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Gaëtan Deslee,1 Pierre-Régis Burgel,2 Roger Escamilla,3 Pascal Chanez,4 Isabelle Court-Fortune,5 Pascale Nesme-Meyer,6 Graziella Brinchault-Rabin,7 Thierry Perez,8 Gilles Jebrak,9 Denis Caillaud,10 Jean-Louis Paillasseur,11 Nicolas Roche2On behalf of the Initiatives BPCO Scientific Committee 1Department of Respiratory Diseases, INSERM UMR 903, Maison Blanche Hospital, University Hospital of Reims, Reims, 2Department of Respiratory Diseases, Cochin Hospital, AP-HP and University Paris Descartes, Sorbonne Paris Cité, Paris, 3Department of Respiratory Diseases, Larrey Hospital, Toulouse, 4Department of Respiratory Diseases, APHM, INSERM U1077, CNRS UMR 7733 Aix Marseille Université, Marseille, 5Department of Respiratory Diseases, University Hospital of St Etienne, 6Department of Respiratory Diseases, La Croix Rousse Hospital, Lyon, 7Department of Respiratory Diseases, Pontchaillou Hospital, University Hospital of Rennes, Rennes, 8Department of Respiratory Diseases, Calmette Hospital, University Hospital of Lille, Lille, 9Department of Respiratory Diseases, Bichat Hospital, AP-HP, Paris, 10Department of Respiratory Diseases, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, 11EFFI-STAT, Paris,FranceBackground: Cough and sputum production are frequent in chronic obstructive pulmonary disease (COPD). The objective of this study was to examine the relationship between cough and sputum production and health-related quality of life in COPD.Methods: A cross-sectional study was conducted in the French Initiatives COPD cohort and assessed cough and sputum production within the past 7 days using the cough and sputum assessment questionnaire (CASA-Q), health-related quality of life, spirometry, smoking status, dyspnea, exacerbations, anxiety and depression, and comorbidities.Results: One hundred and seventy-eight stable COPD patients were included (age, 62 [56–69]years, 128 male, forced expiratory volume in 1 second [FEV1]: 57 [37–72] % predicted) (median [Q1–Q3]). In univariate analyses, health-related quality of life (Saint George’s respiratory questionnaire total score) was associated with each CASA-Q domain and with chronic bronchitis, exacerbations, dyspnea, FEV1, depression, and anxiety. All four domains introduced separately were independently associated with health-related quality of life. When introduced together in multivariate analyses, only the cough impact domain remained independently associated with health-related quality of life (R2=0.60). With chronic bronchitis (standard definition) instead of the CASA-Q, the R2 was lower (R2=0.54).Conclusion: This study provides evidence that current cough in the previous 7 days is an important determinant of health-related quality of life impairment in stable COPD patients.Keywords: signs and symptoms, respiratory, sputum, questionnaires, dyspnea, multivariate analysis

Resume Introduction La pneumonectomie laisse en place un moignon d’artere pulmonaire plus long a droite qu’a gauche. Le cul-de-sac vasculaire ainsi forme peut etre le siege de la constitution, souvent tardive, d’un thrombus. La prevalence, les facteurs de risque et les consequences de ces thrombus sur moignon demeurent meconnus. Observations Nous rapportons trois cas de thrombose arterielle pulmonaire survenue apres pneumonectomie droite pour cancer bronchique. Le diagnostic a ete etabli par une tomodensitometrie thoracique realisee dans le cadre de la surveillance evolutive de la maladie neoplasique. Aucune complication embolique n’a ete observee malgre l’absence de traitement anticoagulant. Discussion La prevalence de cette complication est estimee a 12 %. La decouverte est souvent fortuite a l’occasion d’un scanner thoracique realise a titre systematique. Le thrombus prend l’aspect d’une lacune hypodense, a bord proximal net, convexe ou concave, moule par le produit de contraste et comblant le moignon. Une seule migration embolique est rapportee dans la litterature recente. L’evolution habituellement benigne n’incite pas a proposer d’anticoagulation systematique.

Background F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is increasingly used for the initial staging and restaging of lung cancer. Incidental gastrointestinal findings are often observed on 18F-FDG PET/CT. The objective of this study was to assess incidental 18F-FDG uptake by the gastrointestinal tract (GIT) in patients with lung cancer. Methods Two hundred thirty consecutive 18F-FDG PET/CT examinations performed for lung cancer over a 3-year period were retrospectively reviewed for the presence of incidental FDG uptake in the GIT. The charts of patients with positive FDG uptake were then reviewed and analysed to determine the GIT uptake sites, the standardized uptake value (SUV) max and the final clinical diagnosis. Results Fifty-two patients (52/230, 23 %) demonstrated incidental FDG uptake in the GIT. Thirty-three patients (63.5 %) had diffuse uptake (oesophagus, n = 2, colon, n = 31) and 19 patients (36.5 %) had focal uptake (oesophagus, n = 1, small bowel, n = 1, ascending colon, n = 5, descending colon, n = 4, sigmoid, n = 4, rectum, n = 3, and anal margin, n = 1). Twelve of the 52 patients with GIT uptake were further investigated, revealing, a diagnosis of malignancy in 4 patients with focal FDG uptake. No significant differences in mean SUVmax were observed between patients with malignant and benign GIT diseases. Conclusion This study demonstrates a high incidence of FDG uptake in the GIT associated with lung cancer. Focal GIT uptake was frequently associated with malignant disease. These results suggest that further GIT investigations should be performed in patients with focal GIT uptake.

Background Bronchiectasis is characterized by abnormal, permanent and irreversible dilatation of the bronchi, usually responsible for daily symptoms and frequent respiratory complications. Many causes have been identified, but only limited data are available concerning the association between bronchiectasis and renal transplantation. Methods We conducted a retrospective multicenter study of cases of bronchiectasis diagnosed after renal transplantation in 14 renal transplantation departments (French SPIESSER group). Demographic, clinical, laboratory and CT scan data were collected. Results Forty-six patients were included (mean age 58.2 years, 52.2 % men). Autosomal dominant polycystic kidney disease (32.6 %) was the main underlying renal disease. Chronic cough and sputum (50.0 %) were the major symptoms leading to chest CT scan. Mean duration of symptoms before diagnosis was 1.5 years [0–12.1 years]. Microorganisms were identified in 22 patients, predominantly Haemophilus influenzae. Hypogammaglobulinemia was observed in 46.9 % patients. Bronchiectasis was usually extensive (84.8 %). The total bronchiectasis score was 7.4 ± 5.5 with a significant gradient from apex to bases. Many patients remained symptomatic (43.5 %) and/or presented recurrent respiratory tract infections (37.0 %) during follow-up. Six deaths (13 %) occurred during follow-up, but none were attributable to bronchiectasis. Conclusions These results highlight that the diagnosis of bronchiectasis should be considered in patients with de novo respiratory symptoms after renal transplantation. Further studies are needed to more clearly understand the mechanisms underlying bronchiectasis in this setting.

