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Ancel J, Chen E, Pavot A, Regard L, Le Rouzic O, Guecamburu M, Zysman M, Rapin A, Martin C, Soumagne T, Patout M, Roche N, Deslee G. [Take-home messages from the 2nd COPD 2023 Biennial of the French Society of Respiratory Diseases. Placing the patient at the center of the care pathway]. Rev Mal Respir 2024; 41:331-342. [PMID: 38609767 DOI: 10.1016/j.rmr.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
INTRODUCTION The second COPD Biennial organized by the COPD working group of the French Society of Respiratory Diseases took place in Paris (Cochin) on 13th December 2023. STATE OF THE ART Major trends in 2023 were discussed; they encompassed concepts, definitions, biologics, care pathways, pulmonary rehabilitation and complex situations entailed by respiratory infections, cardiovascular comorbidities and pulmonary hypertension, and modalities of oxygen therapy and ventilation. PERSPECTIVES The different talks underlined major changes in COPD including the concepts of pre-COPD, etiotypes, health trajectories and new definitions of exacerbation. Recent results in biologics for COPD open the door to new pharmacological options. Assessment of current care pathways in France highlighted some causes for concern. For example, pulmonary rehabilitation is a key but insufficiently practiced element. Respiratory infections require careful assessment and treatments. Diagnosis and treatment of cardiovascular comorbidities and pulmonary hypertension are of paramount importance. As of late, oxygen therapy and ventilation modalities have evolved, and are beginning to afford more personalized options. CONCLUSIONS As regards COPD, a personalized approach is crucial, placing the patient at the center of the care pathway and facilitating coordination between healthcare providers.
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Affiliation(s)
- J Ancel
- Université de Reims Champagne-Ardenne, Inserm, P3Cell UMR-S1250, SFR CAP-SANTÉ, Reims, France; Service de pneumologie, hôpital Maison Blanche, CHU de Reims, Reims, France
| | - E Chen
- Service de pneumologie, Hôpital universitaire Avicenne, Bobigny, France
| | - A Pavot
- Centre de recherche cardio-thoracique de Bordeaux, université de Bordeaux, Inserm U1045, Bordeaux, France
| | - L Regard
- Service de pneumologie, institut Cochin, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Inserm UMR1016, université Paris Cité, Paris, France
| | - O Le Rouzic
- Institut Pasteur de Lille, U1019 - UMR 9017 - Center for Infection and Immunity of Lille, CHU de Lille, CNRS, Inserm, University Lille, pneumologie et immuno-allergologie, 59000 Lille, France
| | - M Guecamburu
- Service des maladies respiratoires, CHU de Bordeaux, centre François-Magendie, hôpital Haut-Lévêque, avenue de Magellan, 33604 Pessac, France
| | - M Zysman
- Service de pneumologie, CHU de Haut-Lévèque, Bordeaux, France; Centre de recherche cardio-thoracique, University Bordeaux, Inserm U1045, CIC 1401, Pessac, France
| | - A Rapin
- Département de médecine physique et de réadaptation, centre hospitalo-universitaire de Reims, hôpital Sébastopol, CHU de Reims, 51092 Reims, France; Faculté de médecine, VieFra, EA3797, 51097, université de Reims Champagne-Ardenne, Reims, France
| | - C Martin
- Service de pneumologie, institut Cochin, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Inserm UMR1016, université Paris Cité, Paris, France
| | - T Soumagne
- Service de pneumologie et Soins intensifs respiratoires, hôpital européen Georges-Pompidou, Assistance publique-hôpitaux de Paris, Paris, France
| | - M Patout
- Service des pathologies du sommeil (département R3S), groupe hospitalier universitaire AP-HP - Sorbonne université, site Pitié-Salpêtrière, 75013 Paris, France; UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne université, Inserm, 75005 Paris, France
| | - N Roche
- Service de pneumologie, institut Cochin, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Inserm UMR1016, université Paris Cité, Paris, France
| | - G Deslee
- Université de Reims Champagne-Ardenne, Inserm, P3Cell UMR-S1250, SFR CAP-SANTÉ, Reims, France; Service de pneumologie, hôpital Maison Blanche, CHU de Reims, Reims, France.
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Egenod T, Deslee G, Degano B. [Bronchoscopic COPD treatments]. Rev Mal Respir 2023; 40:820-833. [PMID: 37684196 DOI: 10.1016/j.rmr.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/18/2023] [Indexed: 09/10/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is associated with disabling respiratory symptoms including dyspnea, frequent exacerbations and chronic bronchitis. The currently available pharmacological and non-pharmacological therapies have limited efficacy, necessitating the development of interventional strategies, many of them endoscopic. STATE OF THE ART Endoscopic lung volume reduction has markedly increased over recent years, principally as regards the endobronchial valves currently used in routine care. Indeed, multiple randomized trials have demonstrated a significant clinical benefit in a selected population identifiable due to the absence of interlobar collateral ventilation. Other endoscopic volume reduction techniques (polymers, thermal vapor, spirals) shall require additional studies before being considered as options in routine care. Targeted lung denervation (TLD) has aroused interest as a means of reducing exacerbations in the early phases of relevant studies. Endobronchial techniques (bronchoscopic cryospray, bronchial rheoplasty) are still at a very early stage of development, which is aimed at reducing the symptoms of chronic bronchitis. OUTLOOK Aside from endobronchial valves, which are currently employed in routine care, all the above-mentioned endoscopic techniques require additional studies in order to determine their benefit/risk balance and to identify the population that would benefit the most. CONCLUSIONS Endoscopic treatments constitute a major avenue of research and innovation in the therapeutic management of COPD. Inclusion of patients in disease registries and clinical trials remains essential, the objective being to gauge the interest of these treatments and their future role in everyday COPD management.
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Affiliation(s)
- T Egenod
- Alpes, Inserm 1300, Grenoble, France.
| | - G Deslee
- Service de pneumologie, hôpital universitaire Dupuytren, Limoges, France
| | - B Degano
- Service de pneumologie, hôpital Maison Blanche, Inserm UMRS-1250, université Reims Champagne Ardenne, Reims, France
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Vivien A, Ancel J, Godet S, Dury S, Perotin JM, Deslee G, Launois C. Pomalidomide-induced lung injury: A case report. Medicine (Baltimore) 2023; 102:e32473. [PMID: 36637962 PMCID: PMC9839242 DOI: 10.1097/md.0000000000032473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Pomalidomide is an immunomodulatory imide drug used in multiple myeloma and in Kaposi sarcoma. PATIENT CONCERNS A 72-years-old male, treated for multiple myeloma with dexamethasone, pomalidomide and daratumumab, presented dyspnea, hypoxemia, biological inflammatory syndrome, ground glass opacities on computed tomography scan (CT-scan) and lymphocytic and eosinophilic alveolitis, with no specific cytologic or microbiological findings, 2 months after pomalidomide initiation. INTERVENTION AND OUTCOME Antibiotics were started after bronchoscopy. No improvement was noted in dyspnea and biological inflammatory syndrome after 5 days of treatment. Pomalidomide was then discontinued, with continuation of Daratumumab-Dexamethasone, resulting in a rapid recovery of symptoms and CT-scan anomalies. No recurrence of dyspnea was observed during the 15 months of follow-up. DIAGNOSES Pomalidomide-induced lung injury. LESSONS Pomalidomide-induced lung injury is a rare and serious adverse event that can occur early after Pomalidomide introduction. As pomalidomide use is increasing, the identification of drug toxicity as a possible cause of lung injury appears important. We report a rapid recovery of symptoms and CT-scan anomalies after pomalidomide discontinuation.
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Affiliation(s)
- Alexandre Vivien
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
- * Correspondence: Alexandre Vivien, Department of Respiratory Diseases, Reims University Hospital, Reims, France (e-mail: )
| | - Julien Ancel
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
- INSERM UMR-S 1250 “Pathologies Pulmonaires Et Plasticité Cellulaire,” University of Reims Champagne-Ardenne, Reims, France
| | - Sophie Godet
- Department of Hematology, Reims University Hospital, Reims, France
| | - Sandra Dury
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
- INSERM UMR-S 1250 “Pathologies Pulmonaires Et Plasticité Cellulaire,” University of Reims Champagne-Ardenne, Reims, France
| | - Gaetan Deslee
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
- INSERM UMR-S 1250 “Pathologies Pulmonaires Et Plasticité Cellulaire,” University of Reims Champagne-Ardenne, Reims, France
| | - Claire Launois
- Department of Respiratory Diseases, Reims University Hospital, Reims, France
- INSERM UMR-S 1250 “Pathologies Pulmonaires Et Plasticité Cellulaire,” University of Reims Champagne-Ardenne, Reims, France
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Srikanthan K, Kistemaker L, Slebos DJ, Gesierich W, Darwiche K, Bonta P, Deslee G, Shah P, Gosens R. Targeted lung denervation modulates the mucosal epithelial transcriptome in COPD. ERJ Open Res 2022; 8:00146-2022. [PMID: 36578630 PMCID: PMC9793243 DOI: 10.1183/23120541.00146-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/22/2022] [Indexed: 02/01/2023] Open
Abstract
This study shows that TLD reduces airway epithelial expression of genes related to acetylcholine processing and airway inflammation, which may help to elucidate the mechanism for its effect of reducing severe exacerbations in COPD https://bit.ly/3dWcqZk.
