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Resume Introduction Le poumon de jacuzzi (PJ) est une pneumopathie d’hypersensibilite (PHS) liee a l’inhalation de mycobacteries non tuberculeuses (MNT) lors d’exposition a un jacuzzi. Le debat etiologique n’est pas completement tranche dans la litterature. Methode Etude observationnelle de 14 cas de PJ diagnostiques au Centre Hospitalier Universitaire (CHU) de Besancon entre 2004 et 2018 selon les criteres diagnostiques utilises en clinique. Resultats Cette cohorte correspondait a des PHS de type I (inflammatoire), avec un cas de PHS de type II (fibreuse). L’alteration de la diffusion du monoxyde de carbone etait presente pour 86 % des examens (n = 12/14) et 84 % des lavages bronchoalveolaires etaient hyperlymphocytaires (n = 11/13). L’enquete environnementale avait permis l’identification d’une MNT dans 93 % des cas (n = 13/14), principalement Mycobacterium avium. Les precipitines vis-a-vis de MNT etaient positives dans 10 % des cas (n = 2/20). Trois individus ont recu une corticotherapie et aucun une antibiotherapie. L’eviction antigenique ameliorait la symptomatologie dans tous les cas. Conclusions Notre cohorte renforce l’hypothese que le PJ est une PHS, principalement de type I dans sa presentation. L’eviction antigenique (MNT) est la base du traitement. Le diagnostic est difficile vis-a-vis des tests immunologiques peu contributifs. L’enquete environnementale pourrait faciliter l’identification des MNT. La prevention du PJ passe par une education du clinicien et du patient.

Atopic allergic diseases have become a public health problem because of the marked increase in their incidence along the second half of the 20th century, and their relationship with environmental changes observed in that period of time. Within the "hygiene hypothesis" which associated this increased incidence with a decrease in children's exposure to microbial agents, cross-sectional studies stressed the relationship between dairy farm specific environments with a significant protection against allergy. For the last 15 years, since the last trimester of their mother's pregnancy until now, in the PASTURE cohort 1000 children have been studied in dairy farming regions of 5 European countries (Austria, Finland, France/Franche-Comte, Germany, and Switzerland); 500 lived on a farm and 500 also lived in rural areas, but did not live on a farm. The results of this multidisciplinary endeavor pointed to the role of (1) the diversity of exposure to animals, microbes, and food in early childhood; (2) the consumption of raw milk and milk products; (3) maternal exposure before delivery for the immunological and allergic future of the child; (4) an early orientation/differentiation of dendritic cells, T cells and secreted cytokines towards a "regulatory profile", under the influence of the environmental factors. The PASTURE cohort is a remarkable example of European cooperation to better understand a public health problem, and of the involvement of families in a very demanding clinical research project. Its coordinators now expect to maintain the follow-up of the children until adult age and to work on "farm-like" preventive measures. (C) 2019 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved.

Resume Introduction La pneumopathie d’hypersensibilite (PHS) des utilisateurs de jacuzzi est une PHS domestique consecutive a l’exposition a des mycobacteries non tuberculeuses inhalees, la plus frequente etant Mycobacterium avium complex (MAC). Observations Un couple de patients presentait une PHS typique liee a l’utilisation repetee d’un jacuzzi. Le mari avait une forme severe hypoxemiante alors que son epouse presentait une forme micronodulaire et avec verre depoli au scanner thoracique, moins severe fonctionnellement. Les differents prelevements ont retrouve MAC dans l’eau du jacuzzi, mais pas dans le liquide de lavage broncho-alveolaire, et les serologies etaient negatives. Une enquete a domicile a montre une exposition inhabituelle a Aureobasidium pullulans et Aspergillus flavus, ainsi que la presence de moisissures domestiques potentiellement imputables, avec presence de precipitines sanguines pour ces differents micro-organismes. L’evolution a ete favorable apres eviction du jacuzzi. Conclusions Il s’agit de deux formes typiques de poumon de jacuzzi pour lesquelles on retient une reaction d’hypersensibilite possiblement a d’autres antigenes que MAC, peut-etre favorisee par la pression fongique generee par l’exposition chronique a de multiples micro-organismes.

Resume Introduction La pneumopathie d’hypersensibilite (PHS) est une pneumopathie interstitielle diffuse liee a une reaction immunitaire d’hypersensibilite dont le mecanisme physiopathologique reste mal connu. Son diagnostic peut etre difficile, notamment si la presentation est atypique ou si l’antigene causal n’est pas identifie et demande un interrogatoire minutieux. Observation Nous rapportons le cas d’une femme de 75 ans presentant une adenopathie intramammaire dans le cadre d’un carcinome mammaire. L’analyse anatomopathologique de l’adenopathie revele un granulome epithelioide et gigantocellulaire sans necrose caseeuse. La presentation clinique, fonctionnelle, radiologique et microbiologique est en faveur d’une pneumopathie d’hypersensibilite du jacuzzi associee a une atteinte granulomateuse ganglionnaire extrapulmonaire. L’evolution est favorable avec une regression des lesions apres eviction antigenique. Conclusion L’existence d’une atteinte granulomateuse extrapulmonaire est rare dans la PHS, suggerant une atteinte inflammatoire systemique.