Background: Targeted lung denervation (TLD) is a novel bronchoscopic therapy that ablates parasympathetic pulmonary nerves along the main bronchi. Bilateral (single procedure) TLD treatment has previously been reported as feasible ( Eur Resp J 2014 44: Suppl 58, P1775). Aim: Evaluate long-term safety of treating both lungs in a single TLD procedure. Methods: A prospective, multicenter, study of patients with COPD (FEV 1 /FVC 1 30-60% predicted) was performed (NCT01716598). Patients underwent bilateral TLD using a lung denervation system (Holaira, Inc., USA) in a single procedure in an outpatient setting. Long-term safety was determined by bronchoscopic inspection of the treatment sites at 1-year and registration of all AEs through 18 months. Results: Fifteen patients (47% male, age 63.2±4.0 yrs) underwent TLD at 15 watts. Bronchoscopic inspection at 1-year was completed in 14 patients with complete healing reported in all. 12 patients completed 18-month follow-up with no deaths or unexpected AEs. 8 serious AEs were observed; 3 COPD exacerbations, 1 arrhythmia, 1 BPH, 1 hemoptysis, 1 motorcycle accident and 1 urinary retention. Overall respiratory AE rates have remained low over longer-term follow up. Conclusion: TLD delivered to both lungs in a single procedure is safe with no bronchoscopic findings at 1-year and consistent low number of respiratory related adverse events reported through 18 months.

Background: Indacaterol is an inhaled, once-daily, ultra-long-acting beta(2)-agonist for the treatment of chronic obstructive pulmonary disease (COPD). We report on the effectiveness of indacaterol and other bronchodilators compared with placebo in patients across the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 categories A to D.Methods: A post-hoc, subgroup pooled analysis of 6-month efficacy data from three randomized, placebo-controlled, parallel-group studies involving 3862 patients was performed across GOLD 2011 categories A to D, according to baseline forced expiratory volume in 1 s (FEV1) % predicted, modified Medical Research Council (mMRC) dyspnea scale, and exacerbation history in the 12 months prior to entry. Efficacy of once-daily indacaterol 150 and 300 mu g, open-label tiotropium 18 mu g, twice-daily salmeterol 50 mu g, and formoterol 12 mu g was compared with placebo. End points analysed were trough FEV1, transition dyspnea index (TDI), and St George's Respiratory Questionnaire (SGRQ) total score, all at Week 26, and mean rescue medication use over 26 weeks.Results: Indacaterol 150 and 300 mu g significantly improved FEV1, compared with placebo across all GOLD groups. Indacaterol 150 and 300 jig also significantly improved TDI, SGRQ total score, and mean rescue medication use compared with placebo across most GOLD subgroups.Conclusions: Treatment selection according to patient's symptoms as well as lung function is an important consideration in maintenance treatment of COPD. Indacaterol 150 and 300 mu g effectively improved lung function and symptoms in patients across all GOLD 2011 categories. (C) 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Background: Bronchoscopic coil treatment has been shown to improve pulmonary function, exercise capacity, and quality of life in patients with severe emphysema. Objectives: To perform a meta-analysis of the results of four independent European clinical trials investigating this coil therapy for emphysema. Methods: Data on all patients included in the four European clinical trials were analyzed for efficacy and safety outcomes. Results: A total of 2,536 coils were placed during 259 procedures in 140 patients. A total of 37 chronic obstructive pulmonary disease exacerbations and 27 pneumonias were recorded as serious adverse events up to 1 year after treatment. The pneumothorax rate was 6.4%. Both 6 and 12 months after treatment, significant (all p < 0.001) improvements were observed for: forced expiratory volume in 1 s [+0.08 liters (±0.19) and +0.08 liters (±0.21)], residual volume [RV; -510 ml (±850) and -430 ml (±720)], 6-min walking distance [6MWD; +44.1 m (±69.8) and +38.1 m (±71.9)], and St. George's Respiratory Questionnaire score [SGRQ; -9.5 points (±14.3) and -7.7 points (±14.2)]. No differences in any outcome measures were observed between heterogeneous and homogeneous emphysema patients. Only a high baseline RV was found to be an independent predictor of successful treatment. Conclusions: Bronchoscopic coil treatment improves pulmonary function, 6MWD, and quality of life in patients with severe emphysema up to 1 year after treatment, independent of the distribution of the disease.

This article is the summary of a workshop, which took place in November 2013, on the roles of microorganisms in chronic respiratory diseases. Until recently, it was assumed that lower airways were sterile in healthy individuals. However, it has long been acknowledged that microorganisms could be identified in distal airway secretions from patients with various respiratory diseases, including cystic fibrosis (CF) and non-CF bronchiectasis, chronic obstructive pulmonary disease, asthma and other chronic airway diseases (e.g.post-transplantation bronchiolitis obliterans). These microorganisms were sometimes considered as infectious agents that triggered host immune responses and contributed to disease onset and/or progression; alternatively, microorganisms were often considered as colonisers, which were considered unlikely to play roles in disease pathophysiology. These concepts were developed at a time when the identification of microorganisms relied on culture-based methods. Importantly, the majority of microorganisms cannot be cultured using conventional methods, and the use of novel culture-independent methods that rely on the identification of microorganism genomes has revealed that healthy distal airways display a complex flora called the airway microbiota. The present article reviews some aspects of current literature on host–microbe (mostly bacteria and viruses) interactions in healthy and diseased airways, with a special focus on distal airways.

Resume Introduction Lors de leurs demonstrations, les cracheurs de feu utilisent le plus souvent le kerdane, produit derive du petrole. L’inhalation accidentelle du kerdane est a l’origine de manifestations respiratoires decrites sous le nom de pneumopathie des “cracheurs de feu”. Observations Nous rapportons 8 cas de pneumopathie des cracheurs de feu. Les caracteristiques cliniques, radiologiques et evolutives, ont ete comparees aux 44 cas decrits dans la litterature francophone et anglo-saxonne. La presentation etait stereotypee : survenue chez un adulte jeune et inexperimente; une phase initiale immediate, caracterisee par une toux et des troubles digestifs; apres une phase de latence, apparition d’une symptomatologie respiratoire pseudo-infectieuse s’associant frequemment a des manifestations extra-respiratoires le plus souvent digestives; une evolution clinique et radiologique habituellement favorable, rarement compliquee par la formation de pneumatoceles ou la survenue d’un pneumothorax. Conclusion Le diagnostic des pneumopathies des cracheurs de feu repose sur l’anamnese et sur un ensemble clinique et radiologique tres caracteristique. Le traitement est symptomatique. La prevention repose sur une diffusion de l’information concernant les risques lies a l’exercice de cracheur de feu.