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Affiliation(s)
- Karthi Srikanthan
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College, London, UK,Karthi Srikanthan ()
| | | | - Dirk-Jan Slebos
- University Medical Center Groningen, Groningen, The Netherlands
| | | | - Kaid Darwiche
- Department for Interventional Pneumology, Ruhrlandklinik – University Medicine, Essen, Germany
| | - Peter Bonta
- Academic Medical Centre, Amsterdam, The Netherlands
| | - Gaetan Deslee
- Department of Pulmonary Medicine, INSERM UMRS 1250, CHU of Reims, Reims, France
| | - Pallav Shah
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College, London, UK,These authors contributed equally
| | - Reinoud Gosens
- Department of Molecular Pharmacology, University of Groningen, Groningen, The Netherlands,These authors contributed equally
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Dumazet A, Launois C, Lebargy F, Kessler R, Vallerand H, Schmitt P, Hermant C, Dury S, Dewolf M, Dutilh J, Abouda M, Ferreira M, Atallah I, Lachkar S, Charriot J, Jouneau S, Uzunhan Y, Chouabe S, Coiffard B, Dutau H, Hagenburg J, Briault A, Dormoy V, Lirsac M, Vergnon JM, Deslee G, Perotin JM. Tracheobronchopathia osteochondroplastica: clinical, bronchoscopic, and comorbid features in a case series. BMC Pulm Med 2022; 22:423. [PMID: 36397041 PMCID: PMC9670617 DOI: 10.1186/s12890-022-02225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Tracheobronchopathia osteochondroplastica (TO) is a rare condition of unknown etiology. TO is characterized by submucosal nodules, with or without calcifications, protruding in the anterolateral walls of the trachea and proximal bronchi. The objective of this study was to describe TO features and associated comorbidities in a series of patients. Methods Patients suffering from TO were retrospectively included by investigators from the Groupe d’Endoscopie Thoracique et Interventionnelle Francophone (GETIF). Demographic, clinical, comorbidities, bronchoscopic, functional, and radiological characteristics, and outcomes were recorded and analyzed. Results Thirty-six patients were included (69% male with a mean of 65 ± 12 years). Chronic symptoms were described by 81% of patients including cough (74%) and dyspnea on exertion (74%). TO was associated with COPD in 19% of the cases and gastroesophageal reflux disease in 6%. A mild to severe airflow obstruction was present in 55% of the cases. CT scan showed tracheal submucosal nodules in 93% of patients and tracheal stenosis in 17%. Bronchoscopy identified TO lesions in the trachea in 65% of the cases, and 66% of them were scattered. A bronchoscopic reevaluation was performed in 7 cases, 9 ± 14 months [1–56] after initial diagnosis, and showed the stability of lesions in all cases. Three patients underwent interventional bronchoscopic treatment. Conclusion The diagnosis of TO relies on typical bronchoscopic findings and can be evoked on a CT scan. Histologic diagnosis can be useful in atypical cases for differential diagnosis. Given its low consequences in terms of symptoms, lung functions, and evolution, no treatment is usually required.
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Perotin JM, Gierski F, Bolko L, Dury S, Barrière S, Launois C, Dewolf M, Chouabe S, Bongrain E, Picard D, Tran E, N'Guyen Y, Mourvillier B, Servettaz A, Rapin A, Marcus C, Lebargy F, Kaladjian A, Salmon JH, Deslee G. Cluster analysis unveils a severe persistent respiratory impairment phenotype 3-months after severe COVID-19. Respir Res 2022; 23:199. [PMID: 35918719 PMCID: PMC9344257 DOI: 10.1186/s12931-022-02111-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/09/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The mid-term respiratory sequelae in survivors of severe COVID-19 appear highly heterogeneous. In addition, factors associated with respiratory sequelae are not known. In this monocentric prospective study, we performed a multidisciplinary assessment for respiratory and muscular impairment and psychological distress 3 months after severe COVID-19. We analysed factors associated with severe persistent respiratory impairment, amongst demographic, COVID-19 severity, and 3-month assessment. METHODS Patients with severe SARS-CoV-2 pneumonia requiring ≥ 4L/min were included for a systematic 3-month visit, including respiratory assessment (symptoms, lung function, CT scan), muscular evaluation (body composition, physical function and activity, disability), psychopathological evaluation (anxiety, depression, post-traumatic stress disorder-PTSD) and quality of life. A cluster analysis was performed to identify subgroups of patients based on objective functional measurements: DLCO, total lung capacity and 6-min walking distance (6MWD). RESULTS Sixty-two patients were analysed, 39% had dyspnea on exercise (mMRC ≥ 2), 72% had DLCO < 80%, 90% had CT-scan abnormalities; 40% had sarcopenia/pre-sarcopenia and 31% had symptoms of PTSD. Cluster analysis identified a group of patients (n = 18, 30.5%) with a severe persistent (SP) respiratory impairment (DLCO 48 ± 12%, 6MWD 299 ± 141 m). This SP cluster was characterized by older age, severe respiratory symptoms, but also sarcopenia/pre-sarcopenia, symptoms of PTSD and markedly impaired quality of life. It was not associated with initial COVID-19 severity or management. CONCLUSIONS AND CLINICAL IMPLICATION We identified a phenotype of patients with severe persistent respiratory and muscular impairment and psychological distress 3 months after severe COVID-19. Our results highlight the need for multidisciplinary assessment and management after severe SARS-CoV-2 pneumonia. Trial registration The study was registered on ClinicalTrials.gov (May 6, 2020): NCT04376840.
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Affiliation(s)
- Jeanne-Marie Perotin
- Department of Pulmonary Medicine, University Hospital of Reims, Reims, France. .,INSERM P3Cell UMR-S1250, SFR CAP-SANTE, University of Reims Champagne Ardenne, Reims, France.
| | - Fabien Gierski
- Department of Psychiatry, Marne Public Mental Health Institution & Reims University Hospital, Reims, France.,Cognition Health Society Laboratory (C2S - EA 6291), SFR CAP-SANTE, University of Reims Champagne Ardenne, Reims, France
| | - Lois Bolko
- Faculty of Medicine, Rheumatology Department, University of Reims Champagne-Ardenne, Maison Blanche Hospital, Reims University Hospitals, 3797, Reims, EA, France
| | - Sandra Dury
- Department of Pulmonary Medicine, University Hospital of Reims, Reims, France.,EA7509 IRMAIC, University of Reims Champagne-Ardenne, Reims, France
| | - Sarah Barrière
- Department of Psychiatry, Marne Public Mental Health Institution & Reims University Hospital, Reims, France
| | - Claire Launois
- Department of Pulmonary Medicine, University Hospital of Reims, Reims, France.,INSERM P3Cell UMR-S1250, SFR CAP-SANTE, University of Reims Champagne Ardenne, Reims, France
| | - Maxime Dewolf
- Department of Pulmonary Medicine, University Hospital of Reims, Reims, France
| | - Stéphane Chouabe
- Department of Pulmonary Medicine, Charleville Mézière Hospital, Charleville Mézière, France
| | - Eric Bongrain
- Department of Pulmonary Medicine, Epernay Hospital, Epernay, France
| | - Davy Picard
- Department of Pulmonary Medicine, University Hospital of Reims, Reims, France.,Department of Pulmonary Medicine, Chalons en Champagne Hospital, Chalons en Champagne, France
| | - Eric Tran
- Department of Psychiatry, Marne Public Mental Health Institution & Reims University Hospital, Reims, France
| | - Yoann N'Guyen
- Department of Infectious and Tropical Diseases, Reims University Hospital, Reims, France
| | - Bruno Mourvillier
- Medical Intensive Care Unit, University Hospital of Reims, Reims, France
| | - Amélie Servettaz
- Internal Medicine, Clinical Immunology and Infectious Diseases Department, University Hospital Centre, Reims, France
| | - Amandine Rapin
- Physical and Rehabilitation Medicine Department, Sebastopol Hospital, University Hospital of Reims, Reims, France.,Faculty of Medicine, University of Reims Champagne Ardennes, 3797, VieFra, Reims, UR, France
| | - Claude Marcus
- Department of Radiology, University Hospital of Reims, Reims, France
| | - François Lebargy
- Department of Pulmonary Medicine, University Hospital of Reims, Reims, France.,EA7509 IRMAIC, University of Reims Champagne-Ardenne, Reims, France
| | - Arthur Kaladjian
- Department of Psychiatry, Marne Public Mental Health Institution & Reims University Hospital, Reims, France.,Cognition Health Society Laboratory (C2S - EA 6291), SFR CAP-SANTE, University of Reims Champagne Ardenne, Reims, France
| | - Jean-Hugues Salmon
- Faculty of Medicine, Rheumatology Department, University of Reims Champagne-Ardenne, Maison Blanche Hospital, Reims University Hospitals, 3797, Reims, EA, France
| | - Gaetan Deslee
- Department of Pulmonary Medicine, University Hospital of Reims, Reims, France.,INSERM P3Cell UMR-S1250, SFR CAP-SANTE, University of Reims Champagne Ardenne, Reims, France
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Whittaker H, Van Ganse E, Dalon F, Nolin M, Marrant-Micallef C, Pison C, Ryan DP, Deslee G, Quint JK, Belhassen M. Differences in severe exacerbations rates and healthcare utilisation in COPD populations in the UK and France. BMJ Open Respir Res 2022; 9:9/1/e001150. [PMID: 35944943 PMCID: PMC9367183 DOI: 10.1136/bmjresp-2021-001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/31/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality in Europe; however, it is important to understand how clinical practice patterns differ between countries and how this might relate to disease outcomes, to identify ways of improving local disease management. We aimed to describe and compare the management of patients with COPD in the UK and France between 2008 and 2017. Methods We used data from the Clinical Practice Research Datalink GOLD and Hospital Episode Statistics in the UK and the Echantillon Généraliste des Bénéficiaire in France to identify patients with COPD each year between 2008 and 2017. We compared patient characteristics, all-cause mortality and COPD exacerbations each year between 2008 and 2017 for patients in the UK and France separately. Health care utilisation and COPD exacerbations in 2017 were compared between France and the UK using t-tests and χ2 tests. Results Patients with COPD were similar in gender and comorbidities in both countries. Incidence of COPD exacerbations remained stable in the UK and France between 2007 and 2017. In 2017, the proportion of all-cause and COPD-related hospitalisations was greater in the UK than in France (43.9% vs 32.8% and 8.3% vs 4.9%, respectively; p<0.001) as was the proportion of patients visiting accident and emergency (A&E) (39.8% vs 16.2%, respectively; p<0.001). In addition, the mean length of stay in hospital for COPD-related causes was shorter in the UK than in France (6.2 days (SD 8.4) vs 10.5 days (SD 9.1), respectively; p<0.001). Discussion Overall, UK patients were more likely to go to A&E, be hospitalised for COPD-related causes and stay in hospital for fewer days after being admitted for COPD-related reasons compared with patients in France, illustrating a difference in health-seeking behaviours and access to healthcare.
