1
|
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:S0761-8425(24)00174-8. [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] [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.
Collapse
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.
| |
Collapse
|
2
|
Jestin-Guyon N, Raherison-Semjen C. [Pesticide exposure and chronic respiratory diseases]. Rev Mal Respir 2024:S0761-8425(24)00170-0. [PMID: 38594123 DOI: 10.1016/j.rmr.2024.03.004] [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: 10/26/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Pesticides are used worldwide, mainly in agriculture as a means of controlling pests and protecting crops. That said, the entire world population is ultimately subject to pesticide exposure (consumption of fruits and vegetables, living near treated fields…), with varying degrees of toxicity involved. STATE OF THE ART In recent decades, epidemiological studies have contributed to the identification of chemical pesticide families with detrimental effects on human health: cognitive disorders, Parkinson's disease, prostate cancer… and impairment in respiratory functioning. Current scientific evidence points to the implication of the active substances in insecticides, herbicides and fungicides in chronic respiratory diseases, two examples being chronic obstructive pulmonary disease (COPD) in exposed workers, and asthmatic wheezing in children during prenatal or postnatal exposure. PERSPECTIVES The safety of individuals exposed to pesticides is of key importance in public health. Further epidemiological investigations are needed to identify the chemical families affecting certain populations. CONCLUSIONS The scientific literature suggests strong links between pesticide exposure and respiratory health. Whether it be environmental or occupational, pesticide exposure can lead to respiratory disorders and symptoms of varying severity.
Collapse
Affiliation(s)
- N Jestin-Guyon
- UMR1219 Bordeaux Population Health Centre de Recherche, ISPED, université de Bordeaux, 146, rue Léo-Saignat, 33000 Bordeaux, France.
| | - C Raherison-Semjen
- UMR1219 Bordeaux Population Health Centre de Recherche, ISPED, université de Bordeaux, 146, rue Léo-Saignat, 33000 Bordeaux, France; Centre hospitalier universitaire de la Guadeloupe, 97159 Pointe-à-Pitre, Guadeloupe
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Balland MH, Sizaret O, Fraih E. [Hindrances to the prescription of respiratory rehabilitation in general medicine]. Rev Mal Respir 2022:S0761-8425(22)00207-8. [PMID: 35725676 DOI: 10.1016/j.rmr.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 05/04/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Respiratory rehabilitation (RR) is a global and interdisciplinary approach designed to improve quality of life of patients with chronic obstructive pulmonary disease (COPD). In France, however it is prescribed in only 10 % of eligible cases. The aim of this study was to find out why general practitioners so seldom include RR in their patient care. METHODS Semi-structured and individual interviews were conducted between April and July 2018 with general practitioners working in the Upper-Rhine region (France). Verbatims were coded using inductive thematic analysis. RESULTS Fifteen interviews were conducted. Lack of expert knowledge, available time, and adequate means emerged as the main reasons for not including RR in patient care. General practitioners also described complicated emotional relationships with COPD patients, and admitted to an occasional sense of fatalism or powerlessness. At times they projected these feelings onto their patients, perceiving them as devoid of motivation or compliance. CONCLUSIONS Negative perceptions of patients and their disease represent an obstacle to optimal COPD management, especially when referring them to RR. Improved medical expertise and comprehension of patients' coping mechanisms would enable general practitioners to better adapt their management, of which motivational interviewing could become a key component.
Collapse
|
5
|
Hedhli A, Slim A, Mjid M, Ouachi Y, Kacem M, Cheikh Rouhou S, Merai S, Toujani S, Dhahri B. [Nutritional status and dietary intake in patients with chonic obstructive pulmonary disease]. Rev Mal Respir 2021; 38:689-697. [PMID: 34092448 DOI: 10.1016/j.rmr.2021.04.017] [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: 01/10/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Undernutrition is a predictor of mortality in chronic obstructive pulmonary disease (COPD). The objectives of our study were to assess nutritional intake in COPD and to study its relationship with disease severity. METHODS A cross-sectional study that included 66 patients followed for COPD. Patients included had a body composition study and a respiratory and nutritional assessment. RESULTS The mean age of the population was 66±9 years. The lean body mass index (LMI) was reduced in 26.1% of patients. It was significantly associated with the GOLD group (P=0.04) and significantly correlated with the forced expiratory volume in the first second (FEV1) (P=0.02) and the distance covered during the six-minute walk test (TM6) (P=0.01). A significant difference was found between the caloric intakes and the different GOLD groups (P=0.04). Mean intakes of calories (P=0.002; r=0.07), protein (P=0.01; r=0.16), carbohydrates (P=0.02; r=0.2) and iron (P=0.01; r=0.13) were significantly correlated with the TM6 results. Caloric intake was significantly correlated with LMI (P=0.01; r=0.16), body mass index (P=0.04; r=0.12), FEV1 (P=0.04; r=-0.12) and GOLD stage (0.002). Similarly, protein intake was significantly correlated with LMI (P=0.001; r=0.11), body mass index (P=0.02; r=0.16), FEV1(%) (P=0.001; r=-0.16) and GOLD stage (P=0.002). CONCLUSION Undernutrition in COPD is caused by decreased food intake and increased resting energy expenditure. Adequate intakes of glucose, protein, fibers, vitamins and zinc are associated with improved ventilatory function.
