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L’Excellent S, Denjean A, Dalle JH, Houdouin V. Évolution respiratoire à 10 ans d’une cohorte pédiatrique allogreffé de moelle. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pautrat J, Gaigher I, Ringot M, Matrot B, Denjean A, Gallego J, Ramanantsoa N. Syndrome d’Ondine : tentative de traitement sur un modèle murin par le 17-AAG. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2015.02.084] [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: 10/23/2022]
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3
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Luu-Eschard L, Denjean A, Gallego J. Syndrome d’hypoventilation alvéolaire central congénital : apport d’un modèle murin PHOX2B conditionnel, physiologie et perspectives thérapeutiques. Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2014.06.022] [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: 10/24/2022]
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4
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Radoui A, Benkadour L, Attia A, Benzerga S, Denjean A. Apport de la spirométrie dans le suivi des enfants asthmatiques non contrôlés. Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2013.10.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Luu-Eschard L, Denjean A, Gallego J. Syndrome d’hypoventilation alvéolaire central congénital : apport d’un modèle murin PHOX2B conditionnel, physiologie et perspectives thérapeutiques. Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2013.10.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jutand L, Tremoureux L, Pichon A, Delpech N, Denjean A, Raux M, Straus C, Similowski T. Ventilatory response to exercise does not evidence electroencephalographical respiratory-related activation of the cortical premotor circuitry in healthy humans. Acta Physiol (Oxf) 2012; 205:356-62. [PMID: 22356255 DOI: 10.1111/j.1748-1716.2012.02427.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 10/10/2011] [Accepted: 02/12/2012] [Indexed: 11/26/2022]
Abstract
AIM The neural structures responsible for the coupling between ventilatory control and pulmonary gas exchange during exercise have not been fully identified. Suprapontine mechanisms have been hypothesized but not formally evidenced. Because the involvement of a premotor circuitry in the compensation of inspiratory mechanical loads has recently been described, we looked for its implication in exercise-induced hyperpnea. METHODS Electroencephalographical recordings were performed to identify inspiratory premotor potentials (iPPM) in eight physically fit normal men during cycling at 40 and 70% of their maximal oxygen consumption ((V)·O(2max) ). Relaxed pedalling (0 W) and voluntary sniff manoeuvres were used as negative and positive controls respectively. RESULTS Voluntary sniffs were consistently associated with iPPMs. This was also the case with voluntarily augmented breathing at rest (in three subjects tested). During the exercise protocol, no respiratory-related activity was observed whilst performing bouts of relaxed pedalling. Exercise-induced hyperpnea was also not associated with iPPMs, except in one subject. CONCLUSION We conclude that if there are cortical mechanisms involved in the ventilatory adaptation to exercise in physically fit humans, they are distinct from the premotor mechanisms activated by inspiratory load compensation.
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Affiliation(s)
| | | | - A. Pichon
- Université Paris 13; UFR SMBH, STAPS, UPRES EA 2363; Laboratoire Réponses Cellulaires et Fonctionnelles à l'Hypoxie; 74 rue Marcel Cachin; 93017; Bobigny; France
| | - N. Delpech
- Université de Poitiers; Laboratoire des Adaptations Physiologiques aux Activités Physiques; Faculté des Sciences du Sport; UPRES EA 3813; 4 Allée Jean Monnet; 86000; Poitiers; France
| | - A. Denjean
- Assistance Publique - Hôpitaux de Paris; Hôpital Robert Debré; Service de physiologie, Explorations Fonctionnelles; 75019; Paris; France
| | | | | | - T. Similowski
- Assistance Publique - Hôpitaux de Paris; Groupe Hospitalier Pitié-Salpêtrière; Service de Pneumologie et Réanimation; 75013; Paris; France
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Denjean A. Une histoire de gènes respiratoires. Rev Mal Respir 2012; 29:374-5. [DOI: 10.1016/j.rmr.2012.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 01/07/2012] [Indexed: 11/27/2022]
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Mahut B, Trinquart L, Le Bourgeois M, Becquemin MH, Beydon N, Aubourg F, Jala M, Bidaud-Chevalier B, Dinh-Xuan AT, Randrianarivelo O, Denjean A, de Blic J, Delclaux C. Multicentre trial evaluating alveolar NO fraction as a marker of asthma control and severity. Allergy 2010; 65:636-44. [PMID: 19845572 DOI: 10.1111/j.1398-9995.2009.02221.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [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: 11/29/2022]
Abstract
BACKGROUND Exhaled NO can be partitioned in its bronchial and alveolar sources, and the latter may increase in the presence of recent asthmatic symptoms and in refractory asthma. The aim of this multicentre prospective study was to assess whether alveolar NO fraction and FE(NO) could be associated with the level of asthma control and severity both at the time of measurement and in the subsequent 3 months. METHODS Asthma patients older than 10 years, nonsmokers, without recent exacerbation and under regular treatment, underwent exhaled NO measurement at multiple constant flows allowing its partition in alveolar (with correction for back-diffusion) and bronchial origins based on a two-compartment model of NO exchange; exhaled NO fraction at 50 ml/s (FE(NO,0.05)) was also recorded. On inclusion, severity was assessed using the four Global initiative for asthma (GINA) classes and control using Asthma Control Questionnaire (ACQ). Participants were followed-up for 12 weeks, control being assessed by short-ACQ on 1st, 4th, 8th and 12th week. RESULTS Two-hundred patients [107 children and 93 adults, median age (25th; 75th percentile) 16 years (12; 38)], 165 receiving inhaled corticosteroid, were included in five centres. The two-compartment model was valid in 175/200 patients (87.5%). Alveolar NO and FE(NO,0.05) did not correlate to control on inclusion or follow-up (either with ACQ /short-ACQ values or their changes), nor was influenced by severity classes. Alveolar NO negatively correlated to MEF(25-75%) (rho = -0.22, P < 0.01). CONCLUSION Alveolar and exhaled NO fractions are not indexes of control or severity in asthmatic children and adults under treatment.
