Search

Resume Introduction Nous decrivons un cas de cryptococcose disseminee survenue chez une patiente aux antecedents de sarcoidose pulmonaire asymptomatique. Cette association particuliere ne parait pas fortuite. Observation Une patiente de 35 ans a ete hospitalisee pour une pleuro-pneumopathie communautaire evoluant depuis trois semaines. A l’examen, elle presentait un syndrome pleural droit. L’imagerie retrouvait un aspect de pleuro-pneumopathie associe a des adenopathies mediastinales. La fibroscopie bronchique retrouvait un bourgeon de la bronche de Nelson. Les biopsies et le LBA affirmaient une infection a Cryptococcus neoformans . Le bilan d’extension confirmait une atteinte disseminee (neurologique et urinaire). L’evolution etait favorable sous-traitement antifongique prolonge. Discussion L’infection a Cryptococcus neoformans est classiquement l’apanage des sujets immunodeprimes. Nous pensons que la sarcoidose, meme asymptomatique, peut etre un facteur favorisant la survenue de l’infection a Cryptococcus neoformans . Bien que rare, la cryptococcose est l’affection opportuniste la plus frequemment rencontree dans la sarcoidose. La corticotherapie est en general le facteur medicamenteux immunosuppresseur le plus souvent retrouve. Les similitudes histologiques entre les deux pathologies et le role du macrophage qui phagocyte le Cryptococcus neoformans sont des pistes permettant d’expliquer cette association pathologique. Un registre exhaustif des cas d’infections opportunistes associees a la sarcoidose permettrait de mieux comprendre la pathogenie.

Introduction La derniere enquete conduite en population generale et estimant la prevalence de l’asthme en France a ete conduite en 2006 [1] . L’objectif principal de la presente enquete etait d’estimer, en population generale, la prevalence de l’asthme en France en 2018 et de decrire la repartition des asthmatiques en fonction des paliers de traitement GINA (paliers 1 a 5). Les objectifs secondaires etaient de decrire le profil des asthmatiques, leur prise en charge et le fardeau de la maladie. Methodes Il s’agit d’une enquete cross-sectionnelle ayant interroge le panel de foyers Kantar-TNS, representatif de la population francaise. Un questionnaire de 4 pages a ete adresse par voie postale a 19 676 panelistes âges de 18 ans et plus. Les donnees ont ete recueillies entre le 10 janvier et le 21 fevrier 2018. Des questionnaires valides ont ete utilises pour l’evaluation du controle de l’asthme (ACQ-6), la qualite de vie (EQ-5D-5L) et l’observance au traitement (MMAS−4). Resultats L’analyse a ete conduite sur 15 587 questionnaires. La prevalence de l’asthme au cours de la vie a ete evaluee a 12,8 % (n = 1 989) et la prevalence de l’asthme actuel (dans l’annee precedente) a 6,4 % (soit 993 asthmatiques) ( Tableau 1 ). L’âge moyen de ces asthmatiques etaient de 48,2 ans, 60,5 % etaient des femmes, l’IMC moyen etait de 26,7 kg/m2 et l’âge median au diagnostic de 19,2 ans ; 32 % des asthmatiques ont rapporte avoir une rhinite allergique et 19 % une hypertension arterielle. Un total de 946 asthmatiques ont dit recevoir un traitement pour l’asthme dont 42,6 % un traitement quotidien comprenant un corticoide inhale. Un peu moins de la moitie (46,4 %) ont indique avoir une bonne observance au traitement (MMAS − 4 score = 4). Conclusion La prevalence de l’asthme actuel est estimee en France a 6,4 % en 2018, avec une proportion de patients ayant un traitement equivalent au palier 5 de GINA en ligne avec les precedentes estimations. L’asthme n’est pas controle pour une proportion importante d’individus et de nombreux asthmatiques presentent des exacerbations, meme en palier 1 de GINA. En 2018 en France, il reste necessaire d’optimiser la prise en charge de l’asthme.

