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Resume Introduction L’objectif de cette etude est d’evaluer l’observance aux traitements et ses determinants dans une population d’asthmatiques severes. Methodes Le college des pneumologues des hopitaux generaux a realise une vaste etude observationnelle, prospective, transversale et multicentrique sur 1502 patients adultes asthmatiques severes. Resultats Le nombre moyen de traitements de fond etait de 2,5 ± 1,1. L’observance evaluee par auto-questionnaire chez 1289 patients etait de 64,8 %, concordant avec l’impression du pneumologue traitant (p Conclusion Dans cette large etude, 64,8 % des patients asthmatiques severes etaient observants et semblaient etre associes a un meilleur controle selon les criteres definis dans notre etude. L’observance est meilleure chez les patients plus âges, de longue duree d’evolution de l’asthme ou recevant une biotherapie par anti-IgE.

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

Even though COVID-19 clinical features, pathogenesis, complications, and therapeutic options have been largely described in the literature, long-term consequences in patients remain poorly known.The French, multicentre, non-interventional SISCOVID study evaluated lung impairment three (M3) and six months (M6) after hospital discharge in patients recovered from COVID-19. Evaluation was based on clinical examination, pulmonary function tests, and chest computed tomography (CT-scan).Of the 320 included patients (mean age: 61 years; men: 64.1%), 205 had had a severe form of COVID-19, being hospitalised in an intensive care unit (ICU), and requiring high flow nasal cannula, non-invasive ventilation, or invasive mechanical ventilation. At M6, 54.1% of included patients had persistent dyspnoea (mMRC score ≥1), 20.1% severe impairment in gas diffusing capacity (DLSix months after discharge, patients hospitalised for COVID-19, especially those recovered from a severe form of COVID-19, frequently presented persistent dyspnoea, lung function impairment, and persistent fibrotic-like pattern, confirming the need for long-term post-discharge follow-up in these patients and for further studies to better understand long-term COVID-19 lung impairment.

Obstructive sleep apnoea syndrome (OSAS) and severe asthma are frequently associated. This article focuses on the relationship between severe asthma phenotypes and OSAS.FASE-CPHG was an observational, cross-sectional, prospective, multicentric study conducted in 104 non-academic hospitals from May-16 to July-17. 1465 patients with severe asthma were analysed and 1424 patients phenotyped. Clusters were compared for OSAS presence; independent factors associated with OSAS were identified by logistic regression.11% of patients with severe asthma reported OSAS. OSAS incidence differed according to asthma phenotypes. 98% of OSAS patients belonged to the "obese asthma" cluster, and none to the "early onset allergic asthma" cluster. Independent factors associated with OSAS were obesity (OR=5.782 [3.927-8.512]), male gender (OR=3.047 [2.059-4.510]), high blood pressure (OR=2.875 [1.978-4.181]), depression (OR=2.552 [1.607-4.050]), late-onset asthma (OR=1.789 [1.167-2.743]) and atopy (OR=0.622 [0.408-0.948]). Moreover, OSAS patients were more frequently treated with long-term oral corticosteroids (30% vs 15%, p 0.0001), that may contribute to the high prevalence of obesity in this group of patients. They were more frequently uncontrolled (78% vs 69%, p = 0.03) and they engaged in low level physical activity (vs 80% vs 68% p ≤ 0.001).Our study gives an innovative insight into OSAS associated with severe asthma. Most of patients with OSAS belonged to the cluster "obese asthma" and none to the cluster "early onset allergic asthma". In addition to male gender, arterial hypertension and depression, obese asthma, late onset asthma and non-atopic status were identified as specific risk factors. Oral corticosteroids seems to play a deleterious role. Phenotyping asthma can help physicians target severe asthmatic patients with OSAS and may avoid unnecessary examinations.

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

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

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

Introduction L’identification de sous-groupes de patients atteints de BPCO et partageant des caracteristiques cliniques et/ou paracliniques communes est a l’origine du concept de phenotypes dans cette pathologie. De nombreuses etudes de cohortes observationnelles sont en cours, pour tenter d’identifier de nouveaux phenotypes de patients BPCO. L’objectif de cette etude est de determiner l’analyse en cluster la plus optimale (supervise vs non-supervise) pour identifier de facon robuste les phenotypes cliniques dans le cadre de la cohorte PALOMB. Methodes Les patients BPCO (VEMS/CVF Resultats 2968 patients (70 ans, 63,7 % d’hommes, 38,7 % de fumeurs actuels) ont ete inclus ( Tableau 1 ). Parmi eux, 43,6 % ont eu au moins deux exacerbations au cours des 12 derniers mois, 58 % avaient de la toux chronique et 56,3 % avaient une dyspnee plus severe. Selon GOLD 2007, la severite de la BPCO etait representee par le stade I (18,2 %), le stade II (51,7 %), le stade III (24,1 %) et le stade IV (6 %). Le taux de la mortalite a 5 ans est de 11,3 %. Sur la base de notre hypothese, nous avons pu determiner quatre phenotypes, a l’issu de la methode PAM (k-medoides: partition Around Medoids): le phenotype A (24,2 %), B (23,9 %), C (25,5 %), et D (26,2 %). Le phenotype (A) etait constitue de patients âges, comorbides (cardiovasculaire et de diabete), peu symptomatiques, severe sur le VEMS. Le phenotype (B) etait tres severe, plus symptomatique, avec un IMC faible, plus de comorbidite metabolique, osteo-articulaire et neuropsychiatrique. Conclusion Ces Resultats illustrent l’aspect plurifactoriel des differents phenotypes identifies chez les patients BPCO. Parmi toutes les mesures de classification, la methode PAM (Machine Learning) apparait la plus valide.

