Subject(s)
Biomedical Research , Hospitals, General , Pulmonary Medicine , Adult , Aged , Aged, 80 and over , Biomedical Research/organization & administration , Biomedical Research/trends , Community Networks/organization & administration , France , Hospitals, General/organization & administration , Humans , Interdisciplinary Communication , Lung Diseases/epidemiology , Lung Diseases/therapy , Pulmonary Medicine/methods , Pulmonary Medicine/organization & administrationABSTRACT
INTRODUCTION: COPD is a disease whose gravity is underestimated by doctors and patients. The development of acute exacerbations (AE) accelerates the progression of the disease and leads to increased financial costs, notably on account of hospitalisation. MATERIALS AND METHODS: An observational prospective study will be undertaken based on a cohort of consecutive patients hospitalised in departments of respiratory medicine in general hospitals. The main objective is to study the factors predictive of mortality at 3 years after one admission for AE. The secondary objectives are to describe the characteristics of the AE on arrival and 3 months after discharge from hospital. A register will be set up and a questionnaire will be completed for each patient, consisting of items concerning COPD, the AE and the condition of the patient and his treatments 3 months after discharge. The level of mortality at 3 years and the predictive factors will be calculated from the data in the register. EXPECTED RESULTS: Identification the characteristics of the AE and determination of a predictive score for mortality should allow optimisation of the management of patients suffering from COPD.
Subject(s)
Hospitalization , Pulmonary Disease, Chronic Obstructive/physiopathology , Cohort Studies , Disease Progression , Follow-Up Studies , Forecasting , Humans , Oxygen Inhalation Therapy , Patient Admission , Patient Discharge , Prospective Studies , Pulmonary Disease, Chronic Obstructive/therapy , Registries , Respiration, Artificial , Surveys and Questionnaires , Survival RateABSTRACT
INTRODUCTION: Lung cancer continues to have a poor prognosis despite some therapeutic advances. BACKGROUND: The last fifteen years has seen a dramatic increase in the incidence of lung cancer in women and an increased proportion of adenocarcinomas in both sexes. A study of overall survival as a function of gender and other prognostic factors has been established using the cohort of patients from the study KBP-2000-CPHG. METHODS: KBP-2000-CPHG is an epidemiological study carried out throughout the year 2000 looking at histologically confirmed primary lung cancers managed in general hospitals. 5,667 patients have been included. The study of survival looks at 2 and 5-year outcomes. The date and cause of death are recorded for each patient. In the absence of these data the date of the last contact is noted. If this is less than 4 months the patient is considered to be alive. If more than four months have elapsed a graduated strategy for establishing vital status is pursued which involves reviewing records from various different sources. RESULTS AWAITED: A preliminary review of the data was undertaken between September 2004 and March 2005 which obtained data on 5 567 patients. The analysis of survival according to sex and other forecast prognostic factors is underway.
Subject(s)
Lung Neoplasms/mortality , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Adult , Age Distribution , Aged , Carcinoma, Large Cell/mortality , Carcinoma, Large Cell/pathology , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/pathology , Carcinoma, Small Cell/mortality , Carcinoma, Small Cell/pathology , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/pathology , Cause of Death , Cohort Studies , Female , Follow-Up Studies , France/epidemiology , Hospitals, General/statistics & numerical data , Humans , Lung Neoplasms/pathology , Middle Aged , Neoplasm Staging , Prognosis , Sex Distribution , Smoking/adverse effects , Smoking/epidemiology , Socioeconomic Factors , Survival AnalysisABSTRACT
Aging is associated with a progressive decrease in lung function. As a consequence of aging, individual's reserve is diminished, but this decrease is heterogeneous between individual subjects. Many factors are involved in the overall decline in lung function. The prevalence of asthma in the elderly is estimated between 6 and 10%. Mortality due to COPD is increasing, especially among older subjects. Older subjects are at an increased risk of developing chronic diseases such as Parkinson's disease, which can have consequences for lung function. Under-nutrition is also common in the elderly and can produce sarcopenia and skeletal muscle dysfunction. The presentation of respiratory disorders may differ in the elderly, especially because of a lack of perception of symptoms such as dyspnea. The impact of bronchodilatators or corticosteroids on respiratory function has not been studied in the elderly. Drugs usually used for the treatment of hypertension or arrhythmias, which are often observed with aging, can have pulmonary toxicity. There is no difference between functional evaluation in younger and older subjects but it is more difficult to find predicted values for older patients. Performing pulmonary function tests in older patients is often difficult because of a higher prevalence of cognitive impairment and/or poor coordination. When assessing pulmonary function in the elderly, the choice of tests will be depend on the circumstances, with the use of voluntary manoeuvres dependent on the condition of the patient.