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Affiliation(s)
- B Mahut
- Cabinet La Berma, Antony, France
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9
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Karila C, Ravilly S, Gauthier R, Tardif C, Neveu H, Maire J, Ramel S, Cracowski C, Legallais P, Foure H, Halm AM, Saugier J, Bordas G, Loire N, Kirszenbaum M, Dassonville J, Mely L, Wuyam B, Giovannetti P, Ouksel H, Ellaffi M, Denjean A. Activité physique et réentraînement à l’effort du patient atteint de mucoviscidose. Rev Mal Respir 2010; 27:301-13. [DOI: 10.1016/j.rmr.2010.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 02/03/2010] [Indexed: 11/26/2022]
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10
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Denjean A. Plaidoyer pour des normes adaptées ! Rev Mal Respir 2009; 26:575-6. [DOI: 10.1016/s0761-8425(09)74688-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Enea C, Boisseau N, Bayle ML, Flament MM, Grenier-Loustalot MF, Denjean A, Diaz V, Dugué B. Nandrolone excretion in sedentary vs physically trained young women. Scand J Med Sci Sports 2009; 20:90-9. [PMID: 19170961 DOI: 10.1111/j.1600-0838.2008.00877.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We investigated the effects of the menstrual cycle, oral contraception and physical training on exhaustive exercise-induced changes in the excretion of nandrolone metabolites [19-norandrosterone (19-NA), and 19-noretiocholanolone (19-NE)] in young women. Twenty-eight women were allocated to an untrained group (n=16) or a trained group (n=12), depending on their physical training background. The untrained group was composed of nine oral contraceptive users (OC+) and seven eumenorrheic women (OC-), while the trained group was entirely composed of OC+ subjects. Three laboratory sessions were conducted in a randomized order: a prolonged exercise test, a short-term exercise test and a control session. Urine specimens were collected before and 30, 60 and 90 min after the exercise test and at the same times of the day during the control session. Urinary concentrations of nandrolone metabolites were determined by gas chromatography coupled to mass spectrometry. Urinary concentrations of 19-NA and 19-NE ranged from undetectable levels to 1.14 and 0.47 ng/mL, respectively. Nandrolone excretion was not affected by the menstrual cycle phase (early follicular vs mid-luteal), prior physical training, oral contraception or acute physical exercise. Therefore, a urinary concentration of 2 ng/mL of 19-NA appears to be fair as the upper acceptable limit in doping control tests for female athletes.
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Affiliation(s)
- C Enea
- Laboratory of Exercise-Induced Physiological Adaptations (EA 3813), Faculty of Sport Sciences, University of Poitiers, Poitiers, France.
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Affiliation(s)
- C Karila
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-Enfants-malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France.
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13
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Karila C, Gauthier R, Couderc L, Denjean A. [Gas exchanges. Mucoviscidosis]. Rev Pneumol Clin 2008; 64:145-149. [PMID: 18656790 DOI: 10.1016/j.pneumo.2008.04.014] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- C Karila
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-Enfants malades, 75015 Paris, France.
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14
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Denjean A. Les tests d’exercice : outils indispensables pour l’évaluation fonctionnelle cardio-respiratoire chez l’enfant. Rev Mal Respir 2008; 25:271-2. [DOI: 10.1016/s0761-8425(08)71545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Lebras-Isabet MN, Denjean A. [Respiratory function tests in children aged 3-6 years with cystic fibrosis: indications and execution]. Rev Pneumol Clin 2007; 63:313-318. [PMID: 18166934 DOI: 10.1016/s0761-8417(07)74208-6] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- M-N Lebras-Isabet
- Service de Gastroentérologie, Mucoviscidose et Nutrition Pédiatriques (Pr Cezard), CRCM, Hôpital Robert-Debré, 48 boulevard Sérurier, 75019 Paris.
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Counil FP, Karila C, Le Bourgeois M, Matecki S, Lebras MN, Couderc L, Fajac I, Reynaud-Gaubert M, Bellet M, Gauthier R, Denjean A. Mucoviscidose : du bon usage des explorations fonctionnelles respiratoires. Rev Mal Respir 2007; 24:691-701. [PMID: 17632430 DOI: 10.1016/s0761-8425(07)91145-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/22/2022]
Abstract
INTRODUCTION Neonatal screening for cystic fibrosis (CF) leads to early dedicated specialist care for all patients. BACKGROUND Pulmonary function tests (PFT) are mandatory for routine monitoring of CF patients. The aim of this article is to review the current guidelines for PFTs in CF, particularly the type of test, the age and the clinical status of the patient. VIEWPOINT The regular use of spirometry is generally accepted. Many other tests are used but their clinical value in the routine follow-up of CF patients remains to be established. CONCLUSION Further efforts should be made to evaluate the value of PFTs in CF, particularly in very young children.
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Affiliation(s)
- F P Counil
- CHU Arnaud de Villeneuve, Montpellier, France.
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Aguilaniu B, Richard R, Costes F, Bart F, Martinat Y, Stach B, Denjean A. Méthodologie et Pratique de l’Exploration Fonctionnelle à l’eXercice (EFX). Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)91121-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Aguilaniu B, Richard R, Costes F, Bart F, Martinat Y, Stach B, Denjean A. [Cardiopulmonary exercise testing]. Rev Mal Respir 2007; 24:2S111-60. [PMID: 17389842] [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: 05/14/2023]
Affiliation(s)
- B Aguilaniu
- HYLAB, Physiologie Clinique et Exercice, Grenoble, France.
