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Allergy is a hypersensitivity reaction induced by immunological mechanisms. In asthma, allergy has a complex role and is usually IgE mediated. Allergy must be evaluated during the work up but evidence of IgE sensitivity does not mean that allergens play a role in the pathophysiology of the disease. The clinical relevance of the sensitivity has to be considered. This paper describes current available tools to screen for IgE sensitivity, allergen exposure and their role in asthma., (Copyright © 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: This paper reports the French data from a post-hoc analysis of the international IDEAL study, which aimed to describe a recent cohort of patients with severe asthma, the impact of the disease on quality of life, as well as the population of patients eligible for treatment with omalizumab, mepolizumab and reslizumab., Methods: Eligible patients were≥12 years of age, with severe asthma (GINA steps 4 and 5)., Results: A total of 129 patients were included in this post-hoc analysis. Their mean age was 53 years, the majority were overweight, they were mainly women (64%) and had at least one medical comorbidity (85%). More than half had suffered from asthma for more than 25 years and were non-smokers. Lung function was moderately impaired. Blood eosinophil count was≥150 cells/μL in 66% of patients,≥300 cells/μL in 34% of patients, and≥500 cells/μL in 12% of patients. One out of three patients was currently treated with omalizumab and 24% had maintenance oral corticosteroids. Asthma was poorly controlled with a negative impact on quality of life (ACQ≥1.5) in 67% of patients. In this population 40% of patients were eligible for omalizumab, 27% for mepolizumab and 2% for reslizumab., Conclusions: These findings show that a considerable proportion of patients with severe asthma remain uncontrolled and are not eligible for any of the available biological treatments. This underlines the need for therapeutic innovations in this disease., (Copyright © 2018. Published by Elsevier Masson SAS.)

Rhinitis and asthma are common diseases that are strongly linked from both the epidemiological and patho-physiological point of view. A precise aetiological diagnosis is required in order to optimize treatment. Nasal provocation tests (NPT) determine precisely the role of the allergen in the initiation of the symptoms of rhinitis particularly when the history does not produce convincing evidence of the clinical relevance of an allergen. It may also have important consequences for the choice of an allergenic immunotherapy. NPT are not standardized but simple methods based on international recommendations provide us with good diagnostic accuracy. In this paper, we will discuss the practical aspects of NPT as well as the clinical or research situations where they may be useful for the respiratory physician., (Copyright © 2018 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Perthes syndrome, or traumatic asphyxia syndrome, is a rare clinical entity, associating cyanosis, cervicofacial petechiae and subconjunctival hemorrhage. It is usually secondary to chest trauma, but can occur in any situation of abrupt rise in intrathoracic pressure with closed glottis. In this paper, we present a case of Perthes syndrome that triggered an asthma attack for a child during surgery., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Copyright of Environnement, Risques & Santé is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Asthma is a chronic inflammatory disease of the airways. The recent increase in its global prevalence suggests a possible role of environmental factors such as indoor air pollution. In 2000, according to the Institute Of Medicine, there was insufficient evidence to determine whether or not an association existed between high priority indoor air pollutants, listed by the French Indoor Air Quality Observatory, and asthma. The objective of this paper is to describe the current state of knowledge on the links between exposure to high priority indoor air pollutants and exacerbations of adult asthma., Method: A review of the Medline database has been undertaken of the following pollutants: formaldehyde, benzene, acetaldehyde, volatile organic compounds, particles (PM2.5, PM10) and diethylhexyl-phthalate. The studies were classified by type and source of pollutant., Results: Twenty-three studies were included in the analysis. Most of the observational studies have shown an association between pollutants (by type and source) and adult asthma. The best documented pollutants were formaldehyde and volatile organic compounds. No studies were found on acetaldehyde and diethylhexyl-phthalate., Conclusion: The analysis of the literature is complicated on account of the difficulty of comparing different studies. However, since the synthesis performed in 2000, the existence of a link between chemical indoor air pollutants and increased respiratory symptoms appears to be reinforced. It seems necessary to adopt preventive health measures while pursuing scientific research on this topic., (Copyright © 2013 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Allergic diseases represent a major health problem in Europe. They are increasing in prevalence, severity and costs. GA2LEN (Global Allergy and Asthma European Network), an FP6 Network of Excellence, was created in 2005 as a vehicle to ensure excellence in research bringing together research and clinical institutions to combat fragmentation in the European research area and to tackle Allergy in its globality. GA2LEN benefited greatly from the voluntary efforts of researchers who are strongly committed to this model of pan-European collaboration. The network was organized in order to increase networking for scientific projects in allergy and asthma around Europe and to make GA2LEN the world leader in the field. Besides these activities, research has been jointly made and the first papers are being published. GA2LEN achievements in general can be grouped as those for a durable infrastructure built up during the project phase those which are project-related work based on these novel infrastructures, and the development and implementations of guidelines. The major achievements of GA2LEN are reported in this paper.

