Thoracic Electrical Impedance Tomography (EIT) is a functional respiratory imaging technique first developed in the 1970s. It provides real-time functional information at the patient's bedside, without ionizing radiation...Thoracic Electrical Impedance Tomography (EIT) is a functional respiratory imaging technique first developed in the 1970s. It provides real-time functional information at the patient's bedside, without ionizing radiation. Its growing interest in clinical practice in recent years is the result of numerous technological advances, providing the practitioner with a tool for monitoring pulmonary ventilation, assessing the efficacy of therapeutic interventions, detecting complications such as pneumothorax, and obtaining data on pulmonary perfusion. Its use is gradually extending beyond the field of critical care, as it has become a promising tool for diagnosing and monitoring patients with chronic pulmonary disorders. This general review aims to raise physician awareness of this emerging technology, explaining its operating principles, the data it can collect and its main clinical applications, both inside and outside critical care units, thereby paving the way for new clinical management and research perspectives.
INTRODUCTION: Eosinophilic lung disease encompasses a group of diffuse pulmonary parenchymal diseases characterized by eosinophilic infiltration, either localized or associated with a systemic process. Acute eosinophilic...INTRODUCTION: Eosinophilic lung disease encompasses a group of diffuse pulmonary parenchymal diseases characterized by eosinophilic infiltration, either localized or associated with a systemic process. Acute eosinophilic pneumonia, a rare and severe form, is often confused with infectious pneumonia. Its main triggers include smoking, medication, and idiopathic causes. Cases reported in the literature link sertraline, a commonly prescribed antidepressant, to this condition. CASE REPORT: A 15-year-old female patient was admitted to hospital for febrile dyspnea, cough, chest pain, and hypoxemia. Her medical history included treatment with sertraline and smoking. Thoracic imaging revealed bilateral infiltrates, and bronchoalveolar lavage showed significantly increased eosinophils. Discontinuation of sertraline and initiation of corticosteroid therapy led to clinical improvement. CONCLUSIONS: This case highlights the importance of quickly identifying the rare adverse effects of antidepressants, particularly sertraline-induced acute eosinophilic pneumonia. Special attention is required when prescribing off-label this antidepressant to adolescents, especially in a context of rising mental health disorders in this population.
INTRODUCTION: In France, the fixed combination fluticasone/umeclidinium/vilanterol (FF/UMEC/VI) is prescribed for the treatment of moderate to severe COPD in adults not adequately treated by LABA/LAMA or ICS/LABA dual th...INTRODUCTION: In France, the fixed combination fluticasone/umeclidinium/vilanterol (FF/UMEC/VI) is prescribed for the treatment of moderate to severe COPD in adults not adequately treated by LABA/LAMA or ICS/LABA dual therapy since 2018. The aim of our study was to describe the characteristics, prescribing trajectories and care pathways of patients prior to their first prescription of FF/UMEC/VI in France. METHODS: A retrospective cohort study included all patients aged over 40years with a first prescription of FF/UMEC/VI between 2018 and 2019 in France using data from the SNDS database. Descriptive analysis were conducted in the 3years preceding initiation of this medication. RESULTS: Of the 34,906 patients included, 92% had received a prescription for dual or triple therapy in the 3years prior to starting FF/UMEC/VI. The mean age at inclusion was 69, with a majority of men. A description of the care pathway showed that 68% of patients had moderate exacerbations and 25% had severe exacerbations leading to hospitalization. CONCLUSIONS: Our results demonstrate that triple inhaled therapy with FF/UMEC/VI is used in accordance with its marketing authorization in France in the vast majority of cases.
