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• Persistent and symptomatic periodic breathing (PB) was observed after 1 month of life in infants born at term. • Persistent and symptomatic PB was observed with the presence of obstructive sleep apnea syndrome (OSAS) and/or central apnea syndrome (CAS), along with gastroesophageal reflux. • Persistent and symptomatic PB improved after temporary treatment with oxygen or ventilatory support. • Persistent and symptomatic PB decreased with age and disappeared during the first year of life. • Polysomnography recording and its interpretation by professionals trained in pediatric sleep is important for distinguishing between PB, OSAS, and CAS and for proposing an adapted treatment. Periodic breathing (PB) is considered physiological in the neonatal period and usually disappears in the first months of life. There are few data available on persistent PB after the neonatal period. The objective of this study was to characterize infants born at term with persistent PB after the age of 1 month through polysomnography (PSG) performed during symptoms. This retrospective case series included infants born at term between 2012 and 2021, without an underlying disease, who presented with symptoms of persistent PB during a PSG. Persistent PB was defined as more than 1 % of total sleep time (TST) of PB after 1 month of life, and PB was defined as a succession of at least three episodes of central apnea lasting more than 3 s and separated by less than 20 s of normal breathing. A total of 10 infants born at term were included. They underwent PSG for brief resolved unexplained events, desaturation, pauses in breathing, cyanosis, and/or signs of respiratory distress. The percentage of TST spent with PB was 18.1 % before 3 months of age (n = 7), and 4.7 % between 3 and 6 months of age (n = 10). During the first PSG, ≥3 % of desaturation events were observed in 77–100 % of the PB episodes. At the first PSG, nine of the 10 infants had an obstructive apnea–hypopnea index of >10/h and five of 10 infants had a central apnea index of >5/h. Gastroesophageal reflux (GER) was suspected in eight infants. All infants showed improvement in the initial symptoms during the first year of life. This study presents cases of persistent and symptomatic PB after 1 month of life in infants born at term. The interesting finding was the presence of obstructive sleep apnea syndrome and/or central apnea syndrome in the majority of children, along with GER. [ABSTRACT FROM AUTHOR]

Objectives Osteogenesis imperfecta (OI) is the most common genetic skeletal disorder. Extraskeletal findings are common but an association with sleep-disordered breathing (SDB) has never been described. The aim of this study was to investigate clinical features of children with OI and suspected SDB. Methods A retrospective study of clinical records, signs of SDB and polysomnographic recordings of children with OI was performed. We paid particular attention to symptoms that could be associated with SDB in this population – scoliosis, kyphosis, vertebral arthrodesis, chest wall deformities, basilar impression, autonomy – as well as data already known to be associated with obstructive sleep apnea such as body mass index and upper-airway impairment. Results We reviewed the clinical charts of 188 patients referred to our genetic skeletal disorders reference center for OI. Among the 15 patients (8%) with polysomnographic recordings, 12 (6.4%) had sleep-disordered breathing. We found a negative correlation between the Brief Assessment of Motor Function score and Apnea Hypopnea Index ( r = −0.68; p = 0.01) and Desaturation Index ( r = −0.62; p = 0.02). The Apnea Hypopnea Index was higher for non-walkers than walkers (mean [SD]: 6.5 [3.6] vs. 2.4 [1.5]; p = 0.02) and with type III versus IV OI. Two patients were started on continuous positive airway pressure ventilation, with clinical improvement. Conclusion For OI children, symptoms suggesting obstructive sleep disorders should be searched for systematically, especially in children with compromised autonomy, high body mass index, trunk deformations, and severe OI type. [ABSTRACT FROM AUTHOR]

The respiratory tract is continually exposed to various insults that are a permanent threat to the maintenance of lung homeostasis. Repair of the parenchyma structure, particularly of the alveolar epithelium, requires complex cellular strategies. Among the molecular components that play an important role in these processes are the surfactant proteins (SPs), particularly SP-A. The present review examines current evidence regarding the role of SP-A in lung host defence mechanisms through its implication in innate/adaptive immunity of the lung and epithelium integrity and repair. New information on SP-A deficiency in various forms of pulmonary diseases could help define therapeutic strategies aimed at restoring functional SP-A within the alveolar structure. [ABSTRACT FROM AUTHOR]

Résumé La médecine « personnalisée », ou médecine des 4P pour « personnalisée », « prédictive », « préventive » et « participative », est en plein essor pour la mucoviscidose avec le développement de thérapies ciblant certaines mutations de CFTR . Les différents enjeux de la médecine personnalisée appliquée à la mucoviscidose sont discutés dans cette mise au point. Summary Personalized medicine, or P4 medicine for “Personalized”, “Predictive”, “Preventive” and “Participatory”, is currently booming for cystic fibrosis, with the development of therapies targeting specific CFTR mutations. The various challenges of personalized medicine applied to cystic fibrosis issues are discussed in this paper. [ABSTRACT FROM AUTHOR]