In France, an annual seasonal influenza vaccination has been recommended since 2000 for patients suffering from chronic respiratory diseases, including asthma. Each year, a free influenza vaccination voucher is sent by the French Public Health Insurance authorities to patients with chronic respiratory disease, including severe asthma. In November 2006, this measure was extended to all asthmatic patients, irrespective of asthma severity. The present paper examines the 2006-2007 influenza vaccination coverage rate in 433 asthmatic children aged six to 17 years (mean age: 9.5 years; male: 61%) who consulted a pediatric pulmonologist between March and September 2007 in eight hospitals throughout France. The influenza vaccination coverage rate was 15.7% for the 2006-2007 season (13.9% for the 2005-2006 season and 10.9% for the 2004-2005 season). General practitioners vaccinated 72.1% of the children. Lack of information (42%) was the most frequently reported reason for non-vaccination. Free vouchers (received by 39.6% of the children) significantly increased the vaccination coverage rate (31% versus 5.9%; p < 0.001). In France, in 2006-2007, the influenza vaccination coverage rate in asthmatic children was far below the national public health objective to achieve for the year 2008 (at least 75%). Concerted action is needed to improve the influenza vaccination coverage rate in asthmatic children.

Background: The atopic family transmission is the topic of many studies. In addition to the allergy total transmission, which is well established, it seems that atopic organ manifestations and their gravity are family transmitted. To our knowledge, very few authors studied the specific transmission of allergen sensitizing., Aim: The aim of this paper is to study the specific family transmission of atopic organ manifestations and allergen sensitizing, in Tunisian families., Methods: 659 supposed allergic Tunisian families are studied, which include 1494 patients, 444 parents and 1050 children, consulting for rhinitis and/or asthma. All patients were submitted to a family investigation and had an allergologic check including skin prick test., Results: We highlighted a transmission of the allergy according to the body between parents and their children. Asthma is more transmitted by the mother (p = 0.002) than by the father (p = 0.05). However, rhinitis is transmitted only by the father (p = 0.03). There is no significant concordance neither for asthma nor for rhinitis between children. Concerning the transmission of the allergenic sensitivity, our study doesn't show a statistically significant concordance between parents and children and between children., Conclusion: These results confirm the atopic family transmission of the symptoms especially between parents and children. It doesn't seem to exist of hereditary factor concerning the sensitizing allergen.

Asthma is an inflammatory disease of the airways, for which many therapeutic options are available. Guidelines for the management of asthma suggest a stepwise approach to pharmacotherapy based on assessment of asthma severity and control. However, the assessment of asthma control presently relies on surrogate measures, such as the frequency of symptoms or the frequency of use of short-acting beta2-adrenergic agonists. There is no simple, noninvasive technique for the assessment of severity of actual airway inflammation in asthma. The collection and analysis of nitric oxide (NO) levels in exhaled breath has recently become feasible in humans. Based on increased exhaled NO (eNO) levels in patients with asthma, eNO analysis has been proposed as a novel, noninvasive approach to the assessment and monitoring of airway inflammation, and as a basis for adjustments in asthma therapy. In the present paper, the relationship of elevated eNO levels in asthma with inflammatory, physiological and clinical markers of asthma in adults was reviewed. Use of eNO is a promising tool for diagnosing asthma, for monitoring asthma control and for guiding optimal anti-inflammatory asthma therapy. However, because of many unresolved questions, eNO cannot be recommended at present for routine clinical management of adults with asthma.

This article presents many products used against asthma since half of 19th century, until they've been took off from the market, in 1992. Thoses products were used in fumigation or inhalation, without any complex machine. They were powders, impragnated papers, cigares an cigarets. They contained more often nitrates and Solanacées. An exemple of struggle between two specialities is studied: Cléry's powder against Exibard's powder.

