Effets immédiats d’une séance de thérapie manuelle orthopédique chez des patients adultes atteints de mucoviscidose

La thérapie manuelle orthopédique (TMO) existe depuis de nombreuses années, mais reste cependant peu connue des différents praticiens de santé. Le concept Mulligan® est une des branches de cette discipline. Des évidences scientifiques existent pour soutenir l’utilisation de cette méthode, mais très peu concernent le rachis thoracique, et aucune ne s’intéresse, à notre connaissance, aux modifications des paramètres ventilatoires qui pourraient en découler. Le but de cette étude était d’analyser les modifications des paramètres ventilatoires (VEMS, CVF, DEP, DEMM, résistances bronchiques), de la sensation de bien être respiratoire, et de la sensation de confort respiratoire après une séance de TMO suivant le concept Mulligan chez des patients adultes atteints de mucoviscidose. Cette étude était réalisée chez des patients suivis au CRCM adulte de Lille, en état stable. Les patients effectuaient une spirométrie, une mesure des résistances bronchiques par oscillations forcées, deux échelles visuelles analogiques et deux échelles GRoC avant et après la séance de TMO d’une durée moyenne de 30 minutes. Douze patients ont été inclus dans l’étude. Ils présentaient un trouble ventilatoire obstructif sévère (VEMS 41,7 % ± 13,7). Après TMO on observait une amélioration statistiquement significative des sensations de bien être général (p<0,04) et de confort respiratoire (p< 0,002). En revanche, aucune modification significative des résistances bronchiques ni des paramètres ventilatoires obtenus par la spirométrie n’était observée. Notre étude démontre l’impact d’une séance de thérapie manuelle orthopédique avec les techniques Mulligan sur le confort respiratoire et le bien être général chez des patients adultes atteints de mucoviscidose.Master [120] en sciences de la motricité, orientation générale, Université catholique de Louvain, 201

Variabilitätsmodellierung in Software Produktlinien Drei Lösungsansätze im Fokus

INTRODUCTION: The aim of this study was to gain insight into the physiological changes occurring in subjects with cystic fibrosis (CF) after autogenic drainage (AD). Changes in respiratory system resistance (Rrs), reactance (Xrs), and spirometry were analyzed in adult CF subjects after a single AD physiotherapy session. METHODS: This prospective observational study was conducted during the annual check-up of adult CF subjects in stable condition. Spirometry and Rrs and Xrs measurements using the forced oscillations technique at 5, 11, and 19 hertz (Hz) were performed before and 30 min after a 20-min AD session. Control CF subjects were tested at baseline and 50 min without AD. Results are expressed as mean ± standard deviation or median [interquartile range]. RESULTS: Thirty subjects were included in the physiotherapy group (age 29 [25-34] years, forced expiratory volume in 1 s (FEV1) 40.3 [30.1-57.9]% predicted) and 11 in the control group (age 31 [28.5-36.5] years, FEV1 43.6 [31.1-51.9] % predicted). No significant changes in any parameter were observed in the control group. AD modestly but significantly increased the forced vital capacity (FVC) and FEV1 (p<0.001). Inspiratory resistance was also significantly improved by AD: Rrs5 from 5.74±2.39 to 5.24±2.17 cmH2O/L/s, p<0.05; Rrs11 from 4.83±1.98 to 4.32±1.7 cmH2O/L/s, p = 0.003; and Rrs19 from 4.18 [3.46-5.07] to 3.86 [2.76-4.98] cmH2O/L/s, p<0.001. In contrast, AD had no significant effects on frequency dependence of resistance (Rrs5-Rrs19) or expiratory resistance. Inspiratory Xrs5, but not ΔXrs5 (expiratory-inspiratory Xrs), was improved by AD (p<0.05). Moderate correlations were detected between the improvement in FEV1 and FVC and inspiratory resistance (r = 0.53, p = 0.005 and r = 0.44, p = 0.02, respectively). CONCLUSION: A single session of AD improved inspiratory airway resistance, except in the distal airways. The forced oscillations technique provides a new tool for understanding the pathophysiological effects of airway clearance physiotherapy in CF

Effets du drainage autogène sur la mécanique ventilatoire de patients adultes atteints de mucoviscidose