Rev Mal Respir
· 2025 Jun · PMID 40447511
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Nebulization is a commonly applied therapy for patients with respiratory conditions, encompassing those infected with respiratory viruses such as SARS-CoV-2, influenza and RSV. Since the COVID-19 pandemic occurred, conce...Nebulization is a commonly applied therapy for patients with respiratory conditions, encompassing those infected with respiratory viruses such as SARS-CoV-2, influenza and RSV. Since the COVID-19 pandemic occurred, concerns have arisen regarding the release into the environment of airborne particles during nebulization. While this treatment is known to expose healthcare workers to drug particles, the risk of viral dispersion remains poorly documented in the literature. The following narrative review explores this risk with the aim of fostering discussions and recommendations, the objectives being to minimize airborne contamination risk for healthcare workers during future epidemics, and in the management of seasonal viruses.
Pernaut LA, Wallyn F, Dhalluin X
… +3 more, Ouennoure O, Rouzé A, Fournier C
Rev Mal Respir
· 2025 Jun · PMID 40447510
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INTRODUCTION: Pulmonary infections complicating COVID-19 are common. The aim of this study was to describe the main findings regarding the impact of bronchoalveolar lavage (BAL) in severe COVID-19 patients in intensive c...INTRODUCTION: Pulmonary infections complicating COVID-19 are common. The aim of this study was to describe the main findings regarding the impact of bronchoalveolar lavage (BAL) in severe COVID-19 patients in intensive care. METHODS: Retrospective observational study including all BALs performed in our institution between September 2020 and May 2021 in patients intubated for COVID-19. RESULTS: Two hundred and fifty-eight BALs carried out in 195 patients were analyzed; 12.9% of patients had an early bacterial infection, mainly in contexts of immunodeficiency (ID) and/or chronic respiratory disease (CRD). A bacterial ventilation-acquired lower respiratory tract infection (VA-LRTI) was diagnosed in 29.6% of patients. COVID-19-associated pulmonary aspergillosis (CAPA), according to the ECMM/ISHAM criteria, was found in 7.8%, particularly in cases of ID and/or CRD. CMV and/or HSV-1 PCR were positive in nearly one-third of the BALs, of which 43.8% were treated. The histopathological results had no obvious therapeutic consequences. CONCLUSION: Early bacterial pulmonary infections and CAPA appear more frequent in cases of ID and/or CRD, and should be investigated in the affected patients. Incidence of VA-LRTI, which is more frequent in cases of prolonged ventilation, does not differ based on the underlying condition. The benefit of virology is uncertain. Cytological examination of BAL appears to have a limited therapeutic impact.
Biney F, Giroux-Leprieur É, Daniel C
… +5 more, Du Rusquec P, Auliac JB, Assié JB, Anane-Abrous S, Chouaid C
Rev Mal Respir
· 2025 Jun · PMID 40374498
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INTRODUCTION: Lung cancer is the leading cause of death worldwide. It occurs mainly in smokers, but also in 25% of cases in non-smokers. As regards metastatic stages, while immunotherapy has led to improved overall survi...INTRODUCTION: Lung cancer is the leading cause of death worldwide. It occurs mainly in smokers, but also in 25% of cases in non-smokers. As regards metastatic stages, while immunotherapy has led to improved overall survival, smoking status may potentially influence its effectiveness. The objective of this study was to analyze its effectiveness as first-line treatment for advanced non-small cell lung cancers (NSCLC) according to patient smoking status. METHOD: This retrospective study covers all patients with stage IV NSCLC treated with first- line immunotherapy, alone or in combination, between January 2018 and 2019, in three Ile de France centers. The primary and secondary endpoints were, respectively, overall survival and progression-free survival, according to smoking status. RESULTS: The analysis included 105 patients (66.7% men) of whom 38% were active smokers and 9.5% non-smokers, with adenocarcinoma in 65.7% of cases. Median OS and PFS were 17, 23.2, and 24.9 months and 4.9, 7.6, and 4 months for smokers, ex-smokers, and non-smokers respectively, without significant differences. CONCLUSION: In this study, smoking status did not seem to modify the effectiveness of immunotherapy. Studies on a larger population are called for.
