[Adherence to inhaled therapy in adult patients affected by asthma or COPD]. / Adhérence aux traitements inhalés chez les patients adultes atteints d'un asthme ou d'une BPCO.

Inhaled treatment is the cornerstone of drug treatment for the two most common chronic obstructive respiratory diseases: asthma and chronic obstructive pulmonary disease (COPD). Therapeutic adherence is essential in the management of any chronic disease. In real life, only one-third of adult patients with chronic obstructive pulmonary disease have "good adherence". In this article, we will define therapeutic adherence before describing ways to assess and improve it in patients receiving inhaled therapies.

Le traitement inhalé est la pierre angulaire de la prise en charge médicamenteuse des deux maladies pulmonaires chroniques obstructives (MPCO) les plus fréquentes : l'asthme et la bronchopneumopathie chronique obstructive (BPCO). Comme dans toute maladie chronique, l'adhérence thérapeutique est primordiale. Dans la vie réelle, seul un tiers des patients adultes souffrant d'une MPCO présente une « bonne adhérence ¼. Dans cet article, nous définirons l'adhérence thérapeutique avant de décrire les moyens de l'évaluer et de l'améliorer chez les patients bénéficiant de traitements par inhalation.

[Systemic mastocytosis and bone impact]. / Mastocytose systémique et impact osseux.

Systemic mastocytosis is a rare disease characterized by the uncontrolled clonal proliferation of abnormal mast cells in one or more extracutaneous organs. It is no longer considered a myeloproliferative neoplasia but a distinct subgroup following the review of the classification by WHO in 2016. The average age at diagnosis is 60 years regardless of gender. Bone involvement, in the broad sense, is very common and often asymptomatic. Osteoporosis or bone fragility concerns approximately 20 % of cases. The particularity of bone damage directly induced by mast cell proliferation is its heterogeneity, sometimes combining osteolysis and osteosclerosis simultaneously. This makes the interpretation of paraclinical values (bone density, biomarkers) complex and the therapeutic attitude becomes a real challenge.

La mastocytose systémique est une maladie rare se caractérisant par la prolifération clonale incontrôlée de mastocytes anormaux dans un ou plusieurs organes extracutanés. La classification par l'OMS a été révisée en 2016 et ne la considère plus comme une néoplasie myéloproliférative mais comme un sous-groupe disctint. L'âge moyen au diagnostic est de 60 ans sans distinction de sexe. L'atteinte osseuse, au sens large, est très fréquente et souvent asymptomatique. L'ostéoporose ou fragilité osseuse concerne environ 20 % des cas. La particularité de l'atteinte osseuse directement induite par la prolifération mastocytaire est son hétérogénéité, mêlant ostéolyse et ostéosclérose parfois simultanément. Cela rend l'interprétation des valeurs paracliniques (densité osseuse, biomarqueurs) complexe et l'attitude thérapeutique devient un vrai challenge.

Patient Perspectives on Nurse-led Consultations Within a Pilot Structured Transition Program for Young Adults Moving From an Academic Tertiary Setting to Community-based Type 1 Diabetes Care.

PURPOSE: We aimed to evaluate patient self-management activities, patient perceptions of the therapeutic relationship and satisfaction with nurse-led consultations as part of a structured, pilot program transitioning young adults with type 1 diabetes (T1DM) to adult-oriented community-based practices. DESIGN AND METHODS: A descriptive, cross-sectional study of patients receiving nurse-led consultations. Patients provided sociodemographic/health information, glycated hemoglobin (HbA1c) measures and completed questionnaires assessing self-management (Revised Self-Care Inventory) and the therapeutic relationship (Caring Nurse-Patient Interaction - short scale). HbA1c values were compared to guideline recommendations. RESULTS: Twenty patients participated. HbA1c was ≤7.5% in 3/14 (21%) and 5/14 (36%) exhibited poor glycemic control (≥9.5%). The greatest concordance for self-care was in relation to insulin therapy (4.5±0.5) while patients reported the lowest adherence to diet recommendations (2.9±0.8). Overall satisfaction with nurse-led consultations was high (4±0.5 out of 5). Patients considered diabetes knowledge and technical competence as very important and were most pleased with the humanistic aspects of nursing care. Respect for privacy was deemed the most important (and most frequently observed) nursing attitude/behavior during consultations. CONCLUSIONS: Young adults found the nurse-led consultations with therapeutic education to develop T1DM self-care skills are an important complement to medical management during transition. PRACTICE IMPLICATIONS: Patient autonomy and privacy should be respected during this developmental period. Nurses taking a humanistic approach towards accompanying and supporting the patient can enhance the therapeutic relationship during transition and promote continuity of care. Transition nurses can use technical competence and therapeutic education to empower patients for self-management.