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Resume Introduction Les donnees sur l’activite physique dans l’asthme severe sont rares. Cet article presente differents parametres cliniques et therapeutiques en fonction de l’activite physique chez des patients atteints d’asthme severe. Methodes Entre mai 2016 et juin 2017, 1502 patients adultes vus en consultation pour un asthme severe par un pneumologue exercant dans l’un des 104 centres hospitaliers non universitaires participant a l’etude ont ete consecutivement inclus apres avoir donne leur consentement de participation a l’etude. Leur activite physique etait classee selon 4 niveaux. Resultats Respectivement, 440, 528, 323, et 99 patients avaient une activite physique de niveau 1 (aucune), 2 (occasionnelle), 3 (reguliere), ou 4 (frequente). Le pourcentage de patients avec un asthme controle augmentait avec l’activite physique. L’observance therapeutique ne variait pas avec l’activite physique. Les pourcentages de patients obeses, de patients avec un VEMS Conclusions Dans cette large etude, l’activite physique est associee au controle de l’asthme severe et a une moindre frequence de comorbidites. Nos donnees incitent a encourager la pratique d’une activite physique et a proposer une rehabilitation respiratoire aux patients asthmatiques severes, en complement des traitements medicamenteux.

In recent years, several researchers have attempted to identify COPD phenotypes using different cluster analysis. This study aimed to determine the most optimal cluster analysis (supervised vs unsupervised) to robustly identify clinical phenotypes. 2,968 COPD patients have been included from January 2014 until February 2020. General information (age, BMI, smoking, comorbidities), lung function, exacerbations and symptoms were collected. After 5 years of follow-up, vital status was recorded. A hierarchical classification on the principal components (HCPC) was performed, followed by two unsupervised classification algorithms: k-means and PAM (Partition Around Medoids). Robustness was defined according to three different indices of validation (Connectivity, Dunn and silhouette). The mean age was 70 years, 63.7% of males, current smokers: 38.7%, mean FEV1: 61.3% predicted, ≥2 exacerbations: 43.6%, mMRC dyspnea grade≥2: 56.3%, chronic cough: 58%. The 5-year mortality rate was 11.3%. Based on our hypothesis, four phenotypes were described, using the PAM method. The phenotype A (24.2%) consisted of elderly patients with severe airflow limitation, low symptoms, cardiovascular comorbidities, diabetes and a higher mortality. The phenotype B (23.9%) contained more female patients, young patients with moderate airflow limitation and a high rate of current smokers. The phenotype C (25.5%) contained patients with very severe airflow limitation, more symptoms and low BMI. The Phenotype D (26.2%) was composed of patients with mild airflow limitation and low dyspnoea. These results showed the superiority of PAM classification compared with two other algorithms (k-means and HCPC) in terms of the robustness.

Introduction and objective Dyspnoea is a major symptom in COPD patients, but the determinants that could be associated with a higher dyspnoea mMRC score in COPD patients remain unclear. Our research aimed to study the determinants of dyspnoea at the threshold of 1, 2, 3 and 4 mMRC. Patients and methods Diagnosis of COPD was made using spirometry with post-bronchodilator FEV 1 FVC 70 % . An online questionnaire has been employed by pulmonologists to recruit COPD patients. The following variables were collected: age, gender, BMI, FEV1, RV, IC, TLC, FRC, mMRC, frequency of exacerbations and comorbidities. The LASSO was used to select the variables associated with the mMRC dyspnoea scale in a subgroup (who had no missing IC, RV and FRC values) of 421 COPD patients defined by the previously mentioned variables. Results One thousand nine hundred and sevety-three patients (65.3% males, average age = 66 ± 10, 38% current smokers) were included. Dyspnoea was correlated with a low FEV1 and with the number of exacerbations in the past 12 months. Multivariate analysis showed that the determinants of dyspnoea(mMRC ≥ 2) are: FEV1: OR = 3.71[2.86–4.82]; anxiety: OR = 2.52[1.82–3.47]; cough: OR = 1.94[1.57–2.40]; bronchiectasis: OR = 1.84[1.03–3.29]; age: OR = 1.80[1.45–2.24]; hyperinflation (RV/TLC): OR = 1.68[1.34–2.11]; ischemic cardiopathy: OR = 1.63[1.22–2.18]; hypertension: OR = 1.52[1.21–1.91]; exacerbations (≥ 2): OR = 1.41[1.10–1.81]; women: OR = 1.39[1.10–1.74] and overweight: OR = 1.33[1.06–1.67]. The subgroup analysis showed that: FEV1: OR = 3.47[1.96–6.12]; exacerbations (≥ 2) OR = 2.31[1.33–4.17] and hyperinflation (IC/TLC) OR = 0.57[0.35–0.85] were associated with higher dyspnoea (mMRC ≥ 2). Conclusion Our results showed that dyspnoea is related to the severity of airflow limitation, gender, exacerbations, comorbidities and hyperinflation.