Résumé: Les macrolides sont une des plus anciennes classes d’antibiotiques à large spectre. En plus de leur action antibactérienne, ils exercent une action anti-inflammatoire et immunomodulatrice. Depuis l’observation de bénéfices spectaculaires sur la fonction respiratoire et la survie de patients atteints de panbronchiolites diffuses, les macrolides ont été prescrits au long cours dans différentes maladies respiratoires chroniques. Cette mise au point examine les résultats des essais thérapeutiques ayant évalué les effets d’un traitement prolongé par macrolides dans le traitement de la mucoviscidose, des dilatations des bronches non liées à la mucoviscidose, et de l’asthme, ciblant plus particulièrement les études ayant inclus des enfants. De nouvelles indications des macrolides au long cours sont discutées, comme les affections parenchymateuses diffuses. [ABSTRACT FROM AUTHOR]

Summary: Background: Fine particulate matter has been linked to allergies by experimental and epidemiological data having used aggregated data or concentrations provided by fixed-site monitoring stations, which may have led to misclassification of individual exposure to air pollution. Methods: A semi-individual design was employed to relate individual data on asthma and allergy of 5338 school children (10.4±0.7 years) attending 108 randomly chosen schools in 6 French cities to the concentrations of PM2.5 (fine particles with aerodynamic diameter ⩽2.5μm) assessed in proximity of their homes. Children underwent a medical visit including skin prick test (SPT) to common allergens, exercise-induced bronchial (EIB) reactivity and skin examination for flexural dermatitis. Their parents filled in a standardised health questionnaire. Results: After adjustment for confounders and NO2 as a potential modifier, the odds of suffering from EIB and flexural dermatitis at the period of the survey, past year atopic asthma and SPT positivity to indoor allergens were significantly increased in residential settings with PM2.5 concentrations exceeding 10μg/m3 (WHO air quality limit values). The relationships were strengthened in long-term residents (current address for at least 8 years). Conclusions: Findings support the hypothesis that changes in allergy prevalence observed in recent decades might be partly related to interactions between traffic-related air pollution and allergens. Further longitudinal investigations are needed to corroborate such results. [Copyright &y& Elsevier]

Summary: Among early-life environmental factors, parental smoking (ETS) has been associated with adverse respiratory outcomes in children. The aim of the study was to evaluate whether parental smoking might lead to asthma and allergies taking into account family history of asthma, personal atopy, breast feeding as confounders and owing pets and day-care during the first 6 months of life as modifiers. About 9000 children of fourth and fifth grade were selected in six cities of France. About 7798 answered an epidemiological questionnaire, underwent a medical examination including skin prick test positivity to common allergens, skin examination for eczema, and run test to assess exercise-induced asthma (EIA). Prevalence of allergies was, respectively, 25.2% for eczema, 12.9% for rhinitis, 9.9% for asthma and 25% for atopy. About 8.3% had an EIA. About 21.6% of children were exposed to maternal tobacco smoking during pregnancy. Maternal smoking, in utero and later, was significantly related to lifetime wheezing (odds ratio (OR): 1.24[1.10–1.56]) and asthma (OR: 1.22[1.04–1.66]). There was no association between atopy, rhinitis, eczema and parental smoking, respectively. ETS remains a risk factor of wheezing in childhood. Counselling parents of children to quit smoking still remains a public health policy. [Copyright &y& Elsevier]

Summary: Background: Smoking is a preventable cause of increased morbidity and mortality. Therefore, interventions have been used to assist smokers in overcoming their addiction. The aim of the study was to describe factors associated with smoking cessation, in patients applied to our smoking cessation (SC) unit in 1999, in a prospective study. Methods: Patients were followed-up during two years. Detailed medical history, Fagerström test, Hospital Anxiety and Depression (HAD) scale questionnaire, Motivation scale and replacement therapy were systematically recorded. Results: Three hundred patients (58% men, 42% women) applied to the SC unit from January to December 1999. The mean age was 42yrs old. They smoked in average 24 cig/d. Mean duration of smoking was 20 years. Fagerström score was 5.86 (min 0; max: 10). Patients seemed to be more anxious (score 9.6) than depressed (5.09), according to the HAD score. 79% of them received both psychosocial intervention, pharmacotherapy and nicotine replacement therapy. 66% of patients were followed-up (). Two years later, the smoking cessation rate was 12% (). Motivation, Fagerström and HAD scores were not associated with the quitting rate. Quitting rate was higher (25.9%) in patients who attempted to quit smoking for the first time than in others (19%). By contrast, the quitting rate was significantly associated with age (). Conclusion: Success to quit smoking was positively associated with age, and negatively with alcohol dependence. [Copyright &y& Elsevier]