Dinh A, Barbier F, Bedos JP
… +17 more, Blot M, Cattoir V, Claessens YE, Duval X, Fillâtre P, Gautier M, Guegan Y, Jarraud S, Le Monnier A, Lebeaux D, Loubet P, de Margerie C, Serayet P, Tandjaoui-Lambotte Y, Varon E, Welker Y, Basille D
Rev Mal Respir
· 2025 Jun · PMID 40340209
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Rev Mal Respir
· 2025 Jun · PMID 40268574
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INTRODUCTION: Fibrosing interstitial lung diseases (ILD) are severe respiratory conditions that can lead to respiratory failure and death. Over the past decade, antifibrotic therapies have represented a significant thera...INTRODUCTION: Fibrosing interstitial lung diseases (ILD) are severe respiratory conditions that can lead to respiratory failure and death. Over the past decade, antifibrotic therapies have represented a significant therapeutic advancement and are now widely used. STATE OF THE ART: Pirfenidone and nintedanib have been approved for the treatment of idiopathic pulmonary fibrosis (IPF), while only nintedanib has been approved for systemic sclerosis-related ILD and progressive pulmonary fibrosis (PPF). Both drugs help to reduce the decline in forced vital capacity (FVC) characterizing these three indications and to decrease mortality, acute exacerbations, and quality of life impairment in patients with IPF and PPF. PERSPECTIVES: Tolerance to these treatments remains a major challenge, prompting evaluation of alternative administration routes, such as inhalation. Numerous ongoing clinical trials and encouraging results from phase 3 studies are expected to lead to the approval of new antifibrotic molecules. CONCLUSIONS: Antifibrotic therapies have proven to be crucial in the management of IPF and PPF. Prescription should be a shared decision with the patient and may be considered at an early stage, even in elderly individuals, provided that dedicated support is avaialble.
Maurier L, Chéné AL, Hulo P
… +3 more, Chen J, Sagan C, Pons-Tostivint E
Rev Mal Respir
· 2025 May · PMID 40263022
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INTRODUCTION: Antibody-drug conjugates (ADCs) represent a promising new therapeutic class in non-small-cell lung cancer (NSCLC) patients. Studies assessing ADC have highlighted a pulmonary toxicity profile in the form of...INTRODUCTION: Antibody-drug conjugates (ADCs) represent a promising new therapeutic class in non-small-cell lung cancer (NSCLC) patients. Studies assessing ADC have highlighted a pulmonary toxicity profile in the form of interstitial lung disease (ILD). STATE OF THE ART: Several ADCs for NSCLC are currently being developed. In studies evaluating Trastuzumab-Deruxtecan (Her-2 target), incidence of drug-induced ILD ranged from 10.7 to 26.0%, and from 3.6 to 25.0% in those evaluating Datopotamab-Deruxtecan (TROP-2 target). Incidence of 9.9 and 5% of ILD was observed with Telisotuzumab-Vedotin (c-MET target) and Patritumab-Deruxtecan (Her-3 target), respectively. No cases of ILD have been reported with Sacituzumab-Govitecan (TROP-2 target) or Tusamitamab-Ravtansine (CEACAM5 target). PERSPECTIVES: Several risk factors for ADC-induced ILD seem to emerge, including respiratory comorbidities, renal insufficiency, or type and dosage of ADC. Current studies are focusing on the combination of ADC and immunotherapy, although there are few data now available on pulmonary toxicity profiles. CONCLUSION: Among the many ADCs being developed, several can cause ILD of varying grades and intensity. Knowledge of their risks, diagnostic and therapeutic modalities is required in order to quickly detect and treat ADC-induced ILD.