Collapse
Affiliation(s)
- A Hedhli
- Service de pneumologie, faculté de médecine de Tunis, université Tunis El Manar, CHU la Rabta, rue Jbel Lakhdar La Rabta, LR18SP02, 1007 Tunis, Tunisie
| | - A Slim
- Service de pneumologie, faculté de médecine de Tunis, université Tunis El Manar, CHU la Rabta, rue Jbel Lakhdar La Rabta, LR18SP02, 1007 Tunis, Tunisie.
| | - M Mjid
- Service de pneumologie, faculté de médecine de Tunis, université Tunis El Manar, CHU la Rabta, rue Jbel Lakhdar La Rabta, LR18SP02, 1007 Tunis, Tunisie
| | - Y Ouachi
- Service de pneumologie, faculté de médecine de Tunis, université Tunis El Manar, CHU la Rabta, rue Jbel Lakhdar La Rabta, LR18SP02, 1007 Tunis, Tunisie
| | - M Kacem
- Service de pneumologie, faculté de médecine de Tunis, université Tunis El Manar, CHU la Rabta, rue Jbel Lakhdar La Rabta, LR18SP02, 1007 Tunis, Tunisie
| | - S Cheikh Rouhou
- Service de pneumologie, faculté de médecine de Tunis, université Tunis El Manar, CHU la Rabta, rue Jbel Lakhdar La Rabta, LR18SP02, 1007 Tunis, Tunisie
| | - S Merai
- Service de pneumologie, faculté de médecine de Tunis, université Tunis El Manar, CHU la Rabta, rue Jbel Lakhdar La Rabta, LR18SP02, 1007 Tunis, Tunisie
| | - S Toujani
- Service de pneumologie, faculté de médecine de Tunis, université Tunis El Manar, CHU la Rabta, rue Jbel Lakhdar La Rabta, LR18SP02, 1007 Tunis, Tunisie
| | - B Dhahri
- Service de pneumologie, faculté de médecine de Tunis, université Tunis El Manar, CHU la Rabta, rue Jbel Lakhdar La Rabta, LR18SP02, 1007 Tunis, Tunisie
| |
Collapse
|
6
|
Zapata-Foch E, Canuet M, Enache I, Pistea C, Remetter R, Charloux A. [Variation in ventilatory response to CO 2 in patients treated by non-invasive ventilation]. Rev Mal Respir 2021; 38:3-12. [PMID: 33246772 DOI: 10.1016/j.rmr.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 09/26/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION There are many mechanisms for improving the clinical and blood gas status of patients with the obesity hypoventilation syndrome (OHS) or chronic obstructive pulmonary disease (COPD) by non-invasive ventilation (NIV) at home. Our objective was to set up a pilot study to evaluate the potential modification of the sensitivity of the respiratory centers to CO2 by NIV in paired new COPD and OHS patients. METHODS We assessed the sensitivity of the respiratory centers to CO2 by the Read method in 3 COPD patients and 3 OHS patients newly treated by NIV and again 3 months later. We compared their results to those of 6 control subjects. RESULTS All the patients included had altered ventilatory responses to CO2 with slopes of less of than 1 L.min-1.mmHg-1. Mean coefficients of variation were significantly higher in patients than in healthy subjects (P=0.007). Patients who improved their CO2 sensitivity slope were those most observant of NIV. CONCLUSION This work showed significant changes in the ventilatory response to hypercapnia in patients with either OHS or COPD after NIV therapy. The significance of these changes deserves to be studied.
Collapse
|
7
|
Slim A, Hedhli A, Ouahchi Y, Toujani S, Cheikh Rouhou S, Hadj Taeib S, Mjid M, Merai S, Feki M. [Testosterone and chronic obstructive pulmonary disease]. Rev Mal Respir 2020; 37:790-799. [PMID: 33067077 DOI: 10.1016/j.rmr.2020.08.013] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Testosterone level has been shown to be associated with respiratory function and loss of lean body mass in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess the relationship between testosterone level and functional respiratory parameters during COPD. METHODS We conducted a cross-sectional study that included 95 male patients with stable COPD. Functional tests (body plethysmography, six-minute walk test (6MWT), arterial blood gas) were performed in all patients and serum levels of testosterone, prolactin, FSH, LH and C-reactive protein were determined. Lean body mass was measured using bioelectric impedance. RESULTS The average age was 63.78±8.90years. COPD was classified as stage 3 in 38% of cases and stage 4 in 11% of cases, group C in 10% of cases and group D in 18% of cases. The average testosterone was 20.87±8.60nmol/L. A significant positive correlation was found between FEV1 (P=0.005), FVC (P=0.005), FEV1/FVC ratio (P=0.001), lean mass index (P=0.021), and testosterone. However, testosterone was not correlated with 6MWT or blood gas parameters. Similarly, it was not correlated with FSH, LH, prolactin and C-reactive protein. CONCLUSION This study found that serum testosterone level was associated with lung function and lean mass during COPD. Further investigations are required to better evaluate the relationship between COPD and serum testosterone levels and the effect of androgen substitution in lung function.
