[Consequences of atmospheric pollution fluctuations in patients with COPD]. / Répercussions des fluctuations de la pollution atmosphérique chez les patients atteints de bronchopneumopathie chronique obstructive.

INTRODUCTION: Fluctuations in atmospheric pollution are responsible for an important morbidity and mortality in the patients suffering from chronic obstructive pulmonary disease (COPD). BACKGROUND: Epidemiological studies show a significant increase in the mortality and hospitalization rates in COPD patients in relation to moderate increases in atmospheric pollution. In vitro and in vivo studies demonstrate a pro-inflammatory role and an oxidative toxicity of atmospheric particles and secondary morphological and functional changes in the respiratory epithelium and the immune system. An excess of particulate matter, ozone, NO(2), SO(2) and CO is directly correlated to the number of episodes of acute respiratory failure in different countries all over the world. The mechanisms implicated are complex and variable, dependent on the different pollutant agents, climatic variations and inter-individual susceptibility. VIEWPOINT: Further experimental studies are necessary in order to clarify our fundamental understanding and, alongside better control of air quality, to reduce short-term respiratory complications. CONCLUSION: The consequences of atmospheric pollution fluctuations on the exacerbation rate and therefore on the morbidity and mortality of patients with COPD emphasize the importance of preventive environmental management in the field of public health.

[Management of dyslipidemias diagnosed in general practice in France--The PRAGMA Study]. / Prise en charge des dyslipidémies diagnostiquées en médecine générale en France--etude PRAGMA.

Several studies have reported the penetration and impact of national and international recommendations on the management of dyslipidaemia, a major cardiovascular risk factor. Most of them were carried out on patients participating in clinical trials or on in-hospital cases. The PRAGMA study was developed in order to evaluate management of this condition in general practice, at the heart of the health care system. From September to December 1998, 1,717 general practitioners were chosen randomly and included 6,623 patients considered to have a lipid disorder. In this sample, the prevalence of the main risk factors was as follows: hypertension: 39.6%, diabetes: 11.6%, obesity: 19.6%, past or present smokers: 33.8%. The main lines of management consisted in prescribing lipid lowering drugs (96.6%) with dietary recommendations (95.8%) and a fall lipid profile (59.9%). The main factors spontaneously cited by the general practitioners as being decisional were: the total cholesterol level (47.8%), diet (40.8%), body weight (29.4%) and drug therapy (19.2%). The cardiovascular risk factors were rarely taken into account in their totality. These results suggest that the management of dyslipidaemia patients by general practitioners is far from being optimal. Efforts should be made to change attitudes to take into consideration the global cardiovascular risk factors of patients with lipid disorders.