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Physical activity is reduced in people with asthma compared to the general population, especially in situations where patients have uncontrolled asthma symptoms, persistent airflow obstruction and other long-term medical problems, in particular obesity and anxiety. Exertional dyspnea, which is of multifactorial origin, is the main cause of reduced physical activity reduction and draws patients into a vicious circle further impairing quality of life and asthma control. Both the resumption of a regular physical activity, integrated into daily life, adapted to patients' needs and wishes as well as physical and environmental possibilities for mild to moderate asthmatics, and pulmonary rehabilitation (PR) for severe and/or uncontrolled asthmatics, improve control of asthma, dyspnea, exercise tolerance, quality of life, anxiety, depression and reduce exacerbations. A motivational interview to promote a regular programme of physical activity in mild to moderate asthma (steps 1 to 3) should be offered by all health professionals in the patient care pathway, within the more general framework of therapeutic education. The medical prescription of physical activities, listed in the Public Health Code for patients with long-term diseases, and pulmonary rehabilitation should be performed more often by specialists or the attending physician. Pulmonary rehabilitation addresses the needs of severe asthma patients (steps 4 and 5), and of any asthmatic patient with poorly controlled disease and/or requiring hospitalized for acute exacerbations, regardless of the level of airflow obstruction, and/or with associated comorbidities, and before prescribing biological therapies.

Pulmonary rehabilitation, whether performed at home or in a specialised centre, is effective in the management of COPD. As gender-related differences in COPD were previously reported, we aimed to evaluate the impact of gender on pulmonary rehabilitation outcomes in the short, medium and long term. In this retrospective observational study of 170 women and 310 men with COPD, we compared the outcomes of an 8-week home-based pulmonary rehabilitation programme including an individualised plan of retraining exercises, physical activities, therapeutic education, and psychosocial and self-management support. Exercise tolerance, anxiety, depression, and quality of life (QOL) were assessed using the 6-min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS) and Visual Simplified Respiratory Questionnaire (VSRQ), respectively. Assessments were carried out before, immediately after the pulmonary rehabilitation programme (T2) and at 8 (T8) and 14 months (T14). At baseline, women were younger (mean 62.1 versus 65.3 years), more often nonsmokers (24.7% versus 7.7%) and had a higher body mass index (28 versus 26.4 kg·m−2). They more often lived alone (50.6% versus 24.5%) and experienced social deprivation (66.7% versus 56.4%). They had significantly lower exercise tolerance (−34 strokes, 6MST) and higher anxiety and depression (+3.2 HADS total score), but there were no between gender differences in QOL (VSRQ). Both groups showed similar improvements in all outcome measures at T2, T8 and T14 with a tendency for men to lose QOL profits over time. Despite some differences in baseline characteristics, women and men with COPD had similar short-, medium- and long-term benefits of a home-based pulmonary rehabilitation programme., Despite some differences in baseline characteristics, women and men with COPD had similar short-, medium- and long-term benefits of a home-based pulmonary rehabilitation programme https://bit.ly/2XfFakK

Jérémy B Coquart,1 Natacha Heutte,1 Gaelle Terce,2 Jean-Marie Grosbois3 1Université de Rouen-Normandie, UFR STAPS, CETAPS, EA 3832, Mont Saint Aignan F-76821, France; 2Centre Hospitalier de Béthune, Service de Pneumologie et de Réhabilitation Respiratoire, Beuvry F-62660, France; 3FormAction Santé, Pérenchies F-59840, FranceCorrespondence: Jérémy B CoquartUniversité de Rouen-Normandie, UFR STAPS, CETAPS, EA 3832, Mont Saint Aignan F-76821, FranceTel +33 235 146 775Email jeremy.coquart@univ-rouen.frPurpose: Short and easy questionnaires have been developed to assess the health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD), such as the Maugeri Foundation Respiratory Failure Questionnaire (MRF-28) and the COPD-specific HRQoL Questionnaire (VQ11). Both are valid, reliable, and sensitive, but their minimal clinically important differences (MCID) are unknown. Consequently, this study aimed to confirm the convergent validities of the MRF-28 and VQ11 and establish their MCID. A retrospective design was used to evaluate the effect of individual home-based pulmonary rehabilitation (PR) in 400 COPD patients.Patients and methods: Exercise tolerance, anxiety and depression based on the Hospital Anxiety and Depression Scale (HADS), and HRQoL using three questionnaires (MRF-28, VQ11, and the Visual Simplified Respiratory Questionnaire: VSRQ) were assessed before and after an individualized home-based PR program (5 sessions of 30–45 mins/week for 8 weeks, including a weekly session supervised by a team member).Results: PR improved all measured variables (p < 0.0001). The correlations were significant (p < 0.0001) between VSRQ and MRF-28 (r = −0.685 at baseline and r = −0.686 after the PR program), and between VSRQ and VQ11 (r = −0.691 at baseline and r = −0.753 after the PR program). Moreover, changes in score (delta between after and before PR program) of VSRQ were also significantly correlated (p < 0.0001) to changes in score of MRF-28 (r = −0.372) and VQ11 (r = −0.423). Last, we calculated MCIDof −5.2 and −2.0 units for MRF-28 and VQ11, respectively.Conclusion: The MRF-28 and VQ11 can be used in routine practice to evaluate the effects of PR on the HRQoL of COPD patients, with MCID of −5.2 and −2.0, respectively.Keywords: visual simplified respiratory questionnaire, VSRQ, home-based pulmonary rehabilitation