Resume La prevalence de l'asthme et son evolution sont differentes en fonction du sexe et de l'âge, avec un asthme plus prevalent chez les garcons avant l'adolescence et une inversion de cette tendance apres la puberte. L'epidemiologie a permis de retrouver de nombreux facteurs influencant l'asthme de maniere differente chez la femme par rapport a l'homme. Notamment l'atopie maternelle influence differemment l'âge d'apparition de l'asthme chez le garcon ou la fille. Elle semble egalement etre un facteur de risque d'asthme uniquement chez la fille dans l'enfance et a l'adolescence. D'autres facteurs comme le milieu environnemental semblent jouer un role different chez la fille et le garcon. On retrouve egalement que l'effet de l'obesite sur la severite de l'asthme est plus marque chez la femme que chez l'homme. Chez les femmes le facteur hormonal influence l'asthme et sa severite puisqu'il existe des variations significatives de l'hyperreactivite bronchique au cours du cycle menstruel, et une aggravation significative des symptomes respiratoires et du VEMS apres la menopause.

To determine the association between dyspnea at entry into the PAQUID cohort and 13-year mortality, taking into consideration BMI and other mortality-related factors. Longitudinal study. In Dordogne and Gironde, South Western France. A total of 3646 French community dwellers aged 65 years old and over from the PAQUID study were included. Main outcome measures: dyspnea measured on 5-grades scale, mortality measured over 13 years of follow-up. Adjustment variables: age, gender, BMI (kg/m2), antecedent of ischemic heart disease, antecedent of stroke, hypertension, smoking history and diabetes. The study sample included 3646 subjects out of whom 54.11% died at 13 years of follow-up, 57.3% of participants were women and mean age was 75.3 (SD 6.8) years. Univariate analysis showed that dyspnea was associated with 13-year mortality. Death occurred in 45.6% of non-dyspneic subjects, 51.8% in those with level 1 of dyspnea, 65.6% in level 2 and 80.6% in level 3 and 4 (P

The central nervous system (CNS), through carcinomatous meningitis or solid brain metastases, is the most common site of recurrence in non-small cell lung cancers (NSCLC) with activating mutations. Our retrospective study describes the population of patients with CNS metastases of NSCLC harboring activating mutation with targeted therapy (EGFR, ALK, BRAF, HER2) in 4 French regional reference hospitals. 60 patients were analyzed. The proposed treatments were heterogeneous and included combinations of chemotherapy, targeted therapy and radiotherapy±associated with topical treatments. Median overall survival following CNS metastasis in these patients was 15.8 months for meningitis carcinoma and 26 months for brain metastases. In patients with brain metastases, the addition of targeted therapy treatment allows a significant improvement in median progression free survival from 5.9 months to 10.6 months (HR 0.48 CI95 [0.24 to 0.97] P=0.035). These patients seem therefore benefit from systemic therapy and particularly targeted therapy with better survival than usual.

This work is based on the data of REALISE™, a survey conducted among 8000 European patients to identify the profiles of adult asthma patients and how these are linked with treatment adherence behaviors.A cluster analysis was performed by combining data in three ways: control of asthma, attitude towards the disease, compliance with treatment. A multidisciplinary group analyzed the results for the 1024 French survey respondents.Four patient profiles were identified: "rather confident" (28% of patients), rather young patients with a low level of concern about their asthma. "Rather committed" (23%) patients considering themselves to be mostly healthy, reporting better therapeutic declared. "Rather questing" (26%), patients poorly controlled, seeking to manage their asthma themselves. "Rather concerned" profile (23%), a bit older, with poor clinical control, considering their asthma to be severe.Cluster analysis provides a multidimensional approach to understand the therapeutic behavior of the different patient profiles better and so adjust communication by and education of healthcare professionals.

Anti-TNFα agents have proved effective in the treatment of various inflammatory, rheumatologic, dermatologic, and gastrointestinal diseases. Severe respiratory tract infections of bacterial or fungal origin have emerged as important complications in patients receiving such treatments. The risk of infection due to anti-TNFα therapy is difficult to assess in these patients who are immunocompromised because of the underlying disease itself and of previous or concomitant immunosuppressive drugs. This excessive infection risk seems real, particularly in the first six months following treatment initiation, and higher for patients receiving anti-TNFα monoclonal antibodies than for those receiving soluble TNFα receptor. The involved pathogens are pyogenic bacteria but also Mycobacterium tuberculosis , mostly by reactivation of latent tuberculosis infection, warranting a systematic preventive approach to screening and chemoprophylaxis before initiating the anti-TNFα therapy. In countries with low tuberculosis endemicity, an increased prevalence of nontuberculous mycobacterial infections has been reported. The incidence rate of legionellosis is high in this population. In case of pneumonia, empirical antibiotic therapy should cover Legionella pneumophila . Several cases of histoplasmosis have also been reported and this diagnosis should be suspected in patients who have traveled to endemic areas. Other opportunistic infections have been reported including Pneumocystis pneumonia, aspergillosis, and nocardiosis mostly in patients receiving other immunosuppressive treatments. The risk of infection should be evaluated as an individual risk depending on comorbidities and past or concomitant treatments.

