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Association of asthma with myasthenia gravis presents a twofold peculiarity. First, as dyspnea characterizes both conditions, diagnostic orientation is difficult. Second, from a therapeutic standpoint, the initiation of anticholinesterase treatment requires a multidisciplinary approach due to possible contraindication for asthma. We report on the case of a patient monitored for severe asthma and treated with biotherapy, and also monitored for myasthenia gravis, and treated with anticholinesterase.

Pneumoconiosis is defined as a diffuse interstitial lung disease secondary to inhalation of mineral particles. Haemoptysis is common in pneumoconiosis. But it is usually secondary to bronchiectasis, bronchitis or pulmonary tuberculosis occurring with silicosis.A 74-year-old Portuguese man, known to have chronic respiratory failure secondary to chronic silicosis, was treated for moderate haemoptysis. CT angiography revealed bilateral fibrosing peri-hilar masses, inferior lobe nodules and previously known mediastinal lymphadenopathy, without active bleeding. Fibreoptic bronchoscopy showed an anthracotic appearance with lesions typical of silicosis on pathological examination of trans-bronchial biopsies and needle aspiration of mediastinal adenopathy by endobronchial ultrasound.After a full aetiological assessment, no cause other than silicosis has been identified. Haemoptysis is frequently observed in silicosis, but it results from silicosis complications. It is not a classic complication of isolated silicosis.

Data on severe asthma in France are scarce. The aim of this study was to evaluate adherence to asthma treatments and its determinants in a population of severe asthmatics.From May 2016 to June 2017, the French Collège des Pneumologues des Hôpitaux Généraux organized a large-scale prospective, cross-sectional, multicenter study on this topic; 1502 patients with severe asthma were included.The average number of substantive treatments was 2.5±1.1. Assessed by self-questionnaire in 1289 patients, overall adherence was 64.8%, in good agreement with the findings of the pneumologist in charge (p0.0001). Control of asthma according to the GINA criteria was more successful in compliant patients (p0.01). In univariate analysis, the most compliant participants were frequent exacerbator patients (p=0.02), those with nasal polyposis (p=0.01) and those receiving an anticholinergic agent (p0.01), anti-IgE biotherapy (p0.0001) or oral corticosteroids (p0.01). The least compliant participants were younger (p0.0001), active smokers (p0.001), with shorter average disease duration (24.2±15.7 vs 29.1±18.7 years, p0.0001) and a lower number of substantive asthma treatments (2.2±1 vs 2.6±1, p0.0001). In multivariate analysis, age, length of disease and anti-IgE treatment were the only factors affecting therapeutic compliance.In this large-scale study of severe asthmatic patients, 64.8% were compliant according to the MMAS-4© self-administered questionnaire and appeared to be better monitored according to the criteria defined in our study. Overall, adherence was more satisfactory among older patients and those whose disease had been evolving over a long period of time or were receiving anti-IgE biotherapy.

Endobronchial hamartochondroma is a rare benign tumor which differs from the parenchymal form in its symptomatology and also by its treatment which should be as conservative as possible. The endobronchial location is exceptional. Here we present the cases of two patients with endobronchial hamartochondroma associated with clinical manifestation, chest pain and repeated pulmonary infections, respectively. The diagnosis was made after performing a CT-scan, a PET-SCAN and histological analysis. After discussion in a multidisciplinary staff meeting, conservative treatment was chosen in both cases.

Data on physical activity in severe asthma are scarce. From May 2016 to June 2017, 1502 adult patients with severe asthma visiting a pulmonologist practicing in one of the 104 non-academic hospitals participating in the study were included in this prospective, cross-sectional, multicenter study, provided they gave consent. Physical activity was classified according to 4 levels: 1 (no activity), 2 (occasional), 3 (regular), or 4 (frequent). Clinical and therapeutic parameters were described according to these levels.Respectively, 440, 528, 323, and 99 patients had physical activity of level 1, 2, 3, and 4. The percentage of patients with controlled asthma increased with physical activity. Treatment adherence did not differ with physical activity. Percentages of obese patients, patients with FEV160%, and patients with anxiety, depressive syndrome, gastro-esophageal reflux disease, arterial hypertension, diabetes, obstructive sleep apnoea-hypopnoea syndrome, and osteoporosis decreased with physical activity. Respiratory rehabilitation was offered to only 5% of patients.In this large study, physical activity is associated with disease control in severe asthma and with less comorbidity. Its practice should be encouraged and respiratory rehabilitation offered more often.