The main factors that increase the mortality risk of COPD patients are age, comorbidities and the severity of airflow obstruction. This study aimed to validate the clinically relevant COPD phenotypes found by Burgel P-R et al [1] and analyzed their impact on 5-year mortality in the PALOMB cohort. COPD patients (post-BD FEV1/FVC 2,653 patients (66 years old, 64.27% males) were included. Application of the CART-based algorithm to Palomb cohort confirmed that it identified 5 COPD phenotypes with different clinical characteristics. In addition: The high proportion of FEV1 decline (≥100 ml/yr) belongs to phenotype 1 and 4; the majority of patients in these phenotypes were under oxygen therapy and they were associated with higher rates of exacerbation, lung cancer, anxiety and depression. These results confirmed the identification of five clinically relevant COPD phenotypes. A novel finding of this study is that FEV1 decline, frequency of exacerbations and other comorbidities were associated with the more severe phenotypes. Fundings: Bordeaux Univ Foundation, Novartis, Isis Medical, GSK, BI, Chiesi.

Introduction Exacerbations are key events in the natural history of COPD, but our understanding of their longitudinal determinants remains unclear. We used data from a large observational study to test the hypothesis that vaccination status and comorbidities could be associated with the occurrence of exacerbations profile. Methods Diagnosed COPD patients have been included by their pulmonologists, with up to 3 years of follow-up. Data were analyzed using the KmL method designed to cluster longitudinal data and receiver operating characteristic curve analysis to determine the best threshold to allocate patients to identified clusters. Results 932 COPD patients were included since January 2014, 446 patients (65.68% males, 35.59% current smokers) were followed over a period of 3 years with complete data. 239(28.15%) patients reported two or more exacerbations in the year before enrolment (frequent exacerbations). Among them 142(16.68%) also had frequent exacerbations in the first year of the study, and 69(8.10%) who remained frequent exacerbators in the second year. Based on our hypothesis, we were able to determine four phenotypes: A (infrequent), B (frequent in underweight patients), C (transient), and D (frequent in obese patients). Frequent exacerbators had more airflow limitation and symptoms. Irrespective of cut-offs set to define the optimal number of clusters, a history of exacerbations OR: 3.72[2.53–5.49], presence of anxiety OR: 2.03[1.24–3.31] and absence of the annual influenza vaccination OR: 1.97[1.20–3.24] remained associated with the frequent exacerbator phenotypes. Conclusions The most important determinants of frequent exacerbations are a history of exacerbations, anxiety and unvaccinated against influenza.

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.

Background Real-world data describing management of patients with severe asthma are limited. To address this issue, we conducted FASE-CPHG (France Asthme Sevère – Collège des Pneumologues des Hôpitaux Généraux), a descriptive, multicentric, and observational cross-sectional study. Methods French pulmonologists from nonacademic hospitals completed questionnaires on patient characteristics and ongoing asthma treatment for severe asthmatic patients observed during the inclusion period. In addition, we collected data from patients via self-assessment questionnaires. Findings 104 physicians recruited 1502 patients within 1 year. The mean age of the 1465 patients analysed was 54.4±16.1 years. Severe asthmatic patients were more frequently female (63%), with a history of atopy (65%). Most patients remained poorly controlled or uncontrolled, with an important difference between physicians' opinion and the Global Initiative for Asthma criteria (63% versus 96%). The most common comorbidities included ear, nose and throat diseases (59% of cases); anxiety (40%); and gastro-oesophageal reflux disease (39%). Allergic sensitisation tests and/or blood eosinophil count evaluation, and spirometry were performed in 92% and 98% of patients, respectively. The mean eosinophil count and total serum IgE were 437 cells·mm−3 and 546 UI·L−1, respectively. In addition to high doses of inhaled corticosteroids plus long-acting β2-agonists, patients were receiving leukotriene receptor antagonists (52%), anticholinergic drugs (34%), anti IgE (27%) and oral corticosteroids (17%); 65% adhered to their treatment. Interpretation This study provides insight into the characteristics and management of severe asthma in France and may help improve knowledge on this pathology, which represents a high burden to healthcare., This is a large study of severe asthma, with >1500 patients included, that gives new insights into epidemiological data, patients' characteristics and disease management http://bit.ly/2K9NqMT

