[Updated indications and contraindications in 2022 for lung transplantation in France]. / Transplantation pulmonaire en France : actualisation des indications et contre-indications en 2022.

Lung transplantation (LTx) is the last-resort treatment for end-stage respiratory insufficiency, whatever its origin, and represents a steadily expanding field of endeavor. Major developments have been impelled over the years by painstaking efforts at LTx centers to improve donor and recipient selection, and multifaceted attempts have been made to meet the challenges raised by surgical management, perioperative care, and long-term medical complications. The number of procedures has increased, leading to improved post-LTx prognosis. One consequence of these multiple developments has been a pruning away of contraindications over time, which has, in some ways, complicated the patient selection process. With these considerations in mind, the Francophone Pulmonology Society (Société de Pneumology de Langue Française [SPLF]) has set up a task force to produce up-to-date working guidelines designed to assist pulmonologists in managing end-stage respiratory insufficiency, determining which patients may be eligible for LTx, and appropriately timing LTx-center referral. The task force has examined the most recent literature and evaluated the risk factors that continue to limit patient survival after LTx. Ideally, the objectives of LTx are to prolong life while improving quality of life. The guidelines developed by the task force apply to a limited resource and are consistent with the ethical principles described below.

[How to improve patient's access to Respiratory Rehabilitation?] / Comment améliorer l'accès des patients à la réadaptation respiratoire ?

Despite effectiveness and clear international guidelines, respiratory rehabilitation remains underutilized: less than 15% of suitable patients in France and worldwide receive this treatment. The factors of this lack of referral and uptake have been studied and are not limited to a problem of quantitative adequacy of supply and demand. The lack of knowledge of health professionals, patients, payers, heterogeneous programs which does not necessary correspond to the needs of the patient (modalities, geography, duration), the lack of trained and available professionals, the profile of patients and prescribers and the quality of the programs are identified as potentially hindering the completion of a rehabilitation program. It is essential to analyze these barriers and to find solutions to the greatest number of respiratory patients can benefit optimal healthcare and integrate into a coherent care planning.

Long-term effects of pulmonary rehabilitation on daily life physical activity of patients with stage IV sarcoidosis: A randomized controlled trial.

INTRODUCTION: Pulmonary rehabilitation (PR) is known to improve exercise tolerance, mood, and quality of life in patients with chronic respiratory diseases. The aim of this work was to determine whether PR provides long-term benefits in increasing daily life physical activity in patients with chronic sarcoidosis. METHODS: This randomized prospective study (registered ClinicalTrials.gov NCT02044939) of 38 patients with stage IV chronic sarcoidosis was performed between 2012 and 2016. Patients were assigned to participate in a 2-month PR program (n=20) or receive counseling (n=18). Assessments were performed at baseline, 2 months (end of the PR program), 6months, and 12months, and included daily life physical activity parameters (measured for 5 consecutive days), exercise tolerance, dyspnea, anxiety, depression, fatigue, and quality of life. The primary outcome was the 12-month change in time spent in activities above an estimated energy expenditure of 2.5metabolic equivalents (METs). Secondary daily life physical activity outcomes included number of steps per day, total daily energy expenditure, and total energy expenditure above 2.5METs. RESULTS: The primary outcome did not differ between the two groups; mean between-group differences were -13.2min (95% confidence interval [CI]: -76.3 to 49.8) at 6 months and -18.1min (95% CI: -55.7 to 19.4) at 12months. Although PR had no effect on secondary daily life physical activity outcomes, it did significantly increase exercise tolerance at 6 and 12 months and decrease the dyspnea score at 6 months and the fatigue score at 12months. CONCLUSION: This trial failed to demonstrate a beneficial effect of PR on daily life physical activity in sarcoidosis patients, suggesting that long-term behavioral programs may be necessary to complement PR.

Management of acute exacerbations of chronic obstructive pulmonary disease (COPD). Guidelines from the Société de pneumologie de langue française (summary).

Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.

[Manifestations and diagnosis of extrapulmonary tuberculosis]. / Manifestations et diagnostic de la tuberculose extrapulmonaire.

Extra pulmonary tuberculosis currently represents 25 per cent of notified tuberculosis in France. All organs can be involved but the most frequent localisation are the lymph nodes. Immunodepressed patients notably those infected with HIV are particularly prone to a polyvisceral tuberculous infection. The diagnosis is often difficult on account of the polymorphism of the disease and the weak specificity of the clinical manifestation. A firm diagnosis always rests on histological or microbiological evidence. Certain recent developments should enable a more rapid microbiological diagnosis notably as a result of development in molecular biology and rapid culture techniques. The mortality and morbidity remain elevated in developing counties as in industrialised counties and clinical situations in which extra pulmonary tuberculosis occur often worsen the prognosis.

[Tuberculosis in a Parisian pneumology department: 151 cases]. / La tuberculose dans un service de pneumologie parisien: 151 cas.

OBJECTIVES: The incidence of tuberculosis has risen since 1992. We studied cases observed in our department to search for factors favouring this increased incidence. METHODS: A retrospective assessment of 151 cases of tuberculosis observed over a 3 year period in a department of pneumology in Paris was performed. RESULTS: Fifty-two percent of the patients were foreigners; 66% lived in a poor socio-economic environment included 18% with no permanent residence; 29% were alcoholics. An association with human immunodeficiency virus infection was seen in 7% of the cases. Another immunodepression factor was found in 15%. Tuberculosis was discovered in a context of respiratory distress in 7% or the patients. Outcome was fatal in 6%. Three months after diagnosis 22% of the patients were lost to follow-up. CONCLUSION: This series emphasizes the major role of socio-economic factors in the rising incidence of tuberculosis and the need for urgent and adapted measures for therapeutic management in an often non-compliant and socially instable population.

Influence of socioeconomic status on features and outcome of community-acquired pneumonia.

The influence of socioeconomic status on the features and evolution of community-acquired pneumonia in 107 consecutive hospitalized patients was investigated. Thirty-four (31.8%) patients were considered to have a low socioeconomic status. These patients were more likely immigrants, middle-aged, with fewer comorbid illnesses, and were more often tobacco, alcohol, or drug consumers (P<0.01). The distribution of etiologies was significantly different according to socioeconomic status, with tuberculosis occurring more frequently in the low socioeconomic group (P < 0.05). Low socioeconomic status was not associated with a more severe presentation or outcome of pneumonia but was an independent factor that predicted a significantly longer length of hospitalization (5.9 days longer; 95% confidence interval, 2.2-9.5 days; P<0.003), entailing a substantial excess cost per hospital stay.

Mycobacterium xenopi pulmonary infection in an HIV infected patient under highly active antiretroviral treatment.

Highly active antiretroviral therapy (HAART) is responsible for a striking reduction in AIDS related morbidity and mortality by partly restoring immune function. However, HAART can also precipitate the development of clinically apparent opportunistic infections in patients with latent infections. We report a case of an HIV infected patient who developed granulomatous nodular and cavitatory lesions of the lungs due to Mycobacterium xenopi as a manifestation of the immune restoration syndrome.

Mycobacterium xenopi pulmonary infection in an HIV infected patient under highly active antiretroviral treatment.

Highly active antiretroviral therapy (HAART) is responsible for a striking reduction in AIDS related morbidity and mortality by partly restoring immune function. However, HAART can also precipitate the development of clinically apparent opportunistic infections in patients with latent infections. We report a case of an HIV infected patient who developed granulomatous nodular and cavitatory lesions of the lungs due to Mycobacterium xenopi as a manifestation of the immune restoration syndrome.