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Affiliation(s)
- Hannah Whittaker
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Eric Van Ganse
- PELyon, Pharmaco Epidemiologie Lyon, Lyon, France.,Respiratory Medicine, Hospital Croix-Rousse, Lyon, France
| | | | - Maeva Nolin
- PELyon, Pharmaco Epidemiologie Lyon, Lyon, France
| | | | - Christophe Pison
- Clinique de Pneumologie, Centre Hospitalier Universitaire de Grenoble, Service de Pneumologie, Grenoble, France
| | - Dermot P Ryan
- Allergy and Respiratory Research Group, Centre for Population Health Sciences: GP Section, University of Edinburgh, Edinburgh, UK
| | - Gaetan Deslee
- Department of Respiratory Medicine, INSERM UMRS 903, University Hospital of Reims, Reims, France
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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Rapin A, Noujaim PJ, Taiar R, Carazo-Mendez S, Deslee G, Jolly D, Boyer FC. Characteristics of COVID-19 Inpatients in Rehabilitation Units during the First Pandemic Wave: A Cohort Study from a Large Hospital in Champagne Region. Biology (Basel) 2022; 11:biology11060937. [PMID: 35741459 PMCID: PMC9219626 DOI: 10.3390/biology11060937] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 06/01/2023]
Abstract
Background: Data describing patients hospitalized in medical rehabilitation wards after the acute phase of COVID-19 could help to better understand the rehabilitation needs in the current pandemic situation. Methods: Cohort including all patients with COVID-19 hospitalized in a single, large university hospital in Northeast France from 25 February to 30 April 2020. Results: 479 patients were admitted with COVID-19 during the study period, of whom 128 died (26.7%). Among the 351 survivors, 111 were referred to rehabilitation units, including 63 (17.9%) referred to physical and rehabilitation medicine (PRM) units. The median age of patients referred to rehabilitation units was 72 years. Patients who had been in intensive care, or who had had a long hospital stay, required referral to PRM units. Two biomarkers were associated with referral to rehabilitation units, namely, elevated troponin (p = 0.03) and impaired renal function (p = 0.03). Age was associated with referral to PRM units (p = 0.001). Conclusions: Almost one-third of COVID-19 patients required post-acute care, but only one-fifth had access to PRM units. The optimal strategy for post-acute management of COVID-19 patients remains to be determined. The need for rehabilitation wards during a pandemic is a primary concern in enabling the long-term functioning of infected patients.
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Affiliation(s)
- Amandine Rapin
- Faculté de Médecine, Université de Reims Champagne Ardennes, UR 3797 VieFra, 51097 Reims, France; (A.R.); (D.J.); (F.C.B.)
- Service de Médecine Physique et de Réadaptation, Hôpital Sébastopol, CHU de Reims, 51092 Reims, France;
| | - Peter-Joe Noujaim
- Unité D’aide Méthodologique, Pôle Recherche et Santé Publique, Hôpital Robert Debré, CHU de Reims, 51092 Reims, France;
| | - Redha Taiar
- Matériaux et Ingénierie Mécanique MATIM, Université de Reims Champagne Ardennes, CEDEX 2, 51687 Reims, France
| | - Sandy Carazo-Mendez
- Service de Médecine Physique et de Réadaptation, Hôpital Sébastopol, CHU de Reims, 51092 Reims, France;
| | - Gaetan Deslee
- Service des Maladies Respiratoires, Hôpital Maison Blanche, CHU de Reims, 51092 Reims, France;
- Inserm UMR-S1250, P3Cell, University of Reims Champagne-Ardenne, SFR CAP-SANTE, 51092 Reims, France
| | - Damien Jolly
- Faculté de Médecine, Université de Reims Champagne Ardennes, UR 3797 VieFra, 51097 Reims, France; (A.R.); (D.J.); (F.C.B.)
- Unité D’aide Méthodologique, Pôle Recherche et Santé Publique, Hôpital Robert Debré, CHU de Reims, 51092 Reims, France;
| | - François Constant Boyer
- Faculté de Médecine, Université de Reims Champagne Ardennes, UR 3797 VieFra, 51097 Reims, France; (A.R.); (D.J.); (F.C.B.)
- Service de Médecine Physique et de Réadaptation, Hôpital Sébastopol, CHU de Reims, 51092 Reims, France;
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9
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Ancel J, Guecamburu M, Marques Da Silva V, Schilfarth P, Boyer L, Pilette C, Martin C, Devillier P, Berger P, Zysman M, Le Rouzic O, Gonzalez-Bermejo J, Degano B, Burgel PR, Ahmed E, Roche N, Deslee G. [Take-home messages from the COPD 2021 biennial of the French Society of Respiratory Diseases. Understanding to so as to better innovate]. Rev Mal Respir 2022; 39:427-441. [PMID: 35568574 DOI: 10.1016/j.rmr.2022.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/23/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The first COPD biennial organized by the French Society of Respiratory Diseases (SPLF) took place on 17 December 2021. STATE OF THE ART The objective of the biennial was to discuss current knowledge regarding COPD pathophysiology, current treatments, research development, and future therapeutic approaches. PERSPECTIVES The different lecturers laid emphasis on the complexity of pathophysiologic mechanisms including bronchial, bronchiolar and parenchymal alterations, and also dwelt on the role of microbiota composition in COPD pathenogenesis. They pointed out that addition to inhaled treatments, ventilatory support and endoscopic approaches have been increasingly optimized. The development of new therapeutic pathways such as biotherapy and cell therapy (stem cells…) call for further exploration. CONCLUSIONS The dynamism of COPD research was repeatedly underlined, and needs to be further reinforced, the objective being to "understand so as to better innovate" so as to develop effective new strategies for treatment and management of COPD.
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Affiliation(s)
- J Ancel
- Inserm UMRS-1250, service de pneumologie, université Reims Champagne Ardenne, hôpital Maison Blanche, Reims, France
| | - M Guecamburu
- Service des maladies respiratoires, hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France
| | - V Marques Da Silva
- Inserm U955, FHU SENEC, université Paris-Est Créteil, institut Mondor de recherche biomédicale, équipe GEIC2O, Créteil, France
| | - P Schilfarth
- Service des maladies respiratoires, hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France; Inserm U1045, centre de recherche cardio-thoracique de Bordeaux, Pessac, France
| | - L Boyer
- Département de physiologie-explorations fonctionnelles, université Paris-Est, hôpital Henri-Mondor, AP-HP, UMR S955, FHU SENEC, UPEC, Créteil, France
| | - C Pilette
- Département de pneumologie, université catholique de Louvain, cliniques universitaires Saint-Luc et institut de recherche expérimentale et clinique, Bruxelles, Belgique
| | - C Martin
- Inserm U1016, service de pneumologie, AP-HP Paris, hôpital Cochin et institut Cochin, université de Paris, Paris, France
| | - P Devillier
- Département des maladies respiratoires, unité de recherche en pharmacologie respiratoire, VIM Suresnes (UMR 0892, université Paris-Saclay), hôpital Foch, Suresnes, France
| | - P Berger
- Service d'exploration fonctionnelle respiratoire, département de pharmacologie, centre de recherche cardiothoracique, U1045, CIC 1401, Pessac, France
| | - M Zysman
- Service des maladies respiratoires, hôpital du Haut-Lévêque, CHU de Bordeaux, Bordeaux, France; Inserm U1045, centre de recherche cardio-thoracique de Bordeaux, Pessac, France
| | - O Le Rouzic
- Inserm, CIIL Center for infection and immunity of Lille, université de Lille, CHU de Lille, pneumologie et immuno-allergologie, Institut Pasteur de Lille, U1019 - UMR9017, Lille, France
| | - J Gonzalez-Bermejo
- Inserm, UMRS115 neurophysiologie respiratoire expérimentale et clinique, service de pneumologie, médecine intensive et réanimation (département R3S), Sorbonne université, groupe hospitalier universitaire AP-HP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - B Degano
- Inserm 1042, service de pneumologie physiologie, CHU de Grenoble, Grenoble, France
| | - P-R Burgel
- Inserm U1016, service de pneumologie, AP-HP Paris, hôpital Cochin et institut Cochin, université de Paris, Paris, France
| | - E Ahmed
- Département des maladies respiratoires, IRMB, université de Montpellier, CHU de Montpellier, Montpellier, France
| | - N Roche
- Inserm U1016, service de pneumologie, AP-HP Paris, hôpital Cochin et institut Cochin, université de Paris, Paris, France
| | - G Deslee
- Inserm UMRS-1250, service de pneumologie, université Reims Champagne Ardenne, hôpital Maison Blanche, Reims, France.
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10
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Launois C, Mulette P, Ancel J, Dury S, Hagenburg J, Lebargy F, Dormoy V, Deslee G, Perotin JM. [Treatment of GERD in asthma]. Rev Mal Respir 2021; 38:733-742. [PMID: 34016495 DOI: 10.1016/j.rmr.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
Gastro-oesophageal reflux disease (GORD) is one of the most frequent conditions associated with asthma. GORD has an impact on asthma control and quality of life of asthmatic patients. Its treatment relies on lifestyle modifications, anti-acidic treatment with proton pump inhibitors (PPI) and/or surgical management by fundoplication in some situations. The impact of lifestyle modifications has not been analysed on asthma outcomes alone. Several randomised controlled trials assessed the efficacy of PPI on asthma control, peak expiratory flow and/or quality of life. The impact of fundoplication in asthma has mainly been analysed in retrospective or prospective observational studies. This review highlights the limited impact of GORD treatment on asthma control. Current guidelines are to restrict GORD treatment in asthma to asthmatic patients with actual symptomatic GORD. Given the lack of controlled studies, the place of surgical management of GORD in asthma is currently not defined.
