[Case report of severe acute eosinophilic pneumonia induced by amoxicillin]. / Une forme sévère de pneumopathie aiguë à éosinophiles liée à l'amoxicilline.

INTRODUCTION: Acute eosinophilic pneumonia (AEP) is a rare and potentially severe disorder, characterized by an acute febrile respiratory illness with diffuse pulmonary infiltrates, pleural effusions and an eosinophilic alveolitis identified on broncho-alveolar lavage or lung biopsy. The condition can be idiopathic, or induced by the inhalation of toxic substances, by infections or by medications. The condition tends to respond rapidly to treatment with systemic steroids. CASE REPORT: We report the case of a 16-year old patient who presented severe acute interstitial pneumonia with eosinophilia (1.17g/L). They had taken a seven-day course of amoxicillin treatment two weeks previously for a dental abscess. The patient initially required respiratory support by mechanical ventilation followed by extracorporeal membrane oxygenation due to severe refractory hypoxemia. After exhaustive investigation a diagnosis of amoxicillin-induced acute eosinophilic pneumonia was made. After steroid treatment was initiated the clinical response was rapidly favorable and remission was achieved. The patient has been advised to avoid beta lactam antibiotics for life. CONCLUSION: This case illustrates a rare case of severe acute eosinophilic pneumonia induced by amoxicillin.

[Telemonitoring in continuous positive airway pressure-treated patients with obstructive sleep apnoea syndrome: An algorithm proposal]. / Télésuivi des patients traités par pression positive continue pour un syndrome d'apnées/hypopnées obstructives du sommeil : proposition d'un arbre décisionnel.

Most of the continuous positive airway pressure (CPAP) devices currently in use allow telemonitoring of observance, leaks and the apnoea-hypopnoea index (AHI). La Société française de recherche et de médecine du sommeil (SFRMS) and La Société de pneumologie de langue française (SPLF) workgroup offer to CPAP prescribers and to home care providers a scientific document which has the following purposes: to underline the relevance of the telemonitoring of leaks and the AHI, to define alert thresholds, to describe the principal mechanisms generating excessive leaks and high AHI, and to propose a diagnostic algorithm.

[Effects of smoking on the thyroid gland, digestive system, kidney and bone]. / Effets du tabagisme sur la thyroïde, le tube digestif, le rein et l'os.

INTRODUCTION: In addition to being a major cardiovascular risk factor, smoking promotes or worsens thyroid, digestive, renal and bone diseases. BACKGROUND: Smoking is positively associated with hyperthyroidism. It is associated with Graves' disease and it especially increases the risk of the development of severe exophthalmos. In contrast, smoking might exert a protective action for thyroid carcinoma. Smoking increases the severity of hepatic lesions in patients with chronic hepatitis C. Smoking accelerates the progression of primary biliary cirrhosis and increases the risk of hepatocellular carcinoma. Smoking increases risk of both hyperplastic and adenomatous polyps. While Crohn's disease is associated with smoking, ulcerative colitis is largely a disease of non smokers. Smoking increases risk of development of both renal cell carcinoma and chronic nephropathies, particularly in types 1 and 2 diabetes. Smoking is a risk factor for decreased bone density and is associated with a significantly increased risk of fracture. Smoking is related to the development of rheumatoid arthritis and may adversely influence its severity. CONCLUSIONS: Smoking might be considered a risk factor for the development of several thyroid, digestive, renal and bone diseases. Consequently, smoking prevention and cessation programs must be strongly encouraged among the patients concerned.

[Obstructive sleep apnoea syndrome (OSAS) in women: a specific entity?]. / Pathologie pulmonaire au féminin: le SAOS de la femme, une entité particulière?

Despite a variable prevalence in the literature, OSAS is characterized by a higher frequency in men. This study involved a review of published data describing the impact of gender on features of OSAS. In women, OSAS seems to be associated with certain anatomical factors such as more significant obesity, a thinner oropharyngeal junction, a shorter uvula and reduced upper airway (UA) collapsibility, in comparison with men. Sleep related breathing disorders observed during pregnancy are more likely UA resistance syndrome than true OSAS, and are associated with severe fetal and maternal complications that could be improved by the use of nasal CPAP. Though OSAS symptoms are underestimated by women, the Epworth score as well as snoring are not influenced by gender. Gender does not seem to be a risk factor for increased mortality. Compliance with nasal CPAP is identical in both sexes, but oral appliance seem to be more effective in women. Further studies are needed to produce the required complementary data to confirm specific sex-related features in the diagnosis and treatment of OSAS.