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Pichon A, Venisse N, Krupka E, Pérault-Pochat MC, Denjean A. Urinary and blood concentrations of beta2-agonists in trained subjects: comparison between routes of use. Int J Sports Med 2006; 27:187-92. [PMID: 16541373 DOI: 10.1055/s-2005-865627] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We aimed to assess the plasma and urine concentrations of beta2-agonists and evaluate the difference between three routes of administration in trained adults in order to distinguish doping from prevention of exercise-induced asthma. Ten young healthy Caucasian male subjects received during a four treatment period study: 1) inhaled salbutamol (S(I)) 2 x 100 microg t.i.d. for 3 days, 2) inhaled formoterol (F(I)) 2 x 12 microg b.i.d. for 3 days, 3) a single subcutaneous injection of salbutamol (S(S)) 0.5 mg, and 4) salbutamol 2 x 2 mg t.i.d. orally for 3 days (S(O)). Blood samples were taken during the first and the third day of experimentation at baseline, 30 min, 1 h, 2 h, 4 h and 6 h after administration; additional blood samples were drawn at 15 min for S(I), S(S) and F(I) and at 12 h for F(I). Urinary samples were collected at baseline, 2 h, 4 h, 6 h and 12 h after administration. Urinary concentrations were 20 to almost 50 times higher after S(O) than after S(I). Mean urinary concentration after S(O) increased to above 800 ng.mL(-1) within the two hours and above 1000 ng.mL(-1) at 6 to 12 hours post-drug administration. Urinary concentrations after S(S) were maximal during the first 2 hours (mean: 340 +/- 172 ng.mL(-1)). Plasma concentrations were very low, whatever the routes of administration. Results showed that we could eliminate the use of S(I) (authorized) and S(S) administration when individual urinary concentrations are higher than 230 ng.mL(-1) and 615 ng.mL(-1), respectively. Therefore, at rest, the cut-off value used to discriminate therapeutic from doping salbutamol intake could be fixed at 250 ng.mL(-1) instead of the 1000 ng.mL(-1) still authorized by international committees.
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Affiliation(s)
- A Pichon
- Laboratoire des Adaptations Physiologiques aux Activités Physiques, Faculté des Sciences du Sport, UPRES EA 3813, Poitiers, France.
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Affiliation(s)
- C Gaultier
- Service de Physiologie-Explorations Fonctionnelles, Université Paris VII, Hôpital Robert Debré, France.
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Beydon N, Matran R, Wuyam B, Amsallem F, Boule M, Alberti C, Denjean A, Gaultier C. Test à la métacholine chez le jeune enfant : mesure de la résistance par interruption. Rev Mal Respir 2005. [DOI: 10.1016/s0761-8425(05)85727-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Denjean A. Question 3-4. Physiopathologie de la dyspnée. Rev Mal Respir 2005. [DOI: 10.1016/s0761-8425(05)85701-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Denjean A. [Question 3-4. Physiopathology of dyspnea]. Rev Mal Respir 2005; 22:7S40-7S41. [PMID: 16340812] [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: 05/05/2023]
Affiliation(s)
- A Denjean
- Service de Physiologie, Explorations Fonctionnelles, Hôpital Robert-Debré, Paris, France.
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Beydon N, Matran R, Wuyam B, Amsallem F, Boule M, Alberti C, Denjean A, Gaultier C. [Methacholine challenge in young children: measurement of resistance by interruption]. Rev Mal Respir 2005; 22:959-66. [PMID: 16160677 DOI: 10.1019/200530110] [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: 11/05/2022]
Abstract
The aims of this study were 1. To evaluate the measurement of resistance by interruption (Rint) of bronchoconstriction induced by inhalation of methacholine and 2. To determine a threshold of increase of resistance in young children to differentiate responders from non-responders. Forty-six children (mean age 5 [4.3-6.1] years) referred for methacholine challenge were tested by measurement of Rint and transcutaneous oxygen tension. A fall of 20% or more in oxygen tension from the baseline was used to define the responders. The children studied had a baseline Rint significantly higher than normal (0.84 [0.68-1.01] vs. 0.76 [0.60-0.90] kPa L(-1)s; p < 0.03). Forty-one children were responders and had an increase in Rint significantly different from the non-responders (p < 0/04). An increase in Rint of 35% distinguished responders from non-responders in young children with chronic cough. Interrupter resistance increases significantly during bronchial provocation in responding young children and may be used to measure the degree of bronchoconstriction.
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Affiliation(s)
- N Beydon
- Service de Physiologie, Hôpital, Robert Debré, Paris, France.
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Pichon A, Roulaud M, Denjean A, de Bisschop C. Airway Tone During Exercise in Healthy Subjects: Effects of Salbutamol and Ipratropium Bromide. Int J Sports Med 2005; 26:321-6. [PMID: 15895312 DOI: 10.1055/s-2004-821021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 10/25/2022]
Abstract
In healthy subjects changes in airway calibre during exercise are conflicting and smaller than in asthmatics. Methodological differences could explain the discrepancies between the results obtained in healthy subjects. Therefore, our aim was to assess during exercise the changes in airway diameter and the effects of 200 microg salbutamol (SAL) or 40 microg ipratropium bromide (IPR) inhalations versus placebo (PLA), using spirometry and respiratory resistance (Rrs). Eight non-asthmatic subjects exercised 9 min at 70 % of their maximal aerobic power after inhalation of 200 microg SAL, 40 microg IPR, or PLA. Maximal flow-volume curves were obtained before and after inhalations, at 3 (E3) and 6 (E6) minutes of exercise, and during recovery. Rrs were measured by impulse oscillometry before and after inhalation, and immediately at the end of exercise. At rest, FEV (1) increased significantly after inhalation of SAL and IPR. Rrs decreased only after SAL. During exercise FEV (1) increased significantly from rest with SAL and IPR while forced mid expiratory flow (FEF (25 - 75)) increased significantly for all conditions. At E6 the rise of FEV (1) and FEF (25 - 75) were greater with SAL compared to PLA and IPR. In all conditions Rrs increased significantly immediately at the end of exercise as compared to rest but less than during flow-matched hyperpnea. It is concluded that a similar bronchodilation was observed during exercise with and without anticholinergic drug which suggests a withdrawal of parasympathetic control of airways during exercise in healthy subjects. Nevertheless, the bronchodilation observed during exercise is not maximal since it can be reinforced by beta (2)-mimetic drug.
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Affiliation(s)
- A Pichon
- Laboratoire d'Analyse de la Performance Motrice Humaine, Faculté des Sciences du Sport, UPRES EA 2253, Poitiers, France
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Enea C, Schmitt N, Dugué B, Boisseau N, Le Creff C, Denjean A. Évaluation du stress oxydant chez des patients atteints de bronchopneumopathie chronique obstructive après un entraînement de type aérobie. Sci Sports 2005. [DOI: 10.1016/j.scispo.2004.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
INTRODUCTION Measurement of maximal respiratory pressures against an occlusion has been used for a long time to assess respiratory muscle strength in the follow up of children with respiratory disease. In the early stage of disease this is the main test for diagnosing respiratory muscle involvement and the degree of that involvement. STATE OF KNOWLEDGES: The interpretation of the results is difficult on account of variability of the measurements and of the reference values. The aim of this article is to present, in the form of a literature review, the normal values available and the different determining factors as well as the advantages and limitations of these measurements. PERSPECTIVES The use by all the centres undertaking maximal respiratory pressure measurements in children of methodological techniques similar to those presented in this revue could be the starting point for obtaining an identical range of reference values for all. CONCLUSION Age, sex and the level of physical aptitude seem to be the most important determinants of maximal respiratory pressures. However, other methodological factors such as co-operation, training of the child in the performance of the manoeuvres and the type of device and protocol used, will all influence the results. These factors must be taken into consideration in order to diminish, as much as possible, the variability of the maximal pressures obtained.