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Affiliation(s)
- C Launois
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - P Mulette
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - J Ancel
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - S Dury
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; EA 4683, université de Reims Champagne-Ardenne, 51092 Reims, France
| | - J Hagenburg
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - F Lebargy
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; EA 4683, université de Reims Champagne-Ardenne, 51092 Reims, France
| | - V Dormoy
- Inserm UMR-S 1250, P3Cell, université de Reims Champagne-Ardenne, 51092 Reims, France
| | - G Deslee
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Inserm UMR-S 1250, P3Cell, université de Reims Champagne-Ardenne, 51092 Reims, France
| | - J-M Perotin
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France; Inserm UMR-S 1250, P3Cell, université de Reims Champagne-Ardenne, 51092 Reims, France.
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11
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Pison C, Shah PL, Slebos DJ, Ninane V, Janssens W, Perez T, Kessler R, Deslee G, Garner JL, Hartman JE, Degano B, Mayr A, Mayse M, Peterson AD, Valipour A. Correction to: Safety of denervation following targeted lung denervation therapy for COPD: AIRFLOW-1 3-year outcomes. Respir Res 2021; 22:83. [PMID: 33722230 PMCID: PMC7962218 DOI: 10.1186/s12931-021-01678-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Christophe Pison
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, CS10217, 38043, Grenoble Cedex 9, France. .,Université Grenoble Alpes, Grenoble, France.
| | - Pallav L Shah
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College, London, UK
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vincent Ninane
- CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Wim Janssens
- Department of Respiratory Diseases, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Thierry Perez
- CHU Lille, Center for Infection and Immunity of Lille, INSERM U1019-UMR9017, Univ Lille Nord de France, Lille, France
| | - Romain Kessler
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
| | - Gaetan Deslee
- Service de Pneumologie, INSERM UMRS-1250, CHU de Reims, Hôpital Maison Blanche, Reims, France
| | - Justin L Garner
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College, London, UK
| | - Jorine E Hartman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruno Degano
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, CS10217, 38043, Grenoble Cedex 9, France.,Université Grenoble Alpes, Grenoble, France
| | - Anna Mayr
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | | | | | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
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12
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Pison C, Shah PL, Slebos DJ, Ninane V, Janssens W, Perez T, Kessler R, Deslee G, Garner JL, Hartman JE, Degano B, Mayr A, Mayse M, Peterson AD, Valipour A. Safety of denervation following targeted lung denervation therapy for COPD: AIRFLOW-1 3-year outcomes. Respir Res 2021; 22:62. [PMID: 33608007 PMCID: PMC7893728 DOI: 10.1186/s12931-021-01664-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/11/2021] [Indexed: 01/09/2023] Open
Abstract
Background Targeted lung denervation (TLD) is a novel bronchoscopic therapy that disrupts parasympathetic pulmonary nerve input to the lung reducing clinical consequences of cholinergic hyperactivity. The AIRFLOW-1 study assessed safety and TLD dose in patients with moderate-to-severe, symptomatic COPD. This analysis evaluated the long-term impact of TLD on COPD exacerbations, pulmonary function, and quality of life over 3 years of follow up. Methods TLD was performed in a prospective, energy-level randomized (29 W vs 32 W power), multicenter study (NCT02058459). Additional patients were enrolled in an open label confirmation phase to confirm improved gastrointestinal safety after procedural modifications. Durability of TLD was evaluated at 1, 2, and 3 years post-treatment and assessed through analysis of COPD exacerbations, pulmonary lung function, and quality of life. Results Three-year follow-up data were available for 73.9% of patients (n = 34). The annualized rate of moderate to severe COPD exacerbations remained stable over the duration of the study. Lung function (FEV1, FVC, RV, and TLC) and quality of life (SGRQ-C and CAT) remained stable over 3 years of follow-up. No new gastrointestinal adverse events and no unexpected serious adverse events were observed. Conclusion TLD in COPD patients demonstrated a positive safety profile out to 3 years, with no late-onset serious adverse events related to denervation therapy. Clinical stability in lung function, quality of life, and exacerbations were observed in TLD treated patients over 3 years of follow up.
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Affiliation(s)
- Christophe Pison
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, CS10217, 38043, Grenoble Cedex 9, France. .,Université Grenoble Alpes, Grenoble, France.
| | - Pallav L Shah
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College, London, UK
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vincent Ninane
- CHU Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Wim Janssens
- Department of Respiratory Diseases, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Thierry Perez
- CHU Lille, Center for Infection and Immunity of Lille, INSERM U1019-UMR9017, Univ Lille Nord de France, Lille, France
| | - Romain Kessler
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
| | - Gaetan Deslee
- Service de Pneumologie, INSERM UMRS-1250, CHU de Reims, Hôpital Maison Blanche, Reims, France
| | - Justin L Garner
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College, London, UK
| | - Jorine E Hartman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruno Degano
- Service Hospitalier Universitaire Pneumologie Physiologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, CS10217, 38043, Grenoble Cedex 9, France.,Université Grenoble Alpes, Grenoble, France
| | - Anna Mayr
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | | | | | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
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13
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Valipour A, Shah PL, Herth FJ, Pison C, Schumann C, Hübner RH, Bonta PI, Kessler R, Gesierich W, Darwiche K, Lamprecht B, Perez T, Skowasch D, Deslee G, Marceau A, Sciurba FC, Gosens R, Hartman JE, Conway F, Duller M, Mayse M, Norman HS, Slebos DJ. Two-Year Outcomes for the Double-Blind, Randomized, Sham-Controlled Study of Targeted Lung Denervation in Patients with Moderate to Severe COPD: AIRFLOW-2. Int J Chron Obstruct Pulmon Dis 2020; 15:2807-2816. [PMID: 33177818 PMCID: PMC7652218 DOI: 10.2147/copd.s267409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose COPD exacerbations are associated with worsening clinical outcomes and increased healthcare costs, despite use of optimal medical therapy. A novel bronchoscopic therapy, targeted lung denervation (TLD), which disrupts parasympathetic pulmonary innervation of the lung, has been developed to reduce clinical consequences of cholinergic hyperactivity and its impact on COPD exacerbations. The AIRFLOW-2 study assessed the durability of safety and efficacy of TLD additive to optimal drug therapy compared to sham bronchoscopy and optimal drug therapy alone in subjects with moderate-to-severe, symptomatic COPD two years post randomization. Patients and Methods TLD was performed in COPD patients (FEV1 30-60% predicted, CAT≥10 or mMRC≥2) in a 1:1 randomized, sham-controlled, double-blinded multicenter study (AIRFLOW-2) using a novel lung denervation system (Nuvaira, Inc., USA). Subjects remained blinded until their 12.5-month follow-up visit when control subjects were offered the opportunity to undergo TLD. A time-to-first-event analysis on moderate and severe and severe exacerbations of COPD was performed. Results Eighty-two subjects (FEV1 41.6±7.4% predicted, 50.0% male, age 63.7±6.8 yrs, 24% with prior year respiratory hospitalization) were randomized. Time-to-first severe COPD exacerbation was significantly lengthened in the TLD arm (p=0.04, HR=0.38) at 2 years post-TLD therapy and trended towards similar attenuation for moderate and severe COPD exacerbations (p=0.18, HR=0.71). No significant changes in lung function or SGRQ-C were found 2 years post randomization between groups. Conclusion In a randomized trial, TLD demonstrated a durable effect of significantly lower risk of severe AECOPD over 2 years. Further, lung function and quality of life remained stable following TLD. Clinical Trial Registration NCT02058459.
