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, FEV(1), 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 FEV(1) and with the number of exacerbations in the past 12 months. Multivariate analysis showed that the determinants of dyspnoea(mMRC?2) are: FEV(1): OR=3.712.86-4.82; anxiety: OR=2.521.82-3.47; cough: OR=1.941.57-2.40; bronchiectasis: OR=1.841.03-3.29; age: OR=1.801.45-2.24; hyperinflation (RV/TLC): OR=1.681.34-2.11; ischemic cardiopathy: OR=1.631.22-2.18; hypertension: OR=1.521.21-1.91; exacerbations (?2): OR=1.411.10-1.81; women: OR=1.391.10-1.74 and overweight: OR=1.331.06-1.67. The subgroup analysis showed that: FEV(1): OR=3.471.96-6.12; exacerbations (?2) OR=2.311.33-4.17 and hyperinflation (IC/TLC) OR=0.570.35-0.85 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.
Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD ...is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.
Le tabagisme est la première cause de prématurité et en France, 22 % des femmes enceintes fument pendant leur grossesse, le plus mauvais résultat européen. Une conférence de consensus ayant insisté ...sur une prise en charge prioritaire, le but de ce travail a été d’étudier l’offre des consultations de tabacologie en Picardie et les délais de prise en charge pour les femmes enceintes.
Il s’agit d’une enquête téléphonique anonyme en début de semaine auprès des centres de tabacologie de la région picarde par une personne de sexe féminin qui a demandé une consultation pour arrêter de fumer.
L’indentification des centres de tabacologie a été difficile, témoignant d’une communication insuffisante. Le délai d’accès à la consultation est en moyenne de neuf jours (extrêmes : 2–24). Seuls huit centres sur les 21 ont été en mesure d’avancer le rendez-vous quand la demandeuse a indiqué qu’elle était enceinte. Le délai moyen est alors à sept jours (extrêmes : 1–16). Aucun centre ne s’est enquis de la possibilité de cette situation, contrairement aux conclusions de la conférence de consensus.
Le tabac est aussi la première cause de cancer du poumon, de récidive après infarctus. L’insuffisance des moyens et l’incohérence des dispositifs existants en France sont discutées et comparées à la situation d’autres pays. Une mobilisation des professionnels est indispensable pour obtenir des tutelles des moyens pour une prise en charge adaptée, comme pour toute maladie chronique. Ce type d’enquête permet d’évaluer les points forts et les points faibles de la prise en charge et doit permettre de mobiliser l’ensemble des professionnels pour une prise en charge adaptée.
France has the highest rate in Europe for smoking during pregnancy, the first cause of preterm birth.
We aimed to study the accessibility of smoking clinics for pregnant women in Picardy. A woman simulated by phone a request for a visit.
Smoking cessation visits are poorly publicized. The mean delay for a visit is nine days (range: 2–42). Only eight centers out of 21 could reduce the delay when it was stressed that the request was for a pregnant woman, reducing the delay to seven days (range: 1–16). None of the centres has checked for this condition.
Smoking is a major burden. Inconsistencies in the French healthcare system are reviewed. Professionals’ involvement in smoking cessation programs must be improved, however consistency in the support from health care authorities is needed.
France has the highest rate in Europe for smoking during pregnancy, the first cause of preterm birth.
We aimed to study the accessibility of smoking clinics for pregnant women in Picardy. A woman ...simulated by phone a request for a visit.
Smoking cessation visits are poorly publicized. The mean delay for a visit is nine days (range: 2-42). Only eight centers out of 21 could reduce the delay when it was stressed that the request was for a pregnant woman, reducing the delay to seven days (range: 1-16). None of the centres has checked for this condition.
Smoking is a major burden. Inconsistencies in the French healthcare system are reviewed. Professionals' involvement in smoking cessation programs must be improved, however consistency in the support from health care authorities is needed.
IgE spécifiques et histamino-libération Bernady, A.; Taytard, A.; Tunon de Lara, J.M.
Revue française d'allergologie et d'immunologie clinique,
12/1996, Letnik:
36, Številka:
8
Journal Article, Conference Proceeding
La mesure de l'histamine libérée après activation des basophiles a été largement utilisée en recherche et parfois en pratique allergologique. Cette technique permet en effet de mettre en évidence la ...présence d'IgE spécifiques à la surface de ces cellules et de démontrer ainsi une sensibilisation IgE-dépendante. La comparaison de cette méthode aux techniques de référence que sont les tests cutanés et les RAST pour diagnostiquer la sensibilisation à IgE montre que l'histaminolibération est une méthode dont le rapport coût efficacité interdit son utilisation en routine. De nouvelles techniques visant à évaluer la dégranulation des basophiles (e.g. expression du CD63, dosage des leucotriènes) permettent d'en améliorer la sensibilité ou la spécificité mais n'ont pas à ce jour démontré une performance supérieure à celle des tests cutanés ou des dosages directs d'IgE spécifiques. En revanche, la recherche d'IgE vis-à-vis de certains médicaments induisant une allergie IgE-dépendante peut être réalisée en mesurant l'histaminolibération lorsque les dosages directs d'IgE ne sont pas disponibles et que les tests cutanés ne sont pas interprétables. La procédure doit cependant être validée pour une molécule donnée et comparée aux techniques utilisant l'allergène couplé à un support.
Histamine release measurement from basophils has been widely used for research purposes and has sometimes been proposed to investigate IgE sensitization ex vivo. When compared with reference techniques (i.e. skin tests and RAST), histamine release measurement is less cost-effective and should not to be used for routine diagnosis of specific allergens responsible for IgE-mediated disease. Both sensitivity and specificity of basophil degranulation study have been improved using other techniques such as the measurement of CD63 expression or leukotriene assay. However, their comparative merits with that of skin tests and RAST remain to be evaluated and their cost does not allow routine utilisation. Histamine release has nevertheless been used in drug allergy diagnosis when specific IgE assay is not available. This procedure remains to be validated for each allergenic molecule and needs to be compared with techniques using antigen coupling.
The catheter of an implantable chamber migrated into the pulmonary infundibulum in a patient given chemotherapy for bronchogenic cancer. Current management of such cases is to remove the catheter ...under pulmonary angiography control using a basket system.