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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.

Resume Introduction La performance de la ponction ganglionnaire a l’aiguille par voie transbronchique sous reperage echographique (EBUS-PTBA) pour le diagnostic d’adenopathies mediastinales survenant chez des patients aux antecedents de neoplasie extrapulmonaire est peu decrite. Patients et methodes Sur la periode de janvier 2007 a juillet 2011, 68 patients aux antecedents de neoplasie extrapulmonaire, actuels ou passes, ont beneficie d’une exploration par EBUS-PTBA dans le cadre d’adenopathies mediastinales suspectes. Resultats Sur les 68 patients, 31 presentaient un diagnostic de cancer. Dix-neuf avaient un resultat anatomopathologique similaire a l’histologie initiale (essentiellement pour les neoplasies coliques, œsophagiennes et lymphomateuses), 12 etaient « inattendus » dont dix cancers pulmonaires. Parmi les 37 patients sans diagnostic, 27 avaient du materiel lymphoide, deux une inflammation non specifique et huit un examen non contributif. On constatait que les conditions de realisation etaient plus souvent rapportees difficiles chez ces patients. Conclusion Le rendement de l’EBUS-PTBA dans un contexte de neoplasie extrapulmonaire est tres variable selon l’origine neoplasique. Neanmoins, un diagnostic est retenu dans pres de 50 % des cas. Ces resultats sont encourageants et mettent l’accent sur l’interet de mieux cibler les indications et les conditions de realisation.

Resume La pasteurellose est une pathologie d’inoculation principalement rencontree dans le cadre d’une contamination cutanee. Le germe pathogene responsable dans 50 a 60 % des cas est Pasteurella multocida dont le vecteur principal est le chat. Un terrain immunodeprime favorise l’apparition de formes systemiques. Nous rapportons une observation de pneumopathie infectieuse par Pasteurella multocida chez un patient de 81 ans suspect de pneumopathie infectieuse communautaire ne presentant aucune porte d’entree cutanee. Le patient presentait plusieurs facteurs d’immunodepression dont des antecedents de neoplasies rectale et prostatique traites respectivement par curietherapie et hormonotherapie. Il presentait egalement un facteur environnemental favorisant (presence d’un chat au domicile). La confirmation du diagnostic etait faite par hemocultures et le traitement antibiotique permettait une evolution favorable sur le plan clinique, biologique et radiologique. Cette observation pose la question de la possibilite d’une autre porte d’entree pour cette pathologie qualifiee d’« inoculation ».

Resume Introduction L’embolie pulmonaire est une pathologie frequente au cours des cancers bronchopulmonaires dont la clinique peut etre trompeuse. Observation Un patient âge de 60 ans presentait une masse lobaire superieure droite et une adenomegalie hilaire droite hyperfixante en tomographie par emission de positon. La fibroscopie bronchique etant normale, il beneficiait d’une echoendoscopie bronchique pour realisation d’une ponction ganglionnaire diagnostique de la region interlobaire droite (11R). Cet examen montrait la presence d’une image hypoechogene dans une branche de l’artere pulmonaire droite. L’angioscanner thoracique realise dans les suites immediates confirmait le diagnostic d’embolie pulmonaire droite et les ponctions la nature neoplasique de l’adenomegalie. Il s’agit de la premiere description d’embolie pulmonaire diagnostiquee fortuitement au cours d’une echoendoscopie bronchique. Cette observation confirme les resultats recemment publies dans une etude demontrant les bonnes performances de cet examen pour retrouver des embolies proximales deja visualisees sur un scanner thoracique. Conclusion Bien que cet examen n’ait pas vocation a remplacer les examens actuellement preconises par les societes savantes dans l’embolie pulmonaire, nous attirons l’attention de nos confreres sur la necessite de bien examiner les arteres pulmonaires au cours d’une echoendoscopie bronchique.