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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]

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]