The increase in asthma prevalence over the past 20 years could be due to modification of exposure to environmental factors (environmental theory) or to the lost of protective factors (hygienist theory). Among environmental factors this paper reviewed the controversial role of exposure to house dust mite (HDM). If exposure to HDM is deleterious in asthmatics known to be sensitised to this allergen, the effect of HDM exposure on asthma incidence has been challenged recently, based on longitudinal studies showing no correlation between level of exposure to HDM and asthma incidence. Exposure to animal dander may have protective effects. This review has shown that, even if some studies have shown potential protective effect of early exposure, the protection seems to be better in families with a low risk of atopy; almost all studies tend to show a deleterious effect of current exposure; exposure to dog dander may be more protective than cat. These studies cannot give definite conclusions to change current advices of early eviction of HDM and animal dander, especially in families with a high risk of atopy. The deleterious effect of passive smoking on asthma prevalence and severity is undisputable and our efforts should concentrate on obtaining effective eviction of passive smoking.

Asthma exacerbations constitute a common medical emergency, which in the past has been shown to be poorly managed. Although its management has recently improved, it remains suboptimal. For instance, acute life-threatening asthma is still responsible for 2000 death each year in France. More than two thirds of deaths should be avoided by a prompt and adjusted treatment. Initial assessment of the severity of the exacerbation is fundamental. The clinical story, physical examination and objective measurement of airflow obstruction by peak flow meter should permit to quickly establish an adapted treatment. The aim of this paper is, once general considerations about clinical approach and currently used treatments have been made, to propose a home and a hospital-based management of the asthma exacerbations.

Introduction: The aim of this cohort study was to describe the evolution of recently diagnosed (<12 months) asthma, and to identify outcome predictive factors. This paper describes the evolution of an adult cohort and the factors related to asthma severity and control., Methods: In 1995, 251 chest specialists from throughout France, recruited 347 asthmatic adults (subjects with severe asthma were excluded). 220 eligible patients were examined every four months over a three year period. Data (socio-demographic characteristics, asthma history, results of atopy testing and lung function tests, treatment, drug compliance, respiratory infections, changes in lifestyle and environment, and major life events) were collected by means of detailed standardised questionnaires completed by physicians. Asthma severity, recorded one year after study inclusion, and asthma control, assessed at each follow-up visit in the second and third year, were defined according to the international guidelines., Results: The clinical status of these adult patients generally improved rapidly. Asthma severity correlated closely with allergy, with a history of childhood asthma and with sensitisation to indoor allergens. After adjusting for severity, poor asthma control was associated with poor compliance, with respiratory infections, and, to a lesser extent, with animals inside the home., Conclusions: This cohort study highlights the association of asthma severity with allergy, and of poor asthma control with poor compliance and respiratory infections.

This paper illustrates the principles of construction and validation of an epidemiological questionnaire by using various aspects of the questionnaire prepared for the Epidemiological Study of the Genetic and Environmental Factors in Asthma, Bronchial Hyper-responsiveness and Atopy (EGEA). Standardised international questionnaires (for adults and children) were adapted and augmented for the requirements of the study. New areas in relation to international epidemiological studies are described (detailed descriptions of asthma and allergic rhinitis, trigger factors exposure tovarious environmental factors and family history). Various aspects of validation are discussed: the acceptibility by the study of missing data in the description of asthmatic symptoms, the construct validity for a score for allergic rhinitis, the reliability of a new self-administered questionnaire for perceived hyper responsiveness to various stimuli and the validity of reported family history using information obtained from family members. Some of these elements could be used in the context of other clinical and epidemiological studies. The complete questionnaire, together with the source of the questions, instructions for interviewers and the method of coding are presented in an appendix available on the internet (http://www.splf.org/bbo/revues-articles/RMR/depotElectronique/2001-110&#95;Kauffmann/Kauffmann2002.htm) which supplements the printed paper.

Purpose: The paper describes the clinical characteristics of patients with aspirin-induced asthma and/or urticaria, angioedema, shock, the results of the challenge tests and the evolution of this disease., Main Point: The authors present the different arguments supporting the physiopathological mechanisms from genetics to the inhibition of cyclooxugenase or the leukotriene hypothesis., Prospectives: Finally, they recall the methodology to be used for a good clinical practice on this controversial field of research.