Collapse
Affiliation(s)
- A Slim
- Service de pneumologie CHU la Rabta, faculté de médecine de Tunis, université Tunis El Manar, LR18SP02, code postal : 1007, rue Jbel Lakhdar, La Rabta Jebbari, Tunis, Tunisie.
| | - A Hedhli
- Service de pneumologie CHU la Rabta, faculté de médecine de Tunis, université Tunis El Manar, LR18SP02, code postal : 1007, rue Jbel Lakhdar, La Rabta Jebbari, Tunis, Tunisie
| | - Y Ouahchi
- Service de pneumologie CHU la Rabta, faculté de médecine de Tunis, université Tunis El Manar, LR18SP02, code postal : 1007, rue Jbel Lakhdar, La Rabta Jebbari, Tunis, Tunisie
| | - S Toujani
- Service de pneumologie CHU la Rabta, faculté de médecine de Tunis, université Tunis El Manar, LR18SP02, code postal : 1007, rue Jbel Lakhdar, La Rabta Jebbari, Tunis, Tunisie
| | - S Cheikh Rouhou
- Service de pneumologie CHU la Rabta, faculté de médecine de Tunis, université Tunis El Manar, LR18SP02, code postal : 1007, rue Jbel Lakhdar, La Rabta Jebbari, Tunis, Tunisie
| | - S Hadj Taeib
- Service de pneumologie CHU la Rabta, faculté de médecine de Tunis, université Tunis El Manar, LR18SP02, code postal : 1007, rue Jbel Lakhdar, La Rabta Jebbari, Tunis, Tunisie
| | - M Mjid
- Service de pneumologie CHU la Rabta, faculté de médecine de Tunis, université Tunis El Manar, LR18SP02, code postal : 1007, rue Jbel Lakhdar, La Rabta Jebbari, Tunis, Tunisie
| | - S Merai
- Service de pneumologie CHU la Rabta, faculté de médecine de Tunis, université Tunis El Manar, LR18SP02, code postal : 1007, rue Jbel Lakhdar, La Rabta Jebbari, Tunis, Tunisie
| | - M Feki
- Service de pneumologie CHU la Rabta, faculté de médecine de Tunis, université Tunis El Manar, LR18SP02, code postal : 1007, rue Jbel Lakhdar, La Rabta Jebbari, Tunis, Tunisie
| |
Collapse
|
8
|
Chapuis Cellier C, Narjoz C, Zerimech F, Odou MF, Joly P, Lombard C, Mornex JF, Balduyck M. [Screening for alpha1-antitrypsin deficiency using dried blood spot: Assessment of the first 20 months]. Rev Mal Respir 2020; 37:633-43. [PMID: 32859429 DOI: 10.1016/j.rmr.2020.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/17/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Alpha1-antitrypsin deficiency is a predisposing factor for pulmonary disease and under-diagnosis is a significant problem. The results of a targeted screening in patients with respiratory symptoms possibly indicative of severe deficiency are reported here. METHODS Data were collected from March 2016 to October 2017 on patients who had a capillary blood sample collected during a consultation with a pulmonologist and sent to the laboratory for processing to determine alpha1-antitrypsin concentration, phenotype and possibly genotype. RESULTS In 20 months, 3728 test kits were requested by 566 pulmonologists and 718 (19 %) specimens sent: among these, 708 were analyzable and 613 were accompanied by clinical information. Of the 708 samples, 70 % had no phenotype associated with quantitative alpha1- antitrypsin deficiency, 7 % had a phenotype associated with a severe deficiency and 23 % had a phenotype associated with an intermediate deficiency. One hundred and eight patients carried at least one PI*Z allele which is considered to be a risk factor for liver disease. CONCLUSIONS The results of this targeted screening program for alpha1- antitrypsin deficiency using a dried capillary blood sample reflect improvement in early diagnosis of this deficiency in lung disease with good adherence of the pulmonologists to this awareness campaign.