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Affiliation(s)
- Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Pallav L Shah
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College, London, UK
| | - Felix J Herth
- Thoraxklinik, Department of Pneumology and Critical Care Medicine and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany
| | - Christophe Pison
- CHU Grenoble Alpes, Service Hospitalier Universitaire Pneumologie Physiologie; Université Grenoble Alpes, Grenoble, France
| | - Christian Schumann
- Clinic of Pneumology, Thoracic Oncology, Sleep- and Respiratory Critical Care, Klinikverbund Allgaeu, Kempten and Immenstadt, Germany
| | - Ralf-Harto Hübner
- Charité Universitätsmedizin Berlin, Medizinische Klinik m. Schw. Infektiologie und Pneumologie, Campus Virchow, Berlin, Germany
| | - Peter I Bonta
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Romain Kessler
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
| | - Wolfgang Gesierich
- Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, Ruhrlandklinik - University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler Universitatsklinikum GmbH, Linz, Austria
| | | | - Dirk Skowasch
- Department of Internal Medicine II - Cardiology/Pneumology, University of Bonn, Bonn, Germany
| | - Gaetan Deslee
- CHU de Reims, Hôpital Maison Blanche, Service de Pneumologie, Reims, France
| | - Armelle Marceau
- Service de Pneumologie, Hôpital Universitaire Bichat, Paris, France
| | - Frank C Sciurba
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Reinoud Gosens
- Department of Molecular Pharmacology, University of Groningen, Groningen, the Netherlands
| | - Jorine E Hartman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Francesca Conway
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College, London, UK
| | - Marina Duller
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | | | | | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - On behalf of the AIRFLOW-2 Trial Study Group
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College, London, UK
- Thoraxklinik, Department of Pneumology and Critical Care Medicine and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany
- CHU Grenoble Alpes, Service Hospitalier Universitaire Pneumologie Physiologie; Université Grenoble Alpes, Grenoble, France
- Clinic of Pneumology, Thoracic Oncology, Sleep- and Respiratory Critical Care, Klinikverbund Allgaeu, Kempten and Immenstadt, Germany
- Charité Universitätsmedizin Berlin, Medizinische Klinik m. Schw. Infektiologie und Pneumologie, Campus Virchow, Berlin, Germany
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
- Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany
- Department of Pulmonary Medicine, Section of Interventional Pneumology, Ruhrlandklinik - University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Pulmonary Medicine, Kepler Universitatsklinikum GmbH, Linz, Austria
- CHU de Lille – Hôpital Calmette, Lille, France
- Department of Internal Medicine II - Cardiology/Pneumology, University of Bonn, Bonn, Germany
- CHU de Reims, Hôpital Maison Blanche, Service de Pneumologie, Reims, France
- Service de Pneumologie, Hôpital Universitaire Bichat, Paris, France
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Molecular Pharmacology, University of Groningen, Groningen, the Netherlands
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Nuvaira, Inc., Minneapolis, MN, USA
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14
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Slebos DJ, Shah PL, Herth FJF, Pison C, Schumann C, Hübner RH, Bonta PI, Kessler R, Gesierich W, Darwiche K, Lamprecht B, Perez T, Skowasch D, Deslee G, Marceau A, Sciurba FC, Gosens R, Hartman JE, Srikanthan K, Duller M, Valipour A. Safety and Adverse Events after Targeted Lung Denervation for Symptomatic Moderate to Severe Chronic Obstructive Pulmonary Disease (AIRFLOW). A Multicenter Randomized Controlled Clinical Trial. Am J Respir Crit Care Med 2020; 200:1477-1486. [PMID: 31404499 PMCID: PMC6909835 DOI: 10.1164/rccm.201903-0624oc] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rationale: Targeted lung denervation (TLD) is a bronchoscopic radiofrequency ablation therapy for chronic obstructive pulmonary disease (COPD), which durably disrupts parasympathetic pulmonary nerves to decrease airway resistance and mucus hypersecretion. Objectives: To determine the safety and impact of TLD on respiratory adverse events. Methods: We conducted a multicenter, randomized, sham bronchoscopy–controlled, double-blind trial in patients with symptomatic (modified Medical Research Council dyspnea scale score, ≥2; or COPD Assessment Test score, ≥10) COPD (FEV1, 30–60% predicted). The primary endpoint was the rate of respiratory adverse events between 3 and 6.5 months after randomization (defined as COPD exacerbation, tachypnea, wheezing, worsening bronchitis, worsening dyspnea, influenza, pneumonia, other respiratory infections, respiratory failure, or airway effects requiring therapeutic intervention). Blinding was maintained through 12.5 months. Measurements and Main Results: Eighty-two patients (50% female; mean ± SD: age, 63.7 ± 6.8 yr; FEV1, 41.6 ± 7.3% predicted; modified Medical Research Council dyspnea scale score, 2.2 ± 0.7; COPD Assessment Test score, 18.4 ± 6.1) were randomized 1:1. During the predefined 3- to 6.5-month window, patients in the TLD group experienced significantly fewer respiratory adverse events than those in the sham group (32% vs. 71%, P = 0.008; odds ratio, 0.19; 95% confidence interval, 0.0750–0.4923, P = 0.0006). Between 0 and 12.5 months, these findings were not different (83% vs. 90%; P = 0.52). The risk of COPD exacerbation requiring hospitalization in the 0- to 12.5-month window was significantly lower in the TLD group than in the sham group (hazard ratio, 0.35; 95% confidence interval, 0.13–0.99; P = 0.039). There was no statistical difference in the time to first moderate or severe COPD exacerbation, patient-reported symptoms, or other physiologic measures over the 12.5 months of follow-up. Conclusions: Patients with symptomatic COPD treated with TLD combined with optimal pharmacotherapy had fewer study-defined respiratory adverse events, including hospitalizations for COPD exacerbation. Clinical trial registered with www.clinicaltrials.gov (NCT02058459).
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Affiliation(s)
| | - Pallav L Shah
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College London, London, United Kingdom
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, and.,Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Christophe Pison
- CHU Grenoble Alpes, Service Universitaire Pneumologie Physiologie, Université Grenoble Alpes, Grenoble, France
| | - Christian Schumann
- Clinic of Pneumology, Thoracic Oncology, Sleep and Respiratory Critical Care, Klinikverbund Kempten-Oberallgäu, Kempten and Immenstadt, Germany
| | - Ralf-Harto Hübner
- Charité Universitätsmedizin Berlin, Medizinische Klinik m. Schw. Infektiologie und Pneumologie, Campus Virchow, Berlin, Germany
| | - Peter I Bonta
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Romain Kessler
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
| | - Wolfgang Gesierich
- Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, Ruhrlandklinik-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler Universitatsklinikum GmbH, Linz, Austria
| | | | - Dirk Skowasch
- Department of Internal Medicine II-Cardiology/Pneumology, University of Bonn, Bonn, Germany
| | - Gaetan Deslee
- CHU de Reims, Hôpital Maison Blanche, Service de Pneumologie, Reims, France
| | - Armelle Marceau
- Service de Pneumologie, Hôpital Universitaire Bichat, Paris, France
| | - Frank C Sciurba
- Department of Molecular Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Reinoud Gosens
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | | | - Karthi Srikanthan
- Royal Brompton & Harefield NHS Trust, Chelsea & Westminster Hospital and Imperial College London, London, United Kingdom
| | - Marina Duller
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
| | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Karl-Landsteiner-Institute for Lung Research and Pulmonary Oncology, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria
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15
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Guguen C, Launois C, Dormoy V, Dewolf M, Dumazet A, Dury S, Lebargy F, Deslee G, Perotin JM. [Obesity and asthma: Mechanisms and therapeutic options]. Rev Mal Respir 2019; 37:134-143. [PMID: 31864881 DOI: 10.1016/j.rmr.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/06/2019] [Indexed: 12/22/2022]
Abstract
Asthma and obesity are both common conditions, which lead to a substantial public health burden. The obese-asthma phenotype is characterized by poor asthma control, impaired lung function and decreased efficacy of inhaled treatment. However, this phenotype is highly heterogeneous and involves numerous mechanisms, including systemic inflammation and adipokines. A role for microbiota modifications and genetics has been suggested. Obese-asthma patient management currently consists in weight loss and usual anti-asthmatic treatment. New therapeutic options are being evaluated.
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Affiliation(s)
- C Guguen
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - C Launois
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - V Dormoy
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - M Dewolf
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - A Dumazet
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - S Dury
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - F Lebargy
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - G Deslee
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - J-M Perotin
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France.
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Valipour A, Shah PL, Pison C, Ninane V, Janssens W, Perez T, Kessler R, Deslee G, Garner J, Abele C, Hartman JE, Slebos DJ. Safety and Dose Study of Targeted Lung Denervation in Moderate/Severe COPD Patients. Respiration 2019; 98:329-339. [PMID: 31220851 DOI: 10.1159/000500463] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022] Open
Abstract
RATIONALE Targeted lung denervation (TLD) is a novel bronchoscopic treatment for the disruption of parasympathetic innervation of the lungs. OBJECTIVES To assess safety, feasibility, and dosing of TLD in patients with moderate to severe COPD using a novel device design. METHODS Thirty patients with COPD (forced expiratory volume in 1 s 30-60%) were 1:1 randomized in a double-blinded fashion to receive TLD with either 29 or 32 W. Primary endpoint was the rate of TLD-associated adverse airway effects that required treatment through 3 months. Assessments of lung function, quality of life, dyspnea, and exercise capacity were performed at baseline and 1-year follow-up. An additional 16 patients were enrolled in an open-label confirmation phase study to confirm safety improvements after procedural enhancements following gastrointestinal adverse events during the randomized part of the trial. RESULTS Procedural success, defined as device success without an in-hospital serious adverse event, was 96.7% (29/30). The rate of TLD-associated adverse airway effects requiring intervention was 3/15 in the 32 W versus 1/15 in the 29 W group, p = 0.6. Five patients early in the randomized phase experienced serious gastric events. The study was stopped and procedural changes made that reduced both gastrointestinal and airway events in the subsequent phase of the randomized trial and follow-up confirmation study. Improvements in lung function and quality of life were observed compared to baseline values for both doses but were not statistically different. CONCLUSIONS The results demonstrate acceptable safety and feasibility of TLD in patients with COPD, with improvements in adverse event rates after procedural enhancements.