Contexte : La kinésithérapie respiratoire de désencombrement bronchique est un composant majeur de la prise en charge de la mucoviscidose qui permet de ralentir la dégradation de la fonction respiratoire. Peu d’études mécanistiques ont analysé les effets de la kinésithérapie sur la fonction respiratoire. L’objectif est de vérifier si la kinésithérapie par drainage autogène améliore rapidement les résistances des voies aériennes. Méthode : Étude observationnelle réalisée lors du bilan annuel des patients en état stable suivis au CRCM adulte de Lille. La mesure des résistances bronchiques par oscillations forcées (à 5, 11 et 19 Hz) et une spirométrie étaient réalisées avant et 30 minutes après la séance de kinésithérapie respiratoire d’une durée de 20 minutes. Les sécrétions émises par les patients étaient recueillies. Trente patients (14 femmes et 16 hommes) âgés d’en moyenne 30,4 ans (± 8,42) atteints de mucoviscidose avec un VEMS moyen de 45,5 % (± 21). Le critère d’évaluation principal est les résistances bronchiques ; pour les critères secondaires, les réactances et les débits sont mesurés en spirométrie. Résultats : Après kinésithérapie, augmentation modeste mais significative de la CVF (3,22 %), du VEMS (1,7 %) et du DEP (2,9 %) (p < 0,001). Aucune différence au niveau du DEMM. Diminution significative des résistances inspiratoires pour les fréquences de 5 Hz, 11 Hz et 19 Hz mais pas pour les R5-19 Hz. Pas de variation significative des résistances expiratoires aux 3 fréquences testées. Diminution significative des résistances totales aux fréquences 11 Hz et 19 Hz. Amélioration des résistances inspiratoires à 5 Hz chez 21/30 patients, à 11 Hz chez 22 et enfin à 19 Hz chez 23 patients. Corrélation entre l’amélioration du VEMS (ou de la CVF) et l’amélioration des résistances inspiratoires. Pas de corrélation entre les données fonctionnelles mesurées et le poids (sec ou humide) des sécrétions bronchiques. Conclusion : Cette étude a donc montré une amélioration statistiquement significative des résistances inspiratoires après drainage autogène. L’absence d’amélioration des R5-19 Hz est compatible avec une absence d’effet au niveau des petites voies aériennes. Nos résultats apportent une information objective sur les effets, au plan physiologique, d’une séance de désencombrement bronchique chez des patients atteints de la mucoviscidose et permet d’envisager des études prospectives sur d’autres techniques de kinésithérapie

Characteristics of the cystic fibrosis patients.

<p>Characteristics of the cystic fibrosis patients.</p

Individual values of inspiratory resistances before and after autogenic drainage in 30 CF patients.

<p>A, Rrs_5; B, Rrs_11; C, Rrs_19; D, Rrs₅–Rrs₁₉.</p

AIRWAYS-ICPs (European Innovation Partnership on Active and Healthy Ageing) from concept to implementation

Chronic respiratory diseases (CRDs) are major non-communicable diseases (NCDs) that induce a significant burden. Asthma often occurs along the life cycle from early childhood, affecting 30 million children and adults under 45 years of age in Europe. Chronic obstructive pulmonary disease (COPD) has an estimated annual death rate of over 3 million people globally. The annual direct and indirect costs in the 28 European Union (EU) countries due to COPD or asthma are estimated at 48 billion euros and 34 billion euros respectively. Rhinitis occurs in over 100 million people in Europe, and indirect costs are enormous [4]. Asthma is a common risk factor for COPD. CRDs impact ageing and should be prevented, recognised and managed across the life cycle to promote active and healthy ageing (AHA). There is an urgent need to act globally

AIRWAYS-ICPs (European Innovation Partnership on Active and Healthy Ageing) from concept to implementation

