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

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

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

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

How metabolomics can contribute to bio-processes: a proof of concept study for biomarkers discovery in the context of nitrogen-starved microalgae grown in photobioreactors

International audienc

Impact of current cough on health-related quality of life in patients with COPD

International audienceBackground: Cough and sputum production are frequent in chronic obstructive pulmonary disease (COPD). The objective of this study was to examine the relationship between cough and sputum production and health-related quality of life in COPD.Methods: A cross-sectional study was conducted in the French Initiatives COPD cohort and assessed cough and sputum production within the past 7 days using the cough and sputum assessment questionnaire (CASA-Q), health-related quality of life, spirometry, smoking status, dyspnea, exacerbations, anxiety and depression, and comorbidities.Results: One hundred and seventy-eight stable COPD patients were included (age, 62 [56–69] years, 128 male, forced expiratory volume in 1 second [FEV ]: 57 [37–72] % predicted) (median [Q1–Q3]). In univariate analyses, health-related quality of life (Saint George’s respiratory questionnaire total score) was associated with each CASA-Q domain and with chronic bronchitis, exacerbations, dyspnea, FEV1, depression, and anxiety. All four domains introduced separately were independently associated with health-related quality of life. When introduced together in multivariate analyses, only the cough impact domain remained independently associ- ated with health-related quality of life (R2=0.60). With chronic bronchitis (standard definition) instead of the CASA-Q, the R2 was lower (R2=0.54).Conclusion: This study provides evidence that current cough in the previous 7 days is an important determinant of health-related quality of life impairment in stable COPD patients

Burden and Characteristics of Severe Chronic Hypoxemia in a Real-World Cohort of Subjects with COPD

International audienc

Relationship between gender and survival in a real-life cohort of patients with COPD

International audienceBackground: Although COPD affects both men and women, its prevalence is increasing more rapidly in women.Disease outcomes appear different among women with more frequent dyspnea and anxiety or depression but whetherthis translates into a different prognosis remains to be determined. Our aim was to assess whether the greater clinicalimpact of COPD in women was associated with differences in 3-year mortality rates.Methods: In the French Initiatives BPCO real-world cohort, 177 women were matched up to 458 menon age (within 5-year intervals) and FEV1 (within 5% predicted intervals). 3-year mortality rate and survival were analyzed. Univariate andmultivariate logistic regression analyses were performed.Results: For a given age and level of airflow obstruction, women with COPD had more severe dyspnea, lower BMI, andwere more likely to exhibit anxiety. Nevertheless, three-year mortality rate was comparable among men and women,respectively 11.2 and 10.8%. In a multivariate model, the only factors significantly associated with mortality were dyspneaand malnutrition but not gender.Conclusion: Although women with COPD experience higher levels of dyspnea and anxiety than men at comparablelevels of age and FEV1, these differences do not translate into variations in 3-year mortality rates

<p>Predictors in routine practice of 6-min walking distance and oxygen desaturation in patients with COPD: impact of comorbidities</p>

International audienc