[Early palliative care for the management of breathlessness in pulmonary diseases]. / Prise en charge palliative précoce de la dyspnée dans les maladies pulmonaires.

Dyspnoea in chronic respiratory disease is a very frequent symptom with a significant impact on quality of life (QoL). The aim of palliative care is to improve and maintain the QoL of patients with life-threatening diseases and its early implementation is now recommended in many evolving pulmonary diseases. The effectiveness of symptomatic treatments to relieve refractory breathlessness (morphine, oxygen supply, hypnosis, pulmonary rehabilitation) is often limited. These measures are more effective if offered early in the holistic management of the patient. This article illustrates and describes, with the help of a clinical situation, these treatments options and the collaborations established between the palliative care and pneumology divisions.

La dyspnée en lien avec une maladie respiratoire chronique est un symptôme très fréquent avec un impact important sur la qualité de vie (QoL). Les soins palliatifs ont pour objectif d'améliorer la QoL et les symptômes des personnes atteintes de maladies potentiellement mortelles et sont recommandés dans la prise en charge usuelle de nombreuses pathologies pulmonaires évolutives. Les traitements symptomatiques de la dyspnée réfractaire (morphine, oxygène, hypnose, réadaptation respiratoire) ont souvent un effet limité. Ces mesures sont d'autant plus efficaces si elles sont proposées précocement dans la prise en charge holistique du patient. Cet article illustre et décrit, à partir d'une situation clinique, ces modalités thérapeutiques et les collaborations établies entre les soins palliatifs et la pneumologie.

[Pulmonary effects of inhaled cannabis]. / Conséquences respiratoires de l'inhalation de cannabis.

The respiratory consequences of cannabis inhalation remain poorly understood. The main challenges are the biases due to the combined consumption of tobacco and to the various consumption modalities. While some similarities can be drawn between cannabis and tobacco, such as certain carcinogenic components present in their smoke, as well as the clinical chronic bronchitis, the pulmonary repercussion of these two substances differ in several aspects. It should be remembered that research on cannabis benefits from less hindsight than that of tobacco and concerns a younger population, opening up the need for further research. This article aims to offer an overview of current knowledge.

Les conséquences respiratoires de l'inhalation de cannabis restent peu connues à ce jour. La difficulté principale de la recherche dans ce domaine est inhérente à la consommation conjointe de tabac et aux diverses modalités de consommation. Bien qu'il existe certaines similitudes entre les toxicités du cannabis et du tabac, dues notamment à certains composants carcinogènes de leur fumée, ainsi qu'un tableau clinique de bronchite chronique commun, les répercussions pulmonaires de ces deux substances se distinguent sur plusieurs points. Il convient de rappeler que l'évaluation des conséquences respiratoires du cannabis bénéficie de moins de recul que celle du tabac et concerne une population plus jeune, nécessitant des études supplémentaires. Cet article dresse l'état des lieux des connaissances actuelles.

Exercise ventilatory response after COVID-19: comparison between ambulatory and hospitalized patients.

Inefficient ventilatory response during cardiopulmonary exercise testing (CPET) has been suggested as a cause of post-COVID-19 dyspnea. It has been described in hospitalized patients (HOSP) with lung parenchymal sequelae but also after mild infection in ambulatory patients (AMBU). We hypothesize that AMBU and HOSP have different ventilatory responses to exercise, due to different etiologies. We analyzed CPET realized between July 2020 and May 2022 of patients with persisting respiratory symptoms 3 mo after COVID-19. Chest computed tomography (CT) scan, pulmonary function tests, quality of life, and respiratory questionnaires were collected. CPET data were specifically explored as a function of ventilation (V̇e) and time. Seventy-nine consecutive patients were included (42 AMBU and 37 HOSP, median: 54 [44-60] yr old, 57% female). Patients were hospitalized for a median of 20 [8-34] days, with pneumonia (41%) or acute respiratory distress syndrome (ARDS; 30%). Among HOSP, 12(32%) patients had abnormal values for spirometry and 18(51%) for carbon monoxide diffusing capacity (P < 0.001). CPET showed no differences between AMBU and HOSP in peak absolute O2 uptake (V̇o2) (1.59 [1.22-2.11] mL·min-1; P = 0.65). Tidal volume (VT) as a function of V̇e, was lower in AMBU than in HOSP (P < 0.01) toward the end of exercise. The slope of the V̇e-CO2 production was higher than normal in both groups (30.9 [26.1-34.3]; P = 0.96). In conclusion, the severity of COVID-19 did not influence the exercise capacity, but AMBU demonstrated a less efficient ventilatory response to exercise as compared with HOSP. CPET with exploration of data as a function of V̇e and throughout the exercise better unveil ventilatory inefficiency.NEW & NOTEWORTHY We evaluated the exercise ventilatory response in patients with persisting dyspnea after severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. We found that despite similar peak power and peak absolute O2 uptake, tidal volume as a function of ventilation was lower in ambulatory than in hospitalized patients toward the end of exercise, reflecting ventilatory inefficiency. We call for evaluation of minute ventilation with the exploration of data throughout the exercise and not only peak data to better unveil ventilatory inefficiency.