Background: Lung cancer is the leading cause of cancer morbidity and mortality. Its management has a significant economic impact on society. Despite a high incidence of cancer, so far, there is no national register for this disease in Morocco. The main goal of this report was to estimate the medical costs of lung cancer in our country. Methods: We first estimated the number of annual new cases according to stage of the disease on the basis of the Grand-Casablanca-Region Cancer Registry data. For each sub-group, the protocol of treatment was described taking into account the international guidelines, and an evaluation of individual costs during the first year following diagnosis was made. Extrapolation of the results to the whole country was used to calculate the total annual cost of treatments for lung cancer in Morocco. Results: Overall approximately 3,500 new cases of lung cancer occur each year in the country. Stages I and II account for only 4% of cases, while 96% are diagnosed at locally advanced or metastatic stages III and IV. The total medical cost of lung cancer in Morocco is estimated to be around USD 12 million. This cost represents approximately 1% of the global budget of the Health Department. According to AROME Guidelines, about 86% of the newly diagnosed lung cancer cases needed palliative treatment while 14% required curative intent therapy. The total cost of early and advanced stages lung cancer management during the first year were estimated to be 4,600 and 3,420 USD, respectively. Conclusion: This study provides health decision-makers with a first estimate of costs and the opportunity to achieve the optimal use of available data to estimate the needs of health facilities in Morocco. A substantial proportion of the burden of lung cancer could be prevented through the application of existing cancer control knowledge and by implementing tobacco control programs.

Resume Les infections chroniques, virales ou bacteriennes, sont frequentes chez les patients atteints de bronchopneumopathie chronique obstructive. L’infection virale latente, principalement representee par le virus respiratoire syncitial et l’adenovirus, semble etre presente chez un grand nombre de patients atteints de bronchopneumopathies chroniques obstructives stables. De nombreux travaux semblent montrer un effet pro-inflammatoire, systemique et endobronchique, de cette infection virale, notamment en association avec la fumee de cigarette ou la pollution. La colonisation bacterienne, principalement representee par l’Haemophilus influenzae, est presente chez plus du tiers des patients atteints de bronchopneumopathies chroniques obstructives stables. Les patients colonises presentent une inflammation endobronchique et un declin de leur fonction respiratoire plus eleves que les patients non colonises. Ces infections chroniques jouent probablement un role dans l’aggravation de leur maladie en maintenant une inflammation endobronchique persistante et favorisant les exacerbations de leur maladie.

Poor adherence to treatment is a cause of inadequate asthma control and increased exacerbations. Better understanding of the factors associated with adherence could lead to recognition of appropriate solutions.An online, quantitative, self-completed questionnaire-based survey was conducted among 1024 French adults with asthma (aged 18-50years). Data were collected on socio-demographic characteristics, asthma control, patient perception of the disease and adherence.Only 11% of asthma patients considered that their asthma is uncontrolled while 48% were uncontrolled according to the GINA criteria. More than half (56%) of respondents admitted not taking their maintenance therapy every day. The perception that asthma was well controlled and lack of impact of the disease on daily activities were the most common reasons cited (46% of respondents) for not taking maintenance therapy. The other main reasons cited were forgetting and use only during symptomatic periods (21% and 14% of respondents, respectively).Adult asthma patients tend to overestimate their level of asthma control. Improving the management of asthma requires systematic detection of respiratory symptoms, awareness of the patient that asthma is a chronic disease and improved physician assessment of patients' expectations and perception of their disease.

