INTRODUCTION: Pulmonary embolism (PE) is the major complication of thromboembolic disease. While a few qualitative studies have explored patient experience after PE, to our knowledge no literature review is available to...INTRODUCTION: Pulmonary embolism (PE) is the major complication of thromboembolic disease. While a few qualitative studies have explored patient experience after PE, to our knowledge no literature review is available to date. The aim of this work was to explore patient experience after a PE episode through a systematic review of the literature comprising: patient experience, clinicians' perception of the patients' attitude and knowledge, and the patients' perception of VTE prevention strategies. METHODS: A search of PubMed, Web of science, Cochrane and EMBASE databases. The search was conducted without filters. Search results were combined and duplicates were removed. The selection was blinded by two independent researchers using the Rayyan application. RESULTS: Fifty studies were assessed for quality and 23 were included. Individual semi-structured interviews and focus groups were widely used to explore patient experience after a PE episode. Patients described deterioration in their quality of life, their psychological state and an initial feeling of carer abandonment. The trends observed appear to be more pronounced in patients with an episode characterized as unprovoked. CONCLUSION: These preliminary results call for further longitudinal studies, the objective being to better understand the evolution of these factors in the short and long terms.
INTRODUCTION: Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive disease. The majority of patients are asymptomatic. The disease is often diagnosed on routine radiological examination. CASE REPORTS: We...INTRODUCTION: Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive disease. The majority of patients are asymptomatic. The disease is often diagnosed on routine radiological examination. CASE REPORTS: We report two familial cases of PAM. A 17-year-old girl with a chest X-ray showing an alveolar syndrome, especially on the right side, a bronchointerstitial syndrome, and diffuse calcifications. The thoracic CT scan showed calcified micro- and macronodules with pleural and pericardial calcifications. Respiratory function tests showed restrictive syndrome and normal blood gas values suggestive if PAM, which was confirmed by the presence of microliths in bronchoalveolar lavage (BAL). Family investigation led to chest radiograph of a 14-year-old sister who was asymptomatic but presented with an aspect of "sandstorm" calcifications. CONCLUSION: PAM is known to be radio-clinically dissociative. In typical cases, radiology can suggest the diagnosis, which is often confirmed by SLC34A2 mutation or microliths in BAL or sputum. The prognosis is compromised in the long-term. The only effective treatment nowadays is lung transplantation.
Rev Mal Respir
· 2023 Oct · PMID 37500325
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The concept of oligometastatic disease was first introduced in the late 1990s to describe an situation more or less midway between locally advanced tumours and multifocal metastatic cancer. Four concepts are currently us...The concept of oligometastatic disease was first introduced in the late 1990s to describe an situation more or less midway between locally advanced tumours and multifocal metastatic cancer. Four concepts are currently used: synchronous oligometastatic disease, metachronous oligometastatic disease (or oligo-recurrence), oligo-persistence and oligo-progression. Some phase II studies, randomised or not, have validated this concept in non-small cell lung cancer (NSCLC) and suggest the interest of adding local ablative therapy to systemic treatment. That said, numerous questions remain, and the impact of this therapeutic approach in the framework of immunotherapies and targeted therapies has yet to be assessed. Which of these new treatments offer hope of significantly improved long-term survival in stage IV NSCLC? This article appraises current knowledge and therapeutic regarding oligometastatic NSCLC.
Rev Mal Respir
· 2023 Sep · PMID 37422341
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During the COVID-19 pandemic, airborne transmission of lung disease was a cause for major concern, and scientific societies published strict hygiene guidelines for pulmonary function tests (PFT) and cardiopulmonary exerc...During the COVID-19 pandemic, airborne transmission of lung disease was a cause for major concern, and scientific societies published strict hygiene guidelines for pulmonary function tests (PFT) and cardiopulmonary exercise testing (CPET). These guidelines led to a major decrease in patient access to PFT and CPET, and their relevance in the 2023 post-pandemic context may be called into question. Under the hypothesis that PFT/CPET expert centers have modified their practices in accordance with the applicable guidelines, a survey was conducted from the 8th through the 23rd of February 2023 in 28 French PFT/CPET hospital departments. An overwhelming majority of the centers (96%) did not limit indications for PFT/CPET, and requested neither a vaccination or recovery certificate (93%) nor a negative diagnostic test (89%). While the use by patients and caregivers of surgical masks and antimicrobial filters was unanimously adopted, only 36% of centers declared that FFP2/N95-filtering face masks were worn. Disinfection of caregivers' hands was carried out by 96%, and a majority of centers reported break time (75%) and disinfection of equipment surfaces (89%) between the testing of two patients. In conclusion: aside from a few modifications, the practices reported by PFT/CPET French expert centers in 2023 were close to those in force prior to the COVID-19 epidemic.
