[Allergenic and chemical pollutants of indoor environments and asthma: Characterization, assessment and eviction]. / Polluants allergéniques et chimiques de l'environnement intérieur et asthme : caractérisation, évaluation et éviction.

The environment of an asthmatic patient can contain numerous sources of pollutants that degrade the quality of indoor air and have major repercussions on the occurrence and control of asthma. Assessment and improvement of the quality of indoor air should be assigned a major role in pneumology and allergology consultations. Characterization of an asthmatic's environment entails a search for biological pollutants with mite allergens, mildew, and allergens resulting from the proximity of pets. It is important to evaluate the chemical pollution represented by exposure to volatile organic compounds, which are increasingly present in our lodgings. Active or second-hand smoking must in all circumstances be sought out and quantified. Assessment of the environment is mediated by several methods, of which the application depends not only on the pollutant sought out, but also on enzyme-linked immunosorbent assay (ELISA), which has an essential role in quantification of biological pollutants. Attempts at expulsion of the different indoor environment pollutants is mediated by indoor environment advisors, whose efforts are aimed at obtaining reliable evaluation and control of indoor air. Implemented as a form of tertiary prevention, their methods are conducive to improved asthma control, in adults as well as children.

[Safety culture assessment in a university pulmonary medicine department]. / Mesure de la culture de sécurité des soins dans un service universitaire de pneumologie.

INTRODUCTION: Improvement in treatment safety is a major issue in Western healthcare systems, with the aim of reducing the number of treatment associated undesirable events. The safety culture, defined as an integrated and coherent collection of individual and organizational behavior that seeks continuously to reduce harm to patients, possibly related to treatment, could fulfill this aim. METHODS: We have used an adaption of the American "Hospital Survey on Patient Safety" questionnaire (HSOPSC), which examines professionals' perception of treatment safety, to assess the safety culture in our respiratory medicine service in the Strasbourg University Hospital. RESULTS: Of the 110 questionnaires distributed to the service personnel, 93 were returned (85 %). The level of treatment safety was judged "acceptable" for 56 % of the personnel, "very good" for 32 %, against "weak" or "failing" for 10 %. Of the 10 dimensions explored, 8 were considered to need improvement and 2 had a level of positive responses greater than 50 %. CONCLUSIONS: Treatment safety culture seems to be an area to develop in our service. A strong safety culture should allow health care professionals to adhere better to treatment safety mechanisms.

Noninvasive methods for assessment of airway inflammation in occupational settings.

The present document is a consensus statement reached by a panel of experts on noninvasive methods for assessment of airway inflammation in the investigation of occupational respiratory diseases, such as occupational rhinitis, occupational asthma, and nonasthmatic eosinophilic bronchitis. Both the upper and the lower airway inflammation have been reviewed and appraised reinforcing the concept of 'united airway disease' in the occupational settings. The most widely used noninvasive methods to assess bronchial inflammation are covered: induced sputum, fractional exhaled nitric oxide (FeNO) concentration, and exhaled breath condensate. Nasal inflammation may be assessed by noninvasive approaches such as nasal cytology and nasal lavage, which provide information on different aspects of inflammatory processes (cellular vs mediators). Key messages and suggestions on the use of noninvasive methods for assessment of airway inflammation in the investigation and diagnosis of occupational airway diseases are issued.

[Pharmacists' role in the management of asthma: a survey of 120 pharmacists in Bas-Rhin]. / Prise en charge de l'asthme à l'officine: enquête auprès de 120 pharmaciens du Bas-Rhin.

INTRODUCTION: The pharmacist plays an essential role in the management of the asthmatic patients on account of their frequent visits to the pharmacy to obtain their medication. METHODS: In order to evaluate the practice and knowledge of asthma among the pharmacists of the department of Bas-Rhin, 120 pharmacists were selected at random to reply to a standardised questionnaire. RESULTS: The 86 pharmacists who replied to the questionnaire had a good general understanding of asthma and its treatment. However, only 26.4% knew all the criteria of the severity of an attack of asthma. Among the 57 pharmacists who gave a demonstration of the use of inhaler devices, 16.3% showed all the steps in the use of a metered dose aerosol. These results are comparable to those of non-specialist doctors and nurses in whom poor techniques were found in 63-100% and 65-96% respectively. The mean scores of the pharmacists were 10.5/12 (+/- 1.2) steps for metered dose aerosols, 10.4/11 (+/- 1.0) for the Tubuhaler, 9.3/12 (+/- 1.7) for the Autohaler and 8.1/9 (+/- 0.9) for the Volumatic spacer. The asthmatic patient's main expectation of the pharmacist concerned the use of the prescribed systems (87.2%), underlining the lack of information received by the patient at the time of prescription. CONCLUSIONS: An improvement in the knowledge of the signs of severity of asthma and the use of inhaled devices could usefully be one of the objectives in the training of a dispensing pharmacist.

Dust and airborne exposure to allergens derived from cockroach (Blattella germanica) in low-cost public housing in Strasbourg (France).

BACKGROUND: Although a strong association between allergy to cockroach (CR) and asthma has been observed in the United States and Asia, there are little data about the extent of exposure to CR allergen in Europe. OBJECTIVE: To determine the levels of CR allergens in dust samples from apartments in Strasbourg and to determine the concentration and size of CR allergens in the air. METHODS: Nine apartments in a public housing complex were chosen on the basis of visual evidence of CR infestation. Levels of CR allergens (Bla g 1 and Bla g 2) in kitchen and mattress dust samples were measured by immunoassay with the use of monoclonal antibodies. Air was sampled for 3 to 8 hours in the kitchen under undisturbed conditions, during artificial disturbance, and during normal domestic activity by using an impinger and a parallel glass fiber filter and at flow rates of 2 to 20 L/min. Airborne CR and mite allergens were measured concurrently in the bedroom of one apartment before, during, and after artificial disturbance. RESULTS: High levels of Bla g 1 and Bla g 2 were found in kitchen dust from the nine apartments (geometric means of 3919 U/gm [range 530 to 14306 U/gm] and 497 U/gm [range 73 to 1946 U/gm], respectively). Under undisturbed conditions, airborne CR allergens were not detectable in any of the apartments. During vigorous artificial disturbance, Bla g 1 and Bla g 2 were detectable in air samples from seven apartments (geometric means of 4.5 U/m3 [range 0.7 to 17.2 U/m3] and 1.0 U/m3 [range 0.4 to 3.4 U/m3], respectively). Both allergens were predominantly collected on the first stage of the impinger, and 76% to 80% of the airborne allergen was associated with particles greater than 10 microns in diameter. The levels were significantly higher than those collected on the second or third stages of the impinger (p < 0.001). A comparison of the levels of mite and CR allergens showed that the airborne properties of these allergens were similar, that is, measurable only during disturbance and not detectable 30 minutes after disturbance. CONCLUSION: Levels of CR allergen in low-cost public housing in Strasbourg can be as high as or higher than the levels measured in towns in the United States. CR allergens become airborne during disturbance and are primarily associated with particles greater than 10 microns in diameter. Patients with asthma living in urban areas of Europe in housing prone to CR infestation should be evaluated for sensitization and exposure to CR allergens.