[Alveolar hemorrhage and cocaine use]. / Hémorragies intra-alvéolaires et consommation de cocaïne.

In France, cocaine is the second most commonly illicit drug used after cannabis. Cocaine, mainly smoked in the form of crack, can be responsible for a wide range of respiratory disorders. The aim of this systematic literature review was to clarify what is known about the link between cocaine use and alveolar hemorrhage. We performed a Medline search covering the period 1980-2016 and collected data from 84 articles. The number of acute forms described in the literature is small but postmortem studies show that hidden forms are frequent. The diagnosis is based on the association of hemoptysis, anemia and diffuse alveolar opacity. Bronchoalveolar lavage shows hemosiderin-laden macrophages. Of the 13 cases identified, 12 patients had hemoptysis, anemia and diffuse alveolar infiltration on pulmonary or chest CT. In 9 cases, the presence of hemosiderin-laden macrophages was identified in bronchoalveolar lavage or pulmonary biopsy. Except for 2 deaths, the outcome was favorable when cocaine use was stopped. Systematic interventions to help people stopping using this psychoactive substance will protect lung health.

Evaluation of autoCPAP devices in home treatment of sleep apnea/hypopnea syndrome.

BACKGROUND AND PURPOSE: Quality of life (QOL) and sleepiness for patients with sleep apnea/hypopnea syndrome (SAHS) might improve with continuous positive airway pressure devices working in auto-adjust mode (autoCPAP) by allowing pressure modulations following patient needs. Clinical comparisons between devices driven by different algorithms are needed. METHODS: We compared the clinical effectiveness of fixed pressure CPAP and four different autoCPAP devices by assessing compliance and QOL (36-item short-form health survey [SF-36]). SAHS patients were randomly allocated to five groups. Polysomnography (PSG) was performed to titrate the effective pressure in the constant CPAP group and evaluate residual apnea/hypopnea index (AHI) under autoCPAP. Follow-up consisted of clinical visits at three and six months by homecare technicians who assessed compliance, symptom scores and SF-36 scores. A laboratory-based PSG using the same CPAP/autoCPAP device as at home was performed at six months. RESULTS: Eighty-three patients (mean age 56+/-10 yrs) with mean body mass index (BMI) 30.8+/-5.3 kg/m(2) and severe SAHS (mean AHI: 52.3+/-17.8/h) were included. There were no differences in clinical symptoms or QOL scores, and similar clinical and PSG improvements were seen in all groups. CPAP use was >5 h per night, without any significant difference between groups. CONCLUSIONS: AutoCPAP is equally as effective as fixed CPAP for long-term home treatment in severe SAHS patients.

A multicentre trial of education strategies at CPAP induction in the treatment of severe sleep apnoea-hypopnoea syndrome.

BACKGROUND AND PURPOSE: Compliance with continuous positive airway pressure (CPAP) treatment in obstructive sleep apnoea syndrome (OSAS) may be difficult. Patient education is important but strategies and their outcomes are not clear. PATIENTS AND METHODS: We studied the effects of four education strategies on compliance and quality of life changes with CPAP treatment in seven centres in the French ANTADIR homecare network. Patients received from prescribers either a simple oral explanation (SP) or an oral and written explanation (RP) of CPAP use. In addition, they received from homecare technicians either a single home visit (SH) at CPAP onset or repeated home visits at CPAP onset and at 1 week, 1 month and 3 months after (RH). Compliance and quality of life were evaluated at CPAP onset, and at 3, 6 and 12 months after initiation of treatment. RESULTS: One hundred twelve patients with severe OSAS (mean age 58+/-11 year, apnoea-hypopnoea index 58+/-25/h) were allocated randomly to groups (SP+SH; SP+RH; RP+SH; RP+RH) with no initial differences. Quality of life, evaluated by the generic SF-36 questionnaire, improved in the combined emotional domains. Compliance was over 5h in all four education groups. These effects were sustained over 12 months and were not different between the four groups. We conclude that standard education strategies for CPAP induction in France are sufficient for good compliance and improved quality of life with CPAP. Education with reinforced input should be focussed on identified subgroups prone to problems.

[Obstructive Sleep Apnea Syndrom during pregnancy: prevalence of main symptoms and relationship with Pregnancy Induced-Hypertension and Intra-Uterine Growth Retardation]. / Le syndrome d'apnées du sommeil pendant la grossesse: prévalence des symptômes cliniques et corrélation avec la pathologie vasculaire gravidique.

