Search

Resume Introduction La pneumoconiose est definie comme une maladie pulmonaire interstitielle diffuse secondaire a l’inhalation de particules minerales. L’hemoptysie est frequente dans la pneumoconiose. Mais elle est generalement secondaire a une bronchectasie, une bronchite ou tuberculose pulmonaire, survenant au cours d’une silicose. Observation Il s'agit d'un homme de 74 ans, d’origine portugaise, connu pour une insuffisance respiratoire chronique secondaire a une silicose chronique, pris en charge pour une hemoptysie de moyenne abondance. L’angioscanner thoracique retrouvait des masses peri-hilaires fibrosantes bilaterales, des nodules lobaires inferieurs et une lymphadenopathie mediastinale precedemment connue, sans saignement actif. La fibroscopie bronchique montrait un aspect anthracosique avec des lesions typiques de silicose a l’examen anatomopathologique des biopsies transbronchiques et de la cytoponction d’adenopathie mediastinale par echographie endobronchique. Conclusion Apres une evaluation etiologique complete, aucune autre cause que la silicose n’a ete identifiee. L’hemoptysie est frequemment observee dans la silicose, mais elle resulte de complications de la silicose. Le cas montre qu’une hemoptysie peut s’observer en cas de silicose isolee.

Resumen La contaminacion atmosferica es el resultado de una mezcla compleja de contaminantes que proceden de fuentes antropicas (trafico automovilistico, transportes aereos o maritimos, produccion de energia, industrias, fabricas de incineracion, calefaccion domestica, agricultura) y de fuentes naturales. Segun la Organizacion Mundial de la Salud, el 23% de los fallecimientos en el mundo se deberia al medio ambiente. Los contaminantes se clasifican en contaminantes en particulas y contaminantes gaseosos. La exposicion a la biomasa en los paises emergentes y con un bajo nivel de ingresos supone un autentico problema de salud publica, con un mayor riesgo de infecciones respiratorias y asma en mujeres y ninos. En los paises con un elevado nivel de ingresos, se conoce el impacto de la contaminacion incluso para niveles de contaminacion por debajo de los umbrales de alerta. La exposicion a la contaminacion empieza en la vida intrauterina y existe una ventana de vulnerabilidad de los contaminantes sobre el crecimiento pulmonar entre el nacimiento y la edad adulta. El concepto de exposoma corresponde a la consideracion de todas las exposiciones acumuladas desde la preconcepcion que pueden tener un impacto sobre la salud humana. La exposicion a los diferentes contaminantes aumenta el riesgo de infecciones respiratorias, asma, rinitis y sensibilizacion. La exposicion a la contaminacion por particulas aumenta el riesgo de desarrollar una enfermedad pulmonar obstructiva cronica.

Association of asthma with myasthenia gravis presents a twofold peculiarity. First, as dyspnea characterizes both conditions, diagnostic orientation is difficult. Second, from a therapeutic standpoint, the initiation of anticholinesterase treatment requires a multidisciplinary approach due to possible contraindication for asthma. We report on the case of a patient monitored for severe asthma and treated with biotherapy, and also monitored for myasthenia gravis, and treated with anticholinesterase.

Introduction: Reunion Island is a French overseas department characterized by a tropical climate with 2 distinct seasons. While the prevalence of asthma among adults in Reunion Island is close to that in mainland France, mortality and hospitalization rates are twice as high. To date, however, no epidemiological studies have evaluated the influence of environmental factors in asthma exacerbations in Reunion Island. Methods: From January 2010 to June 2013, 1,157 residents of Saint Denis visited the emergency rooms of the Centre hospitalier universitaire site Nord de Saint Denis for asthma. After exclusion of children under the age of 3, 864 visits were analyzed. These were correlated with the following daily factors: pollens and molds, meteorological parameters (temperature, precipitation levels, humidity and relative humidity levels, wind), pollutants (sulfur dioxide (SO2), nitrogen oxide (NOx), and the fine particles PM10 and PM2.5), and the influenza virus. The correlation between these factors was evaluated using the DLNM and GO-GARCH models. Results: Of the 864 analyzed visits, 532 were by pediatric patients (aged 3 to 16 years) and 332 by adult patients (aged over 16 years). In adults, pollens positively correlated with asthma exacerbations were Urticaceae, Oleaceae, Moraceae, and Chenopodiaceae. In children, these were Urticaceae, Oleaceae, Poaceae, and Myrtaceae. Molds positively correlated with asthma exacerbations in adults were ascospores and basidiospores. Only basidiospores were positively correlated with exacerbations in children. Temperature was positively correlated with exacerbations in both adults and children. The pollutants PM10 and NOx were positively correlated with exacerbations in children. Influenza epidemics were strongly correlated with exacerbations in both adults and children. Conclusion: Our analysis shows that in Reunion Island, asthma is exacerbated by pollens (Urticaceae, Oleaceae, Moraceae, Chenopodiaceae in adults; Urticaceae, Oleaceae, Poaceae, Myrtaceae in children), molds (ascospores and basidiospores in adults; basidiospores in children), temperature, influenza, and the pollutants PM10 and NOx (in children).