Collapse
|
9
|
Lorenzo M, Delpeyroux S, Dupre V. [Pack-years threshold and HAS self-questionnaire for COPD early diagnosis]. Rev Mal Respir 2020; 37:624-632. [PMID: 32675005 DOI: 10.1016/j.rmr.2020.06.011] [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: 05/02/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The Haute Autorité de santé (HAS) in France offers a patient self-questionnaire to optimize targeted chronic obstructive pulmonary disease (COPD) screening among at-risk patients in primary care. It includes smoking but does not have a threshold for pack-years (PY) smoked. The objective of this study was to compare the positive predictive values (PPV) of the HAS self-questionnaire alone and with the addition of a PY threshold. METHODS This was a prospective pilot study conducted in a multi-professional health centre. Identification among smoking or former smoking patients without a COPD diagnosis of subjects with a positive HAS self-questionnaire, a positive PY threshold, or both. We performed spirometry after bronchodilatation. RESULTS Thirty-five people were included in the study. All 35 had a positive PY threshold. The HAS questionnaire was positive for 22 of them (62.9%). Spirometry diagnosed 18 participants with COPD (51%). The PPV for the HAS questionnaire was 0.41 and the PPV for the HAS+PY questionnaire was 0.51. There was no statistically significant difference between these two PPVs (P=0.3692). CONCLUSIONS The addition of a PY threshold to the HAS self-questionnaire may allow better targeting of the population at risk of developing COPD.
Collapse
Affiliation(s)
- M Lorenzo
- Département de médecine générale, UFR de médecine, université de Strasbourg, Strasbourg, France; Maison de santé pluriprofessionnelle Guillaume Tell, 2, place Guillaume-Tell, 68100 Mulhouse, France.
| | - S Delpeyroux
- Département de médecine générale, UFR de médecine, université de Strasbourg, Strasbourg, France
| | - V Dupre
- Département de médecine générale, UFR de médecine, université de Strasbourg, Strasbourg, France; Maison de santé pluriprofessionnelle Guillaume Tell, 2, place Guillaume-Tell, 68100 Mulhouse, France
| |
Collapse
|
10
|
Fieldès M, Ahmed E, Bourguignon C, Mianné J, Vernisse C, Fort A, Vachier I, Bourdin A, Assou S, De Vos J. [Modelling the bronchial epithelium in chronic obstructive pulmonary disease using human induced pluripotential stem cells]. Rev Mal Respir 2020; 37:197-200. [PMID: 32146059 DOI: 10.1016/j.rmr.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/12/2020] [Indexed: 11/24/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic lung disease leading to irreversible destruction of the terminal bronchioles. Although the precise patho-physiological mechanisms remain to be elucidated, the bronchial epithelium seems to play a pivotal role in the disease. Recent studies have highlighted a great heterogeneity among COPD patients, with various disease courses including, in about half the cases, an origin in childhood. Modelling of COPD is a major goal but currently available models are imperfect. Our work aims to create a new in vitro cellular model to study the pathology of the disease. The differentiation of human induced pluripotential stem cells (hiPSCs) in bronchial epithelium is a step towards a better understanding of the developmental origin and the identification of new therapeutic targets.
Collapse
|
11
|
Pennequin N, Léger P, Freymond N, Coullandaye N, Poupon D, Tranchard É, Cuoq O, Pacheco Y. [Feasibility and benefits of training to screen for chronic obstructive pulmonary disease]. Rev Mal Respir 2019; 36:861-869. [PMID: 31279593 DOI: 10.1016/j.rmr.2019.05.041] [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: 02/26/2018] [Accepted: 05/09/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Though still under-diagnosed, chronic obstructive pulmonary disease (COPD) currently affects nearly 3.5 million people in France. The present study presents the results of continuing medical education sessions on COPD screening by electronic mini-spirometry. METHODS From April 2013 to December 2015, the sessions involved 73 health professionals. The study analysed three questionnaires administered before, after, and long after sessions led by experts within a professional associative network. RESULTS The sessions proved efficient in increasing the participants' theoretical knowledge. It increased the percentage of correct answers regarding the nature of COPD (90 % vs. 81%), the functions, features, and outputs of mini-spirometers, and the treatment recommendations. The sessions led to non-negligible changes in everyday medical practice regarding the acquisition of a mini-spirometer (+13 devices), the presentation of COPD to the patients (+33 practitioners), the dialogue on tobacco use (+32 practitioners), vaccination (+33 practitioners), and compliance with the treatment recommendations (+43 practitioners). CONCLUSION These results encourage both holding and following up such sessions. The specialized professional environment ensures knowledge updates and offers subsequent assistance. Further improving these sessions will increase their benefits in terms of diagnosis, treatment, and health economy.