Hypersensitivity pneumonitis (HP) is an interstitial lung disease due to an immunological reaction to exposure, by inhalation, to a large variety of antigens. The patho-physiological mechanism remains poorly understood. The diagnosis can be challenging and requires a detailed medical history taking especially when the clinical presentation is atypical or when the causal agent remains unknown.We report the case of a 75-year-old woman with a history of mammary carcinoma who presented with recently identified intramammary adenopathy. Biopsy of the adenopathy revealed non-necrotising, giant cell epithelioid granuloma. A diagnosis of hot tub lung with extra-pulmonary granulomatous lymph node involvement was made based on the clinical, functional, radiological and microbiological investigations. The evolution was favorable following antigen avoidance.Extrapulmonary lymph node involvement is rare in HP, suggesting a systemic inflammatory involvement.

Hypersensitivity pneumonitis and allergic bronchopulmonary aspergillosis are two forms of lung disease with presumed distinct immunoallergic mechanisms. We report the observation of a 38-year-old French farmer who, for one month, had fever and dyspnoea resistant to antibiotic therapy. A diagnosis of farmer's lung, and allergic bronchopulmonary aspergillosis was made on clinical, biological, functional and radiological evidence and according to the criteria established. The evolution was favorable with antigenic eviction and corticosteroid therapy. This observation is to our knowledge the 5th case that describes the association of hypersensitivity pneumonitis and allergic bronchopulmonary aspergillosis. It suggests the existence of risk factors and immunoallergic mechanisms common to both diseases and discusses the hypothesis that the same antigen(s) is (are) responsible for them.

Chronic obstructive pulmonary disease (COPD) most often results from the inhalation of toxic agents. Cigarette smoking still remains the principal cause but the pertinence of occupational COPD is now clearly established. After a brief overview of the epidemiology of this "other COPD", the clinical and functional characteristics are summarized, taking into account recent advances in this field. The combined effects of occupational exposure and tobacco are also considered, providing evidence of the need to continuously reinforce campaigns of education and prevention in occupational COPD.

L’asma acuto comprende varie presentazioni, dalla forma minima, che puo essere trattata ambulatorialmente, all’asma acuto molto grave, che richiede la rianimazione. E una malattia comune, che colpisce il 7% della popolazione in Francia, con un ricorso frequente al Pronto Soccorso in caso di riacutizzazione. Quindi, la rivelazione di segni di gravita e un elemento essenziale nella gestione e richiede un trattamento precoce con nebulizzazione di beta-2-mimetici e di anticolinergici e corticosteroidi per via endovenosa durante la fase preospedaliera. Il ricorso all’intubazione e alla ventilazione meccanica e, talvolta, necessario, secondo criteri clinici ben definiti. Nei casi meno gravi, l’evoluzione sotto trattamento e fondamentale per la gestione e per decidere le indicazioni di ricovero in ospedale, tenendo conto del contesto psicosociale e delle comorbilita.

Introduction La fibrose pulmonaire idiopathique (FPI) est une affection rare et peu de donnees epidemiologiques sont disponibles en France. Ce projet vise a decrire les caracteristiques en vie reelle des patients atteints de FPI recevant un traitement anti-fibrosant, ainsi que leurs comorbidites et la mortalite. Methodes RaDiCo-PID est une cohorte longitudinale a long terme incluant des patients enfants et adultes atteints de pneumopathies interstitielles diffuses (PID) idiopathiques suivis dans des centres de reference et de competence de la filiere Respifil et des reseaux OrphaLung et Respirare. RaDiCo-PID comporte un sous-groupe de patients atteints de FPI. Nous presentons ici les caracteristiques de base des patients atteints de FPI apres 2 ans d’inclusion. Resultats Entre le 15 juin 2017 et le 4 septembre 2019, 1246 patients atteints de pneumopathie interstitielle diffuse ont ete inclus dans le registre Radico-PID dans 18 centres, dont 847 atteints de FPI (68 %). Les patients atteints de FPI etaient en majorite des hommes (82,7 %), avec un âge moyen de 72,5 ± 9 ans a l’inclusion et un index de masse corporelle moyen de 26,8 ± 4,3. Parmi les patients avec FPI, 44,6 % etaient des cas incidents avec une duree mediane entre le diagnostic et l’inclusion de 8,9 mois (Q1 = 0,9 et Q3 = 26,4) ; 25,3 % de ces patients avaient eu une biopsie. La capacite vitale forcee moyenne au diagnostic etait de 73,4 ± 25,0 % de la valeur theorique (n = 561), et la capacite de transfert du monoxyde de carbone moyenne au diagnostic etait de 39,6 ± 18,2 % (n = 498). Selon les donnees disponibles sur les traitements anti-fibrosants (n = 661), 347 patients ont ete traites, au moins une fois, par du nintedanib et 312 patients par de la pirfenidone ; 113 patients ont recu sequentiellement ces 2 molecules. Conclusion La cohorte Radico-PID fournit des donnees concretes precieuses sur les caracteristiques demographiques des patients, notamment au moment du diagnostic de FPI. Les effectifs actuels permettent d’envisager des analyses plus approfondies.