Resume L’asthme est plus frequent chez les garcons comparativement aux filles. Cette relation s’inverse apres la puberte. La litterature donne des pistes suggerant un role hormonal et metabolique dans la survenue de l’asthme de la femme, et un impact sur la fonction respiratoire, mais la physiopathologie demeure mal connue. L’impregnation hormonale de la femme varie selon l’âge des premieres regles, le cycle menstruel, la grossesse, l’allaitement, la menopause, et les taux hormonaux peuvent egalement varier selon d’autres facteurs metaboliques comme l’obesite. L’asthme est plus frequent et plus severe chez les femmes apres la puberte. Des exacerbations d’asthme ont ete rapportees comme associees a des variations du cycle menstruel ; les cycles menstruels irreguliers, la menopause sont associees a une augmentation du risque d’asthme et une diminution de la fonction respiratoire.

Resume Les etudes de cohortes permettent d’analyser au long cours le devenir d’une population en fonction de facteurs de risques donnes. Dans le domaine respiratoire, certaines d’entre elles ont permis de surveiller, de l’enfance a l’âge adulte les parametres cliniques et fonctionnels respiratoires. Ces travaux ont demontre que le devenir respiratoire d’un sujet etait conditionne par son etat respiratoire dans l’enfance. En matiere d’asthme, plus particulierement, ces cohortes montrent que la persistance de symptomes dans la grande enfance et a l’adolescence s’accompagnent plus souvent d’asthme a l’âge adulte. Alors qu’une amelioration est souvent observee a l’adolescence, la recidive des symptomes d’asthme a l’âge adulte est frequente. Atopie et tabac semblent etre les facteurs de risque essentiels a la perennisation des symptomes.

Background: The AIR II study is a prospective multicentre assessing management of lower respiratory tract infections (LRTIs) in adults by general practitioners (GPs). Epidemiological studies generally address the prescriptions of antibiotics. To our knowledge, little is known about the real impact of non-antibiotic therapeutic prescriptions (defined here as co-prescriptions) in LRTI. Therefore, the aim of the study was to evaluate non-antibiotic prescriptions in LRTIs. Methods: Two thousand general practitioners (GPs) were randomly selected and asked to participate in each of 30 predefined areas covering mainland France. The patient's sociomedical record was completed by the GP during the consultation and sent to the data processing centre at the same time as an anonymous copy of his prescription. The GP also had to report the inclusion by telephone and agree to a telephone appointment with an interviewer. Results: GPs (n=3144) reported 5469 evaluable cases. Pneumonia accounted for 9.6% of diagnoses, acute exacerbations of chronic bronchitis 14.9% and acute bronchitis 72.5%. Antibiotics were prescribed to 96.5% of patients. In addition to the 5270 prescriptions of antibiotics, co-prescriptions proved to be twice as numerous as prescriptions of antibiotics (10,027 prescriptions for 5115 patients). Mucomodifiers, steroidal anti-inflammatory drugs and bronchodilators were significantly more prescribed in AECB than others. Non-steroidal anti-inflammatory drugs and antitussives were significantly more prescribed in acute bronchitis than AECB or CAP. Conclusions: Our results suggest that recommendations of management in LRTIs need to take into account co-prescriptions.

The Analyse Infections Respiratoires (AIR) II study is a prospective, multicentre survey of the management of lower respiratory tract infections in patients aged 15-65 yrs by general practitioners (GPs) in France. To obtain real-time data recording, practitioners were required to submit an anonymous copy of their drug prescriptions. They were then interviewed over the telephone about the patients' sociodemographic data, signs and symptoms, as well as their presumptive diagnosis and the investigations they had decided upon. GPs (n=3,144) reported 5,469 evaluable cases. Pneumonia accounted for 9.6% of diagnoses, acute exacerbations of chronic bronchitis 14.9% and acute bronchitis 72.5%. The symptomatology covered an extremely wide range of clinical features, which, although statistically different in terms of incidence, overlapped to a large extent across diagnoses. By contrast, hospitalization, investigations or referral to a specialist were much more prevalent in pneumonia, although still very infrequent in general terms (0.5, 1.2 and 10.8%, respectively). Antibiotics were prescribed in 96.5% of patients, with minor differences between diagnoses. However, other medications such as nonsteroid, anti-inflammatory drugs, steroids, nonspecific antitussives and bronchial liquefiers accounted for two-thirds of the prescriptions. This study demonstrates the lower respiratory tract infections encountered by general practitioners are usually mild. However, antibiotic prescription was more systematic than in previous studies and the prescription of nonspecific symptomatic treatments was twice as frequent. General practitioners did not perform additional examinations or refer on a regular basis. There was a high prescription rate for symptomatic treatment.