With first cases noted towards the end of 2019 in China, COVID-19 infection was rapidly become a devastating pandemic. Even if most patients present with a mild to moderate form of the disease, the estimated prevalence of COVID-19-related severe acute respiratory failure (ARF) is 15-20% and 2-12% needed intubation and mechanical ventilation. In addition to mechanical ventilation some other techniques of respiratory support could be used in some forms of COVID-19 related ARF. This position paper of the Respiratory Support and Chronic Care Group of the French Society of Respiratory Diseases is intended to help respiratory clinicians involved in care of COVID-19 pandemic in the rational use of non-invasive techniques such as oxygen therapy, CPAP, non-invasive ventilation and high flow oxygen therapy in managing patients outside intensive care unit (ICU). The aims are: (1) to focus both on the place of each technique and in describing practical tips (types of devices and circuit assemblies) aimed to limit the risk of caregivers when using those techniques at high risk spreading of viral particles; (2) to propose a step-by-step strategy to manage ARF outside ICU.

Pneumoconiosis is defined as a diffuse interstitial lung disease secondary to inhalation of mineral particles. Haemoptysis is common in pneumoconiosis. But it is usually secondary to bronchiectasis, bronchitis or pulmonary tuberculosis occurring with silicosis.A 74-year-old Portuguese man, known to have chronic respiratory failure secondary to chronic silicosis, was treated for moderate haemoptysis. CT angiography revealed bilateral fibrosing peri-hilar masses, inferior lobe nodules and previously known mediastinal lymphadenopathy, without active bleeding. Fibreoptic bronchoscopy showed an anthracotic appearance with lesions typical of silicosis on pathological examination of trans-bronchial biopsies and needle aspiration of mediastinal adenopathy by endobronchial ultrasound.After a full aetiological assessment, no cause other than silicosis has been identified. Haemoptysis is frequently observed in silicosis, but it results from silicosis complications. It is not a classic complication of isolated silicosis.

Chronic obstructive pulmonary disease (COPD) is expected to be the 3rd leading cause of death worldwide by 2020. Despite improvements in survival by using acute non-invasive ventilation (NIV) to treat patients with exacerbations of COPD complicated by acute hypercapnic respiratory failure (AHRF), these patients are at high risk of readmission and further life-threatening events, including death. Recent studies suggested that NIV at home can reduce readmissions, but in a small proportion of patients, and with a high level of expertise. Other studies, however, do not show any benefit of home NIV. This could be related to the fact that respiratory failure in patients with stable COPD and their response to mechanical ventilation are influenced by several pathophysiological factors which frequently coexist in the same patient to varying degrees. These pathophysiological factors might influence the success of home NIV in stable COPD, thus long-term NIV specifically adapted to a patient’s “phenotype” is likely to improve prognosis, reduce readmission to hospital, and prevent death. In view of this conundrum, Rescue2-monitor (R2M), an open-label, prospective randomized, controlled study performed in patients with hypercapnic COPD post-AHRF, will investigate the impact of the quality of nocturnal NIV on the readmission-free survival. The primary objective is to show that any of 3 home NIV strategies (“rescue,” “non-targeted,” and “targeted”) will improve readmission-free survival in comparison to no-home NIV. The “targeted” group of patients will receive a treatment with personalized (targeted) ventilation settings and extensive monitoring. Furthermore, the influence of comorbidities typical for COPD patients, such as cardiac insufficiency, OSA, or associated asthma, on ventilation outcomes will be taken into consideration and reasons for non-inclusion of patients will be recorded in order to evaluate the percentage of ventilated COPD patients that are screening failures. ClinicalTrials.gov NCT03890224. Registered on March 26, 2019.