In a woman's life, asthma can affect her in a variety of ways, with the onset of premenstrual asthma currently under-diagnosed. It is estimated that about 20% of women with asthma have premenstrual asthma, which is more common in patients with severe asthma. Women with asthma are at high risk of exacerbations and of severe asthma. Asthma is the most common chronic disease during pregnancy with potential maternal and foetal complications. Asthma medications are safe for the foetus and it is essential to continue pre-existing treatment and adapt it to the progress of asthma during the pregnancy. Sex steroids modulate the structure and function of bronchial and immune cells. Understanding their role in asthma pathogenesis is complicated by the ambivalent effects of bronchodilating and pro-inflammatory oestrogens as well as the diversity of response to their association with progesterone. Menopausal asthma is a clinical entity and is part of one of the phenotypes of severe non-allergic and low steroid-sensitive asthma. Targeted assessment of the domestic and professional environment allows optimization of asthma management.

In patients suffering from chronic obstructive pulmonary disease (COPD), the acceptance of the illness is probably a major factor in the improvement of quality of life. The aim of this study is to identify the criteria associated with a good or bad acceptance of the disease and to identify means of improving it.We have undertaken a telephone enquiry among patients with COPD with the aid of a standardized questionnaire established by several health experts.Of the 1040 patients who have been contacted, 356 (34 %) replied to the questionnaire. Ninety-nine patients reported unacceptance of their disease (28 %). The patients who did not accept their disease were significantly more severe, with more difficulty in performing daily life activities, particularly exercising. These patients had significantly greater difficulty in understanding their disease and also reported more frequently a moralizing attitude among their family.The greater the handicap of the disease, the greater is the difficulty in accepting the disease by the patient. The doctor could have an impact in improving the therapeutic education and involving the family in the patient's care.

Smoking remains common, with an exposure that begins early during pregnancy. It induces epigenetic changes, with a trans-generational transmission. Smoking increases the risk of uncontrolled asthma during childhood and adult life. Asthma is also associated with increased risk of a decline of lung function and chronic obstructive pulmonary disease (COPD). Women are more at risk of developing early and severe COPD. The mechanisms are currently poorly known.

Lyme disease is not uncommon and can sometimes progress to neurological complications. We report here an unusual case of bilateral diaphragmatic paralysis secondary to Lyme neuroborreliosis.A 79-year-old man was admitted to the intensive care unit for acute respiratory distress requiring intubation and the long-term use of nocturnal non-invasive ventilation. Three months beforehand he had been bitten by a tick and developed erythema migrans which was treated with Doxycycline for 10 days. This clinical presentation became complicated a few days later by the progressive onset of severe dyspnoea. At admission, chest radiography revealed bilateral elevation of the diaphragm. Pulmonary function tests revealed a severe restrictive disorder aggravated by decubitus. A diaphragmatic electromyogram showed bilateral axonal polyneuropathy of the phrenic nerves. IgG and IgM antibodies to Borrelia burgdorferi were detectable in serum and cerebrospinal fluid, leading to the diagnosis of Lyme disease. He was treated with intravenous ceftriaxone 2g per day for 21 days, leading to a substantial improvement in symptoms.In the presence of unilateral or bilateral diaphragmatic paralysis of undetermined aetiology, it seems relevant to perform Lyme serology in the blood and, in positive cases, to follow up with a lumbar puncture in order to detect intrathecal IgG synthesis.

The central nervous system (CNS), through carcinomatous meningitis or solid brain metastases, is the most common site of recurrence in non-small cell lung cancers (NSCLC) with activating mutations. Our retrospective study describes the population of patients with CNS metastases of NSCLC harboring activating mutation with targeted therapy (EGFR, ALK, BRAF, HER2) in 4 French regional reference hospitals. 60 patients were analyzed. The proposed treatments were heterogeneous and included combinations of chemotherapy, targeted therapy and radiotherapy±associated with topical treatments. Median overall survival following CNS metastasis in these patients was 15.8 months for meningitis carcinoma and 26 months for brain metastases. In patients with brain metastases, the addition of targeted therapy treatment allows a significant improvement in median progression free survival from 5.9 months to 10.6 months (HR 0.48 CI95 [0.24 to 0.97] P=0.035). These patients seem therefore benefit from systemic therapy and particularly targeted therapy with better survival than usual.