OBJECTIVE: To investigate the frequency of main symptoms of Obstructive Sleep Apnea Syndrom (OSAS) and their relationship with Pregnancy Induced-Hypertension (PIH) as well as Intrauterine Growth Retardation (IGR) as suggested by recent studies. METHODOLOGY: Four hundred (and) thirty-eight enquiry forms completed during post-partum period were analysed, after exclusion of multiple pregnancies. Collected data were demographic characteristics, obstetrical events, sleep disorders during last trimester, screening of snoring and vigilance troubles with an Epworth score. RESULTS: Forty-five percentages of the patients reported to have habitual snoring during pregnancy. Among these, 85% were non-snorers before pregnancy. Daytime somnolence concerned 84,5% of the population with an Epworth score significatively increased (P<0,0001). The prevalence of PIH was found to be 4,5%, with two apparently independent risk factors: the body mass index (OR=1,1) and an association between snoring and increased vigilance trouble (OR=2,6). No statistical difference was found concerning IGR. CONCLUSIONS: SAS symptoms are frequent during pregnancy and snoring appears to be linked with PIH. However, polysomnographic data are not yet sufficient to explain pathophysiological mechanisms and find relevant diagnostic markers during pregnancy.

[Cigarette smoking and sleep disturbance]. / Tabagisme et troubles du sommeil.

INTRODUCTION: Sleep disturbances may make smoking cessation more difficult and relapses more frequent. STATE OF THE ART: Nicotine increases vigilance and decreases sleeping time. Cigarette smoking is associated both with difficulty initiating and maintaining sleep. The disruption is associated with arousals on EEG recordings. Smoking promotes snoring and obstructive sleep apnoea. Insomnia is recognised as one of the criteria for nicotine withdrawal syndrome. Awakening from sleep and daytime sleepiness can occur frequently in this situation and are predictive factors for relapse. Nicotine replacement therapy itself induces frequent awakenings, a decrease in total sleep duration, early morning waking, dreams and sometimes nightmares with associated arousals on EEG. Sleep disruption is the most common side effect observed with bupropion when used as an aid in smoking cessation. PERSPECTIVES: Sleep disturbance must be taken into account in smoking cessation programs. More detailed investigations are needed, both clinical studies looking at measures of the main sleep parameters using sleep diaries and more detailed studies using polysomnography. CONCLUSION: In smokers, sleep disturbances must be taken into account, because they increase cardio-vascular and cerebro-vascular morbidity. During smoking cessation, relieving these disturbances should make quitting easier and prevent relapses.

[Influence of smoking among family physicians on their practice of giving minimal smoking cessation advice]. / Influence du tabagisme des médecins généralistes sur leur pratique du conseil minimal d'aide à l'arrêt du tabac.

INTRODUCTION: The aim of the study was to establish whether family physicians are influenced by their own smoking habits when issuing prevention messages to patients who smoke. METHODS: 257 Family physicians of the Vienne Department answered a survey (participation rate: 70%) investigating their own smoking habits and how they approach patients who smoke. RESULTS: The prevalence of smoking among respondents was 26%; 30% were ex-smokers and 44% had never smoked. Regular smokers (16%) generally smoked 15 cigarettes a day and 49% were nicotine dependent--15% highly so. When consulting, 44% of doctors stated that they systematically addressed smoking habits and 41% declared that they gave minimal smoking cessation advice. Doctors who smoke were less prone to ask their patients whether they smoke (p = 0.036) and whether they had considered quitting (p = 0.045). Unlike those who didn't smoke or had quit smoking, doctors who smoke often believed that their smoking habits had no impact on their relationship with the patients or that it might even make communication with the patient easier (p < 0.0001). CONCLUSIONS: Family physicians' smoking habits have an impact on their interaction with patients who smoke. This must be taken into account in training sessions for smoking cessation.

[Co-infection with Mycobacterium tuberculosis and Pneumocystis jiroveci in a patient without HIV infection]. / Co-infection à Mycobacterium tuberculosis et Pneumocystis jiroveci chez une patiente non infectée par le VIH.

INTRODUCTION: Co-infection with Pneumocystis jiroveci and Mycobacterium tuberculosis is rarely reported in patients without HIV infection. CASE REPORT: We report the case of a 30 year old woman admitted to hospital for respiratory distress associated with a diffuse infiltrative pneumopathy. Corticosteroid therapy had been started two months earlier for suspected pulmonary sarcoidosis. Fibreoptic bronchoscopy and broncho-alveolar lavage produced evidence of Mycobacterium tuberculosis and cysts of Pneumocystis jiroveci. HIV serology was negative. Clinical progress was satisfactory following anti-tuberculous and anti-fungal therapy. CONCLUSION: Pneumocystis pneumonia is rare in subjects without HIV infection and is most often associated with a pathology or treatment leading to depression of cellular immunity. Corticosteroid treatment, even of short duration, presents the greatest risk. Systematic antibiotic prophylaxis should be considered in relation to the immune status of the patient. Co-infection with the tubercle bacillus as reported here is exceptionally rare.