Jean-Marie Grosbois,1,2 Justine Heluain-Robiquet,3 François Machuron,4 Gaelle Terce,2 Cécile Chenivesse,3,5,6 Benoit Wallaert,3,5,6 Olivier Le Rouzic3,5 1FormAction Santé, Pérenchies F-59840, France; 2CH Béthune, Service de Pneumologie et Réhabilitation Respiratoire, Béthune F-62400, France; 3CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France; 4CHU Lille, Department of Biostatistics, University Lille, EA 2694 - Santé Publique: Epidémiologie Et Qualité Des Soins, Lille F-59000, France; 5University Lille, Lille F-59000, France; 6Inserm, CNRS, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille F-59000, FranceCorrespondence: Jean-Marie Grosbois Email jmgrosbois@formactionsante.comBackground: Pulmonary rehabilitation (PR) improves exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD), regardless of disease severity. Socioeconomic deprivation has been linked to the incidence of COPD; however, little is known about its impact on PR outcomes.Methods: In this retrospective observational study, 459 COPD patients were enrolled and dichotomized into socially deprived (n=276) and non-socially deprived (n=183) groups based on a cut-off of 30.17 in the EPICES questionnaire (Evaluation of Deprivation and Inequalities in Health Centers), which evaluates socioeconomic disadvantage. The PR program consisted of once-weekly home sessions for 8 weeks, and consisted of an individualized plan of retraining exercises, physical activities, therapeutic education, and psychosocial and motivational support. Exercise tolerance, anxiety and depression, and quality of life were assessed using the 6min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS), and Visual Simplified Respiratory Questionnaire (VSRQ). Assessments were made before the PR program (baseline) and then at 2 (T2), 8 (T8), and 14 (T14) months after baseline.Results: Compared with the non-socially deprived group, socially deprived patients were younger, more frequently women, active smokers, and living alone, and belonged to lower socioprofessional categories. At baseline, 6MST, VSRQ, and HADS measures were lower for the socially deprived than the non-socially deprived group. At T2, T8, and T14, there were no significant between-group differences in any outcome, and the percentage of patients showing clinically important improvements was the same in both groups.Conclusion: Home-based PR is effective for COPD patients in the short and long term, regardless of socioeconomic status.Keywords: home-based pulmonary rehabilitation, exercise tolerance, quality of life, anxiety, depression, socioeconomic deprivation

Resume Introduction Les dyspnees inexpliquees apres des epreuves fonctionnelles respiratoires de repos (EFR) et un bilan cardiovasculaire representent une situation frequente en pratique clinique. Le but de ce travail etait de preciser l’interet de l’epreuve fonctionnelle a l’exercice (EFX) pour le diagnostic de ces dyspnees inexpliquees. Methodes Cette etude monocentrique retrospective incluait des patients successifs ayant des examens de repos normaux (examen clinique, hemoglobine, radiographie thoracique, ECG, EFR, echographie cardiaque). L’EFX etait realisee avec analyse des gaz du sang. L’analyse descriptive et la synthese etaient realisees par consensus entre au moins 3 des auteurs et permettait d’evoquer les etiologies suivantes : deconditionnement, hyperventilation inappropriee a l’exercice (HV), anomalies echanges gazeux (AEG), EFX sous-maximale, anomalies cardiovasculaires (ACV) et EFX normale. Resultats Au total, 194 patients etaient inclus, (âge median 53 ans ; sex-ratio (H/F) 0,83 ; IMC moyen 27,3 kg/m2 ± 5,36). On retrouvait 32 % de profils compatibles avec un deconditionnement, 20 % HV, 18 % AEG, 13 % d’epreuves sous-maximales, 9 % ACV, 8 % d’epreuves maximales et normales. Conclusion Cette etude illustre l’interet de realiser l’EFX precocement dans les dyspnees inexpliquees car dans plus de 50 % des cas, celles-ci correspondent soit a un deconditionnement soit a un syndrome d’hyperventilation, redevables d’une prise en charge simple en rehabilitation respiratoire.