Deslais S, Pierre C, Goter T
… +5 more, Giordanengo C, Lester MA, Le Guen Y, Lena H, Ricordel C
Rev Mal Respir
· 2025 May · PMID 40240186
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INTRODUCTION: Immune checkpoint inhibitors have revolutionized the management of advanced non-small cell lung cancer (NSCLC). While the proportion of "long-term survivors" is estimated to be between 8% and 16%, this popu...INTRODUCTION: Immune checkpoint inhibitors have revolutionized the management of advanced non-small cell lung cancer (NSCLC). While the proportion of "long-term survivors" is estimated to be between 8% and 16%, this population remains poorly understood. METHODS: BREATH is a retrospective observational study including patients with metastatic or non-radically treatable locally advanced NSCLC, treated with immunotherapy and presenting with controlled disease for at least 12 months after the first immunotherapy injection. The main objective is to describe the characteristics of this population. RESULTS: Forty-nine patients were included in the study. After a median follow-up of 51 months, median progression-free survival (PFS) or overall survival (OS) was not reached. At 36 months, PFS was 64.7% and OS was 91.6%. Patients who received a complete immunotherapy regimen (two years) had a higher rate of PFS (HR 0.046; 95% CI [0.14-0.98]; P=0.03) than those who received an incomplete regimen. An albumin level≥35g/L at the start of immunotherapy was the only factor associated in multivariate analysis with prolonged PFS. CONCLUSION: Patients with advanced NSCLC and prolonged disease control under immunotherapy exhibit exceptionally long survival, pointing to a possible paradigm shift in our practices.
Grosz T, Calcaianu G, Palpacuer C
… +9 more, Riou M, Kassegne L, Marcot C, Degot T, Leroux J, Kalmuk L, Fore M, Kessler R, Renaud-Picard B
Rev Mal Respir
· 2025 May · PMID 40169321
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INTRODUCTION: The use of inhaled treatments for chronic obstructive pulmonary disease (COPD) in France follows the management proposals issued by the Société de Pneumologie de Langue Française (SPLF). We conducted a retr...INTRODUCTION: The use of inhaled treatments for chronic obstructive pulmonary disease (COPD) in France follows the management proposals issued by the Société de Pneumologie de Langue Française (SPLF). We conducted a retrospective study in two hospitals in Alsace, France to determine the rate of compliance with the recommended treatments. METHODS: Data were collected from patients with follow-up for COPD between August 2022 and January 2023. Asthma-COPD Overlap and Overlap syndrome phenotypes were excluded from the study. The data were extracted from the patient's most recent pulmonology consultation at one of the two centers. RESULTS: Out of the 250 patients recruited, 183 (73.2%) had compliant prescriptions. Among those with non-compliant prescriptions, 38 exhibited over-prescribing (56.7%), often secondary to inappropriate use of inhaled corticosteroids (ICS), while 29 cases showed under-prescribing (43.3%), due mainly to lack of treatment with long-acting bronchodilators. CONCLUSIONS: Treatment prescription in COPD remains sub-optimal, with a high proportion of therapeutic non-conformities, especially the over-prescribing of ICS. Further studies are needed to develop strategies for improving prescribing practices.
Le Guen P, Poté N, Debray MP
… +3 more, Gounant V, Crestani B, Taillé C
Rev Mal Respir
· 2025 May · PMID 40155277
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INTRODUCTION: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare, chronic condition that predominantly affects women over the age of 60. CURRENT KNOWLEDGE: DIPNECH combines non-specific clin...INTRODUCTION: Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is a rare, chronic condition that predominantly affects women over the age of 60. CURRENT KNOWLEDGE: DIPNECH combines non-specific clinical signs (chronic cough, dyspnea), bronchial obstruction on PFT and signs suggestive of bronchiolitis on chest CT associated with nodules and multiple micronodules. The diagnosis is most often histological, associating neuroendocrine cell hyperplasia, tumorlets and, inconsistently, carcinoid tumors and constrictive bronchiolitis. PROSPECTS: There are currently no recommendations for DIPNECH treatment and the literature is limited to case reports and retrospective series. Inhibitors of mTOR and somatostatin analogs are possible treatments requiring validation by clinical trials. Functional follow-up and CT scan monitoring are necessary in order to detect complications. CONCLUSIONS: DIPNECH is a rare, usually insidious pathology, and may in some cases expose the patient to a risk of tumor and chronic respiratory failure. The diagnosis should be made in the event of a chronic cough in a middle-aged woman.
