[Evaluation of inhaler techniques in patients with asthma and chronic obstructive disease]. / Évaluation des techniques d'inhalation dans l'asthme et la bronchopneumopathie chronique obstructive.

INTRODUCTION: The correct method for using inhalation devices (DI) is essential to optimize treatment efficacy. OBJECTIVE: To evaluate the method of inhalation technique, study the correlations with patient characteristics, disease, treatment and measure the impact of direct and individual educational method, centered on the use of technical DI, on improving this technique and control of the disease. METHOD: Prospective study of 54 patients. The therapeutic education program included 3 levels of action: identifying errors in the inhalation technique, demonstrating the inhalation technique and evaluation of therapeutic education. RESULT: The most used DI was metered-dose inhalers (AD) (66.67%). The average error was 4.63 errors/patient for AD and 5.11 for dry powder inhalers. The main factors related to the misuse of DI were lower advanced level of education and age. The therapeutic education has significantly improved the number of errors/patient with improved asthma control (P<0.05) and COPD assessment test (CAT) in the case of COPD. CONCLUSION: Our study confirms the important role of therapeutic education focused on inhalation techniques in improving the use of DI technology and the evolution of asthma and COPD.

[Pulmonary actinomycosis. Diagnostic and therapeutic features]. / Actinomycose pulmonaire. Particularités diagnostiques et thérapeutiques.

INTRODUCTION: Actinomycosis is a rare suppurative infection, subacute or chronic caused by bacteria of the genus Actinomyces. OBSERVATIONS: A case study of 4 patients with prolonged respiratory symptoms. The clinical examination was poor in all cases. The CT-scan showed, in all cases, a suspicious tissue mass. The bronchoscopy diagnosis showed, in 2 cases, a tumor budding and was normal for the 2 other cases. Bronchial biopsies were negative in all cases. Before the prolonged symptomatology, the poor general condition, the endoscopic and the CT aspects; there was a suspect around a pulmonary neoplasia diagnosis, thus raising the need of a surgical treatment for diagnostic and therapeutic purposes. The anatomopathological examination of the resected specimen was in favour of the actinomycosis. The aim of these observations is to draw the attention to the radio-clinical, histological, therapeutic and evolutive aspects as well as the diagnostic difficulties of this condition. CONCLUSION: The radio-clinical presentation of the actinomycosis is often misleading, thus a diagnostic confirmation is required before any useless surgical resection.

[Adherence to treatment with continuous positive airways pressure]. / L'observance du traitement par pression positive continue : étude prospective de 103 patients suivis au service de pneumologie de Nabeul-Tunisie.

INTRODUCTION: Continuous positive airways pressure (CPAP) is the standard treatment for obstructive sleep apnea syndrome (OSAS). It produces substantial benefits if used for the appropriate indication and if patients adhere to treatment. METHODS: We conducted a prospective study of 103 patients treated with CPAP over four years follow-up. RESULTS: Our population had a mean age of 52 years with a sex ratio of 0.63. Face to face, individual education was provided in all cases. CPAP titration was performed by an unattended domiciliary autoadjusted CPAP device in 83.5% of patients for 15 days to one month. Twenty patients refused CPAP treatment after the period of titration. Eighty two patients (98.8%) were treated by constant CPAP. Seventy five percent of the patients complained of at least one side effect. The more common were nasal (56.6%) and mask related problems (40%). Seventy six percent of patients used CPAP for more than 4hours per day. Eleven patients stopped CPAP therapy because of intolerance (10 cases) and reluctance to instrumental therapy (one case). Adherence to CPAP therapy was associated with the severity of OSAS, the level of daytime sleepiness, higher pressures, repeated education during the course of follow up, clinical efficacy and the presence of fewer side-effects. CONCLUSIONS: We obtained satisfactory rates of adherence and tolerance of CPAP assisted by regular medical and technical follow-up of patients.

[Asthma control and quality of life]. / Contrôle de l'asthme et qualité de vie.

INTRODUCTION: The assessment of asthma control is based on objective measures: clinical, pharmacological and spirometry. However subjective component may be also necessary for assessing asthma control. OBJECTIVES: To study the feasibility and clinical value of the assessment of the quality of life of patients with asthma by the SF-36 (Medical Outcomes Study Short Form) and the possible existence of a correlation between controlled asthma and a better quality of life. PATIENTS AND METHODS: A prospective study that included 167 patients with asthma in a stable condition. Control of asthma and SF-36 were established three months after the inclusion of patients. RESULTS: The SF-36 was lower in the uncontrolled group in all areas of the physical component and the difference was significant in the "limitation related to physical activity" and "perceived health". In the mental component, the score was lower in "mental health" and the "limitation due to mental state" in the group with uncontrolled asthma and the difference was significant only in the limitation due to mental state (P=0.043). CONCLUSION: The quality of life of asthmatic patients is correlated to the control of this disease.

[Endobronchial hamartochondroma]. / Hamartochondrome endobronchique.

INTRODUCTION: Endobronchial hamartochondroma is a form of rare benign tumour. Compared to those that occur in the lung parenchyma, the endobronchial form can potentially be managed by relatively conservative treatment involving per-endoscopic resection. COMMENT: A 61-year-old patient had a dry cough and chest pain for 3 months. Their clinical examination was normal, but thoracic CT scan showed lingular collapse. Bronchoscopy revealed the presence of a multilobar tumour occluding the orifice of the lingula bronchus. Bronchial biopsies were consistent with the diagnosis of a hamartochondroma. Before the destruction of any of the left upper lobe parenchyma, the tumor was resected surgically and the patient had an uneventful postoperative course. CONCLUSION: Endobronchial hamartochondroma support must be rapid to avoid irreversible parenchymal consequences downstream obstruction involving an often mutilating surgery. Essentially endoscopic treatment should be the most conservative possible.

[Case report of skin manifestations in infantile Mediterranean kala-azar]. / A propos d'un cas de manifestations cutanées au cours du kala-azar infantile Méditerranéen.

The case of a 19-month-old girl with visceral leishmaniasis and unusual skin manifestations is reported. Emphasis is put on the fact that such manifestations are unusual in Mediterranean infantile leishmaniasis. The clinical features, parasitology, histology, and course of these skin lesions are discussed.