Leitlinie der Deutschen Atemwegsliga und der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD)

Inhalt Seite Vorwort e2 Ziele und Anwendungsbereich der Leitlinie e2 Entwicklungsprozess der Leitlinie e2 Klinische Algorithmen e3 Sponsoring e3 Strategien zur Förderung der Verbreitung und Implementierung der Leitlinie e3 Weiterentwicklung der COPD-Leitlinie e4 Definitionen e4 Epidemiologie und sozioökonomische Bedeutung e4 Verlauf der Erkrankung e5 Management der COPD e5 Diagnostik e5 Leitsätze e5 Untersuchungsmethoden e5 Anamnese e5 Körperliche Untersuchung e6 Lungenfunktionsdiagnostik e6 Reversibilitätstest mit Bronchodilatatoren e6 Reversibilitätstest mit Glukokortikoiden zur differenzialdiagnostischen Abgrenzung zwischen Asthma und COPD e7 Weitere Lungenfunktionstests e7 Blutgasanalyse e7 CO-Diffusionskapazität e7 Belastungstests e7 Röntgenaufnahme der Thoraxorgane e7 Computertomographie des Thorax e7 Elektrokardiogramm e8 Echokardiographie e8 Laboruntersuchungen e8 Sputumdiagnostik e8 Diagnostisches Vorgehen bei Verdacht auf COPD e8 Schweregradeinteilung der stabilen COPD e8 Leichtgradige COPD (Schweregrad I) e8 Mittelgradige COPD (Schweregrad II) e8 Schwere COPD (Schweregrad III) e8 Sehr schwere COPD (Schweregrad IV) e9 Differenzialdiagnosen e10 Weitere differenzialdiagnostische Aspekte e10 Verlaufsuntersuchungen e11 Therapie e11 Prävention e11 Leitsätze zur Prävention e11 Prävention des Tabakrauchens e12 Verzicht auf Tabakrauchen e12 Raucherentwöhnung e12 Prophylaxe von arbeitsplatzbezogenen Schadstoffen e13 Schutzimpfungen e13 Influenzaschutzimpfung e13 Influenzaprophylaxe e13 Pneumokokkenschutzimpfung e13 Langzeitbehandlung der stabilen COPD e13 Leitsätze e13 Bronchodilatatoren e14 Anticholinergika e15 β2-Sympathomimetika e15 Theophyllin e15 Kombinationen von Bronchodilatatoren e16 Inhalation mit Verneblern e16 Glukokortikoide e16 Inhalative Glukokortikoide e16 Systemische Glukokortikoide e16 Kombinationen aus langwirksamen β2-Sympathomimetika und Glukokortikoiden e17 Mukopharmaka e17 Immunmodulatoren e17 Antitussiva e18 Atemstimulanzien e18 Analgetika (Morphin) e18 Weitere medikamentöse Therapieoptionen e18 Substitutionstherapie bei Alpha-1-Protease-Inhibitor-Mangel e18 Behandlung der Osteoporose e18 Nichtmedikamentöse Therapie e18 Körperliches Training e18 Patientenschulung e19 Physiotherapie e19 Hilfsmittel zur Sekretelimination e20 Ernährung e20 Pneumologische Rehabilitation e21 Komponenten der pneumologischen Rehabilitation e21 Effekte der pneumologischen Rehabilitation bei Patienten mit COPD e21 Auswahl der Patienten e21 Organisation der Pneumologischen Rehabilitation e21 Langzeitsauerstofftherapie (LOT) e22 Heimbeatmung e22 Operative Therapieverfahren e23 Bullektomie e23 Lungenvolumenreduktion e23 Lungentransplantation e23 Palliative Therapie e24 Management akuter Exazerbationen e25 Leitsätze e25 Definition e25 Diagnostik e25 Therapie der Exazerbation e26 Medikamentöse Therapie e27 Bronchodilatatoren e27 Antibiotika e27 Glukokortikoide e28 Zusätzliche Maßnahmen bei der Behandlung akuter Exazerbationen im Krankenhaus e28 Beatmung e29 Nichtinvasive Beatmung mit positivem Druck (NIPPV) e29 Invasive Beatmung e30 Management nach der akuten Exazerbation im Krankenhaus e30 Exazerbationsprophylaxe e30 Appendix A: e31 Berufsbedingte Bronchitis e31 Bronchitis im Unfall- und Berufskrankheitenrecht e31 Bronchitis im sozialen Entschädigungsrecht und im Schwerbehindertenrecht e31 Prävention am Arbeitsplatz e31 Appendix B: e32 Teilnehmerliste der Konsensus-Konferenz e32 Literaturverzeichnis e33

Literatur

• 1 Worth H, Buhl R, Cegla U. et al . Leitlinie der Deutschen Atemwegsliga und der Deutschen Gesellschaft für Pneumologie zur Diagnostik und Therapie von Patienten mit chronisch obstruktiver Bronchitis und Lungenemphysem (COPD).  Pneumologie. 2002;  56 704-738
• 2 Global Initiative for Chronic Obstructive Lung Disease (GOLD) .Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2005 http://www.goldcopd.com(goldwr2005.pdf
• 3 Celli B R, MacNee W. and committee members . Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper.  Eur Respir J. 2004;  23 932-946
• 4 National Collaborating Centre for Chronic Conditions, National Institute of Clinical Excellence (NICE) . Chronic obstructive pulmonary disease. National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care.  Thorax. 2004;  59 Suppl 1 1-232
• 5 Pauwels R A, Buist A S, Calverley P MA. et al . Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2001;  163 1256-1276
• 6 ATS Statement . Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1995;  152 S77-S120
• 7 Siafakas N M, Vermeire P, Pride N B. et al . ERS-Consensus statement. Optimal assessment and management of chronic obstructive pulmonary disease.  Eur Respir J. 1995;  8 1388-1420
• 8 BTS . Guidelines for the management of chronic obstructive pulmonary disease.  Thorax. 1997;  52 (Suppl 5) S1-S28
• 9 Canadian Respiratory Review Panel .Guidelines for the treatment of chronic obstructive pulmonary disease (COPD). Monograph 1998
• 10 Laitinen L, Koskela K. et al . Chronic bronchitis and chronic obstructive pulmonary disease: Finnish national guidelines for prevention and treatment 1998 - 2007.  Respir Med. 1999;  93 297-332
• 11 Lorenz W, Ollenschläger G. et al . Das Leitlinienmanual von AWMF und ÄZQ.  ZaeFQ. 2001;  95 (Suppl. I) 41-43
• 12 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften .Erarbeitung von Leitlinien für Diagnostik und Therapie. Methodische Empfehlungen. Abrufbar unter: http://www.uni-duesseldorf.de/WWW/AWMF
• 13 Society for Medical Decision Making . Committee on standardization of clinical algoritms. Proposals for clinical algorithm standards.  Med Decis Making. 1992;  12 149-154
• 14 Report of an expert committee: Definition and diagnosis of pulmonary disease with special reference to chronic bronchitis and emphysema.  WHO Techn Rep Ser. 1961;  213 14-19
• 15 Ciba guest symposium report: Terminology, definitions and classifications of chronic pulmonary emphysema and related conditions.  Thorax. 1959;  14 286-299
• 16 Konietzko N, Fabel H. Weißbuch Lunge 2000. Stuttgart-New York: Thieme
• 17 Statistisches Bundesamt .Statistisches Jahrbuch, Jahrgänge 1968 - 1999. Stuttgart-Mainz: Kohlhammer
• 18 Murray C JL, Lopez A D. The global burden of disease: A comprehensive assessment of mortality and disability from diseases. Injuries and risk factors in 1990 and projected to 2020. Cambridge: Harvard University Press 1996
• 19 Lopez A D, Murray C JL. The global burden of disease, 1990 - 2020.  Nature Med. 1998;  4 1241-1243
• 20 Nowak D, Berger K, Lioppert B. et al . Epidemiology and health economics of COPD across Europe. A Critical Analysis.  Treat Respir Med. 2006;  4 381-395
• 21 Fabel H, Konietzko N. (Hrsg) .Weißbuch Lunge. Stuttgart, New York: Thieme Verlag 2005
• 22 Rulff L K, Volmer T, Nowak D. The economic inpact of smoking in Germany.  Eur Respir J. 2000;  16 385-390
• 23 Rychlik R, Pfeil T, Daniel D. et al . Zur sozioökonomischen Relevanz akuter Exacerbationen der chronischen Bronchitis in der Bundesrepublik Deutschland.  Dtsch Med Wschr. 2001;  126 353-359
• 24 Nowak D, Dietrich E S, Oberender P. et al . Krankheitskosten von COPD in Deutschland.  Pneumologie. 2004;  58 (12) 837-844
• 25 Laurell C B, Eriksson S. The electrophoretic alpha-1 globulin pattern of serum in alpha-1 antitrypsin deficiency.  Scand J Clin Lab Invest. 1963;  15 132-140
• 26 Orie N GM, Sluiter H J, De Vreis K. et al .Bronchitis, an international symposium. Assen, Netherlands: Royal Vangorum 1961: 43-59
• 27 Svanes C, Omenaas E, Heuch J M. et al . Birth characteristics and asthma symptoms in young adults: results from a population-based cohort study in Norway.  Eur Respir J. 1998;  12 1366-1370
• 28 Todisco T, de Benedictis F M, Iannacci L. et al . Mild prematurity and respiratory functions.  Eur J Pediatr. 1993;  152 55-58
• 29 Stein C E, Kumaran K, Fall C H. et al . Relation of fetal growth to adult lung function in South India.  Thorax. 1997;  52 895-899
• 30 Morgan W J. Maternal smoking and infant lung function: further evidence for an in utero effect.  Am J Respir Crit Care Med. 1998;  158 689-690
• 31 U.S. Surgeon General .The health consequences of smoking: chronic obstructive pulmonary disease. Washington DC: U.S. Department of health and human services 1984. Publication No. 84-50205
• 32 Leuenberger P, Schwartz J, Ackermann-Liebrich U. et al . Passive smoking exposure in adults and chronic respiratory symptoms (SAPALDIA Study). Swiss Study on air pollution and lung diseases in adults. SAPALDIA Team.  Am J Respir Crit Care Med. 1994;  150 1222-1228