Introduction Paraneoplastic nephrotic syndrome associated with malignant broncho-pulmonary tumors. Three cases and literature review. Malignant broncho-pulmonary tumours are the principal cause of a paraneoplastic nephrotic syndrome. These tumours are most often small cell or squamous bronchial carcinomas. In 75% of cases the nephrotic syndrome is due to a membranous glomerulonephritis and it usually precedes the discovery of the causative tumour. Cases report Three cases of paraneoploastic nephrotic syndrome associated with bronchial carcinoma are described. The first is of a bronchial carcinoid tumour associated with a membrano-proliferative glomerulonephritis. In the second a bronchial adenocarcinoma was revealed by a membranous glomerulonephritis. The last case concerns a squamous carcinoma associated with a nephrotic syndrome in which the histological lesions were not documented on account of progression to rapidly fatal acute renal failure. Conclusion A revue of the literature describes the associations between paraneoplastic nephrotic syndrome and bronchial carcinoma.

To the Editor: Clinical trials in chronic obstructive pulmonary disease (COPD) patients have shown that the long-term use of inhaled corticosteroids (ICS) in COPD patients reduced the number of exacerbations per patient per year and improved health status [1]. Early studies have suggested increased ICS efficacy in patients with low lung function and frequent exacerbations [2]. The efficacy was reinforced when ICS was used in conjunction with long-acting β2-agonists (LABA) [3]. In most countries, health authorities approved ICS/LABA combinations in COPD patients with severe airflow impairment and frequent exacerbations, as also recommended in the Global Initiative for Obstructive Lung Disease (GOLD) 2007 document [4]. However, several surveys found poor adherence to this proposal among primary care physicians and pulmonologists in “real life”, ICS being often prescribed at a milder stage of the disease. The GOLD 2011 document proposed a new multidimensional system for the assessment and management of patients with COPD [5]. This system classifies COPD patients into four categories (A, B, C and D) based on the level of symptoms (dyspnoea or global clinical impact) and the risk of future exacerbations, as assessed using the severity of airflow limitation and the past history …

Introduction Les lesions bronchiques de bas grade (dysplasie moderee ou inferieur) evoluent en cancer invasif dans 3 %des cas. Leur surveillance n’est pas consensuelle. L’objectif de cette etude est de comparer une surveillance endoscopique semestrielle a une surveillance standard chez des patients presentant uniquement des lesions precancereuses bronchiques de grade inferieur ou egal a une dysplasie moderee. Methodes SELEPREBB ( NCT00213603 ) est une etude randomisee menee dans18 centres francais entre 2002 et 2006. Les principaux criteres d’inclusion etaient : tabagisme > 30PA, exposition professionnelle a un carcinogene bronchique, presence d’au moins une lesion preinvasive bronchique sans lesion de grade superieur a une dysplasie moderee, scanner thoracique sans lesion suspecte. Dans les deux bras, les patients beneficiaient d’un examen clinique et d’une radiographie thoracique tous les 6 mois pendant 3 ans. Dans le bras experimental (B), une endoscopie avec autofluorescence etait realisee a chaque visite. Le critere principal de jugement etait la survenue d’un carcinome invasif ou in situ ou d’une dysplasie severe persistante a 3 mois. Resultats L’etude a inclus 364 patients (bras A : 180, bras B : 184). Une dysplasie mineure ou moderee etait presente au debut de l’etude chez 74 (20,3 %). Il n’y avait pas de difference entre les deux bras pour le nombre de cancer diagnostique a 3 ans ( p = 0,42), ni pour le delai jusqu’au diagnostic de cancer ( p = 0,18). Huit (11 %) des 74 patients presentant une dysplasie au debut de l’etude ont developpe un cancer bronchopulmonaire a 3 ans et 16/74 (22 %) au recul maximum (mediane 4,7 ans). La presence d’une dysplasie mineure ou moderee etait un facteur de risque significatif de cancer ( p p = 0,03, OR = 2,88, IC95 = [1,1–7,53]). Au recul maximum, l’arret du tabac etait significativement associe a une meilleure survie ( p = 0,04, OR = 0,15, IC95 = [0,003–0,99]). Parmi les 74 patients avec dysplasie au debut de l’etude, la survie etait amelioree en cas d’arret du tabac (95 % vs. 90 %, NS). Conclusion Cette etude identifie les patients porteurs d’une dysplasie mineure ou moderee sans lesion de grade superieur comme une population a tres haut risque de cancer bronchopulmonaire et de deces. Neanmoins, une surveillance endoscopique intensive ne permet pas d’ameliorer leur pronostic. L’arret du tabac apparait tres efficace dans la reduction du risque de cancer et de deces, y compris dans cette population a tres haut risque.

Resume Introduction Les cellules dendritiques (cellules dentritiques) sont capables de presenter l’antigene aux lymphocytes T et d’orienter la reponse immune vers un profil Th1 ou Th2. Etat des connaissances Cette synthese expose une serie de travaux portant sur l’etude comparative des cellules dentritiques issues de patients allergiques aux acariens et de sujets sains, en conditions experimentales in vitro et in vivo . Ces travaux ont permis de montrer que les cellules dentritiques de patients allergiques aux acariens : i) capturent plus efficacement l’allergene d’acarien, ii) secretent apres stimulation avec l’allergene d’acarien un panel particulier de cytokines et de chimiokines, et expriment preferentiellement certaines molecules de co-stimulation favorisant un profil Th2, iii) induisent apres stimulation par l’allergene d’acarien une secretion de cytokines de type Th2 par les lymphocytes T, et iv) favorisent le developpement d’une reaction inflammatoire de type Th2 specifique de l’allergene dans un modele in vivo de souris humanisee. Perspectives La modulation fonctionnelle des cellules dentritiques pourrait constituer la base de nouveaux concepts therapeutiques en pathologie allergique respiratoire. Conclusions Ces resultats montrent l’existence de specificites phenotypiques et fonctionnelles des cellules dentritiques chez les patients allergiques aux acariens, et soulignent le role-cle des cellules dentritiques dans la physiopathologie de la reponse respiratoire allergene-dependante.

Introduction Selon certaines etudes, l’ACOS serait associe a une severite clinique et a une mortalite plus elevee que la BPCO depourvue de composante asthmatique. La realite de cette specificite de l’ACOS a ete exploree au sein de la cohorte francaise « Initiatives BPCO ». Methodes Tous les patients repondent aux criteres diagnostiques de BPCO. L’ACOS a ete defini par des antecedents d’asthme avant l’âge de 40 ans. Les donnees analysees ont ete : sociodemographie, anthropometrie, clinique (dyspnee mMRC, bronchite chronique), qualite de vie (questionnaire Saint-George's), anxiete-depression (HAD), facteurs de risque (tabac, traits atopiques), exacerbations, comorbidites, fonction respiratoire, traitements et mortalite. Resultats Cent vingt-neuf sur 998 patients (13 %) ont ete qualifies « ACOS ». En analyses multivariees, l’ACOS etait associe aux traits atopiques (rhinite saisonniere : OR 5,5 ; 3,4–9,0 ; dermatite : OR : 3,8 ; 2,1–6,6), a un tabagisme cumule moindre (OR : 0,992 ; IC 95 % 0,984–1,000 par paquet-annee), a l’obesite (OR : 2,0 ; IC 95 % : 1,2–3,2), a des traitements plus frequents par associations de corticoides inhales et bronchodilatateurs longue duree d’action (OR : 1,9 ; 1,3–2,7) et antileucotrienes (OR : 4,8 ; 1,6-14,3), theophylline (OR : 2,5 ; 1,2–4,9) et corticotherapie orale au long cours (OR : 3,0 ; 1,3–7,1). Aucune association n’a ete retrouvee avec la severite clinique (dyspnee, exacerbations, VEMS, comorbidites) ni la mortalite. Conclusion Par rapport aux BPCO « pures », l’ACOS est associe aux traits atopiques, a l’obesite, a un moindre tabagisme cumule, a des traitements « anti-asthmatiques » plus frequents, mais non a une severite clinique ou a une mortalite plus importante.

