Rev Mal Respir
· 2024 Dec · PMID 39516083
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Long-term oxygen therapy (defined by oxygen administration exceeding 15hours/day) for patients with severe resting chronic hypoxemia is the most validated modality of home oxygen therapy, its survival benefit having been...Long-term oxygen therapy (defined by oxygen administration exceeding 15hours/day) for patients with severe resting chronic hypoxemia is the most validated modality of home oxygen therapy, its survival benefit having been demonstrated several decades ago. In addition to this well-accepted indication for home oxygen therapy, other modalities of home oxygen administration have been proposed, such as long-term oxygen therapy for patients with moderate hypoxemia, ambulatory oxygen therapy for patients with severe exertional room air hypoxemia, and nocturnal oxygen therapy for patients with nocturnal hypoxemia. The aim of the present manuscript is to review the evidence supporting the indications for the different modalities of home oxygen therapy for patients with chronic obstructive pulmonary disease or interstitial lung disease, two lung pathologies for which most data are available. We also wished to synthetize the recommendations of different thoracic societies/groups of experts on the indications for long-term oxygen therapy.
Lemaire M, Durieux V, Meert AP
… +1 more, Berghmans T
Rev Mal Respir
· 2024 Dec · PMID 39490318
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INTRODUCTION: Non-small cell lung cancers (NSCLC) are the most common lung cancers, withpeak incidence at 65years of age. These cancers rarely occur before the age of 40. METHODS: Based on an illustrative clinical case,...INTRODUCTION: Non-small cell lung cancers (NSCLC) are the most common lung cancers, withpeak incidence at 65years of age. These cancers rarely occur before the age of 40. METHODS: Based on an illustrative clinical case, a systematic review of the literature was conducted to study the epidemiological, clinical, histological, and biological characteristics of NSCLC in adults under 40years of age. Two equations were developed to search for articles on Medline and Scopus. RESULTS: Sixty-five articles were included in the review; 1.7% of patients were under 40years old, 50.7% were women, 66.7% presented adenocarcinoma, 51.9% were diagnosed at stage IV, 75% were non-smokers, 39.9% were exposed to other toxins, 33% had an EGFR mutation, 6.6% had a KRAS mutation, 25% had an ALK translocation, 73.7% were symptomatic, and over 75% had PS<2. CONCLUSION: NSCLC in patients under 40years of age presents characteristics different from those in older patients. Various factors are implicated, one example being lower exposure to tobacco, and they can influence the distribution of histological subtypes and the frequency of mutations.
Roche N, Bernady A, Piperno D
… +6 more, Bachiri A, Fiocca J, Lardy-Cléaud A, Lafargue S, Guillemin S, Devillier P
Rev Mal Respir
· 2024 Dec · PMID 39488461
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INTRODUCTION: The Trilife study describes the real-life use, in France, of the beclomethasone/formoterol/glycopyrronium triple fixed-dose combination in solution for inhalation, which is indicated as continuous treatment...INTRODUCTION: The Trilife study describes the real-life use, in France, of the beclomethasone/formoterol/glycopyrronium triple fixed-dose combination in solution for inhalation, which is indicated as continuous treatment for moderate-to-severe chronic obstructive pulmonary disease. METHODS: This prospective, non-interventional, multicentric study, involving hospital and office-based pulmonologists, evaluates the proportion of patients for whom the triple fixed combination was prescribed in compliance with the indication and dosage specified in the summary of product characteristics (SPC). Patients were followed for six months. RESULTS: In a population of 346 patients, the prescription was compliant with the SPC for 75.1% of patients (95% confidence interval: [70.6; 79.7]). The only variable associated with compliance with SPC in multivariate analyses was smoking (P=0.019). The results also show improved patient adherence to treatment and improved clinical status in terms of moderate or severe exacerbations, dyspnea, quality of life and satisfaction with treatment. CONCLUSION: Three quarters of the fixed triple combination prescriptions by French pulmonologists comply with the indication and dosage specified in the summary of product characteristics.