Collapse
Affiliation(s)
- N Pennequin
- Cabinet de médecine générale, 69100 Villeurbanne, France
| | - P Léger
- Réseau de santé SPIRO, 69003 Lyon, France
| | - N Freymond
- Service de pneumologie, centre hospitalier Lyon Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | | | - D Poupon
- Réseau de santé SPIRO, 69003 Lyon, France
| | - É Tranchard
- Laboratoire d'exploration fonctionnelle respiratoire, centre hospitalier Lyon Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | - O Cuoq
- Cabinet de médecine générale, 69100 Villeurbanne, France
| | - Y Pacheco
- Service de pneumologie, centre hospitalier Lyon Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France.
| |
Collapse
|
12
|
Chapron A, Pelé F, Andres É, Fiquet L, Laforest C, Veislinger A, Fougerou C, Turmel V, Fouchard J, Yourish B, Oumari S, Allory E, Banâtre A, Schweyer FX, Pommier J, Brinchault G, Guillot S, Laviolle B, Jouneau S. [Targeted screening of COPD in primary care: Feasibility and effectiveness]. Rev Mal Respir 2019; 36:162-170. [PMID: 30686560 DOI: 10.1016/j.rmr.2018.08.023] [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: 03/01/2018] [Accepted: 08/14/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a common but under-diagnosed pathology in primary care. The objective was to study the feasibility of a randomized controlled trial in general practice to detect new cases of COPD at an earlier stage. METHODS A cluster randomized, controlled, multicenter intervention study comparing, according to a 2×2 factorial plan, two case finding strategies: a systematic GOLD-HAS hetero-questionnaire and coordination of the patient's path to facilitate access to spirometry. The PIL-DISCO pilot study took place in 2017. Patients between 40 and 80 years old, with no previous history of COPD, consulting their GP on a given day regardless of the reason, were included. RESULTS 176 patients were included in 1.5 days. Spirometry was performed in none of the control arm, in 13 (29.5%) of the questionnaire arm, in 22 (50%) in the coordination arm and in 32 (72.7%) with the combination of the two strategies. Two cases of stage 2 COPD and thirteen other respiratory diseases were diagnosed. CONCLUSIONS This study confirms the feasibility of the protocol in primary care in terms of speed of inclusion and acceptability. An extension phase aiming to include 3200 patients will assess the diagnostic value of the two strategies tested in general practice.
Collapse
Affiliation(s)
- A Chapron
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France; Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France; Université Rennes, CNRS, ARENES - UMR 6051, 35000 Rennes, France.
| | - F Pelé
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France; Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France; Irset, institut de recherche en santé, environnement et travail, université Rennes, UMR_S 1085, 35000 Rennes, France
| | - É Andres
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France
| | - L Fiquet
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France; Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - C Laforest
- Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - A Veislinger
- Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - C Fougerou
- Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - V Turmel
- Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - J Fouchard
- Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - B Yourish
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France
| | - S Oumari
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France
| | - E Allory
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France; Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - A Banâtre
- Département de médecine générale, université Rennes, 2, avenue du Pr-Léon-Bernard, 35000 Rennes, France; Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - F-X Schweyer
- EHESP, école des hautes études en santé publique, université Rennes, 35000 Rennes, France
| | - J Pommier
- Université Rennes, CNRS, ARENES - UMR 6051, 35000 Rennes, France; EHESP, école des hautes études en santé publique, université Rennes, 35000 Rennes, France
| | - G Brinchault
- Services de pneumologie et explorations fonctionnelles respiratoires, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - S Guillot
- Services de pneumologie et explorations fonctionnelles respiratoires, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - B Laviolle
- Inserm, CIC 1414, centre d'investigation clinique de Rennes, université Rennes, CHU de Rennes, 35000 Rennes, France
| | - S Jouneau
- Irset, institut de recherche en santé, environnement et travail, université Rennes, UMR_S 1085, 35000 Rennes, France; Services de pneumologie et explorations fonctionnelles respiratoires, université Rennes, CHU de Rennes, 35000 Rennes, France
| |
Collapse
|
13
|
Zysman M, Chabot F, Devillier P, Housset B, Morelot-Panzini C, Roche N. Pharmacological treatment optimization for stable chronic obstructive pulmonary disease. Proposals from the Société de Pneumologie de Langue Française. Rev Mal Respir 2016; 33:911-936. [PMID: 27890625 DOI: 10.1016/j.rmr.2016.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/23/2016] [Indexed: 10/20/2022]
Abstract
The Société de Pneumologie de Langue Française proposes a decision algorithm on long-term pharmacological COPD treatment. A working group reviewed the literature published between January 2009 and May 2016. This document lays out proposals and not guidelines. It only focuses on pharmacological treatments except vaccinations, smoking cessation treatments and oxygen therapy. Any COPD diagnosis, based on pulmonary function tests, should lead to recommend smoking cessation, vaccinations, physical activity, pulmonary rehabilitation in case of activity limitation, and short-acting bronchodilators. Symptoms like dyspnea and exacerbations determine the therapeutic choices. In case of daily dyspnea and/or exacerbations, a long-acting bronchodilator should be suggested (beta-2 agonist, LABA or anticholinergics, LAMA). A clinical and lung function reevaluation is suggested 1 to 3 months after any treatment modification and every 3-12 months according to the severity of the disease. In case of persisting dyspnea, a fixed dose LABA+LAMA combination improves pulmonary function (FEV1), quality of life, dyspnea and decreases exacerbations without increasing side effects. In case of frequent exacerbations and a FEV1≤70%, a fixed dose long-acting bronchodilator combination or a LABA+ inhaled corticosteroids (ICS) combination can be proposed. A triple combination (LABA+LAMA+ICS) is indicated when exacerbations persist despite one of these combinations. Dyspnea in spite of a bronchodilator combination or exacerbations in spite of a triple combination should lead to consider other pharmacological treatments (theophylline if dyspnea, macrolides if exacerbations, low-dose opioids if refractory dyspnea).
