Search

Asthma is an inflammatory airway disease which presentation is highly heterogeneous. Last two decades provided new clinical and basic data concerning asthma physiopathology that make global understanding much complex. Phenotypes based on clinical settings and paraclinical investigations from large cohorts confirm old paradigm (eosinophilic vs. non-eosinophilic asthma) but also introduce new concepts (obesity-related asthma, late onset asthma, etc.). Conversely, improvement of big data analytics allows to initiate new cohorts aiming at better understanding the pathophysiology underlying those phenotypes and unraveling new ones. However, clinical and therapeutic impacts of those big data need to be further detailed. In parallel, biotherapies and innovative techniques as bronchial thermoplasty become available for severe asthmatic patients who did not respond to specific treatment in the past. Development of a personalized medicine in severe asthma becomes an important challenge for tomorrow. This review will focus on new pathophysiological concepts arisen from large cohorts and new therapeutic strategies available and in progress for severe asthma., L’asthme est une pathologie inflammatoire chronique touchant les voies aériennes, hétérogène tant dans sa présentation que dans sa physiopathologie. Les données fondamentales et cliniques sur la compréhension de l’asthme se sont considérablement complexifiées au cours des dernières décennies. Dépassant l’archétype de l’asthme allergique de l’adulte jeune, de nouveaux paradigmes sont apparus. Des phénotypes d’asthme déterminés à partir de données cliniques et paracliniques simples ont permis la caractérisation de formes inflammatoires diverses (éosinophiliques et non éosinophiliques) ainsi que de nouveaux phénotypes jusqu’alors peu explorés (obésité, âge avancé, etc.). L’avènement des techniques d’analyses de données à haut débit a rendu possible le développement de nouvelles cohortes de patients visant à préciser les multiples mécanismes physiopathologiques sous-tendant ces nouveaux phénotypes. De nouvelles données apparaissent régulièrement, mais leurs impacts cliniques et thérapeutiques restent à déterminer. Parallèlement, des biothérapies et des techniques innovantes telles que la thermoplastie bronchique se sont développées afin d’améliorer la prise en charge des patients asthmatiques sévères pour lesquels il n’existait jusqu’alors que le recours à une corticothérapie systémique au long cours, non dénuée d’effets indésirables. Le développement de la médecine personnalisée du patient asthmatique sévère est désormais devenu une priorité. L’objectif de cette revue est de tracer un tour d’horizon des nouveaux concepts physiopathologiques et de présenter les nouvelles stratégies thérapeutiques dans l’asthme sévère.

OBJECTIVE: The aim of this article is to describe conditions of abortions practices in France. MATERIALS AND METHODS: The study was based on the COCON survey. This survey was carried out among a representative sample of 2863 women aged 18 to 44 living in metropolitan France. Women were interviewed by telephone. The analysis was performed among a sub-sample of 320 women who had had an abortion between 1996 and 2000. Results were compared with those of the national notification of induced abortions. RESULTS: Altogether, the way in which abortions were carried out was appropriate, but differences were observed according to the type of hospital: access to care was easier in the private sector; however a pre-abortion interview was less often carried out and a post-abortion interview less often proposed in the private sector. Besides, in both sectors, women were rarely allowed to choose the abortion technique, or the type of anesthesia in the case of a surgical abortion. CONCLUSION: The COCON study is the first population based survey describing the characteristics of care regarding voluntary abortion. It shows the persistence of differences in practices between the public and the private sectors.