Dournes G, Zysman M, Benlala I
… +1 more, Berger P
Rev Mal Respir
· 2024 Dec · PMID 39488460
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Chronic obstructive pulmonary disease (COPD), commonly defined as irreversible airflow limitation, is associated with specific morphological changes involving all three parts of the lung, namely the bronchi, parenchyma a...Chronic obstructive pulmonary disease (COPD), commonly defined as irreversible airflow limitation, is associated with specific morphological changes involving all three parts of the lung, namely the bronchi, parenchyma and pulmonary vessels. In vivo imaging, with its ability to describe the different types of lung alterations and their regional distribution, helps to elucidate the relationship between lung structure and respiratory function. High-resolution computed tomography (CT) of the lung is the imaging modality best suited to assessing the pathological changes associated with airflow obstruction occurring in COPD. Over the last few decades, numerous studies have demonstrated the role of CT as a morphological and functional method conducive to the phenotyping of COPD patients. This review proposes to examine the data on CT imaging of COPD with a critical approach to recent data, and to determine the extent to which CT could be integrated into care or clinical research on patients with this/these disease(s).
Rev Mal Respir
· 2024 Dec · PMID 39455375
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Obstructive sleep apnea hypopnea syndrome (OSA) in pregnant women is an under-diagnosed but common condition, due to the numerous physiological changes favoring upper airway collapse. Risk factors such as significant wei...Obstructive sleep apnea hypopnea syndrome (OSA) in pregnant women is an under-diagnosed but common condition, due to the numerous physiological changes favoring upper airway collapse. Risk factors such as significant weight gain during the 1st trimester, maternal age and parity should be systematically investigated. Diagnosis is made by sleep recording. OSA can lead to maternal and fetal complications (gestational diabetes, eclampsia, intrauterine growth restriction, prematurity…) during pregnancy, delivery and the post-partum period. It is therefore essential to treat apneic patients as early as possible in pregnancy. Treatment includes hygienic and dietary measures, as well as continuous positive airway pressure (CPAP). Systematic post-partum follow-up with polygraphic monitoring should be proposed.
Rev Mal Respir
· 2024 Nov · PMID 39426876
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INTRODUCTION: Following the Omicron wave in early 2022, an estimated 60-70% of the French population was infected with the SARS-CoV-2 virus. One out of ten infected subjects could have persistent symptoms three months af...INTRODUCTION: Following the Omicron wave in early 2022, an estimated 60-70% of the French population was infected with the SARS-CoV-2 virus. One out of ten infected subjects could have persistent symptoms three months after infection, representing a public health challenge. CURRENT STATE OF KNOWLEDGE: The persistent symptoms may be secondary to diverse entities with distinct mechanisms. While organic infection sequelae occur mainly after severe COVID-19, some symptoms appear to be essentially psychological in origin; in addition, many subjects present stereotyped symptoms of fluctuating intensity with no identified anatomical or psychic substratum, often in the aftermath of a benign infection. The most frequent complaints are fatigue, pain, dyspnea and difficulty concentrating. PERSPECTIVES: The hypotheses explored to explain these symptoms include: persistent immune dysfunction, inducted autoimmunity, and microbiome disturbances. Persistent viral antigens may lie at the crossroads of these mechanisms. To date, these different etiological avenues have yet to lead to the development of diagnostic tests or specific therapeutic strategies. CONCLUSION: Prolonged symptoms after COVID-19 correspond to heterogeneous nosological entities with poorly understood mechanisms.
Zayene B, Rivera C, Mallet M
… +2 more, Falchetti A, Mazeres F
Rev Mal Respir
· 2024 Nov · PMID 39426875
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Enhanced Recovery After Surgery (ERAS) is a series of measures designed to promote early recovery after surgery. Application of this approach has led to significantly decreased morbi-mortality and reduced length of hospi...Enhanced Recovery After Surgery (ERAS) is a series of measures designed to promote early recovery after surgery. Application of this approach has led to significantly decreased morbi-mortality and reduced length of hospital stay. The aim of our study was to determine whether non-completion of the ERAS protocol following robotic-assisted mini-invasive lobectomy could be the cause of prolonged hospital stay (exceeding 6 days). We conducted a longitudinal retrospective analysis of 34 patients (17 men and 17 women) having undergone robotic-assisted lobectomy for early-stage primary lung carcinoma from January 1, 2022 to December 31, 2022. The study population was divided into two groups based on length of hospital stay: group 1 with length of stay not exceeding 6 days and group 2 with a stay of 7 days or more. Comparative analysis showed no significant difference in ERAS completion score between the two groups, whatever the preoperative (P=0.15), perioperative (P=0.73) or postoperative (P=0.97) time. That said, prolonged air leak (P=0.01) was the main difference among the analyzed variables, followed by Charlson score (P=0.01), grade of complications (P=0.03) and smoking status (P=0.01). Incorporation of complementary measures in our ERAS protocol strategy would in all probability optimize air leak management and further reduce length of hospital stay.