This work is based on the data of REALISE™, a survey conducted among 8000 European patients to identify the profiles of adult asthma patients and how these are linked with treatment adherence behaviors.A cluster analysis was performed by combining data in three ways: control of asthma, attitude towards the disease, compliance with treatment. A multidisciplinary group analyzed the results for the 1024 French survey respondents.Four patient profiles were identified: "rather confident" (28% of patients), rather young patients with a low level of concern about their asthma. "Rather committed" (23%) patients considering themselves to be mostly healthy, reporting better therapeutic declared. "Rather questing" (26%), patients poorly controlled, seeking to manage their asthma themselves. "Rather concerned" profile (23%), a bit older, with poor clinical control, considering their asthma to be severe.Cluster analysis provides a multidimensional approach to understand the therapeutic behavior of the different patient profiles better and so adjust communication by and education of healthcare professionals.

Poor adherence to treatment is a cause of inadequate asthma control and increased exacerbations. Better understanding of the factors associated with adherence could lead to recognition of appropriate solutions.An online, quantitative, self-completed questionnaire-based survey was conducted among 1024 French adults with asthma (aged 18-50years). Data were collected on socio-demographic characteristics, asthma control, patient perception of the disease and adherence.Only 11% of asthma patients considered that their asthma is uncontrolled while 48% were uncontrolled according to the GINA criteria. More than half (56%) of respondents admitted not taking their maintenance therapy every day. The perception that asthma was well controlled and lack of impact of the disease on daily activities were the most common reasons cited (46% of respondents) for not taking maintenance therapy. The other main reasons cited were forgetting and use only during symptomatic periods (21% and 14% of respondents, respectively).Adult asthma patients tend to overestimate their level of asthma control. Improving the management of asthma requires systematic detection of respiratory symptoms, awareness of the patient that asthma is a chronic disease and improved physician assessment of patients' expectations and perception of their disease.

A workshop has been organized in April 2013 by the Société de Pneumologie de Langue Française about COPD epidemiology and COPD screening in France and other European countries. This article deals with epidemiological data and their consequences on the French screening strategy.According to the most recent data, spirometric prevalence of COPD in France is 7.5% in individuals over 45 years old. During 2000-2002, COPD was responsible for 1.4% of all causes of death in France and was mentioned to be an associated cause of death in 3% of all death certificates. The average medical costs for one COPD patient is estimated to be 4366 €/year, until 7502 €/year in very severe COPD patients. All clinical studies that have been performed in France show that COPD screening via mini-spirometry is feasible in general practice or in an ambulatory setting; however, a mass screening proved to be difficult to perform. A simple technique like the Piko-6(®) implies a concomitant formalized training. The non-reimbursement by the French Social Security is also a limiting factor, as the absence of medical and economical validation of this strategy. Therefore, COPD screening should be focused to individuals at risk and should include tobacco issues and cessation.COPD screening strategies have to be medically evaluated and experiments have to take the specificities of the French health organization into consideration. Any COPD screening strategy should be considered as an overall fight against the tobacco epidemics.

The prevalence and control of asthma are modulated by hormonal changes in women, suggesting an influence of sex hormones on the airways.The blood levels of both oestrogens and progesterone can modulate airway tone and inflammation. Asthma prevalence changes at puberty and the menopause, events also associated with modifications of adipose tissue and behaviour. Changes in lung function and asthma control are well documented during the menstrual cycle. However, an effect of hormone therapy on asthma control has not been demonstrated.The effect of a targeted hormonal therapeutic intervention in menopausal asthma, a phenotype, which is frequently particularly severe, or in premenstrual asthma, should be evaluated by randomized trials.Involvement of sex hormones and their cyclical variations in the characteristics of asthma in women is probable, despite lack of convincing data. However, no definitive protective or deleterious effect can be assigned. Complex interactions with adipose tissue, airways anatomy and the domestic or working environment must be taken into account to explain these differences.