• 33 Dayal H H, Khuder S, Sharrar R. et al . Passive smoking in obstructive respiratory disease in an industrialized urban population.  Environ Res. 1994;  65 161-171
• 34 Holt P G. Immune and inflammatory function in ciacutegarette smokers.  Thorax. 1987;  42 241-249
• 35 Kauffmann F, Droulet D, Lellouch J. et al . Twelve years spirometric changes among Paris area workers.  Int J Epidemiol. 1979;  8 201-212
• 36 Niewoehner D E. Anatomic and pathophysiological correlations in COPD. In: Baum Gl, Crapo JD, Celli BR, Karlinsky JB (eds). Textbook of pulmonary diseases. Philadelphia: Lippincott-Raven 1998: 823-842
• 37 Chen J C, Mannino M D. Worldwide epidemiology of chronic obstructive pulmonary disease.  Current Opin Pulmon Med. 1995;  5 93-99
• 38 Behera D, Jindal S K. Respiratory symptoms in Indian women using domestic cooking fuels.  Chest. 1991;  100 385-388
• 39 Georgopoulos D, Anthonisen N R. Symptoms and signs of COPD. In: Cherniack NS (ed). Chronic obstructive pulmonary disease Toronto: Saunders 1991: 357-363
• 40 Criée; C-P, Berdel D, Heise D. et al .Empfehlungen der Deutschen Atemwegsliga zur Spirometrie. Dustri-Verlag Dr. Karl Feistle, ISBN 3-87185-364-X)
• 41 Pellegrino R, Viegi G, Brusasco V. et al . Interpretative strategies for lung function tests.  Eur Respir J. 2005;  26 948-968
• 42 Taube M D, Lehnigk B, Paasch K. et al . Factor analysis of changes in dyspnea and lung function parameters after bronchodilatation in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2000;  162 216-220
• 43 O'Donnell D E, Lam M, Webb K A. Measurement of symptoms, lung hyperinflation, and endurance during exercise in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1998;  158 1557-1565
• 44 O'Donnell D E, Lam M, Webb K A. Spirometric correlates for improvement in exercise performance after anticholinergic therapy in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1999;  160 542-549
• 45 Marin J M, Carrizo S J, Gascon M. et al . Inspiratory capacity, dynamic hyperinflation, breathlessness, and exercise performance during the 6-minute-walk test in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2001;  163 1395-1399
• 46 Traver G A, Cline M G, Burrows B. Predictors of mortality in COPD.  Am Rev Respir Dis. 1979;  119 895-902
• 47 Burrows B. The course and prognosis of different types of chronic airflow limitation in a general population sample from Arizona: comparison with the Chicago “COPD” series.  Am Rev Respir Dis. 1989;  140 S92-S94
• 48 Seemungal T A, Donaldson G C, Bhownik A. et al . Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2000;  161 1608-1613
• 49 Calverley P MA, Burge P S, Spencer S. et al . Bronchodilator reversibility testing in chronic obstructive pulmonary disease.  Thorax. 2003;  58 659-664
• 50 Berger R, Smith D. Effect of an inhaled metaproterenol on exercise performance in patients with stable “fixed” airway obstruction.  Am Rev Respir Dis. 1988;  138 626-629
• 51 Casaburi R, Mahler D A, Jones P W. et al . A long-term evaluation of once-daily inhaled tiotropium in chronic obstructive pulmonary disease.  Eur Respir J. 2002;  19 217-224
• 52 Vincken W, Noord J A von, Greefhorst A P. et al . Improved health outcomes in patients with COPD during 1 yr's treatment with tiotropium.  Eur Respir J. 2002;  19 209-216
• 53 Celli B, ZuWallack R, Wang S. et al . Improvement in Resting Inspiratory Capacity and Hyperinflation With Tiotropium in COPD Patients With Increased Static Lung Volumes.  Chest. 2003;  124 1743-1748
• 54 Calverley P, Pauwels R, Vestbo J. et al . Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomised controlled trial.  Lancet. 2003;  361 449-456
• 55 Callahan C M, Cirrus R S, Katz B P. Oral corticosteroid therapy for patients with stable chronic obstructive pulmonary disease: a meta-analysis.  Ann Intern Med. 1991;  114 216-223
• 56 Kardos P, Brutsche M, Buhl R. et al . Kombination von Asthma und COPD - häufiger als man denkt?.  Pneumologie. 2006;  60 366-372
• 57 Casanova C, Cote C, de Torres J P. et al . Inspiratory-to-Total Lung Capacity Ratio Predicts Mortality in Patients with Chronic Obstructive Pulmonary Disease.  Am J Respir Crit Care Med. 2005;  171 591-597
• 58 Roberts C M, Bugler J R, Melchor R. et al . Value of pulse oximetry for long-term oxygen therapy requirement.  Eur Respir J. 1993;  6 559-562
• 59 Hughes J MB, Pride N B. In defense of the carbon monoxide transfer coefficent Kco (TL/VA).  Eur Respir J. 2001;  17 168-174
• 60 McLean A, Warren P M, Gilooly M. et al . Microscopic and macroscopic measurement of emphysema: relation to carbon monoxide transfer.  Thorax. 1992;  47 14-19
• 61 Gevenois P A, de Vuyst P, de Maertelaer V. et al . Comparison of computed density and microscopic morphometry in pulmonary emphysema.  Am J Respir Crit Care Med. 1996;  154 187-192
• 62 Gould G A, Redpath A T, Ryan M. et al . Lung CT density correlates with measurements of airflow limitation and the diffusing capacity.  Eur Respir J. 1991;  4 141-146
• 63 Worth H, Breuer HW M, Dorow P. et al . Deutsche Gesellschaft für Pneumologie. Empfehlungen zur Durchführung und Bewertung von Belastungsuntersuchungen in der Pneumologie.  Pneumologie. 1998;  52 225-231
• 64 Thurlbeck W M, Simon G. Radiographic appearance of the chest in emphysemas.  Am J Roentgenol. 1978;  130 429-440
• 65 Morgan M DL, Denison D M, Stricklund B. Value of computed tomography for selecting patients with bullous emphysema.  Thorax. 1986;  41 855-862
• 66 Lehtonen J, Sutinen S, Ikaheimo M. et al . Electrocardiographic criteria for the diagnosis of right ventricular hypertrophy verified at autopsy.  Chest. 1988;  93 839-842
• 67 Niedermeier J, Barner A, Borst M. et al . Deutsche Gesellschaft für Pneumologie. Empfehlungen zur Anwendung der Echokardiographie in der pneumologischen Diagnostik.  Pneumologie. 1998;  52 519-521
• 68 O'Donnell D E, Forkert L, Webb K A. Evaluation of bronchodilator responses in patients with “irreversible” emphysema.  Eur Respir J. 2001;  18 914-920
• 69 Begin P, Grassino A. Inspiratory muscle dysfunction and chronic hypercapnia in chronic obstructive pulmonary disease.  Am Rev Respir Dis. 1991;  143 901-903
• 70 Baldi S, Miniati M, Bellina C R. et al . Relationship between extent of pulmonary emphysema by high-resolution computed tomography and lung elastic recoil in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2001;  169 585-589
• 71 Wolkove N, Dacezman E, Colacone A. et al . The relationship between pulmonary function and dyspnoea in obstructive lung disease.  Chest. 1989;  96 1247-1251
• 72 Connolly M C, Crowley J J, Charan N B. et al . Reduced subjective awareness of bronchoconstriction by metacholine in elderly asthmatic and normal subjects as measured on a simple awareness scale.  Thorax. 1992;  47 410-413
• 73 Celli B R, Cote C G, Marin J M. et al . The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index in Chronic Obstructive Pulmonary Disease.  NEJM. 2004;  350 1005-1012
• 74 Stavem K, Sandvik L, Erikssen J. Can Global Initiative for Chronic Obstructive Lung Disease Stage 0 provide prognostic information on long-term mortality in men?.  Chest. 2006;  130 318-325
• 75 Vestbo J, Lange P. Can GOLD Stage 0 Provide Information of Prognostic Value in Chronic Obstructive Pulmonary Disease?.  Am J Respir Crit Care Med. 2002;  166 329-332
• 76 Vestbo J, Lange P. Can GOLD Stage 0 Provide Information of Prognostic Value in Chronic Obstructive Pulmonary Disease?.  Am J Respir Crit Care Med. 2002;  166 329-332
• 77 Weiner P, Weiner M, Azgad Y. et al . Inhaled budesonide therapy for patients with stable COPD.  Chest. 1995;  108 1568-1571
• 78 Kardos P, Brutsche M, Buhl R. et al . Kombination von Asthma und COPD - häufiger als man denkt?.  Pneumologie. 2006;  60 (6) 366-372
• 79 Seemugal T AR, Donaldson G C, Bhowmik A. et al . Time Course and Recovery of Exacerbations in Patients with Chronic Obstructive Pulmonary Disease.  Am J Respir Crit Care Med. 2000;  161 1608-1613
• 80 Schols A MWJ, Slangen J, Volorris A. et al . Wouters. Weigth loss is a reversible factor in the prognosis of COPD.  Am J Respir Crit Care Med. 1998;  157 1791-1797
• 81 Hurst R, Donaldson G C, Wilkinson T MA. et al . Epidemiological relationships between the common cold and exacerbation frequency in COPD.  Eur Respir J. 2005;  26 846-852
• 82 Donaldson G C, Seemungal T AR, Bhowmik A. et al . Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease.  Thorax. 2002;  57 847-852
• 83 Anthonisen N R, Skeans M A, Wise R A. et al . The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial.  Ann Intern Med. 2005;  142 (4) 233-239
• 84 Thomas R. School-based programmes for preventing smoking.  Cochrane Database Syst Rev. 2002;  (4) CD001293