Introduction Les reflexions actuelles visant a faire reconnaitre la dyspnee comme une cause de souffrance humaine et son soulagement comme un droit humain, ont fait emerger le concept de dyspnee refractaire. Celle-ci est definie par une dyspnee persistant dans le temps malgre un traitement etiologique optimal. Methodes Au cours d’une etude prospective, nous avons evalue chez les patients presentant une pneumopathie interstitielle diffuse idiopathique (PIDI) (fibrose pulmonaire idiopathique et pneumopathie interstitielle non specifique) la frequence de la dyspnee refractaire selon la definition de Currow (mMRC ≥ 3 depuis plus de 4 semaines malgre un traitement etiologique optimal) [1] et ses caracteristiques cliniques de facon multidimensionnelle a l’aide notamment de l’hetero-questionnaire Multidimensional Dyspnea Profile (MDP). Resultats Quarante patients (24 hommes, 16 femmes, 72,3 ans ± 8,3) ont ete inclus. La frequence de la dyspnee refractaire etait de 37,5 % (IC95 % [22,7–54,2]). Selon la definition de Matsuda [2] (EVA dyspnee au repos ≥ 2) la frequence etait de 67 % (IC95 % [49,8–80,9]). La concordance entre les deux definitions etait mediocre (coefficient Kappa a 0,0952). La presence d’une dyspnee refractaire etait associee a une alteration plus severe du VEMS (58 % [50–78] vs 76 % [69–100]) et de la DLco (24 % [22–43] vs 47 % [43–51] ; p = 0,014). Il n’y avait pas de difference entre les patients avec ou sans dyspnee refractaire (mMRC ≥ 3) en termes d’intensite des dimensions sensorielle (QS 15/50 [3–23] vs 7/50 [4–15], p : 0,25) et emotionnelle (A2 8/50 [3–11] vs 5/50 [1–15], p : 0,53), d’anxiete (p : 0,26) et de depression (p : 0,18). La dyspnee refractaire etait associee a une sensation de manque d’air predominante (5/10 [3–6] vs 2/10 [0–5], p : 0,018) et une diminution des activites (BDI a 5/12[IQ] [2–7] vs 7/12 [6–8] ; p : 0,005). Un seul patient (du groupe dyspnee refractaire) recevait un traitement opioide a visee eupneisante. Conclusion Les resultats de cette etude exploratrice suggerent que la dyspnee refractaire est frequente et tres peu prise en charge dans les PIDI.

Chronic dyspnoea that remains unexplained after resting pulmonary function and cardiovascular testing is a common problem in clinical practice. The aim of this study was to determine the utility of cardiopulmonary exercise testing (CPET) in the diagnosis of unexplained dyspnoea.This retrospective single-centre study included consecutive patients with dyspnoea who had normal resting cardiopulmonary examinations (including chest X-ray, electrocardiography, pulmonary function tests [PFTs], and cardiac ultrasound). CPET was performed using a cycle ergometer with analysis of blood gases. The results were interpreted as being most likely due to one of the six pathophysiological mechanisms shown below. Consensus required agreement between at least three of the authors.Of the 194 patients included (median age 53 years, sex-ratio (M:F) 0.83, mean body mass index 27.3±5.36kg/mCPET may greatly facilitate the diagnosis of unexplained dyspnoea. More than 50% of the dyspnoea cases examined here were due to deconditioning or hyperventilation syndrome and would benefit from a simple pulmonary rehabilitation program.