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Affiliation(s)
- S Matecki
- Service Central de Physiologie Clinique, Laboratoire de Physiologie des Interactions, Hôpital Arnaud de Villeneuve, Montpellier, France.
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Affiliation(s)
- A Denjean
- Service d'Explorations fonctionnelles, Physiologie respiratoire et de l'exercice, Département de Physiologie, CHU de Poitiers, 86021 Poitiers Cedex, France.
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Jonville S, Jutand L, Similowski T, Denjean A, Delpech N. Putative protective effect of inspiratory threshold loading against exercise-induced supraspinal diaphragm fatigue. J Appl Physiol (1985) 2004; 98:991-8. [PMID: 15489255 DOI: 10.1152/japplphysiol.00528.2004] [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] [Indexed: 11/22/2022] Open
Abstract
The present investigation was intended to assess the consequences of an inspiratory load on the diaphragm central component of fatigue during exercise. We recorded the motor potential evoked (MEP) by transcranial magnetic stimulation of the motor cortex in 10 subjects. The diaphragm and rectus femoris were studied before and 10, 20, and 40 min after two 16-min cycling exercise (E) trials requiring 55% of maximal oxygen uptake: 1) one with an inspiratory threshold load (E + ITL), corresponding to 10% of maximal inspiratory pressure; and 2) the other without the load (E). Dyspnea, heart rate, electromyographic activity of the sternocleidomastoid, and diaphragm work were significantly higher in E + ITL than in E. Neither trial affected the response to phrenic magnetic stimulation, which was performed 15 and 25 min postexercise, or the maximal inspiratory pressure (116 and 120 cm H(2)O before E and E + ITL, respectively, and 110 and 114 cm H(2)O at 30 min postexercise). Whereas the amplitude of the diaphragm MEP was unaffected by E + ITL (+2.1 +/- 29.4%), a significant decrease was observed 10 min after E compared with baseline (-37.1 +/- 22.3%) and compared with E + ITL. The MEP amplitude of rectus femoris remained unchanged with E and E + ITL. The recruitment of synergistic agonists during E + ITL may have normalized the major ventilatory stress and reset up the excitability of the diaphragm pathway.
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Affiliation(s)
- S Jonville
- Laboratoire des Adaptations Physiologiques aux Activités Physiques, UPRES EA 3813, Faculté des Sciences du Sport, 4 allée Jean Monnet, 86000 Poitiers, France.
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Prioux J, Matecki S, Amsallem F, Denjean A, Ramonatxo M. [Ventilatory response to maximal exercise in healthy children]. Rev Mal Respir 2003; 20:904-11. [PMID: 14743092] [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: 04/28/2023]
Abstract
INTRODUCTION The evaluation of the ventilatory response of children during exercise is essential to determine its role in impaired exercise tolerance. The aim of this review is to describe the variables and the values of maximal ventilatory parameters observed in healthy children in the published literature. STATE OF ART The maximal ventilation (VEmax) and the tidal volume (VTmax) increase in a linear fashion with age and plateau in boys at 15 years, and in girls at 13 years. The main variables for the parameters connected to volume--VEmax and VTmax--are anthropometric characteristics, in particular, the lean body mass. Most studies show a value of 30 ml.kg(-1) for a VTmax on the total body mass in pre-puberty and a slight increase thereafter. The ventilatory reserves and the VTmax on vital capacity increase with age until respective values of 30% and 50% are reached at 17 years. The maximal parameters connected to time are independent of anthropometric characteristics. The TI/TTOT ratio (inspiratory time to total time of the respiratory cycle) is stable with a value of 0.5. The maximal respiratory frequency decreases slightly with age without differences between the genders. PERSPECTIVES AND CONCLUSION Only studies of larger numbers of children, proposing relationships derived from allometric equations, will be able to provide real reference values.
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Affiliation(s)
- J Prioux
- Service central de Physiologie clinique, Hôpital Arnaud de Villeneuve, Montpellier, France.
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Denjean A. [Asthma and sports: danger!]. Rev Mal Respir 2003; 20:331-3. [PMID: 12910106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Abstract
This study aimed at determining whether twitch mouth pressure (TwPmo) induced by cervical magnetic stimulation (CMS) was sensitive to inspiratory muscle fatigue produced by whole body exercise (WBE) in normal subjects. Twenty subjects performed one or two of the following protocols: (i). cycling at 85% V(O(2),max) until exhaustion; (ii). inspiratory resistive load (IRL) breathing at 62% of maximal inspiratory pressure until task failure. In eight subjects, oesophageal (TwPoes), gastric (TwPga) and transdiaphragmatic (TwPdi) pressures were recorded. The TwPmo was significantly reduced (P<0.05) 20 min after both WBE and IRL, from 17.5+/-4.4 to 15.9+/-3.9 cmH(2)O and from 19.4+/-4.9 to 17.7+/-4.5 cmH(2)O, respectively. Subsequently to IRL, the TwPdi decrease was associated with a reduction in TwPoes/TwPga ratio; not after WBE. Independently of the mode of ventilatory loading, inspiratory muscle fatigue was detected. Thus, inspiratory muscle fatigue after WBE can be assessed in normal subjects with a noninvasive technique.
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Affiliation(s)
- N Delpech
- Laboratoire d'Analyse de la Performance Motrice Humaine, UPRES EA 2253, Faculté des Sciences du Sport, Université de Poitiers, 4 allée Jean Monnet, 86000 Poitiers, France.