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

In a woman's life, asthma can affect her in a variety of ways, with the onset of premenstrual asthma currently under-diagnosed. It is estimated that about 20% of women with asthma have premenstrual asthma, which is more common in patients with severe asthma. Women with asthma are at high risk of exacerbations and of severe asthma. Asthma is the most common chronic disease during pregnancy with potential maternal and foetal complications. Asthma medications are safe for the foetus and it is essential to continue pre-existing treatment and adapt it to the progress of asthma during the pregnancy. Sex steroids modulate the structure and function of bronchial and immune cells. Understanding their role in asthma pathogenesis is complicated by the ambivalent effects of bronchodilating and pro-inflammatory oestrogens as well as the diversity of response to their association with progesterone. Menopausal asthma is a clinical entity and is part of one of the phenotypes of severe non-allergic and low steroid-sensitive asthma. Targeted assessment of the domestic and professional environment allows optimization of asthma management.

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

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

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

Introduction La dyspnee est un des symptomes cardinaux de la BPCO, et fait partie des elements d’evaluation pour apprecier la severite de la BPCO et decider de la prise en charge therapeutique. L’evaluation de la dyspnee en pratique clinique n’est pas chose aisee, et il est parfois difficile d’apprecier la part attribuable respiratoire de la dyspnee chez des patients ayant des comorbidites. L’objectif de ce travail est d’evaluer les determinants de la dyspnee chez des patients BPCO, inclus dans le cadre de la cohorte PALOMB. Methodes Les patients ont ete inclus depuis le 01/01/2014 par leur pneumologue par web-questionnaire. Les variables suivantes ont ete recueillies : âge, sexe, l’IMC, la severite de la BPCO (VEMS), la dyspnee (echelle mMRC), les comorbidites, la frequence des exacerbations, la distension evaluee par le VR (> 130 %). Une analyse descriptive a ete realisee puis une analyse multivariee afin de determiner les facteurs associes a la dyspnee definie par mMRC ≥ 2. Resultats Au total, 1973 patients ayant une BPCO (VEMS/CVF 130 %) et au nombre d’exacerbations (> 2). L’analyse multivariee avec ajustement sur l’âge, le tabagisme, montre que les determinants de la dyspnee (≥ 2 mMRC) sont : etre une femme OR : 0,71 [0,57–0,9] ; la severite du VEMS OR : 3,7 [2,8–4,8] ; l’HTA OR : 1,5 [1,2–1,9] ; l’anxiete OR : 2,5 [1,8–3,4] ; les DDB OR : 1,84 [1,01–1,81] ; le nombre d’exacerbations (≥ 2) : OR : 1,41 [1,1–1,81] ; le surpoids OR : 1,33 [1,06–1,67] ; et la distension thoracique OR : 1,68 [1,34–2,1]. Conclusion Ces resultats illustrent dans une cohorte de vraie vie l’aspect plurifactoriel de la dyspnee chez les patients BPCO. Financement : fondation de Bordeaux universite, Novartis Pharma, Isis Medical, GSK, Boehringer Ingelheim.

Introduction Les tendances epidemiologiques montrent que la BPCO devient plus frequente chez les femmes, et qu’il existerait des specificites differentes de la BPCO de l’homme. L’objectif de ce travail est de decrire les caracteristiques des femmes BPCO, et de les comparer aux hommes BPCO dans le cadre de la cohorte PALOMB. Methodes Les patients ont ete inclus depuis le 01/01/2014 par leur pneumologue par webquestionnaire. Les variables suivantes ont ete recueillies : âge, sexe, l’IMC, la severite de la BPCO (VEMS), la dyspnee (echelle mMRC), les comorbidites, la frequence des exacerbations, la distension evaluee par le VR (> 130 %). Resultats Au total, 2259 patients ayant une BPCO (VEMS/CVF Conclusion Ces resultats montrent que l’on retrouve plus souvent et significativement chez les femmes BPCO de la cohorte PALOMB, deux facteurs de mauvais pronostic : les exacerbations frequentes (≥ 2) et l’IMC

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