Exposure to allergens could be either a risk factor of sensitization and nonspecific hyperresponsiveness in genetically predisposed patients or a risk of onset of asthma attack in certain allergic asthma. During the past 20 years, in western countries the houses have become higher and the number of furred pets have increased and have been more kept inside the house which makes probable that exposure to indoor aeroallergen has increased. The development of new methods of allergen measurements allows a more precise identification of allergen source and reservoirs, an assessment of allergen exposure and a monitoring of allergen eviction methods. Concerning mite allergens, controlled studies which showed a clinical efficacy are those with a global mite eviction and at least a 6 months follow-up for cat and dog allergens, high efficiency-filters air cleaners or vacuum-cleaners are able to reduce airborne cat or dog allergen levels. According to the increasing number of papers about allergen eviction, it seems logical to propose allergen eviction as "first line treatment" of allergic asthma. In the future, it would be interesting to develop biological markers to identify more accurately patients who have a clinical improvement after allergen eviction.

A Meta-analysis was conducted on 107 original epidemiological papers published between 1980 and 1993 on the respiratory health impact of suspended particles, sulfur dioxide, ozone and nitrogen dioxide. These are the usual air quality indicators that are monitored in urban ambient air. The range of exposures that were studied (averages and 90th percentiles are respectively up to 88, 83, 124 and 53 mu/m3 (averages) and 180, 147, 234 and 131 micrograms/m3 (90th percentile) for each of the four pollution indicators) allowed assessment of dose-response functions for irritative pulmonary conditions (cough and/or asthma episodes) and respiratory function (FEVI and peak expiratory flow). The dose-response functions seem linear in the range of observed concentrations, with nitrogen dioxide showing the least consistent association across different health indicators. When applied to exposures measured as a 100 micrograms/m3 increase of pollutant's concentrations compared to low background values, the average relative risks of airway irritation (cough and/or asthma épisodes) range, according to the pollutant, from 1.08 to 1.47; average relative decreases of respiratory function amount to 1.1 to 2.2%. The effects are most often stronger among young subjects. The results of this study, when applied to air pollution concentrations in the range of values that were observed in this study, should foster health risk assessment studies in places where population air pollution exposures are available.

The key issue in asthma research is allergen capture and presentation. An increase in understanding in this area may result in the development of new types of therapeutic drugs, although at present there remain a number of points to be elucidated. In this paper, we review recent research in this field. Allergens are small air-conducted soluble antigens which are capable of inducing a specific immune response characterized by a significant synthesis of IgE. The allergen passes through the bronchial epithelium and specialized antigen presenting cells (APC) capture and present the antigen to T-cells, causing their activation via an interaction with class II MHC molecules on the APC. Allergens are also capable of activating other cell types and the subsequent release of inflammatory mediators, chemoattractants and cytokines may result in bronchial inflammation which is one of the cardinal signs of asthma.

Respiratory acidosis of severe acute asthma is a severity factor. In this paper the treatment of associated metabolic acidosis is discussed. Among 34 consecutive episodes of severe acute asthma with acidosis (pH < 7.35) treated with continuous adrenaline perfusion, theophylline and hydrocortisone hemisuccinate, respiratory acidosis was observed in 12, metabolic acidosis in 2 and mixed respiratory and metabolic acidosis in 20. The association of hypercapnic acidosis with hypochloraemic acidosis reflected a time of installation longer than when respiratory acidosis only was present (p < 0.05). Among the 22 patients who had metabolic acidosis on admission, 14 were treated with 168 +/- 82 mmol of sodium bicarbonate, the remaining 8 patients being untreated and acting as controls. The rapidity with which pH was corrected was the same in the treated and untreated groups (9.1 +/- 5.5 hours vs 6.7 +/- 3.7 hours), whereas dyspnoea (respiratory rate < 18/min) was more rapidly corrected in the treated group that in controls (11.6 +/- 5.7 hours vs 5.9 +/- 5.9 hours; p < 0.05). It is concluded that in more than 50% of the cases respiratory acidosis of severe acute asthma is associated with a metabolic acidosis. Correcting this metabolic acidosis with sodium bicarbonate results in improvement of respiration, perhaps by facilitating the action of bronchodilator catecholamines.

