1
|
Lestelle F, Beigelman C, Rotzinger D, Si-Mohamed S, Nasser M, Wemeau L, Hirschi S, Prevot G, Roux A, Bunel V, Gomez E, Sohier L, Pradier HM, Gaubert MR, Gondouin A, Lazor R, Glerant JC, Bejui FT, Colombat M, Cottin V. Phenotypes and outcome of diffuse pulmonary non-amyloid light chain deposition disease. Respir Res 2024; 25:159. [PMID: 38600600 PMCID: PMC11005206 DOI: 10.1186/s12931-024-02798-y] [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: 10/18/2023] [Accepted: 04/01/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Light chain deposition disease (LCDD) is a very rare entity. Clinical manifestations of LCDD vary according to the organs involved. Data on pulmonary LCDD are scarce and limited to small series or case reports. This study aimed to describe the characteristics and outcome of diffuse pulmonary non-amyloid LCDD localized to the lungs. STUDY DESIGN AND METHODS A multicenter retrospective cohort study was conducted. Clinical characteristics were collected, and chest CTs were centrally reviewed. The diagnosis of pulmonary non-amyloid LCDD was confirmed by immunohistochemistry. RESULTS Thirty-one cases were identified (68% female), with a median age at diagnosis of 50 years (IQR 20). Baseline FEV1/FVC was < 0.70 in 45% of patients. Mean (± SD) FEV1 and DLCO were 86% ± 26.2 and 52% ± 23.9, respectively. CT revealed peculiar patterns of thin-walled cysts (58%) and thin-walled cystic bronchiectases (27%). Increased serum kappa light chain was found in 87% of patients. Histological analysis showed kappa light chain deposits in all patients, except one with lambda chain deposits. Median annual FEV1 decline was 127 ml (IQR 178) and median DLCO decline was 4.3% (IQR 4.3). Sixteen patients received immunomodulatory treatment or chemotherapy; serum light chain levels decreased in 9 cases (75%), without significant improvement in FEV1 (p = 0.173). Overall, 48% of patients underwent bilateral lung transplantation. Transplant-free survival at 5 and 10 years were 70% and 30%, respectively. An annual FEV1 decline greater than 127 ml/year was associated with increased risk of death or transplantation (p = 0.005). CONCLUSIONS Diffuse pulmonary LCDD is characterised by female predominance, a peculiar imaging pattern with bronchiectasis and/or cysts, progressive airway obstruction and severe DLCO impairment, and poor outcome. Lung transplantation is a treatment of choice.
Collapse
Affiliation(s)
- François Lestelle
- Hospices Civils de Lyon, Centre de Référence Coordinateur Des Maladies Pulmonaires Rares (OrphaLung), Hôpital Louis Pradel, Service de Pneumologie, 69677, Lyon, France
| | - Catherine Beigelman
- Service de Radiologie Et de Radiologie Interventionnelle, Hôpital Universitaire de Lausanne, Université de Lausanne, Lausanne, Suisse
| | - David Rotzinger
- Service de Radiologie Et de Radiologie Interventionnelle, Hôpital Universitaire de Lausanne, Université de Lausanne, Lausanne, Suisse
| | - Salim Si-Mohamed
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service de Radiologie, Lyon 69677U1206, Université de Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS, UMR 5220, F-69621, 7 Avenue Jean Capelle O, 69100, Villeurbanne, France
| | - Mouhamad Nasser
- Hospices Civils de Lyon, Centre de Référence Coordinateur Des Maladies Pulmonaires Rares (OrphaLung), Hôpital Louis Pradel, Service de Pneumologie, 69677, Lyon, France
| | - Lidwine Wemeau
- Centre de Référence Constitutif Des Maladies Pulmonaires Rares (OrphaLung), CHU Lille, Service de Pneumologie, Lille, France
| | - Sandrine Hirschi
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Strasbourg, Service de Pneumologie, Strasbourg, France
| | - Grégoire Prevot
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Toulouse, Hôpital LarreyUniversité Paul Sabatier, Toulouse, France
| | - Antoine Roux
- Service de Pneumologie Et de Transplantation Pulmonaire, Hopital Foch, Suresnes, France
| | - Vincent Bunel
- Service de Pneumologie B Et de Transplantation Pulmonaire, AP-HP, Hôpital Bichat Claude-Bernard, Inserm U1152, Paris, France
| | - Emmanuel Gomez
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Nancy, Service de Pneumologie, Nancy, France
| | - Laurent Sohier
- Centre Hospitalier Bretagne Sud, Service de Pneumologie, Lorient, France
| | - Helene Morisse Pradier
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Rouen, Service de Pneumologie, Rouen, France
| | - Martine Reynaud Gaubert
- Service de Pneumologie Et Transplantation Pulmonaire, CHU Marseille Nord, Aix-Marseille Université Marseille, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Anne Gondouin
- Centre de Compétence Des Maladies Pulmonaires Rares (OrphaLung), CHU Besançon, Service de Pneumologie, Besançon, France
| | - Romain Lazor
- Service de Pneumologie, Centre Hospitalier Universitaire Vaudois, Lausanne, CH, Suisse
| | - Jean-Charles Glerant
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'explorations Fonctionnelles Respiratoires, 69677, Lyon, France
| | | | - Magali Colombat
- CHU Toulouse, Institut Universitaire du Cancer de Toulouse, Service d'anatomie Et Cytologie Pathologiques, Toulouse, France
| | - Vincent Cottin
- Hospices Civils de Lyon, Centre de Référence Coordinateur Des Maladies Pulmonaires Rares (OrphaLung), Hôpital Louis Pradel, Service de Pneumologie, 69677, Lyon, France.