Subject(s)
Aging , Respiratory Function Tests/methods , Respiratory Tract Diseases/diagnosis , Aged , Algorithms , Asthma/diagnosis , Diagnosis, Differential , France/epidemiology , Humans , Predictive Value of Tests , Prevalence , Pulmonary Disease, Chronic Obstructive/diagnosis , Quality of Life , Respiratory Tract Diseases/epidemiologyABSTRACT
BACKGROUND: To improve asthma control, the management of rhinosinusitis often leads the physician to perform sinonasal imaging and/or nasal endoscopy, but their respective contributions are still insufficiently understood. OBJECTIVE: To evaluate the potential contribution of a symptoms questionnaire, sinus radiography (SR) and computed tomography (CT) scan to the diagnosis of nasal diseases in asthmatic patients when compared with ENT examination. METHODS: A total of 124 patients completed a questionnaire on nasal symptoms administered by the chest physician. Then, they underwent ENT examination. On the same day, SR and CT scans were performed independently. RESULTS: Patients (80.3%) had nasal symptoms during the month preceding the consultation. The ENT examination was normal in 8.1% (n = 10) and revealed rhinitis in 57.3% (n = 71), rhinosinusitis in 14.5% (n = 18) and nasal polyposis in 20.2% (n = 25). For rhinitis, the negative predictive value of bilateral nasal obstruction was 87.8%. Both SR and CT had low sensitivity and specificity. For rhinosinusitis, the negative predictive value of nasal symptoms varied from 85.4 to 95.2%. Sinus CT was at least as accurate as SR for the diagnosis of rhinosinusitis. In a multivariate analysis, only the CT scan (score > or =12) appeared to be significantly associated with the diagnosis of nasal polyposis. CONCLUSION: In asthmatic patients, physicians need to enquire systematically about the existence of nasal symptoms by using this simple questionnaire which is sensitive for rhinitis, and has good negative predictive value for excluding rhinosinusitis and nasal polyposis.
Subject(s)
Asthma/diagnosis , Nasal Polyps/diagnosis , Paranasal Sinuses/diagnostic imaging , Rhinitis/diagnosis , Sinusitis/diagnosis , Adult , Aged , Asthma/diagnostic imaging , Asthma/pathology , Endoscopy , Female , Humans , Male , Middle Aged , Multivariate Analysis , Nasal Polyps/diagnostic imaging , Nasal Polyps/pathology , Rhinitis/diagnostic imaging , Rhinitis/pathology , Sensitivity and Specificity , Sinusitis/diagnostic imaging , Sinusitis/pathology , Tomography, X-Ray ComputedABSTRACT
We report on one young adult male patient who had severe anaphylactoid reaction after eating cheese made from goat's milk. This allergy to goat and sheep's milk, known by the patient, gave mainly rise to oral pruritus. Cow's milk and cheese were always eaten without any incident. Labial test and specific IgE antibodies confirm goat and sheep's milk allergy without cow's milk allergy.
Subject(s)
Anaphylaxis/etiology , Cheese/adverse effects , Goats/immunology , Milk Hypersensitivity/etiology , Adult , Animals , Cattle , Female , Humans , Immunoglobulin E/blood , Immunoglobulin E/immunology , Male , Sheep/immunology , Skin TestsABSTRACT
A 37-year-old male non-smoker developed rapidly severe respiratory disease after a 3-hour exposure to hydrobromic acid fumes. An upper airway syndrome ensued with anosmia and aphonia as well as non-specific bronchial hyperreactivity, obstructive bronchiolitis (which led to a persistent respiratory volume of about 20% of the normal level with exercise-induced dyspnea) and obstructive bronchiolitis. Lung transplantation is currently being considered. When inhaled at irritant concentrations, certain toxic gases, such as chlorine, can lead to reflex apnea via laryngeal nerve reaction, limiting gas penetration into the bronchial tree. Other gases are cell toxins and can enter the deeper part of the lung before provoking irritating cough. This is what occurred for our patient who continued work in the polluted atmosphere until his severe cough obliged him to leave his job. This case is an example of cellular toxicity resulting from atmospheric gas fumes at low weakly-irritative concentrations, explaining the insidious nature of disease onset.
