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International audience; Background In allergic bronchopulmonary aspergillosis (ABPA), prolonged nebulised antifungal treatment may be a strategy for maintaining remission. Methods We performed a randomised, single-blind, clinical trial in 30 centres. Patients with controlled ABPA after a 4-month attack treatment (corticosteroids and itraconazole) were randomly assigned to nebulised liposomal-amphotericin-B or placebo for 6 months. The primary outcome was occurrence of a first severe clinical exacerbation within 24 months following randomisation. Secondary outcomes included the median time-to-first severe clinical exacerbation, number of severe clinical exacerbations per patient, ABPA-related biological parameters. Results Among 174 enrolled patients with ABPA from March 2015 through July 2017, 139 were controlled after 4-month attack treatment and were randomised. The primary outcome occurred in 33 (50.8%) of 65 patients in nebulised liposomal-amphotericin-B group and 38 (51.3%) of 74 in placebo group (absolute difference −0.6%, 95% CI −16.8% to +15.6%, odds ratio 0.98, 95% CI 0.50 to 1.90; p=0.95). The median time-to-first severe clinical exacerbation was longer in liposomal-amphotericin-B group, 337 days (IQR, 168 to 476) versus 177 (64 to 288). At the end of maintenance therapy, total immunoglobulin-E and Aspergillus precipitins were significantly decreased in nebulised liposomal-amphotericin-B group. Conclusions In ABPA, maintenance therapy using nebulised liposomal-amphotericin-B did not reduce the risk of severe clinical exacerbation. The presence of some positive secondary outcomes creates clinical equipoise for further research.

Une erreur s’est glissée dans l’orthographe du nom de l’auteur G. Ferretti.; National audience

Introduction Placing a patient on the national lung transplant waiting list remains a difficult matter, and is more a question of timing than selection of the candidate according to disease-specific criteria. Back-ground The listing criteria for cystic fibrosis are FEV1 less than 30% of the predicted value, hypoxaemia with a PaO2 less than 55 mm Hg and hypercapnia with a PaCO2 over 50 mm Hg. The rate of decline of FEV1, increasing antibiotic requirements and life threatening complications can all accelerate the listing procedure. For primary pulmonary hypertension the criteria are persistent dyspnoea, NYHA grade III or IVA, despite epoprostenol treatment and a 6 minute walk test of less than 250 metres. Sarcoidosis, lymphangioleiomyomatosis, histiocytosis X and connective tissue diseases are rare indications for which the listing criteria are similar to those for the more usual respiratory diseases. View points Further therapeutic advances, increased numbers of available organs and changes in the allocation rules will necessitate periodical updates of these selection and listing criteria. Conclusion The optimal time for placing lung transplantation patients who have been referred early in the course of their disease on the waiting list will be determined by clinical experience and individual patient follow-up., Introduction L’inscription d’un patient sur la liste nationale d’attente de transplantation pulmonaire reste une question délicate non tant par les critères de sélection des candidats que par le choix du moment. État des connaissances Les critères d’inscription pour la mucoviscidose sont définis par un VEMS inférieur à 30 % de la valeur théorique, une hypoxémie inférieure à 55 mmHg et une hypercapnie supérieure à 50 mmHg. La vitesse du déclin du VEMS, l’antibiodépendance et une complication mettant en jeu le pronostic vital accélèrent l’inscription. Les contre-indications restent relatives. Ceux de l’hypertension artérielle pulmonaire sont une dyspnée stade III ou IV NHYA persistante après traitement par époprosténol et un périmètre de marche inférieur à 250 mètres. La sarcoïdose, la lymphangioleïomyomatose, l’histiocytose et les connectivites sont des indications rares dont les critères d’inscription rejoignent ceux des autres pathologies respiratoires plus classiques. Perspectives Les innovations thérapeutiques, l’augmentation des greffons disponibles et les changements des règles d’allocations des greffons devront faire réévaluer les critères de sélection des patients et d’inscription sur la liste d’attente. Conclusion L’expérience clinique et le suivi de chaque patient restent des éléments primordiaux pour juger du moment opportun d’inscription sur liste de transplantation de patients adressés suffisamment tôt aux centres spécialisés.