We report a case of cryptococcal infection that underwent in a patient with a medical history of asymptomatic sarcoidosis. This finding seems to be not incidental.A 35-years-old female was referred to hospital for a community-acquired pneumonia with pleural involvement. A physical examination showed a pleural syndrome. Chest imaging showed a parenchymal involvement with pleural effusion and numerous mediastinal nodes. Fiberoptic bronchoscopy revealed an obstruction of the right apical bronchus of the lower lobe. Biopsies and bronchoalveolar lavage confirmed a cryptococcal infection. The disease was considered as disseminated with a urinary and neurologic involvement. The outcome was fair under prolonged antifungal therapy.Cryptococcal infection is generally associated with immunosuppression. We suggest that sarcoidosis, although non symptomatic, may be a condition that promote the onset of cryptococcal infection. Even rare, cryptococcal infection is the most frequent opportunistic infection recorded with sarcoidosis patients. Histologic similarities between sarcoidosis and cryptococcal infection and the role of the macrophages which phagocyte the Cryptococcus neoformans are one of the hypothesis to assess these pathologic findings. A register is warranted to recover all opportunistic infection related to sarcoidosis in order to better understand the pathogeny.

Most hospital admissions for asthma exacerbation are avoidable with adequate disease management. The objective of this study was to describe admissions for asthma in children in France using data from the French nationwide hospital database.We selected admissions having either a main diagnosis of asthma or a main diagnosis of acute respiratory failure (ARF) with asthma as an associated diagnosis, occurring in children (age15years) between 2002 and 2010 in France (excluding French Guyana).In 2010, 35,004 asthma admissions and 1381 cases of asthma-related ARF were recorded (crude admission rate, 30.1/10,000 children); the mean length of stay was 2days. The in-hospital lethality rate ranged from 0.01% to 0.03% depending on the year. The annual age-standardized admission rate increased between 2002 and 2010 (+2.5% per year on average in metropolitan France). In 2010, 11.8% of children admitted for asthma or asthma-related ARF were readmitted for asthma or asthma-related ARF at least once within the same calendar year, and 1.3% were readmitted within the week following admission. The proportion of children aged less than 5 years who were readmitted within the same calendar year increased between 2002 and 2010.The increase in admission and readmission rates indicates non-optimal management of asthma in children in France.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a cause of suffering for patients and a burden for healthcare systems and society. Their prevention represents individual and collective challenge. The present article is based on the work of a group of experts who met on 5th and 6th May 2011 and seeks to highlight the importance of AECOPD.In the absence of easily quantifiable criteria, the definition of AECOPD varies in the literature, making identification difficult and affecting interpretation of study results. Exacerbations increase mortality and risk of cardiovascular disease. They also increase the risk of developing further exacerbations, accelerate the decline in lung function and contribute to reduction in muscle mass. By limiting physical activity and affecting mental state (anxiety, depression), AECOPD are disabling and impair quality of life. They increase work absenteeism and are responsible for about 60% of the global cost of COPD.Earlier identification with simple criteria, possibly associated to patient phenotyping, could be helpful in preventing hospitalization.Given their immediate and delayed impact, AECOPD should not be trivialized or neglected. Their prevention is a fundamental issue.

The aim of the ISAAC 1 study was to determine the prevalence and severity of asthma among adolescents in Guadeloupe.The study was carried out with a representative sample of young people in the second and third years of "college" (secondary school) in classes selected at random. The anonymous questionnaires were completed by pupils in 2003. 5097 questionnaires were processed.49.7% of the adolescents stated they had already felt breathless or oppressed; 29% said they had experienced wheezing. Of the 812 adolescents who declared they had already suffered asthma attacks the medical diagnosis was confirmed for 89%. 22% had been hospitalised at least once for asthma. A high proportion had suffered severe attacks (3.5%). A considerable number of school days had been lost by asthma sufferers. Medical care is inappropriate and the pupils' knowledge of the peak flow is poor (only 15%).The study confirmed the high frequency of asthma in Guadeloupe (14.1%) with high indicators of severity and it allowed a comparison to be made between Guadeloupe and the other regions which have carried out the ISAAC 1 study.

