[Respiratory oscillometry: Theoretical foundations and clinical applications]. / L'oscillométrie respiratoire : théorie et applications cliniques.

Oscillometry measures the mechanical properties of the respiratory system. As they are carried out during spontaneous breathing, oscillometry measurements do not require forced breathing maneuvers or the patient's active cooperation. The technique is complementary to conventional pulmonary function testing methods for the investigation of respiratory function, diagnosis and monitoring of respiratory diseases, and assessment of response to treatment. The present review aims to describe the theoretical foundations and practical methodology of oscillometry. It describes the gaps in scientific evidence regarding its clinical utility, and provides examples of current research and clinical applications.

[Pulmonary function test: The testing of children]. / Exploration fonctionnelle respiratoire : explorer l'enfant.

In paediatrics, the pulmonary function test (PFT) is most often performed to support the diagnosis or in follow-up of asthma patients. Whatever the pathology responsible for respiratory symptoms and/or functional impairment, repeated PFTs make it possible to establish a prognosis (pulmonary function trajectories…) and to orient preventive interventions. PFT can be performed routinely from the age of three years, provided that the following requirements are met: suitable techniques and equipment, staff trained to apply the techniques and to receive young children, reference values for each technique indicating the limits of normal values and of between-test significant variation. From the age of three, children can be subjected to tidal breathing measurement of: resistance of the respiratory system (oscillometry, Rrs; airflow interruption, Rint) or of airways specific resistance (sRaw) and functional residual capacity (by applying a dilution technique). With maturity, the child will become capable of mobilizing his or her slow vital capacity to measure total lung capacity (TLC), once again by applying a dilution technique, then later by breathing against a closed shutter (plethysmography TLC and Raw). Finally, the child will be able to carry out forced expiration (forced spirometry) along with all of the other PFTs. It is important to take into account the paediatric adaptations specified in the international recommendations regarding the performance, reproducibility and quality of PFTs targeting this population.

[Approaches to the pre-operative functional assessment of patients with lung cancer and preoperative rehabilitation]. / Bilan fonctionnel préopératoire du cancer bronchique et réhabilitation préopératoire.

Surgery is the best treatment for early lung cancer but requires a preoperative functional evaluation to identify patients who may be at a high risk of complications or death. Guideline algorithms include a cardiological evaluation, a cardiopulmonary assessment to calculate the predicted residual lung function, and identify patients needing exercise testing to complete the evaluation. According to most expert opinion, exercise tests have a very high predictive value of complications. However, since the publication of these guidelines, minimally-invasive surgery, sublobar resections, prehabilitation and enhanced recovery after surgery (ERAS) programmes have been developed. Implementation of these techniques and programs is associated with a decrease in postoperative mortality and complications. In addition, the current guidelines and the cut-off values they identified are based on early series of patients, and are designed to select patients before major lung resection (lobectomy-pneumonectomy) performed by thoracotomy. Therefore, after a review of the current guidelines and a brief update on prehabilitation (smoking cessation, exercise training and nutritional aspects), we will discuss the need to redefine functional criteria to select patients who will benefit from lung surgery.

[Asthma and obesity: relationship and therapeutic implications in patients with asthma at the Department of Pneumology in Monastir, Tunisia]. / Asthme et obésité: relation et implications thérapeutiques auprès des patients asthmatiques du Service de Pneumologie de Monastir, Tunisie.

INTRODUCTION: Obesity and asthma are two chronic diseases affecting millions of people around the world. A causal relationship has been suggested. The purpose of our study is to examine the profile in obese people with asthma and to determine the relationship between the different severity parameters in asthma and the degree of obesity. METHODS: We conducted a retrospective, monocentric, analytical study involving 450 asthmatics with a body mass index (BMI) ≥ 30 kg/m2 having follow up visit at less than 6 months. The study was conducted in the Department of Pneumology and Allergology at the Fattouma Bourguiba Hospital in Monastir. RESULTS: The average age at diagnosis was 45±12.8 years. Mean BMI was 34.8±4.2 kg/m2. Asthma was well-controlled in 55.3% of patients. Severity criteria were reported in 37.4% of cases. According to GINA 2016, 24.2% of patients received treatment at step 4. Two asthma phenotypes associated with obesity were reported. The first phenotype (52.4%) was characterized by early-onset asthma associated with a higher incidence of allergic disease and manifestations of atopy. The second phenotype (47.6%) was characterized by late onset asthma, commonly occurring in female sex as well as a higher rate of comorbidities and hospitalizations. Patients with class II and III obesity had significant ventilatory deficiency (CVF: p = 0.002 and FEV1: p = 0.007). CONCLUSION: Obesity is one of the key factors involved in poor asthma control. Its management, which has not yet been codified, should be multidisciplinary.

[Evaluation of permanent disability levels in occupational pulmonary diseases]. / Comment évaluer en 2019 les taux d'incapacité permanente des pathologies professionnelles pulmonaires ?