Chronic respiratory diseases (CRDs) are major non-communicable diseases (NCDs) that induce a significant burden. Asthma often occurs along the life cycle from early childhood, affecting 30 million children and adults under 45 years of age in Europe. Chronic obstructive pulmonary disease (COPD) has an estimated annual death rate of over 3 million people globally. The annual direct and indirect costs in the 28 European Union (EU) countries due to COPD or asthma are estimated at 48 billion euros and 34 billion euros respectively. Rhinitis occurs in over 100 million people in Europe, and indirect costs are enormous. Asthma is a common risk factor for COPD. CRDs impact ageing and should be prevented, recognised and managed across the life cycle to promote active and healthy ageing (AHA). There is an urgent need to act globally. European Innovation Partnerships (EIPs) aim to enhance EU competitiveness and tackle societal challenges through research and innovation. To tackle the potential of ageing in the EU, the European Commission, within its Innovation Union policy, launched the EIP on AHA (between the Directorate General for Health and Food Safety (DG Santé) and Directorate General for Communications Networks, Content and Technology (DG CONNECT)). The B3 Action Plan promotes integrated care models for chronic diseases, including the use of remote monitoring. The initiative AIRWAYS-ICPs (integrated care pathways for airway diseases) has been approved by the EIP on AHA as the model of chronic diseases of the B3 Action Plan. It is a Research Demonstration Project of the World Health Organization's Global Alliance against Chronic Respiratory Diseases (GARD). AIRWAYS-ICPs was initiated in 2013 by the WHO Collaborating Centre of Montpellier and the EIP on AHA Reference Site MACVIA-LR (Contre les MAladies Chroniques Pour un VIeillissement Actif en Languedoc-Roussillon, France) led by the Région Languedoc-Roussillon (France)

Integrated care pathways for airway diseases (AIRWAYS-ICPs)