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Affiliation(s)
- Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Vienna, Austria
| | - Pallav L Shah
- Royal Brompton and Harefield NHS Trust, Chelsea and Westminster Hospital, and Imperial College, London, United Kingdom
| | - Christophe Pison
- Service Hospitalier Universitaire Pneumologie Physiologie, Centre Hospitalier Universitaire Grenoble Alpes, InsermU1055, Université Grenoble Alpes, Grenoble, France
| | - Vincent Ninane
- CHU Saint-Pierre, Université libre de Bruxelles, Bruxelles, Belgium
| | - Wim Janssens
- Department of Respiratory Diseases, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Thierry Perez
- CHU Lille, Center for Infection and Immunity of Lille, INSERM U1019, CNRS UMR 8204 Univ Lille Nord de France, Lille, France
| | - Romain Kessler
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
| | - Gaetan Deslee
- CHU de Reims, Hôpital Maison Blanche, INSERM UMRS 1250, Service de Pneumologie, Reims, France
| | - Justin Garner
- Royal Brompton and Harefield NHS Trust, Chelsea and Westminster Hospital, and Imperial College, London, United Kingdom
| | - Christine Abele
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Vienna, Austria
| | - Jorine E Hartman
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,
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Carette H, Zysman M, Morelot-Panzini C, Perrin J, Gomez E, Guillaumot A, Burgel PR, Deslee G, Surpas P, Le Rouzic O, Perez T, Chaouat A, Roche N, Chabot F. Prevalence and management of chronic breathlessness in COPD in a tertiary care center. BMC Pulm Med 2019; 19:95. [PMID: 31096982 PMCID: PMC6524222 DOI: 10.1186/s12890-019-0851-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/24/2019] [Indexed: 02/08/2023] Open
Abstract
Background Breathlessness is the prominent symptom of chronic obstructive pulmonary disease (COPD). Despite optimal therapeutic management including pharmacological and non-pharmacological interventions, many COPD patients exhibit significant breathlessness. Chronic breathlessness is defined as breathlessness that persists despite optimal treatment of the underlying disease. Because of the major disability related to chronic breathlessness, symptomatic treatments including opioids have been recommended by several authors. The prevalence of chronic breathlessness in COPD and its management in routine clinical practice have been poorly investigated. Our aim was to examine prevalence, associated characteristics and management of chronic breathlessness in patients with COPD recruited in a real-life tertiary hospital-based cohort. Methods A prospective study was conducted among 120 consecutive COPD patients recruited, in stable condition, at Nancy University Hospital, France. In parallel, 88 pulmonologists of the same geographical region were asked to respond to an on-line questionnaire on breathlessness management. Results Sixty four (53%) patients had severe breathlessness (modified Medical Research Council scale≥3), despite optimal inhaled medications for 94% of them; 40% had undergone pulmonary rehabilitation within the past 2 years. The severity of breathlessness increased with increasing airflow limitation. Breathlessness was associated with increased symptoms of anxiety, depression and with osteoporosis. No relation was found with other symptoms, exacerbation rate, or cardiovascular comorbidities. Among the patients with chronic breathlessness and Hospitalized Anxiety and/or Depression score > 10, only 25% were treated with antidepressant or anxiolytic. Among the pulmonologists 46 (52%) answered to the questionnaire and expressed a high willingness to prescribe opioids forchronic breathlessness, which contrasted with the finding that none of these patients received such treatments against breathlessness. Conclusion Treatment approaches to breathlessness and associated psychological distress are insufficient in COPD. This study highlights underuse of pulmonary rehabilitation and symptomatic treatment for breathlessness. Electronic supplementary material The online version of this article (10.1186/s12890-019-0851-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - M Zysman
- Pulmonary Department, Nancy, France. .,InsermU955, team 04, 8 rue du general Sarrail, 94000, Créteil, France.
| | - C Morelot-Panzini
- GH Pitié-Salpêtrière, Respiratory and Intensive Care Medicine Department, Paris, France
| | - J Perrin
- Pulmonary Department, Nancy, France
| | - E Gomez
- Pulmonary Department, Nancy, France
| | | | - P R Burgel
- Respiratory and Intensive Care Medicine Department, Cochin Hospital, AP-HP and Paris Descartes University (EA 2511), Sorbonne Paris Cité, Paris, France
| | - G Deslee
- Pulmonary Department, Maison Blanche University Hospital, INSERM U01250, Reims, France
| | - P Surpas
- Centre médical de Bayère, 30, route du Vieux-Château, 69380, Charnay, France
| | - O Le Rouzic
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France
| | - T Perez
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, F-59000, Lille, France
| | | | - N Roche
- Respiratory and Intensive Care Medicine Department, Cochin Hospital, AP-HP and Paris Descartes University (EA 2511), Sorbonne Paris Cité, Paris, France
| | - F Chabot
- Pulmonary Department, Nancy, France
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Bulsei J, Pfister J, Deslee G, Durand-Zaleski I. Justification de l’utilisation de deux questionnaires de qualité de vie, le SGRQ et l’EQ-5D-5L, dans une étude clinique contenant un volet économique. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2019.03.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Burgel P, Perez T, Deslee G, Zysman M, Paillasseur J, Roche N. Relations entre les phénotypes de BPCO et la distance parcourue lors du test de marche de 6 minutes. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Deslee G. Endobronchial Lung Volume Reduction in Severe Emphysema. Time to Translate Randomized Controlled Trial Results into Routine Clinical Practice? Am J Respir Crit Care Med 2018; 198:1110-1112. [DOI: 10.1164/rccm.201805-0983ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gaetan Deslee
- Department of Pulmonary Medicine INSERM 1250University Hospital of ReimsReims, France
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21
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Evans R, Brutsche M, Busca R, Deslee G, de Soyza A, Fellrath JM, Franzen D, Hartman J, Mealing S, Morton T, Munavvar M, Sculpher M, Shah P, Slebos DJ, Durand-Zaleski I. Quantifying patient centered outcomes associated with the use of bilateral endobronchial coil treatment in patients with severe emphysema. Curr Med Res Opin 2018; 34:1927-1932. [PMID: 29625529 DOI: 10.1080/03007995.2018.1462784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine the impact of endobronchial coils on health-related quality-of-life (HRQoL). This paper utilizes trial data to identify the predictors of HRQoL in patients with severe emphysema, and subsequently estimates the impact of a new treatment on HRQoL (measured by utilities). These utility estimates are used to generate indicative long-term QALY estimates for a range of clinically plausible scenarios as a precursor to cost-effectiveness analyses. METHODS Patient level HRQoL data from RENEW and the National Emphysema Treatment Trial (NETT) were combined and mapped to generic EuroQol 5-dimension health utility questionnaire (EQ-5D) values using a published algorithm. Multilevel statistical models were developed using treatment, time, response, and baseline characteristics (EQ-5D, age, gender, FEV1, lung RV) to predict EQ-5D over time. Lifetime QALY estimates were generated using published survival data from NETT (assuming no impact of treatment on mortality) and four clinically plausible response profiles. Each response profile was combined with assumptions around treatment impact (constant or time varying). RESULTS After controlling for baseline characteristics, both treatment and response had a statistically significant impact (p < .001) on utility (+0.101 and +0.061, respectively). When combined with selected baseline characteristics and time, Coils and Standard of Care (SoC) generated more QALYs than SoC alone in all scenarios, with incremental lifetime benefit ranging from 0.29-0.55 QALYs. CONCLUSIONS Coils and SoC resulted in statistically significant improvements in HRQoL compared to SoC alone in patients with severe emphysema.
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Affiliation(s)
| | | | | | - Gaetan Deslee
- d University Hospital, INSERM UMRS 903 , Reims , France
| | | | | | | | - Jorine Hartman
- h University Medical Center , Groningen , The Netherlands
| | - Stuart Mealing
- i York Health Economics Consortium , North Yorkshire , UK
| | - Tim Morton
- j Decision Resources Group Bicester , Oxfordshire , UK
| | | | | | - Pallav Shah
- m Royal Brompton & Harefield NHS Foundation Trust , and Imperial College , London , UK
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22
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Valipour A, Asadi S, Pison C, Jondot M, Kessler R, Benneddif K, Deslee G, Verdier M, Slebos DJ, Mayse M. Long-term safety of bilateral targeted lung denervation in patients with COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:2163-2172. [PMID: 30038492 PMCID: PMC6052931 DOI: 10.2147/copd.s158748] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Targeted lung denervation (TLD) is a novel bronchoscopic therapy for COPD which ablates parasympathetic pulmonary nerves running along the outside of the two main bronchi with the intent of inducing permanent bronchodilation. The goal of this study was to evaluate the feasibility and long-term safety of bilateral TLD during a single procedure. Patients and methods This prospective, multicenter study evaluated 15 patients with moderate-to-severe COPD (forced expiratory volume in 1 s [FEV1] 30%–60%) who underwent bilateral TLD treatment following baseline assessment without bronchodilators. The primary safety end point was freedom from documented and sustained worsening of COPD directly attributable to TLD up to 1 year. Secondary end points included technical feasibility, change in pulmonary function tests, exercise capacity, and health-related quality of life. Follow-up continued up to 3 years for subjects who reconsented for longer-term follow-up. Results A total of 15 patients (47% male, age 63.2±4.0 years) underwent TLD with a total procedure time of 89±16 min, and the total fluoroscopy time was 2.5±2.7 min. Primary safety end point of freedom from worsening of COPD was 100%. There were no procedural complications reported. Results of lung function analysis and exercise capacity demonstrated similar beneficial effects of TLD without bronchodilators, when compared with long-acting anticholinergic therapy at 30 days, 180 days, 365 days, 2 years, and 3 years post-TLD. Five of the 12 serious adverse events that were reported through 3 years of follow-up were respiratory related with no events being related to TLD therapy. Conclusion TLD delivered to both lungs in a single procedure is feasible and safe with few respiratory-related adverse events through 3 years.
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Affiliation(s)
- Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Vienna, Austria,
| | - Sherwin Asadi
- Department of Respiratory and Critical Care Medicine, Ludwig-Boltzmann-Institute for COPD and Respiratory Epidemiology, Otto-Wagner-Spital, Vienna, Austria,
| | - Christophe Pison
- CHU Grenoble Alpes, Clinique Universitaire de Pneumologie, Université Grenoble Alpes, Grenoble, France
| | - Marie Jondot
- CHU Grenoble Alpes, Clinique Universitaire de Pneumologie, Université Grenoble Alpes, Grenoble, France
| | - Romain Kessler
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
| | - Khaled Benneddif
- Service de Pneumologie, Nouvel Hôpital Civil, Université de Strasbourg, Strasbourg, France
| | - Gaetan Deslee
- CHU de Reims, Hôpital Maison Blanche, Service de Pneumologie, INSERM UMRS903, Reims, France
| | - Margaux Verdier
- CHU de Reims, Hôpital Maison Blanche, Service de Pneumologie, INSERM UMRS903, Reims, France
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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van Geffen WH, Herth FJ, Deslee G, Slebos DJ, Shah PL. Lung volume reduction for emphysema - Authors' reply. Lancet Respir Med 2018; 5:e24. [PMID: 28664863 DOI: 10.1016/s2213-2600(17)30232-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Wouter H van Geffen
- Department of Pulmonary diseases, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Felix J Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Gaetan Deslee
- Department of Pulmonary Medicine, University Hospital of Reims, Reims, France
| | - Dirk-Jan Slebos
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Netherlands
| | - Pallav L Shah
- Royal Brompton & Harefield NHS Foundation Trust, London SW3 6NP, UK; Chelsea and Westminster Hospital NHS Foundation Trust, London UK.