• 85 Fichtenberg C M, Glantz S A. Effect of smoke-free workplaces on smoking behaviour: systematic review.  BMJ. 2002;  325 (7357) 188
• 86 Lovato C, Linn F, Stead L F. et al . Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours.  Cochrane Database Syst Rev. 2003;  (4) CD003439
• 87 Wilson D H, Wakefield M A, Steven I D. et al . “Sick of smoking” evaluation of a targeted minimal smoking cessation intervention in general practice.  Med J Aust. 1990;  152 518-521
• 88 Britton J, Knox A. Helping people to stop smoking: the new smoking cessation guidelines.  Thorax. 1999;  54 1-2
• 89 Kottke T E, Ballista R N, de Friese G H. et al . Attributes of successful smoking cessation interventions in medical practise. A meta-analysis of 39 controlled trials.  JAMA. 1988;  259 2883-2889
• 90 Ockene J K, Kristeller J, Goldberg R. et al . Increasing the efficacy of physician deliverd smoking interventions: a randomized controlled clinical trial.  J Gen Intern Med. 1991;  6 1-9
• 91 Fiore M C, Bailey W C, Cohen S J. Smoking cessation: information for specialists. U.S. department of health and human services. Public health service. Agency for health care policy and research and centers for disease control and prevention. Rockville. M.D. AHCPR Publication No. 96-0694 1996
• 92 The tobacco use and dependence clinical practice guideline panel, staff, and consortium repesentatives. A clinical practice guideline for treating tobacco use and dependence.  JAMA. 2000;  83 3244-3254
• 93 American Medical Association .Guidelines for the diagnosis and treatment of nicotine dependence. How to help patients stop smoking. Washington D.C.: American Medical Association 1994
• 94 Glynn T J, Manley M W. How to help your patients stop smoking. A national cancer institute manual for physicians. U.S. Department of health and human service, public health service. National institutes of health. National Cancer Institute, Bethesda. M.D. NIH Publication 90-3064 1990
• 95 Anthonisen N R, Connett J E, Kiley J P. et al . Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV₁: The Lung Health Study.  JAMA. 1994;  272 1497-1505
• 96 Arzneimittelkommission der Deutschen Ärzteschaft .Empfehlungen zur Therapie der Tabakabhängigkeit. Köln: AVP-Reihe 2001
• 97 Jorenby R E, Leischow S J, Nides M A. et al . A controlled trial of sustained release bupropion, a nicotine patch, or both for smoking cessation.  N Engl J Med. 1999;  340 685-691
• 98 Tashkin D P, Kanner R J, Buist S. et al . Smoking cessation in patients with chronic obstructive pulmonary disease: a double blind, placebo-controlled randomised trial.  Lancet. 2001;  357 1571-1575
• 99 WHO .Tobacco free initiative: Policies for public Health: www.who//int/toh/world notto-bacco 99. 
• 100 Fiore M C, Bailey W C, Cohen S J. et al .Treating tobacco use as dispendence : A clinical practical guideline. Rockville, M.D. US Dept Health and Human Services. A. public health service report 2000
• 101 Schwartz J L. Review and evalution of smoking cessation methods: United States and Canada, 1978 - 1985. Bethesda, M.D.: National Institute of Health. NIH publication 87-2940 1987
• 102 Fiore M C, Smith S S, Jorenby D E. et al . The effectiveness of the nicotine patch for smoking cessation. A meta-analysis.  JAMA. 1994;  271 1940-1947
• 103 Sachs D E, Benowitz N L. Individual medical treatment for tobacco dependence [editorial; comment].  Eur Respir J. 1996;  9 629-631
• 104 Murray R P, Connett J E, Rand C S. et al . Anthonisen. Persistence of the effect of the Lung Health Study (LHS) smoking intervention over eleven years.  Prev Med. 2002;  35 (4) 314-319
• 105 Bundesversicherungsanstalt für Angestellte (BfA) .Rehabilitationsbedürftigkeit und Indikationsübergreifende Problembereiche - Leitlinien für den Beratungsärztlichen Dienst der BfA 2002: http://www.bfa.de/nn 5910/de/Inhalt/Publikationen/Sonstige/Infos 20f C3 BCr 20 C3 84rzte Dokumente/Reha Bed C3 Bcrftigkeit 20 2F 20 Indiaktions C3 Bcbergreifend.html,. 
• 106 Eisner M D, Balmes J, Yelin E H. et al . Directly measured secondhand smoke exposure and COPD health outcomes.  BMC Pulm Med 2006Jun. 6;  6 12
• 107 Berufsgenossenschaftlicher Grundsatz für arbeitsmedizinische Vorsorgeuntersuchungen „G 23 - Obstruktive Atemwegserkrankungen”. Hrsg.: Hauptverband der gewerblichen Berufsgenossenschaften, St. Augustin
• 108 Nichol K, Margolis L, Wourenma J. et al . The efficacy and cost effectiveness of vaccination against influenza among elderley persons living in the community.  N Engl J Med. 1994;  331 778-784
• 109 Hak E, Essen G A van, Buskens E. et al . Is immunising all patients with chronic lung disease in the community against influenza cost effective? Evidence from a general based clinical prospective cohort study in Utrecht. The Netherlands.  J Epidemiol Community Health. 1998;  52 120-125
• 110 Peters P H. Long-term use of oseltamivir for the prophylaxis of influenza in a vaccinated frail older population.  J Am Geriatr Soc. 2001;  49 (8) 1025-1031
• 111 Hayden F G, Belshe R, Villanueva C. et al . Management of influenza in households: a prospective, randomized comparison of oseltamivir treatment with or without postexposure prophylaxis.  J Infect Dis. 2004;  189 (3) 440-449
• 112 Simberkoff M S, Cross A P, Al-Ibrahim M. et al . Efficacy of pneumococcal vaccine in high-risk patients. Results of a Veterans Administration Cooperative Study.  N Engl J Med. 1986;  315 1318-1327
• 113 Williams J HJ, Moser K M. Pneumococcal vaccine and patients with chronic lung disease.  Ann Intern Med. 1986;  104 106-109
• 114 Christenson B, Lundbergh P, Hedlund J. et al . Effects of a large-scale intervention with influenza and 23-valent pneumococcal vaccines in adults aged 65 years or older: a prospective study.  Lancet. 2001;  357 1008-1011
• 115 Davis A L, Aranda P, Schiffman G. et al . Pneumococcal infection and immunologic response to pneumococcal vaccine in chronic obstructive pulmonary disease. A pilot study.  Chest. 1994;  92 204-212
• 116 Schaberg T. Pneumokokkenschutzimpfung.  Pneumologie. 2001;  55 543-545
• 117 Ständige Impfkommission am Robert Koch-Institut (STIKO).  Epidemiologisches Bulletin des RKI. 2001;  28 203-218
• 118 Pauwels R A, Lofdahl C G, Laitinen L A. et al . Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking.  N Engl J Med. 1999;  340 1948-1953
• 119 Vestbo J, Sorensen T, Langer P. et al . Longterm effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: a randomised controlled trial.  Lancet. 1999;  355 1819-1823
• 120 Burge P S, Calverley M A, Jones P W. et al . Randomised, placebo-controlled study of fluticasone proprionate in patients with moderate to severe chronic obstructive pulmonary disease; the Isolde trial.  Br Med J. 2000;  320 1297-1303
• 121 The Lung Health Study Research Group . Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease.  N Engl J Med. 2000;  343 1902-1909
• 122 Schayck C P van, Dompeling E, Heerwaarden C LA van. et al . Bronchodilator treatment in modern asthma or chronic bronchitis. Continuous or on demand. A randomised controlled study.  BMJ. 1991;  303 1426-1431
• 123 Voshaar T, App E M, Berdel D. et al . Empfehlungen für die Auswahl von Inhalationssystemen für die Medikamentenverabreichung.  Pneumologie. 2001;  55 579-586
• 124 Dahl R, Greefhorst L A, Nowak D. et al . Inhaled formoterol dry powder versus ipratropium bromide in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2001;  164 778-784
• 125 Mahler D A, Donohue J F, Barbee R A. et al . Efficacy of salmeterol xinafoate in the treatment of COPD.  Chest. 1999;  115 957-965
• 126 Karpel J P, Pesin J, Greenberg D. et al . A comparison of the effects of ipratropium bromide and metaproterenol sulfate in acute exazerbations of COPD.  Chest. 1990;  98 835-839
• 127 Patrick D M, Dales R E, Stark R M. et al . Severe exacerbations of COPD and asthma. Incremental benefit of adding ipratropium to usual therapy.  Chest. 1990;  98 295-297
• 128 Braun S R, Mc Kenzie W N, Copeland C. et al . A comparison of the effect of ipratropium and albuterol in the treatment of chronic airways disease.  Arch Intern Med. 1989;  149 544-547
• 129 Tashkin D P, Ashutosh K, Bleeker E R. et al . Comparison of the anticholinergic bronchodilator ipratropiumbromide with metaproterenol in chronic obstructive pulmonary disease: a multicenter study.  Am J Med. 1986;  81 (Suppl. 5a) 1411-1419
• 130 COMBIVENT Inhalation Aerosol Study Group . In chronic obstructive pulmonary disease, a combination of ipratropium and albuterol is more effective than either agent alone: an 85-day multicenter trial.  Chest. 1994;  105 1411-1419
• 131 Rennard S I. Extended bronchodilator treatment in chronich obstructive pulmonary disease.  European Respiratory Review. 1996;  6 282-286