The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life. in the longer term, the incidence of disease may be reduced by innovative prevention strategies. AIRWAYS-ICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers).Region Languedoc-RoussillonUniv Hosp Montpellier, Montpellier, FranceMACVIA LR, Fighting Chron Dis Hlth Ageing, Region Languedoc Roussil, FranceARIA, Montpellier, FranceEuropean Acad Allergy & Clin Immunol, Montpellier, FranceEuropean Innovat Partnership Act & Hlth Ageing, Montpellier, FranceEuropean Innovat Partnership Act & Hlth Ageing, Commitment Act B3, Montpellier, FranceUniv Montpellier I, Montpellier, FranceEuropean Innovat Partnership Act & Hlth Ageing, Regione Emilia Romagna, ItalyUniv London Imperial Coll Sci Technol & Med, Natl Heart & Lung Inst, London, EnglandRoyal Brompton & Harefield NIHR Biomed Res Unit, London, EnglandRomanian Alliance Chron Resp Dis, Brasov, RomaniaTransylvania Univ, Fac Med, Brasov, RomaniaUniv Barcelona, Hosp Clin Barcelona, IDIBAPS, Thorax Inst, Barcelona, SpainCIBER Enfermedades Resp, Barcelona, SpainHosp Clin Barcelona, FCRB, Barcelona, SpainUniv Pompeu Fabra, CIBER Epidemiol & Salud Publ CIBERESP, IMIM Hosp del Mar Med Res Inst, Ctr Res Environm Epidemiol CREAL, Barcelona, SpainGhent Univ Hosp, Dept Resp Med, Ghent, BelgiumGhent Univ Hosp, ENT Dept, Ghent, BelgiumCatholic Univ, Fac Med, Res Ctr Resp Med CIMER, Cordoba, ArgentinaChinese Med Assoc, Shanghai Resp Res Inst, Shanghai, Peoples R ChinaEuroAsian Resp Soc, Astana City, KazakhstanPortuguese Natl Programme Resp Dis, PNDR, Lisbon, PortugalUniv Cape Town, Fac Hlth Sci, Dept Med, Div Pulmonol, ZA-7700 Rondebosch, South AfricaHlth Innovat Ctr Southern Denmark, Region Southern Denmark, DenmarkUniv Amsterdam, Acad Med Ctr, NL-1105 AZ Amsterdam, NetherlandsBangladesh Lung Fdn, Dhaka, BangladeshNatl Inst Dis Chest & Hosp, Dhaka, BangladeshLinkoping Univ, Dept Clin & Expt Sci, Ctr Individualised Med, Linkoping, SwedenEuropean Innovat Partnership Act & Hlthy Ageing, Aura Andalucia, SpainAndalusian Healthcare Serv, Andalucia, SpainNHS England, London, EnglandOdense Univ Hosp, Odense Res Ctr Anaphylaxis, Dept Dermatol, DK-5000 Odense, DenmarkOdense Univ Hosp, Odense Res Ctr Anaphylaxis, Allergy Ctr, DK-5000 Odense, DenmarkUniv Milan, IRCCS Ca Granda, European Resp Soc, Milan, ItalyUniv Roma La Sapienza, Dept Publ Hlth & Infect Dis, I-00185 Rome, ItalyUniv Naples 2, Naples, ItalyItalian Natl Res Council, Inst Translat Med, Naples, ItalyUniv Laval, Inst Univ Cardiol & Pneumol Quebec, Quebec City, PQ, CanadaINSERM, U1046, Montpellier, FranceGlenfield Hosp, Leicester Resp Biomed Res Unit, Natl Inst Hlth Res, Leicester, Leics, EnglandUniv Glasgow, Inst Hlth & Wellbeing, Hlth Econ & Hlth Technol Assessment, Glasgow, Lanark, ScotlandMcMaster Univ, Dept Clin Epidemiol, Hamilton, ON, CanadaMcMaster Univ, Dept Biostat & Med, Hamilton, ON, CanadaMainz Univ Hosp, Med Ctr, Dept Pulm, Mainz, GermanyUniv London Imperial Coll Sci Technol & Med, Dept Paediat Resp Med, Royal Brompton Hosp, London, EnglandUniv Costa Rica, San Jose, Costa RicaUniv London Imperial Coll Sci Technol & Med, Royal Brompton Hosp, Sect Allergy & Clin Immunol, London, EnglandUniv Liverpool, Inst Ageing & Chron Dis, Liverpool L69 3BX, Merseyside, EnglandAintree Univ Hosp NHS Fdn Trust, Liverpool L9 7AL, Merseyside, EnglandUniv