[Effects of physical activity on tobacco craving for smoking cessation]. / Effets de l'activité physique sur le syndrome de sevrage et le craving à l'arrêt du tabac.

One in two people who smoke for their whole lifetime will die from a disease related to tobacco use. The smoking habit is sustained by nicotine dependence, which makes smoking cessation very difficult because of withdrawal syndrome and craving (urge to smoke without delay). The aim of this review was to evaluate the impact of physical activity interventions to reduce tobacco craving in smoking cessation. It included 18 randomized controlled trials, which incorporated physical activity. Seventeen of the 18 trials demonstrate the effectiveness of the physical activity in reducing tobacco craving. The consistency of these results constitutes solid evidence of the importance of physical activity as an aid to smoking cessation. Advice to increase physical activity should therefore be given during quit attempts and should be incorporated into smoking cessation programs.

[Smoking and adherence to anti-tuberculosis treatment]. / Tabagisme et observance du traitement antituberculeux.

Smoking and tuberculosis are two major public health issues. Tobacco smoke increases the risk of Mycobacterium tuberculosis infection and the severity of pulmonary tuberculosis. Active smoking increases the risk of relapse of pulmonary and extra-pulmonary tuberculosis after treatment; smokers are less adherent to anti-tuberculosis treatment. Smoking cessation represent a means of controlling the tuberculosis epidemic in developing countries. This general review identified 17 studies in the international literature on the link between active smoking and the adherence to anti-tuberculosis treatment. It highlights a positive association between smoking and a lack of adherence to anti-tuberculosis treatment. This justifies the systematic application of aid to stopping smoking in smokers with tuberculosis.

[Pneumoperitoneum and pneumomediastinum complicating non-invasive ventilation]. / Un pneumoperitoine compliquant un pneumomediastin au cours de la ventilation non invasive.

INTRODUCTION: Pneumoperitoneum is known to be a rare complication of invasive mechanical ventilation. However it has not previously been described as a consequence of non-invasive ventilation. CASE REPORT: The authors report a case of pneumoperitoneum associated with pneumomediastinum occurring in a 64-year-old patient treated for 3 years with bilevel ventilation via a nasal mask (expiratory pressure = 9 cm H2O, inspiratory pressure = 15 cm H2O) for obesity hypoventilation syndrome. Respiratory and gastroenterological investigations did not demonstrate a cause for this complication which resolved spontaneously following the cessation of ventilation. Nine months later, clinical deterioration and a worsening of blood gas parameters led to a recommencement of non-invasive mechanical ventilation at the same levels as previously. Over two years of follow up there have been no clinical or radiological signs of a recurrence of pneumomediastinum or pneumoperitoneum. CONCLUSION: In the absence of any other explanation, barotrauma due to nasal ventilation appears to be the most likely explanation for this complication.

[Influence of tobacco smoking on quality of life in patients with lung cancer]. / Influence du tabagisme sur la qualité de vie des patients atteints de cancer bronchique.

Tobacco smoking is the leading cause of lung cancer. This cancer is the most specific indicator of the effects of tobacco on health. Regardless of the type of lung cancer and the stage of the disease, continued smoking has a negative impact on its development and its treatment. For this reason, smoking cessation is an essential step in the management of patients with lung cancer who smoke. It has been clearly demonstrated that quality of life is worse in smokers than in non-smokers. The aim of this general review is to study the relationship between tobacco use and quality of life specifically in patients with lung cancer. Among the twelve studies selected, six of them clearly demonstrate a deleterious effect of continued smoking tobacco or a beneficial effect of smoking cessation on the quality of life in patients with lung cancer. These findings should lead clinicians to offer support to smokers with lung cancer in order to assist them to quit smoking.

[Continuous positive airways pressure treatment for obstructive sleep apnoea]. / Le traitement du syndrome d'apnées-hypopnées obstructives du sommeil par pression positive continue.