A workshop has been organized in April 2013 by the Société de Pneumologie de Langue Française about COPD epidemiology and COPD screening in France and other European countries. This article deals with epidemiological data and their consequences on the French screening strategy.According to the most recent data, spirometric prevalence of COPD in France is 7.5% in individuals over 45 years old. During 2000-2002, COPD was responsible for 1.4% of all causes of death in France and was mentioned to be an associated cause of death in 3% of all death certificates. The average medical costs for one COPD patient is estimated to be 4366 €/year, until 7502 €/year in very severe COPD patients. All clinical studies that have been performed in France show that COPD screening via mini-spirometry is feasible in general practice or in an ambulatory setting; however, a mass screening proved to be difficult to perform. A simple technique like the Piko-6(®) implies a concomitant formalized training. The non-reimbursement by the French Social Security is also a limiting factor, as the absence of medical and economical validation of this strategy. Therefore, COPD screening should be focused to individuals at risk and should include tobacco issues and cessation.COPD screening strategies have to be medically evaluated and experiments have to take the specificities of the French health organization into consideration. Any COPD screening strategy should be considered as an overall fight against the tobacco epidemics.

Resume L'enquete ISAAC (International Study of Asthma and Allergies in Childhood) a pour objectif general de mieux connaitre la frequence et les facteurs de risque des maladies allergiques de l'enfant. L'objectif specifique de l'enquete de phase 1, est de mieux connaitre la prevalence des maladies allergiques (asthme, rhinite et eczema) dans le Monde grâce a l'utilisation d'un questionnaire simple et valide. En France 18 000 adolescents des zones de Bordeaux, Fos l'Etang de Berre, region du Languedoc-Roussillon, Ouest-Marne et Strasbourg et 8 700 enfants des villes de Bordeaux et Strasbourg ont participe a cette enquete en 1994 et 1995. Dans les zones de l'Etang de Berre et Strasbourg, le questionnaire papier a ete suivi d'un questionnaire video concernant les symptomes asthmatiques. Le questionnaire papier a ete traduit de l'anglais, la traduction etant validee par retraduction. La reproductibilite du questionnaire et la comparabilite des reponses des adolescents et de leurs parents ont fait l'objet d'une enquete complementaire portant sur un echantillon de 300 personnes. L'analyse des resultats comporte une partie purement descriptive par centre puis une comparaison des taux de prevalence entre centres.

Resume L'education therapeutique en general ameliore significativement le nombre de jours sans symptomes, la frequence des genes nocturnes, la qualite de vie et diminue le recours aux soins. Chez l'enfant et l'adolescent ayant un asthme considere comme severe, les programmes d'education ont un effet plus important sur les criteres habituels de morbidite, comparativement aux patients ayant un asthme leger a modere. En revanche, chez l'adulte les resultats sont plus nuances.

The prevalence and control of asthma are modulated by hormonal changes in women, suggesting an influence of sex hormones on the airways.The blood levels of both oestrogens and progesterone can modulate airway tone and inflammation. Asthma prevalence changes at puberty and the menopause, events also associated with modifications of adipose tissue and behaviour. Changes in lung function and asthma control are well documented during the menstrual cycle. However, an effect of hormone therapy on asthma control has not been demonstrated.The effect of a targeted hormonal therapeutic intervention in menopausal asthma, a phenotype, which is frequently particularly severe, or in premenstrual asthma, should be evaluated by randomized trials.Involvement of sex hormones and their cyclical variations in the characteristics of asthma in women is probable, despite lack of convincing data. However, no definitive protective or deleterious effect can be assigned. Complex interactions with adipose tissue, airways anatomy and the domestic or working environment must be taken into account to explain these differences.