- UMR754, INRAE; Member of RespiFil and ERN-LUNG, Université, Claude Bernard Lyon 1, Lyon, France.
| |
Collapse
|
2
|
Desaintjean C, Ahmad K, Traclet J, Gerfaud-Valentin M, Durel CA, Glerant JC, Hot A, Lestelle F, Mainbourg S, Nasser M, Seve P, Turquier S, Devouassoux G, Cottin V. Mepolizumab and benralizumab in patients with severe asthma and a history of eosinophilic granulomatosis with polyangiitis. Front Med (Lausanne) 2024; 11:1341310. [PMID: 38585151 PMCID: PMC10998444 DOI: 10.3389/fmed.2024.1341310] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/26/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Asthma associated with eosinophilic granulomatosis with polyangiitis (EGPA) is often severe and corticosteroid-dependent, leading to significant morbidity. Mepolizumab and benralizumab are humanized monoclonal antibodies targeting interleukin 5 (IL-5) and its receptor, respectively. They have been shown to be effective in steroid-sparing in patients with severe eosinophilic asthma. Objective Our aim was to evaluate the efficacy and safety of mepolizumab and benralizumab prescribed for severe asthma in patients with EGPA under "real-world" conditions. Methods This was a retrospective analysis of patients with EGPA and persistent asthma who received either mepolizumab 100 or 300 mg administered every 4 weeks, or benralizumab 30 mg administered every 4 weeks for the initial 3 injections and followed by an injection every 8 weeks thereafter, whilst combined with oral glucocorticoids. The follow-up every 6 ± 3 months included an assessment of clinical manifestations, pulmonary function tests and eosinophil cell count. The primary outcome was the proportion of patients at 12 months receiving a daily oral dose of prednisone or equivalent of 4 mg or less with a BVAS of 0. Results Twenty-six patients were included. After 12 months of treatment with mepolizumab or benralizumab, 32% of patients met the primary outcome and were receiving less than 4 mg of prednisone per day with a BVAS of 0. The median dose of prednisone was 10 mg per day at baseline, 9 mg at 6 months, and 5 mg at 12 months (p ≤ 0.01). At 12 months, 23% of patients were weaned off corticosteroids, while an increase or no change in dose was observed in 27% of patients. The median eosinophil count was significantly reduced from 365 cells/mm3 to 55 cells/mm3 at 6 months and 70 cells/mm3 at 12 months, respectively. No significant change was observed in FEV1. After 12 months of treatment, 14% of patients had had an average of 1 exacerbation of asthma, compared with 52% of patients before baseline. The tolerability profile was favorable. Conclusion In this real-world study in patients with severe asthma and a history of EGPA asthma, mepolizumab and benralizumab had a significant steroid-sparing effect and reduced asthma exacerbation, but no significant effect on lung function.