Most hospital admissions with asthma are avoidable. The objective of the analysis was to describe hospital readmissions for asthma.Using data from the French hospital information system, admissions for asthma or for acute respiratory failure associated with asthma that occurred in 2-44 years-old patients between 2002 and 2005 in France (excluding French overseas departments) were analysed. Readmission rates at 7 days and at 1 year were estimated using the Kaplan-Meier method.The risk of readmission at 1 year was 15.0%. It varied according to age (higher in 2-4 year and 35-44 years-old patients) and sex (higher in 10-34 years-old females) and increased with the length of stay of the index admission. The risk of readmission at 7 days was 1.1% and was higher for the shortest lengths of stay.Readmissions for asthma are pertinent indicators for the monitoring of asthma, especially the clinical management of the disease. Using data from an increasing number of years, together with linkage of hospital admissions and asthma drug reimbursement data, should allow a better understanding of severe asthma in France.

Chronic Obstructive Pulmonary Disease (COPD) is a disorder resulting from an interaction between a genetic predisposition, still poorly understood, and the impact of environmental factors including tobacco smoke or professional or domestic air contaminants.The prevalence of COPD in the world concerns women as much as men, but it remains under diagnosed among women smokers. The mortality data show an increase in mortality among women compared to men. It thus seems that COPD in women presents more often a particular phenotype, characterized more by bronchial attacks than by emphysema, and by more marked functional effects on the quality of life. Anxiety and depression seem more marked with further repercussions on the quality of life. The effectiveness of treatment may be different, in particular with regard to nicotine weaning and respiratory rehabilitation.In the evaluation of chronic diseases in women little is known about COPD. Further studies, focusing specifically on these differences, are needed in order to improve the diagnosis and management of COPD in women.

A growing body of basic and clinical science implicates Mycoplasma pneumonia in asthma, but its exact contribution to asthma development, exacerbation and persistence is as yet unclear.M. pneumoniae infection, with the induction of bronchial hyperresponsiveness, seems to be a precipitating factor for asthma development in predisposed subjects. M. pneumoniae has been seen both in acute exacerbation (18-20%) and in chronically infected adults with stable asthma, where it may be enhancing chronic airway inflammation.If M. pneumoniae plays a role in the development or progression of asthma, its eradication might influence the clinical course of the disease and improve symptoms. Macrolide treatment, with antimicrobial and anti-inflammatory properties, could have a place in the management of asthma, especially steroid-dependent asthma.M. pneumoniae infection seems to be important in asthma pathogenesis and the clinical course of the disease. Difficulty in detecting the pathogen complicates investigations. Ongoing research will further determine the place of macrolide antibiotics in asthma management.

Renal complications of sarcoidosis are rare but they may lead to renal failure. The two most common mechanisms are interstitial nephritis and acute hypercalcaemic renal failure. We report the case of a woman who presented both of these complications.

To update on the state of knowledge in mild asthma (intermittent and persistent mild asthma, according to the GINA classification) review the literature, and the position statement of the French Mild Asthma Working Group.The French Mild Asthma Working Group (11 lung specialists, 4 paediatricians, 1 pharmacologist, and 1 general practitioner) selected, analysed, and summarised the literature on the descriptive epidemiology, physiopathology, clinical signs, and management of mild asthma. The position of the working group on the descriptive epidemiology (causal factors excluded) and the nature of the bronchial inflammation has been presented in a previous article. The present article focuses on the clinical features of mild asthma and the use of medication for it.Mild asthma was more frequent, more symptomatic, and less well controlled in children than in adults. Its generally benign evolution may in some (10%) cases be complicated by severe episodes. Patients with mild persistent asthma require controller medication every day: permanent low-dose inhaled corticosteroid monotherapy is the reference foundation treatment for persistent mild asthma.The present findings should help clinicians and guide them in their approach to managing this condition.