We report a case of cryptococcal infection that underwent in a patient with a medical history of asymptomatic sarcoidosis. This finding seems to be not incidental.A 35-years-old female was referred to hospital for a community-acquired pneumonia with pleural involvement. A physical examination showed a pleural syndrome. Chest imaging showed a parenchymal involvement with pleural effusion and numerous mediastinal nodes. Fiberoptic bronchoscopy revealed an obstruction of the right apical bronchus of the lower lobe. Biopsies and bronchoalveolar lavage confirmed a cryptococcal infection. The disease was considered as disseminated with a urinary and neurologic involvement. The outcome was fair under prolonged antifungal therapy.Cryptococcal infection is generally associated with immunosuppression. We suggest that sarcoidosis, although non symptomatic, may be a condition that promote the onset of cryptococcal infection. Even rare, cryptococcal infection is the most frequent opportunistic infection recorded with sarcoidosis patients. Histologic similarities between sarcoidosis and cryptococcal infection and the role of the macrophages which phagocyte the Cryptococcus neoformans are one of the hypothesis to assess these pathologic findings. A register is warranted to recover all opportunistic infection related to sarcoidosis in order to better understand the pathogeny.

Most hospital admissions for asthma exacerbation are avoidable with adequate disease management. The objective of this study was to describe admissions for asthma in children in France using data from the French nationwide hospital database.We selected admissions having either a main diagnosis of asthma or a main diagnosis of acute respiratory failure (ARF) with asthma as an associated diagnosis, occurring in children (age15years) between 2002 and 2010 in France (excluding French Guyana).In 2010, 35,004 asthma admissions and 1381 cases of asthma-related ARF were recorded (crude admission rate, 30.1/10,000 children); the mean length of stay was 2days. The in-hospital lethality rate ranged from 0.01% to 0.03% depending on the year. The annual age-standardized admission rate increased between 2002 and 2010 (+2.5% per year on average in metropolitan France). In 2010, 11.8% of children admitted for asthma or asthma-related ARF were readmitted for asthma or asthma-related ARF at least once within the same calendar year, and 1.3% were readmitted within the week following admission. The proportion of children aged less than 5 years who were readmitted within the same calendar year increased between 2002 and 2010.The increase in admission and readmission rates indicates non-optimal management of asthma in children in France.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a cause of suffering for patients and a burden for healthcare systems and society. Their prevention represents individual and collective challenge. The present article is based on the work of a group of experts who met on 5th and 6th May 2011 and seeks to highlight the importance of AECOPD.In the absence of easily quantifiable criteria, the definition of AECOPD varies in the literature, making identification difficult and affecting interpretation of study results. Exacerbations increase mortality and risk of cardiovascular disease. They also increase the risk of developing further exacerbations, accelerate the decline in lung function and contribute to reduction in muscle mass. By limiting physical activity and affecting mental state (anxiety, depression), AECOPD are disabling and impair quality of life. They increase work absenteeism and are responsible for about 60% of the global cost of COPD.Earlier identification with simple criteria, possibly associated to patient phenotyping, could be helpful in preventing hospitalization.Given their immediate and delayed impact, AECOPD should not be trivialized or neglected. Their prevention is a fundamental issue.

The aim of the ISAAC 1 study was to determine the prevalence and severity of asthma among adolescents in Guadeloupe.The study was carried out with a representative sample of young people in the second and third years of "college" (secondary school) in classes selected at random. The anonymous questionnaires were completed by pupils in 2003. 5097 questionnaires were processed.49.7% of the adolescents stated they had already felt breathless or oppressed; 29% said they had experienced wheezing. Of the 812 adolescents who declared they had already suffered asthma attacks the medical diagnosis was confirmed for 89%. 22% had been hospitalised at least once for asthma. A high proportion had suffered severe attacks (3.5%). A considerable number of school days had been lost by asthma sufferers. Medical care is inappropriate and the pupils' knowledge of the peak flow is poor (only 15%).The study confirmed the high frequency of asthma in Guadeloupe (14.1%) with high indicators of severity and it allowed a comparison to be made between Guadeloupe and the other regions which have carried out the ISAAC 1 study.

Most hospital admissions with asthma are avoidable. The objective of the analysis was to describe hospital readmissions for asthma.Using data from the French hospital information system, admissions for asthma or for acute respiratory failure associated with asthma that occurred in 2-44 years-old patients between 2002 and 2005 in France (excluding French overseas departments) were analysed. Readmission rates at 7 days and at 1 year were estimated using the Kaplan-Meier method.The risk of readmission at 1 year was 15.0%. It varied according to age (higher in 2-4 year and 35-44 years-old patients) and sex (higher in 10-34 years-old females) and increased with the length of stay of the index admission. The risk of readmission at 7 days was 1.1% and was higher for the shortest lengths of stay.Readmissions for asthma are pertinent indicators for the monitoring of asthma, especially the clinical management of the disease. Using data from an increasing number of years, together with linkage of hospital admissions and asthma drug reimbursement data, should allow a better understanding of severe asthma in France.