International audience

Hot tub lung (HTL) is a hypersensitivity pneumonitis (HP) related to inhalation of non-tuberculous mycobacteria (NTM) when exposed to ejected jet droplets from a jacuzzi. The aetiological debate is not completely settled in the literature.An observational study of 14 cases of HTL, diagnosed at the University Hospital of Besançon, France, between 2004 and 2018 according to the diagnostic criteria used in the clinic.This cohort corresponds to type I HP (inflammatory), with one case of type II HP. Decrease of lung transfer for carbon monoxide was present in 86% of examinations (n=12/14). In total, 84% of bronchoalveolar lavages showed a lymphocytic cellular pattern≥30% (n=11/13). The environmental survey enabled the identification of NTM in 93% of cases (n=13/14), mainly Mycobacterium avium. Serum precipitins directed against NTM were found in 10% of the cases (n=2/20). Three cases received corticosteroid therapy and none received antibiotics. Antigenic eviction has improved the symptomatology in all cases.Our cohort supports the hypothesis that HTL is predominantly a type I HP. Avoidance of the agent involved (NTM) is necessary. The diagnosis is difficult because serum precipitins against NTM are not easily demonstrable. An environmental survey could facilitate the identification of the NTM. Prevention of HTL depends on education of the clinician and the patient.

Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by an immune response to a variety of antigens to which patients have been previously sensitised. It can occur at any age. In children, it is a rare disease, probably under-diagnosed, with an estimated prevalence of 4 per million. The paediatric forms are not really different from those of adults but present some particularities. Avian exposure is by far the most frequent cause of HP, accounting for nearly two-thirds of cases. Although there is no current recommendation for the diagnosis of HP, it is commonly considered that the diagnosis can be made with confidence on the combination of (1) compatible respiratory symptoms, (2) exposure to a known offending antigen, (3) lymphocytic alveolitis, (4) decreased transfer factor for carbon monoxide or hypoxia on exertion and (5) compatible radiologic features. The treatment is based on antigen avoidance that must be complete and definitive. Corticosteroids can be necessary in severe forms. The prognosis of HP in children is better than in adults, with a full clinical and functional recovery in the majority of cases after complete antigenic withdrawal.

Background and objective Omalizumab is a human anti-IgE antibody approved for the treatment of severe allergic asthma (SAA). However, its effectiveness in SAA associated with chronic rhinosinusitis with nasal polyposis (CRSNP+) is less well documented. Objective: The aim of this study was to evaluate the real-life effectiveness of omalizumab in patients with SAA and CRSNP+ who tolerated and did not tolerate aspirin. Methods We performed a retrospective, observational, multicenter, real-life study of patients with SAA and CRSNP+ treated with omalizumab for 6 months. Asthma outcome parameters (symptoms, number of salbutamol rescues/wk, number of moderate/severe exacerbations, Asthma Control Test score, and lung function), sinonasal outcome parameters (symptoms, number of episodes of acute rhinosinusitis, sinus computed tomography images, nasal polyps endoscopy score), and serum eosinophil levels were analyzed 6 months before and after treatment with omalizumab. Results Twenty-four adult patients were included (9 with documented aspirin intolerance). All respiratory parameters were significantly improved by the treatment. In parallel, a significant improvement was observed in sinonasal clinical outcomes and sinus computed tomography images, with no major effect on the nasal polyps endoscopy score. The serum eosinophil count decreased significantly after 6 months of treatment with omalizumab. Conclusion Treatment of SAA with omalizumab improves the outcome of associated CRSNP+, thus supporting the concept of a "one airway disease".

