[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.

[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.

[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.

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.

[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.

[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.

[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.

[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.

[Cannabis smoking and lung cancer]. / Cannabis et cancer bronchique.

Cannabis is the most commonly smoked illicit substance in the world. It can be smoked alone in plant form (marijuana) but it is mainly smoked mixed with tobacco. The combined smoking of cannabis and tobacco is a common-place phenomenon in our society. However, its use is responsible for severe pulmonary consequences. The specific impact of smoking cannabis is difficult to assess precisely and to distinguish from the effect of tobacco. Marijuana smoke contains polycyclic aromatic hydrocarbons and carcinogens at higher concentration than tobacco smoke. Cellular, tissue, animal and human studies, and also epidemiological studies, show that marijuana smoke is a risk factor for lung cancer. Cannabis exposure doubles the risk of developing lung cancer. This should encourage clinicians to identify cannabis use and to offer patients support in quitting.

[Cannabis use and impairment of respiratory function]. / Usage du cannabis et retentissement fonctionnel respiratoire.

Cannabis is the most commonly smoked illicit substance in many countries including France. It can be smoked alone in plant form (marijuana) but in our country it is mainly smoked in the form of cannabis resin mixed with tobacco. The technique of inhaling cannabis differs from that of tobacco, increasing the time that the smoke spends in contact with the bronchial mucosal and its impact on respiratory function. One cigarette composed of cannabis and tobacco is much more harmful than a cigarette containing only tobacco. In cannabis smokers there is an increased incidence of respiratory symptoms and episodes of acute bronchitis. Cannabis produces a rapid bronchodilator effect; chronic use provokes a reduction in specific conductance and increase in airways resistance. Studies on the decline of Forced Expiratory Volume are discordant. Cannabis smoke and tetrahydrocannabinol irritate the bronchial tree. They bring about histological signs of airways inflammation and alter the fungicidal and antibacterial activity of alveolar macrophages. Inhalation of cannabis smoke is a risk factor for lung cancer. Stopping smoking cannabis will bring about important benefits for lung function. This should encourage clinicians to offer patients support in quitting smoking.

[Smoking and active tuberculosis]. / Tabac et tuberculose maladie.

The link between tuberculosis and HIV infection has long been established but the link between tuberculosis and smoking is not well understood. However, many patients with tuberculosis are smokers and an increasing proportion of them live in developing countries where there is a high incidence of the disease. Smoking increases the risk of tuberculosis and of subsequent death from the disease. Henceforth, smoking cessation will become a way of controlling the tuberculosis epidemic in developing nations. This evidence must be used to mobilize an international effort to deal with these two major public health issues.

[Tobacco smoking and latent tuberculous infection]. / Tabagisme et infection tuberculeuse latente.

Tobacco smoking has a significant impact on the risk of tuberculosis and the mortality of the disease. There is a strong dose-response relationship both in terms of quantity and duration of smoking. Latent tuberculous infection and tuberculosis disease are different stages of the same infectious process but the relation between smoking and the risk of being infected with Mycobacterium tuberculosis is less well understood. The aim of this review is to describe the relationship between tobacco consumption and tuberculous infection and the mechanism by which smoking increases the risk. It outlines the public health consequences of the increased risk of latent tuberculous infection due to active and passive smoking. This justifies promotion of smoking cessation as a way of limiting the epidemic of tuberculosis in developing countries.

[Smoking habits among staff at the Rochefort-sur-Mer Hospital]. / Tabagisme du personnel du centre hospitalier de Rochefort-sur-Mer.

OBJECTIVE: The aim of the study was to establish an inventory of staff in the hospital who smoked to allow better identification of people at risk and thus develop targeted preventive strategies, which we hoped would be more effective. PATIENTS AND METHODS: This survey was conducted at the Rochefort-sur-Mer Hospital in March 2008. The sociodemographic characteristics of the population responding and differences in characteristics between smokers and non-smokers were examined. The level of dependence of smokers and patterns of smoking in the workplace were also evaluated. The results were compared with those of the survey "Baromètre tabac personnel hospitalier 2003". RESULTS: The response rate was 57%, with the study population characterized by a high proportion of women (82%). The proportion of smokers was 29%, similar to that found in the general population (30%) but higher than 24% of the survey of hospital staff Tobacco Barometer 2003. The hospital staff is still weakly dependent on tobacco. The attitude to smoking was strongly linked to socioeconomic group and the domestic staff and health care assistants were most likely to smoke and were also the most dependent. Finally, the hospital has itself become a smoke free environment without tobacco. CONCLUSION: It is essential to promote measures to prevent smoking among hospital staff taking into account its specific features (high proportion of women). Targeted actions should in particular be conducted amongst the groups of workers who are the most affected.