Collapse
Affiliation(s)
- M Zysman
- EA Ingres, département de pneumologie, université de Lorraine, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - F Chabot
- EA Ingres, département de pneumologie, université de Lorraine, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - P Devillier
- UPRES EA 220, département des maladies des voies respiratoires, hôpital Foch, université Versailles-Saint-Quentin, 92150 Suresnes, France
| | - B Housset
- Service de pneumologie, UPEC, université Paris-Est, UMR S955, centre hospitalier intercommunal de Créteil, 94000 Créteil, France
| | - C Morelot-Panzini
- Service de pneumologie et réanimation médicale, groupe hospitalier Pitié-Salpêtrière Charles-Foix, Inserm, université Pierre-et-Marie-Curie, UMRS 1158, 75013 Paris, France
| | - N Roche
- Service de pneumologie, hôpital Cochin, AP-HP, EA2511, université Paris Descartes, Sorbonne Paris Cité, 75014 Paris, France.
| | | |
Collapse
|
14
|
Sakhri L, Saint-Raymond C, Quetant S, Pison C, Lagrange E, Hamidfar Roy R, Janssens JP, Maindet-Dominici C, Garrouste-Orgeas M, Levy-Soussan M, Terzi N, Toffart AC. [Limitations of active therapeutic and palliative care in chronic respiratory disease]. Rev Mal Respir 2016; 34:102-120. [PMID: 27639947 DOI: 10.1016/j.rmr.2016.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/07/2015] [Accepted: 06/29/2016] [Indexed: 11/16/2022]
Abstract
The issue of intensive and palliative care in patients with chronic disease frequently arises. This review aims to describe the prognostic factors of chronic respiratory diseases in stable and in acute situations in order to improve the management of these complex situations. The various laws on patients' rights provide a legal framework and define the concept of unreasonable obstinacy. For patients with chronic obstructive pulmonary disease, the most robust decision factors are good knowledge of the respiratory disease, the comorbidities, the history of previous exacerbations and patient preferences. In the case of idiopathic pulmonary fibrosis, it is necessary to know if there is a prospect of transplantation and to assess the reversibility of the respiratory distress. In the case of amyotrophic lateral sclerosis, treatment decisions depend on the presence of advance directives about the use of intubation and tracheostomy. For lung cancer patients, general condition, cancer history and the tumor treatment plan are important factors. A multidisciplinary discussion that takes into account the patient's medical history, wishes and the current state of knowledge permits the taking of a coherent decision.
Collapse
Affiliation(s)
- L Sakhri
- Institut de cancérologie Daniel-Hollard, groupe hospitalier Mutualiste, 38000 Grenoble, France
| | - C Saint-Raymond
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France
| | - S Quetant
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France
| | - C Pison
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France; Laboratoire de bioénergétique fondamentale et appliquée, Inserm 1055, 38400 Saint-Martin-d'Hères, France; Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France
| | - E Lagrange
- Pôle psychiatrie, neurologie et rééducation neurologique, clinique de neurologie, CHU de Grenoble, 38000 Grenoble, France
| | - R Hamidfar Roy
- Pôle urgences médecine aiguë, clinique de réanimation médicale, CHU de Grenoble, 38000 Grenoble, France
| | - J-P Janssens
- Service de pneumologie, hôpital Cantonal universitaire, Genève, Suisse
| | - C Maindet-Dominici
- Pôle anesthésie réanimation, centre de la douleur, CHU de Grenoble, 38000 Grenoble, France
| | - M Garrouste-Orgeas
- Service de médecine intensive et de réanimation, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - M Levy-Soussan
- Unité mobile d'accompagnement et de soins palliatifs, hôpital universitaire Pitié-Salpêtrière, 75006 Paris, France
| | - N Terzi
- Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France; Pôle psychiatrie, neurologie et rééducation neurologique, clinique de neurologie, CHU de Grenoble, 38000 Grenoble, France; Inserm U1042, université Grenoble Alpes, HP2, CHU de Grenoble, 38000 Grenoble, France
| | - A-C Toffart
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France; Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France; Institut pour l'avancée des biosciences, centre de recherche UGA, Inserm U 1209, CNRS UMR 5309, 38000 Grenoble, France.