Hypersensitivity pneumonitis and allergic bronchopulmonary aspergillosis are two forms of lung disease with presumed distinct immunoallergic mechanisms. We report the observation of a 38-year-old French farmer who, for one month, had fever and dyspnoea resistant to antibiotic therapy. A diagnosis of farmer's lung, and allergic bronchopulmonary aspergillosis was made on clinical, biological, functional and radiological evidence and according to the criteria established. The evolution was favorable with antigenic eviction and corticosteroid therapy. This observation is to our knowledge the 5

International audience

The existence of occupational chronic obstructive pulmonary diseases (COPD) is now well established. Since 1989, several regulations have been progressively introduced, allowing compensation for some cases of occupational COPD. Following a brief review of the main occupational causes of COPD, the authors describe the present context for compensation in France and the procedures to be followed to ensure that patient's interests are supported.

Allergy is a hypersensitivity reaction induced by immunological mechanisms. In asthma, allergy has a complex role and is usually IgE mediated. Allergy must be evaluated during the work up but evidence of IgE sensitivity does not mean that allergens play a role in the pathophysiology of the disease. The clinical relevance of the sensitivity has to be considered. This paper describes current available tools to screen for IgE sensitivity, allergen exposure and their role in asthma.

Introduction La pratique d’un instrument a vent est une cause de pneumopathie d’hypersensibilite de plus en plus frequemment rapportee. Cependant, les connaissances actuelles sur la contamination fongique des instruments a vent et la sensibilisation specifique des musiciens a ces champignons sont rares. Nous avons donc cherche : (i) a evaluer la prevalence actuelle et le type de contamination fongique des instruments a vent ; (ii) a identifier les facteurs de risque potentiels associes a la contamination de ces instruments et (iii) a estimer la prevalence de la sensibilisation a ces champignons parmi les musiciens. Methodes Des musiciens issus d’ecoles de musique de l’Est de la France et jouant d’un instrument a vent comportant une anche ont ete inclus de maniere prospective ( NCT01487850 ). Le type et la concentration des especes fongiques ont ete analyses sur l’embout et l’anche de chaque instrument. Un examen physique ainsi que le dosage de precipitines seriques contre les especes fongiques les plus frequemment isoles dans les instruments ont ete realises chez chaque musicien. Les resultats ont ete compares a ceux de 40 sujets temoins sains non exposes. Resultats Quarante patients pratiquant un instrument a vent (clarinette, saxophone, basson et hautbois) ont ete inclus. Quatre-vingt-quinze pour cent des instruments etaient colonises par une espece fongique dont les plus frequents etaient Phoma spp., Penicillium spp. et Rhodotorula mucilaginosa. Le facteur de risque principal associe au developpement de champignons etait l’absence de sechage systematique de l’instrument apres usage. Les precipitines seriques des principales especes fungiques retrouvees dans les instruments etaient significativement plus elevees chez les musiciens que chez les temoins. Conclusion Notre etude met en evidence une contamination quasi constante et specifique des instruments a vent comportant une anche par des especes fongiques ainsi qu’une sensibilisation importante des musiciens a ces micro-organismes. Ces resultats plaident pour un entretien regulier des instruments a vent. Par ailleurs, ces instruments sont a considerer comme une source d’exposition antigenique potentielle notamment lors du bilan d’une pneumopathie d’hypersensibilite.

Resume Introduction La maladie du poumon de fermier (PDF) est la forme la plus courante de pneumopathie d’hypersensibilite (PHS), avec une prevalence estimee entre 0,5 et 1,5 % chez les fermiers en milieu de production laitiere. Dans les formes chroniques, la litterature rapporte en grande majorite des formes fibrosantes alors que notre experience et les rares etudes epidemiologiques mettent en valeur la frequence des formes emphysemateuses. Observation Nous rapportons un cas typique de PDF chez un patient de 37 ans au regard de l’aspect clinique (dyspnee d’effort, alveolite lymphocytaire, aspect tomodensitometrique) et anamnestique (preuve d’une exposition allergenique). L’evolution se fait vers un emphyseme pulmonaire. L’exposition massive et repetee a des substances antigeniques provenant des micro-organismes bacteriens ou fongiques chez ce patient semble expliquer ce mode d’evolution. Conclusion La classification actuelle des PHS differencie des formes aigues, subaigues et chroniques mais ne prend pas en compte le mode d’exposition et l’evolutivite de la maladie. Une nouvelle classification des PHS qui differencie deux types a ete proposee : le type 1 qui suggere une exposition massive et intermittente (comme dans le PDF) avec une evolution preferentiellement vers une forme emphysemateuse et le type 2, ou l’exposition est constante mais moins intense, (comme dans la maladie des eleveurs d’oiseaux) vers une forme fibrosante.