• 132 Barnes P J. The pharmacological properties of tiotropium.  Chest. 2000;  117 63S-66S
• 133 Calverley P MA. The future of tiotropium.  Chest. 2000;  117 67S-69S
• 134 Noord J A van, Aumann J L, Janssens E. et al . Effects of tiotropium with and without formoterol on airflow obstruction and resting hyperinflation in patients with COPD.  Chest. 2006 Mar;  129 (3) 509-517
• 135 O'Donnell D E, Fluge T, Hamilton A. et al . Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD.  Eur Respir J. 2004;  23 832-840
• 136 Niewoehner D E, Rice K, Cote C. et al . Prevention of exacerbations of chronic obstructive pulmonary disease with tiotropium, a once-daily inhaled anticholinergic bronchodilator: a randomized trial.  Ann Intern Med. 2005;  143 317-326
• 137 Dusser D, Bravo M L, Iacono P. The effect of tiotropium on exacerbations and airflow in patients with COPD.  Eur Respir J. 2006;  27 547-555
• 138 Casaburi R, Kukafka D, Cooper C B. et al . Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD.  Chest. 2005;  127 809-817
• 139 Brusasco V, Hodder R, Miravitlles M. et al . Health outcomes following treatment for six months with once daily tiotropium compared with twice daily salmeterol in patients with COPD.  Thorax. 2003 May;  58 (5) 399-404, Erratum in: Thorax 2005 Feb; 60 (2): 105
• 140 Campbell M, Eliraz A, Johannson G. et al . Formoterol for maintenance and as-needed treatment of chronic obstructive pulmonary disease.  Respiratory medicine. 2006;  99 1511-1520
• 141 Nisar M, Earis J E, Pearson M G. et al . Acute bronchodilator trials in chronic obstructive pulmonary disease.  Am Rev Respir Dis. 1992;  146 555-559
• 142 Ulrik C S. Efficacy of inhaled salmeterol in the management of smokers with chronic obstructive pulmonary disease: a single centre randomised, double blind, placebo controlled, crossover study.  Thorax. 1995;  50 750-754
• 143 Grove A, Lipworth B J, Reid P. et al . Effects of regular salmeterol on lung function and exercise capacity in patients with chronic obstructive airways disease.  Thorax. 1996;  51 689-693
• 144 Boyd G, Mirice A H, Pounsford J G. et al . An evaluation of salmeterol in the treatment of chronic obstructive pulmonary disease (COPD).  Eur Respir J. 1997;  10 815-821
• 145 Maesen B LP, Wedermann C JJ, Duarkens V AM. et al . Effects of formoterol in apparently poorly reversible chronic obstructive pulmonary disease.  Eur Respir J. 1999;  13 1103-1108
• 146 O'Donnell D E, Voduc N, Fitzpatrick M. et al . Effect of salmeterol on the ventilatory response to exercise in chronic obstructive pulmonary disease.  Eur Respir J. 2004;  24 86-94
• 147 Jones P W, Bosh T K. Quality of life changes in COPD patients treated with salmeterol.  Am J Respir Crit Care Med. 1997;  155 1283-1289
• 148 Peach H, Pathy M S. Follow-up study of disability among elderly patients discharged from hospital with exacerbations of chronic bronchitis.  Thorax. 1981;  36 585-589
• 149 Cazzola M, Imperatore F, Salzillo A. et al . Cardiac effects of formoterol and salmeterol in patients suffering from COPD with preexisting cardiac arrhythmia.  Chest. 1998;  114 411-415
• 150 Murciano D, Auclair M-A, Pariente R. et al . A randomized controlled trial of theophylline in patients with severe chronic obstructive pulmonary disease.  N Engl J Med. 1989;  320 1512-1525
• 151 McKay S E, Howie C A, Thomson A H. et al . Value of theophylline treatment in patients handicapped by chronic obstructive pulmonary disease.  Thorax. 1993;  48 227-232
• 152 Mulloy E, McNicholas W T. Theophylline improves gas exchange during rest, exercise and sleep in severe chronic obstructive pulmonary disease.  Am Rev Respir Dis. 1993;  148 1030-1036
• 153 Evans W W. Plasma theophylline concentrations, six minute walking distances and breathlessness in patients with chronic airflow obstruction.  BMJ. 1984;  289 1649-1651
• 154 Cooper C B, Davidson A C, Cameron I R. Aminophylline, respiratory muscle strength and exercise tolerance in chronic obstructive airway disease.  Clin Respir Physiol. 1987;  23 15-22
• 155 Murciano D, Aubier M, Lecolguic Y. et al . The effects of theophylline on diaphragmatic strength an exercise tolerance in patients with chronic obstructive pulmonary disease.  N Engl J Med. 1984;  322 349-353
• 156 Williamson B H, Milligan C, Griffiths K. et al . Thompson. An assessment of major and minor side effects of theophylline.  Aust NZ J Med. 1988;  19 539
• 157 Kirsten D, Wegner R E, Jörres R A. et al . Effects of theophylline withdrawal in severe chronic obstructive pulmonary disease.  Chest. 1993;  104 1101-1107
• 158 The COMBIVENT Inhalation Solution Study Group . Routine nebulized ipratropium and albuterol together are better than either alone in COPD.  Chest. 1997;  112 1514-1521
• 159 Taylor D R, Buick B, Kinney C. et al . The efficacy of orally administered theophylline, inhaled salbutamol and a combination of the two as chronic therapy in the management of chronic bronchitis with reversible airflow obstruction.  Am J Respir Dis. 1985;  131 747-751
• 160 Friedman M, Serby C, Menjoge S. et al . Pharmaeconomic evaluation of a combination of ipratropium plus albuterol compared with ipratropium alone and albuterol alopne in COPD.  Chest. 1999;  115 635-641
• 161 D'Urzo A D, de Salvo M C, Ramirez-Rivera A. et al . In patients with COPD, treatment with a combination of formoterol and ipratropium is more effective than a combination of salbutamol and ipratropium.  Chest. 2001;  119 1347-1356
• 162 Guyatt G H, Townsend M, Pugsley S O. et al . Bronchodilators in chronic air-flow limitation: effects on airway function, exercise capacity and quality of life.  Am Rev Respir Dis. 1987;  135 1069-1074
• 163 Noord J A van, Aumann J-L, Janssens E. et al . Comparison of tiotropium once daily, formoterol twice daily and both combined once daily in patients with COPD.  Eur Respir J. 2005;  26 214-222
• 164 O'Driscoll B R, Kay E A, Taylor R J. et al . A long-term prospective assessment of home nebulizer treatment.  Respir Med. 1992;  S6 317-325
• 165 Gan W Q, Man S FP, Sin D D. Effects of inhaled corticosteroids on sputum cell counts in stable chronic obstructive pulmonary disease: a systematic review and a meta-analysis.  BMC Pulmonary Medicine. 2005;  5 3
• 166 Senderovitz T, Vestbo J, Frandsen J. et al . Steroid reversibility test followed by inhaled budesonide or placebo in outpatients with stable chronic obstructive pulmonary disease. The Danish Society or Respiratory Medicine.  Respir Med. 1999;  93 715-718
• 167 Rice K L, Rubins J B, Lebhahn F. et al . Withdrawal of chronic systemic corticosteroids in patients with COPD: a randomized trial.  Am J Respir Crit Care Med. 2000;  162 174-178
• 168 Calverley P M, Boonsawat W, Cseke Z. et al . Maintenance therapy with budesonide and formoterol in chronic obstructive pulmonary disease.  Eur Respir J. 2003;  22 912-919
• 169 Szafranski W, Cukier A, Ramirez A. et al . Efficacy and safety of budesonide/formoterol in the management of chronic obstructive pulmonary disease.  Eur Respir J. 2003;  21 74-81
• 170 Wouters E F, Postma D S, Fokkens B. et al . Withdrawal of fluticasone propionate from combined salmeterol/fluticasone treatment in patients with COPD causes immediate and sustained disease deterioration: a randomized controlled trial.  Thorax. 2005;  60 480-487
• 171 Valk P van der, Monninkhof E, Palen J van der. et al . Effect of discontinuation of inhaled corticosteroids in patients with chronic obstructive pulmonary disease: the COPE study.  Am J Respir Crit Care Med. 2002;  166 1358-1363
• 172 Kardos P, Wencker M, Glaab T. et al . Impact of salmeterol/fluticasone versus salmeterol on exacerbations in severe chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2007;  175 144-149
• 173 Decramer M, Lacquet L M, Fagard R. et al . Corticosteroids contribute to muscle weakness in chronic airflow obstruction.  Am J Respir Crit Care Med. 1994;  150 11-16
• 174 Decramer M, Stas K J. Corticosteroid-induced myopathy involving respiratory muscles in patients with chronic obstructive pulmonary disease or asthma.  Am J Respir Dis. 1992;  146 800-802
• 175 Schols A MWJ, Wesseling G, Keser A DM. et al . Dose dependent increased mortality risk in COPD patients treated with oral glucocorticoids.  Eur Respir J. 2001;  17 337-342
• 176 Mahler D A, Wire P, Horstmann D. et al . Effectiveness of fluticasone propionate and salmeterol combination delivered via the diskus device in the treatment of chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2002;  166 1084-1091
• 177 Hanania N A, Darken P, Horstman D. et al . The efficacy and safety of fluticasone propionate (250 micro g)/salmeterol (50 micro g) combined in the diskus inhaler for the treatment of COPD.  Chest. 2003;  124 834-843
