Un nouveau phénotype dans l'asthme sévère (les hypersécréteurs)

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

Une première évaluation en France de la présence d'allergènes de rongeurs dans les bâtiments publics

INTRODUCTION: L'exposition aux allergènes d'intérieur est impliquée dans les maladies allergiques respiratoires et contribue à la morbidité asthmatique. L'allergène Mus M1 joue un rôle dans l'asthme. Aucune étude ne s'est intéressée à la prévalence de cet allergène dans les bâtiments publics français. METHODES: 46 échantillons de poussière ont été prélevés ne aspirant le sol de 5 bâtiments publics en région Provence-Alpes-Cote-d'Azur. Ils ont été répartis en deux sous groupes (petite et grandes structures). La poussière échantillonnée a été analysée pour évaluer la concentration de 5 alergènes d'intérieurs, avec la technique Multiplex Aray for Indoor Allergens (MARIA). RESULTATS: Les allergènes Mus M&, Fel d1, Can f1, Bla g2, Rat n1 sont retrouvés dans 936%, 87%, 61%, 35% et 7% des échantillons avec une concentration médiane (extrêmes) à 19,6 ng/g (0,2-6454,2), 37,9 ng/g (2,4-841,2), 28,2 ng/g (2,4-484,8)n 188 ng/g (20,8-527,8) et 3,8 ng/g (3,8-12,8), respectivement. Dans les petites et grandes structures, la concentration médiane de Mux n1 est à 0,5 ng/g et 31,8 ng/g respectivement (p<0,0001). L'allergène Rat n1 est uniquement présent dans les grandes structures, avec une concentration médiane à 3,8 ng/g. La dératisation est plus réalisée dans les grandes structures (p<0,005). Les déjections de souris ne sont pas associées à la détection de l'allergène Mus m1. CONCLUSION: La prévalence de Mus M1 est importante mais sa concentration est souvent négligeable. L'allergène Mus M& ne semblerait donc pas être un facteur de risque majeur de morbidité asthmatique en région PACAAIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

An update on the efficacy and safety of aclidinium bromide in patients with COPD

Aclidinium is a potent and selective muscarinic antagonist, which interacts rapidly with muscarinic receptors and shows subnanomolar affinity for the five human muscarinic receptors (M 1 –M 5 ); its association rate for the M 3 receptor is similar to that of ipratropium and 2.6 times faster than that of tiotropium. Aclidinium dissociates slightly faster from M 2 and M 3 receptors than tiotropium but much more slowly than ipratropium. A potent bronchodilatory activity has been observed after inhaled administration of aclidinium. Aclidinium undergoes rapid hydrolysis in the plasma into two major compounds, the alcohol (LAS34823) and the carboxylic acid (LAS34850) metabolites, resulting in low and transient systemic exposure to the active drug. The two major metabolites show no significant affinity for human muscarinic receptors. A potent bronchodilatory activity has been observed after inhaled administration of aclidinium. Clinical trials have provided evidence of sustained bronchodilation similar to that observed with tiotropium. Trial results have confirmed the positive safety profile of aclidinium, particularly in terms of a very low propensity to cause anticholinergic adverse events. Aclidinium is now moving to phase III clinical development for chronic obstructive pulmonary disease (COPD)

Goblet Cell Hyperplasia as a feature of neutrophilic asthma

International audienceBackground : Goblet cell hyperplasia (GCH) is a pathological finding classically reported across asthma severity levels and usually associated with smoking. Multiple biological mechanisms may contribute to excessive mucus production.Objective : We aimed to decipher the clinical meanings and biological pathways related to GCH in non‐smokers with asthma.Methods : Cough and sputum assessment questionnaire (CASA‐Q) responses at entry and 1 year later were compared to clinical and functional outcomes in 59 asthmatic patients. GCH was assessed through periodic‐acid shift (PAS) staining on endobronchial biopsies obtained at entry in a subset of 32 patients.Results : Periodic‐acid shift‐staining analysis revealed a double wave distribution discriminating patients with (>10% of the epithelial area) or without GCH. CASA‐Q scores were mostly driven by overall asthma severity (P < 0.0001). CASA‐Q scores remained stable at 1 year and were independently associated with BAL eosinophil content irrespective of the presence of GCH. GCH was unrelated to the presence of bronchiectasis at CT, GERD or chronic rhinosinusitis, but correlated well with neutrophilic inflammatory patterns observed upon BAL cellular analysis (P = 0.002 at multivariate analysis). BALF bacterial loads were unrelated to GCH or to CASA‐Q.Conclusions and Clinical Relevance : Goblet cell hyperplasia is disconnected from chronic cough and sputum when assessed by a specific questionnaire. GCH is related to neutrophilic asthma whereas symptoms are related to airway eosinophilia. The clinical counterpart of GCH is unlikely assessed by the CASA‐Q

Hereditary lysozyme amyloidosis with sicca syndrome, digestive, arterial, and tracheobronchial involvement: case-based review

International audienc