Subject(s)
Bronchiolitis Obliterans/chemically induced , Hydrobromic Acid/poisoning , Occupational Diseases , Respiratory Tract Diseases/chemically induced , Adult , Humans , Male , SyndromeABSTRACT
The purpose of this study was to investigate the effect of a constant infusion rate of terbutaline on circadian bronchial peak expiratory flow rate (PEFR), heart rate and arterial pressure in patients with asthma exacerbation. Fifteen hospitalized asthmatic patients (6 females and 9 males, mean age 43.3 years, mean weight 67.0 kg) were included in this study. In order to reach the desired plasma concentrations of terbutaline immediately, a pharmacokinetic simulation was done. Based on the predicted values thus obtained, an initial 5-min bolus dose of 2.94 micrograms/kg was given to all patients at 7 a.m., i.e. at the beginning of the study. Over the following 24 h (7 a.m. to 7 a.m.), 33 micrograms/kg of terbutaline was infused intravenously at a constant rate with an electric pump. Since severe acute asthma requires corticosteroids, a 40-mg injection of methylprednisolone was given to all patients at 7 a.m. PEFR, heart rate, systolic arterial pressure, side effects and plasma terbutaline levels were recorded at 7 and 10 a.m., 1, 4, 7 and 11 p.m., and 3 and 7 a.m. the following morning. Terbutaline had a significant favorable effect on asthma exacerbation but no circadian rhythm was found in PEFR. Although terbutaline was infused at a constant rate, plasma levels depended on circadian variations.
Subject(s)
Asthma/physiopathology , Hemodynamics/drug effects , Terbutaline/pharmacology , Adult , Analysis of Variance , Asthma/drug therapy , Blood Pressure/drug effects , Circadian Rhythm/drug effects , Drug Administration Schedule , Female , Heart Rate/drug effects , Humans , Infusions, Intravenous , Male , Peak Expiratory Flow Rate/drug effects , Systole/drug effects , Terbutaline/administration & dosage , Terbutaline/bloodABSTRACT
The benefit of chemotherapy for patients with disseminated non small cell lung cancer (NSCLC) is controversial. The introduction of cisplatinum in the combination chemotherapy for NSCLC gave rise to higher response rates. To study the question of the usefulness of cisplatinum-based chemotherapy in disseminated NSCLC we conducted a prospective randomized trial comparing best supportive care to vindesine + cisplatin. Between December 1985 and March 1988, 49 patients with stage IV NSCLC were enrolled. Of the 46 eligible patients 24 were in the chemotherapy group and 22 in the best supportive care group. The treatment groups were not significantly different in terms of age, performance status, histology. Toxicity on the chemotherapy arm grade 3 or more was observed in 17.5% for neutropenia, in 8.75% for vomiting. There was one death related to treatment. The overall response rate in the chemotherapy group was 41.7%. Patients of the chemotherapy group had a median survival time of 199 days and the patients of the best supportive care group had a median survival time of 73 days. The difference in survival is highly significant (p less than 0.001).
Subject(s)
Carcinoma, Non-Small-Cell Lung/drug therapy , Cisplatin/therapeutic use , Lung Neoplasms/drug therapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Non-Small-Cell Lung/epidemiology , Carcinoma, Non-Small-Cell Lung/pathology , Cisplatin/administration & dosage , Female , Humans , Lung Neoplasms/epidemiology , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Staging , Prospective Studies , Vindesine/administration & dosage , Vindesine/therapeutic useABSTRACT
Our study investigated the differential effects of continuous or unequal day-night terbutaline dosing on circadian bronchial patency, heart rate, and arterial pressure in severe acute asthma. Forty-five hospitalized asthmatic patients (19 women and 26 men, mean age 45.4 years, mean weight 63.5 kg) were included in this multicenter study. Three groups of patients (corresponding to three dosing schedules) were randomized; the three groups were comparable, since no statistically significant difference was detected in the age, weight, or peak expiratory flow values at the beginning of the study. In order to reach immediately the concentrations of terbutaline corresponding to the desired unequal day-night concentrations, a theoretical pharmacokinetic simulation was done to predict the outcome in terms of the plasma concentrations after the three dosing regimens; the results of this simulation allowed us to calculate the initial bolus dose to be given over 5 min to groups A, B, and C, i.e., 1.47, 2.94, and 4.41 micrograms/kg, respectively. This bolus was given to all patients at 0700 h, the beginning of the study.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Asthma/drug therapy , Blood Pressure/drug effects , Bronchi/physiopathology , Heart Rate/drug effects , Terbutaline/administration & dosage , Acute Disease , Adult , Analysis of Variance , Asthma/physiopathology , Bronchi/drug effects , Circadian Rhythm , Drug Administration Schedule , Female , Humans , Male , Middle Aged , Random Allocation , Terbutaline/blood , Terbutaline/therapeutic useSubject(s)
Adrenal Cortex Hormones/therapeutic use , Asthma/drug therapy , Beclomethasone/therapeutic use , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , Aerosols , Beclomethasone/administration & dosage , Beclomethasone/adverse effects , Female , Humans , Male , Time FactorsABSTRACT
Respiratory function (V.E.M.S.-C.V.) and cardiovascular function (pulse and blood pressure) were studied in 5 asthmatic patients who were given isoprenaline aerosols after I.V. injection of normal saline solution (in the first step) and acebutolol (in the second step). The respiratory function is not disturbed by acebutolol. On the other hand, the cardio-accelerating effect of isoprenaline was not neutralized by acebutolol during these two assays, but significantly reduced.