Chronic Obstructive Pulmonary Disease (COPD) is a disorder resulting from an interaction between a genetic predisposition, still poorly understood, and the impact of environmental factors including tobacco smoke or professional or domestic air contaminants.The prevalence of COPD in the world concerns women as much as men, but it remains under diagnosed among women smokers. The mortality data show an increase in mortality among women compared to men. It thus seems that COPD in women presents more often a particular phenotype, characterized more by bronchial attacks than by emphysema, and by more marked functional effects on the quality of life. Anxiety and depression seem more marked with further repercussions on the quality of life. The effectiveness of treatment may be different, in particular with regard to nicotine weaning and respiratory rehabilitation.In the evaluation of chronic diseases in women little is known about COPD. Further studies, focusing specifically on these differences, are needed in order to improve the diagnosis and management of COPD in women.

A growing body of basic and clinical science implicates Mycoplasma pneumonia in asthma, but its exact contribution to asthma development, exacerbation and persistence is as yet unclear.M. pneumoniae infection, with the induction of bronchial hyperresponsiveness, seems to be a precipitating factor for asthma development in predisposed subjects. M. pneumoniae has been seen both in acute exacerbation (18-20%) and in chronically infected adults with stable asthma, where it may be enhancing chronic airway inflammation.If M. pneumoniae plays a role in the development or progression of asthma, its eradication might influence the clinical course of the disease and improve symptoms. Macrolide treatment, with antimicrobial and anti-inflammatory properties, could have a place in the management of asthma, especially steroid-dependent asthma.M. pneumoniae infection seems to be important in asthma pathogenesis and the clinical course of the disease. Difficulty in detecting the pathogen complicates investigations. Ongoing research will further determine the place of macrolide antibiotics in asthma management.

The article by Jennings and colleagues1 described interesting findings regarding the common nature of mixed viral/bacterial aetiology in patients with community acquired pneumonia (CAP) and the association between mixed rhinovirus/pneumococcal infection and severe disease. We have also examined the role of respiratory picornaviruses as causative agents of CAP in adults and their contribution to disease severity. As part of a larger prospective clinical study2 of the aetiology of CAP, the occurrence of rhinoviruses and enteroviruses was analysed in 231 patients. Detailed information on the study design …

Renal complications of sarcoidosis are rare but they may lead to renal failure. The two most common mechanisms are interstitial nephritis and acute hypercalcaemic renal failure. We report the case of a woman who presented both of these complications.

This review is the synthesis of a working group on mild asthma. Mild asthma includes intermittent and persistent mild asthma according to the Global Initiative for Asthma (GINA) classification, and affects between 50% and 75% of asthmatic patients. Mild asthma is more frequent, more symptomatic, and less well controlled in children than in adults. Cohort studies from childhood to adulthood show that asthma severity usually remains stable over time. Nevertheless, mild asthma can lead to severe exacerbations, with a frequency ranging from 0.12 to 0.77 per patient-year. Severe exacerbations in mild asthma represent 30-40% of asthma exacerbations requiring emergency consultation. In mild asthma, inflammation and structural remodelling are constant, of varying intensity, but nonspecific. Therapy with inhaled corticosteroids (ICS) decreases bronchial inflammation, but has only a slight effect on structural remodelling, and, when stopped, inflammation immediately recurs. Permanent low-dose ICS therapy is the reference treatment for persistent mild asthma. Effectiveness is to be reassessed at 3 months, and if it is insufficient the patient is no longer considered mildly asthmatic, and treatment has to be stepped up. As mild asthma is the most frequent form of the disease, diagnosis and management require physicians' particular attention.