Fed Minas Gerais, Sch Med, Dept Pediat, Belo Horizonte, MG, BrazilUniv Genoa, IRCCS San Martino IST, Dept Internal Med, Genoa, ItalyUniv Oslo, Oslo, NorwayOslo Univ Hosp, Dept Paediat, Oslo, NorwayUniv Roma Tor Vergata, Dept Syst Med, Rome, ItalyUniv Simon Bolivar, Metropolitan Univ, Allergy & Immunol Lab, Barranquilla, ColombiaSoc Latinoamer Allergia Asma & Immunol, SLaai, Rome, ItalyIRCCS San Raffaele Pisana, Rome, ItalyPeking & Ctr Asthma Res & Educ, Asthma Clin & Educ Ctr, Capital Inst Pediat, Natl Cooperat Grp Paediat Res Asthma, Beijing, Peoples R ChinaGrigol Robakidze Univ, David Tvildiani Med Univ, AIETI Med Sch, Chachava Clin, Tbilisi, Rep of GeorgiaInt Primary Care Resp Grp, Leiden, NetherlandsLeiden Univ, Dept Publ Hlth & Primary Care, Med Ctr, Leiden, NetherlandsWHO, Global Alliance Against Chron Resp Dis, GARD, Moscow, RussiaPulmonol Res Inst, Moscow, RussiaRussian Resp Soc, Moscow, RussiaNova SE Univ, Coll Osteopath Med, Davie, FL USANHS Scotland, European Innovat Partnership Act & Hlth Ageing, Glasgow, Lanark, ScotlandHull York Med Sch, Ctr Cardiovasc & Metab Res, Kingston Upon Hull, N Humberside, EnglandUniv Fed Bahia, Nucleo Excelencia Asma, ProAR, Salvador, BA, BrazilCNPq, Salvador, BA, BrazilUniv Manchester, Manchester, Lancs, EnglandKarolinska Inst, Inst Environm Med, Ctr Allergy Res, CfA, S-10401 Stockholm, SwedenSoc Francaise Allergol, Strasbourg, FranceStrasbourg Univ, Strasbourg, FranceEuropean Reg & Hlth Author, EUREGHA, Brussels, BelgiumUniv Med & Pharm Iuliu Hatieganu, Cluj Napoca, RomaniaUniv Versailles St Quentin, UPRES, EA 220, Suresnes, FranceSoc Pneumol Langue Francaise, Toulouse, FranceUniv Toulouse, Dept Resp Med, Toulouse, FranceParis Descartes Univ, Hop Cochin, AP HP, Serv Physiol,EA 2511, F-75674 Paris, FranceUniv Southampton, Fac Med, Southampton SO9 5NH, Hants, EnglandNIHR, Southampton Resp Biomed Res Unit, Southampton, Hants, EnglandUniv Ss Cyril & Methodius, Univ Clin Pulmol & Allergy, Skopje, MacedoniaCtr Hosp Univ Beni Messous, Serv Pneumoallergol, Algiers, AlgeriaLithuanian Soc Allergol & Clin Immunol, Vilnius, LithuaniaVilnius State Univ, Fac Med, Vilnius, LithuaniaUniv Liverpool, Fac Hlth & Life Sci, NHS R&D North West, Liverpool L69 3BX, Merseyside, EnglandNHS Scotland, European Innovat Partnership Act & Hlth Ageing, Edinburgh, Midlothian, ScotlandUniv Modena & Reggio Emilia, Policlin Modena, Dept Oncol Haematol & Resp Dis, Modena, ItalyGlobal Allergy & Asthma Patient Platform, Vienna, AustriaEduc Hlth, Warwick, EnglandEuropean Rhinol Soc, Oporto, PortugalPorto Age Up Consortium, Oporto, PortugalUniv Porto, Sch Med, Hosp S Joao, Dept Hlth Informat & Decis Sci, P-4100 Oporto, PortugalUniv Porto, Sch Med, Hosp S Joao, CINTESIS, P-4100 Oporto, PortugalInst & Hosp CUF Porto, Oporto, PortugalUniv Nice Sophia Antipolis, F-06189 Nice, FranceRepatriat Gen Hosp, Adelaide, SA, AustraliaWakefield Council, Wakefield, W Yorkshire, EnglandAthens Chest Hosp, Resp Med Dept 7, Athens, GreeceAthens Chest Hosp, Asthma Ctr, Athens, GreeceEuropean Innovat Partnership Act & Hlth Ageing, Valencia, SpainUniv Valencia, Polibienestar Res Inst, Valencia, SpainNatl Ctr Dis Control & Publ Hlth Georgia, Tbilisi, Rep of GeorgiaUniv Chile, Dept Med, Immunol & Allergol Div, Clin Hosp, Santiago, ChileHelsinki Univ Hosp, Dept Allergy, Skin & Allergy Hosp, Helsinki, FinlandPubl