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Beydon N, Abou Taam R, Delclaux C, Du Boisbaudry C, Gauthier R, Ioan I, Le Bourgeois M, Giroux-Metges MA, Matecki S. [Pulmonary function test: The testing of children]. Rev Mal Respir 2024; 41:488-497. [PMID: 39003097 DOI: 10.1016/j.rmr.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/30/2024] [Indexed: 07/15/2024]
Abstract
In paediatrics, the pulmonary function test (PFT) is most often performed to support the diagnosis or in follow-up of asthma patients. Whatever the pathology responsible for respiratory symptoms and/or functional impairment, repeated PFTs make it possible to establish a prognosis (pulmonary function trajectories…) and to orient preventive interventions. PFT can be performed routinely from the age of three years, provided that the following requirements are met: suitable techniques and equipment, staff trained to apply the techniques and to receive young children, reference values for each technique indicating the limits of normal values and of between-test significant variation. From the age of three, children can be subjected to tidal breathing measurement of: resistance of the respiratory system (oscillometry, Rrs; airflow interruption, Rint) or of airways specific resistance (sRaw) and functional residual capacity (by applying a dilution technique). With maturity, the child will become capable of mobilizing his or her slow vital capacity to measure total lung capacity (TLC), once again by applying a dilution technique, then later by breathing against a closed shutter (plethysmography TLC and Raw). Finally, the child will be able to carry out forced expiration (forced spirometry) along with all of the other PFTs. It is important to take into account the paediatric adaptations specified in the international recommendations regarding the performance, reproducibility and quality of PFTs targeting this population.
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Affiliation(s)
- N Beydon
- Inserm U938, unité fonctionnelle d'explorations fonctionnelles respiratoire et somnologie, centre de recherche Saint-Antoine, hôpital Armand-Trousseau, Sorbonne université, AP-HP, 75012 Paris, France.
| | - R Abou Taam
- Laboratoire d'explorations fonctionnelles respiratoires pédiatriques, service de pneumologie et allergologie pédiatriques, hôpital Necker-Enfants-Malades, université de Paris, AP-HP, Paris, France
| | - C Delclaux
- Inserm NeuroDiderot, service de physiologie et centre du sommeil, hôpital Robert-Debré, université Paris-Cité, AP-HP, 75019 Paris, France
| | - C Du Boisbaudry
- EA 4324 Orphy, service d'explorations fonctionnelles, centre hospitalier de Brest, 29200 Brest, France
| | - R Gauthier
- Service de cardiologie et pneumo-allergologie pédiatriques, unité d'explorations fonctionnelles respiratoires pédiatriques, CHU d'Amiens-Picardie, Amiens, France
| | - I Ioan
- Service de physiologie, unité d'explorations fonctionnelles pédiatriques, hôpital d'Enfants, CHRU de Nancy, Nancy, France
| | - M Le Bourgeois
- Laboratoire d'explorations fonctionnelles respiratoires pédiatriques, service de pneumologie et allergologie pédiatriques, hôpital Necker-Enfants-Malades, université de Paris, AP-HP, Paris, France
| | - M-A Giroux-Metges
- EA 4324 Orphy, service d'explorations fonctionnelles, centre hospitalier de Brest, 29200 Brest, France
| | - S Matecki
- Inserm U1046, Physiology and experimental Medicine: Heart-Muscle UMR CNRS 9214, Unité d'Exploration Fonctionnelle Pédiatrique, Université de Montpellier, CHU de Montpellier, Montpellier, France
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Wanin S, Amat F, Carsin A, Coutier L, Ioan I, Weiss L, Schweitzer C, Lejeune S, Giovannini-Chami L. [Definition, positive and differential diagnosis]. Rev Mal Respir 2024; 41 Suppl 1:e1-e12. [PMID: 39181754 DOI: 10.1016/j.rmr.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Affiliation(s)
- S Wanin
- Service d'allergologie pédiatrique, Sorbonne université, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - F Amat
- Inserm 1018, centre de recherche en épidémiologie et santé des populations, épidémiologie respiratoire intégrative, Villejuif, France; Service de pneumologie et d'allergologie pédiatrique, hôpital Robert-Debré, AP-HP, Paris, France
| | - A Carsin
- Service espace jour pédiatrique, hôpital Saint-Joseph, Marseille, France
| | - L Coutier
- Unité Inserm U1028 CNRS UMR 5292, université Lyon 1, Lyon, France; Service de pneumologie pédiatrique, hospices civils de Lyon, hôpital femme-mère-enfant, Bron, France
| | - I Ioan
- DeVAH EA 3450, service de médecine infantile et explorations fonctionnelles pédiatriques, faculté de médecine de Nancy, CHRU de Nancy, université de Lorraine, hôpital d'enfants, Vandœuvre-lès-Nancy, France
| | - L Weiss
- Service de pneumologie pédiatrique, CHU de Strasbourg, hôpital de Hautepierre, Strasbourg, France
| | - C Schweitzer
- DeVAH EA 3450, service de médecine infantile et explorations fonctionnelles pédiatriques, faculté de médecine de Nancy, CHRU de Nancy, université de Lorraine, hôpital d'enfants, Vandœuvre-lès-Nancy, France
| | - S Lejeune
- Univ. Lille, Service de pneumologie et d'allergologie pédiatrique, hôpital Jeanne de Flandre, CHU de Lille, F-59000 Lille, France..