Four cases of primary endobronchial actinomycosis associated with an inhaled foreign body are described. In the light of these cases and those previously reported in the literature, we describe the main features of this uncommon association. All patients were > 55 years old, were predominantly men, and were usually in a debilitated state. In > 50% of cases, the clinical presentation was suggestive of lung cancer. Thoracic CT rarely revealed a foreign body, but the granulomatous reaction of the bronchial wall was sometimes suggestive of bronchial thickening. Sulfur granules identified on bronchial biopsies were highly suggestive of actinomycosis in most cases, but microbiological culture findings were usually negative. Antibiotics generally ensure good recovery. Extraction of the foreign body was delayed after antibiotic therapy in one half of cases, suggesting the need for endoscopic follow-up in bronchial actinomycosis.

Objet La bronchopneumopathie chronique obstructive (BPCO) est la cinquieme cause de mortalite mondiale. Elle est notamment caracterisee par des remaniements de l’epithelium des voies aeriennes alterant la clairance mucociliaire [1] . Etant donne que la cellule basale non differenciee est a l’origine des cellules secretrices et ciliaires de l’epithelium respiratoire [2] et qu’elle possede un cil primaire [3] , l’objectif de cette etude est la caracterisation des cils primaires des cellules basales chez des patients BPCO et non BPCO. Methodes L’analyse de la presence des cils primaires et moteurs a ete realisee par immunohistochimie sur des coupes tissulaires de bronches de 32 patients ayant subi une resection pulmonaire dans un contexte de pathologie cancereuse. Les patients sont classes en fonction de leur statut tabagique et du stade de severite spirometrique de la BPCO : 16 patients non BPCO (9 non-fumeurs, 4 ex-fumeurs, 3 fumeurs) et 16 patients BPCO (4 BPCO de stade 1, 10 BPCO de stade 2 et 2 BPCO de stade 3). Resultats Nous avons montre pour la premiere fois que les cellules basales de l’epithelium respiratoire normal presentent des cils primaires. De facon tres interessante, les cellules basales situees dans les zones de remodelage epithelial contiennent un nombre plus eleve de cils primaires. Les cellules basales presentes au sein de l’epithelium respiratoire histologiquement normal chez les patients atteints de BPCO ont 2 a 3 fois plus de cils primaires que des patients non BPCO et d’un facteur 10 dans les zones de remodelage. Conclusion La presence d’une quantite elevee de cils primaires au niveau des cellules basales est associee a un remodelage epithelial, notamment chez des patients BPCO. L’etude des cils primaires et l’identification des acteurs responsables de l’alteration de la ciliogenese pourraient constituer un outil diagnostique et aboutir au developpement de strategies therapeutiques dans le contexte des pathologies respiratoires obstructives chroniques.

International audience; Severe emphysema is a difficult to treat condition with limited efficacy of currently available treatments. Endobronchial coil treatment (ECT) is a minimally invasive endobronchial treatment which consists of placing shape-memory nitinol coils in emphysematous lobes to enhance lung recoil and reduce lung hyperinflation at rest and during exercise [1, 2]. Randomised studies demonstrated an improvement in exercise capacity, lung function and quality of life, and showed an acceptable safety profile at 1 year [3–6]. However, to our best knowledge, longer term safety and effectiveness results beyond 1 year have not been reported thus far.REVOLENS (Réduction volumique endobronchique par spirales) (NCT01822795) is a 1:1 randomised controlled study of 100 patients (50 patients treated with coils and optimal medical management and 50 patients treated with optimal medical management only) in 10 centres across France. Patients treated with optimal medical management only were offered coil treatment after 1 year. The study protocol [7] and 1-year results [5] of the REVOLENS study have been previously described, demonstrating a decrease in lung hyperinflation and improvement in quality of life. In the present study, we analysed efficacy and safety data at 2 years in the 50 patients randomised to the ECT group.

Basement membrane collagens or derived fragments are measured in biological fluids such as blood and urine of patients and appear to be useful for diagnosis, prognostication, or treatment monitoring as proposed for endostatin, a fragment of collagen XVIII, or tumstatin, a fragment of collagen IV. Tetrastatin, the NC1 alpha 4 collagen IV domain, was previously reported to inhibit tumor growth and angiogenesis. The aim of this study was to develop and validate a method to measure tetrastatin concentrations in human fluids. We developed a competitive enzyme-linked immunosorbent assay (ELISA). It allowed measuring tetrastatin levels in human serum, bronchial aspiration and bronchoalveolar lavage fluids, and lung tissue extracts. The tetrastatin level was significantly higher in tumor tissues than in healthy lung tissues. Tetrastatin competitive ELISA could be useful to quantify tetrastatin in tissues and biological fluids for the diagnosis or prognostication of diseases in which basement membrane metabolism may be altered, especially tumor progression.