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Le Creff C, Lecron J, Legros P, Denjean A. Synthèse endogène d’érythropoïétine et hypoxémie induite par l’exercice chez des cyclistes de haut niveau. Sci Sports 2002. [DOI: 10.1016/s0765-1597(02)00153-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Mercier FJ, Naline E, Bardou M, Georges O, Denjean A, Benhamou D, Advenier C. Relaxation of proximal and distal isolated human bronchi by halothane, isoflurane and desflurane. Eur Respir J 2002; 20:286-92. [PMID: 12212957 DOI: 10.1183/09031936.02.00275702] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [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
Volatile anaesthetics relax airway smooth muscle in vitro. The amount of relaxation might depend on the type and concentration of volatile anaesthetics, the calibre and precontraction level of the bronchi, and also on the species considered. These effects were investigated on isolated human bronchi. Isometric relaxations produced by halothane, isoflurane and desflurane bubbled on human bronchial rings precontracted with carbachol were recorded and compared with time controls. Volatile anaesthetics induced a concentration-dependent relaxation at 0.66, 1.33 and 2 minimum alveolar concentration (MAC). The relaxation was greater in mildly (carbachol 3x10(-7) M) than in highly (carbachol 2x10(-6) M) precontracted bronchi. Halothane was more potent in relaxing distal as compared to proximal bronchi; this differential effect was less pronounced with isoflurane and not observed with desflurane. While the three volatile anaesthetics induced similar relaxation on proximal bronchi, halothane was significantly more potent than desflurane on distal bronchi, with isoflurane being intermediate. The relaxation induced by 1.33 MAC of halothane, isoflurane and desflurane on moderately precontracted distal bronchi (carbachol 1x10(-6) M) was attenuated by pretreatment with glibenclamide 1x10(-5) M. In conclusion, halothane, isoflurane and desflurane exert direct but differential relaxant effects on human isolated bronchial smooth muscle. This may provide supplemental bronchodilation during anaesthesia. Although adenosine triphosphate-sensitive K+ channels are involved in these relaxant effects, they are unlikely to explain the observed differences between the three volatile anaesthetics.
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Affiliation(s)
- F J Mercier
- University of Medicine Paris-Ouest and UFR Biomédicale des St Pères, Paris, France.
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Abstract
The factors that may modulate ventilatory muscle fatigue during exercise are controversial. In this study the contribution of acidosis to exercise-induced diaphragmatic fatigue was investigated, using measurements of the twitch mouth pressure response (tw,Pmo) to cervical magnetic stimulation. After learning sessions, 14 healthy subjects performed two cycling tests (at 60% of maximal aerobic power for 16 min), one while breathing spontaneously (mean minute ventilation (V'E) 67.9 L x min(-1)) and the other while hypoventilating voluntarily (mean V'E 53.8 L x min(-1)). Exercise was voluntarily set at a moderate power to avoid a fatiguing effect of exercise per se. As compared with spontaneous breathing (SB), voluntary hypoventilation (VHV) significantly increased mean carbon dioxide tension in arterial blood (Pa,CO2) (51 mmHg versus 41 mmHg) and significantly decreased arterial pH (7.28 versus 7.34). After 10 min of SB test, tw,Pmo was unchanged compared to the baseline value (19.1 versus 18.5 cmH2O) whereas tw,Pmo fell significantly as compared to baseline (17.1 versus 18.5 cmH2O) and to SB (17.1 versus 19.1 cmH2O) after the VHV test. The results of this study suggest that exposure to hypercapnia may impair respiratory muscle function. This impairment could be more clinically relevant in patients with chronic obstructive lung disease.
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Affiliation(s)
- S Jonville
- Sports Sciences Dept, University of Poitiers, and University Hospital of Poiters, France.
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Matecki S, Paruit C, Chaussain M, Ramonatxo M, Denjean A. [Indications and application of exercise tests in children]. Rev Mal Respir 2001; 18:491-8. [PMID: 11887766] [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
Exercise tests are routinely used in children to assess cardio-respiratory and muscular adaptations to exercise. However these tests are of relatively recent use, and there is a lack of standardization and of relevant data in large groups in this population. The aim of this paper was to specify the common medical indications of exercise tests in children, to propose standardized protocols of these tests in some of the most common pathological situations as: exercise-induced asthma, chronic respiratory diseases (bronchopulmonary dysplasia, cystic fibrosis), muscular diseases. These tests can provide clinically relevant parameters only when they are used in strict conditions of standardization.
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Affiliation(s)
- S Matecki
- Service Central de Physiologie Clinique, Hôpital Arnaud de Villeneuve, Montpellier
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Abstract
BACKGROUND Beta-2 agonists such as salbutamol are used, not only by asthmatic athletes to prevent exercise induced asthma, but also by non-asthmatic athletes as a potentially ergogenic agent. We have investigated whether inhaled salbutamol enhances endurance performance in non-asthmatic athletes. METHODS A prospective double blind, randomised, three way crossover design was used to study the effects of 200 microg and 800 microg inhaled salbutamol versus a placebo in 12 trained triathletes. The treatments were compared in three identical cycle ergometer sessions at 85% of the predetermined maximal oxygen uptake. Lung function, endurance time, metabolic parameters (glucose, potassium, lactate, free fatty acid, and glycerol), and psychomotor performance were evaluated. RESULTS Neither endurance time nor post-exercise bronchodilation were significantly different between the treatments. Metabolic parameters were affected by exercise but not by treatment. CONCLUSIONS Inhaled salbutamol, even in a high dose, did not have a significant effect on endurance performance in non-asthmatic athletes, although the bronchodilating effect of the drug at the beginning of exercise may have improved respiratory adaptation. Our results do not preclude an ergogenic effect of beta2 agonists given by other routes or for a longer period.