INTRODUCTION: While the screening of chronic obstructive lung diseases (COPD, asthma, etc.) constitutes a major public health issue in France and worldwide, simple spirometry appears currently as the key to meeting the c...INTRODUCTION: While the screening of chronic obstructive lung diseases (COPD, asthma, etc.) constitutes a major public health issue in France and worldwide, simple spirometry appears currently as the key to meeting the challenge. Since description of the forced expiratory maneuver by Robert Tiffeneau in 1947, it has been admitted that the FEV/VC ratio permits diagnosis obstructive pulmonary diseases. However, the diagnostic criteria for this ratio remain uncertain. The long-lasting debate between advocates of a 0.7 "fixed ratio" (FR) of 0.7 and advocates of the "lower limit of normal" (LLN) remains relevant. STATE OF THE ARTS: In this general review, we describe the respective advantages of the FR and LLN criteria according to the most recently published studies, and characterize the conditions associated with discrepancies between these criteria. PERSPECTIVES AND CONCLUSIONS: FR and LLN appear not to share similar diagnosis values and the use of both criteria facilitates proposal of an up-to-date interpretation and diagnosis strategy in the context of first-line spirometry, particularly for patients with FEV/VC ratio in the "grey zone".
The environment of an asthmatic patient can contain numerous sources of pollutants that degrade the quality of indoor air and have major repercussions on the occurrence and control of asthma. Assessment and improvement o...The environment of an asthmatic patient can contain numerous sources of pollutants that degrade the quality of indoor air and have major repercussions on the occurrence and control of asthma. Assessment and improvement of the quality of indoor air should be assigned a major role in pneumology and allergology consultations. Characterization of an asthmatic's environment entails a search for biological pollutants with mite allergens, mildew, and allergens resulting from the proximity of pets. It is important to evaluate the chemical pollution represented by exposure to volatile organic compounds, which are increasingly present in our lodgings. Active or second-hand smoking must in all circumstances be sought out and quantified. Assessment of the environment is mediated by several methods, of which the application depends not only on the pollutant sought out, but also on enzyme-linked immunosorbent assay (ELISA), which has an essential role in quantification of biological pollutants. Attempts at expulsion of the different indoor environment pollutants is mediated by indoor environment advisors, whose efforts are aimed at obtaining reliable evaluation and control of indoor air. Implemented as a form of tertiary prevention, their methods are conducive to improved asthma control, in adults as well as children.
INTRODUCTION: In health care, measures against cross-transmission of microorganisms are codified by standard precautions, and if necessary, they are supplemented by additional precautions. STATE OF THE ART: Several facto...INTRODUCTION: In health care, measures against cross-transmission of microorganisms are codified by standard precautions, and if necessary, they are supplemented by additional precautions. STATE OF THE ART: Several factors impact transmission of microorganisms via the respiratory route: size and quantity of the emitted particles, environmental conditions, nature and pathogenicity of the microorganisms, and degree of host receptivity. While some microorganisms necessitate additional airborne or droplet precautions, others do not. PROSPECTS: For most microorganisms, transmission patterns are well-understood and transmission-based precautions are well-established. For others, measures to prevent cross-transmission in healthcare facilities remain under discussion. CONCLUSIONS: Standard precautions are essential to the prevention of microorganism transmission. Understanding of the modalities of microorganism transmission is essential to implementation of additional transmission-based precautions, particularly in view of opting for appropriate respiratory protection.