To update on the state of knowledge in mild asthma (intermittent and persistent mild asthma, according to the GINA classification) review the literature, and the position statement of the French Mild Asthma Working Group.The French Mild Asthma Working Group (11 lung specialists, 4 paediatricians, 1 pharmacologist, and 1 general practitioner) selected, analysed, and summarised the literature on the descriptive epidemiology, physiopathology, clinical signs, and management of mild asthma. The position of the working group on the descriptive epidemiology (causal factors excluded) and the nature of the bronchial inflammation has been presented in a previous article. The present article focuses on the clinical features of mild asthma and the use of medication for it.Mild asthma was more frequent, more symptomatic, and less well controlled in children than in adults. Its generally benign evolution may in some (10%) cases be complicated by severe episodes. Patients with mild persistent asthma require controller medication every day: permanent low-dose inhaled corticosteroid monotherapy is the reference foundation treatment for persistent mild asthma.The present findings should help clinicians and guide them in their approach to managing this condition.

Update on the state of knowledge in the mild asthma (intermittent and persistent mild asthma, according to the GINA classification) literature, and position of a French Mild Asthma Working Group.The French Mild Asthma Working Group (11 lung specialists, 4 paediatricians, 1 pharmacologist, and 1 general practitioner) selected, analysed, and summarised the literature on the epidemiology, physiopathology, clinical signs, and management of mild asthma. The present article shows the position of the working group on mild asthma descriptive epidemiology (causal factors excluded) and the nature of the bronchial inflammation. Clinical signs and medicinal treatments will be presented in a second article.Between 50% and 75% of asthma patients, depending on the study, present mild asthma. Childhood-to-adulthood cohort monitoring found severity to be unchanged over developmental time. Its generally benign evolution may in some (10%) cases be complicated by severe episodes. Inflammation and airway-wall remodelling were always found, although of variable intensity, and non-specific (except for absence of infiltration by polymorphonuclear neutrophils). Corticosteroid therapy by inhalation reduces bronchial inflammation, but with little impact on airway-wall remodelling.The present findings should help clinicians in identifying and understanding mild asthma.

The level of a patient's knowledge about his disease and its treatment is an essential part of an educational assessment. It is useful therefore to make use of a rapid, easy and valid method to collect the information necessary to develop an educational programme adapted to the needs of the patient. The aim of this study is to validate, in a structured way, a knowledge questionnaire on chronic obstructive pulmonary disease (COPD).Following a revue of the literature an initial questionnaire was constructed. It included of four domaines: biomedical aspects; symptoms and signs of severity; general knowledge and treatments. The questionnaire was tested on 35 subjects with COPD in order to assess its clarity and comprehensibility. It was reviewed and modified in both content and format by 11: French experts. The reproducibility was studied by repeat testing.The first version of the questionnaire developed by the working party consisted of 50 items. It was reduced to 41 items after interviews with 35 COPD patients and evaluation by 11 experts. The questionnaire appeared to be reproducible: mean concordance 79.5%; minimum 53.3%; maximum 100% and intra-class correlation coefficient 0.53.This study lead to the development of a French language COPD knowledge questionnaire.

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, Fagerstrom 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. Fagerstrom 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 ( n = 198 ). Two years later, the smoking cessation rate was 12% ( n = 36 ). Motivation, Fagerstrom 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 ( P = 0.03 ). Conclusion : Success to quit smoking was positively associated with age, and negatively with alcohol dependence.

A patient's knowledge of his disease and its treatment is an essential part of the evaluation of an educational process. It is useful therefore to use a rapid, easy and valid means of collecting the information necessary to produce an educational programme adapted to the needs of the patient.Following a review of the literature an initial questionnaire was constructed. It included four domains: biomedical, signs and symptoms of severity, general knowledge and treatment. The questionnaire was administered to 73 asthmatics in order to assess its clarity and comprehensibility. It was then reviewed and modified in both format and content by 10 French experts. The revised questionnaire was completed by 108 asthmatics distributed throughout 10 French respiratory centres, a group of 83 non-asthmatic subjects and 203 sixth year medical students at the Bordeaux University School of Medicine.The mean scores were: 19 for the non-asthmatics (range 2-36), 25.7 for the asthmatics (range 4-38) and 32.9 for the students (range 17-40), p 0.0001. The questionnaire was shown to be discriminating with good reliability and reproducibility: alpha Cronbach coefficient=0.82; intra-class correlation coefficient=0.70.This study has validated a French language asthma knowledge questionnaire.