Neveu S, Antonowicz J, Colantonio M
… +2 more, Deleris R, Raherison-Semjen C
Rev Mal Respir
· 2025 May · PMID 40087131
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Granulomatosis with polyangiitis (GPA) was diagnosed in a 65-year-old Afro-Caribbean patient presenting initially with hearing loss and a pseudo-tumoral 6cm lung mass. Lung biopsy findings favored the diagnosis of vascul...Granulomatosis with polyangiitis (GPA) was diagnosed in a 65-year-old Afro-Caribbean patient presenting initially with hearing loss and a pseudo-tumoral 6cm lung mass. Lung biopsy findings favored the diagnosis of vasculitis. Rapid disease progression was noted with near-complete deafness and lack of speech, severe renal failure necessitating dialysis, and persisting disturbance of consciousness following tonic-clonic seizures due to posterior reversible encephalopathy syndrome (PRES). The patient died one month after admission due to ARDS secondary to ventilator-associated pneumonia. Otological symptoms are frequently the first signs of GPA and should alert the clinician when concomitant with lung nodules, even among Afro-Caribbean patients, in whom GPA is unusual. GPA is a rare disease occurring nearly exclusively in Caucasian populations and is associated with anti-neutrophil cytoplasm antibodies (ANCA) with anti-proteinase 3 (PR3) specificity. Diagnosis is based on clinical, radiological, and biological findings. While pathology from lung localizations is inconsistently specific and rarely made, it can help to establish the diagnosis. This clinical case aptly illustrates the specific clinical presentation of GPA and the potential severity of its multi-organ manifestations.
Annesi-Maesano I, Bonniaud P, Bouchaud G
… +18 more, Boyer L, Gosset P, Gras D, Guignabert C, Ladjemi MZ, Matecki S, Morelot C, Pilette C, Planes C, Plantier L, Polette M, Si-Tahar M, Taillé C, Zaragosi LE, Vachier I, Mari B, Guibert C, membres du groupe RESPIRenT
Rev Mal Respir
· 2025 Mar · PMID 40074604
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Lopes Goncalves R, Gauthier-Isola M, Vassaux G
… +2 more, Mari B, Rezzonico R
Rev Mal Respir
· 2025 Mar · PMID 40069040
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A better understanding of the molecular mechanisms associated with the aggressiveness and high recurrence rate of non-small cell lung cancers is needed to identify new biomarkers and therapeutic targets to improve patien...A better understanding of the molecular mechanisms associated with the aggressiveness and high recurrence rate of non-small cell lung cancers is needed to identify new biomarkers and therapeutic targets to improve patient management. In this context, this review provides a non-exhaustive update on the emerging family of long non-coding RNAs, important regulators of gene expression, frequently deregulated in cancers and in response to hypoxia - an environmental factor that plays an important role in the development, aggressiveness and treatment resistance of these tumors.
INTRODUCTION: Myelolipoma is a rare, benign, usually adrenal. tumor, In rare cases, it may be extra-adrenal, for example thoracic. OBSERVATION: We report the case of the fortuitous discovery of a posterior mediastinal ma...INTRODUCTION: Myelolipoma is a rare, benign, usually adrenal. tumor, In rare cases, it may be extra-adrenal, for example thoracic. OBSERVATION: We report the case of the fortuitous discovery of a posterior mediastinal mass with a fatty component, not immediately identifiable on the PET scan. Because of the atypical appearance on imaging and the lack of diagnostic certainty, the patient received surgical management, which has ultimately made it possible to accurately diagnose and curatively remove extra-adrenal myelolipoma. CONCLUSION: Most often incidentally detected, extra-adrenal myelolipoma is a rare tumor with a good prognosis. Management is primarily surgical. Monitoring of the lesion depends on its size and location.