• 178 Dal Negro R, Pomari C, Tognella S. et al . Salmeterol & fluticasone 50 micro g/250 microg bid in combination provides a better long-term control than salmeterol 50 micro g bid alone and placebo in COPD patients already treated with theophylinne.  Pulmonary Pharmacology and Therapeutics. 2003;  16 241-246
• 179 Maltais F, Hamilton A, Marciniuk D. et al . Improvement in symptom-limited exercise performance over 8 h in pateints with COPD.  Chest. 2005;  128 1168-1178
• 180 Weiner P, Magadle R, Berar-Yanay N. et al . The cumulatie effect of long-acting bronchodilators, exercise,and inspiratory muscle training in the perception of dyspnea in patients with advanced COPD.  Chest. 2000;  118 672-678
• 181 Liesker J JW, De Velde V van, Meysman M. et al . Effects of formoterol (Oxis Turbuhaler) and ipratropium on exercise capacity in patients with COPD.  Respir Med. 2002;  96 559-566
• 182 Boyd G, Morice A H, Pounsford J C. et al . An evaluation of salmeterol in the treatment of chronic obstructive pulmonary disease (COPD).  Eur Respir J. 1997;  10 815-821
• 183 Rennard St I, Anderson W, ZuWallack R. et al . Use of long-acting inhaled beta₂-adrenergic agonist Salmeterol xinafoate, in patients wirh chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2001;  163 1087-1092
• 184 Man W DC, Mustfa N, Nikoletou D. et al . Effecr of Salmeterol on respiratory muscle activity during exercise in poorly reversible COPD.  Thorax. 2004;  59 471-476
• 185 Aalbers R, Ayres J, Backer V. et al . Formoterol in patients with chronic obstructive pulmonary disease: a randomized, controlled, 3-month trial.  Eur Respir J. 2002;  19 936-943
• 186 Wadbo M, Löfdahl C-G, Larsson K. et al . Effects of formoterol and ipratropiumbromide in COPD: a 3-month placebo-controlled study.  Eur Respir J. 2002;  20 1138-1146
• 187 Grassi C. and the multicenter Study Group . Longterm oral acetylcysteine in chronic bronchitis. A double blind controlled study.  Eur J Respir Dis. 1980;  61 (Suppl. 111) 93-108
• 188 Boman G, Bäcker U, Larsson S. et al . Oral acetylcysteine reduces exacerbation rate in chronic bronchitis. Report of a trial organized by the Swedish Society for Pulmonary Diseases.  Eur J Respir Dis. 1983;  64 405-415
• 189 Jackson M, Barnes J, Cooksey P. Efficacy and tolerability of oral acetylcysteine (Fabrol) in chronic bronchitis: A double-blind placebo-controlled study.  J Int Med Res. 1984;  12 198-205
• 190 McGavin C R. and the British Thoracic Society Research Committee . Oral N-acetylcysteine and exacerbation rates in patients with chronic bronchitis and severe airway obstruction.  Thorax. 1985;  40 832-835
• 191 Meister R. Langzeittherapie mit Acetylcystein Retard-Tabletten bei Patienten mit chronischer Bronchitis. Eine doppelblinde-plazebokontrollierte Studie.  Forum Prakt Allg Arzt. 1986;  25 18-22
• 192 Parr G D, Huitson A. Oral fabrol (oral N-acetylcysteine) in chronic bronchitis.  Br J Dis Chest. 1987;  81 341-348
• 193 Rasmussen J B, Glennow C. Reduction in days of illness after long-term treatment with N-acetylcysteine controlled-release tablets in patients with chronic bronchitis.  Eur Respir J. 1988;  1 351-355
• 194 Hansen N CG, Skriver A, Brorsen-Ries L. et al . Orally administered N-acetylcysteine may improve general well-being in patients with mild chronic bronchitis.  Respir Med. 1994;  88 531-535
• 195 Pela R, Calcagni A M, Subiaco S. et al . N-ace-tylcysteine reduces the exacerbation rate in patients with moderate to severe COPD.  Respiration. 1999;  66 495-500
• 196 Grandjean E M, Berthet P, Ruffmann R. et al . Efficacy of oral long-term N-acetylcysteine in chronic bronchopulmonary disease: A metaanalysis of published double blind, placebo-controlled clinical trials.  Clin Therapeutics. 2000;  22 209-221
• 197 Stey C, Steuer J, Bachmann S. et al . The effect of oral N-ace-tylcysteine in chronic bronchitis - a quantitative systematic review.  Eur Respir J. 1999;  14 (Suppl. 30) 381s
• 198 Poole P J, Black P N. Oral mucolytic drugs for exacerbations of chronic obstructive pulmonary disease.  BMJ. 2001;  322 1-6
• 199 Olivieri D, Zavattini G, Tomasini G. et al . Ambroxol for the prevention of chronic bronchitis exazerbations: long term multicenter trial.  Respiration. 1987;  51 (Suppl. 1) 42-51
• 200 Decramer N, Rutten-van Molken M, Dekhuijzen P N. et al . Effects of N-acetylcysteine on outcomes in chronic obstructive pulmonary disease (Bronchitis Randomized on NAC Cost-Utility Study, BRONCUS): a randomized placebo-controlled trial.  Lancet. 2005;  365 1552-1560
• 201 Collet J P, Shapiro S, Ernst P. et al . Effect of an immunostimulating agent on acute exacerbations and hospitalizations in COPD patients.  Am J Respir Crit Care Med. 1997;  156 1719-1724
• 202 Li J, Zheng H P, Yuan J P. et al . Protective effect of a bacterial extract against acute exacerbations in patients with chronic bronchitis accompanied by chronic obstructive pulmonary disease.  Chin Med J. 2004;  173 4164-4170
• 203 Anthonisen N R. Editoral. OM-85BV for COPD.  Am J Respir Crit Care Med. 1997;  156 1713-1714
• 204 Irwin R S, Boulet L P, Cloutier M M. et al . Managing cough as a defense mechanism and as a symptom: a consensus panel report of the American College of Chest Physicans.  Chest. 1998;  114 133S-181S
• 205 Bardsley P A, Howard P, DeBacker W. et al . Two years treatment with almitrine bismesylate in patients with hypoxic chronic obstructive airways disease.  Eur Respir J. 1991;  4 308-310
• 206 Watanabe S, Kanner R E, Cutillo A G. et al . Long-term effect of almitrine bismesylate in patients with hypoxemic chronic obstructive pulmonary disease.  Am J Respir Dis. 1989;  140 1269-1273
• 207 Winkelmann B R, Kullmer T H, Kneissl D G. et al . Low-dose almitrine bismesylate in the treatment of hypoxemia due to chronic obstructive pulmonary disease.  Chest. block;  105 1383-1391
• 208 Eiser N, Denman W T, West C. et al . Oral diamorphine: lack of effect on dyspnoea and exercise tolerance in the “pink puffer” syndrome.  Eur Respir J. 1991;  4 926-931
• 209 Young I H, Daviskas E, Keena V A. Effect of low dose nebulised morphine on exercise endurance in patients with chronic lung disease.  Thorax. 1989;  44 387-390
• 210 Rice K L, Kronenberg R S, Hedemark L L. et al . Effects of chronic administration of codeine and promethazine on breathlessness and exercise tolerance in patients with chronic airflow obstruction.  Br J Dis Chest. 1987;  81 287-292
• 211 Woodcock A A, Gross E R, Gellert A A. et al . Effects of dihyrocodeine, alcohol and caffeine on breathlessness and exercise tolerance in patients with chronic obstructive lung disease and normal blood gases.  N Engl J Med. 1981;  305 1611-1616
• 212 Poole P J, Veale A G, Black P N. The effect of sustained release morphine on breathlessness and quality of life in severe chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1998;  157 1877-1880
• 213 Schönhofer B, Suchi S, Haidl P. et al . Eine Epidemiologie zum Stellenwert von oral appliziertem Morphium als Therapieform des schwergradigen Lungenemphysems vom Pink-Puffer-Typ.  Med Klin. 2001;  96 325-330
• 214 Alpha-1-Antitrypsin Deficiency Registry Group . Survival and FEV1 decline in individuals with severe deficiency of a1-antitrypsin.  Am J Respir Crit Care Med. 1998;  158 49-59
• 215 Seersholm N, Kokjensen A. Clinical features and prognosis of life time non-smokers with severe a1-antitrypsin deficiency.  Thorax. 1998;  53 265-268
• 216 Wencker M, Banik N, Buhl R. Long-term treatment of a1-antitrypsin deficiency related pulmonary emphysema with human a1-antitrypsin.  Eur Respir J. 1998;  11 428-433
• 217 Incalci R A, Caradonna P, Ranieri P. et al . Correlates of osteoporosis in chronic obstructive pulmonary disease.  Respir Med. 2000;  94 1079-1084
• 218 American College of Rheumatology ad hoc Committee on glucocorticoid-induced osteoporosis. Recommendations for the prevention and treatment of glucocortocoid-induced osteoporosis.  Arthritis Rheumatism. 2001;  44 1496-1503
• 219 Chavannes N, Vollenberg J J, Schayck C P van. et al . Effects of physical activity in mild to moderate COPD: a systematic review.  Br J Gen Pract. 2002;  52 547-548
• 220 Berry M J, Rejeski W J, Adair N E. et al . Exercise rehabilitation and chronic obstructive pulmonary disease stage.  Am J Respir Crit Care Med. 1999;  160 1248-1253
• 221 ACCP/AAC/VPR Pulmonary Rehabilitation Guidelines Panel . Pulmonary Rehabilitation.  Chest. 1997;  112 1363-1395
• 222 American Thoracic Society . Pulmonary Rehabilitation 1999.  Am J Respir Crit Care Med. block;  159 1666-1682
• 223 Lacasse Y, Wong E, Guyatt G H. et al . Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease.  Lancet. 1996;  348 1115-1119