Noureddine S, Roux-Claudé P, Eberst G
… +3 more, Westeel V, Barnig C, Claudé F
Rev Mal Respir
· 2023 Sep · PMID 37357041
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INTRODUCTION: Long COVID refers to persistent symptoms, lasting more than 4 weeks after acute SARS-CoV-2 infection, even though the infection itself has been successfully controlled and remedied. Patient complaints are d...INTRODUCTION: Long COVID refers to persistent symptoms, lasting more than 4 weeks after acute SARS-CoV-2 infection, even though the infection itself has been successfully controlled and remedied. Patient complaints are diverse, and the underlying physiopathological mechanisms are not well understood. Dyspnea and muscle fatigue are among the most commonly reported symptoms. STATE OF THE ART: Cardiopulmonary exercise test (CPET) has been recognized as a useful tool in investigation of unexplained dyspnea. In patients with chronic lung disease, pulmonary rehabilitation is a program designed to counteract dyspnea, to increase exercise capacity and to improve quality of life. PERSPECTIVES: Publications on CPET and pulmonary rehabilitation are needed in order to deepen comprehension and enhance management of long-COVID-19. CONCLUSIONS: CPET reports have shown that symptoms persisting in the aftermath of acute SARS-CoV-2 infection may be related to deconditioning, a common occurrence after ICU stay, to cardiac dysautonomia subsequent to critical infections and, finally, to dysfunctional breathing subsequent to mild infections. These findings justify pulmonary rehabilitation, which has proven to be effective regardless of the severity of the initial infection, not only immediately after hospital discharge, but also at later points in time.
Menigoz C, Dirou S, Sagan C
… +13 more, Corne F, Moui A, Defrance C, Liberge R, Morla O, Patarin V, Nicolas A, Kandel-Aznar C, Lacoste P, Clarke JP, Cavailles A, Cellerin L, Blanc FX
Rev Mal Respir
· 2023 Jun · PMID 37308261
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In some cases of interstitial lung disease (ILD), clinical and biological findings associated with CT scan pattern during multidisciplinary discussion (MDD) fail to yield a confident diagnosis. In these cases, histology...In some cases of interstitial lung disease (ILD), clinical and biological findings associated with CT scan pattern during multidisciplinary discussion (MDD) fail to yield a confident diagnosis. In these cases, histology may be necessary. Transbronchial lung cryobiopsy (TBLC) is a bronchoscopic procedure that has been developed in recent years and currently contributes to diagnostic work-up in patients with ILD. TBLC provides tissue samples for histological analysis with an acceptable risk of complications, consisting mainly in pneumothorax or bleeding. In addition to higher diagnostic yield than conventional forceps biopsies, the procedure shows a better safety profile than surgical biopsies. The indication to perform TBLC is decided during a 1st MDD and during a 2nd MDD, results can provide a diagnostic yield approximating 80%. TBLC appears to be an attractive, minimally invasive technique to be proposed as a first-line procedure in selected patients in experienced centers, while surgical lung biopsy may be considered as a second-line solution.
The year 2023 is marked by the officialization in French law of medical telemonitoring. Adult patients suffering from severe chronic respiratory failure (CRF) and being treated non-invasive ventilation (NIV) and/or oxyge...The year 2023 is marked by the officialization in French law of medical telemonitoring. Adult patients suffering from severe chronic respiratory failure (CRF) and being treated non-invasive ventilation (NIV) and/or oxygen therapy in a home setting are eligible for telemonitoring, of which the costs are to be covered by French health insurance. Telemonitoring allows a medical professional to remotely interpret the data necessary for follow-up and, if necessary, to make decisions regarding management of a given patient. Its objectives are, at the very least, to stabilize the disease through appropriate monitoring, to improve efficiency and quality of care, and to improve that patient's quality of life. The objective of this synthesis is to review the current state of remote monitoring of CRF patients by identifying, through a narrative analysis of the literature, its current benefits and limitations, and to compare present-day telemonitoring with the guidelines of the official French health authority (Haute Autorité de santé) for its nationwide application.
Launois C, Lebargy A, L'Huillier JP
… +2 more, Lalliard S, Lebargy F
Rev Mal Respir
· 2023 Jun · PMID 37208290
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Recognition and compensation for occupational diseases (OD) is based on the principle of presumption of occupational origin, provided that the disease meets the medical and administrative condition detailed in an OD tabl...Recognition and compensation for occupational diseases (OD) is based on the principle of presumption of occupational origin, provided that the disease meets the medical and administrative condition detailed in an OD table appended to the French social security code. A complementary system calling upon a regional committee for recognition of respiratory diseases (CRRMP, in French) attends to cases in which the medical or administrative conditions pertaining to the disease are not fulfilled. Decisions of health insurance funds may be appealed, by employer and employee alike, within the statutory timelines. That said, recent reform of social security litigation and the law of modernization of the justice system have thoroughgoingly modified appeal and redress procedures. Challenge of a decision of non-recognition of the occupational nature of a disease is now addressed to the social pole of the judicial tribunal (JT), which can request the assistance of a CRRMP other than the one that issued the first opinion. As for technical challenges having to do with the date of consolidation (date of the injury) or the degree of partial permanent incapacity (PI), they are put forward in a mandatory preliminary settlement proposal addressed to an amicable settlement board (CRA, in French), whose decisions can be contested face to the social pole of the JT. All judgments regarding medical litigations of social security may be appealed. Information for patients on compensation procedures and available means of remedying decisions by social security is essential to the establishment of the initial medical certificate and to the sequencing of the different phases of expert appraisals, the objectives being to avoid administrative incoherence and inappropriate legal recourse.