Hlth Blackburn Darwen, Blackburn, Lancs, EnglandQueens Univ Belfast, Sch Med Dent & Biomed Sci, Ctr Infect & Immun, Belfast, Antrim, North IrelandUniv Hosp Leuven, Dept Otolaryngol Head & Neck Surg, Leuven, BelgiumPubl Hlth Kirklees, Huddersfield, W Yorkshire, EnglandUniv Plymouth, Sch Psychol, Plymouth PL4 8AA, Devon, EnglandUniv Salerno, Dept Med & Surg, I-84100 Salerno, ItalyIRCCS Multimed, Milan, ItalyUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilGeorge Inst Global Hlth, Sydney, NSW, AustraliaUniv Sydney, Sydney, NSW 2006, AustraliaUniv London Imperial Coll Sci Technol & Med, Natl Heart & Lung Inst, Airway Dis Infect Sect, London, EnglandHallym Univ, Sacred Heart Hosp, Coll Med, Gyeonggi Do, South KoreaHacettepe Univ, Sch Med, Paediat Allergy & Asthma Unit, Ankara, TurkeyCharite, Inst Social Med Epidemiol & Hlth Econ, D-13353 Berlin, GermanyUniv Wurzburg, Inst Clin Epidemiol & Biometry, D-97070 Wurzburg, GermanyCzech Alliance Against Chron Resp Dis, CARO, Lodz, PolandMed Univ Lodz, Fac Med, Dept Immunol Rheumatol & Allergy, Lodz, PolandKarolinska Inst, Inst Environm Med, Dept Clin Sci & Educ, S-10401 Stockholm, SwedenMed Univ Lodz, Barlicki Univ Hosp, Dept Internal Med Asthma & Allergy, Lodz, PolandVilnius State Univ, Pulmonol & Allergol Ctr, Vilnius, LithuaniaUniv Med & Pharm, Thanh Pho Ho Chi Minh, VietnamUniv Liege, CHU Liege, GIGA I3 Res Ctr, Liege, BelgiumUniv Edinburgh, Queens Med Res Inst, Edinburgh, Midlothian, ScotlandScottish Govt, Dept Hlth, Directorate Finance eHlth & Pharmaceut, Edinburgh, Midlothian, ScotlandUniv Bratislava, Bratislava, SlovakiaBon Secours Hosp, Royal Coll Surg Ireland, Sch Med, Dept Med, Dublin, IrelandKronikgune, Basque Region, SpainShahid Beheshti Univ Med Sci, Natl Res Inst TB & Lung Dis, Chron Resp Dis Res Ctr, Tehran, IranRoyal Brompton Hosp, London SW3 6LY, EnglandGeneva Sch Med, Geneva, SwitzerlandUniv Hosp Geneva, Geneva, SwitzerlandUniv Hosp Pulm Dis, Zagreb, CroatiaInst Pneumol Marius Nasta, Bucharest, RomaniaUniv Belgrade, Fac Med, Belgrade, SerbiaCOPD Serbia, Belgrade, SerbiaBordeaux Univ, Bordeaux, FranceParis Descartes Univ, Dept Publ Hlth & Biostat, EA 4064, Paris, FranceParis Municipal, Dept Social Act Childhood & Hlth, Paris, FranceHosp CUF Descobertas, Immunoallergy Dept, Lisbon, PortugalHop Polyclin Dakar IHS, Serv Med Interne & Pathol Profess, Dakar, SenegalMustapha Hosp, Algiers, AlgeriaHosp Hosp Bros Buda, Budapest, HungaryCharite, Allergy Ctr Charite, Berlin, GermanyCHUV Lausanne, Serv Pneumol, CH-1011 Lausanne, SwitzerlandAlfred Hosp, Dept Allergy Immunol & Resp Med, Melbourne, Vic, AustraliaMonash Univ, Melbourne, Vic 3004, AustraliaTokyo Natl Hosp, Natl Hosp Org, Tokyo, JapanTeikyo Univ, Sch Med, Tokyo 173, JapanUniv Hosp Pisa, Cardiothorac & Vasc Dept, Pisa, ItalyUniv York, Ctr Reviews & Disseminat, York YO10 5DD, N Yorkshire, EnglandUniv Athens, Paediat Clin 2, Dept Allergy, Athens, GreeceUniv Ferrara, I-44100 Ferrara, ItalyUniv Oxford, Oxford, EnglandUniv JJ Strossmayer, Sch Med, Childrens Hosp Srebrnjak, Osijek, CroatiaUniv Groningen, Univ Med Ctr Groningen, GRIAC Res Inst, Dept Pulmonol, Groningen, NetherlandsUniv Aberdeen, Acad Primary Care, Aberdeen, ScotlandUniv Kiel, LungenClin Grosshansdorf, Airway Res Ctr North, German Ctr Lung Res DZL, Kiel, GermanyUniv Valencia, Res Inst INCLIVA, CIBERObn, Hlth