Introduction Grâce aux progres de prise en charge du cancer bronchique non a petites cellules (CBNPC) dus a l’arrivee de nouvelles therapeutiques mais aussi a l’amelioration des soins de support, il n’est plus rare d’avoir recours a une 4e ligne de traitement. Le benefice sur la survie d’un tel traitement n’a jamais ete demontre. Nous avons mene une etude visant a identifier les facteurs pronostiques associes a une survie prolongee en 4e ligne afin d’ameliorer la selection des patients pouvant en tirer benefice. Methodes Dans cette etude retrospective, multicentrique, nous avons inclus les patients suivis pour un CBNPC de stade avance ayant recu une 4e ligne de traitement. Les facteurs associes a une survie prolongee (definie par une survie superieure a 6 mois depuis le 1er jour de traitement de 4e ligne) ont ete identifies par une analyse univariee puis multivariee selon une methode pas a pas ascendante (forward). Resultats Au total, 151 patients ont ete inclus dans l’analyse entre janvier 2015 et decembre 2016. L’âge median etait de 60 ans (55–64). La majorite des patients etaient de sexe masculin (70 %) et avaient un adenocarcinome (72 %). Les principaux traitements recus auparavant comprenaient un doublet a base de sels de platine (92 %), une monochimiotherapie (81 %), une therapie ciblee (46 %) et une immunotherapie (9 %). La mediane de survie globale etait de 7,39 mois (6,7–9,43). En analyse univariee, 9 facteurs etaient significativement associes a la survie a 6 mois. En analyse multivariee, 4 facteurs restaient associes de maniere independante a cette survie : le stade localise initial (hazard ratio (HR) 0,37 : intervalle de confiance a 95 % (IC95 %) [0,16–0,58]), l’absence de toxicite de grade ≥ 3 en premiere ligne (HR 0,56 : IC 95 % [0,32–0,98]), l’absence de controle de la maladie lors des trois premieres lignes (HR 3,06 : (IC 95 % [1,64–5,73]) et l’indice de Karnofsky ≥ 90 % au debut de la quatrieme ligne (HR 0,31 : (IC 95 % [0,16–0,58]). Conclusion Nous avons mis en evidence 4 facteurs associes a une survie prolongee en 4e ligne de chimiotherapie. Une validation prospective de ces facteurs est necessaire afin de mieux selectionner les patients pouvant tirer benefice d’un tel traitement.

Introduction Le syndrome d’apnees–hypopnees obstructives du sommeil (SAHOS) est une maladie frequente qui a un impact sur de nombreuses pathologies. L’incidence et le risque de mortalite par cancer seraient influences, d’apres des etudes cliniques recentes, par le SAHOS. Aucune donnee n’est disponible a ce jour pour le cancer bronchopulmonaire. Methodes De juin 2014 a juin 2015, nous avons mene une etude prospective, observationnelle et bicentrique, proposant aux patients atteints de cancer bronchopulmonaire, un depistage de SAHOS par l’intermediaire d’un autoquestionnaire. En cas de suspicion clinique de SAHOS, les patients etaient invites a confirmer ce diagnostic, dans un premier temps, par la realisation en ambulatoire, d’un APNEALINK AIR puis, en fonction des resultats, d’une polygraphie ventilatoire ou d’une polysomnographie en laboratoire de sommeil. Resultats Cent treize patients ont ete inclus et ont repondu a l’autoquestionnaire. Quarante-six pour cent des patients jugent leur sommeil de mauvaise qualite. Le questionnaire est positif dans 63 % des cas. Vingt-quatre patients ont beneficie d’un APNEALINK AIR qui s’est avere positif chez 18 patients. Au total 6 patients ont eu un diagnostic de SAHOS par enregistrement en laboratoire de sommeil et 9 patients etaient deja connus porteur d’un SAHOS severe lors de l’inclusion. La survie globale a 2 ans est inferieure chez les patients avec un questionnaire positif (56 % versus 84 %), cependant de maniere non significative (p = 0,06). Le faible taux de participation des patients aux examens de confirmation diagnostique ne nous a pas permis de conclure sur l’impact reel du SAHOS sur le pronostic du cancer bronchique. Conclusion Les patients atteints de cancer bronchique ont, dans notre travail, un sommeil de mauvaise qualite avec une suspicion clinique forte de SAHOS. L’existence de symptomes compatibles avec des troubles respiratoires du sommeil pourrait etre associee a une plus grande severite de la maladie cancereuse.