Insufficient Pulmonary Rehabilitation Uptake After Severe Exacerbation of COPD: A Multicentre Study in the South West Region of France

Marina Gueçamburu,1– 3 Guillaume Verdy,4 Julie Cuadros,1 Cécilia Nocent-Ejnaini,2 Julie Macey,1 Laurent Portel,3 Amandine Rapin,5,6 Maéva Zysman1,7 1Service des Maladies Respiratoires, CHU Bordeaux, Pessac, 33604, France; 2Service de pneumologie, Centre Hospitalier de la Côte Basque, Bayonne, France; 3Service de pneumologie, Centre Hospitalier Robert Boulin, Libourne, France; 4Unité d’Informatique et d’Archivistique Médicales, Service d’Information Médicale, CHU Bordeaux, Pessac, 33604, France; 5Université de Reims Champagne-Ardenne, VieFra, Reims, F-51100, France; 6CHU de Reims, Unité de Médecine Physique et de Réadaptation, Reims, F-51100, France; 7Univ-Bordeaux, Centre de Recherche cardio-thoracique de Bordeaux, U1045, CIC 1401, Pessac, F-33604, FranceCorrespondence: Marina Gueçamburu, Service des Maladies Respiratoires, CHU Bordeaux, Pessac, 33604, France, Email [email protected]: Pulmonary rehabilitation (PR) is a type of multidisciplinary care strongly recommended after severe exacerbation of chronic obstructive pulmonary disease (COPD). Recently, a national French study reported a very low rate of PR uptake (8.6%); however, important clinical data were missing. Here, we aimed to identify the main factors associated with insufficient PR uptake after hospitalisation for COPD exacerbation.Patients and Methods: This multicentre retrospective study included patients hospitalised with COPD exacerbation between 1 January 2017 and 31 December 2018, as identified by both coding and a detailed review of medical records. PR was defined as inpatient care in a specialised centre or unit within 90 days of discharge. Multivariate logistic regression was used to identify associations between PR uptake and patient characteristics, such as comorbidities, non-invasive ventilation (NIV), inhaled treatment, and forced expiratory volume in 1 second (FEV1).Results: Among the 325 patients admitted for severe COPD exacerbation, 92 (28.3%) underwent PR within 90 days of discharge. In univariate analysis, relative to those who underwent PR, patients without PR had significantly more comorbidities, were less often treated with triple bronchodilator therapy or NIV, and had a higher FEV1. In multivariate analysis, variables independently associated with the lack of PR uptake were the presence of comorbidities (adjusted odds ratio (aOR) = 1.28 [1.10– 1.53], p = 0.003) and a higher FEV1 (aOR = 1.04 [1.02– 1.06], p < 0.001). There was no significant correlation between PR uptake and departmental PR centre capacity (notably, some departments had no PR facilities).Conclusion: These data highlight the lack of PR in the early stages of COPD. Collaboration among all healthcare providers involved in patient management is crucial for improved PR uptake.Plain Language Summary: Pulmonary rehabilitation (PR) is multidisciplinary care strongly recommended after severe exacerbation of chronic obstructive pulmonary disease (COPD); however, referral remains very low in France. We have shown, in three French centres, that early-stage COPD and associated comorbidities are the main factors contributing to insufficient PR after hospitalisation for exacerbation. Collaboration among all healthcare providers involved in patient management is crucial to improve PR uptake in the years ahead because physical medicine and rehabilitation professionals play key roles in the promotion and early initiation of PR programs.Keywords: COPD, comorbidities, healthcare resources, pulmonary rehabilitatio

Smoking, Urban Housing and Work-Aggravated Asthma are Associated with Asthma Severity in a Cross-Sectional Observational Study