| |
Collapse
|
15
|
Bocquillon V, Briault A, Reymond E, Arbib F, Jankowski A, Ferretti G, Pison C. [Prediction of the efficiency of endoscopic lung volume reduction by valves in severe emphysema]. Rev Mal Respir 2016; 33:794-8. [PMID: 27444697 DOI: 10.1016/j.rmr.2016.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 02/15/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In severe emphysema, endoscopic lung volume reduction with valves is an alternative to surgery with less morbidity and mortality. In 2015, selection of patients who will respond to this technique is based on emphysema heterogeneity, a complete fissure visible on the CT-scan and absence of collateral ventilation between lobes. Our case report highlights that individualized prediction is possible. CASE REPORT A 58-year-old woman had severe, disabling pulmonary emphysema. A high resolution thoracic computed tomography scan showed that the emphysema was heterogeneous, predominantly in the upper lobes, integrity of the left greater fissure and no collateral ventilation with the left lower lobe. A valve was inserted in the left upper lobe bronchus. At one year, clinical and functional benefits were significant with complete atelectasis of the treated lobe. CONCLUSION The success of endoscopic lung volume reduction with a valve can be predicted, an example of personalized medicine.
Collapse
|
16
|
Menou A, Pain M, Pivette J, Chenivesse C, Magnan A, Chambellan A. [Importance of comorbidities in the anemia of COPD: Economic implications and 3-year survival analysis]. Rev Mal Respir 2016; 33:565-72. [PMID: 26803449 DOI: 10.1016/j.rmr.2015.12.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/24/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Anemia occurs commonly in COPD and is associated with a poor prognosis. The role of comorbidities in this is suspected but poorly characterized and the economic implications of anemia combined with COPD in France have not been studied. The healthcare resource utilization and cost impact of anemia remain to be investigated. METHODS One hundred and fifty-one COPD patients attending a pulmonology outpatient department during a 6 months period were retrospectively selected if they had undergone a pulmonary function test, a blood gas analysis or a blood count. The Charlson comorbidity index, resource utilization and economic data from the year before the diagnosis of anemia were compared between anemic and non-anemic patients as well as 3-year survival analysis. RESULTS The prevalence of anemia was 18.5% and was not influenced by GOLD stage. The identification of anemia was similar from blood gas results and full blood count analysis. Comorbidities - mainly cardiovascular - were found in 86% of the anemic patients. The Charlson index was 5.4±2 in the anemic group compared to 4.1±1.5 in the non-anemic group (P<0.01). The Charlson index was the only predictive factor of anemia using logistic regression analysis. The 3-year mortality was 36% in the anemic versus 7% in the non-anemic group (P<0.05). The main factor identified which predicted 3-year mortality was the presence of anemia using logistic regression. Healthcare costs the year prior to the diagnosis of anemia were not significantly different between groups, but there was a tendency to an increase in the cost of the hospitalizations in the anemic group. CONCLUSIONS Anemia is easy to diagnose in COPD from the blood gas analysis. It is frequently linked to the presence of comorbidities - mainly cardiovascular diseases - and is the more important predictive factor of the 3-year mortality. There was a tendency towards an increase in the costs of hospitalizations in anemic patients but this remains to be confirmed in a larger economic study.
Collapse
Affiliation(s)
- A Menou
- Université de Nantes, 44000 Nantes, France; L'institut du thorax, Inserm UMR1087, 44000 Nantes, France
| | - M Pain
- Université de Nantes, 44000 Nantes, France; L'institut du thorax, Inserm UMR1087, 44000 Nantes, France
| | - J Pivette
- Caisse régionale d'assurance maladie, 44000 Nantes, France
| | - C Chenivesse
- Service de pneumologie, groupement hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - A Magnan
- Université de Nantes, 44000 Nantes, France; L'institut du thorax, Inserm UMR1087, 44000 Nantes, France; Service de pneumologie, l'institut du thorax, CHU de Nantes, 44000 Nantes, France
| | - A Chambellan
- Université de Nantes, 44000 Nantes, France; L'institut du thorax, Inserm UMR1087, 44000 Nantes, France; Explorations fonctionnelles, CHU de Nantes, 44000 Nantes, France.
| |
Collapse
|
17
|
Palot A, Charpin D. [The feasibility of screening for COPD and asthma in the general population]. Rev Mal Respir 2015; 33:25-31. [PMID: 26228110 DOI: 10.1016/j.rmr.2015.02.089] [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: 04/02/2014] [Accepted: 02/09/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There are very few surveys devoted to the prevalence of asthma and COPD in the general population. The Motorola Health System has been developed to make such surveys easier. OBJECTIVES The main objective was to assess the acceptability and efficacy of the Motorola Health system in collecting health data at home in the context of an epidemiological study of respiratory health. The secondary objective was to determine whether a home-based survey would lead to a higher participation rate than a hospital-based survey. METHODS Four hundred and eighty-three individuals were selected from the electoral rolls of the 15th district of Marseille and randomly divided into two groups: home-based and hospital-based. The protocol included a questionnaire, several measurements: height, weight, blood pressure, spirometry and pulse oxymetry, and blood sampling. All data were transferred to a portable computer. RESULTS Data acquisition and transfer worked well. Among the 232 subjects from the home-based survey, 62 (26.7%) participated, whereas only 36 (14.3%) of the 251 subjects from the hospital-based group did so (P<0.001). In an additional telephone survey, participants (13.6%) and non-participants (11.0%) had the same (P<0.9) prevalence of asthma. CONCLUSION The Motorola Health System allowed accurate data acquisition and transfer in the context of an epidemiological survey of respiratory health. A home-based survey gave a higher participation rate than a hospital-based one.
