Comorbidities of COPD

International audienceBy 2020, chronic obstructive pulmonary disease (COPD) will be the third cause of mortality. Extrapulmonary comorbidities influence the prognosis of patients with COPD. Tobacco smoking is a common risk factor for many comorbidities, including coronary heart disease, heart failure and lung cancer. Comorbidities such as pulmonary artery disease and malnutrition are directly caused by COPD, whereas others, such as systemic venous thromboembolism, anxiety, depression, osteoporosis, obesity, metabolic syndrome, diabetes, sleep disturbance and anaemia, have no evident physiopathological relationship with COPD. The common ground between most of these extrapulmonary manifestations is chronic systemic inflammation. All of these diseases potentiate the morbidity of COPD, leading to increased hospitalisations and healthcare costs. They can frequently cause death, independently of respiratory failure. Comorbidities make the management of COPD difficult and need to be evaluated and treated adequately. Extrapulmonary comorbidities are common in COPD and influence prognosis; we propose an exhaustive comorbidities revie

Anti-Inflammatory Effect of Fluvastatin on IL-8 Production Induced by Pseudomonas aeruginosa and Aspergillus fumigatus Antigens in Cystic Fibrosis

International audienceBACKGROUND: Early in life, patients with cystic fibrosis (CF) are infected with microorganisms including bacteria and fungi, particularly Pseudomonas aeruginosa and Aspergillus fumigatus. Since recent research has identified the anti-inflammatory properties of statins (besides their lipid-lowering effects), we investigated the effect of fluvastatin on the production of the potent neutrophil chemoattractant chemokine, IL-8, in whole blood from CF patients, stimulated by Pseudomonas aeruginosa (LPS) and Aspergillus fumigatus (AFA) antigens. RESULTS: Whole blood from adult patients with CF and from healthy volunteers was collected at the Rennes University Hospital (France). Blood was pretreated for 1 h with fluvastatin (0-300 µM) and incubated for 24 h with LPS (10 µg/mL) and/or AFA (diluted 1/200). IL-8 protein levels, quantified by ELISA, were increased in a concentration-dependent manner when cells were stimulated by LPS or AFA. Fluvastatin strongly decreased the levels of IL-8, in a concentration-dependent manner, in whole blood from CF patients. However, its inhibitory effect was decreased or absent in whole blood from healthy subjects. Furthermore, the inhibition induced by fluvastatin in CF whole blood was reversed in the presence of intermediates within the cholesterol biosynthesis pathway, mevalonate, farnesyl pyprophosphate or geranylgeranyl pyrophosphate that activate small GTPases by isoprenylation. CONCLUSIONS: For the first time, the inhibitory effects of fluvastatin on CF systemic inflammation may reveal the important therapeutic potential of statins in pathological conditions associated with the over-production of pro-inflammatory cytokines and chemokines as observed during the manifestation of CF. The anti-inflammatory effect could be related to the modulation of the prenylation of signalling proteins

Les atteintes pulmonaires interstitielles de la dermatomyosite et polymyosite (à propos de trois observations)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Education thérapeutique en pratique courante (évaluation gestuelle de la bonne utilisation des traitements inhalés en consultation entre mars 2013 et septembre 2013)

Le traitement inhalé est un pilier de la prise en charge de la BPCO et de l'asthme. Il existe 3 classes de dispositifs d'inhalation: aérosols doseurs, dispositifs à poudre sèche et dispositifs de nébulisation. L'objectif de notre étude était l'évaluation gestuelle de la bonne utilisation des traitements inhalés chez les patients en ambulatoire. 54 patients adultes avaient été inclus prospectivement de mars à septembre 2013 chez le médecin généraliste et à la CPAM de Rennes. Les patients remplissaient un questionnaire puis l'examinateur évaluait chaque démonstration à l'aide de grilles d'évaluation. 57% des évaluations gestuelles étaient acquises quel que soit le dispositif d'inhalation utilisé. Le spray était le dispositif d'inhalation le moins bien utilisé (86,2% des patients). L'examinateur passait en moyenne 9 minutes avec chaque patient. Notre étude montre qu'il est utile, nécessaire et faisable de réaliser une évaluation gestuelle des dispositifs d'inhalation, un premier pas vers une démarche éducative en médecine générale.Inhalation therapy plays a major role in the treatment of COPD and asthma. There are 3 classes of inhalation devices: metered-dose inhalers, dry powder inhalers and nebulisers. The aim of our study was to evaluate the gestures needed to ensure effective usage of inhalers by outpatients. From March to September 2013, 54 adult patients were included in the study either during a visit to the GP or at the French National Health Centre at Rennes. The patients completed a questionnaire and demonstrated their gestures, the result of with were recorded on an evaluation scale. 57% of the patients used the range of devices correctly. The p-MDI was the least successfully handled (86,2% of its users). The examiner spent on average 5 minutes with each patient. Our study shows that it is useful, necessary and feasible to carry out a gestural evaluation of an inhalation device during a doctor's appointment: the first step towards an educational approach in general medical practice.RENNES1-BU Santé (352382103) / SudocSudocFranceF