Update on the state of knowledge in the mild asthma (intermittent and persistent mild asthma, according to the GINA classification) literature, and position of a French Mild Asthma Working Group.The French Mild Asthma Working Group (11 lung specialists, 4 paediatricians, 1 pharmacologist, and 1 general practitioner) selected, analysed, and summarised the literature on the epidemiology, physiopathology, clinical signs, and management of mild asthma. The present article shows the position of the working group on mild asthma descriptive epidemiology (causal factors excluded) and the nature of the bronchial inflammation. Clinical signs and medicinal treatments will be presented in a second article.Between 50% and 75% of asthma patients, depending on the study, present mild asthma. Childhood-to-adulthood cohort monitoring found severity to be unchanged over developmental time. Its generally benign evolution may in some (10%) cases be complicated by severe episodes. Inflammation and airway-wall remodelling were always found, although of variable intensity, and non-specific (except for absence of infiltration by polymorphonuclear neutrophils). Corticosteroid therapy by inhalation reduces bronchial inflammation, but with little impact on airway-wall remodelling.The present findings should help clinicians in identifying and understanding mild asthma.

The level of a patient's knowledge about his disease and its treatment is an essential part of an educational assessment. It is useful therefore to make use of a rapid, easy and valid method to collect the information necessary to develop an educational programme adapted to the needs of the patient. The aim of this study is to validate, in a structured way, a knowledge questionnaire on chronic obstructive pulmonary disease (COPD).Following a revue of the literature an initial questionnaire was constructed. It included of four domaines: biomedical aspects; symptoms and signs of severity; general knowledge and treatments. The questionnaire was tested on 35 subjects with COPD in order to assess its clarity and comprehensibility. It was reviewed and modified in both content and format by 11: French experts. The reproducibility was studied by repeat testing.The first version of the questionnaire developed by the working party consisted of 50 items. It was reduced to 41 items after interviews with 35 COPD patients and evaluation by 11 experts. The questionnaire appeared to be reproducible: mean concordance 79.5%; minimum 53.3%; maximum 100% and intra-class correlation coefficient 0.53.This study lead to the development of a French language COPD knowledge questionnaire.

A patient's knowledge of his disease and its treatment is an essential part of the evaluation of an educational process. It is useful therefore to use a rapid, easy and valid means of collecting the information necessary to produce an educational programme adapted to the needs of the patient.Following a review of the literature an initial questionnaire was constructed. It included four domains: biomedical, signs and symptoms of severity, general knowledge and treatment. The questionnaire was administered to 73 asthmatics in order to assess its clarity and comprehensibility. It was then reviewed and modified in both format and content by 10 French experts. The revised questionnaire was completed by 108 asthmatics distributed throughout 10 French respiratory centres, a group of 83 non-asthmatic subjects and 203 sixth year medical students at the Bordeaux University School of Medicine.The mean scores were: 19 for the non-asthmatics (range 2-36), 25.7 for the asthmatics (range 4-38) and 32.9 for the students (range 17-40), p 0.0001. The questionnaire was shown to be discriminating with good reliability and reproducibility: alpha Cronbach coefficient=0.82; intra-class correlation coefficient=0.70.This study has validated a French language asthma knowledge questionnaire.

A 43-year-old woman presented with a recent history of intermittent dyspnea with wheezing. The chest x-ray evidenced mediastinal nodes. A CT scan showed vascular embolism. Mediastinoscopy was performed and pathology examination of the node confirmed the diagnosis of sarcoidosis. The patient responded to corticosteroid and anticoagulation therapy. Is this a fortuitous association? A vascular localization of sarcoidosis? Thrombosis by compression?

Recent epidemiological studies have shown an increase in the prevalence of asthma and allergic diseases. Among aetiological factors, the domestic environment and, in particular, pet ownership may be a part of it. The relationship between severity of asthma and pets is still unclear. The aim of this study was to evaluate the relationship of asthma and rhinitis prevalence in teenagers with pet ownership.ISAAC I studied 3,303 teenagers (13-14 years old) in Bordeaux in 1994. They completed a written questionnaire about asthma, rhinitis, eczema and their domestic environment. Four groups (asthmatics, asthmatics with rhinitis, teenagers with only rhinitis and a control group without asthma and rhinitis) were studied.4.6% had only asthma. 43.2% had only rhinitis. 10.3% had asthma and rhinitis, 41.7% had no allergic disease. 34.9% kept a cat and 79.4% allowed the cat to go inside. No difference was found between the four groups with regard cat, dog, bird or other pet ownership irrespective if the pet was kept in-doors or out doors. The prevalence of previous asthma was 45.8% and 50.3% for current asthma. No difference was found between the severity of asthma and pet ownership.This is an epidemiological study based on a written questionnaire. Furthermore there is no data on the presence of pets during the first year of life. However, our results suggest that pet ownership amongst asthma and rhinitis sufferers is not different to that in the group without allergic disease.