COPD is generally considered to be more prevalent in men than women. However, some studies report the existence of differences in the rising trend of COPD severity in women. This study aimed to compare the COPD severity (GOLD III-IV vs I-II) in both women and men in PALOMB cohort. Diagnosed COPD patients were included by their pulmonologists. The following variables were collected: age, sex, BMI, FEV1, dyspnea (mMRC), the frequency of exacerbations, static hyperinflation (RV/TLC ≥130%) and comorbidities. 35.64% of 2,259 COPD patients followed were women (64 average age). Statistically significant (P≤0.001) findings in female COPD patients were as follows: younger, underweight, more likely to be current cigarette smokers, more frequent static hyperinflation (76.1% vs 70.6%) and higher dyspnea. GOLD stage III was lower in women. Exacerbator phenotype was more frequent in women (31.9% vs 23.2%), regardless of their COPD severity. Anxiety (22.7% vs 9.2%) and depression (23.7% vs 9.2%) were more frequent in women. Adjusted multivariate analysis showed that: Hyperinflation: 5.78[3.99-8.36]; higher dyspnea: 2.74[1.96-3.82]; anxiety: 2.04[1.47-2.84]; asthma: 1.55[1.05-2.3] and frequent exacerbations: 1.39[1.04-1.86] were associated with COPD severity in women. Contrastingly in men: Hyperinflation: 7.39[5.81-9.4]; higher dyspnea: 2.8[2.21-3.54]; left heart failure: 1.75[1.13-2.71]; sputum: 1.62[1.32-2]; age: 1.39[1.11-1.74] and hypertension: 1.27[1.03-1.58] were associated with COPD severity. The results are reflective of the commonly found factors of poor prognosis in COPD women: Frequent exacerbations and underweight. Funding: Bordeaux University Foundation, Novartis, Isis Medical, GSK, Boehringer Ingelheim

Dyspnea is one of the cardinal symptoms in COPD, and is part of the assessment of COPD severity and therapeutic management. Assessment of dyspnea is sometimes difficult in clinical practice. The objective of this study was to evaluate the determinants of dyspnea in COPD patients included in the PALOMB cohort. Patients have been included since 01/01/2014 by their pulmonologist using a web questionnaire. Diagnosis of COPD was made using spirometry (FEV1/CVF 130%). We followed 1973 COPD patients in South-West of France. 65.3% of patients were men, 66 years old. 38% were still active-smokers. 59% of the patients reported one or more exacerbations during the past 12 months. The three more frequent level of severity were GOLD A, grade II (21.2%); GOLD B, grade II (20%) and GOLD B, grade III (12.9%). Dyspnea was more frequent in women, in overweight patients, and in patients with cardiovascular comorbidities. Dyspnea was also associated with low FEV1 and number of exacerbations. There was also a significant association with increase of distension. Multivariate analysis with adjustment, showed that the following factors were associated with dyspnea (mMRC ≥2) : to be a woman OR: 0.71[0.57-0.9]; the severity of FEV1 : 3.7[2.8-4.8]; HTA OR: 1.5[1.2-1.9]; anxiety OR: 2.5[1.8-3.4]; bronchiectasis OR: 1.84[1-1.8]; number of exacerbations (≥2) OR: 1.41[1.1-1.81]; overweight OR: 1.33[1.06-1.67]; and distension OR: 1.68[1.34-2.1]. These results showed that in a real life cohort of COPD patients, dyspnea is not only related to FEV1 but also with comorbidities.

International audience; BACKGROUND: The impact of COPD on patient's quality of life is well established, but gender differences have received little attention. METHODS: To describe factors associated with the health-related quality of life by gender Methods: A cross-sectional observational study (NCT01007734) was conducted in COPD patients followed by pulmonologists. The first patient included had to be a woman. Data concerning the patient, COPD and their management were collected by the physician. The patient had to fill in several questionnaires: Saint-George Hospital respiratory Questionnaire (SGRQ-C), and motivation to quit smoking. RESULTS: Four hundred and thirty patients were included: mean age 63.9 +/- 11.3 years; 57.4% were women. Women were significantly younger than men (61.9 vs. 66.6) and their tobacco use was lower (37.1 vs. 40.4 PY). Cardiovascular comorbidities were more frequent in men while osteoporosis, anxiety and depression were frequent in women. The frequency of cough, sputum and the severity of dyspnea did not differ significantly between genders. Lung function impairment was less severe in women than in men (mean FEV1 52% predicted normal vs. 47. 8%). Anxiety score was higher (score 9.8 vs. 7.1) and quality of life (SGRQ-C) more impaired in women (scores 50.6 vs. 45.4; p < 0.02) than in men. Moreover, in multivariate analysis, chronic sputum was associated with higher SGRQ-C scores in women but not in men. CONCLUSIONS: This study underlines that despite less airflow limitation, quality of life is more impacted by chronic sputum in women than in men.