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Resume Il existe peu de donnees concernant l’impact de la bronchopneumopathie chronique obstructive (BPCO) sur la qualite de vie des patients, en Europe. L’etude de la qualite de vie, par stade de severite de la BPCO, liee a la sante des patients en medecine generale, avait pour objectif d’evaluer l’impact de la BPCO sur la qualite de vie chez 2430 patients BPCO dans sept pays europeens (la France, la Belgique, l’Allemagne, l’Italie, la Hollande, l’Espagne et l’Angleterre), dont 573 patients en France. Cette etude transversale, epidemiologique, non randomisee a ete realisee en utilisant deux questionnaires generiques de qualite de vie et deux questionnaires specifiques de la BPCO. Les resultats sur le sous-groupe des patients francais montrent un etat de sante des patients altere des le stade leger de la maladie. Les differences entre les stades de severite, selon l’appreciation des medecins generalistes, sont cliniquement significatives avec une forte dispersion des scores de la qualite de vie au sein de chaque stade de severite. L’impact de la BPCO sur les activites quotidiennes du patient est un element majeur et devrait faire systematiquement l’objet d’une evaluation et d’une prise en charge en routine, au meme titre que pour les autres manifestations de la BPCO.

Background In Europe, administration of an inhaled corticosteroid (ICS) combined with a long-acting β2 agonist is approved in chronic obstructive pulmonary disease (COPD) patients with a pre-bronchodilator FEV1 75%) had moderate to very severe COPD. Strict compliance by prescribing physicians with the market-approved population for dry powder inhaler SFC in COPD was low, notably in ICS-naïve patients; all three conditions were fulfilled in less than a quarter of patients with prior ICS and less than 7% of ICS-naïve patients. Conclusions Prescription of dry powder inhaler SFC by GPs and pulmonologists has very low conformity with the three conditions defining the licensed COPD population. Prescription practices need to be improved and systematic FEV1 evaluation for COPD diagnosis and treatment management should be emphasized.

Dyspnea is one of the principal signs of chronic respiratory diseases.To determine the appropriate questions and tests for recognizing dyspnea, 295 general practitioners questioned 1991 patients with or at risk of COPD in this cross-sectional study. After a brief training session, the physicians were asked to assess respiratory function with a small electronic spirometer.A questionnaire with a six-point semi-quantitative scale of dyspnea detected more dyspneic patients (78.1%) than the single question "Are you usually short of breath?" (68.6%), which in turn detected this symptom more often than simply listening for spontaneous complaints (33.7%). Even when dyspnea was reported only for substantial exertion, it was associated with impairment of all domains of quality of life. Only half the spirometry results met the minimal criteria of validity and reproducibility.These results underline the importance of a specific, systematic assessment of dyspnea in patients at risk, and the need for sufficient training and practice before the use of electronic spirometers in general practice.

The basics of asthma treatment are well defined in the guidelines, however the criteria for the choice between fixed and free combinations of inhaled corticosteroids and long acting beta 2-agonist have not been clearly established.A modified Juniper questionnaire (using peak expiratory flow rather than maximal expiratory volume per second) was used by 421 general practitioners to assess asthma control in 861 adult patients (aged 47 +/- 17 years) having received inhaled corticosteroids and long-acting beta 2-agonist in a fixed (n = 413) or free (n = 448) combination for at least 6 weeks.Treatment groups were comparable for demographics, asthma history and severity as assessed by the physician. Despite better compliance to treatment in the fixed combination group and a mean daily dose of corticosteroids around two-fold greater compared with free combination group (913 +/- 450 micrograms/d vs 401 +/- 178 micrograms/d), the mean Juniper score was lower in the free combination group (1.60 +/- 0.94 vs 1.73 +/- 0.96) with a greater percentage of patients controlled (Juniper score2): 67.6% vs 60.8%. Other treatments for asthma were significantly less frequent with the free combination (14.2% vs 22.3%), as were local side effects and notably voice changes (3.3% vs 9.5%.The apparently greater efficacy/safety ratio of the free combination was probably due to the greater severity of asthma in the patients treated with a fixed combination. This highlights the interest of free combinations as first-line therapy for patient with mild to moderate asthma.