Background Airway epithelium integrity is essential to maintain its role of mechanical and functional barrier. Recurrent epithelial injuries require a complex mechanism of repair to restore its integrity. In chronic obstructive pulmonary disease (COPD), an abnormal airway epithelial repair may participate in airway remodeling. The objective was to determine if airway epithelial wound repair of airway epithelium is abnormal in COPD. Methods Patients scheduled for lung resection were prospectively recruited. Demographic, clinical data and pulmonary function tests results were recorded. Emphysema was visually scored and histological remodeling features were noted. Primary bronchial epithelial cells (BEC) were extracted and cultured for wound closure assay. We determined the mean speed of wound closure (MSWC) and cell proliferation index, matrix metalloprotease (MMP)-2, MMP-9 and cytokines levels in supernatants of BEC 18 hours after cell wounding. In a subset of patients, bronchiolar epithelial cells were also cultured for wound closure assay for MSWC analyze. Results 13 COPD and 7 non COPD patients were included. The severity of airflow obstruction and the severity of emphysema were associated with a lower MSWC in BEC (p = 0.01, 95% CI [0.15-0.80]; p = 0.04, 95% CI [−0.77;-0.03] respectively). Cell proliferation index was decreased in COPD patients (19 ± 6% in COPD vs 27 ± 3% in non COPD, p = 0.04). The severity of COPD was associated with a lower level of MMP-2 (7.8 ± 2 105 AU in COPD GOLD D vs 12.8 ± 0.13 105 AU in COPD GOLD A, p = 0.04) and a lower level of IL-4 (p = 0.03, 95% CI [0.09;0.87]). Moreover, higher levels of IL-4 and IL-2 were associated with a higher MSWC (p = 0.01, 95% CI [0.17;0.89] and p = 0.02, 95% CI [0.09;0.87] respectively). Clinical characteristics and smoking history were not associated with MSWC, cell proliferation index or MMP and cytokines levels. Finally, we showed an association of the MSWC of bronchial and corresponding bronchiolar epithelial cells obtained from the same patients (p = 0.02, 95% CI [0.12;0.89]). Conclusion Our results showed an abnormal bronchial epithelial wound closure process in severe COPD. Further studies are needed to elucidate the contribution and the regulation of this mechanism in the complex pathophysiology of COPD. Electronic supplementary material The online version of this article (doi:10.1186/s12931-014-0151-9) contains supplementary material, which is available to authorized users.

Background The lung volume reduction (LVR) coil is a minimally invasive bronchoscopic nitinol device designed to reduce hyperinflation and improve elastic recoil in severe emphysema. We investigated the feasibility, safety and efficacy of LVR coil treatment in a prospective multicentre cohort trial in patients with severe emphysema. Methods Patients were treated in 11 centres. Safety was evaluated by recording all adverse events, efficacy by the St George's Respiratory Questionnaire (SGRQ) as primary endpoint, and pulmonary function testing, modified Medical Research Council dyspnoea score (mMRC) and 6-min walk distance (6MWD) up to 12 months after the final treatment. Results Sixty patients (60.9 ± 7.5 years, forced expiratory volume in 1 s (FEV1) 30.2 ± 6.3% pred) were bronchoscopically treated with coils (55 bilateral, 5 unilateral), with a median of 10 (range 5-15) coils per lobe. Within 30 days post-treatment, seven chronic obstructive pulmonary disease exacerbations (6.1%), six pneumonias (5.2%), four pneumothoraces (3.5%) and one haemoptysis (0.9%) occurred as serious adverse events. At 6 and 12 months, respectively, DSGRQ was −12.1±12.9 and −11.1±13.3 points, D6MWD was +29.7±74.1 m and +51.4±76 m, DFEV1 was +0.11±0.20 L and +0.11±0.30 L, and DRV (residual volume) was −0.65±0.90 L and −0.71±0.81 L (all p

Broncholithiasis is characterized by calcified perihilar and mediastinal lymph nodes eroding into the tracheobronchial tree. We report herein 4 cases of symptomatic broncholithiasis managed by surgical resection in 2 cases and bronchoscopic removal in 2 cases. From our experience and from the literature review, bronchoscopic removal should be considered in cases of uncomplicated and loose broncholithiasis, whereas surgical management should be chosen first in complicated cases such as obstructive pneumonitis, bronchiectasis, massive hemoptysis, and bronchoesophageal fistulas.

15 sujets sains ont realise des contractions maximales volontaires du quadriceps. Pendant chaque contraction, l’activation cerebrale etait etudiee au moyen de la spectroscopie proche infrarouge (variation de [O2Hb]) sur les aires corticales motrices (M1), sensorielles (S1) primaires, premotrices (PMC) et prefrontales (PFC). Resultats et discussion.– Compares aux sujets sains, la force maximale etait diminuee de 24,8 % chez les patients (131,9 64,3 Nm vs 175,4 49,3, p < 0,05). Parallelement, un deficit d’activation cerebrale significatif (p < 0,05) a ete observe sur M1, PMC et PFC chez les patients, indiquant que la commande nerveuse en provenance des aires motrices etait alteree. Conclusion.– Les muscles extenseurs du genou ne sont pas actives de maniere optimale par le cerveau chez les patients BPCO. Ces resultats permettent de comprendre pourquoi une perte de force musculaire est retrouvee chez certains patients en l’absence evidente d’atrophie musculaire [2]. Un nouveau champ physiopathologique demande donc a etre explore, de facon a comprendre les origines et les repercussions precises de ces alterations de la commande centrale dans la tolerance a l’effort.

Introduction Chez les patients atteints de BPCO, plusieurs etudes suggerent des associations entre le taux d’eosinophiles circulants (Eos) et (i) la frequence des exacerbations et (ii) l’efficacite des corticoides inhales pour la prevention des exacerbations [1] . Le but de cette etude etait de determiner si Eos definit un groupe de patients avec un phenotype particulier. Nous avons analyse les donnees cliniques et la mortalite des patients de la cohorte francaise initiatives BPCO selon le taux d’eosinophiles sanguins. Methodes Les donnees suivantes ont ete recueillies a l’inclusion dans la cohorte : tabagisme, antecedents personnels, exposition professionnelle, dyspnee, toux, expectorations, exacerbation annuelle, histoire d’allergie ou d’asthme, IMC, score total SGRQ, spirometrie, plethysmographie, CRP et traitements. La survie a 3 ans etait disponible pour tous les patients. Les scores de BOD et ADO ont ete calcules. Les analyses ont ete effectuees avec deux seuils d’eosinophiles sanguins : ≥ 2 % vs. Resultats Le taux d’eosinophile etait disponible pour 458 patients (âge moyen : 62 ans, 72 % d’hommes, VEMS moyen : 51 %) dont 223 Eos+ (49 %) avec un suivi moyen de 48 mois. Le taux d’Eos median etait de 1,9 % [0,9–3,4]. Avec le seuil de 2 %, la mortalite toutes causes confondues etait de 13 % pour les patients Eos+ (≥ 2 %) vs. 17 % pour les patients Eos– ( p = 0,23). Chez les patients Eos+, le diabete etait plus frequent (8 % vs. 17 %, p = 0,02) et la qualite de vie etait meilleure (SGRQ median a 40 vs. 48, p = 0,007). En revanche, il n’y avait aucune difference entre les deux groupes pour le taux d’exacerbation (1,6/patient/an) ou les antecedents d’asthme (15 % de la population). Les resultats etaient similaires en utilisant un seuil de 3 % ( n = 149 pour Eos ≥ 3 % et n = 309 pour Eos Conclusion Les patients atteints de BPCO Eos+ ne presentaient aucune caracteristique clinique particuliere, notamment concernant les symptomes, la fonction respiratoire, les exacerbations ou le pronostic. Seule la qualite de vie etait meilleure et le diabete moins frequent chez les patients Eos+. Ces resultats different de ceux d’autres etudes, ce qui suggere que le taux d’eosinophiles circulants n’est pas un biomarqueur fiable pour identifier des phenotypes specifiques de patients atteints de BPCO.

