Clinical practice guidelines: Medical follow-up of patients with asthma—Adults and adolescents

SummaryThe follow-up of patients with asthma should focus on asthma control (disease course over a number of weeks)→ There are 3 levels of asthma control•Acceptable:All control criteria (Table 1 below) are met•Unacceptable:One or more criteria are not met•Optimal:All control criteria are normal or, in a patient with acceptable control, the best compromise has been achieved between degree of control, acceptance of treatment and possible side effectsTable 1 Criteria defining acceptable asthma control.CriterionValue or frequency*Day-time symptoms<4 days/weekNight-time symptoms<1 night/weekPhysical activityNormalExacerbationsMild, infrequentAbsence from work or schoolNoneUse of short-acting β2-agonists<4 doses/weekFEV1 or PEF>85% of personal bestPEF diurnal variation (optional)<15%*Mean during control assessment period (1 week–3 months).FEV: forced expiratory volume; PEF: peak expiratory flow.→ Follow-up includes monitoring of treatment side effects and adherence.→ Treatment should be adjusted to level of control and current long-term therapy.•If control is unacceptable:○Check: that the disease is asthma, adherence, correct use of inhalation devices.○Look for and treat: aggravating factors, concomitant disease, specific clinical forms.○Adjust long-term therapy (see Table 2 below) in steps of 1–3 months.•If control is acceptable or optimal:○Find the minimum effective treatment to maintain at least acceptable and ideally optimal control. Each step should last 3 months.Table 2 Adjusting long-term therapy if control is unacceptable.Current therapyNew treatmentaOption 1Option 2No ICSAverage-dose ICSAverage ICS dose+AMbPatients on ICS onlyLow- or average-dose ICSAdd AMIncrease ICS dose with or without AMHigh-dose ICSAdd AMPatients on ICS and additional medication (AM)Low dose of ICS (+1 AM)Increase ICS doseAverage dose of ICS (+1 AM)Increase ICS doseAdd second AM with or without increasing ICS doseHeavy dose of ICS (+1 AM)Add second AMOral corticosteroidscHeavy dose of ICS (+2 AMs)Oral corticosteroidscAdd third AMaThe choice between options will depend on symptom frequency and respiratory function (particularly post-bronchodilator FEV1).bAdditional medication (AM) covers long-acting β2-agonists, cysteinyl-leukotriene receptor antagonists, theophylline and its derivatives (bamiphylline).cOral corticosteroids are rarely used in adolescents.→ Frequency of follow-up visits (V) and lung function tests (LFTs) according to the dose of inhaled corticosteroids (ICS) needed for acceptable control (see Table 3 below)Table 3 Frequency of follow-up visits and LFTs.ICS doseV (months)LFT (months)High33–6Low or average66–12None1212 or +Low, average and high daily dose of ICS (μg/day) in adults.Low doseAverage doseHigh doseBeclomethasonea<500500–1000>1000Budesonide<400400–800>800Fluticasone<250250–500>500aDose should be halved for QVAR® and NEXXAIR®SynopsisTitleMedical follow-up of patients with asthma—adults and adolescentsPublication dateSeptember 2004Requested byFrench National Health DirectorateProduced byAnaes—French National Agency for Accreditation and Evaluation in Healthcare (Guidelines Department)Intended forAll health professionals who manage patients with asthmaAssessment method•Systematic review of the literature (with evidence levels)•Discussion among members of an ad hoc working group•External validation by peer reviewers (see Anaes guide “Recommandations pour la pratique clinique—base méthodologique pour leur réalisation en France—1999”)ObjectivesAddress the practical aspects of long-term medical follow-up of patients with asthma (adults and adolescents only)Literature searchJanuary 1997–December 20032957 articles identified of which 696 analysedEconomic studyNoneAnaes project leader(s)Dr. Philippe Martel (Department head: Dr. Patrice Dosquet)(Literature search: Emmanuelle Blondet with the help of Maud Lefèvre (Department head: Rabia Bazi); secretarial work: Elodie Sallez)Authors of draft reportDr. Hugues Morel, chest physician, DinanDr. Nicolas Roche, chest physician, ParisCollaborations and participants•Learned societies•Steering committee•Working group (Chair: Professor Philippe Godard, chest physician/allergologist, Montpellier)•Peer reviewers(Appendix A)Internal validationAnaes Scientific Council (Referees: Professor Bruno Housset, chest physician, Créteil; Michel Paparemborde, Head of physiotherapy training college, Lille)Validated on September 2, 2004Other Anaes publications on the topicMedical follow-up is complemented by ongoing patient education, which is dealt with in the guidelines “Therapeutic education for patients with asthma—adults and adolescents” (Anaes 2001