Collapse
Affiliation(s)
- A Palot
- Clinique des bronches, allergie et sommeil, hôpital Nord, chemin des Bourrelly, 13015 Marseille, France
| | - D Charpin
- Clinique des bronches, allergie et sommeil, hôpital Nord, chemin des Bourrelly, 13015 Marseille, France; Aix-Marseille université, 58, boulevard Charles-Livon, 13284 Marseille, France.
| | | |
Collapse
|
18
|
Perrin C, Rolland F, Berthier F, Duval Y, Jullien V. [Noninvasive ventilation for acute respiratory failure in a pulmonary department]. Rev Mal Respir 2015; 32:895-902. [PMID: 26050081 DOI: 10.1016/j.rmr.2015.03.002] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/11/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Noninvasive ventilation (NIV) is considered as the first choice treatment for selected patients with acute respiratory failure (ARF), but many hospitals are forced to start NIV on medical wards. METHODS The aim of this retrospective study was to assess the outcomes of NIV initiated for ARF on a respiratory ward and to find the criteria predictive of failure. All patients were treated in a four-bed ward specifically dedicated to NIV. Failure of NIV was defined as the need for intubation and transfer to ICU, or death. RESULTS Among 105 admissions with ARF, 49 episodes needed NIV. These episodes were divided into 2 groups: PaCO2<45mmHg (10) and PaCO2>45mmHg (39). The overall failure rate of NIV and overall in-hospital mortality rate were 26.5% and 17% respectively. On multivariate analysis, SAPS II and respiratory acidosis with a pH less than 7.30 were significantly associated with failure of NIV. CONCLUSIONS NIV is practicable and is effective in the management of mild to moderate ARF on a respiratory ward. However, patients with respiratory acidosis and a pH less than 7.30 are at risk of NIV failure.
Collapse
Affiliation(s)
- C Perrin
- Service de pneumologie, pôle des spécialités médicales, centre hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France.
| | - F Rolland
- Service de pneumologie, pôle des spécialités médicales, centre hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France
| | - F Berthier
- Département d'information médicale, hôpital Princesse Grâce, Principauté de Monaco, Monaco, France
| | - Y Duval
- Service de pneumologie, pôle des spécialités médicales, centre hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France
| | - V Jullien
- Service de pneumologie, pôle des spécialités médicales, centre hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France
| |
Collapse
|
19
|
Laurendeau C, Chouaid C, Roche N, Terrioux P, Gourmelen J, Detournay B. [Management and costs of chronic pulmonary obstructive disease in France in 2011]. Rev Mal Respir 2015; 32:682-91. [PMID: 25613440 DOI: 10.1016/j.rmr.2014.10.731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 03/03/2014] [Accepted: 10/19/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To estimate the prevalence of treated chronic obstructive pulmonary disease (COPD) and its associated costs by stage of severity. METHODS The study was conducted on the 2011 data of the french general beneficiary sample database (EGB). EGB is a 1/97th sample of the whole population of the beneficiaries of the main compulsory national health insurances. COPD cases and the level of severity of the disease have been identified using new algorithms established from the available parameters in EGB. Costs were estimated using a collective perspective. RESULTS The minimal prevalence of treated COPD was estimated at 3.8% in patients of 40 years and older and 1.9% regardless of the age of individuals. This population was predominantly male (58.2%) with a mean age of 68.8 years (±12.7). A total of 6.2% of patients had a health-care utilization suggestive of a very severe stage of COPD and 8.1%, 13.8% and 71.9% suggestive of severe, moderate and mild stages respectively. Over one year, 28.8% of patients visited a specialist respiratory physician, 5.0% were hospitalized (≥24h) for COPD and 6.7% died. Patients experienced an average of 1.7 (±1.5) exacerbations per year and only 61.4% received specific pharmacological treatment for COPD during the year. The average yearly health-care cost of a patient with COPD was estimated at €9382, with €5342 directly related to COPD. CONCLUSION This study based on medico-administrative databases confirms the high epidemiological and economic burden of COPD in France.
Collapse
Affiliation(s)
- C Laurendeau
- Cemka-Eval, 43, boulevard du Maréchal-Joffre, 92340 Bourg-la-Reine, France
| | - C Chouaid
- Service de pneumologie, centre hospitalier intercommunal, 94000 Créteil, France
| | - N Roche
- Service de pneumologie, hôpital Inter-Armées du Val-de-Grâce, 75005 Paris, France
| | | | | | - B Detournay
- Cemka-Eval, 43, boulevard du Maréchal-Joffre, 92340 Bourg-la-Reine, France.
| |
Collapse
|