Collapse
Affiliation(s)
- Charlene Desaintjean
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Member of ERN-LUNG, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Kaïs Ahmad
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Member of ERN-LUNG, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Julie Traclet
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Member of ERN-LUNG, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Cecile-Audrey Durel
- Department of Internal Medicine, Hôpital Saint-Joseph Saint-Luc, Lyon, France
| | - Jean-Charles Glerant
- Pulmonary Function Tests Department, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Arnaud Hot
- Department of Internal Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - François Lestelle
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Member of ERN-LUNG, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sabine Mainbourg
- Department of Internal Medicine and Vascular Medicine, Lyon Sud Hospital, and Lyon Immunopathology Federation (LIFe), Hospices Civils de Lyon, Lyon, France
- UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Claude Bernard University Lyon 1, Lyon, France
| | - Mouhamad Nasser
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Member of ERN-LUNG, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pascal Seve
- Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard University Lyon 1, Lyon, France
| | - Ségolène Turquier
- Pulmonary Function Tests Department, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | - Gilles Devouassoux
- Department of Respiratory Medicine, CIERA, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- CRISALIS INSERM, F-CRIN Network, Toulouse, France
- VirPath, INSERM U1111-CNRS UMR 5308-ENS de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Vincent Cottin
- Department of Respiratory Medicine, National Reference Centre for Rare Pulmonary Diseases, Member of ERN-LUNG, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
- UMR 754, INRAE, Claude Bernard University Lyon 1, Lyon, France
| |
Collapse
|
3
|
Diesler R, Cottin V, Gallien Y, Turquier S, Traclet J, Ahmad K, Glerant JC. Pulmonary function test results are correlated with 6-minute walk distance, distance-saturation product, and 6-minute walk work in patients with lymphangioleiomyomatosis. Respir Med Res 2023; 85:101071. [PMID: 38141576 DOI: 10.1016/j.resmer.2023.101071] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/12/2023] [Accepted: 11/20/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Lymphangioleiomyomatosis (LAM) is a rare multicystic lung disease. Although a correlation between pulmonary function test (PFT) results and exercise capacity appears probable, it has not yet been demonstrated. The aim of this study was to assess whether PFT results correlate with 6-minute walk test (6MWT) results in patients with LAM. METHODS We conducted a retrospective study of all patients with a diagnosis of LAM followed in a French reference centre over a 13-year period. PFT and 6MWT data were collected. Distance-saturation product (DSP) and 6-minute walk work (6MWORK) were calculated. RESULTS A total of 62 patients were included. Their median forced expiratory volume in 1 s (FEV1) was 82.7 % predicted and their median forced vital capacity (FVC) was 96.7 % predicted. The median diffusing capacity of the lungs for carbon monoxide (DLCO) was 58.5 % predicted and was decreased in 79 % of the patients. The median 6-minute walk distance was 535 m, which was 90.9 % of the 602 m predicted distance. The median DSP was 497.4 m % and the median 6MWORK was 32,910 kg.m. The distance walked during the 6MWT was significantly correlated with FVC%predicted (R = 0.435), FEV1 %predicted (R = 0.303), TLC%predicted (R = 0.345), FRC%predicted (R = 0.262), RV/TLC ratio (R = -0.271), and DLCO%predicted (R = 0.279). DSP and 6MWORK were each significantly correlated with different PFT results. CONCLUSION The present study shows that PFT results are potential predictors of the exercise capacity in patients with LAM. Additional studies are required to evaluate the interest of DSP and 6MWORK in LAM.
Collapse
Affiliation(s)
- Rémi Diesler
- National Reference Center for Rare Pulmonary Diseases, Hôpital Louis Pradel Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France.