The impact of asthma on every day life is an important consideration in asthma management. Tobacco use often starts during adolescence, but little is known about its effect on the asthmatic process. The aim of this study is to describe the impact of smoking habits on the every day life of adolescents with asthma. A survey of respiratory symptoms in children aged 13-14 years was conducted in Bordeaux France as part of the International Study of Asthma and Allergies in Childhood (ISAAC). 494 out of the 3.302 adolescents surveyed had a diagnosis of asthma. They filled in a further questionnaire on smoking habits and on the impact asthma had on their every day life. Respiratory symptoms were more frequent among current smoking asthmatic adolescents than non-smoking asthmatic adolescents. The impact of asthma on daily life, with implications for performance at school, family life, psychological status and future job prospects were different for smokers and non-smokers, with problems more prevalent for active smoking asthmatic adolescents. In a multiple regression analysis with confounding factors adjustment, school absence was reported more often in active smokers. Active smoking has an important impact on the every day life of asthmatic adolescents.

Respiratory allergic diseases include seasonal allergic rhinitis or hay fever, perennial allergic rhinitis and allergic asthma. Prevalence of asthma is difficult to assess through epidemiological questionnaires. In France hay fever roughly affects 6% of children and 18% of teenagers and nasal allergies, more than one fourth of young adults. Prevalence of asthma is equal to 10 to 15% in teenagers and 7 to 9% in young adults. Risk factors include genetic as well as environmental factors. The role of the former have been exemplified in family studies, especially twin studies, and surveys of inbred populations. Environmental factors can be allergic or non-allergic. The influence of allergenic exposure on sensitization, occurrence and severity of respiratory allergic disease is well documented. The triggering influence of non-allergenic factors on established allergic diseases is also clear. In contrast, their implication in allergic sensitization and occurrence of allergic diseases need to be clarified.

Lower respiratory tract infections (LRTI) are very often managed by General Practitioners (GPs). In France, the 1991 Lille Consensus Conference set out guidelines for the management of respiratory tract infections; in 1994, the Ministry of Health published Official Medical Recommendations (OMR) to be applied to seasonal respiratory infections. The aim of the study is to evaluate the impact of these OMR in 1995 on GPs' attitude when confronted with a community-acquired pneumonia in a previously healthy 40-year-old adult, with no sign of complications. Sixty seven GPs took, part in the same study by questionnaire in 1992 and 1995; we observed an increase in the prescription of aminopenicillin without a beta-lactamase inhibitor (41% in 1992 vs 66% in 1995; p = 0.009), and a reduction in both the use of aminopenicillin with a beta-lactamase inhibitor (35% in 1992 vs 11% in 1995; p = 0.002) and the concomitant prescription of cortico-steroids (43% in 1992 vs 14% vs 14% in 1995; p = 0.0009). Between 1992 and 1995, general practitioners in the Bordeaux region have changed their therapeutic choices in community-acquired pneumonia. In 1995, antibiotic prescriptions followed consensus guidelines more closely.

There is often a discrepancy between doctors' and patients' points of view on asthma. However, few studies have been devoted to the patients' representation of asthma. In this study 27 subjects, with moderate asthma, had to choose from a list of 35 groups of words and expressions, those which look to them to best evoke asthma. The results of this descriptive study show that "allergy" is the most frequently chosen term associated by patients with "suffocate", "attack", "heredity", and "psychic". Asthmatic patients minimise disease severity and refuse to be categorised as ill; they reject terms stigmatising asthmatic subject and the dangerousness of their disease. However, they recognise that asthma has psychological repercussions and prefer self-care. They consider drugs as dangerous and are afraid of their addiction and toxicity. These results have implications on information and education of asthmatic patients. To identify, for each patient, what is his/her representation of his/her disease would be very useful to provide patients with an adapted and personalized help for the management of his/her disease.