Rationale: Organizing pneumonia (OP) is a clinicopathological entity characterized by granulation tissue plugs in the lumen of small airways, alveolar ducts, and alveoli. OP can be cryptogenic (primary) (COP) or secondary to various lung injuries. Patient concerns: We report the case of a 38-year-old male smoker with COP presenting in the form of diffuse micronodules on computed tomography (CT) scan and describe the clinical, radiological, and functional characteristics of micronodular pattern of organizing pneumonia (MNOP) based on a review of the literature including 14 cases. Patients were younger (36.3 ± 15.5 years) than those with the classical form of OP. The clinical presentation was subacute in all cases with a mean duration of symptoms before admission of 14.5 ± 13.2 days. The radiological pattern was characterized by centrilobular nodules and “bud-in-tree” sign in 86.7% of patients. The diagnosis was based on histological examination of transbronchial (28.6%) or surgical biopsies (71.4%). Diagnosis: An associated condition was identified in 65% of cases and included illicit substance abuse (44.5%), myeloproliferative disease (33.5%), and infections (22%). Outcomes: Steroid therapy was effective in all patients with improvement of symptoms and documented radiologic resolution. No relapse was recorded. Lessons: MNOP should be recognized and distinguished from other diagnoses, mainly infectious bronchiolitis and disseminated tumor, as it requires early specific steroid therapy.

Rosai–Dorfman Disease (RDD) is a rare non-neoplastic entity, also known as sinus histiocytosis with massive lymphadenopathy (SHML), characterized by a benign proliferation of histiocytes in lymph nodes. Localized forms of RDD involving the tracheobronchial tree are very rare. There is no consensus regarding the management of central airway forms and recurrence is frequent. We report the case of an 81-year-old Caucasian woman admitted in 2014 for chronic cough. Her main medical past history included a diagnosis of sinonasal RDD in 1996 with recurrent obstructive rhinosinusitis requiring repeated sinonasal surgery, and a diagnosis of tracheal RDD in 2010 with 2 asymptomatic smooth lesions (5 and 7 mm) on the anterior tracheal wall. Physical examination was normal in 2014. Pulmonary function tests showed an obstructive pattern. Computed tomographic scan revealed a mass arising from the anterior wall of the trachea that projects into the tracheal lumen. Fiberoptic bronchoscopy showed a hypervascular multilobular lesion (2 cm) arising from the anterior tracheal wall and causing 50% obstruction of the tracheal lumen. Mechanical resection with electrocoagulation of the tracheal mass was performed by rigid bronchoscopy with no complication. Histological examination demonstrated tracheal RDD. One year after endotracheal resection, the patient presented no recurrence of cough and the obstructive pattern had resolved. Reports on tracheobronchial involvement are scarce. Symptomatic tracheobronchial obstruction requires mechanical resection by rigid bronchoscopy or surgery. Recurrence is frequent, justifying long-term follow-up.

Few studies have evaluated the contribution of multiple virus and bacterial infections in acute exacerbation of chronic obstructive pulmonary disease. This study estimated the burden of multiple viral and bacterial respiratory infections in moderate to very severe chronic obstructive pulmonary disease patients that were prospectively followed‐up during a 12‐month pilot study. Clinical data were collected monthly and sputum was collected at the time of each acute exacerbation event. Classical culture techniques for bacteria and multiplex polymerase chain reaction (PCR) and microarray detection assays were performed to identify viral and atypical bacterial pathogens in the sputum. Overall, 51 patients were included and 45 acute exacerbation events were investigated clinically and microbiologically. Among the 45 acute exacerbation events, 44% had evidence of viral infection involving human rhinovirus (HRV) and metapneumovirus (hMPV) in 20% and 18%, respectively. Intracellular bacteria were not found in sputum by PCR. Common bacterial pathogens were identified in 42% of acute exacerbation patients, most frequently Branhamella catarrhalis, Streptococcus pneumoniae and Haemophilus influenzae. Viral or virus and bacteria co‐infections were detected in 27% of acute exacerbation events (n = 12) with HRV and hMPV involved in 92% of cases. Patients with co‐infections did not present greater clinical severity scores at exacerbation and more recurrence of acute exacerbation events at 3 and 6 months than those with single infections (P > 0.4). These results suggest that HRV and hMPV may be contributors or cofactors of AECOPD. These findings indicate that viral or virus and bacterial co‐infections do not impact significantly on the clinical severity of acute exacerbation of chronic obstructive pulmonary disease and recurrence at 3 and 6 months. J. Med. Virol. 85:866–873, 2013. © 2013 Wiley Periodicals, Inc.

International audience; ABSTRACT: BACKGROUND: Mechanical ventilation (MV) is imperative in many forms of acute respiratory failure (ARF) in COPD patients. Previous studies have shown the difficulty to identify parameters predicting the outcome of COPD patients treated by invasive MV. Our hypothesis was that a non specialized score as the activities daily living (ADL) score may help to predict the outcome of these patients. METHODS: We studied the outcome of 25 COPD patients admitted to the intensive care unit for ARF requiring invasive MV. The patients were divided into those weaning success (group A n = 17, 68%) or failure (group B n = 8, 32%). We investigated the correlation between the ADL score and the outcome and mortality. RESULTS: The ADL score was higher in group A (5.1 +/-1.1 vs 3.7 +/- 0.7 in group B, p < 0.01). Weaning was achieved in 76.5of the cases with an ADL score [greater than or equal to] 4 and in 23.5of the cases with an ADL score < 4 (p < 0.05). Pulmonary function test, arterial blood gases collected during period of clinical stability and at admission and nutritional status were similar in both groups. The mortality, at six months, was 36%. The ADL score was a significant predictor of 6-month mortality (80with an ADL score

We report the first published case of agranulocytosis induced by omeprazole and its recurrence with esomeprazole, the S-isomer form of omeprazole. Interestingly, we found an homozygotous mutation of CYP2C19*17, responsible for the metabolism of proton pump inhibitors.

International audience; BACKGROUND: Idiopathic tracheal stenosis (ITS) is a rare condition representing a difficult therapeutic challenge. Endoscopic management is a therapeutic option but long-term results are not established. The aim of this retrospective multicenter study was to analyze long-term outcome after endoscopic management of ITS. METHODS: Nine institutions involved in interventional bronchoscopy were contacted and asked to identify ITS endoscopically treated. A standard form was used to report the main characteristics and long-term outcome after endoscopic management. RESULTS: Twenty-three patients, 96% women, aged 45±16 years, were endoscopically treated for ITS. Time between first symptoms and diagnosis was 19±18 months. Bronchoscopy showed a weblike (61%) or complex (39%) stenosis, located in the upper part of the trachea, mainly in the cricoid area. Endoscopic treatment included mechanical dilation only (52%) or associated with laser or electrocoagulation (30%) and stent placement (18%). All procedures were efficient. The follow-up after endoscopic management was 41±34 months. The ITS recurrence occurred in 30% at 6 months, 59% at 2 years, and 87% at 5 years, with a delay of 14±16 months. The treatment of recurrence (n=13) included endoscopic management in 12 cases. CONCLUSIONS: Endoscopic management of ITS provides a safe and efficient therapeutic option but late recurrences are frequent and require long-term follow-up.