Impact de la réhabilitation respiratoire à domicile sur la qualité de vie des patients porteurs d'une pathologie respiratoire chronique

La réhabilitation respiratoire est une thérapeutique validée pour les patients porteurs d'une bronchopneumopathie chronique obstructive. Son évaluation à domicile est moins solide. La qualité de vie est un des reflets du handicap respiratoire. Le but de notre travail est de déterminer si la réhabilitation respiratoire à domicile permet une amélioration de la qualité de vie des patients porteurs d'une pathologie respiratoire chronique. Nous avons réalisé une étude prospective de septembre 2009 à août 2010. 51 patients débutant une réhabilitation respiratoire à domicile ont, après information, été inclus. Aucun critère d'exclusion concernant le diagnostic ou le stade de la maladie n'a été retenu. Une analyse descriptive des résultats obtenus a été réalisée. La qualité de vie, les troubles anxieux et dépressifs et le statut nutritionnel des patients dénutris sont améliorés, ce qui est en corrélation avec les données de la littérature.RENNES1-BU Santé (352382103) / SudocSudocFranceF

Quantitative analysis of postural control of individuals with COPD during activities of daily living (ATTRACTION) : a study protocol

International audienceBackground: Chronic obstructive pulmonary disease (COPD) is a common respiratory disease which is associated with the presence of numerous comorbidities. Among these, impaired postural control has been reported to be common. However, postural control has not been extensively studied in tasks of daily living, in this population. Novel solutions for postural control assessment exist, like the quantitative motion analysis, which has shown to be a robust and accurate tool. Objective: The main aim of this study is to characterise the postural control of individuals with COPD during tasks of daily living compared to the postural control of control subjects, using quantitative motion analysis. The secondary aims of this study are to examine the associations between postural control variables of interest and various clinical factors and to investigate the utility of the modified Glittre-ADL for the clinical assessment of postural control in daily tasks. Method: A case-control study will be conducted with sixteen individuals with COPD and a control group (n = 16). Quantitative movement analysis will be used to assess postural control during a modified test (incorporating tasks of daily living) and timed-up-and-go test (normal and dual-task conditions). Clinical factors (e.g., dyspnoea, pain, inspiratory muscle strength, falls, fear of falling, etc.) will also be assessed. Discussion: ATTRACTION will be the first study to propose the assessment of postural control in various daily living tasks in individuals with COPD using quantitative movement analysis and has the potential to precise the relationship between postural control and several clinical factors. Trial registration: ATTRACTION study was registered on ClinicalTrials.gov under the number NCT0521167

Quels sont les facteurs prioritaires à mettre en œuvre pour développer une démarche éducative en médecine générale ?

National audienceLe médecin généraliste (MG) occupe une place privilégiée pour mener une démarche éducative auprès de ses patients atteints de maladies chroniques. Malgré le souhait d’implication des MG, cette démarche reste en pratique peu réalisée.Objectif  : Faire déterminer par des MG les facteurs nécessaires au développement d’une démarche éducative en médecine générale.Méthode  : Étude qualitative par la technique du groupe nominal modifié, réalisée auprès de 21 MG investigateurs d’une étude interventionnelle qui testait une démarche éducative structurée à partir d’outils conçus pour une utilisation en soins primaires. Il s’agissait de MG libéraux non spécifiquement formés à l’éducation thérapeutique, ayant mené lors de leurs consultations habituelles une démarche éducative individuelle par micro-objectifs personnalisés auprès de 31 patients atteints de BPCO durant un suivi de 9 mois.Résultats  : À la lumière de l’expérience vécue par les MG, le groupe a produit 23 facteurs, regroupés après l’étape de clarification-reformulation en six facteurs nécessaires au développement de la démarche éducative en médecine générale. Le consensus hiérarchisé a indiqué que le renforcement d’une formation médicale initiale et continue était le facteur le plus cité et le plus prioritaire. Le développement de coopérations inter et intra-professionnelles était le second facteur à privilégier.Conclusion  : Renforcer la formation et les coopérations des MG avec d’autres professionnels peut permettre aux MG de développer lors de leurs consultations une démarche éducative structurée. Ces résultats peuvent éclairer les orientations de la politique régionale de santé publique concernant le déploiement de l’éducation thérapeutique en soins primaires