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Affiliation(s)
- C Goubault
- Service d'Explorations Fonctionnelles, Physiologie Respiratoire et de l'Exercice, CHU de Poitiers, 86021 Poitiers, France
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Goubault C, Perault MC, Leleu E, Bouquet S, Legros P, Vandel B, Denjean A. Effects of inhaled salbutamol in exercising non-asthmatic athletes. Thorax 2001. [DOI: 10.1136/thx.56.9.675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUNDBeta-2 agonists such as salbutamol are used, not only by asthmatic athletes to prevent exercise induced asthma, but also by non-asthmatic athletes as a potentially ergogenic agent. We have investigated whether inhaled salbutamol enhances endurance performance in non-asthmatic athletes.METHODSA prospective double blind, randomised, three way crossover design was used to study the effects of 200 μg and 800 μg inhaled salbutamol versus a placebo in 12 trained triathletes. The treatments were compared in three identical cycle ergometer sessions at 85% of the predetermined maximal oxygen uptake. Lung function, endurance time, metabolic parameters (glucose, potassium, lactate, free fatty acid, and glycerol), and psychomotor performance were evaluated.RESULTSNeither endurance time nor post-exercise bronchodilation were significantly different between the treatments. Metabolic parameters were affected by exercise but not by treatment.CONCLUSIONSInhaled salbutamol, even in a high dose, did not have a significant effect on endurance performance in non-asthmatic athletes, although the bronchodilating effect of the drug at the beginning of exercise may have improved respiratory adaptation. Our results do not preclude an ergogenic effect of β2 agonists given by other routes or for a longer period.
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Castel O, Planchon C, Denjean A, Soyer S, Barrière M, Merle C, Fauchere JL. [Assessment of three filters for respiratory function tests]. Rev Mal Respir 1998; 15:759-64. [PMID: 9923030] [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: 02/10/2023]
Abstract
Several filters specific for respiratory function tests have been on the market for several years. Recommended by the manufacturers to avoid contaminating the equipment and thus improve patient safety, these filters require a considerable financial investment. We studied the passage of diluted blood into artificial saliva in a patient model simulating inspiration tests and rapid forced expiration to assess the retention capacity of three filters used for respiratory function tests: Multi SPIRO MI-90016 (MultiSPIRO), PF 30S (Pall Biomedical) and Spirobac (Dar. S.p.A). The mean percentage of passage was 1.48% through the MI-90016 filter, 57.15% through the PF 30 S filter and 70.45% through the Spirobac filter. These findings provide further elements for choosing filters for respiratory function tests. Indeed, despite the manufacturers' commercial arguments, the technical documents provided do not give necessary information on the filtering capacity of the filters on the market. We have observed that two out of the three filters tested do no meet the standards expected by clinicians.
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Affiliation(s)
- O Castel
- Unité d'Hygiène Hospitalière, Centre Hospitalier Universitaire de Poitiers
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Denjean A, Paris-Llado J, Zupan V, Debillon T, Kieffer F, Magny JF, Desfrères L, Llanas B, Guimaraes H, Moriette G, Voyer M, Dehan M, Breart G. Inhaled salbutamol and beclomethasone for preventing broncho-pulmonary dysplasia: a randomised double-blind study. Eur J Pediatr 1998; 157:926-31. [PMID: 9835439 DOI: 10.1007/s004310050969] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.4] [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: 10/28/2022]
Abstract
UNLABELLED Early inflammatory lesions and bronchial hyperresponsiveness are characteristics of the respiratory distress in premature neonates and are susceptible to aggravation by assisted ventilation. We hypothesized that treatment with inhaled salbutamol and beclomethasone might be of clinical value in the prevention of bronchopulmonary dysplasia (BPD) in ventilator-dependent premature neonates. The study was double-blinded and placebo controlled. We studied 173 infants of less than 31 weeks of gestational age, who needed ventilatory support at the 10th postnatal day. They were randomised to four groups and received either placebo + placebo, placebo + salbutamol, placebo + beclomethasone or beclomethasone + salbutomol, respectively for 28 days. The major criteria for efficacy were: diagnosis of BPD (with score of severity), mortality, duration of ventilatory support and oxygen therapy. The trial groups were similar with respect to age at entry (9.8-10.1 days), gestational age (27.6-27.8 weeks), birth weight and oxygen dependence. We did not observe any significant effect of treatment on survival, diagnosis and severity of BPD, duration of ventilatory support or oxygen therapy. For instance, the odds-ratio (95% confidence interval) for severe or moderate BPD were 1.04 (0.52-2.06) for inhaled beclomethasone and 1.54 (0.78-3.05) for inhaled salbutamol. CONCLUSION This randomised prospective trial does not support the use of treatment with inhaled beclomethasone, salbutamol or their combination in the prevention of BPD in premature ventilated neonates.
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Affiliation(s)
- A Denjean
- Services d'Explorations Fonctionnelles et Réanimation Néonatale, Hôpital Antoine Béclère, Clamart, France.
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Meurice JC, Paquereau J, Denjean A, Patte F, Series F. Influence of correction of flow limitation on continuous positive airway pressure efficiency in sleep apnoea/hypopnoea syndrome. Eur Respir J 1998; 11:1121-7. [PMID: 9648966 DOI: 10.1183/09031936.98.11051121] [Citation(s) in RCA: 48] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We evaluated the efficiency of two different treatment procedures with continuous positive airway pressure (CPAP) on sleep, nocturnal breathing characteristics and daytime vigilance in 18 newly diagnosed patients with untreated sleep apnoea/hypopnoea syndrome (SAHS) randomly allocated to two different groups. In group I, the positive pressure (PP) level was set to suppress flow limitation (PFL), while in group II the PP was set at a level that eliminated only apnoea/hypopnoea and snoring (PAHS). At the end of a 3 week period of home CPAP therapy, a follow-up sleep study, vigilance and cognitive tests were made. Overall, PFL was significantly higher than PAHS values (PFL: 10.42.6 cmH2O; PAHS: 8.9+/-2.6 cmH2O; p<0.01, mean+/-SD). We found no difference in sleep quality, nocturnal saturation and apnoea/hypopnoea index, or in daytime vigilance tests between the two groups at the end of the treatment period. However, there was a significantly greater scattering in the changes of sleep latency in group II than in group I. This was associated with a significant difference in the daily duration of nasal CPAP use between the two groups (group I: 7.29+/-0.95 h x day(-1); group II: 6.01+/-0.94 h x day(-1); p=0.01) and with a positive correlation between final maintenance of wakefulness test values and the duration of CPAP use (p<0.05; r=0.55). These results tend to show that correcting flow limitation is associated with a higher observance and a more important efficiency in normalizing daytime vigilance than with conventional nasal continuous positive airway pressure.