We report a case of isocyanate induced asthma in a patient who had been previously exposed to isocyanate and had become a porter in a factory producing polyurethene foam. The test for exposure to TDI was positive. The recognition of occupational asthma was nevertheless challenged and the patient was not considered to be carrying out work involving exposure to the inhalation of isocyanates. The effect of a change of job in the development of occupational asthma, and the risk of asthma induced by isocyanates despite inhaled concentrations inferior to the VME, the difficulty of obtaining a recognition of occupational asthma when the working conditions fulfilled do not exactly correspond to those labelled in the schedule for occupational diseases, are discussed in this paper.

Some important pharmacodynamic and clinical data on ketotifen, a benzocycloheptathiophene used in the prophylaxis of allergic asthma, are provided as an introduction to papers discussing the therapeutic use of this substance in adults and children. Ketotifen, which is active when administered orally, has a therapeutic efficacy comparable to that of cromoglycate but characterized by a somewhat different mechanism of action. The therapeutic efficacy of ketotifen appears to be associated with a progressive diminution of bronchial hyper-reactivity to various specific or nonspecific spasmogenic factors (allergens, histamine, exercise). An antagonistic action to, and an inhibitory effect on, the activation and release of the principal mediators of anaphylactic hypersensibility (SRS-A, histamine) have been demonstrated in several experimental models both in animals and in man.

The present paper studies in asthmatic patients the variations of the plasmatic levels of cAMP and cGMP as control of an eventual adrenergic beta receptors trouble. The first part includes the study of relations of the plasmatic level of nucleotides with the parameters: age, sex, time of sampling in a population of normal subjects (n = 91) and asthmatic patients (n = 203). There is a significant correlation between the age and the level of plasmatic cAMP in normal subject (r = 0.63) as well as in asthmatic patients (r = 0.73). Age for age, there is no difference between the plasmatic levels of controls and the asthmatic patients. The cGMP level is stable, identical in asthmatic (18 p mu +/- 1.74/ml) and in normal subjects (16.84 p mu +/- 2.77 p mu/ml). No nycthemeral rhythm has been revealed. The second part examines the variations of plasmatic levels of cyclic nucleotids during pharmacodynamic assay: methylcholine, beta blocking drugs, spray and subcutaneous sympathomimetics, corticotherapy. No variation of cAMP and cGMP was shown after inhalation of methylcholine or injection of beta blocking drugs able to induce or to reveal a bronchospasm. On the other hand the sympathomimetic drugs, whatever mean of introduction, bring a significant increase of the average level of cAMP going from 40 p mu/ml +/- 5.09 to 101 p mu/ml +/- 4.67 in healthy subject and of 49.42 p mu/ml +/- 10.10 to 74.38 p mu/ml +/- 13.7 in asthmatic patients. The difference in variation amplitude between asthmatic and control subjects is significant, the asthmatic patients responding less to a beta adrenergic stimulation. The plasmatic cGMP remains unchanged during the assay. Corticotherapy does not modify the initial level of cAMP but restores the response to a beta adrenergic stimulation. Inhalation of cAMP dibutyryl restores the bronchial permeability. The study of the variations of plasmatic levels of cAMP reveals a hyposensitivity of the whole of beta adrenergic receptors in asthmatic patients. The former varies in time and can be normalized either spontaneously or by corticotherapy.

This paper is concerned with the induction of experimental allergic asthma by active sensitization of the airways "vis-à-vis" heterologous protein. Thus in the rodent it is possible to sensitize the airways by direct intra-tracheal injection of the allergen without producing an allergic alveolitis; the concomitant injection of an adjuvant is however indispensable. Confirmation of the sensitized state can be made by in vitro measurements of isometric contraction of tracheal smooth muscle in the presence of the allergen. This active sensitization is accompanied by histocytological changes which are detected by immunomorphological techniques: the rise in the number of plasma cells sensitized to IgE in the mediastinal modes: the appearance (or increase in number) of intra-cytoplasmic IgE in the sub-epithelial tracheal mast cells and in certain non ciliated intra-epithelial cells, probably basophils, morphologically close to the mast cells.

The fiberoscope has widened the applications of bronchial endoscopy, facilitated intrabronchial exploration (including bronchiolo-alveolar lavage) and made it feasible to investigate asthmatic patients. In this paper, the authors compare intra-bronchial findings in 34 patients with allergic asthma explored between attacks and in a control group. In all cases, both endoscopy and bronchiolo-alveolar lavage were well tolerated. The bronchi were normal in only 7 patients; the remaining 27 patients had evidence of mucosal changes and hypersecretion. No definite cytological pattern of allergic asthma could be established from cells removed by lavage. The mean total number of cells was the same in patients as in controls. There were individual variations in the number of lymphocytes, but patients with severe asthma had significantly more lymphocytes than those with mild asthma (p less than 0.02). Eosinophilia was common (28/34) but was more pronounced in patients than in controls (p less than 0.01). Patients also had more free mast-cells likely to release histamine in the presence of allergens.