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Hôpital Louis Pradel Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France
| | - Yves Gallien
- Service de Biostatistique et d'Information Médicale, INSERM U1153, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Université de Paris Cité, Paris, France
| | - Ségolène Turquier
- Service d'Explorations Fonctionnelles Respiratoires, Hôpital Louis Pradel, Hospices Civils de Lyon, University of Lyon, Lyon, France
| | - Julie Traclet
- National Reference Center for Rare Pulmonary Diseases, Hôpital Louis Pradel Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France
| | - Kais Ahmad
- National Reference Center for Rare Pulmonary Diseases, Hôpital Louis Pradel Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France
| | - Jean-Charles Glerant
- Service d'Explorations Fonctionnelles Respiratoires, Hôpital Louis Pradel, Hospices Civils de Lyon, University of Lyon, Lyon, France
| |
Collapse
|
4
|
Louyot C, Portran P, Schweizer R, Glerant JC, Thivolet S, Brassart O, Mewton N, Jacquet-Lagreze M, Fellahi JL. Elaboration of a French version of the Duke Activity Status Index questionnaire and performance to predict functional capacity. Anaesth Crit Care Pain Med 2023; 42:101199. [PMID: 36706990 DOI: 10.1016/j.accpm.2023.101199] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Guidelines recommend detecting poor functional capacity (VO2max < 14 ml.kg-1.min-1) to assess preoperative cardiac risk. This screening is performed via a cardiopulmonary exercise test (CPET), the self-reported inability to climb two flights of stairs, or the use of the Duke Activity Status Index (DASI) questionnaire, which has shown a significant correlation with VO2max and postoperative outcomes. The objectives of the present study were: 1) to create a French version of the DASI questionnaire (FDASI); 2) to assess its diagnostic performance in predicting functional capacity. METHODS Consecutive adult patients undergoing CPET for medical or preoperative evaluation were prospectively included between May 2020 and March 2021. All patients were asked to complete FDASI as a self-questionnaire and report their inability to climb two flights of stairs. RESULTS 122 patients were included. Test-retest reliability was 0.88 and 23 (19%) patients experienced a VO2max < 14 ml.kg-1.min-1. There was a significant positive relationship between FDASI and VO2max: r2 = 0.32; p < 0.001. ROCAUC was 0.81 [95%CI: 0.73-0.89]. The best FDASI score threshold was 36 points, leading to sensitivity and specificity values of 87% [74-100] and 68% [56-79], respectively. Besides, sensitivity and specificity were 35% [17-56] and 92% [86-97] for the self-reported inability to climb two flights of stairs. CONCLUSION A FDASI score of 36 represents a reliable threshold the clinicians could routinely use to identify patients with a VO2max < 14 ml.kg-1.min-1. FDASI could advantageously replace the self-reported inability to climb two flights of stairs.
Collapse
Affiliation(s)
- Claire Louyot
- Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France.
| | - Philippe Portran
- Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France.
| | - Rémi Schweizer
- Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
| | - Jean-Charles Glerant
- Service d'Explorations Fonctionnelles Respiratoires, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
| | - Sophie Thivolet
- Service d'Explorations Fonctionnelles Cardiovasculaires, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
| | - Océane Brassart
- Direction de la Recherche Clinique et de l'Innovation, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France
| | - Nathan Mewton
- Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, France
| | - Matthias Jacquet-Lagreze
- Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France; Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, France
| | - Jean-Luc Fellahi
- Service d'Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, 28 Avenue du Doyen Lépine, 69677 Bron Cedex, France; Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, France
| |
Collapse
|
5
|
Aussedat PH, Chebib N, Ahmad K, Glerant JC, Drevet G, Grima R, Maury JM, Nasser M, Thivolet-Bejui F, Traclet J, Turquier S, Chalabreysse L, Tronc F, Cottin V. Impact of Lung Biopsy on Lung Function in Idiopathic Pulmonary Fibrosis. Respiration 2020; 99:1101-1108. [PMID: 33260187 DOI: 10.1159/000509557] [Citation(s) in RCA: 2] [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: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Video-assisted surgical lung biopsy (SLB) is performed in 10-30% of cases to establish the diagnosis of idiopathic pulmonary fibrosis (IPF). OBJECTIVES The aim of the study was to analyze the impact of SLB on lung function in patients eventually diagnosed with IPF. METHODS This is an observational, retrospective, monocentric study of all consecutive patients eventually diagnosed with IPF in multidisciplinary discussion who underwent SLB over 10 years in a specialized center. The primary end point was the variation in forced vital capacity (FVC) before and after the SLB. The secondary end points were the variations in forced expiratory volume in one second (FEV1), total lung capacity (TLC), carbon monoxide diffusion capacity (DLCO), and morbidity and mortality associated with the SLB. RESULTS In 118 patients who underwent SLB and were diagnosed with IPF, a relative decrease in FVC of 4.8% (p < 0.001) was found between measurements performed before and after the procedure. The mean FVC decrease was 156 ± 386 mL in an average period of 185 days, representing an annualized decline of 363 ± 764 mL/year. A significant decrease was also observed after SLB in FEV1, TLC, and DLCO. Complications within 30 days of SLB occurred in 14.4% of patients. Two patients (1.7%) died within 30 days, where one of them had poor lung function. Survival at 1 year was significantly poorer in patients with FVC <50% at baseline. CONCLUSION In this uncontrolled study in patients ultimately diagnosed with IPF, SLB was followed by a significant decline in FVC, which appears to be numerically greater than the average decline in the absence of treatment in the literature. Summary at a Glance: This study evaluated the change in lung function in 118 consecutive patients diagnosed with idiopathic pulmonary fibrosis by surgical lung biopsy. Forced vital capacity decreased by 156 ± 386 mL in a mean of 185 days between the last measurement before and first measurement after biopsy, representing an annualized decline of 363 ± 764 mL/year.
