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Rev Mal Respir [journal]
- [A comparison of pulmonary rehabilitation delivered in the home or at a centre for patients with COPD.] [JOURNAL ARTICLE]
- Rev Mal Respir 2014 Dec 12.
There are few data showing how pulmonary rehabilitation (PR) for COPD patients carried out at home impacts on health-related quality of life (HRQL). The aim of this study was to determine if PR conducted at home improves quality of life.We compared the results of home-based PR versus PR performed in an outpatient center. The outcomes were the HRQL measured by the Saint-George's Hospital questionnaire and the 6-minute walk test distance (6MWT). Fifty-six COPD patients were included for PR either at home (n=27) or in the outpatient center (n=29) depending on distance from the center and patients preference. The two groups were similar for sex, age, BMI, lung function, and initial peak oxygen uptake.6MWT showed a similar non-significant improvement in both groups after PR (+12±46m in home-based PR,+13±34m in outpatient center). HRQL was significantly improved in the home-based group in 2 domains : "Activity" (-8.6±6.4 vs -0.7±17.7, P<0.05), "Impact" (-8.4±6.5 vs 1.6±11.7, P<0.001) and total score (-8.2±4.0 vs 0.0±8.8, P<0.001).Pulmonary rehabilitation at home is associated with improvements in health-related quality of life, and thus can be considered where availability of treatment in specialized centers is limited.
- [Which factors influence inclusion of thoracic cancer patients in clinical trials?] [LETTER]
- Rev Mal Respir 2014 Nov 11.
- [Is there a place for surgical management in stage IIIA N2 non-small cell lung cancer?] [JOURNAL ARTICLE]
- Rev Mal Respir 2014 Nov 6.
Non-small cell lung cancer (NSCLC) remains a major health problem, with a 5-year overall survival of 25%. Surgical management of stage IIIA NSCLC is still controversial. We conduct a systematic analysis of the different management strategies for stage IIIA-N2 NSCLC.We analyzed randomized control trials published between January 1990 to December 2013, comparing induction chemotherapy followed by surgery vs. surgery alone, and those comparing induction chemo or radiotherapy followed by surgery vs. induction chemotherapy followed by radiotherapy for stage IIIA-N2 NSCLC.A 16% significant increase in overall survival was found in favor of induction chemotherapy followed by surgery vs. surgery alone. However, there was no significant difference in overall survival between induction chemo- or radiotherapy followed by surgery and induction chemotherapy followed by radiotherapy.Current scientific data do not permit the exclusion of surgery as an option in the management of stage IIIA-N2 NSCLC.
- [Impact of lung cancer treatments on renal function.] [REVIEW]
- Rev Mal Respir 2014 Dec; 31(10):1003-1012.
Renal failure in patients with lung cancer may be multifactorial: related to the patients and their comorbidities, direct tumor compression or the toxicity of cancer treatments and other associated medications. This literature review is intended to describe the state of knowledge regarding the nephrotoxicity of treatments used in thoracic oncology.The majority of chemotherapy treatments are potentially nephrotoxic. Cisplatin and pemetrexed exhibit mainly renal tubular toxicity, while vascular renal impairment is found with gemcitabine and bevacizumab. Cisplatin results in acute renal failure in 30% of patients. Renal protective strategies (compliance with recommendations, limitation of nephrotoxic treatments, hydration, magnesium supplementation) must be employed systematically. Targeted therapies do not require any adjustment of the dosage in case of moderate or severe renal insufficiency but adapting the doses of biphosphonates to renal function is necessary.This review highlights the need for monitoring of renal function in patients with lung cancer during treatment with chemotherapy or biphosphonates.
- [Pulmonary alveolar proteinosis.] [REVIEW]
- Rev Mal Respir 2014 Dec; 31(10):975-991.
Alveolar proteinosis (AP) is a rare disease characterized by alveolar accumulation of surfactant components, which impairs gas exchange. AP is classified into three groups: auto-immune AP defined by the presence of plasma autoantibodies anti-GM-CSF, the most frequent form (90 % of all AP); secondary AP, mainly occurring as a consequence of haematological diseases, or following on from toxic inhalation or infections, and genetic AP, which affects almost exclusively children. AP diagnosis is suspected where chest CT-scan demonstrates interstitial lung disease with a crazy paving aspect; and confirmed by bronchoalveolar lavage, which has a milky appearance and contains periodic acid Schiff positive proteinaceous alveolar deposits. The use of surgical lung biopsy to confirm AP is less frequent nowadays. In this context, positive antibodies against GM-CSF indicates an auto-immune etiology of the AP. Concerning management, whole lung lavage is the gold standard therapy. In refractory AP, new treatments are available such as subcutaneous or inhaled GM-CSF supplementation, or rituximab infusions. The clinical course is unpredictable. Spontaneous improvement or even cure can occur, and the 5-year actuarial survival is 95 %. The most frequent complications are infectious etiology.