In this review paper the authors describe the reasons, sometimes complex, which have given birth to such myths as the abuse of beta 2-stimulants generating status asthmaticus, or patients developing clinical tachyphylaxis to this type of drug. While there is no solid ground to believe that beta 2-stimulants can be blamed for the overmortality due to asthma, and while the indications of beta 2-stimulants delivered by metered-dose aerosols can be extended to chronic asthma, it is still necessary to apply certain safety rules when these drugs are inhaled in high doses or given parenterally. Some patients must be encouraged to use inhaled beta 2-stimulants prophylactically, sometimes combined with cromolyn or inhaled corticosteroids, but these patients, their relatives and their doctor should be taught to evaluate lung function by means of a peak-flow meter. A lack of response to beta 2-stimulants must be taken as a warning that systemic corticosteroids and in some cases admission to hospital are needed.

This paper summarizes the results of a longitudinal study on young asthmatic children and particularly on the mother-child relationship in this illness: At both observation times--14 to 30 months and 4 to 6 years--the majority of the children appeaed to be developing in a very adequate manner, both in the area of autonomy and opposition. Similarly, in most situations, the mothers appeared quite adequate in the face of their child's illness, and mother-child relationships, generally, seemed harmonious. However, a certain vulnerability in the area of opposition was more marked in a few cases, more frequently between 4-6 years than between 14-30 months. The author attempts a brief history of the development of the concept of the "bad mother" who has become a scapegoat not only in childhood asthma but also in many illnesses encountered in child psychiatry. In questioning the role which may have been played by dynamic theories in this evolution, psychoanalytic writings are reviewed (for example, S. Freud, M. Klein, Spitz, Brody) and it is hypothesized that psychoanalytic theory has had more of a catalytic than a causal influence in relation with a strong tendency in our culture to the eclosion of negative attitudes toward the mother in her relationship with her child. The emphasis placed by North American culture on the nuclear family, the hypertrophy of the maternal function coupled with a paternal role much reduced in time, as well as the almost complete disappearance of maternal substitutes, have all probably greatly influenced the development of this concept of the "bad mother". The author notes however, that happily, in recent years some child development theories insist on the concept of mother-child interaction and on the mutual role that mother and child have on one another in their exchanges. A review is made of the work of Sander, Bowlby, Schaffer, Lewis and Rosenblum which demonstrates this new trend. The author also studies the question of vulnerability within parent-child relationships, leading to the appearance of child psychopathology, and discusses the development of methods which could help in its early detection. Recent attempts in this direction are reviewed, particularly those of Broussard, Gray et al., Lézine. The importance of Thomas and Chess' work is particularly underlined, which emphasizes the specific interaction between the temperamental characteristics of the child and the parents' specific responses to them, at all levels of development. More recent studies by Brazelton et al. and by Korner are also reviewed, suggesting a very early interaction between mother and child. The author concludes by briefly developing the preventive implications of these works and stressing the importance of closely following the efforts made at pre- and post-natal levels which may have much influence in the early prevention of psychopathology in parent-child relationships.

In the absence of any satisfactory immunological criteria an objective assessment of the results of desensitization in asthma largely rests on clinical criteria. The use of clinical criteria themselves runs into many difficulties, some of which are inherent in the nature of asthma (chronic cause, temporary variations, variations according to the allergen responsible, the association of non-specific factors to specific allergic factors) and others result from the individual characters of the asthmatic under-study. The assessment of the results of desensitization should not rest solely on the observations of the patient and physician. A clinical score can be gathered thanks to a daily diary card. A drug score can be assessed by a daily record of the amount of medication used. The recording of peak flow in spite of its imperfections is particularly well suited to multiple daily measurements of airflow obstruction. The paper work generated by the daily diary cards can be computerised. A study of the correlations existing between the different daily scores recorded shows, that the selection of patients for a trial of desensitization should be carried out over a long enough period to enable non compliant patients to be discarded namely those patients without any good correlation between the symptoms and functional score. Another approach to assessing the efficacy of desensitization is the study of changes in bronchial provocation tests to allergens; these depend on a good reproducibility of the immediate and delayed responses to allergens in each subject at different times.