Inter-technique validation of tropospheric slant total delays

An extensive validation of line-of-sight tropospheric slant total delays (STD) from Global Navigation Satellite Systems (GNSS), ray tracing in numerical weather prediction model (NWM) fields and microwave water vapour radiometer (WVR) is presented. Ten GNSS reference stations, including collocated sites, and almost 2 months of data from 2013, including severe weather events were used for comparison. Seven institutions delivered their STDs based on GNSS observations processed using 5 software programs and 11 strategies enabling to compare rather different solutions and to assess the impact of several aspects of the processing strategy. STDs from NWM ray tracing came from three institutions using three different NWMs and ray-tracing software. Inter-techniques evaluations demonstrated a good mutual agreement of various GNSS STD solutions compared to NWM and WVR STDs. The mean bias among GNSS solutions not considering post-fit residuals in STDs was -0.6 mm for STDs scaled in the zenith direction and the mean standard deviation was 3.7 mm. Standard deviations of comparisons between GNSS and NWM ray-tracing solutions were typically 10 mm +/- 2 mm (scaled in the zenith direction), depending on the NWM model and the GNSS station. Comparing GNSS versus WVR STDs reached standard deviations of 12 mm +/- 2 mm also scaled in the zenith direction. Impacts of raw GNSS post-fit residuals and cleaned residuals on optimal reconstructing of GNSS STDs were evaluated at intertechnique comparison and for GNSS at collocated sites. The use of raw post-fit residuals is not generally recommended as they might contain strong systematic effects, as demonstrated in the case of station LDB0. Simplified STDs reconstructed only from estimated GNSS tropospheric parameters, i.e. without applying post-fit residuals, performed the best in all the comparisons; however, it obviously missed part of tropospheric signals due to non-linear temporal and spatial variations in the troposphere. Although the post-fit residuals cleaned of visible systematic errors generally showed a slightly worse performance, they contained significant tropospheric signal on top of the simplified model. They are thus recommended for the reconstruction of STDs, particularly during high variability in the troposphere. Cleaned residuals also showed a stable performance during ordinary days while containing promising information about the troposphere at low-elevation angles.Web of Science1062208218

Staging of nutrition disorders in non-small-cell lung cancer patients : utility of skeletal muscle mass assessment

Background An international consensus proposed in 2011 a definition and classification system for cachexia (CAX), mainly based on weight loss, sarcopenia [skeletal muscle mass (SMM) loss], inflammation, and anorexia. The aim of this study was to stage CAX in non-small-cell lung cancer (NSCLC) patients by using a classification based on the Fearon criteria and supported by quantifiable parameters. Methods This was a cross-sectional and non-interventional multicentre study. SMM was assessed by analysing L3 computed tomography-scan images. Patients completed the anorexia/CAX subscale of the Functional Assessment of Anorexia/Cachexia Therapy, EORTC QLQ-C30 quality of life (QoL) and International Physical Activity Questionnaire (IPAQ). Results Patients were recruited in 56 sites. The analysis population comprised 531 patients, and SMM was assessed in 312 patients. Male patients were 66.5%, with a mean (SD) age of 65.2 (10.0) years, 79.9% were PS 0-1, and the tumour stage was mainly IIIB-IV (87.3%). Overall, 38.7% of patients had CAX, 33.8% pre-CAX, and 0.9% refractory CAX. Molecular tumour profiles were significantly associated with the presence of CAX: 23.9% in EGFR, ALK, ROS1, BRAF, or HER2+ patients, 41.4% in K-RAS+, and 43.2% in patients with no molecular abnormality (P = 0.003). The more advanced the CAX stage, the poorer the scores of functional items of the QoL (P < 0.001) and International Physical Activity Questionnaire (P < 0.001). Sarcopenia was present in 66.7% of CAX and 68.5% of pre-CAX patients. Overall, 43.8% of pre-CAX patients had only sarcopenia with limited weight loss (<= 2%) and no anorexia. Conclusions This is the first study to show the distribution of CAX in a population of NSCLC patients and an association between molecular abnormality in NSCLC and CAX. The original Fearon classification for CAX stages was supported by the associated functional QoL scores and physical activity levels, resulting in a clinically relevant system for detection of early stages of CAX