Patients with a chronic disease must be considered pivotal in the management of their own disease and they must be actively involved in its management. The current treatment of asthma is assumed to be effective and every effort must be made to see that patients use their treatment optimally. This is the main goal of patient education. Unfortunately, the definition of patient education and its true targets are ambiguous, ranging from improvement in quality of life to cost reduction. In practice, patient education is frequently reduced to a simple information/training process, consisting of gestures, knowledge (facts) and judgments (comments and opinions). This type of “education” is patient–centered. However, it is not, in any case, society''s answer to the patient''s problems. Rather, patients'' needs are reduced to institutional and societal desires. Thus, one may anticipate conflict in the doctor–patient relationship. The aim of true patient–centered care is not to have better-instructed, more compliant patients, as is true of many current patient education programs, but instead to allow patients to have better control of their life. It is all the more important to consider this deficiency since patients psychological reactions will have a greater impact on doctors'' prescriptions than on objective measurements of respiratory function and they will play a more important role in a patient''s decision to go to an emergency room and thus, on the economic burden of asthma. Proper patient education has first to consider patients'' conceptions (their representation and meaning of asthma and their education), expectations and needs. In conclusion, it must be remembered that patient education requires negotiation of conflicts of interest and consideration of values that are long–lasting and based on a human nature that resists arbitrary manipulation. [Copyright &y& Elsevier]

Introduction Le Syndrome d’Apnées Obstructives du Sommeil (SAOS) touche 10 à 60 % des enfants obèses. La Pression Positive Continue (PPC) nocturne est un élément clé du traitement du SAOS. Objectif Décrire une cohorte d’enfants obèses traités pour un SAOS par PPC pour déterminer les caractéristiques spécifiques de ces patients. Matériel et méthodes Étude rétrospective incluant des enfants présentant une obésité constitutionnelle et un SAOS confirmé par une polysomnographie (PSG) et traités par PPC, appariés à des témoins sans SAOS d’âge, de sexe et de corpulence similaires. Résultats Douze patients, d’âge médian de 11,2 ans (4,3–18) et de Z-score d’indice de masse corporelle médian à + 6,1 DS (3,5–9) ont été inclus. Ni la sévérité de l’obésité ni l’âge n’étaient liés à la sévérité du SAOS. Par comparaison aux témoins, les patients présentaient tous des ronflements et des apnées du sommeil associés à un ou plusieurs autres signes cliniques. La PPC avait réduit les signes cliniques de tous les patients avec normalisation de la PSG. Les patients traités n’avaient pas un poids de naissance plus élevé ni une obésité plus précoce que les témoins. La fréquence des complications liées à l’obésité n’était pas plus élevée par rapport aux témoins. Discussion/conclusion Le SAOS nécessite un dépistage systématique chez l’enfant obèse quel que soit son âge, quel que soit son niveau d’obésité, avec recherche de ronflements associés à d’autre(s) signe(s). Sa prise en charge par PPC doit s’intégrer dans une prise en charge globale et pluridisciplinaire. [ABSTRACT FROM AUTHOR]

Abstract: To evaluate whether fine air particles could be involved in the occurrence of atopy and allergic diseases, we performed a cross-sectional epidemiological survey involving primary schoolchildren living in six French towns with contrasted air pollution levels. Air pollution was measured during a week in the schoolyards and by standard air monitoring networks. Children get an examination in school looking for atopic dermatitis and bronchial hyperresponsiveness assessed by a standardized run test. Besides, parents or guardians provided past medical history and environmental data, especially on passive smoking. Overall, 5,338 children, aged 10.4 (±0.7) years, coming from 108 different schools and 401 different classes were included in the survey. Taking into account potential confounders, high exposure to proximity PM2.5 was linked to a higher point prevalence of atopic dermatitis and hyperresponsiveness, to a higher cumulative prevalence of allergic asthma and a higher sensitization rate to common indoor allergens. Thus, these data suggest that chronic exposure to urban fine particles could be a risk factor for atopy, hyperresponsiveness and asthma. [Copyright &y& Elsevier]

