[Long term survival in chronic obstructive pulmonary disease after ventilation in intensive care]. / Survie à long terme des bronchopathes chroniques obstructifs après la réanimation.

OBJECTIVE: To compare the one year survival after discharge from ICU of patients with chronic obstructive pulmonary disease (COPD) admitted for acute hypercapnic respiratory failure and who required mechanical ventilation. METHODS: Retrospective cohort study on 130 patients, 52 patients were treated with non-invasive ventilation (NIV) and 78 patients with conventional mechanical ventilation (CMV). RESULTS: In 73 patients the cause for respiratory failure could not be identified. Long-term survival was significantly better following NIV than with CMV (p=0.02 by log-rank testing), but the better prognosis associated with use of NIV was not found in patients with no documented cause for the respiratory failure. After adjusting for male gender, age>65 years, simplified acute physiology score II>35, prior long-term home oxygen therapy, treatment with steroids, FEV1<30% of predicted value, body-mass index<21 kg/m2, albumin level<30 g/L, right ventricular failure, ventilator-associated pneumonia and cause of respiratory failure, NIV remained independently associated with better outcomes (adjusted hazard ratio 0.55; 95% CI 0.31-0.97; p=0.04). CONCLUSIONS: Our results suggest that in COPD patients requiring mechanical ventilation and who survived after an ICU stay, the use of NIV is an independent factor associated with a better long-term survival, especially in those with a documented cause of respiratory failure.

[Hypersensitivity pneumonitis presenting as acute respiratory distress syndrome]. / Pneumopathie d'hypersensibilité révélée par un syndrome de détresse respiratoire aiguë.

INTRODUCTION: Hypersensitivity pneumonitis (HP) are typically subacute in their presentation and the diagnosis may be difficult. METHOD: We report a case of a hypersensitivity pneumonitis in a 27-years-old woman, caused by exposure to mould in an insalubrious mobile home. The initial presentation was with acute respiratory distress syndrome complicating RSV pneumonia, treated with ribavirin and corticosteroids in winter 2013-2014. The diagnosis of hypersensitivity pneumonitis was based on clinical and radiological relapse occurring during winter 2014-2015 with confirmed exposure to antigen with fungal sampling at home, respiratory deterioration with antigen rechallenge and a compatible chest CT-scan. CONCLUSION: The diagnosis of hypersensitivity pneumonitis should be considered in similar cases. Treatment is based mainly on removing exposure to the causative antigen.

[Search for the T790M mutation: The need to persevere]. / Recherche de la mutation T790M : savoir persévérer.

In cases of advanced EGFR mutation-positive non-small cell lung cancer, first or second generation EGFR-tyrosine kinase inhibitors (TKI-EGFR 1G or TKI-EGFR 2G) are recommended as first line treatment. Inexorably, progressive disease occurs and, in 50-60% of the cases, is secondary to a T790M resistant mutation. The prescription of osimertinib (TKI-EGFR3G) in second line is dependent on identification of the T790M mutation. We report 7 cases in which the identification of the T790M mutation required repeated analyses of cell free DNA and/or biopsies over a period of time. In some cases, a positive result was obtained a long time after progressive disease had been diagnosed during treatment with first or second generation EGFR-TKI. We discuss here the different modalities of screening for the T790M mutation and we encourage persevering in this search when no alternative mechanism of resistance has been identified.

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.

[Relationship between primary lung cancer and tobacco consumption. Results of the KBP-2010-CPHG study by the French College of General Hospital Respiratory Physicians]. / Relation entre cancer bronchique primitif et consommation tabagique. Résultats de l'étude KBP-2010-CPHG du Collège des pneumologues des hôpitaux généraux.

INTRODUCTION: The Collège des Pneumologues des Hôpitaux Généraux has performed a prospective multicentre epidemiological study which aims to describe the baseline characteristics of all new cases of primary lung cancer histologically or cytologically diagnosed in 2010 and followed-up in the respiratory department of general hospitals. The present publication compares the characteristics of these presentations according to their smoking history. METHODS: Seven thousand and fifty-one adult patients were included from 104 respiratory departments. A standardized form was completed at diagnosis and a steering committee checked the completeness of inclusion. RESULTS: Only 10.9% of patients were never-smokers and 89.1% ever-smokers (i.e., current or former smokers). Respectively, 3.7%, 10.7% and 85.6% of ever-smokers consumed/had consumed 1-10, 11-20, and >20 pack-years. Mean smoking duration was 37.5 years. Former smokers had stopped smoking on average 14.8 years previously. Only 20.7% of never-smokers reported that they had been exposed to tobacco smoke passively. At diagnosis, statistically significant differences were found between never- and ever-smokers (P<0.0001) for sex (women: 60.8% vs 18.8%), age (mean: 70.7 years vs 64.9 years), stage (IV: 70.8% vs 58.7%), histology (adenocarcinoma: 68.5% vs 42.6%), EGFR mutation exploration (51.4% vs 28.0%) and positivity (37.0% vs 4.6%). Differences between never- and ever-smokers rose with increasing tobacco consumption. CONCLUSIONS: This study confirms that differences exist between never- and ever-smoker patients presenting with primary lung cancer and shows the impact of the level of tobacco consumption, in particular on histology.

[Pain management, let us be simple but efficient]. / Prise en charge de la douleur, soyons simple mais efficace.

The occurrence of pain during the course of bronchial carcinoma is nearly inescapable and often constitutes the main symptom for patients and those close to them. While pain control is held to be a priority of care in cancerology in the future, this goal is not always reached due to insufficient implementation of recommendations, however widely accessible. Our aim is to present the different aspects of pain treatment through the details of both pharmacological and nonpharmacological means.

Respiratory manifestations of leptospirosis: a retrospective study.

We retrospectively reviewed 34 consecutive patients with serologically confirmed leptospirosis admitted during years 1992-2002. Nine patients (26.5%) had respiratory symptoms on admission including cough (n = 4), shortness of breath (n = 4), cyanosis (n = 2), and hemoptysis (n = 1). Six patients had pulmonary radiographic findings including (1) diffuse, ill-defined, ground-glass density (n = 3); (2) diffuse alveolar opacities (n = 2); and (3) small nodular density (n = 1). Male/female ratio was 8/1 and mean age was 47 years. Seven patients reported their exposure source including hunting (n = 2), fishing (n = 2), fresh water swimming (n = 2), and canoeing (n = 1). All patients had fever (mean = 40.1 degrees C). Other common symptoms were headache (n = 4), vomiting (n = 3), and myalgia (n = 3). Biological abnormalities included elevated liver enzymes (n = 8), proteinuria (n = 7), lymphopenia (n = 6), hematuria (n = 5), renal failure (n = 4), anemia (n = 4), and elevated neutrophil count (n = 4). PaO(2 )was measured for 3 patients while they were breathing room air (32, 55, and 66 mmHg). Suspected diagnosis on admission included leptospirosis (n = 2), bacterial pneumonia (n = 2), intoxication, influenza, viral hepatitis, biliary tract lithiasis, and rapidly progressive glomerulonephritis (one patient each). The first serologic testing for leptospirosis was positive for 5 patients (55%). Serovar was presumptively identified for 7 patients: Australis (n = 3), Grippotyphosa (n = 2), and Icterohaemorrhagiae (n = 2). Seven patients were treated with penicillin; two patients received no antibiotics. All patients were cured. In conclusion, patients with leptospirosis may present predominantly with nonspecific pulmonary symptoms. In these patients, leptospirosis must be suspected when there is a potential exposure to rats, especially in case of high-grade fever, myalgia, hepatitis, and renal abnormalities.