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Affiliation(s)
- J C Meurice
- Service de Pneumologie, CHU de Poitiers, France
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Gallego J, Benammou S, Vardon G, Chambille B, Denjean A, Lorino H. Influence of thoracoabdominal pattern of breathing on respiratory resistance. Respir Physiol 1997; 108:143-52. [PMID: 9232687 DOI: 10.1016/s0034-5687(97)00021-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to test the hypothesis that voluntary changes in thoracoabdominal pattern of breathing may increase total respiratory resistance. Thirty-one normal subjects were asked to control their thoracoabdominal pattern of breathing by using a visual feedback. Thoracic and abdominal volume changes were measured by inductance plethysmography. Respiratory resistance and elastance were measured by forced oscillometry. The mean (+/-SD) percent thoracic contributions to tidal volume during thoracic or abdominal breathing were 75 (+/-11) and 25% (+/-9), respectively. These changes induced small but significant increases in resistance (P < 0.005) and elastance (P < 0.002). The increased resistance was observed in 22 subjects for thoracic breathing (P < 0.016) and in 21 subjects for abdominal breathing (P < 0.043). The mean value (+/-SD) of individual increases in resistance during thoracic or abdominal breathing, compared with normal breathing, were 9.2 +/- 17.5 and 9.4 +/- 19.9%, respectively. The fact that departing from spontaneous pattern increases respiratory resistance is consistent with the notion that breathing pattern is optimally adjusted on the basis of mechanical criteria.
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Affiliation(s)
- J Gallego
- Laboratoire de Neurologie et Physiologie du Développement, Hôpital Robert-Debré, Paris, France
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Abstract
Halothane and isoflurane induce potent bronchodilation during general anaesthesia and have been used successfully during status asthmaticus. The aim of this study was to determine whether airway hyporesponsiveness was prolonged after halothane administration. Sixteen guinea-pigs were submitted for 2 h to either 1.5% halothane in oxygen or 100% oxygen, and were killed 24 h later to elicit isometric tracheal contractions in organ baths with various agonists. Cumulative concentration-response curves to histamine or to KCl and contractions evoked with acetylcholine 1 mM (4.7 +/- 0.8 vs 4.6 +/- 0.5 g) or carbachol 10 microM in calcium-free buffer (4.3 +/- 0.6 vs 4.4 +/- 0.6 g) exhibited no difference between groups. Moreover, when 4% halothane or 4.6% isoflurane were directly bubbled through the organ baths, a significant decrease (13 +/- 1% and 37 +/- 2%) of maximal contractions evoked with acetylcholine and KCI, respectively, was obtained but these relaxant effects did not persist 30 min after cessation of anaesthetic. These results indicate that, even though halothane induces transient airway hyporesponsiveness in vitro, previous halothane anaesthesia in guinea-pigs does not alter subsequent tracheal responsiveness assessed in vitro. Our findings may explain the transient renewal of bronchospasm reported during intermittent periods off halothane in status asthmaticus.
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Affiliation(s)
- F J Mercier
- Département d' Anaesthésie, Université Paris-Sud, Hôpital A. Béclèrc, Clamart, France
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Parat S, Moriette G, Delaperche MF, Escourrou P, Denjean A, Gaultier C. Long-term pulmonary functional outcome of bronchopulmonary dysplasia and premature birth. Pediatr Pulmonol 1995; 20:289-96. [PMID: 8903900 DOI: 10.1002/ppul.1950200506] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.2] [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: 02/02/2023]
Abstract
Pulmonary function and exercise tolerance were evaluated in late childhood in two groups of prematurely born children: one group with bronchopulmonary dysplasia (BPD) [n = 15; gestational age at birth (GA): 29.6 +/- 2.8 weeks; birth weight (BW): 1,367 +/- 548 g; age at test: 7.9 +/- 0.6 years], and a second group without significant neonatal lung disease [pre-term (PT)] (n = 9; GA: 30.3 +/- 1.7 weeks; BW: 1,440 +/- 376 g; age at test: 7.8 +/- 0.22 years). The results were compared with a control group of children of similar ages and heights, born at term [term born (TB)]. We observed that total lung resistance (RL) was significantly higher in BPD (11 +/- 3 cmH2O/L/s), and in PT (9 +/- 2) than in TB [5 +/- 1; (P < 0.001 and P < 0.05, respectively)]. In BPD RL was higher than in PT (P < 0.05). Dynamic lung compliance (CLdyn) was decreased in BPD (43 +/- 11 mL/cmH2O) and in PT (56 +/- 17) compared with TB (76 +/- 20) (P < 0.001 and P < 0.05), and also in BPD compared with PT (P < 0.05). Forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) were lower in BPD (1.07 +/- 0.15 L and 72 +/- 7%) than in PT (1.29 +/- 0.23 L, and 80 +/- 7%) (P < 0.05). Exercise tests were performed in six boys with BPD. The ratio between minute ventilation at maximal workload (VEmax) and the predicted value of maximal voluntary ventilation (MVV) was elevated in the six BPD boys tested, compared with five boys of Group 2 and five TB boys (87 +/- 15% vs. 62 +/- 14% and 65 +/- 13%) (P < 0.05). We conclude that: 1) prematurity and BPD is followed by long-term airway obstruction and a mild degree of exercise intolerance and; 2) premature birth without BPD may be followed by a milder degree of airway obstruction in childhood than in infants who developed BPD during the neonatal period.
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Affiliation(s)
- S Parat
- Service de Medecine Neonatale de Port-Royal, Groupe Hospitalier Cochin Port-Royal, Universite Rene Descartes, Paris, France
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Mercier FJ, Benhamou D, Denjean A. Lack of bronchodilator effect after administration of subanaesthetic concentration of isoflurane in mild asthmatic subjects challenged with methacholine. Br J Anaesth 1995; 74:301-5. [PMID: 7718376 DOI: 10.1093/bja/74.3.301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [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: 01/26/2023] Open
Abstract
Volatile anaesthetics used in high concentrations are potent bronchodilators. The effect of lower subanaesthetic concentrations is less documented, particularly in humans with provoked bronchial obstruction. We have studied seven mild asthmatic subjects twice, 1 week apart, during an asymptomatic period. A provocative test with methacholine was performed to produce a decrease in forced expiratory volume in 1 s (FEV1) of at least 20%. The subjects then inhaled either 100% oxygen or 0.75% isoflurane in oxygen for 8 min, via a face mask. During isoflurane inhalation, the subjects lost consciousness but recovered quickly. There was no significant improvement in FEV1 and maximum expiratory flow at 50% vital capacity (MEF50) recorded 3, 6, 9, 14 and 19 min after the end of isoflurane inhalation compared with time-control values. We conclude that lung function in mild asthmatic subjects challenged with methacholine was not improved after administration of a low subanaesthetic concentration of isoflurane. This may be important during recovery from general anaesthesia.