Regard L, Lazureanu PC, Pascal B
… +2 more, Laurichesse G, Rolland-Debord C
Rev Mal Respir
· 2024 Nov · PMID 39389905
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Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) are characterized by airway inflammation. While corticosteroids (CS) are frequently prescribed during exacerbations of these co...Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) are characterized by airway inflammation. While corticosteroids (CS) are frequently prescribed during exacerbations of these conditions, their repeated use is associated with numerous side effects. The aim of this review is to synthesize the recent literature on the indications, benefits, and risks of short-term CS therapy for these two diseases. French guidelines recommend short-term CS as a first-line treatment during asthma exacerbation (0,5 to 1mg/kg/day, not exceeding 60mg/day, for at least 5 to 7 days) or as a second-line treatment for COPD exacerbation (5 days, 30 to 40mg/day). However, these recommendations are not without limitations; they are primarily based on studies conducted in hospital settings, raising questions about the generalizability of their results to primary care, and as they employ a "one size fits all" strategy, they do not take into account the phenotypic heterogeneity of different patients. Moreover, repeated short-term CS courses generate side effects that even at low doses can appear early in young asthma patients, and they can exacerbate pre-existing comorbidities in COPD patients. The concept of a threshold dose should be employed in routine practice in view of accurately assessing the risk of side effects. In the near future, it will be important to consider recently published data supporting the use of predictive biomarkers for responses to CS, particularly in COPD cases.
Thibaut de Ménonville C, Barakat L, Laborier F
… +4 more, Le Brun M, Dupin C, Neukirch C, Taillé C
Rev Mal Respir
· 2024 Nov · PMID 39368873
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Identification of therapeutic targets other than asthma can guide the choice of biologics in cases of severe asthma. Some of the allergic diseases (atopic dermatitis, food allergies, allergic rhinoconjunctivitis) that ma...Identification of therapeutic targets other than asthma can guide the choice of biologics in cases of severe asthma. Some of the allergic diseases (atopic dermatitis, food allergies, allergic rhinoconjunctivitis) that may be associated with asthma can be treated with biologics. In this review, we aim to assess the effectiveness of these biologic therapies on the allergic comorbidities of asthma. In the treatment of atopic dermatitis, only Dupilumab, an anti-IL4Rα, has proven its effectiveness and has received reimbursement authorization for this indication. In patients presenting with allergic rhinoconjunctivitis, Omalizumab has shown effectiveness, but has not been approved for this indication. Data from post-hoc analyses of studies on severe asthma likewise suggest the effectiveness of Dupilumab regarding allergic rhinitis. While these two biologic therapies have shown positive signals, inducing oral food tolerance, the relevant data are not robust. Biologic therapies targeting IL-5 or its receptor (Mepolizumab, Benralizumab) have seldom been evaluated in allergic comorbidities, excepting atopic dermatitis, for which their effectiveness has not been proven. Lastly, there are interesting data on the combination of biologic therapy and allergen immunotherapy in cases of allergic rhinitis and food allergies, but they need to be confirmed by randomized studies.
Rev Mal Respir
· 2024 Dec · PMID 39366894
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Among the causes of abnormal fetal lung development, active and environmental maternal smoking represents a major potential target in preventive medicine. Prevalence of smoking among women, particularly during pregnancy,...Among the causes of abnormal fetal lung development, active and environmental maternal smoking represents a major potential target in preventive medicine. Prevalence of smoking among women, particularly during pregnancy, varies across the different regions of the world. We reviewed the literature on the repercussions of maternal smoking on the lungs of the fetus and the neonate. One of the main consequences is prematurity, leading to pulmonary bronchodysplasia followed by respiratory infections, which particularly affect young children. In the medium- and long-term, smoking in utero leads to asthma and allergies, and is suspected to be associated with impaired respiratory function in children and teenagers. We also report on the potential effects of e-cigarettes, which represent an emerging threat to children's respiratory health.