To evaluate whether fine air particles could be involved in the occurrence of atopy and allergic diseases, we performed a cross-sectional epidemiological survey involving primary schoolchildren living in six French towns with contrasted air pollution levels. Air pollution was measured during a week in the schoolyards and by standard air monitoring networks. Children get an examination in school looking for atopic dermatitis and bronchial hyperresponsiveness assessed by a standardized run test. Besides, parents or guardians provided past medical history and environmental data, especially on passive smoking. Overall, 5338 children, aged 10.4 (±0.7) years, coming from 108 different schools and 401 different classes were included in the survey. Taking into account potential confounders, high exposure to proximity PM2.5 was linked to a higher-point prevalence of atopic dermatitis and hyperresponsiveness, to a higher cumulative prevalence of allergic asthma and a higher sensitization rate to common indoor allergens. Thus, these data suggest that chronic exposure to urban fine particles could be a risk factor for atopy, hyperresponsiveness and asthma. [Copyright &y& Elsevier]

Abstract: There are a large number of pine trees (Pinus pinaster) in the Bordeaux region, and these trees produce a large load of pollen. We carried out a prospective study of sensitisation to this pollen in patients coming to our allergy–pulmonary consultation service. We found that 1.3% of this population was sensitive to pine pollen; among those found to be atopic, the frequency was 3%. None of the patients was sensitised only to this pollen, the subjects always having a positive skin test to other inhalant allergens. Clinically, the pine-sensitive patients had asthma and rhinitis and sometimes conjunctivitis also. We found no particular characteristics in this group of patients. These results confirm the weak allergenic potential of pine pollen in the region, where the concentration of this pollen is particularly high. [Copyright &y& Elsevier]

Background: Quality of life (QOL) is an important component of evaluation in oncology. Usually, QOL is used in phase III studies to compare two treatments. The aim of this trial was to evaluate the impact of the disclosure of the diagnosis of cancer on QOL by using the European Organisation for Research and Treatment of Cancer core Quality of Life Questionnaire (EORTC QLQ)-C30 questionnaire and the supplemental lung cancer-specific module QLQ-LC13. Patients and methods: Patients hospitalised for exploration of an abnormal chest X-ray, with no previous history of cancer, a performance status ≤2, and able to fulfil the questionnaire were eligible. The patients answered the questionnaire two times: before (Q1) and after (Q2) the disclosure of the diagnosis. Results: Seventy patients answered at Q1 and Q2. After the disclosure, some scores deteriorated: arm pain (P=0.009), physical functioning (P=0.01), role functioning (P=0.008), emotional functioning (P=0.0001) and social functioning (P=0.012), whereas the patients’ own assessment of global QOL (item global QOL in functioning scales) did not show the same evolution. Conclusion: Disclosure of the diagnosis had an impact on social and emotional QOL. Patients with lung cancer need psychological support at the beginning of their disease. [Copyright &y& Elsevier]

Objective. – The authors had for aim to prospectively analyse the management of patients consulting for a lower respiratory tract infection (LRTI).Method. – 3,146 General Practitioners (GPs) submitted an anonymous copy of the drug prescriptions they had given to 5,354 patients, from 15 to 65 years of age. They were then interviewed by phone on possible investigations required and diagnosis.Results. – Pneumonia accounted for 9.6% of diagnostics, acute exacerbations of chronic bronchitis 14.9%, and acute bronchitis 72.5%. Antibiotics were prescribed in 96.5% of patients, with minor differences between diagnostics. Hospitalisation, investigations or referral to a specialist were very infrequent (0.5, 1.2, and 10.8%, respectively) although significantly more frequent in pneumonia. The symptomatology covered an extremely wide range of clinical presentation. Only some patient characteristics, such as age, house calls instead of consultation, fever, and thoracic pain significantly influenced the GPs toward a diagnosis of pneumonia. Pneumonia was also associated with crackles (49% of the cases) but this sign could also frequently occur in other forms of LRTI. Bronchial rales such as ronchi were the most prevalent signs even in case of pneumonia.Comments. – The clinical signs and symptoms of LRTI seen by GPs have both low sensitivity and specificity which may account for the low compliance to guidelines. The definition of criteria to help physicians rule out the diagnosis of pneumonia might constitute an alternative approach. [Copyright &y& Elsevier]

High grade lung neuroendocrine carcinomas, like small and large cell neuroendocrine carcinomas, pose therapeutic problems. Most initially respond to chemotherapeutic agents, but early relapses are frequent and are resistant to the presently available treatments. Our study reports for the first time the development and evaluation of a test for detecting the presence of circulating tumour cells by measuring chromogranin A gene transcripts with reverse transcriptase-polymerase chain reaction (RT-PCR) and Southern blotting. The test is specific and sensitive (detection of 10 cancer cells/ml blood), and only minimally invasive. Positivity is statistically correlated to high grade neuroendocrine carcinomas and to a poor prognosis with a 3-fold higher lethal risk. The test now needs to be assessed for its usefulness as a tool in the initial staging procedures and follow-up by comparison with the recent immunoradiometric assay (RIA) for detection of chromogranin A in the serum. [Copyright &y& Elsevier]