[Smoking, asthma and associated phenotypes. An epidemiological approach].

International audienceINTRODUCTION: The relationship between the respiratory tract and the environment is complex and is based on the dynamic interaction between genetically determined host-defence mechanisms and the toxicity of inhaled pollutants. STATE OF ART: Although the World Health Organisation has decreed that smoking is an avoidable cause of premature death, the epidemiological evaluation of the effects of smoking remains problematical. Indeed, basing assessment on duration of habit and quantity smoked may be miscalculating the true burden of the effects of smoking. Smoking, as a risk factor, is all too often perceived to be confined to development of chronic obstructive pulmonary disease. The consequences of passive smoking on children respiratory health have been established. In adults, active smoking has been related to asthma severity. Recent data demonstrate an effect of passive smoking on the incidence of asthma in adults. PERSPECTIVES: Objective markers of smoking are rarely used in epidemiological studies of asthma. CONCLUSIONS: However, the paucity of published studies linking smoking with asthma should not immediately lead to the conclusion that there is not a causal relationship

Lower respiratory tract infections in adults: non-antibiotic prescriptions by GPs

AbstractBackground: The AIR II study is a prospective multicentre assessing management of lower respiratory tract infections (LRTIs) in adults by general practitioners (GPs). Epidemiological studies generally address the prescriptions of antibiotics. To our knowledge, little is known about the real impact of non-antibiotic therapeutic prescriptions (defined here as co-prescriptions) in LRTI. Therefore, the aim of the study was to evaluate non-antibiotic prescriptions in LRTIs. Methods: Two thousand general practitioners (GPs) were randomly selected and asked to participate in each of 30 predefined areas covering mainland France. The patient's sociomedical record was completed by the GP during the consultation and sent to the data processing centre at the same time as an anonymous copy of his prescription. The GP also had to report the inclusion by telephone and agree to a telephone appointment with an interviewer. Results: GPs (n=3144) reported 5469 evaluable cases. Pneumonia accounted for 9.6% of diagnoses, acute exacerbations of chronic bronchitis 14.9% and acute bronchitis 72.5%. Antibiotics were prescribed to 96.5% of patients. In addition to the 5270 prescriptions of antibiotics, co-prescriptions proved to be twice as numerous as prescriptions of antibiotics (10,027 prescriptions for 5115 patients). Mucomodifiers, steroidal anti-inflammatory drugs and bronchodilators were significantly more prescribed in AECB than others. Non-steroidal anti-inflammatory drugs and antitussives were significantly more prescribed in acute bronchitis than AECB or CAP. Conclusions: Our results suggest that recommendations of management in LRTIs need to take into account co-prescriptions

Alternaria sensitization and allergic rhinitis with or without asthma in the French Six Cities study.

International audienceBACKGROUND: Allergic sensitization to Alternaria has been related to asthma in various studies, but its association with allergic rhinitis is still controversial. OBJECTIVES: The aim of this study was to assess at the population level the relationships in childhood between Alternaria sensitization and 'past-year rhinoconjunctivitis' (PYRC), 'ever hay fever' (EHF) and 'ever allergic rhinitis caused by allergens other than pollens' (EAR) according to the presence or the absence of asthma. METHODS: This study is part of the Six Cities Study, the French contribution to the International Study of Asthma and Allergies in Childhood (ISAAC) Phase II. Children underwent skin prick test (SPT) to Alternaria and parents filled a standardized medical questionnaire. RESULTS: Some 6726 children with a mean age of 10 years were examined. The overall prevalence of Alternaria sensitization was 2.8%, 0.8% for monosensitization. Prevalences of symptoms in sensitized children were 27.7% for PYRC, 27.0% for EHF and 30.4% for EAR. Adjusted Odds Ratios (OR) between Alternaria sensitization and allergic rhinitis phenotypes were 2.34 (95% confidence interval: 1.51-3.63) for PYRC, 2.40 (1.65-3.50) for EHF and 2.95 (2.05-4.23) for EAR. The relationship still remained in the case of monosensitization to Alternaria for both PYRC and EAR when excluding the asthmatic children [OR = 3.87 (1.54-9.78) and 2.88 (1.10-7.55) respectively]. CONCLUSION: In our population-based sample of children, we found a link between Alternaria sensitization and allergic rhinitis, independently of asthma, which is compatible with the mechanisms of deposition of Alternaria in the upper airways