Les patients souffrant de rhinite allergique recherchent plusieurs options thérapeutiques symptomatiques, y compris des traitements non conventionnels, pour contrôler leurs symptômes. Dans la région ...de Montpellier, l’allergie au pollen de cyprès représente l’une des causes les plus fréquentes de consultation allergologique pour des symptômes respiratoires.
Nous avons mené une étude prospective de preuve de concept, pour évaluer le rôle potentiel du spray nasal pour la protection des allergies (SNPA) de Puressentiel® dans la diminution des symptômes de rhinite allergique au pollen de cyprès.
En dehors de la saison pollinique, chez 15 patients adultes, nous avons réalisé deux tests de provocation nasale (TPN), avec un extrait de pollen de cyprès (Leti, Barcelone, Espagne), à 15jours d’intervalle, avec et sans administration randomisée préalable de SNPA. Nous avons évalué, avant chaque TPN et 2heures après, le score de symptômes nasaux (éternuements, rhinorrhée, obstruction nasale, démangeaisons nasales) et le débit de pointe inspiratoire nasal.
En comparant les résultats obtenus avec et sans utilisation préalable du spray SNPA avant le TPN, nous avons constaté une différence significative entre les scores symptomatiques avec et sans pulvérisation de SNPA (p-value <0,01), et une diminution moyenne de 57 % des symptômes (–3,1, p-value <0,01) ; nous avons aussi enregistré une différence moyenne de 62 % du débit de pointe inspiratoire nasal (p-value <0,05), en faveur de l’utilisation du spray.
Le spray SNPA de Puressentiel® est efficace pour réduire les symptômes nasaux et pourrait constituer une option naturelle non pharmacologique valable chez les patients souffrant de rhinite allergique au pollen de cyprès. Une étude chez les patients souffrant de rhinite allergique aux acariens sera développée pour vérifier si cette intervention pourrait être utile même dans cette population.
Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disease characterised by alveolar accumulation of surfactant. It may result from mutations in surfactant proteins or granulocyte ...macrophage-colony stimulating factor (GM-CSF) receptor genes, it may be secondary to toxic inhalation or haematological disorders, or it may be auto-immune, with anti-GM-CSF antibodies blocking activation of alveolar macrophages. Auto-immune alveolar proteinosis is the most frequent form of PAP, representing 90% of cases. Although not specific, high-resolution computed tomography shows a characteristic "crazy paving" pattern. In most cases, bronchoalveolar lavage findings establish the diagnosis. Whole lung lavage is the most effective therapy, especially for auto-immune disease. Novel therapies targeting alveolar macrophages (recombinant GM-CSF therapy) or anti-GM-CSF antibodies (rituximab and plasmapheresis) are being investigated. Our knowledge of the pathophysiology of PAP has improved in the past 20 yrs, but therapy for PAP still needs improvement.
Idiopathic pulmonary alveolar proteinosis is presumed to be an autoimmune disorder that may lead to pulmonary insufficiency. However, steroids do not appear to be effective and the standard of ...therapy is whole-lung lavage. We report the first case of successful therapy with rituximab, which addresses the pathogenic mechanism of pulmonary alveolar proteinosis.
To describe the clinical and economic burden of severe asthma in France over 12 months.
Data were retrieved from the observational, prospective “Cohorte Obstruction Bronchique et Asthme” (COBRA) ...cohort, which has enrolled nearly 1000 asthma patients since 2007 from throughout France. Patients undergoing treatment with GINA step-4 or 5 medications uninterruptedly for 12 months (thus defining “severe asthma”) were identified and their clinical data used to describe the clinical burden of asthma (exacerbations, symptoms outside exacerbations, and level of asthma control). Patients’ utilization of healthcare resources was described and used to estimate the direct medical costs incurred to treat severe asthma.
155 patients were included in the present study. Over the 12-month period of interest, 128 (83%) patients experienced at least one asthma exacerbation, 22 (14%) patients were hospitalized for asthma, 133 (86%) patients experienced continuous symptoms outside exacerbations, and 77 (50%) patients experienced important limitations in daily life activities. The median number of asthma-related drugs used was 4. The mean estimated annual asthma-related cost was 8,222 euros (standard deviation, SD = 11,886), including 7,229 euros (SD = 11,703) for controller medications.