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24
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Marchetti N, Kaufman T, Chandra D, Herth FJ, Shah PL, Slebos DJ, Dass C, Bicknell S, Blaas SH, Pfeifer M, Stanzell F, Witt C, Deslee G, Gesierich W, Hetzel M, Kessler R, Leroy S, Hetzel J, Sciurba FC, Criner GJ. Endobronchial Coils Versus Lung Volume Reduction Surgery or Medical Therapy for Treatment of Advanced Homogenous Emphysema. Chronic Obstr Pulm Dis 2018; 5:87-96. [PMID: 30374446 DOI: 10.15326/jcopdf.5.2.2017.0134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Rationale: Bronchoscopic lung volume reduction utilizing shape-memory nitinol endobronchial coils (EBC) may be safer and more effective in severely hyperinflated homogeneous emphysema compared to medical therapy or lung volume reduction surgery (LVRS). Methods: The effect of bilateral EBC in patients with homogeneous emphysema on spirometry, lung volumes and survival was compared to patients with homogeneous emphysema randomized in the National Emphysema Treatment Trial (NETT) to LVRS or medical therapy. NETT participants were selected to match EBC participants in age, baseline spirometry, and gender. Outcomes were compared from baseline, at 6 and 12 months. Results: There were no significant baseline differences in gender in the EBC, NETT-LVRS or medical treatment patients. At baseline no differences existed between EBC and NETT-LVRS patients in forced expiratory volume in 1 second ( FEV1) or total lung capacity (TLC) %-predicted; residual volume (RV) and diffusing capacity of the lung for carbon monoxide (DLco) %-predicted were higher in the EBC group compared to NETT-LVRS (p < 0.001). Compared to the medical treatment group, EBC produced greater improvements in FEV1 and RV but not TLC at 6 months. FEV1 and RV in the EBC group remained significantly improved at 12-months compared to the medical treatment group. While all 3 therapies improved quality of life, survival at 12 months with EBC or medical therapy was greater than NETT-LVRS. Conclusion: EBC may be a potential therapeutic option in patients with severe homogeneous emphysema and hyperinflation who are already receiving optimal medical treatment.
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Affiliation(s)
- Nathaniel Marchetti
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Theresa Kaufman
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Divay Chandra
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Felix J Herth
- Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Pallav L Shah
- The National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, United Kingdom
| | - Dirk-Jan Slebos
- University Medical Center Groningen, University of Groningen, The Netherlands
| | - Chandra Dass
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | | | | | | | | | - Gaetan Deslee
- Service de Pneumologie Hôpital Maison Blanche, INSERM 903, Reims, France
| | | | | | | | - Sylvie Leroy
- FHU OncoAge Côte d'Azur University, Nice, France
| | - Juergen Hetzel
- Department of Internal Medicine II-Pneumology, University Hospital, Teubingen, Germany
| | - Frank C Sciurba
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Dumazet A, Deslee G, Lebargy F, Kessler R, Schmitt P, Hermant C, Dutilh J, Abouda M, Perotin-Collard J. Trachéobronchopathie ostéochondroplastique : caractérisation clinique, endoscopique et facteurs associés. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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Perotin JM, Deslee G. [Which inhaled pharmacological treatment during acute COPD exacerbation in community-based practice?]. Rev Mal Respir 2017; 34:395-396. [PMID: 28495294 DOI: 10.1016/j.rmr.2017.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J-M Perotin
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - G Deslee
- Service des maladies respiratoires, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
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27
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Ammar Y, Launois C, Perotin JM, Dury S, Servettaz A, Perdu D, Vallerand H, Nardi J, Boulagnon-Rombi C, Pluot M, Lebargy F, Deslee G. Hypoventilation alvéolaire sévère révélant un shrinking lung syndrome lupique. Rev Mal Respir 2017; 34:571-575. [DOI: 10.1016/j.rmr.2016.10.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 10/17/2016] [Indexed: 12/01/2022]
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Caillaud D, Chanez P, Escamilla R, Burgel PR, Court-Fortune I, Nesme-Meyer P, Deslee G, Perez T, Paillasseur JL, Pinet C, Jebrak G, Roche N. Asthma-COPD overlap syndrome (ACOS) vs 'pure' COPD: a distinct phenotype? Allergy 2017; 72:137-145. [PMID: 27501862 DOI: 10.1111/all.13004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Some studies suggest that asthma-COPD overlap syndrome (ACOS) is associated with worse outcomes than chronic obstructive pulmonary disease (COPD). The goal of this study was to further explore the clinical characteristics and survival of patients with ACOS identified in a real-life cohort of patients with COPD. METHODS Data from the French COPD cohort 'INITIATIVES BronchoPneumopathie Chronique Obstructive' (n = 998 patients) were analyzed to assess the frequency of ACOS defined as a physician diagnosis of asthma before the age of 40 years and to analyze its impact. Univariate analyses were performed to assess the relationship between ACOS and sociodemographic characteristics, risk factors (smoking, occupational exposure, atopic diseases), symptoms (chronic bronchitis, dyspnea-modified Medical Research Council scale and baseline dyspnea index), quality of life (QoL), mood disorders, exacerbations, comorbidities, lung function, prescribed treatment, and survival. RESULTS ACOS was diagnosed in 129 patients (13%). In multivariate analyses, ACOS was associated negatively with cumulative smoking (odds ratio [OR]: 0.992; 95% CI 0.984-1.000 per pack-year) and positively with obesity: OR: 1.97 [1.22-3.16], history of atopic disease (hay fever: OR: 5.50 [3.42-9.00] and atopic dermatitis: OR 3.76 [2.14-6.61]), and drug use (LABA + ICS: 1.86 [1.27-2.74], antileukotrienes 4.83 [1.63-14.34], theophylline: 2.46 [1.23-4.91], and oral corticosteroids: [2.99;.1.26-7.08]). No independent association was found with dyspnea, QoL, exacerbations, and mortality. CONCLUSIONS Compared to 'pure' COPD patients, patients with ACOS exhibit lower cumulative smoking, suffer more from obesity and atopic diseases, and use more asthma treatments. Disease severity (dyspnea, QoL, exacerbations, comorbidities) and prognosis (mortality) are not different from 'pure' COPD patients.
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Affiliation(s)
- D. Caillaud
- Pulmonary Department; Gabriel Montpied University Hospital; Auvergne University; Clermont-Ferrand France
| | - P. Chanez
- Pulmonary Department; APHM; INSERM U1077; CNRS UMR 7733 Aix Marseille Université; Marseille France
| | - R. Escamilla
- Pulmonary Department; Larrey University Hospital; Toulouse France
| | - P-R. Burgel
- Respiratory and Intensive Care Medicine; Cochin Hospital; AP-HP and Paris Descartes University; Sorbonne Paris Cité; Paris France
| | | | - P. Nesme-Meyer
- Pulmonary Department; La Croix Rousse University Hospital; Lyon France
| | - G. Deslee
- Pulmonary Department; Maison Blanche University Hospital; INSERM U903; Reims France
| | - T. Perez
- Clinique des Maladies Respiratoires; Albert Calmette University Hospital; Lille France
| | | | - C. Pinet
- Polyclinique Les Fleurs; Pneumologie; Ollioules France
| | - G. Jebrak
- Pulmonary Department; Bichat Hospital; AP-HP; Paris France
| | - N. Roche
- Respiratory and Intensive Care Medicine; Cochin Hospital; AP-HP and Paris Descartes University; Sorbonne Paris Cité; Paris France
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29
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Deslee G, Mal H, Dutau H, Bourdin A, Vergnon J, Pison C, Kessler R, Jounieaux V, Thiberville L, Leroy S, Marceau A, Laroumagne S, Mallet J, Dukic S, Barbe C, Bulsei J, Jolly D, Durand-Zaleski I, Marquette C. Étude randomisée multicentrique évaluant la réduction volumique par spirales dans l’emphysème (STIC REVOLENS). Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Boissière L, Bertin E, Gaubil-Kaladjian I, Diaz Cives A, Perotin Collard J, Dury S, Lebargy F, Nardi J, Deslee G, Launois C. La chirurgie bariatrique améliore la dyspnée des sujets obèses. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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31
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Zouak A, Bongrain É, Launois C, Nardi J, Vella-Boucaud J, Deslee G, Lebargy F, Perotin JM. Pleurésie à éosinophiles : une complication rare d’un traitement par inhibiteur de l’enzyme de conversion de l’angiotensine. Rev Mal Respir 2015; 32:737-41. [DOI: 10.1016/j.rmr.2014.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/14/2014] [Indexed: 10/24/2022]
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32
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Perotin JM, Barbe C, Nguyen KL, Fontaine JF, Gabignon Y, Nardi J, Launois C, Lebargy F, Lavaud F, Deslee G. Work-related respiratory symptoms in Champagne vineyard workers. Eur Ann Allergy Clin Immunol 2015; 47:140-144. [PMID: 26356997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Vineyard workers (VW) are exposed to various respiratory allergens. The aims of the study were to determine the prevalence of work related respiratory symptoms (WRS) in Champagne VW in France and to analyze the relationships between symptoms, occupational exposure and sensitization profile. METHODS VW of Reims area were prospectively recruited between 2007 and 2010. Demographic and occupational characteristics were recorded. Respiratory symptoms were scored for each month of the past year. Results of respiratory functional tests and skin prick tests for common respiratory allergens, grape moulds and vine pollen were recorded. RESULTS 307 subjects were included. The prevalence of WRS was 11%. Compared to subjects with symptoms unrelated to work, subjects with WRS were more frequently sensitized to gramineae (34% vs 18%, p = 0.05), described ocular itching (74% vs 37%, p < 0.001) and seasonal symptoms (88% vs 69%, p = 0.03) mainly during lifting and trellising (57% vs 17%, p < 0.001). CONCLUSION WRS are frequent in Champagne WV and are associated with a sensitization to gramineae and with activities performed close to vine in late spring.