Data on severe asthma in France are scarce. The aim of this study was to evaluate adherence to asthma treatments and its determinants in a population of severe asthmatics.From May 2016 to June 2017, the French Collège des Pneumologues des Hôpitaux Généraux organized a large-scale prospective, cross-sectional, multicenter study on this topic; 1502 patients with severe asthma were included.The average number of substantive treatments was 2.5±1.1. Assessed by self-questionnaire in 1289 patients, overall adherence was 64.8%, in good agreement with the findings of the pneumologist in charge (p0.0001). Control of asthma according to the GINA criteria was more successful in compliant patients (p0.01). In univariate analysis, the most compliant participants were frequent exacerbator patients (p=0.02), those with nasal polyposis (p=0.01) and those receiving an anticholinergic agent (p0.01), anti-IgE biotherapy (p0.0001) or oral corticosteroids (p0.01). The least compliant participants were younger (p0.0001), active smokers (p0.001), with shorter average disease duration (24.2±15.7 vs 29.1±18.7 years, p0.0001) and a lower number of substantive asthma treatments (2.2±1 vs 2.6±1, p0.0001). In multivariate analysis, age, length of disease and anti-IgE treatment were the only factors affecting therapeutic compliance.In this large-scale study of severe asthmatic patients, 64.8% were compliant according to the MMAS-4© self-administered questionnaire and appeared to be better monitored according to the criteria defined in our study. Overall, adherence was more satisfactory among older patients and those whose disease had been evolving over a long period of time or were receiving anti-IgE biotherapy.

Endobronchial hamartochondroma is a rare benign tumor which differs from the parenchymal form in its symptomatology and also by its treatment which should be as conservative as possible. The endobronchial location is exceptional. Here we present the cases of two patients with endobronchial hamartochondroma associated with clinical manifestation, chest pain and repeated pulmonary infections, respectively. The diagnosis was made after performing a CT-scan, a PET-SCAN and histological analysis. After discussion in a multidisciplinary staff meeting, conservative treatment was chosen in both cases.

Additional file 1: COPD burden on sexual well-being, RERE-D-20–00192, R2.

Introduction L’ile de La Reunion est un departement francais dote d’un climat de type tropical caracterise avec une temperature mensuelle moyenne constamment superieure a 18 °C, de fortes precipitations et l’existence d’une saison seche et une saison humide. La prevalence de l’asthme a la Reunion dans la population adulte est proche de celle retrouvee en metropole mais avec des taux de mortalite et d’hospitalisation deux fois plus eleves. Cependant, aucune etude epidemiologique n’existe a l’heure actuelle evaluant l’impact sanitaire des facteurs environnementaux a l’ile de la Reunion sur les exacerbations d’asthme. Methodes De janvier 2010 a juin 2013, 1157 passages aux urgences adultes et pediatriques au CHU Nord ont eu lieu. Les enfants de moins de 3 ans ont ete exclus. Ont ete correles a ces consultations les donnees quotidiennes suivantes : pollens et moisissures, variables atmospheriques (temperature, hauteurs de precipitations, taux d’humidite et humidite relative, vent) les polluants (dioxyde de souffre [SO2], l’oxyde d’azote [NOx] et les particules fines PM 10 et PM 2.5), et enfin le virus grippal. Les methodes DLNMs et GO-GARCH ont ete utilisees pour evaluer la correlation entre les variables. Resultats Sur ces 1157 passages, il y a eu 864 passages pour asthme dont 532 pour la population pediatrique âgee de 3 a 16 ans et 332 pour la population adulte. Concernant les pollens : chez l’adulte, Urticaceae, Oleaceae, Moraceae et Chenopodiaceae, sont lies positivement aux consultations aux urgences pour exacerbation d’asthme. Chez l’enfant, il s’agit d’Urticaceae, Oleaceae, Poaceae et Myrtaceae. Concernant les moisissures : chez l’adulte, Ascospores et Basidiospores sont lies positivement et chez l’enfant, seul Basidiospores l’est. La temperature influence positivement les exacerbations tant chez l’adulte que chez l’enfant, ce qui n’est pas le cas de la pollution ou seuls PM 10 et NOx sont correles positivement chez les enfants. Conclusion L’analyse des exacerbations d’asthme montre l’influence des pollens (Urticaceae, Oleaceae, Moraceae, Chenopodiaceae chez l’adulte ; Urticaceae, Oleaceae, Poaceae et Myrtaceae chez l’enfant), des spores (Ascospores et Basidiospores), du virus grippal et de la pollution chez l’enfant.