Symptoms outside exacerbation periods are highly prevalent in severe asthma patients, for whom the main driver of medical costs is controller medication.
•In severe asthma, asthma symptoms occurring outside exacerbation periods are as frequent in patients with exacerbations than in patients without exacerbations.•The main driver of direct medical cost is asthma controller medication.
Masitinib is a tyrosine kinase inhibitor targeting stem cell factor receptor (c-kit) and platelet-derived growth factor (PDGF) receptor, which are expressed on several cell types including mast cells ...and bronchial structural cells, respectively. We hypothesized that c-kit and PDGF receptor inhibition may decrease bronchial inflammation and interfere with airway remodeling, which are crucial features of severe asthma. The primary endpoint was the percent change from baseline in oral corticosteroids after 16 weeks of treatment. Change in asthma control (asthma control questionnaire), exacerbation rate, pulmonary function tests, rescue medication requirement and safety were secondary endpoints. A 16-week randomized, dose-ranging (3, 4.5, and 6 mg/kg/day), placebo-controlled study was undertaken in 44 patients with severe corticosteroid-dependent asthma who remained poorly controlled despite optimal asthma management. At 16 weeks of treatment, a comparable reduction in oral corticosteroids was achieved with masitinib and placebo (median reduction of -78% and -57% in the masitinib and placebo arms, respectively). Despite this similar reduction, the Asthma Control Questionnaire score was significantly better in the masitinib arm as compared to placebo with a reduction by 0.99 unit at week 16 (P < 0.001) vs 0.43 unit in the placebo arm. Masitinib therapy was associated with more transient skin rash and edema. Masitinib, a c-kit and PDGF-receptor tyrosine kinase inhibitor, may represent an innovative avenue of treatment in corticosteroid-dependent asthma. These preliminary results warrant further long-term clinical studies in severe asthma (ClinicalTrials.gov Identifier: NCT00842270).
In the general population, a history of asthma (HA) is associated with a higher risk of mortality of anaphylactic shock (AS), but it is unknown whether this association remains valid for ...intra‐operative AS. The goal of this retrospective study was to investigate whether a HA was associated with a higher risk of bronchospasm during intra‐operative AS. We analyzed 106 patients (January 2009–December 2012) with intra‐operative AS: 57% of them had a confirmed IgE‐mediated reaction and 27% had a HA. On logistic regression, the only factor statistically associated with bronchospasm was a neuromuscular blocking drug, with both IgE‐ or non‐IgE‐mediated reactions. These results suggest that the mechanisms of bronchospasm in AS may be different from those of asthma and that, in the presence of bronchospasm during anesthesia, AS should be considered to be the most likely cause.
La tuberculose est une maladie humaine due à Mycobacteriumtuberculosis, transmise par voie aérienne. Des cas de contamination du personnel soignant (PS) en milieu de soins ont été documentés tant ...dans les pays industrialisés que dans les pays en développement. La reconnaissance précoce des cas potentiellement contaminants et leur mise immédiate en isolement « Air », leur traitement rapide, sont autant de mesures efficaces pour diminuer les risques de transmission : les techniques de biologie moléculaire, améliorant la précocité du diagnostic, prennent ici tout leur sens. En cas de non-respect des précautions « Air », l’enquête autour du cas doit lister les personnels et patients potentiellement exposés, et rechercher parmi eux les cas d’infection tuberculeuse latente afin de les traiter pour éviter l’évolution vers une tuberculose maladie.
Tuberculosis is a human disease caused by Mycobacteriumtuberculosis, and transmitted by airborne pathway. Documented cases of tuberculosis infection in healthcare workers have been reported in both developed and developing countries. Early recognition of potentially infectious cases, immediate implementation of airborne precautions and prompt medical treatment of cases, are required to lower the risk of disease transmission. Molecular biology techniques allow earlier diagnosis. In the event of non-compliance with airborne precautions, the investigation will further have to establish exhaustive lists of potentially exposed healthcare workers and patients, looking for cases of latent tuberculosis infections whose treatment should help avoid active tuberculosis disease.
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