La prise en charge de la toux chronique

Chronic cough, defined as lasting more than 8 weeks, is a frequent and difficult problem. Since 1981, the north American group of Irwin and coworkers has proposed a diagnostic algorithm with chronic cough being explained in a vast majority of cases by three possible diagnoses :asthma, chronic rhino-sinusitis and gastroesophageal reflux. This algorithm has been amended in order to include eosinophilic bronchitis and has further been severely criticized because of frequent failure in clinical practice. In 2008, Pavord and Chung have proposed to put the emphasis in chronic cough on non specific cough hyperreactivity, with the aetiological factors suggested by the Irwin group acting at most as modulating agents. Severe or persistent chronic cough should be quantitatively assessed, using for instance a visual analogue scale or a cough specific quality of life questionnaire. Where treatment for chronic cough is concerned, the sole definitely effective interventions are smoking cessation and discontinuation of a converting enzyme inhibitor. Long term inhaled steroids are also effective in case of eosinophilic cough (defined on basis of eosinophilia in induced sputum or increased level of exhaled NO). In case of chronic cough unresponsive to the hereinabove described management, an antitussive agent should be considered. As codeine is relatively ineffective, research about new antitussive agents should be encouraged.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Traitements médicamenteux de la BPCO

In patients with COPD bronchodilators improve lung function to some extent and relieve dyspnoea. Within short-acting bronchodilators, ipratropium (anticholinergic agent) is as effective as salbutamol (sympathomimetic agent) with fewer adverse effects. Presently, maintenance therapy is based on long-acting inhaled bronchodilators. Tiotropium (anticholinergic agent) once a day has a better efficacy to adverse effects ratio than salmeterol or formoterol (sympathomimetic agents) twice a day. Inhaled steroids (fluticasone, budesonide) are also able to improve lung function slightly and to relieve symptoms, but have no beneficial effect on the accelerated rate of decline in lung function that characterizes COPD. A short course (10 days) of systemic steroids is useful to treat an exacerbation. On the other hand, potential toxicity of oral steroids is a definite contra-indication for maintenance therapy.SCOPUS: cp.jinfo:eu-repo/semantics/publishe

TRAITEMENT DE L'ASTHME BRONCHIQUE: PLAIDOYER POUR LES BRONCHODILATATEURS EN INHALATION

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Dyspnée et perception de l'obstruction des voies aériennes

Introduction: Dyspnoea, defined as the perception of difficult or laboured breathing, is ideally quantified, using a visual analogue scale or a Borg scale. State of the art: In recent years several studies have explored the correlation between dyspnoea and the degree of airway obstruction, in both healthy subjects and patients with asthma or COPD. In these studies dyspnoea was measured in baseline state, following induced broncho-constriction or during application of an external resistive load. Dyspnoea was measured using a previously validated scale or, in some studies, a simple numerical score. The lung function variables most frequently used to evaluate the degree of correlation with dyspnoea were FEVI, and PEF, although other variables were used in some studies. Despite this marked heterogeneity in the methods used, several studies strongly suggested that, in subjects with CDPD, perceived subjective improvement after an inhaled bronchodilator agent correlated with improvement of inspiratory variables. In asthmatics, the major finding was that some subjects had a very poor perception of their level of airway obstruction, a potential risk factor for severe exacerbations. Perspectives: Further normative studies are needed to define how healthy subjects perceive airway obstruction. Conclusions: The relationship between dyspnoea and lung function in obstructive disorders has to be evaluated separately in asthmatics and in CDPD patients.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Evaluation quantitative de la dyspnée chez le patient présentant une obstruction chronique des voies aériennes

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

Traitement de l'asthme

SCOPUS: re.jinfo:eu-repo/semantics/publishe

EVALUATION DE LA FONCTION CARDIAQUE GAUCHE DANS LA BRONCHOPNEUMOPATHIE CHRONIQUE OBSTRUCTIVE DECOMPENSEE. CORRELATION ENTRE ANALYSE DE LA RADIOGRAPHIE DU THORAX ET DONNEES HEMODYNAMIQUES

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Trois grossesses sous CPAP nasale: À propos d'une observation

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Diagnostic de l'embolie pulmonaire

A good knowledge of clinical presentation and of risk factors for pulmonary embolism is mandatory to improve adequate clinical suspicion. Some recent improvements in diagnostic strategy have to be emphasized. A low D-dimer level has a good negative predictive value to rule out pulmonary embolism. Ventilation-perfusion lung scan is the most often used imaging technique. In case of non diagnostic scan, serial non invasive search for deep vein thrombosis in the limbs is recommended by some experts at least in patients with good cardio-respiratory reserve, pulmonary angiography being recommended otherwise. Spiral CT allows direct demonstration of clots, being hardly less sensitive than pulmonary angiography except for subsegmental emboli. Future perspectives include the use of spiral CT as first choice procedure, as well as magnetic resonance imaging.SCOPUS: ar.jinfo:eu-repo/semantics/publishe