• 224 Worth H, Meyer A, Folgering H. et al . Empfehlungen der Deutschen Atemwegsliga zum Sport und körperlichen Training bei Patienten mit obstruktiven Atemwegserkrankungen.  Pneumologie. 2000;  54 61-67
• 225 Ringbaek T J, Broendum E, Hemmingsen L. et al . Rehabilitation of patients with chronic obstructive pulmonary disease.  Exercise twice a week is not sufficient! Respir Med. 2000;  94 150-154
• 226 Puente-Maestu L, Sanz M L, Sanz P. et al . Comparison of effects of supervised versus self-monitored training programmes in patients with chronic obstructive pulmonary disease.  Eur Respir J. 2000;  5 517-525
• 227 Lacasse Y, Brosseau L, Milne S. et al . Pulmonary rehabilitation for chronic obstructive pulmonary disease.  Cochrane Database Syst Rev. 2002;  CD003793
• 228 Salman G F, Mosier M C, Beasley B W. et al . Rehabilitation for patients with chronic obstructive pulmonary disease: meta-analysis of randomized controlled trials.  J Gen Intern Med. 2003;  18 213-221
• 229 Puhan M A, Schunemann H J, Frey M. et al . How should COPD patients exercise during respiratory rehabilitation? Comparison of exercise modalities and intensities to treat skeletal muscle dysfunction.  Thorax. 2005;  60 367-375
• 230 American Thoracic Society/European Respiratory Society . Statement on Pulmonary Rehabilitation.  Am J Respir Crit Care Med. 2006;  173 1390-1413
• 231 Bernhard S, Whittom F, Leblanc P. et al . Aerobic and strength training in patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1999;  159 896-901
• 232 Belman M J, Botnick W C, Nathan S D. et al . Ventilatory load characteristics during ventilatory muscle training.  Am J Respir Crit Care Med. 1994;  149 925-929
• 233 Griffiths T L, Burr M L, Campbell I A. et al . Results at 1 year of out-patient multidisciplinary pulmonary rehabilitation.  Lancet. 2000;  355 362-368
• 234 Foglio K, Bianchi L, Bruletti G. et al . Long-term effectiveness of pulmonary rehabilitation in patients with chronic airways obstruction.  Eur Respir J. 1999;  13 125-132
• 235 Young P, Dewse M, Ferguson W. et al . Improvements in outcomes for chronic obstructive pulmonary disease (COPD) attributable to a hospital-based respiratory rehabilitation programme.  Aus NZ J Med. 1999;  29 59-65
• 236 Dhein Y, Birkenmaier A, Otte B. et al . Evaluation of a structured education programme (AFBE) for patients with mild to moderate COPD under outpatient conditions.  Am J Respir Crit Care Med. 2002;  165 A420
• 237 Worth H, Dhein Y. Does patient education modify behaviour in the management of COPD?.  Patient Educ Couns. 2004;  52 267-270
• 238 Bourbeau J, Julien M, Maltais F. et al . Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention.  Arch Intern Med. 2003;  163 585-591
• 239 Gadoury M A, Schwarztmann K, Rouleau M. et al . Self-management reduces both short- and long-term hospitalisation in COPD.  Eur Respir J. 2005;  26 853-857
• 240 Steier J, Petro W. Physikalische Therapie bei COPD - Evidence based Medicine?.  Pneumologie. 2002;  556 388-396
• 241 Bekkering G E, Hendriks H JM, Chadwick-Straver R VM. et al .Clinical practice guidelines for physical therapy in patients with chronic obstructive pulmonary disease. 2003 Available from. http://www.fysionet.nl, V-03/2003/US
• 242 Murray J F. The ketch-up bottle method.  N Engl J Med. 1979;  300 1155-1157
• 243 Anthonisen P, Ries P, Sogaard-Andersen T. The value of lung physiotherapy in the treatment of acute exacerbations in chronic bronchitis.  Acta Med Scand. 1964;  145 715-719
• 244 Graham W, Bradley G A. Efficacy of chest physiotherapy and intermittent positive-pressure breathing in the resolution of pneumonia.  N Engl J Med. 1978;  299 624-627
• 245 King M, Philips D M, Gron D. et al . Enhanced tracheal mucus clearance with high frequency chest wall percussion.  Am Rev Respir Dis. 1983;  128 511-515
• 246 Pryer J A. Physiotherapy for airway clearance in adults.  Eur Respir J. 1999;  14 1418-1424
• 247 Hietpas B G, Roth R D, Jensen M W. Huff coughing and airway patency.  Respir Care. 1979;  24 710-713
• 248 Cegla U H, Petzow A. Physiotherapie mit dem VRP1 bei chronisch obstruktiven Atemwegserkrankungen - Ergebnisse einer multizentrischen Vergleichsstudie.  Pneumologie. 1993;  47 636-639
• 249 App E M, Wunderlich M O, Lohse P. et al . Oszillierende Physiotherapie bei Bronchialerkrankungen - rheologischer- und antientzündlicher Effekt.  Pneumologie. 1999;  53 1-12
• 250 Cegla U H, Bautz M, Fröde G. et al . Physiotherapie bei Patienten mit COPD und tracheobronchialer Instabilität - Vergleich zweier oszillierender PEP-Systeme (RC-Cornet, VRP1-Destin).  Pneumologie. 1997;  51 129-136
• 251 King M, Feng W, Deng W W. et al . Short-term efficacy of RC-Cornet in decreasing cohessiveness of sputum in COPD-patients.  Chest. 1998;  225 318
• 252 Engelken M PKJ, Schols A MWJ, Baker W C. et al . Nutritional depletion in relation to respiratory and peripheral muscle function in outpatients with COPD.  Eur Respir J. 1994;  7 1793-1797
• 253 Schols A MWJ, Soeters P B, Dingemans A MC. et al . Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation.  Am Rev Respir Dis. 1993;  147 1187-1196
• 254 Wilson D O, Rogers R M, Wright E C. et al . Body weight in chronic obstructive pulmonary disease. The National Institutes of Health intermittend positive-pressure breathing trial.  Am Rev Respir Dis. 1989;  139 1435-1438
• 255 Wouters E FM, Schols A MWJ. Nutritional depletion in COPD.  Eur Respir Rev. 1997;  7 60-65
• 256 Fitting J W. Nutritional support in chronic obstructive lung disease.  Thorax. 1992;  47 141-143
• 257 Hunter A BN, Carey M A, Lorch H W. The nutritional status of patients with chronic obstructive pulmonary disease.  Am Rev Respir Dis. 1985;  132 1347-1365
• 258 Gray-Donald K, Gibbone L, Shapiro S H. et al . Nutritional status and mortality in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1996;  153 961-966
• 259 Baarends E M, Schols A MWJ, Mostert R. et al . Peak exercise in relation to tissue depletion in patients with chronic obstructive pulmonary disease.  Eur Respir J. 1997;  10 2807-2813
• 260 Shoup R, Dalshy G, Warner G. et al . Body composition and health related quality of life in patients with chronic obstructive airways disease.  Eur Respir J. 1997;  10 1576-1580
• 261 Wijkstra P J, Atena R van, Kraan J. et al . Quality of life in patients with chronic obstructive pulmonary disease improve after rehabilitation at home.  Eur Respir J. 1994;  7 307-311
• 262 Ferreira I M, Brooks D, Lacasse Y. et al . Nutritional supplementation for stable chronic obstructive pulmonary disease.  Cochrane Database Syst Rev. 2005;  block CD000998
• 263 Efthimiou J, Fleming J, Gomes C. et al . The effect of supple-mentary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease.  Am Rev Respir Dis. 1988;  137 1075-1082
• 264 Rogers R M, Donahue M, Constantino J. Physiologic effects of oral supplemental feeding in malnourished patients with chronic obstructive pulmonary disease patients.  Am Rev Respir Dis. block;  145 1511-1597
• 265 Whittaker J S, Buckley C F, Road J D. The effects of re-feeding on peripheral and respiratory muscle function in malnourished chronic obstructive pulmonary disease patients.  Am Rev Respir Dis. 1990;  142 283-288
• 266 Schols A M, Soeters P B, Mostert R. et al . Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. A placebo-controlled randomized trial.  Am J Respir Crit Care Med. 1995;  152 1268-1274, 204
• 267 Creutzberg E C, Wouters E F, Mistert R. et al . A role for anabolic steroids in the rehabilitation of patients with COPD? A double-blind, placebo-controlled, randomized trial.  Chest. 2003;  124 1733-1742
• 268 Casaburi R, Bhasin S, Cosentino L. et al . Effects of testestorone and resistance training in men with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2004;  170 870-878
• 269 Bergmann K C, Fischer J, Schmitz M. et al . Die stationäre Rehabilitation für Erwachsene. Zielsetzung - Diagnostik und therapeutische Standards - Forschungsbedarf.  Pneumologie. 1997;  51 523-532
• 270 Donner C F, Muir J F. Selection criteria and programmes for pulmonary rehabilitation in COPD patients. Rehabilitation and chronic care scientific group of the european respiratory society.  Eur Respir J. 1997;  10 744-757
• 271 British Thoracic Society. Pulmonary rehabilitation.  Thorax. 2001;  56 827-834
• 272 Young P, Dewse M, Fergusson W. et al . Respiratory rehabilitation in chronic obstructive pulmonary disease: predictors of non-adherence.  Eur Respir J. 1999;  13 867-872
• 273 Connors A F, Dawson N V, Thomas C. et al . Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Unterstand Prognoses and Preferences for Outcomes and Risk of Treatments).  Am J Respir Crit Care Med. 1996;  154 959-967