Collapse
Affiliation(s)
- Pierre-Henri Aussedat
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, Groupement Hospitalier Est, Hospices civils de Lyon, UMR 754, INRAE, Université Claude Bernard Lyon 1, Lyon, France
| | - Nader Chebib
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, Groupement Hospitalier Est, Hospices civils de Lyon, UMR 754, INRAE, Université Claude Bernard Lyon 1, Lyon, France
| | - Kais Ahmad
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, Groupement Hospitalier Est, Hospices civils de Lyon, UMR 754, INRAE, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Gabrielle Drevet
- Service de chirurgie thoracique, transplantation pulmonaire et cardio-pulmonaire, Groupement Hospitalier Est, Lyon, France
| | - Renaud Grima
- Service de chirurgie thoracique, transplantation pulmonaire et cardio-pulmonaire, Groupement Hospitalier Est, Lyon, France
| | - Jean-Michel Maury
- Service de chirurgie thoracique, transplantation pulmonaire et cardio-pulmonaire, Groupement Hospitalier Est, Lyon, France
| | - Mouhamad Nasser
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, Groupement Hospitalier Est, Hospices civils de Lyon, UMR 754, INRAE, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Julie Traclet
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, Groupement Hospitalier Est, Hospices civils de Lyon, UMR 754, INRAE, Université Claude Bernard Lyon 1, Lyon, France
| | | | | | - François Tronc
- Service de chirurgie thoracique, transplantation pulmonaire et cardio-pulmonaire, Groupement Hospitalier Est, Lyon, France
| | - Vincent Cottin
- Service de pneumologie, Centre national coordinateur de référence des maladies pulmonaires rares, Groupement Hospitalier Est, Hospices civils de Lyon, UMR 754, INRAE, Université Claude Bernard Lyon 1, Lyon, France,
| |
Collapse
|
6
|
Ginoux M, Turquier S, Chebib N, Glerant JC, Traclet J, Philit F, Sénéchal A, Mornex JF, Cottin V. Impact of comorbidities and delay in diagnosis in elderly patients with pulmonary hypertension. ERJ Open Res 2018; 4:00100-2018. [PMID: 30510957 PMCID: PMC6258090 DOI: 10.1183/23120541.00100-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 06/29/2018] [Accepted: 09/12/2018] [Indexed: 11/05/2022] Open
Abstract
Patient age at diagnosis of pulmonary hypertension is steadily increasing. The present study sought to analyse clinical characteristics, time to diagnosis and prognosis of pulmonary hypertension in elderly and very elderly patients. A study was conducted in a French regional referral centre for pulmonary hypertension. All consecutive patients diagnosed with pre-capillary pulmonary hypertension were included and categorised according to age: <65 years (“young”), 65–74 years (“elderly”) and ≥75 years (“very elderly”). Over a 4-year period, 248 patients were included: 101 (40.7%) were young, 82 (33.1%) were elderly and 65 (26.2%) were very elderly. The median age at diagnosis among the total population was 68 years. Compared with young patients, elderly and very elderly patients had a longer time to diagnosis (7±48, 9±21 and 16±32 months, respectively; p<0.001). Patients ≥75 years also more often had group 4 pulmonary hypertension. The median overall survival was 46±1.4 months, but was only 37±4.9 months in elderly patients and 28±4.7 months in very elderly patients. Survival from the first symptoms and survival adjusted to comorbidity was similar across age groups. Patient age should be taken into account when diagnosing pulmonary hypertension as it is associated with a specific clinical profile and a worse prognosis. The difference in prognosis is likely to be related to a delay in diagnosis and a greater number of comorbidities. More than a quarter of patients diagnosed with pre-capillary pulmonary hypertension are older than 75 years; they have a poorer prognosis, likely related to a longer delay in diagnosis and a higher burden of comorbiditieshttp://ow.ly/87FQ30m0WM7
Collapse
Affiliation(s)
- Marylise Ginoux
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Ségolène Turquier
- Dept of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Nader Chebib
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Jean-Charles Glerant
- Dept of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Julie Traclet
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - François Philit