Rev Mal Respir
· 2023 Jun · PMID 37208289
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Smoking is a major risk factor for chronic obstructive pulmonary disease (COPD). The diagnosis of tobacco addiction and management of tobacco dependence are part and parcel of COPD treatment, especially in respiratory re...Smoking is a major risk factor for chronic obstructive pulmonary disease (COPD). The diagnosis of tobacco addiction and management of tobacco dependence are part and parcel of COPD treatment, especially in respiratory rehabilitation. Management encompasses psychological support, validated treatments and therapeutic education. The objective of this review is to briefly recall the guiding principles of therapeutic patient education (TPE) as it applies to smokers wishing to quit and, more specifically, to present the tools conducive to shared educational assessment and treatment according to the Prochaska's stages of change model. We are also proposing an action plan and a questionnaire through which TPE sessions can be assessed. Finally, culturally adapted interventions and new communication technologies are taken into consideration insofar as they constructively contribute to TPE.
Rev Mal Respir
· 2023 Jun · PMID 37179152
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Hyperventilation syndrome (HVS) is a frequent disorder of which the etiology is unclear. Diagnosis is based on the ruling out of organic disease and, more positively, on results of the Nijmegen questionnaire, reproductio...Hyperventilation syndrome (HVS) is a frequent disorder of which the etiology is unclear. Diagnosis is based on the ruling out of organic disease and, more positively, on results of the Nijmegen questionnaire, reproduction of symptoms during the hyperventilation provocation test (HPVT), and detected hypocapnia. Treatment is based on targeted respiratory physiotherapy consisting in voluntary hypoventilation and instructions to the patient on regular respiratory exercise over an appreciable period of time. Additional research is needed to evaluate the validity of current investigative tools leading to the diagnosis of hyperventilation syndrome and to appraise the efficacy of current respiratory physiotherapy methods.
Bleinc A, Blin T, Legue S
… +3 more, Mankikian J, Plantier L, Marchand-Adam S
Rev Mal Respir
· 2023 May · PMID 37117065
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INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is an irreversible fibrosing disease with median survival at diagnosis of 2-5 years. That said, pirfenidone and nintedanib slow down the gradual decline in respiratory fu...INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is an irreversible fibrosing disease with median survival at diagnosis of 2-5 years. That said, pirfenidone and nintedanib slow down the gradual decline in respiratory function. Clinical trials have shown that while they are not curative, these drugs reduce mortality and increase survival time compared to placebo. This objective of this work was to compare the real-life survival of patients with IPF diagnosed at the Tours University Hospital depending on whether or not they took anti-fibrotic medication. METHODS: This is a monocentric retrospective study involving 176 patients diagnosed with IPF starting from 1997. Out of these 176 patients, 100 were treated with anti-fibrotic agents and 76 did not receive any anti-fibrotic treatment. RESULTS: Survival significantly increased in the group with anti-fibrotic medication, with median survival of 59 months [46-87] versus 39 months [29-65] (P=0.022). Predictive factors for death were neoplasia, IPF exacerbation and decreased DLCO. CONCLUSION: Our study corroborates the beneficial result observed in clinical trials by showing longer survival in patients using anti-fibrotic agents.
Underner M, Perriot J, Peiffer G
… +2 more, Urban T, Jaafari N
Rev Mal Respir
· 2023 Jun · PMID 37087352
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Cannabis is the most widely used illicit psychoactive substance in France. It can be responsible for numerous pulmonary complications, including diffuse alveolar hemorrhage (DAH). The objective of this systematic review...Cannabis is the most widely used illicit psychoactive substance in France. It can be responsible for numerous pulmonary complications, including diffuse alveolar hemorrhage (DAH). The objective of this systematic review of the literature was to present data concerning the relationship between cannabis smoking and DAH, which has rarely been reported in the literature. The review was based on a Medline search covering the 1980-2022 period and utilizing data drawn from 10 articles. DAH diagnosis is based on an association of hemoptysis, anemia and diffuse alveolar opacities on chest radiography with siderophages in the Bronchoalveolar Lavage Fluid (BAL). The 11 patients identified in this review were daily or regular cannabis smokers; in 4 cases they presented recent or recurrent hemoptysis with anemia; imaging revealed diffuse alveolar opacities in 10 of them, while BAL endoscopy highlighted a diffuse hemorrhage in the bronchial tree, and siderophages were observed in 6 cases. While evolution was favorable when cannabis consumption was discontinued, resumption occasioned DAH recurrence, and one patient died. Advice to quit should systematically be accompanied by addictological follow-up.