Resume Introduction La pericardite constrictive est liee a l’epaississement, la fibrose ou l’inflammation du pericarde entrainant des manifestations d’insuffisance cardiaque droite. La pericardite constrictive chronique est la forme la plus typique. Les modes de presentation sont varies. Nous rapportons deux cas de pericardites constrictives associes initialement a un transsudat pleural gauche. Observation Ces observations decrivent deux formes de pericardite constrictive, chronique et effusive. Leur point commun est la majoration d’une dyspnee et un epanchement pleural initialement unilateral. Leur difference est la presence d’un pericarde epaissi et calcifie dans un cas et la presence d’un epanchement pericardique dans l’autre cas. Les examens non invasifs ont ete pris a defaut au contraire du catheterisme cardiaque droit. Le traitement par pericardectomie subtotale a ete efficace. Conclusion Les manifestations thoraciques des pericardites constrictives sont representees le plus souvent par des epanchements bilateraux recidivants. Les atteintes unilaterales exsudatives ou transsudatives, les atteintes fibreuses, les chylothorax ou les atteintes tumorales peuvent etre des modes de decouverte. La pericardite constrictive doit etre evoquee devant ces tableaux et un examen attentif du pericarde doit etre realise. Le catheterisme droit aide au diagnostic differentiel.

National audience; La fibrose pulmonaire idiopathique (FPI) est la forme la plus fréquente de pneumopathie interstitielle diffuse (PID) idiopathique chronique chez l’adulte. Il s’agit d’une maladie fibroproliférative, irréversible, de cause inconnue, dont l’évolution est habituellement progressive, survenant principalement à partir de 60 ans et limitée aux poumons. Qualifiée de maladie orpheline notamment en raison de l’absence de traitement ayant fait la preuve formelle de son efficacité jusqu’à une période très récente, la FPI est une maladie rare dont la prévalence a été évaluée aux États-Unis entre 14 et 28/100 000 personnes [1], ce qui correspondrait à un minimum de 9000 patients en France et une incidence entre 6,8 et 9/100 000 par an [1,2], soit un minimum de 4400 nouveaux patients par an en France.

Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by an immune response to a variety of antigens to which patients have been previously sensitised. It can occur at any age. In children, it is a rare disease, probably under-diagnosed, with an estimated prevalence of 4 per million. The paediatric forms are not really different from those of adults but present some particularities. Avian exposure is by far the most frequent cause of HP, accounting for nearly two-thirds of cases. Although there is no current recommendation for the diagnosis of HP, it is commonly considered that the diagnosis can be made with confidence on the combination of (1) compatible respiratory symptoms, (2) exposure to a known offending antigen, (3) lymphocytic alveolitis, (4) decreased transfer factor for carbon monoxide or hypoxia on exertion and (5) compatible radiologic features. The treatment is based on antigen avoidance that must be complete and definitive. Corticosteroids can be necessary in severe forms. The prognosis of HP in children is better than in adults, with a full clinical and functional recovery in the majority of cases after complete antigenic withdrawal.

Hot tub lung is a hypersensitivity pneumonitis (HP) due to exposure to inhaled non-tuberculous mycobacteria, the most frequent being Mycobacterium avium complex (MAC).A French couple developed typicalHP in the context of a repeated use of hot tubs. The husband had a severe hypoxemic form whereas his wife had a micronodular form with patchy ground glass on the thoracic scan, with less severe functional impairment. MAC was recovered in the hot tub water, but not in broncho-alveolar lavage fluid, and serologies were negative. Samples taken at home showed unusual exposure to Aureobasidium pullulans and Aspergillus flavus, as well as the presence of potentially responsible domestic molds. Blood precipitins for these microorganisms were identified. The evolution was favorable after removal of the hot tub.These cases represent two of the typical presentations of hot tub lung, with a possible HP to an antigen other than MAC, which may have been enhanced by chronic exposure to multiple microorganisms.

Background Accurate assessment of atopic sensitization is pivotal to clinical practice and research. Skin prick test (SPT) and specific IgE (sIgE) are often used interchangeably. Some studies have suggested a disagreement between these two methods, and little is known about their association with allergic diseases. The aims of our study were to evaluate agreement between SPT and sIgE, and to compare their association with allergic diseases in 10-year-old children. Methods Skin prick test, sIgE measurements, and assessment of allergic diseases were performed in children aged 10 years in the Protection against Allergy: STUdy in Rural Environments (PASTURE) cohort. The agreement between SPT and sIgE was assessed by Cohen's kappa coefficient with different cutoff values. Results Skin prick tests and sIgE were performed in 529 children. The highest agreement (κ=.44) was found with a cutoff value of 3 and 5 mm for SPT, and 3.5 IU/mL for sIgE. The area under the curve (AUC) obtained with SPT was not significantly different from that obtained with sIgE. For asthma and hay fever, SPT (cutoff value at 3 mm) had a significantly higher specificity (P