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

Mathematical models for immunology:current state of the art and future research directions

The advances in genetics and biochemistry that have taken place over the last 10 years led to significant advances in experimental and clinical immunology. In turn, this has led to the development of new mathematical models to investigate qualitatively and quantitatively various open questions in immunology. In this study we present a review of some research areas in mathematical immunology that evolved over the last 10 years. To this end, we take a step-by-step approach in discussing a range of models derived to study the dynamics of both the innate and immune responses at the molecular, cellular and tissue scales. To emphasise the use of mathematics in modelling in this area, we also review some of the mathematical tools used to investigate these models. Finally, we discuss some future trends in both experimental immunology and mathematical immunology for the upcoming years

Trabajo y vida indígenas en los trapiches del Nuevo Reino de Granada, 1576 – 16741

ABSTRACT: By a Crown´s rule, native workforce was forbidden inside the trapiches and sugar mills. Nonetheless, some Crown´s employees of the New Kingdom of Granada, in particular chief magistrates, avoided exerting this prohibition drastically, and allowed many indigenous people of encomiendas to pay their tributes with their labor on sugar production. This article studies both the reasons of this permissiveness and the changes that working on the trapiches generated among natives, especially those aspects linked to their community life and their consumption habits.RESUMEN: La mano de obra indígena estaba prohibida dentro de los trapiches e ingenios de azúcar por mandato de la Corona española. Sin embargo, en el Nuevo Reino de Granada los oficiales reales, especialmente los corregidores, evitaron ejercer drásticamente esta prohibición y permitieron que muchos indios de encomienda pagaran su tributación con el trabajo azucarero. En este artículo se estudian las razones de esta permisividad, así como los cambios que generó entre los indígenas trabajar en los trapiches, especialmente los aspectos vinculados a la vida comunitaria y a los hábitos de consumo de los indígenas

Autoantibodies against type I IFNs in patients with critical influenza pneumonia

In an international cohort of 279 patients with hypoxemic influenza pneumonia, we identified 13 patients (4.6%) with autoantibodies neutralizing IFN-alpha and/or -omega, which were previously reported to underlie 15% cases of life-threatening COVID-19 pneumonia and one third of severe adverse reactions to live-attenuated yellow fever vaccine. Autoantibodies neutralizing type I interferons (IFNs) can underlie critical COVID-19 pneumonia and yellow fever vaccine disease. We report here on 13 patients harboring autoantibodies neutralizing IFN-alpha 2 alone (five patients) or with IFN-omega (eight patients) from a cohort of 279 patients (4.7%) aged 6-73 yr with critical influenza pneumonia. Nine and four patients had antibodies neutralizing high and low concentrations, respectively, of IFN-alpha 2, and six and two patients had antibodies neutralizing high and low concentrations, respectively, of IFN-omega. The patients' autoantibodies increased influenza A virus replication in both A549 cells and reconstituted human airway epithelia. The prevalence of these antibodies was significantly higher than that in the general population for patients 70 yr of age (3.1 vs. 4.4%, P = 0.68). The risk of critical influenza was highest in patients with antibodies neutralizing high concentrations of both IFN-alpha 2 and IFN-omega (OR = 11.7, P = 1.3 x 10(-5)), especially those <70 yr old (OR = 139.9, P = 3.1 x 10(-10)). We also identified 10 patients in additional influenza patient cohorts. Autoantibodies neutralizing type I IFNs account for similar to 5% of cases of life-threatening influenza pneumonia in patients <70 yr old