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Agathe Sénéchal
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Jean-François Mornex
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France.,Université Lyon I, INRA, UMR754, Lyon, France
| | - Vincent Cottin
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France.,Université Lyon I, INRA, UMR754, Lyon, France
| |
Collapse
|
7
|
Kiakouama L, Cottin V, Glerant JC, Bayle JY, Mornex JF, Cordier JF. Conditions associated with severe carbon monoxide diffusion coefficient reduction. Respir Med 2011; 105:1248-56. [DOI: 10.1016/j.rmed.2011.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 03/01/2011] [Accepted: 03/04/2011] [Indexed: 11/28/2022]
|
8
|
Glerant JC, Rose D, Oltean V, Dayen C, Mayeux I, Jounieaux V. Noninvasive Ventilation Using a Mouthpiece in Patients with Chronic Obstructive Pulmonary Disease and Acute Respiratory Failure. Respiration 2007; 74:632-9. [PMID: 17622735 DOI: 10.1159/000105163] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 04/02/2007] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Noninvasive positive pressure ventilation (NPPV) delivered via a mouthpiece (mNPPV) has been successfully used in stable chronic restrictive respiratory insufficiency, but not in patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure (ARF). OBJECTIVES The purpose of this matched case-control study was to compare the usefulness of mNPPV to noninvasive ventilation using a nasal or oronasal mask (nNPPV) or standard medical treatment (SMT) in COPD patients with ARF. METHODS Twenty-nine patients receiving mNPPV were matched with 29 patients receiving nNPPV and 29 patients receiving SMT regarding age, SAPSII, admission PaCO(2) and pH. RESULTS In the mNPPV group, admission PaCO(2) and pH were 78.6 +/- 12 mm Hg and 7.30 +/- 0.04, respectively. mNPPV and nNPPV avoided the need for endotracheal intubation in 27 and 25 patients, respectively (nonsignificant) whereas SMT resulted in a higher mechanical ventilation rate (13 patients). At the end of the treatment protocol, PaCO(2) was lower in the mNPPV group (62.2 +/- 9.6 mm Hg) than in the SMT group (72.4 +/- 20.4 mm Hg, p < 0.018) leading to a significantly higher pH. No significant differences were observed between the mNPPV and nNPPV groups. CONCLUSIONS In case of moderate respiratory acidosis, noninvasive ventilation using a mouthpiece significantly reduces the endotracheal intubation rate in comparison with SMT and therefore appears to be a second-line alternative to noninvasive ventilation delivered via a mask, especially when poorly tolerated.
Collapse
Affiliation(s)
- J C Glerant
- Service de Pneumologie et Réanimation Respiratoire, Centre Hospitalier Universitaire SUD, Amiens, France
| | | | | | | | | | | |
Collapse
|
9
|
Glerant JC, Mustfa N, Man WD, Luo YM, Rafferty G, Polkey MI, Moxham J. Diaphragm electromyograms recorded from multiple surface electrodes following magnetic stimulation. Eur Respir J 2006; 27:334-42. [PMID: 16452589 DOI: 10.1183/09031936.06.00029005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The diaphragm compound-muscle action potential (CMAPdi), elicited by unilateral magnetic stimulation (UMS) of the phrenic nerve can be recorded using surface electrodes. However, there is no consensus on the best positioning of surface electrodes and there are no data on the reproducibility of the signal. Using 36 surface electrode pairs, in five healthy subjects, the CMAPdi elicited by UMS and electrical stimulation (ES) were compared and 12 pairs were identified as providing acceptable signals. The latency and amplitude were measured for each CMAPdi, following UMS at 60-100% of maximal stimulator output, in 12 healthy subjects, on two occasions. Latencies obtained using UMS and ES ranged between 6.1-7.33 and 6.25-7.17 ms, respectively. Optimum CMAPdi were not recorded from the same electrode pair in all subjects, or for both hemidiaphragms in each subject. However, the optimal recording site for a particular individual remained unchanged on subsequent testing. When recorded from the optimal site, latencies and amplitudes of CMAPdi elicited on the two occasions were not significantly different. The current study suggests that the use of multiple chest wall electrodes can identify an optimal electrode pair, from which it is possible to obtain reproducible compound-muscle action potential signals.