Gounant V, Brosseau S, Lorut C
… +5 more, Guezour N, Vauchier C, Mohammad W, Khalil A, Zalcman G
Rev Mal Respir
· 2023 May · PMID 37085441
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Patients with a solid tumor or hematologic malignancy are often addressed to emergency units for an acute respiratory complication associated with the underlying cancer or secondary to treatments. The current article is...Patients with a solid tumor or hematologic malignancy are often addressed to emergency units for an acute respiratory complication associated with the underlying cancer or secondary to treatments. The current article is part of a thematic series: "Intensive care and emergencies in solid tumours and blood cancer patients" and will develop the following points: (1) malignant proximal airway obstruction and, more specifically, the role of therapeutic bronchoscopy; (2) superior vena cava syndrome by tumor compression and/or secondary to thrombosis (diagnosis, local and systemic treatments); (3) cancer-related pulmonary embolism (incidence, indications for low-molecular weight heparins and direct oral anticoagulants). Other respiratory emergencies will be dealt in the other articles of this series.
Guilleminault L, Demoulin-Alexikova S, de Gabory L
… +11 more, Bruley des Varannes S, Brouquières D, Balaguer M, Chapron A, Grassin Delyle S, Poussel M, Guibert N, Reychler G, Trzepizur W, Woisard V, Crestani S
Rev Mal Respir
· 2023 May · PMID 37080877
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Patients with chronic cough experience major alteration in their quality of life. Given its numerous etiologies and treatments, this disease is a complex entity. To help clinicians involved in patient management of patie...Patients with chronic cough experience major alteration in their quality of life. Given its numerous etiologies and treatments, this disease is a complex entity. To help clinicians involved in patient management of patients, guidelines have been issued by a group of French experts. They address definitions of chronic cough and initial management of patients with this pathology. We present herein the second-line tests that might be considered in patients whose coughing has persisted, notwithstanding initial management. The experts have also put forward a definition of unexplained or refractory chronic cough (URCC), the objective being to more precisely identify those patients whose cough persists despite optimal management. Lastly, these guidelines indicate the pharmacological and non-pharmacological interventions of use in URCC. Amitriptyline, pregabalin, gabapentin or morphine combined with speech and/or physical therapy are mainstays in treatment strategies. Other treatment options, such as P2X3 antagonists, are being developed and have generated high hopes among physicians and patients alike.
Rev Mal Respir
· 2023 May · PMID 37076416
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INTRODUCTION: Physical activity (PA) has its place in the continuum of care, the objective being to limit alterations associated with cancer and its treatments. This review of the literature collates the evidence and cur...INTRODUCTION: Physical activity (PA) has its place in the continuum of care, the objective being to limit alterations associated with cancer and its treatments. This review of the literature collates the evidence and current data relating to PA carried out at different periods of treatment for lung cancer. STATE OF THE ART: PA is safe and feasible in patients with lung cancer throughout their oncologic treatment. The efficacy of multimodal programs is demonstrated regarding symptoms, exercise capacity, functional capacity, postoperative complications, length of hospital stay and quality of life. Nevertheless, this result remains to be confirmed with more robust upcoming trial, notably in the long term. PERSPECTIVES: Utilization of activity and energy expenditure sensors or PA questionnaires could help to increase the PA level of lung cancer patients during their continuum of care. For those not at ease with conventional training modalities, it may be judicious to offer intermittent high-intensity training or respiratory muscle strength training. Telerehabilitation could also be implemented. The targeting of populations at high risk should be investigated. CONCLUSION: Teams caring for patients with lung cancer during or after their oncologic treatment should develop innovative strategies designed to overcome difficulties of access or adherence to exercise programs, so that the PA be an integral part of the care of these patients. Physical therapists play an important role in supporting these patients during their assessment or treatment.