Studies from the USA have reported that sleep apnoea is common in congestive heart failure (CHF), with Cheyne-Stokes respiration (CSR) being the most frequent type of sleepdisordered breathing (SDB) in these patients. Within the present study, the authors sought to assess the prevalence and type of SDB among CHF patients in Germany.A total of 203 CHF patients participated in this prospective multicentre study. All patients were stable in New York Heart Association classes II and III and had a left ventricular ejection fraction (LVEF) ,40%. The patients were investigated by polygraphy and all data were centrally analysed. Patient enrolment was irrespective of sleep-related symptoms.The majority of patients were male with a mean age of 65 yrs and hospitalised. Of the 203 patients, 145 (71%) had an apnoea/hypopnoea index .10?h -1 , obstructive sleep apnoea (OSA) occurred in 43% (n588) and CSR in 28% (n557) of patients. The prevalence of sleep-disordered breathing is high in patients with stable severe congestive heart failure from a European population. As sleep-disordered breathing may have a negative impact on the prognosis of congestive heart failure, a sleep study should be performed in every patient with congestive heart failure and a left ventricular ejection fraction of ,40%. This diagnostic approach should probably be adopted for all of these patients irrespective of the presence of sleep-related symptoms.

The PC needs of patients with advanced COPD are comparable with LC patients, and breathlessness severity and distress are even higher. The care for COPD patients requires further improvement to address symptom burden and PC needs.

Most breathlessness episodes are short (minutes) and severe with significant differences between chronic obstructive pulmonary disease and lung cancer patients. Effective management strategies are warranted to improve symptom relief and coping.

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Zusammenfassung ! Hintergrund: Um Krisen bei Patienten mit fortgeschrittener COPD oder Lungenkarzinom (LK) effektiv erkennen, bewältigen und vorbeugen zu können, soll ermittelt werden, welche Krisen und belastenden Situationen bei diesen Patienten auftreten und in der wissenschaftlichen Literatur beschrieben werden. Methodik: Begrenzte Literaturrecherche in den Datenbanken MEDLINE, PsycINFO, CINAHL, Cochrane Library unter Nutzung von Suchbegriffen fuer Krise/crisis und COPD oder Lungenkrebs/ lung cancer. Einschlusskriterien: wissenschaftliche Studien oder Übersichtsarbeiten, die Krisen (im Sinne von Problemsituationen, die sich so zuspitzen können, dass externe Hilfe benötigt wird) bei fortgeschrittener COPD oder Lungenkrebs beschreiben. Ergebnisse: Aus einer Gesamtzahl von 11 810 ermittelten Artikeln wurden 268 für diese Literaturübersicht ausgewertet. Der Begriff "Krise" wird in der Literatur nur selten verwendet. Als alternative Begriffe wurden "Distress" und "Notfall" ermittelt. Patienten mit COPD oder LK zeigten bezüg-lich Krisen im letzten Lebensjahr Gemeinsamkeiten aber auch Unterschiede auf. Beide Krankheiten sind charakterisiert durch eine hohe Präva-lenz der Atemnot neben einer hohen generellen Symptomlast (Schwäche, Schmerz etc.). Die Exazerbation wird als Krise bei COPD-Patienten mit Abstract ! Background: Crises are common in patients with advanced diseases. In order to effectively identify, manage and prevent crisis in advanced chronic obstructive pulmonary disease (COPD) and lung cancer patients, the current evidence about typical crises in these patients with emphasis on the patientsʼ and carersʼ needs is reviewed. Methods: Scoping literature review in MEDLINE, PsycINFO, CINAHL and the Cochrane Library using a search strategy of crisis and COPD or lung cancer. Selection criteria: studies of any design examining crisis (the (sudden) occurrence and escalation of a problematic situation necessitating external help) in advanced COPD or lung cancer patients. Results: The term "crisis" is uncommon in the literature. Alternatively, the terms "distress" or "emergency" are used by authors. COPD and lung cancer patients experience crises common to both diseases as well as crises caused by the specific trajectory of the disease. Breathlessness and other symptoms (fatigue, pain) are highly prevalent and cause crises both in patients with COPD or lung cancer. In COPD, the acute exacerbation is an important crisis bearing a high risk of hospitalisation and sudden death. In patients with lung cancer, receiving the diagnosis of a malignancy and being confronted with impending death are experienced as existential crises. Moreover, side effects of treatment contribute significantly to the burden of these patients. Conclusion: Not only physical symptoms (especially dyspnoea) but also psycho-social problems cause crises in patients with advanced COPD or lung cancer and need to be considered for the prevention and management of crises.