Oxidative stress is widely proposed as a pathogenic mechanism for chronic obstructive pulmonary disease (COPD), but the molecular pathway connecting oxidative damage to tissue destruction remains to be fully defined. We suggest that reactive oxygen species (ROS) oxidatively damage nucleic acids, and this effect requires multiple repair mechanisms, particularly base excision pathway components 8-oxoguanine-DNA glycosylase (OGG1), endonuclease III homologue 1 (NTH1), and single-strand–selective monofunctional uracil-DNA glycosylase 1 (SMUG1), as well as the nucleic acid-binding protein, Y-box binding protein 1 (YB1). This study was therefore designed to define the levels of nucleic-acid oxidation and expression of genes involved in the repair of COPD and in corresponding models of this disease. We found significant oxidation of nucleic acids localized to alveolar lung fibroblasts, increased levels of OGG1 mRNA expression, and decreased concentrations of NTH1, SMUG1, and YB1 mRNA in lung samples from subjects with very severe COPD compared with little or no COPD. Mice exposed to cigarette smoke exhibited a time-dependent accumulation of nucleic-acid oxidation in alveolar fibroblasts, which was associated with an increase in OGG1 and YB1 mRNA concentrations. Similarly, human lung fibroblasts exposed to cigarette smoke extract exhibited ROS-dependent nucleic-acid oxidation. The short interfering RNA (siRNA)-dependent knockdown of OGG1 and YB1 expression increased nucleic-acid oxidation at the basal state and after exposure to cigarette smoke. Together, our results demonstrate ROS-dependent, cigarette smoke-induced nucleic-acid oxidation in alveolar fibroblasts, which may play a role in the pathogenesis of emphysema.

Staphylococcus aureus is frequently isolated from lungs of patients with cystic fibrosis (CF). Upon lung infection with S. aureus, airway epithelial cells (AEC) produce high levels of chemokines that enhance T-cell chemotaxis. Although the number of lymphocytes is increased in the airways and bronchoalveolar lavage fluid of patients with CF, the mechanisms responsible for their accumulation and the role of S. aureus in this process are largely unknown. This study investigated early S. aureus impact on chemokine secretion by CF epithelial cells and chemotaxis of CF T cells. CF and non-CF AEC were grown in a cell culture model and apically stimulated with S. aureus. Supernatants were quantified for chemokine secretions and assayed for T-cell chemotaxis. CF AEC secreted constitutively larger amounts of IL-8, GROalpha, MIG, MIP-3beta, and MCP-1 than non-CF epithelial cells. S. aureus interaction with epithelial cells increased chemokine production by non-CF cells but had no effect on CF cells. Chemotaxis of T cells derived from patients with CF was greater than that of T cells from subjects without CF. Moreover, there were more CF T cells expressing CXCR1 as compared with non-CF T cells. Under our experimental conditions, inhibition of IL-8 or its receptor CXCR1 resulted in a considerable decrease in T-cell chemotaxis (up to 80%). These data suggest that IL-8 and its receptor CXCR1 are key players in the chemotaxis of CF T cells and could be used as targets to develop therapies for CF.

IMPORTANCE: Therapeutic options for severe emphysema are limited. Lung volume reduction using nitinol coils is a bronchoscopic intervention inducing regional parenchymal volume reduction and restoring lung recoil. OBJECTIVE: To evaluate the efficacy, safety, cost, and cost-effectiveness of nitinol coils in treatment of severe emphysema. DESIGN, SETTING, AND PARTICIPANTS: Multicenter 1:1 randomized superiority trial comparing coils with usual care at 10 university hospitals in France. Enrollment of patients with emphysema occurred from March to October 2013, with 12-month follow-up (last follow-up, December 2014). INTERVENTIONS: Patients randomized to usual care (n = 50) received rehabilitation and bronchodilators with or without inhaled corticosteroids and oxygen; those randomized to bilateral coil treatment (n = 50) received usual care plus additional therapy in which approximately 10 coils per lobe were placed in 2 bilateral lobes in 2 procedures. MAIN OUTCOMES AND MEASURES: The primary outcome was improvement of at least 54 m in the 6-minute walk test at 6 months (1-sided hypothesis test). Secondary outcomes included changes at 6 and 12 months in the 6-minute walk test, lung function, quality of life as assessed by St George's Respiratory Questionnaire (range, 0-100; 0 being the best and 100 being the worst quality of life; minimal clinically important difference, ≥4), morbidity, mortality, total cost, and cost-effectiveness. RESULTS: Among 100 patients, 71 men and 29 women (mean age, 62 years) were included. At 6 months, improvement of at least 54 m was observed in 18 patients (36%) in the coil group and 9 patients (18%) in the usual care group, for a between-group difference of 18% (1-sided 95% CI, 4% to ∞; P = .03). Mean between-group differences at 6 and 12 months in the coil and usual care groups were +0.09 L (95% CI, 0.05 L to ∞) (P = .001) and +0.08 L (95% CI, 0.03 L to ∞) (P = .002) for forced expiratory volume in the first second, +21 m (95% CI, -4 m to ∞) (P = .06) and +21 m (95% CI, -5 m to ∞) (P = .12) for 6-minute walk distance, and -13.4 points (95% CI, -8 points to ∞) and -10.6 points (95% CI, -5.8 points to ∞) for St George's Respiratory Questionnaire (1-sided P

Introduction Les pseudomembranes fibrineuses obstructives de trachee (OFTP) sont une complication rare mais potentiellement severe des intubations endotracheales. Elles constituent un manchon tubulaire fibrineux obstruant la trachee, survenant apres l’extubation. Ses caracteristiques principales ne sont toutefois pas clairement connues. Methodes L’ensemble des cas d’OFTP publies entre 1981 et 2015 ont ete systematiquement revus. Nous avons analyse les caracteristiques demographiques, cliniques et endoscopiques des OFTP, leur prise en charge therapeutique et leur evolutivite. Resultats Cinquante-neuf patients etaient inclus, 44 % etaient des hommes, avec un âge moyen de 36 ± 22 ans. Dans 77 % des cas, l’intubation endotracheale etait realisee dans des conditions d’urgence, des difficultes mecaniques etaient decrites dans 23 % des cas. Les OFTP etaient revelees par des symptomes respiratoires aigus dans 54 % des cas, avec une detresse respiratoire aigue dans 17 % des cas. Les premiers symptomes survenaient 3,1 ± 3 jours apres l’extubation. Le degre moyen d’obstruction tracheale etait de 79 ± 11 %. Une extraction mecanique de l’OFTP par bronchoscopie etait realisee dans 85 % des cas, efficace dans tous les cas, sans recidive apres 6 ± 11 mois de suivi. Deux patients etaient decedes avant la realisation d’investigations. Trois patients avaient spontanement expectore l’OFTP lors d’un effort de toux. Conclusion Les OFTP sont caracterisees par une presentation clinique et endoscopique typiques et une absence de recidive apres une ablation mecanique par endoscopie interventionnelle. La realisation precoce d’une bronchoscopie est un element clef de la prise en charge diagnostique et therapeutique des OFTP.