Collapse
Affiliation(s)
- J C Glerant
- Respiratory Muscle Laboratory, King's College London School of Medicine, King's College Hospital, London, UK
| | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
Twitch transdiaphragmatic pressure (Pdi,tw), measured following magnetic stimulation of the phrenic nerves, is used to assess diaphragm strength, contractility and fatigue. Although the effects of posture, lung volume and potentiation on Pdi,tw are well described, it is not known whether the degree of gastric filling affects the measurement. Pdi,tw was recorded in seven healthy volunteers on two occasions with antero-lateral magnetic stimulation of the phrenic nerves. On the first occasion, the subjects had fasted for at least 8 h, whilst on the second occasion, measurements were made after each subject had eaten a substantial meal sufficient to produce a feeling of satiation. Mean postprandial unpotentiated and potentiated Pdi,tw were significantly greater than corresponding fasting Pdi,tw in all seven volunteers (29.8 versus 25.7 cmH2O and 38.9 versus 34.4 cmH2O, respectively). This was due to a significantly increased gastric pressure component (1.10 versus 0.84 and 0.94 versus 0.78, respectively), and reduced abdominal compliance (36 versus 62 mL x cmH2O(-1)). Twitch oesophageal pressure was preserved (15.0 versus 15.4 cmH2O). The postprandial state increases twitch transdiaphragmatic pressure, and this should be taken into account when using twitch transdiaphragmatic pressure to follow-up patients or to assess the effects of interventions on diaphragm contractility.
Collapse
Affiliation(s)
- W D C Man
- Dept of Respiratory Medicine and Allergy, Guy's, King's and St Thomas' School of Medicine, London, UK.
| | | | | | | | | | | | | |
Collapse
|
11
|
Mispelaere D, Glerant JC, Audebert M, Remond A, Sevestre-Pietri MA, Jounieaux V. [Pulmonary embolism and sibilant types of chronic obstructive pulmonary disease decompensations]. Rev Mal Respir 2002; 19:415-23. [PMID: 12417857] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Pulmonary Embolism (PE) poses an important diagnostic problem in patients with chronic obstructive pulmonary disease (COPD). Indeed PE may aggravate the already precarious respiratory state of these fragile patients. Moreover, these two conditions share common symptoms: dyspnoea, wheezing, pleural pain, haemoptysis, palpitations and signs of right cardiac insufficiency. In two studies, one retrospective and the other prospective, we investigated the incidence of PE in patients with non-infective exacerbations of their COPD. The retrospective study was carried out over two years and involved 50 COPD patients with non-infective respiratory exacerbations. In this population, 10 patients out of 50 (20%) had a documented PE. No predictive factor was identified. The prospective study was conducted over one year and COPD patients admitted to hospital with exacerbations were included in the study if they had a positive D-dimer blood test and no evidence of acute respiratory infection. 31 patients were studied with Doppler ultra-sound examination of the legs and a lung perfusion scan. The presence or absence of PE was determined and the two groups were compared. 9 patients out of 31 (29%) had a documented PE. Six of these nine patients had a deep venous thrombosis (DVT). Two predictive factors of PE were identified: existence of a DVT and a significant fall in PaO(2) from baseline state (DeltaPaO(2) > 22 mmHg). We conclude that PE is a frequent (20 to 30%) of non-infective respiratory decompensation in COPD patients. Faced with an unexplained respiratory exacerbation in these patients, a lung perfusion scan should be routinely undertaken to rule out a PE when the D-dimers are positive.
Collapse
Affiliation(s)
- D Mispelaere
- Service de Pneumologie et Unité de Réanimation Respiratoire, Groupe Hospitalier Universitaire Sud, 80054 Amiens Cedex 1, France
| | | | | | | | | | | |
Collapse
|
12
|
Dayen C, Mishellany H, Hellmuth D, Mayeux I, Aubry P, Glerant JC, Auquier MA, Reix T, Abet D, Jounieaux V. [Spontaneous rupture of the esophagus or Boerhaave syndrome. Report of 3 cases and review of the literature]. Rev Mal Respir 2001; 18:537-40. [PMID: 11887772] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
A triad of signs constitutes Boerhaave syndrome: forceful vomiting, chest pain and subcutaneous emphysema. The syndrome results from spontaneous rupture of the oesophageal wall leading to an oeso-pleural or oeso-mediastinal fistula. Positive diagnosis is established with a water-soluble swallow, sometimes coupled with computed tomography of the thorax. Boerhaave syndrome is a surgical emergency. We report three cases of spontaneous rupture of the oesophagus and analyze the importance of emergency surgery as well as emergency treatment of the sepsis, an important prognosis factor.