Data on physical activity in severe asthma are scarce. From May 2016 to June 2017, 1502 adult patients with severe asthma visiting a pulmonologist practicing in one of the 104 non-academic hospitals participating in the study were included in this prospective, cross-sectional, multicenter study, provided they gave consent. Physical activity was classified according to 4 levels: 1 (no activity), 2 (occasional), 3 (regular), or 4 (frequent). Clinical and therapeutic parameters were described according to these levels.Respectively, 440, 528, 323, and 99 patients had physical activity of level 1, 2, 3, and 4. The percentage of patients with controlled asthma increased with physical activity. Treatment adherence did not differ with physical activity. Percentages of obese patients, patients with FEV160%, and patients with anxiety, depressive syndrome, gastro-esophageal reflux disease, arterial hypertension, diabetes, obstructive sleep apnoea-hypopnoea syndrome, and osteoporosis decreased with physical activity. Respiratory rehabilitation was offered to only 5% of patients.In this large study, physical activity is associated with disease control in severe asthma and with less comorbidity. Its practice should be encouraged and respiratory rehabilitation offered more often.

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.

Setting National teaching hospital for the management of respiratory diseases, Cotonou, Benin. Objective 1) To estimate the prevalence of lung function impairment (LFI) and associated factors in patients cured of pulmonary tuberculosis (PTB); and 2) to determine the link between human immunodeficiency virus (HIV) infection and LFI occurrence. Design We performed a cross-sectional study in cured patients with smear-positive TB (PTB+) treated between 2012 and 2015. We recruited two control groups of 70 HIV-infected (HIV+/TB-) and 70 HIV-negative participants without TB (HIV-/TB-). We performed spirometry in all participants to identify LFI (obstructive, restrictive or mixed) and the 6-min walk test (6-MWT) in PTB+ participants. We assessed the factors associated with LFI using logistic regression. Results Of 4711 subjects with PTB, 241 were contacted and 189 were included. The median age was 37 years; 128 (68.0%) were male. Overall, 85 cured PTB+ patients had LFI (45.0%). Extent of initial radiological lesions, time between symptom onset and treatment, and female sex were independently associated with LFI. Fifty-five (29.1%) cured PTB+ patients had an abnormal 6-MWT; those with LFI had a higher risk of poor exercise tolerance (OR 2.23; interquartile range 1.16-4.30). We did not find any association between HIV infection and LFI. Conclusion LFI is very common in cured PTB+ patients from Benin and significantly impacts exercise tolerance.

In patients suffering from chronic obstructive pulmonary disease (COPD), the acceptance of the illness is probably a major factor in the improvement of quality of life. The aim of this study is to identify the criteria associated with a good or bad acceptance of the disease and to identify means of improving it.We have undertaken a telephone enquiry among patients with COPD with the aid of a standardized questionnaire established by several health experts.Of the 1040 patients who have been contacted, 356 (34 %) replied to the questionnaire. Ninety-nine patients reported unacceptance of their disease (28 %). The patients who did not accept their disease were significantly more severe, with more difficulty in performing daily life activities, particularly exercising. These patients had significantly greater difficulty in understanding their disease and also reported more frequently a moralizing attitude among their family.The greater the handicap of the disease, the greater is the difficulty in accepting the disease by the patient. The doctor could have an impact in improving the therapeutic education and involving the family in the patient's care.

Smoking remains common, with an exposure that begins early during pregnancy. It induces epigenetic changes, with a trans-generational transmission. Smoking increases the risk of uncontrolled asthma during childhood and adult life. Asthma is also associated with increased risk of a decline of lung function and chronic obstructive pulmonary disease (COPD). Women are more at risk of developing early and severe COPD. The mechanisms are currently poorly known.

