Pneumologie : asthme, BPCO et syndrome d'apnées du sommeil

Among the novelties described in the management of pulmonary disorders during the year 2017, we chose to describe three. First, the indication for inhaled glucocorticosteroids (ICS) in COPD has been revisited, because of their relationship with an increased occurence of pneumonia : ICS are now recommended only in severe COPD (GOLD D) with frequent exacerbations as second line treatment. Secondly, azithromycine has shown very promising results in poorly controlled severe asthma, with a significant impact on symptoms and exacerbations. Finally, despite the association between sleep apnea syndrome and cardiovascular morbidity, the prescription of CPAP in asymptomatic individuals as primary or secondary prevention is not supported by the recent literature

Vivre avec des bronchiectasies

Bronchiectasis is a chronic condition with a prevalence continuously on the rise. Bronchiectasis have a considerable impact on morbidity, healthcare utilization and quality of life. Pulmonary function tests, microbiological variables and exacerbation rate are useful in the initial and follow-up evaluation. Scores that combine those variables with chest CT findings have been established to predict hospitalizations and mortality. Assessment of health-related quality of life cannot rely on physiological variables measurement. Dedicated questionnaires are therefore needed for that purpose

Pneumologie : asthme, bronchopneumopathie chronique obstructive et fibrose pulmonaire idiopathique

D’importantes modifications ont été proposées par les sociétés savantes dans la prise en charge des sujets asthmatiques légers et des sujets souffrant de bronchopneumopathie chronique obstructive (BPCO) : abandon des bêta-2 agonistes à action courte (BAAC) en traitement de secours pour l’asthme pour des raisons de sécurité, en privilégiant le rôle des corticostéroïdes inhalés seuls ou associés à un bêta-2 mimétique chez des sujets symptomatiques, et redéfinition de la place des corticostéroïdes inhalés lors de BPCO. Dans la fibrose pulmonaire idiopathique, la pentraxine-2 humaine recombinante se profile comme une nouvelle option thérapeutique possible, venant compléter la gamme des traitements spécifiques (pirfénidone, nintédanib). Ces nouveautés sont discutées dans cette revue de la littérature récente

Cryobiopsies transbronchiques : diagnostic minimalement invasif de la fibrose pulmonaire

The diagnosis of interstitial lung disease (ILD) is challenging and relies on a multidisciplinary discussion involving clinical, radiological and sometimes histological features. Bronchoscopic lung cryobiopsies have emerged as a new minimally invasive method of lung sampling and an alternative to surgical lung biopsies. A good diagnostic performance and excellent safety profile make it an interesting and worthful procedure which could decrease the number of patients without proper diagnosis and treatment. There is a need for further studies to standardize the technique in expert centers and to establish its role in the diagnostic work-up of ILD