Rev Mal Respir [journal]
- [Prediction of the efficiency of endoscopic lung volume reduction by valves in severe emphysema]. [JOURNAL ARTICLE, ENGLISH ABSTRACT]
- Rev Mal Respir 2016 Jul 18.
In severe emphysema, endoscopic lung volume reduction with valves is an alternative to surgery with less morbidity and mortality. In 2015, selection of patients who will respond to this technique is based on emphysema heterogeneity, a complete fissure visible on the CT-scan and absence of collateral ventilation between lobes. Our case report highlights that individualized prediction is possible.A 58-year-old woman had severe, disabling pulmonary emphysema. A high resolution thoracic computed tomography scan showed that the emphysema was heterogeneous, predominantly in the upper lobes, integrity of the left greater fissure and no collateral ventilation with the left lower lobe. A valve was inserted in the left upper lobe bronchus. At one year, clinical and functional benefits were significant with complete atelectasis of the treated lobe.The success of endoscopic lung volume reduction with a valve can be predicted, an example of personalized medicine.
- [Multicystic presentation of a lepidic mucinous adenocarcinoma]. [JOURNAL ARTICLE, ENGLISH ABSTRACT]
- Rev Mal Respir 2016 Jul 18.
The pneumonic form is very characteristic of lepidic pattern adenocarcinoma of the lung. However, the diagnosis and treatment of the disease when it presents in this way may be delayed by atypical radiological findings and severity of hypoxemia.A 48-year-old female, non-smoker, asthmatic since the age of 20 years, was hospitalized for a diffuse infiltrative pneumonia complicated by severe respiratory failure. The history included chronic cough, gradually increasing dyspnoea on exertion lasting for 14 months and the onset of haemoptysis of low abundance associated with arthralgia in the previous month. She had no professional or domestic exposure to any risk factors. Chest CT scan revealed bilateral alveolar condensations, ground glass areas with thickened septa creating a crazy paving pattern, and numerous large cysts of various sizes and locations, often with irregular thin walls. Microbiological and immunological tests were negative. She required early invasive ventilation and then venovenous ECMO together with broad-spectrum empiric antibiotic therapy, but died after 39 days in intensive care. The autopsy revealed lesions consistent with mucinous lepedic adenocarcinoma with no EGFR mutation and KRAS mutation. There was also associated pulmonary suppuration.Mucinous lepidic adenocarcinoma is an alternative diagnosis for pneumonic consolidation associated with multiple cysts.
- [What place for lung volume reduction surgery for emphysema?] [JOURNAL ARTICLE, ENGLISH ABSTRACT]
- Rev Mal Respir 2016 Jul 18.
Lung volume reduction surgery (LVRS) has been part of the management for the treatment of selected emphysematous patients for two decades. In a large randomized American trial (NETT), lung volume reduction surgery was shown to improve overall survival at 5 years as well as exercise capacity and health-related quality of life, especially in cases of upper-lobe-predominant emphysema and low exercise capacity. Inclusion criteria were pretreatment FEV1≤45 %, TLC≥100 %, RV≥150 %, room air resting PaCO2≤60mmHg and PaO2≥45mmHg. Patients with FEV1≤20 % and either a DLCO<20 % or homogeneous emphysema were at increased risk of mortality following LVRS and should not be considered for this procedure. Despite this evidence base, lung volume reduction surgery is performed infrequently, competing with lung transplantation and new endoscopic volume reduction techniques.
- [French data from the Continuing to Confront COPD (C2C) survey]. [JOURNAL ARTICLE, ENGLISH ABSTRACT]
- Rev Mal Respir 2016 Jul 13.
This article describes the French data which contributed to the international "Continuing to Confront COPD" (C2C) survey conducted in 2013 across 12 countries. Its objective was to describe the characteristics, symptoms and impact of COPD on health status, daily activities and working life in adults identified with the study definition as COPD; i.e., reporting a diagnosis of COPD, emphysema, chronic bronchitis (CB) or symptoms of CB either currently present or for which they had been treated in the past.Subjects 40 years or older were screened using random-digit-dialing and those fulfilling the study COPD definition were invited to complete the full survey.The proportion of respondents with COPD (according to study definition) in France was estimated at 7.5%. Among 300 respondents with COPD and complete questionnaire data, 48% were male, 44% aged over 70years, 45% were overweight and 72% had a smoking history. COPD had a severe or very severe impact (COPD assessment test score>20) on health for 43%. Dyspnea (mMRC ≥ 1) was reported by 70% and a limitation of at least 20% of daily activities by 65%. The mean number of exacerbations was 2/year and 16% had been admitted to hospital for respiratory problems during the past year. However, using direct questions, 80% subjects considered that they had mild to moderately severe disease and 78% reported an acceptable health status.The impact of COPD is markedly underestimated by respondents with COPD despite a high level of symptoms, poor health status and frequent exacerbations as assessed with validated measures.