BackgroundChronic obstructive pulmonary disease (COPD) is characterized by abnormal lung inflammation that exceeds the protective response. Various culture models using epithelial cell lines or primary cells have been used to investigate the contribution of bronchial epithelium in the exaggerated inflammation of COPD. However, these models do not mimicin vivosituations for several reasons (e.g, transformed epithelial cells, protease-mediated dissociation of primary cells, etc.). To circumvent these concerns, we developed a new epithelial cell culture model.MethodsUsing non transformed non dissociated bronchial epithelium obtained by bronchial brushings from COPD and non-COPD smokers, we developed a 3-dimensional culture model, bronchial epithelial spheroids (BES). BES were analyzed by videomicroscopy, light microscopy, immunofluorescence, and transmission electron microscopy. We also compared the inflammatory responses of COPD and non-COPD BES. In our study, we chose to stimulate BES with lipopolycaccharide (LPS) and measured the release of the pro-inflammatory mediators interleukin-8 (IL-8) and leukotriene B4 (LTB4) and the anti-inflammatory mediator prostaglandin E2 (PGE2).ResultsBES obtained from both COPD and non-COPD patients were characterized by a polarized bronchial epithelium with tight junctions and ciliary beating, composed of basal cells, secretory cells and ciliated cells. The ciliary beat frequency of ciliated cells was not significantly different between the two groups. Of interest, BES retained their characteristic features in culture up to 8 days. BES released the inflammatory mediators IL-8, PGE2 and LTB4 constitutively and following exposure to LPS. Interestingly, LPS induced a higher release of IL-8, but not PGE2 and LTB4 in COPD BES (p < 0.001) which correlated with lung function changes.ConclusionThis study provides for the first time a compelling evidence that the BES model provides an unaltered bronchial surface epithelium. More importantly, BES represent an attractive culture model to investigate the mechanisms of injuring agents that mediate epithelial cell inflammation and its contribution to COPD pathogenesis.

Aim To evaluate the proportion of work-related cancers. Methods A descriptive study of incident cases of cancer during 3 years in a French county. All people with cancer having a current or past working history were included in the studied population which was recruited from local hospitals. A working history was obtained from each subject by interview. The different organ cancers were linked using well-defined criteria, to specific occupational carcinogenic exposures. The results obtained were compared to international data on work-related cancer incidences. Results A total of 2009 cases were included and 3.18% (64) met the criteria for work-related cancer as defined. Asbestos and polycyclic hydrocarbons were the main occupational carcinogens identified. Construction and fabricated metal products sectors were linked to almost two-thirds of work-related cancers. The percentage of the studied population with attributable risk for occupational cancer was relatively close to international data (mean 4%) and organ cancer distribution percentages did not vary significantly from international published validated data. Conclusion Work-related cancers tend to be concentrated in relatively small groups of people among whom the risk of developing the disease may be quite large. The detection of occupational hazards should therefore have a higher priority in any programme of cancer prevention. Well-defined criteria to identify specifically cancers with an occupational origin should be specified by the scientific international community.

L’impact de la toux et de l’expectoration sur la qualite de vie au cours de la BPCO a ete peu etudie. Le questionnaire CASA-Q (Cough And Sputum Assessment-Questionnaire) a ete specifiquement developpe pour evaluer ces symptomes et leur impact. L’objectif etait d’evaluer l’association entre toux, expectoration et leurs impacts specifiques, et la qualite de vie dans le cadre de la cohorte Initiatives BPCO. Le questionnaire CASA-Q comporte quatre domaines de symptomes et d’impact sur la toux et l’expectoration. Les domaines de symptome et d’impact etaient combines, aboutissant a deux sous-scores : toux et expectoration. Les variables suivantes etaient considerees : questionnaire de qualite de vie du Saint-George's (SGRQ), index de masse corporelle, echelle d’anxiete depression (HAD), echelle de dyspnee mMRC, exacerbations, statut tabagique, comorbidites et bronchite chronique. Les analyses univariees etaient completees par une analyse multivariee pour identifier les facteurs associes au score SGRQ total. L’analyse finale a porte sur 148 patients (âge median [IQR] : 62 [56–69] ans, 72 % d’hommes, VEMS median : 57 [37–72] %). Une association independante etait identifiee entre le score total SGRQ (44 [29–57]) et le score CASA-Q de toux, le VEMS, la dyspnee, les exacerbations, la depression et les comorbidites cardiovasculaires. L’association avec le score CASA-Q d’expectoration n’atteignait pas la significativite (p = 0,06). Conclusion Ces resultats montrent une relation independante entre la toux evaluee par le CASA-Q et la qualite de vie. Ces resultats suggerent que la toux pourrait constituer une cible therapeutique pour ameliorer la qualite de vie au cours de la BPCO.

Introduction La TEP-TDM est de plus en plus utilisee pour le bilan initial et la reevaluation dans cancers bronchopulmonaires. Son utilisation croissante amene a etre souvent confronte a des lesions hypermetaboliques de decouvertes fortuites extra thoraciques et notamment au niveau du tube digestif. L’objectif de notre etude est d’evaluer l’incidence et l’etiologie de ces lesions. Patients et methodes Deux cent trente patients atteints de cancer bronchopulmonaires ont beneficie d’une TEP-TDM en 3 ans. Les comptes rendus ont ete analyses retrospectivement afin d’identifier ceux avec une fixation au niveau du tube digestif. Les dossiers des patients identifies ont ete ensuite analyses pour obtenir les informations sur la localisation gastro-intestinale, la SUVmax et le diagnostic final. Resultats Une fixation digestive a ete mise en evidence pour 52/230 (23 %). Trente-trois patients (63,5 %) avaient une fixation diffuse et 19 (36,5 %) avaient une fixation focale. Dans les deux groupes, le colon a ete le siege privilegie des fixations. Douze sur cinquante-deux patients ont poursuivi les investigations. Parmi ces 12 patients, 4 patients avec des lesions focales ont eu un diagnostic de malignite. Il n’a pas ete identifie de difference significative dans les moyennes de SUVmax entre les 4 groupes de diagnostic (malignite certaine, haute probabilite de malignite, benignite certaine, haute probabilite de benignite). Conclusion Cette etude montre une incidence elevee de lesion gastro-intestinale hyperfixante de decouverte fortuite associee au cancer du poumon. Ces resultats suggerent que des explorations doivent etre realisees en cas de lesion focale gastro-intestinale de decouverte fortuite en TEP-TDM.