| | - L Giovannini-Chami
- Service de pneumologie et d'allergologie pédiatrique, CHU de Lenval, université Côte d'Azur, hôpitaux pédiatriques de Nice, Nice, France
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Raherison-Semjen C, Guilleminault L, Billiart I, Chenivesse C, De Oliveira A, Izadifar A, Lorenzo A, Nocent C, Oster JP, Padovani M, Perez T, Russier M, Steinecker M, Didier A. [Update of the 2021 recommendations for the management and follow-up of adult asthmatic patients under the guidance of the French Society of Pulmonology and the Paediatric Society of Pulmonology and Allergology. Long version]. Rev Mal Respir 2021; 38:1048-1083. [PMID: 34799211 DOI: 10.1016/j.rmr.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Affiliation(s)
- C Raherison-Semjen
- Université de Bordeaux, INSERM UMR 1219, Epicene Team, Bordeaux, France.
| | - L Guilleminault
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France; Institut toulousain des maladies infectieuses et inflammatoires (Infinity), INSERM, UMR1291, CNRS UMR5051, université Toulouse III, CRISALIS F-CRIN, Toulouse, France
| | | | - C Chenivesse
- CHRU de Lille, service de pneumo-allergologie, 59000 Lille, France
| | - A De Oliveira
- Sorbonne université, département de médecine générale, Paris, France
| | - A Izadifar
- Département de pneumologie, centre cardiologique du Nord, Saint-Denis, France
| | - A Lorenzo
- Sorbonne université, département de médecine générale, Paris, France
| | - C Nocent
- CHG Côte Basque, Bayonne, France
| | - J P Oster
- Service de pneumologie, centre hospitalier Louis-Pasteur, Colmar, France
| | - M Padovani
- Espace Santé Ii, La Seyne-sur-Mer, France
| | - T Perez
- CHRU de Lille, service d'explorations fonctionnelles, 59000 Lille, France
| | - M Russier
- Service de pneumo-allergologie, CHR Orléans, Orléans, France
| | - M Steinecker
- Sorbonne université, département de médecine générale, Paris, France
| | - A Didier
- Université de Bordeaux, INSERM UMR 1219, Epicene Team, Bordeaux, France; Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France
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Pulmonary Function Testing in Work-Related Asthma: An Overview from Spirometry to Specific Inhalation Challenge. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052325. [PMID: 33652998 PMCID: PMC7967683 DOI: 10.3390/ijerph18052325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 11/17/2022]
Abstract
Work-related asthma (WRA) is a very frequent condition in the occupational setting, and refers either to asthma induced (occupational asthma, OA) or worsened (work-exacerbated asthma, WEA) by exposure to allergens (or other sensitizing agents) or to irritant agents at work. Diagnosis of WRA is frequently missed and should take into account clinical features and objective evaluation of lung function. The aim of this overview on pulmonary function testing in the field of WRA is to summarize the different available tests that should be considered in order to accurately diagnose WRA. When WRA is suspected, initial assessment should be carried out with spirometry and bronchodilator responsiveness testing coupled with first-step bronchial provocation testing to assess non-specific bronchial hyper-responsiveness (NSBHR). Further investigations should then refer to specialists with specific functional respiratory tests aiming to consolidate WRA diagnosis and helping to differentiate OA from WEA. Serial peak expiratory flow (PEF) with calculation of the occupation asthma system (OASYS) score as well as serial NSBHR challenge during the working period compared to the off work period are highly informative in the management of WRA. Finally, specific inhalation challenge (SIC) is considered as the reference standard and represents the best way to confirm the specific cause of WRA. Overall, clinicians should be aware that all pulmonary function tests should be standardized in accordance with current guidelines.
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Allado E, Poussel M, Hily O, Chenuel B. The interest of rehabilitation of respiratory disorders in athletes: Myth or reality? Ann Phys Rehabil Med 2020; 65:101461. [PMID: 33271343 DOI: 10.1016/j.rehab.2020.101461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 10/19/2022]
Abstract
BACKGROUND Healthy trained athletes generally have an "overbuilt" respiratory system in order to face the huge ventilation and gas-exchange demand imposed by strenuous exercise. Athletes frequently complain of respiratory symptoms regardless of whether they have a diagnosed respiratory disease, therefore evoking a kind of respiratory limitation during exercise. Some respiratory pathologies athletes present are closely linked to exercise and include asthma, exercise-induced bronchoconstriction (EIB) or exercise-induced laryngeal obstruction. Management of asthma and EIB are mainly based on pharmacological treatments. However, many athletes still complain of respiratory symptoms despite optimal pharmacological treatments, which highlights the need for non-pharmacological approaches including breathing retraining, inspiratory muscle training and/or laryngeal exercise performed under the guidance of a physiotherapist in this specific population. OBJECTIVES With this literature overview, we aimed to report evidence supporting the interest of rehabilitation for athletes with respiratory disorders and discuss whether inspiratory muscle training programs can improve performance in healthy athletes. METHODS We searched MEDLINE and Cochrane databases for trials, reviews and meta-analyses assessing respiratory rehabilitation and muscle training programs in athletes by using the MesH terms "athletes", "asthma", "dyspnea", "rehabilitation" and "education" published from January 2010 to March 2020. The selection of articles was based on the author's expertise to elaborate this review of the literature. RESULTS Major findings suggest that breathing retraining may help asthmatic athletes better control their respiratory symptoms and that inspiratory muscle training may improve respiratory symptoms of exercise-induced laryngeal obstruction in athletes. Improvement of performance by respiratory muscle training still remains controversial. CONCLUSIONS Respiratory rehabilitation could be of interest in the specific population of athletes but should be further evaluated to improve the level of evidence of such strategies.