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Affiliation(s)
- J-M Perotin
- Department of Respiratory Medicine, University Hospital, 51100 Reims, France. INSERM UMRS 903, University Hospital, 51100, 45 Rue Cognacq Jay, 51100 Reims, France. Phone: +33 32 67 87 614 Fax: +33 32 678 40 30 E-mail:
| | - C Barbe
- Clinical Research Unit, University Hospital, 51100 Reims, France
| | - K L Nguyen
- Department of Respiratory Medicine, University Hospital, 51100 Reims, France
| | - J-F Fontaine
- Department of Respiratory Medicine, University Hospital, 51100 Reims, France
| | - Y Gabignon
- Department of Occupational Medicine, Mutualité Sociale Agricole, 51100 Reims, France
| | - J Nardi
- Department of Respiratory Medicine, University Hospital, 51100 Reims, France
| | - C Launois
- Department of Respiratory Medicine, University Hospital, 51100 Reims, France
| | - F Lebargy
- Department of Respiratory Medicine, University Hospital, 51100 Reims, France
| | - F Lavaud
- Department of Respiratory Medicine, University Hospital, 51100 Reims, France
| | - G Deslee
- Department of Respiratory Medicine, University Hospital, 51100 Reims, France. INSERM UMRS 903, University Hospital, 51100 Reims, France
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Slebos DJ, Hartman JE, Klooster K, Blaas S, Deslee G, Gesierich W, Hetzel J, Hetzel M, McNulty W, Kemp SV, Kessler R, Leroy S, Stanzel F, Witt C, Zoumot Z, Herth FJ, Shah PL. Bronchoscopic Coil Treatment for Patients with Severe Emphysema: A Meta-Analysis. Respiration 2015; 90:136-45. [DOI: 10.1159/000431384] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/08/2015] [Indexed: 11/19/2022] Open
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34
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Fedun S, Flucher A, Boyer FC, Lebargy F, Barbe C, Dury S, Schmitt P, Zouak A, Vella-Boucaud J, Deslee G, Nardi J. Évaluations respiratoire et neuro-psychologique dans la dystrophie myotonique de type 1 (DM1). Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2013.10.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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35
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Caillaud D, Chanez P, Escamilla R, Burgel P, Court-Fortune I, Nesme-Meyer P, Deslee G, Perez T, Pinet C, Roche N. La rhinite chronique (RC) est associée à la dyspnée et à une diminution de la qualité de vie (QdV) dans la BPCO. Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2013.10.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Jarrot PA, Dury S, Rakotomalala A, Vella-Boucaud J, Patey M, Deslee G, Lebargy F. Association of sarcoidosis and ulcerative colitis: a review of 20 cases. Sarcoidosis Vasc Diffuse Lung Dis 2013; 30:212-216. [PMID: 24284294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 06/02/2023]
Abstract
Sarcoidosis and ulcerative colitis is a rare association. We report a case of this association and describe its clinical, radiological and functional characteristics based on a review of the literature. This association must be recognized by the physician and must be clearly distinguished from a systemic site of ulcerative colitis or drug-related pneumonitis.
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Affiliation(s)
- P A Jarrot
- Department of Pulmonary Medicine, Centre Hospitalier et Universitaire de Reims, France..
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37
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Launois C, Nardi J, Bertin E, Barbe C, Perotin J, Dury S, Lebargy F, Deslee G. The modified Medical Research Council scale for the assessment of dyspnea in daily living in obesity: A pilot study. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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38
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Slebos DJ, Bicknell S, Gesierich W, Herth F, Hetzel J, Hetzel M, Kessler R, Marquette CH, Pfeifer M, Shah P, Stanzel F, Witt C, Deslee G. Lung Volume Reduction Coil Sustained Treatment Effectiveness in Heterogeneous and Homogeneous Emphysema. Chest 2013. [DOI: 10.1378/chest.1780087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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39
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Deslee G, Kessler R, Blaas S, Gesierich W, Herth FJ, Hetzel J, Hetzel M, Pfeifer M, Stanzel F, Witt C, Slebos DJ, Marquette CH. Étude européenne de faisabilité de la réduction volumique par spirales endobronchiques dans l’emphysème sévère. Résultats préliminaires à 6 et 12 mois. Rev Mal Respir 2013. [DOI: 10.1016/j.rmr.2012.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Deslee G, Barbe C, Bourdin A, Durand-Zaleski I, Dutau H, Jolly D, Jounieaux V, Kessler R, Mal H, Pison C, Thiberville L, Vergnon JM, Marquette CH. [Cost-effectiveness of lung volume reduction coil treatment in emphysema. STIC REVOLENS]. Rev Mal Respir 2012. [PMID: 23200592 DOI: 10.1016/j.rmr.2012.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Medical therapeutic options for the treatment of emphysema remain limited. Lung volume reduction surgery is infrequently used because of its high morbi-mortality. Endobronchial lung volume reduction coil (LVRC(®), PneumRx, Mountain View, CA) treatment has been recently developed and has been shown to be feasible and associated with an acceptable safety profile, while resulting in improvements in dyspnea, exercise capacity and lung function. The objective of this study is to analyze the cost effectiveness of LVRC treatment in severe emphysema. METHODS This prospective, multicenter study, randomized with a 1:1 ratio (LVRC vs conventional treatment) will include 100 patients who will be followed up for 1year. The primary outcome measure is the 6-month improvement of the 6-minute walk test: the percentage of patients showing an improvement of at least 54m will be compared between groups. A cost-effectiveness study will estimate the cost of LVRC treatment, the global cost of this therapeutic option and will compare the cost between patients treated by LVRC and by medical treatment alone. EXPECTED RESULTS This study should allow validating the clinical efficacy of LVRC in severe emphysema. The cost-effectiveness study will assess the medical-economic impact of the LVRC therapeutic option.
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Affiliation(s)
- G Deslee
- Service de pneumologie, hôpital Maison-Blanche, CHU de Reims, 45 rue Cognacq-Jay, Reims, France.
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41
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Borie R, Danel C, Molinier-Frenkel V, Prevot G, Deslee G, Debray MP, Delfau-Larue MH, Crestani B. Tracheobronchial amyloidosis: evidence for local B-cell clonal expansion. Eur Respir J 2012; 39:1042-5. [PMID: 22467728 DOI: 10.1183/09031936.00101811] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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42
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Gompelmann D, Herth FJF, Eberhardt R, Klooster K, Hetzel M, Stanzel F, Deslee G, Witt C, Gesierich W, Kessler R, Pfeifer M, Blaas S, Hetzel J, Marquette CH, Slebos DJ. Endoskopische Lungenvolumenreduktion durch Coilimplantation bei Patienten mit schwerem heterogenem Lungenemphysem. Pneumologie 2012. [DOI: 10.1055/s-0032-1302654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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43
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Perotin JM, Jeanfaivre T, Thibout Y, Jouneau S, Lena H, Dutau H, Ramon P, Lorut C, Noppen M, Vergnon JM, Vallerand H, Merol J, Marquette CH, Lebargy F, Deslee G. Traitement endoscopique des sténoses trachéales idiopathiques. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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44
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Deslee G, Kessler R, Leroy S, Mal H, Vallerand H, Boulay-Malinovsky C, Lebargy F, Marquette CH. Réduction volumique par coils bronchopulmonaires dans l’emphysème : résultats préliminaires de l’étude de faisabilité française. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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45
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Vella-Boucaud J, Chouabe S, Bourin F, Lebargy F, Deslee G. Autobullectomie : une infection salutaire. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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46
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Launois C, Vallerand H, Lebargy F, Deslee G. Une cause exceptionnelle d’emphysème pulmonaire : le syndrome de Protée. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Launois C, Bertin E, Dury S, Lebargy F, Deslee G. Dyspnée associée à l’obésité : une évaluation complexe. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- J-M Perotin
- Service des Maladies Respiratoires et Allergiques, 45 rue Cognacq Jay, Reims, France.
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Angelier AS, Petit L, Wynckel A, Vuiblet V, Birembaut P, Toubas O, Lebargy F, Deslee G. Purpura rhumatoïde révélateur d’un carcinome épidermoïde bronchique. Rev Mal Respir 2011; 28:372-6. [DOI: 10.1016/j.rmr.2010.09.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 09/07/2010] [Indexed: 11/27/2022]
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50
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Perotin JM, Deslee G, Perdu D, Cahn V, Validire P, Rubin S, Magdeleinat P, Toubas O, Lebargy F. [Primary myxoid mediastinal liposarcoma]. Rev Mal Respir 2011; 28:84-7. [PMID: 21277480 DOI: 10.1016/j.rmr.2010.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 05/24/2010] [Indexed: 10/18/2022]
Abstract
Mediastinal liposarcomas (LPS) are rare tumours. We report a case of primary myxoid LPS in a 22-year-old woman suffering from cough, dyspnoea on exercise and asthenia for 3 weeks. Thoracic MRI showed a large tumour on the right side. After neoadjuvant chemotherapy, a complete resection was performed, followed by adjuvant thoracic irradiation. Eighteen months after the diagnosis, no sign of recurrence was detected. Mediastinal LPS include a heterogeneous group of bulky tumours, the progression of which depends on the histological type. The prognosis is dominated by the operability of the tumour. Adjuvant therapies are not established.
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Affiliation(s)
- J-M Perotin
- Service des Maladies Respiratoires, IFR 53, Hôpital Maison-Blanche, CHU de Reims, 45 rue Cognacq-Jay, 51100 Reims, France.
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