Rev Mal Respir
· 2025 Mar · PMID 40044532
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INTRODUCTION: Largely due to climate change, wildland fires are currently increasing in extent and frequency. While particles from fire smoke exhibit higher toxicity, those identified in wildland urban interface (WUI) ar...INTRODUCTION: Largely due to climate change, wildland fires are currently increasing in extent and frequency. While particles from fire smoke exhibit higher toxicity, those identified in wildland urban interface (WUI) areas, which are exacerbated by household and vehicle emissions, are even more toxic. STATE OF THE ART: This review article is based on English-language papers published by peer-reviewed journals. Since a previous review article was published in 2018, only papers since 2017 have been selected. The respiratory impacts of wildfires in the general population include irritative symptoms, exacerbation of chronic respiratory diseases (asthma, rhino-sinusitis, COPD…) and excess short and probably long-term mortality. Among firefighters, the short-term impact of wildfires on respiratory function has yet to be clearly established. Asthma prevalence, asthma exacerbation rates and chronic obstructive pulmonary disease (COPD) occurrence seem to be higher than in other occupational groups. That said, the different studies have not highlighted excess mortality. As regards cancer, while mesothelioma incidence has clearly increased, lung cancer incidence generally has not. PERSPECTIVES: Two areas require clarification: first, short-term respiratory impact according to the characteristics of inhaled smoke; the long-term impact of exposure to particles from fire smoke. CONCLUSION: Forest fires have become increasingly worrisome, in terms of both their negative health impact and their detrimental contribution to climate change.
Yegen CH, Boucheniata C, Bourenane M
… +11 more, Macias C, Buissot C, Georgopoulos M, Cazaunau M, Bergé A, Der Vartanian A, Souktani R, Epaud R, Pandis SN, Coll P, Lanone S
Rev Mal Respir
· 2025 Mar · PMID 40023717
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Cystic fibrosis is a genetic disease in which phenotypic variability is still poorly understood. Our hypothesis is that the exposome, and more specifically exposure to air pollution and/or anxiety, could play a role in t...Cystic fibrosis is a genetic disease in which phenotypic variability is still poorly understood. Our hypothesis is that the exposome, and more specifically exposure to air pollution and/or anxiety, could play a role in this phenomenon. In this context, we have developed an experimental study in which cystic fibrosis mice were exposed to stress (anxiety) and then to complex realistic atmospheres. Our results should provide mechanistic elements for a better understanding of the phenotypic variability observed in cystic fibrosis patients and thus be able to propose new avenues for better management of these patients.
Jacquet J, Marcos E, Lipskaia L
… +5 more, Gros V, Born E, Houssaini A, Adnot S, Boyer L
Rev Mal Respir
· 2025 Mar · PMID 40023716
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Vascular aging leading to microvessel depletion is a key element of organismal aging. The proposed mechanism is a deficiency of vascular endothelial growth factor (VEGF) signaling in the endothelial cells (EC), linked to...Vascular aging leading to microvessel depletion is a key element of organismal aging. The proposed mechanism is a deficiency of vascular endothelial growth factor (VEGF) signaling in the endothelial cells (EC), linked to the increase of a receptor in a soluble form (sVEGFR1) preventing VEGF from binding to its active receptor (VEGFR2). Without the VEGF survival signal, ECs may become senescent, contributing to aging and to various pulmonary pathologies. Deficiency of VEGF signaling in EC senescence could represent a determining element of lung aging and diseases such as pulmonary hypertension (PH) and emphysema.
Biziorek L, Dériot M, Bonniaud P
… +2 more, Goirand F, Burgy O
Rev Mal Respir
· 2025 Mar · PMID 40023715
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Idiopathic pulmonary fibrosis (IPF) is a rare, progressive and fatal disease without pharmacologic curative treatments for the patients. TGF-β is a crucial cytokine in the fibrotic process, and its intracellular signalin...Idiopathic pulmonary fibrosis (IPF) is a rare, progressive and fatal disease without pharmacologic curative treatments for the patients. TGF-β is a crucial cytokine in the fibrotic process, and its intracellular signaling pathways are complex and rely on the activation of its receptor. This review summarizes our knowledge on the regulatory checkpoints of the TGF-β signaling. In addition, the main strategies and key potential therapeutic targets identified over recent years are presented, with particular emphasis laid on how they can be used to develop new treatments for pulmonary fibrosis.