Compensation for occupational pulmonary diseases requires the establishment of guidelines based on standardized and objective criteria, in order to provide compensation that is as fair as possible to patients who suffer from them. A review of the elements necessary for the examination of an individual file was carried out by a working group. It is accepted that respiratory functional exploration is the key element in assessing the level of permanent disability in all of these conditions, with the exception of thoracic malignancies. Guiding scales have been developed for the respiratory impairment of three types of conditions: occupational asthma, thoracic malignancy, and other respiratory diseases. Additional criteria for increasing the permanent disability level are also proposed in order to take into account professional prejudice, in particular the possibility or not of continuing the occupational activity, in the same job or after changing to another. For certain respiratory diseases, a periodic reassessment of the initially attributed permanent disability level is recommended as well as the initial one at the time of definitive cessation of occupational activity.

[Lung function in patients with diabetes mellitus]. / Fonction pulmonaire du patient diabétique.

INTRODUCTION: Diabetes mellitus is a disease affecting a lot of organs. One of the little known diabetes complication is impairment of pulmonary function. The aim of this study was to compare pulmonary function in two groups: diabetic individuals and obese non-diabetic individuals and to investigate predictive factors of alteration of diffusing capacity of lung for carbon monoxide (DLCO). PATIENTS AND METHOD: We retrospectively included all patients hospitalized in department of endocrinology between 1st July 2013 and 31 December 2013 and who underwent pulmonary function tests. All these medical charts of patients were reviewed and patients were classified in two groups: diabetic and obese non-diabetic individuals. RESULTS: Overall, 89 patients were included, 62 diabetic patients and 27 obese non-diabetic patients. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), medium expiratory flow, expiratory residual volume, total lung capacity (TLC) and DLCO were significantly lower in patients with diabetes mellitus compared to obese non-diabetic patients. A low DLCO was significantly associated with diabetic neuropathy, macrovascular complication (carotid atheroma), impairment of renal function, and insulin treatment. CONCLUSION: Respiratory function is impaired in diabetes mellitus, with a significant decrease in FVC, FEV1, TLC and DLCO.

[Interpretation and use of routine pulmonary function tests: Spirometry, static lung volumes, lung diffusion, arterial blood gas, methacholine challenge test and 6-minute walk test]. / Interprétation et utilisation des explorations fonctionnelles respiratoires de routine de l'adulte : spirométrie, volumes non mobilisables, diffusion, hématose, test de provocation bronchique à la métacholine et test de marche.

Resting pulmonary function tests (PFT) include the assessment of ventilatory capacity: spirometry (forced expiratory flows and mobilisable volumes) and static volume assessment, notably using body plethysmography. Spirometry allows the potential definition of obstructive defect, while static volume assessment allows the potential definition of restrictive defect (decrease in total lung capacity) and thoracic hyperinflation (increase in static volumes). It must be kept in mind that this evaluation is incomplete and that an assessment of ventilatory demand is often warranted, especially when facing dyspnoea: evaluation of arterial blood gas (searching for respiratory insufficiency) and measurement of the transfer coefficient of the lung, allowing with the measurement of alveolar volume to calculate the diffusing capacity of the lung for CO (DLCO: assessment of alveolar-capillary wall and capillary blood volume). All these pulmonary function tests have been the subject of an Americano-European Task force (standardisation of lung function testing) published in 2005, and translated in French in 2007. Interpretative strategies for lung function tests have been recommended, which define abnormal lung function tests using the 5th and 95th percentiles of predicted values (lower and upper limits of normal values). Thus, these recommendations need to be implemented in all pulmonary function test units. A methacholine challenge test will only be performed in the presence of an intermediate pre-test probability for asthma (diagnostic uncertainty), which is an infrequent setting. The most convenient exertional test is the 6-minute walk test that allows the assessment of walking performance, the search for arterial desaturation and the quantification of dyspnoea complaint.

[Pulmonary diffusion test to NO and CO time course during thoracic radiotherapy for lung cancer: the CONORT prospective study protocol]. / Évolution de la double diffusion au CO et au NO au cours de la radiothérapie pulmonaire pour cancer bronchique : présentation du protocole de l'étude prospective Conort.

Thoracic radiotherapy is a usual treatment for lung cancer. Early-stages may be treated in stereotactic mode while locally advanced stages are usually treated with conventional radiotherapy mode. Pulmonary function tests show that thoracic irradiation has no impact on lung volume such as forced expiratory volume in one second (FEV1) or forced vital capacity (FCV). However, some studies found that CO (carbon monoxide) diffusing capacity (TLCO) may be altered under thoracic radiotherapy. DLCO alteration is usually symptomatic of either a lesion in the alveolar membrane or a pulmonary capillary alteration. Pulmonary diffusion may be also appreciated by the NO (azote monoxide) diffusion capacity. Moreover, using a double measurement of NO and CO diffusing capacities permit to assess which lung compartment (capillary or membrane) is affected. CONORT is an observational prospective monocentric study, aiming to assess the CO and NO diffusing capacity (as well as other pulmonary function tests) during thoracic radiotherapy. Inclusion criteria are patients with lung cancer, treated by thoracic radiotherapy (conformational or stereotactic), who signed consent. Pulmonary function tests are performed before, during, at the end and six weeks and six months after thoracic irradiation. To estimate a difference of 15% in diffusing capacity test, we have to include 112 patients with a 90% power and a 5% alpha risk. Four months after beginning, 36 patients were included. Preliminary data will be presented at the SFRO meeting.