- [The patient with lung cancer in intensive care.] [REVIEW]
- Rev Mal Respir 2014 Dec; 31(10):961-974.
In Western countries, lung cancer (LC) is the most common cause of cancer death. It is present in 15-20% of patients admitted to the ICU with a neoplastic condition. The purpose of this article is to review the causes of admission to ICU of patients with LC, their prognosis and the results of different life-support techniques. Most studies include mixed populations of non-small cell (NSCLC) and small-cell lung cancers (SCLC). However, there is preponderance of NSCLC (70%) and LC of advanced or metastatic stages, reflecting the distribution in the general population of LC. The cause of admission of LC patients to ICU is most often of respiratory origin. The ICU mortality rate currently ranges from 13 to 47% and the hospital mortality rate from 24 to 65%. The predictors of in-hospital mortality are mainly severity scores, organ dysfunction, general condition (performance status), respiratory distress and the need for mechanical ventilation or vasopressor drugs. When considering the long-term mortality, it is the features of the cancer (presence of metastases, cancer progression) that are important predictive factors.
- [Smoking cessation in smokers with chronic obstructive pulmonary disease.] [REVIEW]
- Rev Mal Respir 2014 Dec; 31(10):937-960.
One out of two smokers who smoke throughout their lifetime will die from a disease related to smoking. Tobacco smoking therefore represents a major global public health issue. Smoking is the leading cause of chronic obstructive pulmonary disease (COPD). Projections for 2020 indicate that by then, COPD will have become the third cause of death and the fifth cause of disability worldwide. Stopping smoking reduces the risk of developing COPD and is an essential treatment for this inflammatory disease. Smoking cessation decreases the prevalence of respiratory symptoms, number of hospitalizations, and decline in FEV1, as well as exacerbation frequency and overall mortality. Among the patients, 38-77 % with COPD are smokers. Their daily cigarette consumption and level of nicotine dependence are often high. The combination of high intensity behavioral interventions and medication treatments (nicotine replacement therapy, varenicline, bupropion) is the most effective strategy for smokers with COPD. In contrast, behavioral interventions without medication are not more effective than simple advice to stop. Two factors seem to predict the success of the attempt to quit in smokers with COPD: a strong motivation to quit and the use of smoking cessation medications.
- [Smoking cessation and social deprivation.] [REVIEW]
- Rev Mal Respir 2014 Dec; 31(10):916-936.
Smoking is a major of public health policy issue; one in two lifelong smokers will die from a disease related to tobacco use. In France, smoking is responsible for more than 70,000 deaths every year. The benefits linked to stopping smoking include reduced mortality and morbidity related to the use of tobacco. Recent data show an increase in the prevalence of smoking in the lowest socioeconomic population. Tobacco control needs a better understanding of the determinants of smoking in this population, which are also factors in the failure of cessation attempts. Based on international literature, this review specifies the educational and socioeconomic factors involved in tobacco smoking and in the result of an attempt to quit. Its aim is to propose ways to improve the management of smoking cessation in a socially deprived population.
- [Pulmonary manifestations in HIV-infected patients: A diagnostic approach.] [REVIEW]
- Rev Mal Respir 2014 Dec; 31(10):903-915.
The spectrum of pulmonary diseases that can affect human immunodeficiency virus (HIV)-infected patients is wide and includes both HIV and non-HIV-related conditions. Opportunistic infections and neoplasms remain a major concern even in the current era of combination antiretroviral therapy. Although these diseases have characteristic clinical and radiological features, there can be considerable variation in these depending on the patient's CD4 lymphocyte count. The patient's history, physical examination, CD4 count and chest radiograph features must be considered in establishing an appropriate diagnostic algorithm. In this article, we propose different diagnostic approaches HIV infected to patients with respiratory symptoms depending on their clinico-radiological pattern.