Altimetry for the future: Building on 25 years of progress

In 2018 we celebrated 25 years of development of radar altimetry, and the progress achieved by this methodology in the fields of global and coastal oceanography, hydrology, geodesy and cryospheric sciences. Many symbolic major events have celebrated these developments, e.g., in Venice, Italy, the 15th (2006) and 20th (2012) years of progress and more recently, in 2018, in Ponta Delgada, Portugal, 25 Years of Progress in Radar Altimetry. On this latter occasion it was decided to collect contributions of scientists, engineers and managers involved in the worldwide altimetry community to depict the state of altimetry and propose recommendations for the altimetry of the future. This paper summarizes contributions and recommendations that were collected and provides guidance for future mission design, research activities, and sustainable operational radar altimetry data exploitation. Recommendations provided are fundamental for optimizing further scientific and operational advances of oceanographic observations by altimetry, including requirements for spatial and temporal resolution of altimetric measurements, their accuracy and continuity. There are also new challenges and new openings mentioned in the paper that are particularly crucial for observations at higher latitudes, for coastal oceanography, for cryospheric studies and for hydrology. The paper starts with a general introduction followed by a section on Earth System Science including Ocean Dynamics, Sea Level, the Coastal Ocean, Hydrology, the Cryosphere and Polar Oceans and the ‘‘Green” Ocean, extending the frontier from biogeochemistry to marine ecology. Applications are described in a subsequent section, which covers Operational Oceanography, Weather, Hurricane Wave and Wind Forecasting, Climate projection. Instruments’ development and satellite missions’ evolutions are described in a fourth section. A fifth section covers the key observations that altimeters provide and their potential complements, from other Earth observation measurements to in situ data. Section 6 identifies the data and methods and provides some accuracy and resolution requirements for the wet tropospheric correction, the orbit and other geodetic requirements, the Mean Sea Surface, Geoid and Mean Dynamic Topography, Calibration and Validation, data accuracy, data access and handling (including the DUACS system). Section 7 brings a transversal view on scales, integration, artificial intelligence, and capacity building (education and training). Section 8 reviews the programmatic issues followed by a conclusion

Altimetry for the future: building on 25 years of progress

In 2018 we celebrated 25 years of development of radar altimetry, and the progress achieved by this methodology in the fields of global and coastal oceanography, hydrology, geodesy and cryospheric sciences. Many symbolic major events have celebrated these developments, e.g., in Venice, Italy, the 15th (2006) and 20th (2012) years of progress and more recently, in 2018, in Ponta Delgada, Portugal, 25 Years of Progress in Radar Altimetry. On this latter occasion it was decided to collect contributions of scientists, engineers and managers involved in the worldwide altimetry community to depict the state of altimetry and propose recommendations for the altimetry of the future. This paper summarizes contributions and recommendations that were collected and provides guidance for future mission design, research activities, and sustainable operational radar altimetry data exploitation. Recommendations provided are fundamental for optimizing further scientific and operational advances of oceanographic observations by altimetry, including requirements for spatial and temporal resolution of altimetric measurements, their accuracy and continuity. There are also new challenges and new openings mentioned in the paper that are particularly crucial for observations at higher latitudes, for coastal oceanography, for cryospheric studies and for hydrology. The paper starts with a general introduction followed by a section on Earth System Science including Ocean Dynamics, Sea Level, the Coastal Ocean, Hydrology, the Cryosphere and Polar Oceans and the “Green” Ocean, extending the frontier from biogeochemistry to marine ecology. Applications are described in a subsequent section, which covers Operational Oceanography, Weather, Hurricane Wave and Wind Forecasting, Climate projection. Instruments’ development and satellite missions’ evolutions are described in a fourth section. A fifth section covers the key observations that altimeters provide and their potential complements, from other Earth observation measurements to in situ data. Section 6 identifies the data and methods and provides some accuracy and resolution requirements for the wet tropospheric correction, the orbit and other geodetic requirements, the Mean Sea Surface, Geoid and Mean Dynamic Topography, Calibration and Validation, data accuracy, data access and handling (including the DUACS system). Section 7 brings a transversal view on scales, integration, artificial intelligence, and capacity building (education and training). Section 8 reviews the programmatic issues followed by a conclusion

Asthme et environnement intérieur : intérêt des méthodes d'éviction globale sur l'exposition domiciliaire au risque fongique et sur le contrôle de l'asthme

RENNES1-BU Santé (352382103) / SudocSudocFranceF