Inst Carlos III, Madrid, SpainUniv Nebraska Med Ctr, Div Pulm Crit Care Sleep & Allergy, Nebraska Med Ctr, Omaha, NE USASalford Royal NHS Fdn Trust, Salford, Lancs, EnglandINSERM, U710 & 988, Montpellier, FranceUniv Paris 05, Hop Cochin, AP HP, Paris, FranceSoc Pneumol Langue Francaise, SPLF, Paris, FranceArcispedale S Maria Nuova Hosp, Reggio Emilia, ItalyAssoc Asthme & Allergies, Boulogne, FranceWoodbrook Med Ctr, Loughborough, Leics, EnglandUniv Edinburgh, Allergy & Resp Res Grp, Ctr Populat Hlth Sci, Sch Med, Edinburgh, Midlothian, ScotlandMed Univ Warsaw, Dept Prevent Environm Hazards & Allergol, Warsaw, PolandCtr Med Docente La Trinidad, Dept Allergy & Clin Immunol, Caracas, VenezuelaHarvard Univ, Brigham & Womens Hosp, Sch Med, Div Gen Internal Med & Primary Care, Boston, MA 02115 USAQueens Univ Belfast, Belfast, Antrim, North IrelandRoyal Belfast Hosp Sick Children, Belfast, Antrim, North IrelandUniv Hosp Heraklion, Dept Thorac Med, Iraklion, GreeceCatholic Univ Louvain, Univ Hosp Mt Godinne, Yvoir, BelgiumUniv Paris 06, Univ Paris 04, Neurophysiol Resp Expt & Clin UMR S 1158, Paris, FranceINSERM, Neurophysiol Resp Expt & Clin UMR S 1158, Paris, FranceGrp Hosp Pitie Salpetriere Charles Foix, AP HP, Serv Pneumol & Reanimat Med, Dept R3S, F-75634 Paris, FranceFonds Dotat Rech Sante Resp Fdn Souffle, Paris, FranceHlth Inst Technol Transfer, HITT, Barcelona, SpainEuroAsian Resp Soc, Bishkek, KyrgyzstanNatl Ctr Cardiol & Internal Med, Bishkek, KyrgyzstanUniv São Paulo, Fac Med, Div Pulm, InCor Heart Inst,Hosp Clin, São Paulo, BrazilUniv Oslo, Fac Med, Oslo Univ Hosp, Dept Neonatal Intens Care, Oslo, NorwayCoimbra Univ Hosp, Immunoallergy Dept, Coimbra, PortugalMed Univ Vienna, Ctr Pathophysiol Infectiol & Immunol, Dept Pathophysiol & Allergy Res, Vienna, AustriaUniv Turku, Dept Lung Dis & Clin Allergol, SF-20500 Turku, FinlandCHU Lyon, Pharmacoepidemiol Unit, Lyon, FranceCHU Lyon, Lyon, FranceUniv Lyon 1, UMR CNRS 5558, F-69365 Lyon, FranceUniv Manchester, Manchester Acad Hlth Sci Ctr, Resp & Allergy Res Grp, Manchester, Lancs, EnglandOdense Univ Hosp, Dept Resp Med J, DK-5000 Odense, DenmarkArcispedale S Maria Nuova IRCCS, EIP AHA Act Grp Delivering Integrated Care Models, Reg Agcy Hlth & Social Care, Res Hosp, Reggio Emilia, ItalyCNR, Inst Biomed, Palermo, ItalyCNR, Inst Mol Immunol, Palermo, ItalyClin Physiol IFC, Pisa, ItalyUniv Marburg, Univ Med Ctr Giessen & Marburg, Dept Med Pulm & Crit Care Med, German Ctr Lung Res DZL, D-35032 Marburg, GermanySotiria Hosp, Athens, GreeceCumbria Cty Council, Carlisle, PA USACHRU, Hop Albert Calmette, Lille, FranceUniv N Carolina, Eshelman Sch Pharm, Chapel Hill, NC USANorth England EU Hlth Partnership, Brussels, BelgiumOlmsted Med Ctr, Dept Res, Rochester, MN USAUniv Minnesota, Dept Family & Community Hlth, Rochester, MN USACyprus Univ Technol, Harvard Sch Publ Hlth, Cyprus Int Inst Environm & Publ Hlth, Limassol, CyprusAllergy & Asthma Inst, Islamabad, PakistanUniv Cape Town, Red Cross War Mem Childrens Hosp, Dept Paediat & Child Hlth, ZA-7925 Cape Town, South AfricaGuangzhou Med Univ, Guangzhou Inst Resp Dis, Guangzhou, Guangdong, Peoples R ChinaGuangzhou Med Univ, State Key Lab Resp Dis, Guangzhou, Guangdong, Peoples R ChinaUniv Clin Resp & Allerg Dis, Golnik, SloveniaUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilWeb of Scienc