Infection à Nocardia farcinica chez un patient porteur d’une mucoviscidose [Nocardia farcinica infection in a patient with cystic fibrosis].

International audienceInfections by Nocardia species are uncommon and generally affect immunocompromised patients. This bacteria has rarely been isolated from cystic fibrosis patients (CF), especially those who are not taking oral corticosteroids. We report a case of a patient with CF harbouring Nocardia farcinica. An 18-year-old male diagnosed with CF at the age of eight (F508 del/G85E) had been treated for allergic bronchopulmonary aspergillosis in 1998 with itraconazole, and a first colonization with Pseudomonas aeruginosa was eradicated in 2003. From May 2006, he presented with recurrent left- and right-sided pneumothorax. In June 2006, he presented with dyspnoea, fever, and nodular eruption on his ankles. Chest X-ray and CT scan revealed a right pneumothorax, severe bronchiectasis and bilateral alveolar consolidation. N. farcinica was idolated from his sputum without any other pathogens. Treatment with intravenous cotrimoxazole associated with imipenem and amikacin was initiated for three weeks followed by oral cotrimoxazole for a further nine months. The patient's symptoms and alveolar consolidation on CT scan improved. During 2007, his respiratory condition worsened and his FEV(1) declined from 50 to 26 % predicted. His pneumothorax recurred. He had chronic colonization with P. aeruginosa and was on the list for lung transplantation. Nocardia, a Gram positive bacillus, causes mainly pulmonary infection, usually in the context of immune suppression. The most frequent species is N. asteroides. In CF, very few cases have been reported; almost always N. asteroides, but exceptionally N. farcinica. In CF patients with worsening pulmonary condition, Nocardia should be considered, as well as other unusual pathogens

On-site screening of farming-induced chronic obstructive pulmonary disease with the use of an electronic mini-spirometer: results of a pilot study in Brittany, France.

International audiencePURPOSE: Dairy farming is a risk factor for the development of chronic obstructive pulmonary disease (COPD). We assessed the prevalence of farming-induced COPD (FI-COPD) using a new screening device, and we analyzed symptoms and occupational risk factors. METHODS: We performed on-site screening study of bronchial obstruction using an electronic mini-spirometer (EMS) on an entire population of dairy farmers (n = 147) from two villages in Brittany, France. Suspected bronchial obstruction (FEV1/FEV6 <0.8) was confirmed with standardized lung function tests (FEV1/FVC ≤0.7). We assessed past medical histories, respiratory symptoms, and occupational tasks of subjects with bronchial obstruction; asthmatics were defined as atopic and/or reversible; smoking-induced COPD patients were defined as non-reversible, non-atopic with smoking histories (≥5 PY); and FI-COPD patients were defined as non-reversible, non-atopic, and non-smokers. RESULTS: Using the EMS, 30.6% (n = 45) of dairy farmers were suspected of bronchial obstruction and underwent standardized spirometry. The FEV1/FEV6 ratio and FEV1/FVC ratio were in good agreement (r² = 0.66, P < 0.0001). The prevalence of confirmed bronchial obstruction was 9.5% (n = 14), which included 4 asthmatics, 3 smoking-induced COPD subjects, and 7 FI-COPD subjects. All the COPD patients were GOLD Stage II, and none were aware of their respiratory disease. Foddering duration was significantly higher in FI-COPD subjects compared with non-obstructive subjects, with 44 versus 17 min/day, respectively. CONCLUSIONS: The EMS was a convenient mean of screening for bronchial obstruction, especially in on-site settings, and allowed us to diagnose FI-COPD in a non-spontaneously complaining dairy farmer population. Foddering was considered a significant risk factor