Collapse
Affiliation(s)
- C Dayen
- Service de Pneumologie, Unité de Réanimation Respiratoire, Centre Hospitalier Universitaire Sud, Amiens
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Glerant JC, Hellmuth D, Schmit JL, Ducroix JP, Jounieaux V. Utility of blood cultures in community-acquired pneumonia requiring hospitalization: influence of antibiotic treatment before admission. Respir Med 1999; 93:208-12. [PMID: 10464880 DOI: 10.1016/s0954-6111(99)90010-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
It has been previously shown that antibiotics given before hospitalization significantly reduce the proportion of positive blood cultures in community-acquired pneumonia (CAP). The aim of this prospective study was to compare the utility and cost-benefits of blood cultures in patients, hospitalized for moderate CAP, who had or had not received antibiotic therapy prior to admission. During 1 year, 53 patients were included and separated into two groups: group 1 patients had not received antibiotic treatment prior to admission (n = 30), whereas group 2 patients had been treated with antibiotics (n = 23). Within the first 48 hours, a set of blood cultures was collected if the body temperature was higher than 38.5 degrees C or in the case of shaking chills. A total of 136 blood cultures was collected; 74 in group 1 and 62 in group 2. Bacteraemia was significantly more frequent in group 1 than in group 2, 5/30 patients vs. 0/23, respectively (P < 0.05). The cost of negative blood cultures was valued at 13,939.2 FF in group 1 and 13,164.8 FF in group 2, respectively 464.6 +/- 244.3 FF and 569.3 +/- 233.4 FF per patient (n.s.). Moreover, blood cultures were the method of diagnosis in only one of the five patients with bacteraemia and in no case did a positive blood-culture result influence the initial therapeutic regime. Thus, our results suggest a reduced clinical utility and cost-benefit of blood cultures in patients hospitalized for moderate CAP who have received an antibiotic treatment prior to admission.
Collapse
Affiliation(s)
- J C Glerant
- Pneumology and Intensive Care Unit, Centre Hospitalier Universitaire Sud, Amiens, France
| | | | | | | | | |
Collapse
|
14
|
Affiliation(s)
- D Hellmuth
- Pulmonary Division, Centre Hospitalier Universitaire Sud, Amiens, France
| | | | | | | | | |
Collapse
|
15
|
Martinez P, Glerant JC, Aubry P, Jounieaux V. [Unusual radiological symmetry]. Rev Mal Respir 1997; 14:229-31. [PMID: 9411603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
16
|
Leleu O, Glerant JC, Coche G, du Couedic L, Remond A, Jounieaux V. [Intense and rapidly progressive dyspnea]. Rev Mal Respir 1997; 14:151-3. [PMID: 9198841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- O Leleu
- Service de Pneumologie, CHU, Hôpital Sud, Amiens
| | | | | | | | | | | |
Collapse
|
17
|
Grimault E, Glerant JC, Aubry P, Laurans G, Poinsot JP, Jounieaux V. [Uncommon site of Bergeyella zoohelcum. Apropos of a case]. Rev Pneumol Clin 1996; 52:387-389. [PMID: 9033932] [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] [Indexed: 05/22/2023]
Abstract
Bergeyella zoohelcum is a Gram negative bacillus which can be found in several pathological localizations in man: leg abscesses, septicemia, meningitis. We observed a case of community-acquired pneumonia caused by Bergeyella zoohelcum. On history taking it was found that the patient was exposed to a dog which may have been the carrier of the Gram negative bacilli. The clinical course was long, one year, with persistent excavation.
Collapse
Affiliation(s)
- E Grimault
- Hôpital Sud d'Amiens, Service de Pneumologie, Amiens
| | | | | | | | | | | |
Collapse
|
18
|
Leduc I, Glerant JC, Ducroix JP, Ossart M, Jounieaux V, Eb F, Orfila J, Baillet J. Pneumopathies communautaires mixtes sévères associant Chlamydia pneumoniae et pneumocoques (deux cas) et Chlamydia pneumoniae et légionnelle (un cas). Rev Med Interne 1995. [DOI: 10.1016/0248-8663(96)86615-x] [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: 10/17/2022]
|