• 274 Garcia-Aymerich J, Farrero E, Felez M A. et al . Risk factors of readmission to hospital for a COPD exacerbation: a prospective study.  Thorax. 2003;  58 100-105
• 275 Puhan M A, Scharplatz M, Troosters T. et al . Respiratory rehabilitation after acute exacerbation of COPD may reduce risk for readmission and mortality - a systematic review.  Respir Res. 2005;  6 54
• 276 Man W D, Polkey M I, Donaldson N. et al . Community pulmonary rehabilitation: a randomised controlled study.  BMJ. 2004;  329 1209
• 277 Schultz K, Bergmann K C, Kenn K. et al . Effektivität der pneumologischen Anschluss-Rehabilitation (AHB): Ergebnisse einer multizentrischen prospektiven Beobachtungsstudie.  Dtsch Med Wochenschr. 2006;  131 1793-1798
• 278 World Health Organization (WHO) .International Classification of Functioning, Disability and Health (ICF). Geneva 2001: http://www.3.who.int/icf/icftemplate.cfm)
• 279 Richtlinien des Gemeinsamen Bundesausschusses über Leistungen zur medizinischen Rehabilitation (Rehabilitations-Richtlinien) nach § 92 Abs. 1 Satz 2 Nr. 8 SGB V in der Fassung vom 16. März 2004 (BAnz. S. 6769) vom 31. März 2004 in Kraft getreten am 1. April 2004. 2004 (cited: 2005 Jul 14). Available from: http://www.aerzteblatt.de/v4/archiv/artiekl.asp?id = 41 621)
• 280 Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based guidelines. ACCP/AACVPR Pulmonary Rehabilitation Guidelines Panel.  Chest. 1997;  112 1363-1396
• 281 Verband deutscher Rentenversicherungsträger (VDR), Reha-Kommission .Krankheitsspezifsiche Konzepte. In: VDR, Reha-Kommission (eds). Kommission zur Weiterentwicklung der Rehabilitation in der gesetzlichen Rentenversicherung.Abschlussberichte.Band III, Teilband 2 Frankfurt: VDR 1991: 483-484, 326
• 282 Bundesversicherungsanstalt für Angestellte (BfA) .Leitlinien zur Rehabilitationsbedürftigkeit bei Krankheiten der Atmungsorgane - für den Beratungsärztlichen Dienst der BfA. 2004 (cited: 2005 Aug 12). Available from: http://www.bfa.de/nn 5910/de/Inhalt/Publikationen/Sonstige/Infos 20f C3 BCr 20 C3 84r zte Dokumente/Reha-Bed C3 Bcrftigkeit 20 2F 20 Pneumologie.html)
• 283 Medizinischer Dienst der Spitzenverbände der Krankenkassen e. V. (MDS) .Begutachtungs-Richtlinien Vorsorge und Rehabilitation vom 12. März 2001. 2001 (cited: 2005 Aug 12). Available from: http://informed.-msd-ev.de/sindbad.nsf/0/1885f053c9a0c58500256a31005377e7?OpenDocument
• 284 Szczepanski R, Taube K, Junggeburth J. et al . Ambulante wohnortnahe pneumologische Prävention und Rehabilitation bei obstruktiven Atemwegserkrankungen - Stand, Perspektive und Forschungsbedarf.  Pneumologie. 1998;  52 476-482
• 285 Goldstein R S, Gort E H, Stubbing D. et al . Randomized controlled trial of respiratory rehabilitation.  Lancet. 1994;  344 1394-1397
• 286 McGavin C R, Gapta S P, Lloyd E L. et al . Physical rehabilitation for the chronic bronchitis. Results of a controlled trial of exercises in the home.  Thorax. 1977;  32 307-311
• 287 Magnussen H, Goeckenjan G, Köhler D. et al . Leitlinien zur Sauerstoff-Langzeit-Therapie.  Pneumologie. 2001;  55 454-464
• 288 Report of the Medical Research Council Working Party. Long-term domiciliary oxygen in chronic cor pulmonale complicating chronic bronchitis and emphysema.  Lancet. 1981;  1 681-685
• 289 Nocturnal oxygen therapy trial group . Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease.  Ann Intern Med. 1980;  93 191-198
• 290 Weitzenblum E, Sautegeau A, Ehrhart M. et al . Long-term oxygen therapy can reverse the progression of pulmonary hypertension in patients with chronic obstructive pulmonary disease.  Am Rev Respir Dis. 1985;  131 493-498
• 291 Leach R M, Davidson A C, Chinn S. et al . Portable liquid oxygen and exercise ability in severe respiratory disability.  Thorax. 1992;  47 78-789
• 292 Tarpy S P, Celli B R. Long-term oxygen therapy.  N Engl J Med. 1995;  333 710-714
• 293 Pelletier Fleury N, Laone J L, Fleury B. et al . The cost of treating COPD patients with long-term oxygen therapy in a French population.  Chest. 1996;  110 411-416
• 294 Heaney L G, McAllister D, MacMahon J. Cost minimisation analysis of provision of oxygen at home: are the drug tariff guidelines cost effective?.  BMJ. 1999;  319 19-23
• 295 Donahoe M, Rogers R M. Nutritional assessment and support in chronic pulmonary disease.  Clin Chest Med. 1990;  11 487-504
• 296 Köhler D, Criée C P, Raschke F. Leitlinien zur häuslichen Sauerstoff- und Heimbeatmungstherapie.  Pneumologie. 1996;  50 927-931
• 297 Simmonds A K, Elliot M W. Outcome of domiciliary nasal intermittent positive pressure ventilation in restrictive and obstructive disorders.  Thorax. 1995;  50 604-609
• 298 Meecham Jones D J, Paul E A, Jones P W. et al . Nasal pressure support ventilation plus oxygen compared with oxygen therapy alone in hypercapnic COPD.  Am J Respir Crit Care Med. 1995;  152 538-544
• 299 Consensus Conference . Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD, and nocturnal hypoventilation. A consensus conference report.  Chest. 1999;  116 521-534
• 300 Mehran R J, Deslauriers J. Indications for surgery and patient work-up for bullectomie.  Chest Surg Clin N Am. 1995;  5 717-734
• 301 Hughes J A, Hutchison D M, MacArthur D CS. et al . Long-term changes in lung function after surgical treatment of bullos emphysema in smokers and exsmokers.  Thorax. 1986;  39 140
• 302 Cooper J D, Trulock E P, Triantafillou A N. et al . Bilateral pneumonectomy (volume reduction) for chronic obstructive pulmonary disease.  J Thorac Cardiovasc Surg. 1995;  109 106-119
• 303 National Emphysema Treatment Trial Research Group . A randomized trial comparing lung-volume reduction surgery with medical therapy for severe emphysema.  N Engl J Med. 2003;  348 2059-2073
• 304 Crouch R, Fishman A P, Ries A L. et al . The Effects of Pulmonary Rehabilitation in the National Emphysema Treatment Trial.  Chest. 2005;  128 3799-3809
• 305 Venuta F, Yim A PC, Wan I YP. et al . Bronchoscopic Lung Volume Reduction for End-Stage Emphysema: Report on the First 98 Patients.  Chest. 2006;  129 518-526
• 306 Trulock E P, Edwards L B, Taylor D O. et al . The registry of the International Society for Heart and Lung Transplantation: Twenty-first Official Adult Lung and Heart-Lung Transplant Report.  J Heart Lung Transplant. 2005;  24 956-967
• 307 Deutsche Stiftung Organtransplantation (DSO) .Bericht über die Tätigkeit der Transplantationszentren sowie die Organspende in der Bundesrepublik Deutschland. http://www.dso.de/pdf/berichte2005/Gesamt_Taetigkeitsbericht2005.pdf
• 308 Hosenpud J D, Bennett L E, Keck B M. et al . Effects of diagnosis on survival benefit of lung transplantation for end-stage lung disease.  Lancet. 1998;  3 24-27
• 309 Charman S C, Sharples L D, McNeil K D. et al . Assessment of Survival Benefit After Lung Transplantation by Patient Diagnosis.  J Heart Lung Transplant. 2002;  21 226-232
• 310 Gottlieb J, Simon A, Welte T. Lungentransplantation.  Pneumologe. 2005;  2 131-141
• 311 Machado M C, Krishnan J A, Buist S A. et al . Sex differences in survival of oxygen-dependent patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2006 Sep 1;  174 (5) 524-529
• 312 Orens J B, Estenne M, Arcasoy S. et al . International Guideline for the selection of lung transplant candidates: 2006 Update - A consensus report from the pulmonary scientific council of the international society for heart and lung transplant.  J Heart Lung Transplant. 2006;  25 745-755
• 313 Meyer D M, Bennett L E, Novick R J. et al . Single vs bilateral, sequential lung transplantation for end-stage emphysema: influence of recipient age on survival and secondary end-points.  J Heart Lung Transplant. 2001 Sep;  20 (9) 935-941
• 314 Trulock E P, Edwards L B, Taylor D O. et al . Registry of the International Society for Heart and Lung Transplantation: twenty-third official adult lung and heart-lung transplantation report - 2006.  J Heart Lung Transplant. 2006;  25 880-892
• 315 Elkington H, White P, Addington-Hall J. et al . The last year of life of COPD: a qualitative study of symptoms and services.  Respir Med. 2004;  98 439-445
• 316 Booth S, Wade R, Johnson M. et al . The use of oxygen in the palliation of breathlessness. A report of the expert working group of the Scientific Committee of the Association of Palliative Medicine.  Respir Med. 2004;  98 66-77
• 317 Jennings A L, Davies A N, Higgins J P. et al . A systematic review of the use of opioids in the management of dyspnoea.  Thorax. 2002;  57 939-944
• 318 Steinkamp G, Dierkesmann R, Gillissen A. et al . COPD und Psyche - ein Überblick.  Pneumologie. 2005;  59 819-830