IF0.576; National audience; IntroductionLa fibrose pulmonaire idiopathique (FPI) est une fibro-prolifération anormale du tissu pulmonaire dont tous les mécanismes ne sont pas compris. Les cellules effectrices de l’inflammation et du système immunitaire jouent un rôle certain dans la physiopathologie de cette maladie incurable. Il existe des thérapies innovantes qui tentent de résoudre l’inflammation selon le processus naturel et non de simplement l’inhiber. Nous avons évalué in vitro l’effet de SuperMApo, l’une de ces thérapies innovantes, sur les marqueurs d’activation des cellules de l’inflammation (Fig. 1).MéthodesLes patients devaient présenter les critères ATS, ERS de la FPI. Étaient exclus les patients présentant une affection susceptible de modifier la réponse immunitaire autre que la FPI (cancer, diabète déséquilibré, pathologie auto-immune). L’étude a évalué, in vitro et par patient, l’effet de SuperMApo (surnageant de co-culture de macrophages ayant phagocyté des cellules apoptotiques) sur l’expression des marqueurs de maturation CD40, CD86 et HLA de classe II (HLA-DR) à la surface des cellules dendritiques et des monocytes traités ou non avec des agents d’activation. L’expression des marqueurs était évaluée par cytométrie de flux et exprimée en moyenne d’intensité de fluorescence (MFI).RésultatsAu total, 15 patients ont été inclus sur le seul centre de Besançon entre décembre 2015 et mars 2016. Nous avons constaté une majoration, sous l’effet du SuperMapo de l’expression de l’HLA-DR sur les cellules dendritiques plasmacytoïdes (p =0,004) et la diminution de l’expression du facteur de co-stimulation CD86 sur les monocytes (p =0,0034). Nous avons remarqué une tendance à l’association entre activation des cellules inflammatoires et caractère précoce de la fibrose pulmonaire idiopathique.ConclusionDans cette étude préliminaire, SuperMApo a un effet immunomodulateur sur les cellules circulantes dans la FPI. Il semble raisonnable de poursuivre son évaluation dans un modèle animal de fibrose pulmonaire.

International audience; no abstract

Introduction. Management of primary spontaneous pneumothorax (PSP) consists of immediate resolution of pleural air, or observation, and prevention of recurrence. The risk factors for recurrence remain debated. Objectives. We aimed to describe and compare the characteristics of patients presenting a first episode of PSP to those of patients presenting a recurrent PSP, in order to identify factors potentially related to recurrence. Methods. We conducted a cross-sectional study including all admissions for PSP in the EDs of fourteen French public hospitals from 2009 to 2013. PSP were classified as a first episode if the patient had no previous history of pneumothorax and as recurrence if a previous episode of spontaneous pneumothorax was documented in the patient’s medical records or if a recurrence was identified during the inclusion period. To identify factors potentially associated with recurrence of PSP, multilevel logistic models were fitted. Results. During the study period, 918 (61,6%) first episodes and 573 (38,4%) episodes of recurrent PSP were identified. Clinical presentation, age, gender, smoking habits, and use of cannabis were similar in both groups. No clinical factor associated with recurrence was identified by multivariate analysis. Conclusion. In this large multicenter study, no clinical factor associated with recurrence was highlighted.

Introduction L’association entre le tabagisme et le risque cardio-vasculaire (RCV) chez les patients atteints de bronchopneumopathie obstructive chronique (BPCO) n’est pas clairement etablie. En effet, la plupart des etudes evaluant le RCV chez ces patients se basent sur des comparaisons entre des patients presentant une BPCO tabagique et des temoins tabagiques. Il est donc difficile de determiner si le tabagisme est un facteur de RCV independant chez les patients presentant une BPCO. Par ailleurs, le RCV chez les patients atteints de BPCO non-tabagisme reste a definir. Objectif : estimer la rigidite arterielle (un facteur predictif independant de la mortalite cardiovasculaire) par la mesure de la vitesse d’onde de pouls (VOP) et evaluer ses determinants chez des patients presentant une BPCO legere a moderee secondaire a une exposition aux poussieres organiques, au tabagisme ou aux deux et indemne de maladie cardiovasculaire apparente. Methodes La VOP a ete mesuree chez 142 patients atteints de BPCO legere a moderee et 155 temoins sains apparies sur l’âge, le sexe, l’indice de masse corporelle et le tabagisme et exposes a des poussieres organiques (respectivement n = 44 et n = 48), au tabac (n = 56 et n = 70) ou les deux (n = 42 et n = 37). Resultats La vitesse d’onde de pouls etait plus elevee chez les patients presentant une BPCO que chez les sujets temoins, meme aux stades precoces de la maladie. L’exposition aux poussieres organiques n’etait pas associee a une augmentation de la VOP. En outre, l’analyse de notre groupe de patients atteints de BPCO de differentes etiologies (exposition au tabac et/ou aux poussieres organiques) a permis de demontrer pour la premiere fois que le tabagisme etait un facteur independant du RCV dans la BPCO. Par ailleurs, le ST2 soluble, un marqueur associe a un risque accru de deces et d’evenements cardiovasculaires majeurs, etait correlee a la rigidite arterielle dans la BPCO. Conclusion Notre etude indique pour la premiere fois que le tabagisme est un facteur independant associe a une rigidite arterielle accrue chez les patients presentant un diagnostic etabli de BPCO.