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Affiliation(s)
- F J Mercier
- Département d'Anesthésie, Hôpital Antoine Béclère, Clamart, France
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Sitbon O, Brenot F, Denjean A, Bergeron A, Parent F, Azarian R, Herve P, Raffestin B, Simonneau G. Inhaled nitric oxide as a screening vasodilator agent in primary pulmonary hypertension. A dose-response study and comparison with prostacyclin. Am J Respir Crit Care Med 1995; 151:384-9. [PMID: 7842196 DOI: 10.1164/ajrccm.151.2.7842196] [Citation(s) in RCA: 180] [Impact Index Per Article: 6.2] [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: 01/27/2023] Open
Abstract
To investigate the capacity of the pulmonary vascular bed to acutely vasodilate, we examined in 35 consecutive patients with primary pulmonary hypertension (PPH), the hemodynamic effects of incremental inhalation periods of an air-NO mixture at different concentrations (10, 20, and 40 ppm), and compared them with those of an acute infusion of prostacyclin (PGI2). An individual pulmonary vasodilator response was defined by a fall in total pulmonary resistance (TPR) > or = 30% relative to mean TPR baseline value. Thirteen patients were responders and 22 were nonresponders to both drugs, and they did not significantly differ in overall baseline characteristics except for mean right atrial pressure (p < 0.03). In responders, both drugs produced similar individual vasodilator response. Changes in mean pulmonary arterial pressure and TPR observed during NO and PGI2 were closely correlated (r2 = 0.9, p < 0.001, and r2 = 0.7, p < 0.01, respectively). The vasodilator response to NO was not concentration-related with a maximal effect obtained at 10 ppm. Combination of both drugs did not lead to any additive vasodilator response. Unlike PGI2, NO did not induce any systemic effect, no adverse reaction, but a moderate increase in methemoglobin. Inhaled NO at low dose (10 ppm) appears to be an effective, safe, and reliable substitute for PGI2 in screening for acute pulmonary vasodilator responsiveness during therapeutic assessment of patients with PPH.
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Affiliation(s)
- O Sitbon
- Service de Pneumologie et Réanimation, Hôpital Antoine Béclère, Clamart, France
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48
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Denjean A, Guimaraes H, Migdal M, Miramand JL, Dehan M, Gaultier C. Dose-related bronchodilator response to aerosolized salbutamol (albuterol) in ventilator-dependent premature infants. J Pediatr 1992; 120:974-9. [PMID: 1593360 DOI: 10.1016/s0022-3476(05)81973-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.9] [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: 12/27/2022]
Abstract
We used a placebo-controlled standardized protocol to define the dose-response relationship to the beta-adrenergic bronchodilator salbutamol (albuterol) in 10 ventilator-dependent premature infants at a postnatal age of 13.3 +/- 4.9 days. Passive respiratory system resistance and compliance were measured at baseline and 10 minutes after administration of salbutamol via a metered-dose inhaler and spacer device. Salbutamol caused a significant dose-related response with a 33% mean decrease in respiratory system resistance (p less than 0.05) and a 67% mean increase in respiratory system compliance (p less than 0.001). In seven and six patients, respectively, 100 micrograms of salbutamol caused significant improvement in resistance and compliance; 200 micrograms was required in the remainder, but one patient had no improvement in compliance. Oxygen saturation increased linearly with the increase in compliance. In 7 of the 10 infants, the duration of action of 200 micrograms of salbutamol on the following day was 3 hours. We conclude that bronchodilator treatment may be useful in the management of ventilator-dependent neonates with respiratory distress syndrome.
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Affiliation(s)
- A Denjean
- Laboratory of Physiology INSERM CJF 89.09, Clamart, France
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49
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Denjean A, Bridey F, Praud JP, Magny JF, Dehan M, Gaultier C. Accuracy of measurements of HbF with OSM3 in neonates and infants. Eur Respir J 1992; 5:105-7. [PMID: 1374349] [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: 12/26/2022]
Abstract
The accuracy of the Radiometer OSM3 oxymeter for measurement of fetal haemoglobin (HbF) in infants was investigated, and compared to one of the standard reference methods using alkali electrophoresis of haemoglobin. Blood samples of 37 infants with different gestational (27-41 weeks) and postnatal (1-198 days) ages were analysed. The two methods gave very close results but a significant mean difference (range -4.5-16.5%). However, agreement between the two methods was judged clinically acceptable (95% limits of agreement -7.5-15.5%). A rapid determination of HbF percentage, using OSM3, is an important determinant for correct assessment of oxygen saturation in newborn infants in intensive care units.
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Affiliation(s)
- A Denjean
- Laboratory of Physiology, Hospital Antoine Béclère, Clamart, France
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50
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Denjean A, Bridey F, Praud JP, Magny JF, Dehan M, Gaultier C. Accuracy of measurements of HbF with OSM3 in neonates and infants. Eur Respir J 1992. [DOI: 10.1183/09031936.93.05010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The accuracy of the Radiometer OSM3 oxymeter for measurement of fetal haemoglobin (HbF) in infants was investigated, and compared to one of the standard reference methods using alkali electrophoresis of haemoglobin. Blood samples of 37 infants with different gestational (27-41 weeks) and postnatal (1-198 days) ages were analysed. The two methods gave very close results but a significant mean difference (range -4.5-16.5%). However, agreement between the two methods was judged clinically acceptable (95% limits of agreement -7.5-15.5%). A rapid determination of HbF percentage, using OSM3, is an important determinant for correct assessment of oxygen saturation in newborn infants in intensive care units.
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