Lezmi G, Deschildre A, Blanc S
… +9 more, Delmas MC, Divaret-Chauveau A, Fayon M, Masson-Rouchaud A, Petat H, Siao V, Schweitzer C, Lejeune S, Giovannini-Chami L
Rev Mal Respir
· 2024 Nov · PMID 39209565
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Smoking during pregnancy is associated with negative pregnancy and perinatal health outcomes. Physiological and societal particularities can modify the smoking behavior of pregnant women. Pregnancy is a teachable moment...Smoking during pregnancy is associated with negative pregnancy and perinatal health outcomes. Physiological and societal particularities can modify the smoking behavior of pregnant women. Pregnancy is a teachable moment for smoking cessation. Increased nicotine clearance may lead to exacerbated tobacco withdrawal symptoms and desire to smoke, which need to be taken into account when helping pregnant smokers to quit. Although most pregnant smokers try to quit on their own, 12% of pregnant women in France reported smoking in 2021 during the 3 trimester of pregnancy. Health care professionals should screen for tobacco consumption and assess the level of addiction. Management of smoking cessation can be multidisciplinary, including non-pharmacological support such as counselling, behavioral support, financial reward contingent on abstinence, and medication (nicotine replacement therapies). Assessment and limitation of secondhand smoke exposure (SHS) is needed because SHS can also have negative maternal and fetal consequences. Management of relapse during the postpartum period is also to be anticipated; in 2021, it concerned 22.4% of women who had stopped smoking during pregnancy. While electronic cigarette use is increasing overall and among pregnant women who smoke (5.4 before pregnancy, 1.3% during the 3rd trimester in 2021), well-conducted smoking cessation studies are necessary to assess its benefits and potential risks in this specific group of smokers.
Rev Mal Respir
· 2024 Oct · PMID 39209564
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Diseases associated with chronic respiratory failure have a negative impact on quality of life and life expectancy, notably through a reduction in patients' functional capacity. Assessing balance, coordination, muscular...Diseases associated with chronic respiratory failure have a negative impact on quality of life and life expectancy, notably through a reduction in patients' functional capacity. Assessing balance, coordination, muscular strength and endurance, as well as exercise tolerance, is therefore an important component of the evaluation of individuals with chronic respiratory failure. This evaluation can be made easier by using simple tools such as sit-to-stand tests. This review presents the main sit-to-stand tests that have been described and that can be used in everyday practice. The aim is to provide information to the clinician on the contribution of each test, and to identify the extent to which and the purpose for which these tests can be incorporated into a routine pulmonology and/or respiratory rehabilitation evaluation. Because of their inherently functional nature, these tests could help to identify the indications and/or the effects of respiratory rehabilitation.
Rev Mal Respir
· 2024 Oct · PMID 39209563
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BACKGROUND: The aim of this work is to assess the quality of observational studies and to make direct and indirect comparisons of robotic surgery with other approaches. METHOD: We searched various databases between 2014...BACKGROUND: The aim of this work is to assess the quality of observational studies and to make direct and indirect comparisons of robotic surgery with other approaches. METHOD: We searched various databases between 2014 and 2024 for observational studies comparing robotic-assisted surgery to thoracoscopy or thoracotomy. RESULTS: Eighteen studies were included in the meta-analysis. Risk of confounding bias was present in 90% of studies, while risk of classification bias appeared in 80%. Robotic-assisted surgery reduced the risk of conversion to thoracotomy compared with thoracoscopy with an odds ratio of 0.21 (95% confidence interval: 0.06-0.65), with high heterogeneity between studies (I=80%). Robotic-assisted surgery did not significantly reduce postoperative complications or 30-day mortality compared with thoracotomy or thoracoscopy. For 5-year overall survival, comparisons of robotic-assisted surgery to thoracoscopy or thoracotomy were non-significant with I of 55%. CONCLUSION: This work demonstrates the need for a randomized controlled trial to validate robotic surgery for the treatment of bronchial cancer.