Introduction La principale complication des ponction-biopsies transthoraciques pulmonaires (PTP) est le pneumothorax (PNO). L’objectif principal de cette etude etait d’identifier les facteurs de risque de PNO secondaires aux PTP, et d’en etablir un score predictif, afin de discriminer les patients pour lesquels une prise en charge ambulatoire serait possible. Methodes Cette etude monocentrique (centre hospitalier universitaire de Besancon) a porte sur la periode de novembre 2012 a mars 2017. Les patients ayant beneficie d’une PTP ont ete evalues retrospectivement sur des facteurs cliniques et radiologiques lies au patient, a la lesion, et au geste, potentiellement lies a la survenue de PNO. Une regression logistique multivariee a permis d’identifier les facteurs de risques de survenue de PNO. Le coefficient de regression logistique de chaque facteur a ensuite permis de realiser un score « SPOT ». L’etude SPOT a fait l’objet d’une declaration a la Commission nationale de l’informatique et des libertes (CNIL) et a Clinical trials sous l’identifiant : NCT03488043. Resultats A partir de 498 patients analyses pour le score SPOT 1, les facteurs de risques de PNO identifies etaient l’indice de masse corporelle ≤ 30 kg/m2 (odds-ratio ajuste (ORa) = 4,48 [1,47–13,63]), la presence de BPCO (ORa = 2,46 [1,18–5,13]), plusieurs passages a travers la plevre (ORa = 8,57 [2,08–35,28]), l’abord anterieur (ORa = 6,81 [3,76–12,32]), l’absence de contact hemorragie-plevre (ORa = 2,96 [1,36–6,46]), et une lame d’epanchement aerique > 10 mm (ORa = 5,66 [2,87–11,15]). Un score « SPOT 1 » Fig. 1 ). Conclusion Le score SPOT 1 permet d’identifier les patients a faible risque de survenue de PNO pour lesquels il pourrait etre propose une prise en charge ambulatoire. Une etude prospective de validation est en cours, destinee a confirmer et preciser nos resultats.

a Inra, UMR754, IFR 128, centre national de reference des maladies pulmonaires rares, centre de competences de l’hypertension pulmonaire, service de pneumologie, universite de Lyon, universite Claude-Bernard Lyon 1, hospices civils de Lyon, hopital Louis-Pradel, 28, rue du Doyen-Lepine, 69000 Lyon, France b CHU Bichat, centre de competences pour les maladies pulmonaires rares, 46, rue Henri-Huchard, 75877 Paris cedex 18, France

Cannabis consumption is common among adolescents and young adults in France. In addition to its neurological effect, cannabis smoking can induce severe pulmonary emphysema, even in young patients. When a spontaneous pneumothorax occurs in a cannabis smoker, the possibility of a secondary spontaneous pneumothorax should be considered. This may be of importance as management of secondary spontaneous pneumothorax may differ from the well-codified handling of primary spontaneous pneumothorax.Clinical and radiological data from three young cannabis-using patients with spontaneous pneumothorax were collected. Given the presence of emphysema, they were all considered secondary spontaneous pneumothorax. Two patients underwent surgical treatment, with simple postoperative follow-up in one case and prolonged air leak in the other case. The management of the third patient, exclusively medical, was prolonged and complicated.The presence of emphysema in young cannabis smokers complicates the management of spontaneous pneumothorax. In this context, a first-line surgical intervention may be an option to be considered.

