[Pulmonary medicine: asthma, chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis]. / Pneumologie: asthme, bronchopneumopathie chronique obstructive et fibrose pulmonaire idiopathique.

Important changes have been proposed by expert groups for the management of mild asthma and chronic obstructive pulmonary disease (COPD): for safety reasons, short-acting beta-2 agonists (SABA) are no longer recommended as «â€…reliever therapy ¼ in mild asthma, and should be replaced by symptom-driven inhaled corticosteroids, alone or combined with a beta-2 agonist ; for COPD patients recommendations as to use of inhaled corticosteroids have been redefined. New therapeutic options for idiopathic pulmonary fibrosis are being evaluated: recombinant human pentraxin 2 may become a new therapeutic option among the existing specific treatments (pirfenidone, nintedanib). These novelties are discussed in this review of the recent medical literature.

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.

Safety and Efficacy of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Used for Analgesia After Bariatric Surgery: A Retrospective Case-Control Study.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are cornerstone in multimodal analgesia protocols. This point is of great value in morbidly obese patients due to the high prevalence of restrictive pulmonary disease and obstructive sleep apnea. The aim of this study was to test the hypothesis that NSAIDs do not increase acute bariatric surgery complications while optimizing postoperative analgesia. METHODS: Databases of two medical centers were retrospectively reviewed to find all patients who underwent bariatric surgery between 1 January 2017 and 31 December 2017. Inclusion criteria were BMI greater than 30 kg/m2 and age of 16-75 years old. Patients who suffered from severe organ failure or coagulation disorders were excluded. Patient's demographics, obesity-related diseases (diabetes, hypertension, dyslipidemia), postoperative pain scores, and morphine consumption in PACU, as well as early and late surgical complications, were collected. Patients included from the first institution (where NSAIDs analgesia was prohibited: control group) were compared to patients from the second institution (where NSAIDs analgesia was mandatory: case group). RESULTS: The study population included 270 patients, 134 in the control group, and 136 in the case group. NSAIDs usage produced better analgesia with significant reduction in morphine consumption and PACU length of stay. Also, incidence of surgical complications was the same in the two groups. CONCLUSIONS: NSAIDs administration do not increase postoperative complication rate after bariatric surgery. Although NSAID administration provided better analgesia and shorter PACU stay, future prospective studies are needed to confirm these encouraging results and to evaluate their impact on postoperative rehabilitation.

[Transbronchial cryobiopsies : a minimally invasive tool for the diagnosis of interstitial lung disease]. / 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.

Le diagnostic des pneumopathies interstitielles (PI) est complexe et repose sur l'analyse d'éléments cliniques, radiologiques et parfois histologiques dans le cadre d'une discussion multidisciplinaire. Pour l'obtention de biopsies pulmonaires, les cryobiopsies transbronchiques constituent une nouvelle méthode minimalement invasive, alternative aux biopsies chirurgicales. Leur très bonne performance diagnostique et leur profil de sécurité favorable expliquent l'intérêt grandissant pour cette technique qui pourrait permettre de diminuer le nombre de patients n'ayant pas de diagnostic définitif établi et de traitement adapté. Des études restent encore nécessaires, au sein de centres experts, afin de standardiser les modalités pratiques de cette technique et de déterminer sa place dans l'algorithme de prise en charge des PI.

ALK-rearranged adenocarcinoma transformed to small-cell lung cancer: a new entity with specific prognosis and treatment?

Driving molecular mutations such as rearrangement of ALK and EGFR mutation is present in 5-10% of non-small-cell lung cancer. Tyrosine kinase inhibitors have shown good efficacy and thus become the standard of care. However, tumors have developed several resistance mechanisms against tyrosine kinase inhibitors, including transformation to small-cell lung carcinoma (SCLC). Transformation to SCLC after administration of anti-EGFR in EGFR-mutated adenocarcinoma has been well documented. Similarly, it appears that the same transformation happens in ALK-rearranged adenocarcinoma after the use of anti-ALK. In fact, to date eight cases have been reported in the literature. We aimed in this paper to focus on the characteristics, prognosis and treatment of these transformed SCLC.

[Pulmonary diseases. Asthma, COPD and sleep apnea syndrome]. / 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.

Parmi les nouveautés thérapeutiques en pneumologie au cours de l'année 2017, nous avons choisi de mettre l'accent sur trois d'entre elles. Tout d'abord, le rôle revisité des corticostéroïdes inhalés dans la BPCO, étant donné le risque accru de pneumonies associé à leur utilisation : leur sevrage est recommandé et leur rôle relégué en 2e ligne, lors de BPCO sévère chez des exacerbateurs fréquents (GOLD D). Ensuite, le rôle de l'azithromycine dans l'asthme sévère incontrôlé : ce traitement semble très prometteur pour un meilleur contrôle des symptômes et des exacerbations. Enfin, en dépit de l'association entre morbidité cardiovasculaire et syndrome d'apnées du sommeil, la prescription d'une PPC chez des sujets asymptomatiques en prévention primaire ou secondaire est remise en question.

[Living with bronchiectasis]. / 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.

La prévalence des bronchiectasies ou dilatations des bronches (DDB) ne cesse d'augmenter. Cette maladie respiratoire chronique a une morbidité considérable, aboutit à une importante consommation de ressources de santé et impacte significativement la qualité de vie. Des variables physiologiques, microbiologiques et la fréquence des exacerbations sont utiles dans l'évaluation initiale et le suivi des patients atteints de DDB. Regroupées sous la forme de scores et associées à l'étendue des bronchiectasies au scanner thoracique, ces variables permettent d'anticiper les hospitalisations et de préciser le pronostic vital de ces patients. L'évaluation de leur qualité de vie ne peut pas reposer sur des mesures de paramètres physiologiques, mais requiert des questionnaires spécifiquement développés à cet effet.