Continuous positive airway pressure (CPAP) still remains the most frequently used and the most efficient treatment for obstructive sleep apnea syndrome. However, its efficiency is conditioned by healthcare quality depending on many factors such as medical specificities of the patients as well as the severity of sleep-related breathing disorders. In order to optimize CPAP efficiency, it is necessary to be aware of the functional abilities of the different devices, and to perform a close monitoring of the patients, particularly during the first weeks of treatment, by maximally using the data provided by the CPAP apparatus. Some questions remain unsolved, such as the impact of nasal CPAP on glucose metabolism or cardiovascular prognosis. Furthermore, the strategy of CPAP use should be improved according to future results of studies dedicated to the interest of home telemonitoring and taking into account the validated mode of CPAP initiation.

[The efficacy of physical activity as an aid to smoking cessation]. / Efficacité de l'activité physique dans l'aide à l'arrêt du tabac.

One over two smokers who smokes all his lifetime will die from a disease related to tobacco use. Tobacco smoking is the primary cause of avoidable death in the world. Medications have an important role in smoking cessation, but physical activity, as well as improving health generally may also represent an important non-pharmacological therapy to help people to stop smoking. The aim of this review was to evaluate the use of physical activity as an aid for smoking cessation and maintaining abstinence. We included 17 randomized controlled trials where the main objective was stopping smoking, and which included at least a six-month follow-up of participants. At the end of this review, only 4 trials revealed a benefit of physical activity on smoking cessation; two of them did not show any persistent benefit after the end of the exercise program. On the basis of this, physical activity cannot itself be considered as a way to help stopping smoking. The heterogeneity among studies summarized in this review was an important methodological bias. However, there is strong evidence that physical activity reduces withdrawal symptoms, craving, negative affect and weight gain during smoking cessation. Advice to practice physical activity should therefore be incorporated into smoking cessation programs.

[Influence of tobacco smoking on the risk of developing asthma]. / Influence du tabagisme sur le risque de développement de l'asthme.

The aim of this general review is to investigate the influence of active and passive smoking on the development of asthma in children and adults. Passive smoking during and after pregnancy facilitates the onset of childhood asthma and wheezing. In particular, smoking during pregnancy is associated with the occurrence of wheezing prior to the age of 4 years. In contrast, the results of studies on the relationship between parental smoking in the post-natal period and the onset of asthma or wheezing are discordant. Exposure to passive smoking during childhood facilitates the occurrence of asthma in adulthood. In adults and adolescents, active smoking appears to be a factor favoring the development of asthma. On the other hand, non-smoking adult subjects without history of asthma exposed to passive smoking have a risk of asthma. The pathophysiological mechanisms by which tobacco smoke is the cause of asthma are still poorly known. Smoking cessation is an essential component in the management of asthmatic subjects who smoke, facilitating the control of the disease.

Adaptive servo-ventilation: How does it fit into the treatment of central sleep apnoea syndrome? Expert opinions.

The preliminary results of the SERVE-HF study have led to the release of safety information with subsequent contraindication to the use of adaptive servo-ventilation (ASV) for the treatment of central sleep apnoeas in patients with chronic symptomatic systolic heart failure with left ventricular ejection fraction (LVEF) ≤ 45%. The aim of this article is to review these results, and to provide more detailed arguments based on data from the literature advocating the continued use of ASV in different indications, including heart failure with preserved LVEF, complex sleep apnoea syndrome, opioid-induced central sleep apnea syndrome, idiopathic central SAS, and central SAS due to a stroke. Based on these findings, we propose to set up registers dedicated to patients in whom ASV has been stopped and in the context of the next setting up of ASV in these specific indications to ensure patient safety and allow reasoned decisions on the use of ASV.

[Comorbidities of COPD]. / Les comorbidités dans la BPCO.

COPD is a slowly progressive chronic respiratory disease causing an irreversible decrease in air flow. The main cause is smoking, which provokes inflammatory phenomena in the respiratory tract. COPD is a serious public health issue, causing high morbidity, mortality and disability. Related comorbidities are linked to ageing, common risk factors and genetic predispositions. A combination of comorbidities increases healthcare costs. For instance, patients with more than two comorbidities represent a quarter of all COPD sufferers but account for half the related health costs. Our review describes different comorbidities and their impact on the COPD prognosis. The comorbidities include: cardiovascular diseases, osteoporosis, denutrition, obesity, ageing, anemia, sleeping disorders, diabetes, metabolic syndrome, anxiety-depression and lung cancer. The prognosis worsens with one or more comorbidities. Clinicians are faced with the challenge of finding practical and appropriate ways of treating these comorbidities, and there is increasing interest in developing a global, multidisciplinary approach to management. Managing this chronic disease should be based on a holistic, patient-centred approach and smoking cessation remains the key factor in the care of COPD patients.