Abstract: Asthma morbidity and mortality have increased over the last ten years in most countries. In some countries now, it apears that asthma prevalence has reached a plateau. The increased prevalence, especially in children, should be explained by environnemental factors, since obviously our genes have not changed. In this paper, we will review the recent data concerning asthma prevalence, mortality, socio-economic impact and both environnemental and genetic risk factors. [Copyright &y& Elsevier]

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Abstract: Recurrent respiratory tract infections are a common reason for visits to primary care practitioners or hospital physicians. They are placed at the junction of several medical specialities: paediatrics, ENT, pneumology, allergology, immunology, infectiology. The great diversity of the laboratory tests requested and on the other hand the proposed treatments, are the consequences of the diversity of the patients encountered and the paucity of the evidence based-medicine studies in this setting. The dilemma is how to identify the child for which recurrent respiratory tract infections are the witness of underlying condition, without performing repeated medical examinations, laboratory tests and treatments for normal children for which immunologic development occurs normally. The essential tools are the history analysis, physical examination and few laboratory tests. The other questions are how to include, for these patients, influenza and pneumococcal vaccines in the immunization program and how to assess the benefit/risk ratio and the cost of surgical treatments. This paper presents the thought of an expert group trying to define the situations where biological tests or treatments are useful. [Copyright &y& Elsevier]

Abstract: If it can be confirmed that variations in the level of nitric oxide (NO) in expired air tells us something about the different physiological processes in which this molecule is involved (bronchomotor, vasomotor, immunoregulation), then we will have available a non-invasive technique that would be useful in conditions as varied as asthma, sickle cell anemia, mucoviscidosis and pulmonary arterial hypertension. This technique can be used routinely to the analysis of the concentration of NO in a single expired breath. However, analysis of the concentration of NO in several expired breaths, which is possible from the age of 8–9 years, also makes it possible, using a method that is now standardized, to determine the bronchial production of NO and its alveolar concentration, thus providing a method for differentiating the respective contribution of these two compartments. Other techniques now being developed should soon allow us to calculate even more precisely events during normal ventilation, which will then allow us to make these measurements in babies, in young children, and in patients on artificial ventilation. The aim of this present paper is to discuss the theoretical basis and the techniques of these different approaches. [Copyright &y& Elsevier]

During the last two decades, quality of life (QOL) has been perceived as an innovative indicator of patients’ self-perceived health status, allowing integration of a qualitative approach in medical decision-making. This is evident from the number of publications related to this topic: during the three decades between 1973 and 2002, 1124 papers dealing with QOL in asthma were cited in Medline, 85% having been published during the last 15 years and 65% during the last 5 years. A number of reasons can be given for the interest in this subject: the limitations of traditional indicators of health outcomes, the evolution of the relationship between patients and physicians, the rationalisation of health care expenditures, the increasing importance of health care interventions, and also the desire to keep up with the fashion. The medical community at large has been trying to define QOL, how to measure it, looking at the available instruments and how to use them; this is also true for allergy. Of the 1124 publications cited above, only 41 (3.5%) were written in French. We point out that QOL is a measurable concept, that it is based on a subjective approach and that it has numerous applications. Nevertheless, for a wider use in France, especially in allergy, decision makers must make it a key issue before clinicians are going to understand QOL and make full use of questionnaires used to measure it. [Copyright &y& Elsevier]

In this paper, special consideration will be given to the following points:

The efficacy of drug therapy in asthma varies widely between patients. Inter-subject variability may be due to environmental factors, differences in patient compliance, biological variations involved in the mechanisms of the disease or in the mode of action of drugs, some of which may be genetic in origin. The study of genetic factors determining treatment response to a given drug defines pharmacogenetics, a science in its infancy at the dawn of this new millennium. In asthma, a comprehensive screen of genes likely to be important in determining treatment response has not yet been performed. This paper will review the recent data regarding two good examples of polymorphisms apparently determining treatment response to two classes of drugs, the β2-agonists and the anti-leukotrienes. [Copyright &y& Elsevier]

Copyright of Journal de Pharmacie Clinique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Therapeutic Patient Education / Éducation Thérapeutique du Patient is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)