- In memoriam Christian Boutin (1933-2015). [Journal Article]
- Rev Mal Respir 2016 Feb; 33(2):85-90.
- Prognostic factors after hospitalization for COPD exacerbation. [JOURNAL ARTICLE]
- Rev Mal Respir 2016 Jun 28.
Hospitalizations for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are increasing in France. AECOPD are associated with impaired health status and increased health care costs.Using data from the French national health insurance information system, we studied mortality, readmissions and lung function testing after discharge among adults hospitalized for AECOPD in 2013.The cumulative probabilities of death and readmission for EACOPD were 21% and 31% respectively. The survival was better among women, even after taking into account the other risk factors (age, previous hospitalization for AECOPD, comorbidities, exacerbation severity). In multivariate analysis, the risk of readmission was increased among men and people living in socially disadvantaged areas. A lung function testing was performed in 34% within 3 months after discharge. Female gender, advanced age, comorbidities and living in a disadvantaged area were associated with a lower frequency of lung function testing.Women had a better prognosis than men after AECOPD hospitalization. The frequency of lung function testing after discharge remained low, particularly among women and people living in disadvantaged areas.
- [Thoracomyoplasty: An alternative approach for the surgical treatment of pleural pockets which are chronic and calcified]. [JOURNAL ARTICLE, ENGLISH ABSTRACT]
- Rev Mal Respir 2016 Jun 27.
Despite the possibility for complete resolution that surgery offers for patients treated early, the management of complicated forms of chronic pyothorax with calcified pleural pockets of tuberculous origin is risky or impossible.The authors report the case of a patient with a chronic pleural pocket and calcified tuberculous origin in which a low thoracomyoplasty was conducted in the context of the impossibility of performing a left pleuro-pneumonectomy. The postoperative course was uneventful with complete filling of the pocket. When reviewed one year later, the patient reported that he had resumed an active social and professional life.Providing a complete obliteration of the pleural pocket, a thoracomyoplasty is an alternative for surgical management.
- [Lung neuroendocrine large cell carcinoma in young women. An unusual presentation]. [JOURNAL ARTICLE, ENGLISH ABSTRACT]
- Rev Mal Respir 2016 Jun 27.
Lung neuroendocrine large cell carcinoma is a rare tumor with a poor prognosis. There are very few guidelines for treating this cancer but a better knowledge of its markers could improve the treatment and the prognosis.We report two patients who presented initially with an early stage carcinoid tumor treated with surgery. Both patients had further new neuroendocrine disease diagnosed because of intermittent carcinoid syndrome, predominantly occurring at the same time as menstruation. They were then diagnosed with metastatic lung neuroendocrine large cell carcinoma and treated with first-line cisplatin-etoposide and second-line octreotide with estrogen plus progestin. They both had a good prognosis with no disease progression to date.The clinical characteristics of these cases raise several questions about the pathophysiology of lung neuroendocrine large cell carcinoma and may suggest potential new treatment options. The unusual clinical presentation and good prognosis may be explained either by the second-line treatment choice or by potential molecular or hormonal biomarkers. There is a need to investigate these potential biomarkers further since they could be new therapeutic targets.
- [Script concordance test and continuing medical education: A marriage that can only be successful!]. [Editorial]
- Rev Mal Respir 2016 May; 33(5):329-31.
- [Smoking cessation support among persons in situation of precariousness]. [JOURNAL ARTICLE, ENGLISH ABSTRACT]
- Rev Mal Respir 2016 Jun 6.
Underprivileged people smoke more frequently, present with a more severe smoking profile and stop less often than wealthier smokers. They can have difficulties to afford smoking cessation treatments as the French medical insurance coverage system requires smokers to pay it in advance with a later reimbursement. The objective of this study was to compare the characteristics, treatment plans and cessation rates of smokers from disadvantaged population in comparison with smokers in wealthier condition.Study population concerned smokers received for a first visit in the smoking cessation service at Georges-Pompidou European Hospital (Paris, France) in 2013. The EPICES score was used to define precariousness. The national file of smoking cessation consultation (CDT) was completed and the nicotine replacement therapy (NRT) prescriptions were detailed, as treatment could be given for free to precarious smokers on a weekly basis. Data were registered in CDTnet, the French national database of smoking cessation services.Precarious smokers (36.8%) presented with a more severe smoking profile and suffered more often from psychiatric disorders than wealthier smokers. They benefited most often from a combination NRT with patch and oral forms. The followed-up precarious smokers attended a greater number of consultations (4.7 against 3.4) and, if they were less often abstainers (22.2% against 41.3%), they were able to significantly reduce their consumption.Precarious smokers adhere to structured care with aid for access to TSN with a positive consequent impact on consumption.