• 319 World Health Organization .Cancer pain relief and palliative care - report of a WHO expert committee. Genf: World Health Organization 1990
• 320 Anthonisen N R, Manfreda J, Warren C P. et al . Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease.  Ann Intern Med. 1987;  106 196-204
• 321 Regueiro C R, Hamel M B, Davis R B. et al . A comparison of generalist and pulmonologist care for patients hospitalized with severe chronic obstructive pulmonary disease: resource intensity, hospital costs and survival.  Am J Med. 1998;  105 366-372
• 322 Gibson P G, Wlodarczyk J H, Wilson A J. et al . Severe exacerbations of chronic obstructive airways disease: health resource use in general practice and hospital.  J Qual Clin Pract. 1998;  18 125-133
• 323 Mushlin A I, Black E R, Connolly C A. et al . The necessary length of hospital stay for chronic pulmonary disease.  JAMA. 1991;  266 80-83
• 324 Connors A F, Dawson N V, Thomas C. et al . Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators.  Am J Respir Crit Care Med. 1996;  154 959-967
• 325 Kong G K, Belman M J, Weingarten S. Reducing length of stay for patients hospi-talized with exacerbation of COPD by using a practice guideline.  Chest. 1997;  111 89-94
• 326 Fuso L, Incalzi R A, Pistelli R. et al . Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease.  Am J Med. 1995;  98 272-277
• 327 Seneff M G, Wagner D P, Wagner R P. et al . Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease.  JAMA. 1995;  274 1852-1857
• 328 MacFarlane J T, Colville A, Macfarlane R M. et al . Prospective study of aetiology and outcome of adult lower-respiratory-tract infections in the community.  Lancet. 1993;  341 511-514
• 329 Stockley R A, O'Brien C, Pye A. et al . Relationship of sputum color to nature and outpatient management of acute exacerbations of COPD.  Chest. 2000;  117 1638-1645
• 330 Seemungal T R, Harpen-Owen R, Bhownik A. et al . Respiratory viruses, symptoms and inflammatory markers in acute exacerbations and stable chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2001;  164 1618-1623
• 331 Anderson H R, Spix C, Medina S. et al . Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: results from the APHEA project.  Eur Respir J. 1997;  10 1064-1071
• 332 Emerman C L, Connors A F, Lukens T W. et al . Relationship between arterial blood gases and spirometry in acute exacerbations of chronic obstructive pulmonary disease.  Ann Emerg Med. 1989;  18 523-527
• 333 Emerman C L, Effron D, Lukens T W. Spirometric criteria for hospital admission of patients with acute exacerbation of COPD.  Chest. 1991;  99 595-599
• 334 Emerman C L, Lukes T W, Effron D. Physician estimation of FEV1 in acute exacerbation of COPD.  Chest. 1994;  105 1709-1712
• 335 Emerman C L, Cydulka R K. Use of peak expiratory flow rate in emergency depart- ment evaluation of acute exacerbation of chronic obstructive pulmonary disease [see comments].  Ann Emerg Med. 1996;  27 159-163
• 336 Tillie-Leblond I, Marquette C H, Perez T. et al . Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease: prevalence and risk factors.  Ann Intern Med. 2006;  144 930-936
• 337 Rice K L, Leatherman J W, Duane P G. et al . Aminophylline for acute exacerbations of chronic obstructive pulmonary disease. A controlled trial.  Ann Intern Med. 1987;  107 305-309
• 338 Barbera J A, Reyes A, Roca J. et al . Effect of intravenously administered aminophylline on ventilation/perfusion inequality during recovery from exacerbations of chronic obstructive pulmonary disease.  Am Rev Respir Dis. 1992;  145 1328-1333
• 339 Mahon J L, Laupacis A, Hodder R V. et al . Theophylline for irreversible chronic airflow limitation: a randomized study comparing n of 1 trials to standard practice.  Chest. 1999;  115 38-48
• 340 Loberes P, Ramis L, Montserrat J M. et al . Effect of three different bronchodilators during an exacerbation of chronic obstructive pulmonary disease.  Eur Respir J. 1988;  1 536-539
• 341 Emerman C L, Connors A F, Lukens T W. et al . Theophylline concentrations in patients with acute exacerbation of COPD [see comments].  Am J Emerg Med. 1990;  8 289-292
• 342 Duffy N, Walker P, Diamantea F. et al . Intravenous aminophylline in patients admitted to hospital with non-acidotic exacerbations of chronic obstruktive pulmonary disease: a prospective randomized controlled trial.  Thorax. 2005;  60 713-717
• 343 Christ-Crain M, Jaccard-Stolz D, Bingisser R. et al . Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial.  Lancet. 2004;  363 (9409) 600-607
• 344 Nouira S, Marghli S, Belghith M. et al . Once daily oral ofloxacin in chronic obstructive pulmonary disease exacerbation requiring mechanical ventilation: a randomised placebo-controlled trial.  Lancet. 2001;  358 2020-2025
• 345 Worth H, Adam D, Handrick W. et al . Prophylaxe und Therapie von bronchopulmonalen Infektionen. Empfehlungen der Deutschen Atemwegsliga.  Pneumologie. 1998;  52 232-237
• 346 Welte T, Marre R, Suttorp N. Kompetenznetzwerk „Ambulant Erworbene Pneumonie” (CAPNETZ). Related Articles, What is new in the treatment of community-acquired pneumonia?.  Med Klin (Munich). 2006 Apr 15;  101 (4) 313-320
• 347 Arancibia F, Bauer T T, Ewig S. et al . Community-acquired Pneumonia caused by gram-negative bacteria: Incidence and risk and prognosis.  Arch Intern Med. 2002;  162 (16) 1849-1858
• 348 Thompson , WH , Nielson C P, Carvalho P. et al . Controlled trial of oral prednisolone in outpatients with acute COPD exacerbation.  Am J Respir Crit Care Med. 1996;  154 407-412
• 349 Davies L, Angus R M, Calverley P M. Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial.  Lancet. 1999;  354 456-460
• 350 Niewoehner D E, Erbland M L, Deupree R H. et al . Effect of systemic glucocorticoids on exacxerbations of chronic obstructive pulmonary disease.  N Engl J Med. 1999;  340 1941-1947
• 351 Bach P B, Brown C, Gelfand S E. et al . Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence.  Ann Intern Med. 2001;  134 600-620
• 352 Rossi A, Gottfried S B, Zocci L. et al . Respiratory mechanics in mechanically ventilated patients with respiratory failure.  J Appl Physiol. 1985;  58 1849-1858
• 353 Georgopoulos D, Rossi A, Moxham J. Ventilatory support in chronic obstructive pulmonary disease.  Eur Respir Mon. 1998;  7 189-208
• 354 Bott J, Carroll M P, Conway J H. et al . Randomized controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease.  Lancet. 1993;  341 1555-1557
• 355 Brochard L, Mancebo J, Wysocki M. et al . Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease.  N Engl J Med. 1995;  33 817-822
• 356 Kramer N, Meyer T J, Meharg J. et al . Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure.  Am J Respir Crit Care Med. 1995;  151 1799-1806
• 357 Barbeacute F, Togores B, Rubi M. et al . Noninvasive ventilatory support does not facilitate recovery from acute respiratory failure in chronic obstructive pulmonary disease.  Eur Respir J. 1996;  9 1240-1245
• 358 Plant P K, Owen J L, Elliott M W. Early use of non-invasive ventilation (NIV) for acute exacerbations of COPD on general respiratory wards: a multicenter randomized controlled trial.  Lancet. 2000;  355 1931-1935
• 359 Nava S, Ambrosino N, Clini E. et al . Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial.  Ann Intern Med. 1998;  128 721-728
• 360 Stoller J K, Lange P A. Inpatient management of chronic obstructive pulmonary disease.  Respir Care Clin N Am. 1998;  4 425-438
• 361 Friedman M, Serby C W, Menjoge S S. et al . Pharmacoeconomic evaluation of a combination of ipratropium plus albuterol compared with ipratropium alone and albuterol alone in COPD.  Chest. 1999;  115 635-641
• 362 Morgan W KG, Reger R B. Chronic airflow limitation and occupation. In: Cherniack NS (Hrsg). Chronic obstructive pulmonary disease. Philadelphia: Saunders 1991
• 363 Nowak D. Berufsbedingte obstruktive Atemwegserkrankung (BK4301 und 4302) gutachterliche Anmerkungen zum Krankheitsbegriff und zur MdE.  Arbeitsmed Sozialmed Umweltmed. 2000;  35 164-167
• 364 Morfeld P, Piekarski C. Chronische Bronchitis und Emphysem als Berufskrankheit der Steinkohlenbergleute. Schrittenreiche Zentralblatt für Arbeitsmedizin Haefer 1998
• 365 Nowak D. Informationen zur neuen Berufskrankheit 4111: „Chronische obstruktive Bronchitis oder Emphysem von Bergleuten unter Tage im Steinkohlenbergbau bei Nachweis der Einwirkung einer kumulativen Feinstaubdosis von in der Regel 100 [(mg/m³) Jahre]”.  Pneumologie. 1996;  50 652-654
• 366 Kroidl R F, Nowak D, Seysen U. Bewertung und Begutachtung in der Pneumologie. Thieme 1999
• 367 Bundesministerium für Arbeit und Sozialordnung .Anhaltspunkte für die Ärztliche Gutachtertätigkeit im sozialen Entschädigungsrecht und nach dem Schwerbehindertengesetz. Köllen 1996