Background: Farm exposure protects against development of allergies early in life. At 4.5 years, protection against asthma by farm-milk exposure was partially mediated by regulatory T cells (Tregs). The aim of this study was to investigate the critical time window of the ‘asthma-protective’ farm effect via Tregs during childhood immune maturation. Methods: Tregs were assessed longitudinally at 4.5 and 6 years in 111 children (56 farm and 55 reference children) from the PASTURE/EFRAIM birth cohort (flow cytometry). Peripheral blood mononuclear cells were cultured unstimulated (U), with phorbol 12-myristate 13-acetate/ionomycin (PI) or lipopolysaccharide (LPS), and stained for Tregs (CD4+CD25highFOXP3upper20%). mRNA expression of Treg/Th1/Th2/Th17-associated cell markers was measured ex vivo. Suppressive capacity of Tregs on effector cells and cytokines was assessed. Detailed questionnaires assessing farm exposures and clinical phenotypes from birth until age 6 years were answered by the parents. Results: Treg percentage before and after stimulation and FOXP3mRNA expression ex vivo decreased from age 4.5 to 6 years (P(U,LPS) < 0.001; P(PI) = 0.051; P(FOXP3) < 0.001). High vs low farm-milk and animal-stable exposure was associated with decreased LPS-stimulated Treg percentage at age 6 years (P(LPS) = 0.045). Elevated LPS-stimulated-Treg percentage at age 6 was associated with increased risk of asthma (aOR = 11.29, CI: 0.96–132.28, P = 0.053). Tregs from asthmatics vs nonasthmatics suppressed IFN-γ (P = 0.015) and IL-9 (P = 0.023) less efficiently. mRNA expression of Th1/Th2/Th17-associated cell markers decreased between 4.5 and 6 years (P < 0.001). Conclusions: Tregs at the age of 6 years were decreased with farm exposure and increased within asthmatics, opposite to age 4.5 years. This immunological switch defines a critical ‘time window’ for Treg-mediated asthma protection via environmental exposure before age 6 years.

Resume Etat des connaissances Une etude pilote suggere que la prevalence de la bronchopneumopathie chronique obstructive (BPCO) chez les producteurs laitiers depasse celle de la population generale malgre une plus faible proportion de sujets tabagiques. Objectifs et methodes L’etude a pour objectifs (1) de mesurer la prevalence de la BPCO en milieu de production laitiere ; (2) de caracteriser les patients en termes de tabagisme, de dyspnee, de qualite de vie, de fonction respiratoire, d’inflammation bronchique et systemique, de fonction vasculaire systemique et de capacite d’exercice ; (3) de comparer les caracteristiques des patients atteints de BPCO en milieu de production laitiere avec celles d’un groupe de BPCO indemnes d’exposition professionnelle (groupe BPCO « temoin ») ; (4) de preciser les facteurs etiologiques de la BPCO en milieu de production laitiere et (5) de constituer une cohorte de patients atteints de BPCO. Pour cela, un depistage de la BPCO sera realise chez 2000 producteurs laitiers et 2000 sujets non exposes, tous âges de 40 a 75 ans. Resultats attendus Les resultats devraient (1) guider la mise en place des procedures de depistage et de prevention de la BPCO en milieu de production laitiere et (2) permettre d’optimiser la prise en charge therapeutique de ces patients.

The follow-up of workers occupationally exposed to asbestos has two possible beneficial effects: (1) individually, both medical by screening for diseases related to asbestos and social by notification of occupational disease and/or compensation from the indemnity funds for asbestos victims; (2) collectively, by the establishment of epidemiological surveillance (follow-up of cohorts) and evaluation of the impact of follow-up in terms of health benefits and compensation. The respiratory disorders related to asbestos are: cancer (malignant pleural mesothelioma and bronchial carcinoma), asbestos-related pulmonary fibrosis, and pleural disease (plaques, pleural fibrosis and benign pleurisy). In the light of the data currently available and the effectiveness of the tools used, medical and public health benefits of screening for mesothelioma have not been demonstrated. The early diagnosis of primary bronchial carcinoma can theoretically improve the prognosis of the subjects screened, particularly by identification of stage I disease on CT (pulmonary nodules). This is a common finding but there are a large number of false-positives. While we await the results of several international randomised trials, the benefits of a screening programme for bronchial carcinoma in the population at risk have not been demonstrated. There is no effective treatment for asbestosis but this is an independent risk factor for bronchial carcinoma and it is evidence of heavy asbestos exposure. Stopping smoking in subjects suffering from asbestosis will reduce the incidence of bronchial carcinoma. There is no effective treatment for asbestos-related benign pleural diseases but these are markers of exposure. The presence of pleural plaques has not been shown to be an aetiological factor for thoracic cancers. Post-occupational follow-up may involve risks to health, particularly repeated irradiation and invasive diagnostic procedures. It is also necessary to consider the psychological consequences inherent in all screening programmes. In conclusion, post-occupational follow-up might reduce the mortality of lung cancer by screening for localised disease and its incidence by a targeted anti-smoking programme. The theoretical benefits, that have not yet been demonstrated, have to be seen in perspective with the risks to physical and psychological health related to both screening and diagnostic procedures.