Marie Chevereau-Choquet,1 Benjamin Thoreau,2,3 Camille Taillé,4,5 Sylvain Marchand-Adam,1,6 Hugues Morel,7 Laurent Plantier,1,6,&ast; Laurent Portel8,&ast; 1Service de Pneumologie et Explorations Fonctionnelles Respiratoires, CHRU de Tours, Tours, France; 2Service de Médecine Interne, National Referral Center for Rare Systemic Autoimmune Diseases, AP-HP, Hôpital Cochin, Paris, France; 3Inserm U1016, CNRS UMR8104, Université Paris Cité, Institut Cochin, Paris, France; 4Service de Pneumologie A, AP-HP Nord, Hôpital Bichat Claude Bernard, Paris, France; 5Inserm U1152, Université Paris Cité, Paris, France; 6CEPR, Inserm UMR1100, Université de Tours, Tours, France; 7Service de Pneumologie, CHR d’Orléans, Orléans, France; 8Service de Pneumologie, Centre Hospitalier Robert Boulin, Libourne, France&ast;These authors contributed equally to this workCorrespondence: Laurent Plantier, Service de Pneumologie et Explorations Fonctionnelles Respiratoires, CHRU de Tours, 2 Bd Tonnellé, Tours, 37044, France, Email [email protected]: Severe asthma affects 5 to 10% of asthmatics and accounts for a large part of asthma-related morbidity and costs. The determinants of asthma severity are poorly understood. We tested the hypothesis that asthma severity was associated with 1) atopy and allergy and 2) markers associated with environmental exposure.Patients and Methods: Data from the FASE-CPHG study, a cross-sectional, observational, multicenter investigation, were analyzed to identify markers associated with asthma severity. Asthma severity was gauged using the ASSESS score, encompassing symptom control, exacerbations, FEV1 and therapeutic load. Bivariate and multivariate analyses were used to identify patient characteristics associated with the ASSESS score.Results: The analysis involved 948 patients, with 592 women, of which 447 patients (47%) had severe asthma. Among these, 491 patients (52%) had at least one positive aeroallergen skin prick test and 525 (55%) had at least one allergic disease among atopic dermatitis, chronic rhinitis and food allergy. The mean±SD ASSESS score was 11.2± 3.4. Characteristics associated with a higher ASSESS score were female sex, secondary or lower education, unemployed occupational status, smoking, work-aggravated asthma and urban housing. There was no association between the ASSESS score and allergic diseases, aeroallergen-specific skin prick tests and IgEs, or blood eosinophil counts.Conclusion: While atopy and allergy were frequent among asthmatics, neither was associated with asthma severity. Modifiable environmental factors such as smoking, urban housing and work-aggravated asthma were independently associated with asthma severity.Keywords: allergy, ASSESS, asthma, environment, severit

[Tuberculosis control in France--evaluation of practice by a working group of the Société de Pneumologie de Langue Française].

International audienceINTRODUCTION: The management of tuberculosis has been the subject of renewed interest in France. Recently, the recommendations and the regulations concerning the disease have been updated. However, the resources that are actually available and the processes in place in different French departments are not clearly known. A national survey was thus carried out by a working group of the SPLF in charge of the recommendations concerning the medical, social and administrative management of the disease. METHODS: A questionnaire was sent to the 100 French departmental Antituberculous Services (SLAT). This explored the structures, activity, organisation involved, and difficulties encountered in Tuberculosis management. RESULTS: Ninety SLAT took part in the study. Their answers reveal: a discordance between a number of cases notified to the Department of Sanitation and Health (DDASS) and the number of cases known to the SLAT; a disparity between means involved in this study and the number of patients followed up as well as the choice of populations targeted for tracing); a willingness to deal with contact tracing although the investigations around individual cases and the definition of which subjects should be followed up were variable; a demand for protocols, networks and national recommendations. CONCLUSIONS: The SLAT are involved in the fight against tuberculosis with 20 years experience. The needs expressed in this survey point the way towards future prioritary actions to improve tuberculosis control nationally

Local Recurrence Of Rectal Cancer - Surgical Approach [recidiva Pélvica De Adenocarcinoma De Reto - Abordagem Cirúrgica]

Local recurrence after rectal cancer resection varies between 3 to 35% in five years. The condition has difficult management, and little is known about the best treatment. Radiotherapy and chemotherapy can be used as paliative methods, and the best results are achieved with radical resection. Purpose: To evaluate patients submitted to surgery for pelvic recurrence by the Coloproctology Unit at Clinical Hospital of Unicamp. Methods and Patients: Between 1999 and 2007, 26 consecutive patients with locally recurrence after rectal cancer surgery were evaluated. According to clinical data, tumor stage at the first surgery, recurrence ressecability and follow-up were analyzed. Results: The most common initial surgery was retossigmoidectomy with colorectal anastomosis (46,1%). Of the 26 patients, five had tumor perforation at the first surgery. Positive lymphnodes were found in 53,8% and 69,2% were classified as T3 or T4 staging. In relation to surgery for local recurrence, the principle was abdominoperineal amputation of the rectum. Radical surgery was performed in 42,3% of the cases. The resection of the tumor was possible in 65,4%. The mean follow-up period was 29,4 months, with an overall survival of 34,6%. Conclusion: Approximately two-thirds of patients with locally recurrent rectal cancer can be submitted- for surgical resection, Improving survival. 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L’organisation médico-sociale et administrative peut-elle améliorer la prise en charge individuelle et collective de la tuberculose en France ?

International audienc