Quelle est la place de l’antibiothérapie ?

International audienc

Inspiratory muscle training during pulmonary rehabilitation in chronic obstructive pulmonary disease: A randomized trial.

International audienceAlthough recommended by international guidelines, the benefit of inspiratory muscle training (IMT) in addition to rehabilitation remains uncertain. The objective was to demonstrate the effectiveness of IMT on dyspnea using Borg scale and multidimensional dyspnea profile questionnaire at the end of a 6-minute walk test (6MWT) in patients with chronic obstructive pulmonary disease (COPD) with preserved average maximum inspiratory pressure (PImax) of 85 cm H2O (95% of predicted (pred.) value) and admitted for a rehabilitation program in a dedicated center. In a randomized trial, comparing IMT versus no IMT in 32 COPD patients without inspiratory muscle weakness (PImax >60 cm H2O) who were admitted for pulmonary rehabilitation (PR) for 3 weeks, we evaluated the effect of IMT on dyspnea, using both Borg scale and multidimensional dyspnea profile (MDP) at the end of the 6MWT, and on functional parameters included inspiratory muscle function (PImax) and 6MWT. All testings were performed at the start and the end of PR. In unadjusted analysis, IMT was not found to be associated with an improvement of either dyspnea or PImax. After adjustment on confounders (initial Borg score) and variables of interaction (forced expiratory volume in 1 second (FEV1)), we found a trend toward an improvement of "dyspnea sensory intensity", items from MDP and a significant improvement on the variation in the 2 items of MDP ("tight or constricted" and "breathing a lot"). In the subgroup of patients with FEV1 50% pred. IMT did not significantly improve dyspnea or functional parameter in COPD patients with PImax > 60 cm H2O. However, in the subgroup of patients with FEV1 < 50% pred., MDP was significantly improved

Les comorbidités dans la BPCO

International audienc

Les comorbidités dans la BPCO [Comorbidities of COPD]

National audienceRésumé La BPCO est une maladie respiratoire chronique lentement évolutive caractérisée par une diminution non complètement réversible des débits aériens. L’agent causal principal est le tabagisme. La BPCO est un problème de santé publique qui se traduit par une morbidité, un handicap et une mortalité élevés. Une de ses caractéristiques est la place que prennent les comorbidités en raison du vieillissement, des facteurs de risque et de facteurs génétiques. Les patients ayant plus de 2 comorbidités représentent 26 % de la population mais plus de la moitié des coûts de traitements. Nous passons en revue les différentes comorbidités (cardiovasculaires, l’ostéoporose, la dénutrition, l’obésité, le sujet âgé, l’anémie, les troubles du sommeil, le diabète et syndrome métabolique, l’anxiété-dépression ou le cancer broncho-pulmonaire) avec leur physiopathologie, prévalence mais aussi leur impact sur le pronostic de la BPCO. En effet, la présence de l’une ou plusieurs de ces comorbidités en altèrent le pronostic. Nous sommes donc confrontés à la question de la multimorbidité et à la difficulté de l’approche pratique et pertinente de la gestion de ces comorbidités. De plus en plus, l’intérêt thérapeutique d’une prise en charge globale des comorbidités par une équipe multidisciplinaire est souligné sans perdre de vue l’essentiel : à savoir le sevrage tabagique. Summary COPD is a slowly progressive chronic respiratory disease causing an irreversible decrease in air flow. The main cause is smoking, which provokes inflammatory phenomena in the respiratory tract. COPD is a serious public health issue, causing high morbidity, mortality and disability. Related comorbidities are linked to ageing, common risk factors and genetic predispositions. A combination of comorbidities increases healthcare costs. For instance, patients with more than two comorbidities represent a quarter of all COPD sufferers but account for half the related health costs. Our review describes different comorbidities and their impact on the COPD prognosis. The comorbidities include: cardiovascular diseases, osteoporosis, denutrition, obesity, ageing, anemia, sleeping disorders, diabetes, metabolic syndrome, anxiety-depression and lung cancer. The prognosis worsens with one or more comorbidities. Clinicians are faced with the challenge of finding practical and appropriate ways of treating these comorbidities, and there is increasing interest in developing a global, multidisciplinary approach to management. Managing this chronic disease should be based on a holistic, patient-centred approach and smoking cessation remains the key factor in the care of COPD patient