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Affiliation(s)
- Edem Allado
- CHRU-Nancy, University Centre of Sports Medicine and Adapted Physical Activity, F-54000 Nancy, France; Université de Lorraine, DevAH, Department of Physiology, F-54000 Nancy, France
| | - Mathias Poussel
- CHRU-Nancy, University Centre of Sports Medicine and Adapted Physical Activity, F-54000 Nancy, France; Université de Lorraine, DevAH, Department of Physiology, F-54000 Nancy, France.
| | - Oriane Hily
- CHRU-Nancy, University Centre of Sports Medicine and Adapted Physical Activity, F-54000 Nancy, France; Université de Lorraine, DevAH, Department of Physiology, F-54000 Nancy, France
| | - Bruno Chenuel
- CHRU-Nancy, University Centre of Sports Medicine and Adapted Physical Activity, F-54000 Nancy, France; Université de Lorraine, DevAH, Department of Physiology, F-54000 Nancy, France
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Villeneuve T, Guilleminault L. [Asthma and obesity in adults]. Rev Mal Respir 2019; 37:60-74. [PMID: 31866123 DOI: 10.1016/j.rmr.2019.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/06/2019] [Indexed: 12/31/2022]
Abstract
Asthma is a chronic inflammatory airway disorder characterized by a multitude of phenotypes. Epidemiological studies show an increase in asthma prevalence in obese patients regardless of age. The association of asthma and obesity is now considered as a phenotype with its own clinical, biological and functional characteristics. Regarding the pathophysiology of asthma and obesity, numerous factors such as nutrition, genetic predisposition, microbiome, ventilatory mechanics and the role of adipose tissue have been identified to explain the heterogeneous characteristics of patients with asthma and obesity. In adult patients with asthma and obesity, respiratory symptoms are particularly prominent and atopy and eosinophilic inflammation is uncommon compared to normal weight asthma patients. Obese asthma patients experience more hospitalizations and use more rescue medications than normal weight asthmatics. Management of asthma in obese patients is complex because these patients have less response to the usual anti-asthmatic treatments. Weight loss through caloric restriction combined with exercise is the main intervention to obtain improvement of asthma outcomes. Bariatric surgery is an invasive procedure with interesting results.
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Affiliation(s)
- T Villeneuve
- Pôles des voies respiratoires, hôpital Larrey, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France
| | - L Guilleminault
- Pôles des voies respiratoires, hôpital Larrey, CHU de Toulouse, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France; Centre de physiopathologie de Toulouse Purpan (CPTP-U1043, Inserm, équipe 12), UPS, Toulouse, France.
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[Evaluation of permanent disability levels in occupational pulmonary diseases]. Rev Mal Respir 2019; 36:307-325. [PMID: 30902443 DOI: 10.1016/j.rmr.2018.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 11/21/2022]
Abstract
Compensation for occupational pulmonary diseases requires the establishment of guidelines based on standardized and objective criteria, in order to provide compensation that is as fair as possible to patients who suffer from them. A review of the elements necessary for the examination of an individual file was carried out by a working group. It is accepted that respiratory functional exploration is the key element in assessing the level of permanent disability in all of these conditions, with the exception of thoracic malignancies. Guiding scales have been developed for the respiratory impairment of three types of conditions: occupational asthma, thoracic malignancy, and other respiratory diseases. Additional criteria for increasing the permanent disability level are also proposed in order to take into account professional prejudice, in particular the possibility or not of continuing the occupational activity, in the same job or after changing to another. For certain respiratory diseases, a periodic reassessment of the initially attributed permanent disability level is recommended as well as the initial one at the time of definitive cessation of occupational activity.
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Taillé C. [Metacholine challenge: The D-dimer of asthma diagnosis?]. Rev Mal Respir 2019; 35:706-707. [PMID: 30189993 DOI: 10.1016/j.rmr.2018.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 08/19/2018] [Indexed: 11/16/2022]
Affiliation(s)
- C Taillé
- Service de pneumologie, centre de référence constitutif des maladies pulmonaires rares, hôpital Bichat, 46, rue Henri Huchard, 75018 Paris, France.
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