Substanzen aus dem Aerosol der E-Zigaretten ausgesetzt. Es gibt Hinweise, dass verschiedene Aromen in E-Zigaretten gesundheitsschädlich sind, wobei für die Mehrheit der Aromen bislang toxikologische Untersuchungen noch fehlen. Hier besteht ein Bedarf für unabhängige wissenschaftliche Untersuchungen. Die beteiligten wissenschaftlichen Fachgesellschaften fordern ein Verbot von Aromen in E-Zigaretten, ein Verbot von Einweg-E-Zigaretten, eine wirksame Regulierung des Verkaufs von E-Zigaretten und eine wirksame Kontrolle und Umsetzung der Bestimmungen des Jugendschutzes.

Since 1875, the "Deutsche Medizinische Wochenschrift" has been published, making it one of the oldest German-language medical journals. This article highlights, exemplarily and without claiming completeness, some of the significant research findings and clinical studies published in the field of pulmonology over the past 150 years. Some of these were historical first publications, at least in the German-speaking world, and in some cases even internationally.

ZusammenfassungDie aktualisierten Empfehlungen zur Lungenfunktion wurden zum Jahreskongress der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) 2024 vorgestellt und sind in der Zeitschrift „Atemwegs- und Lungenkrankheiten, Jahrgang 50 (2024) März (111–184)“, publiziert, wo sie als PDF kostenlos abrufbar sind. Diese Empfehlungen integrieren auch neue Ansätze zur Interpretation von Funktionsuntersuchungen, wie sie von der ERS (European Respiratory Society) in Zusammenarbeit mit der ATS (American Thoracic Society) publiziert worden sind. Dies betrifft die Spirometrie, die Bodyplethysmografie, die Diffusionskapazitätsmessung, den Bronchodilatationstest, die unspezifische bronchiale Provokation sowie die Referenzwerte. Die Empfehlungen adressieren auch die Oszillometrie sowie die atemmuskuläre Funktionsdiagnostik. Die aktuell vorliegende Publikation versteht sich als Kurzversion der wesentlichen Inhalte dieser komplexen Empfehlungen zur Lungenfunktionsdiagnostik, weist aber auch darauf hin, dass dies nicht das Studium der Langversion der aktuellen Empfehlungen ersetzt, was es insbesondere vor dem Hintergrund der großen Bedeutsamkeit der Lungenfunktionsdiagnostik im klinisch-pneumologischen Alltag zu betonen gilt.