Introduction : la bronchopneumopathie chronique obstructive (BPCO) peut se compliquer d’insuffisance respiratoire avec hypoventilation alveolaire a un stade evolue de la maladie et jusqu’a present seule l’oxygenotherapie longue duree a permis d’ameliorer la survie de ces patients. L’utilisation de la ventilation non invasive (VNI) a l’etat stable dans ce contexte reste encore tres debattue bien qu’elle soit largement utilisee dans le monde. Objectif : Analyser les facteurs predictifs de survie chez les patients BPCO sous VNI avec un recul a 5 ans, a partir de la cohorte de patients BPCO en Aquitaine. Methodes : il s’agit d’une etude observationnelle, retrospective et multicentrique realisee a partir des patients BPCO ventiles par VNI issus de la cohorte PALOMB. Apres avoir realise un recueil de donnees exhaustif de chacun de nos patients aupres des professionnels de sante et prestataires de sante ; nous avons realise une analyse descriptive de notre population et de leur evolution a 5 ans. Puis nous avons evalue les facteurs predictifs de survie des patients sous VNI apres 5 ans de suivi. Resultats : 83 patients ont ete inclus dans notre cohorte, 51 patients ont ete inclus dans l’analyse a 5 ans. L’âge moyen toute la cohorte etait de 66 ans, avec 65% d’hommes. Les indications a l’instauration de la VNI etait une hypercapnie chronique (33,7%), au decours d’une exacerbation hypercapnique (41%) et un overlap syndrome (25,3%). L’IMC moyen etait de 29,9 kg/m2. A l’introduction de la VNI le VEMS moyen etait de 38,3 ±14,47 % de la theorique, la PaCO2 moyenne etait de 53,11 ±7,04 mmHg et la PaO2 moyenne de 57,05 ±9,78 mmHg. La ventilation etait realise avec une PEP moyenne de 5,6 cmH20 et une IPAP de 15,3 cmH20 (AI moyenne 9,7 cmH20) ; l’observance a 1 an etait de 6,82 ±3,4h. On retrouvait une amelioration statistiquement significative de la PaCO2 au cours du temps apres la mise sous VNI (-6,63 mmHg a 1 an), ainsi qu’une diminution du nombre d’hospitalisations. Le VEMS et la distension relative (VR/CPT) restent stables ! au cours du temps sous VNI. En analyse bivariee, un VEMS eleve et un poids eleve etaient associes a la survie. En analyse multivariee seule la presence d’une cardiopathie ischemique et d’arythmie cardiaque etait associee au deces des patients. Conclusion : cette etude retrospective montre qu’il y a peu de patients severes ventiles dans la cohorte Palomb. La mortalite des BPCO severes est de 33% a 5 ans. Il semble y avoir une efficacite de la VNI sur la PaCO2 et le nombre d’hospitalisations. La cardiopathie ischemique et l’arythmie cardiaque sont des facteurs de risque de mortalite a 5 ans.

Lyme disease is not uncommon and can sometimes progress to neurological complications. We report here an unusual case of bilateral diaphragmatic paralysis secondary to Lyme neuroborreliosis.A 79-year-old man was admitted to the intensive care unit for acute respiratory distress requiring intubation and the long-term use of nocturnal non-invasive ventilation. Three months beforehand he had been bitten by a tick and developed erythema migrans which was treated with Doxycycline for 10 days. This clinical presentation became complicated a few days later by the progressive onset of severe dyspnoea. At admission, chest radiography revealed bilateral elevation of the diaphragm. Pulmonary function tests revealed a severe restrictive disorder aggravated by decubitus. A diaphragmatic electromyogram showed bilateral axonal polyneuropathy of the phrenic nerves. IgG and IgM antibodies to Borrelia burgdorferi were detectable in serum and cerebrospinal fluid, leading to the diagnosis of Lyme disease. He was treated with intravenous ceftriaxone 2g per day for 21 days, leading to a substantial improvement in symptoms.In the presence of unilateral or bilateral diaphragmatic paralysis of undetermined aetiology, it seems relevant to perform Lyme serology in the blood and, in positive cases, to follow up with a lumbar puncture in order to detect intrathecal IgG synthesis.

Resume Introduction Lors d’un workshop organise en avril 2013 par la Societe de pneumologie de langue francaise, les donnees epidemiologiques et les attitudes relatives au depistage/detection et a la prise en charge de la BPCO en France et en Europe ont ete confrontees. Nous rapportons ici les donnees relatives a l’epidemiologie et ses consequences sur la strategie francaise de depistage de la BPCO. Etat des connaissances Les donnees les plus recentes retrouvent une prevalence spirometrique de la BPCO en France de 7,5 % dans une population âgee de plus de 45 ans. La BPCO est responsable de 1,4 % des deces en France sur la periode 2000–2002 et est mentionnee comme pathologie associee au deces dans 3 % des deces. Le cout annuel d’un patient BPCO est estime a 4366 € par an, atteignant 7502 € par an chez les patients avec BPCO tres severe. Les etudes cliniques realisees en France soutiennent l’idee de la faisabilite d’un depistage par mini-spirometrie en cabinet de medecine generale voire en ambulatoire mais il est difficile d’organiser un depistage de masse de la BPCO. Une technique aussi simple que le Piko-6® implique un temps de formation. L’absence de remboursement par l’Assurance maladie constitue aussi un facteur limitant, tout comme l’absence d’evaluation de l’impact medical mais aussi economique de cette strategie. Il convient vraisemblablement de privilegier des actions ciblant les populations les plus a risque et de profiter de cette occasion pour aborder la question du tabagisme et de son sevrage. Conclusion Les strategies de depistage/detection de la BPCO doivent faire l’objet d’evaluations et d’experimentations prenant en compte les particularites du systeme de sante francais. Elles doivent aussi s’entendre comme un des pans d’une lutte plus globale contre le tabagisme.