PANDORA dyadic project: hope, spiritual well-being and quality of life of dyads of patients with chronic obstructive pulmonary disease in Switzerland - a multicentre longitudinal mixed-methods protocol study.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is responsible for 2.9 million deaths annually in Europe. Symptom burden and functional decline rise as patients reach advanced stages of the disease enhancing risk of vulnerability and dependency on informal caregivers (ICs).Evidence shows that hope is an important psycho-social-spiritual construct that humans use to cope with symptom burden and adversity. Hope is associated with increased quality of life (QoL) comfort and well-being for patients and ICs. A better understanding of the meaning and experience of hope over time as patients transition through chronic illness may help healthcare professionals to plan and deliver care more appropriately. METHODS AND ANALYSIS: This is a longitudinal multicentre mixed-methods study with a convergent design. Quantitative and qualitative data will be collected from dyads of advanced COPD patients and their ICs in two university hospitals at two points in time. The Herth Hope Index, WHO Quality of Life BREF, Functional Assessment of Chronic Illness Therapy-Spiritual Well-being and the French version of the Edmonton Symptom Assessment Scale will be used to collect data. Dyadic interviews will be conducted using a semi-structured interview guide with five questions about hope and their relationship with QoL.Statistical analysis of data will be carried out using R V.4.1.0. To test whether our theoretical model as a whole is supported by the data, structural equation modelling will be used. The comparison between T1 and T2 for level of hope, symptom burden, QoL and spiritual well-being, will be carried out using paired t-tests. The association between symptom burden, QoL, spiritual well-being and hope will be tested using Pearson correlation. ETHICS AND DISSEMINATION: This study protocol received ethical approval on 24 May 2022 from the Commission cantonale d'éthique de la recherche sur l'être humain-Canton of Vaud. The identification number is 2021-02477.

[Hypoxemia: from pathophysiology to diagnosis]. / Hypoxémie : de la physiopathologie au diagnostic.

Hypoxemia is defined as a decreased oxygen partial pressure in arterial blood. This frequent clinical phenomenon can lead to tissue hypoxia and requires a prompt diagnostic approach to guide its management. Five pathophysiological mechanisms should be assessed in the presence of hypoxemia: alveolar hypoventilation, ventilation/perfusion mismatches, diffusion disorders, true shunts and a decrease in the partial pressure of inspired oxygen. In this article, we synthesize the main etiologies of hypoxemia based on respiratory pathophysiology and suggest a diagnostic approach for its evaluation.

L'hypoxémie est définie comme la diminution de la pression partielle en oxygène dans le sang artériel. Ce phénomène fréquent en clinique peut amener à une hypoxie tissulaire et nécessite une approche diagnostique rapide afin d'orienter sa prise en charge. Cinq mécanismes physiopathologiques doivent être évoqués devant une hypoxémie : l'hypoventilation alvéolaire, les inégalités de ventilation/perfusion, les troubles de la diffusion, les shunts vrais et la diminution de la pression partielle d'oxygène inspiré. Dans cet article, nous résumons les étiologies principales d'hypoxémie en se basant sur la physiopathologie respiratoire et proposons une démarche diagnostique pour son évaluation.

The pandemic toll and post-acute sequelae of SARS-CoV-2 in healthcare workers at a Swiss University Hospital.

Healthcare workers have potentially been among the most exposed to SARS-CoV-2 infection as well as the deleterious toll of the pandemic. This study has the objective to differentiate the pandemic toll from post-acute sequelae of SARS-CoV-2 infection in healthcare workers compared to the general population. The study was conducted between April and July 2021 at the Geneva University Hospitals, Switzerland. Eligible participants were all tested staff, and outpatient individuals tested for SARS-CoV-2 at the same hospital. The primary outcome was the prevalence of symptoms in healthcare workers compared to the general population, with measures of COVID-related symptoms and functional impairment, using prevalence estimates and multivariable logistic regression models. Healthcare workers (n = 3083) suffered mostly from fatigue (25.5 %), headache (10.0 %), difficulty concentrating (7.9 %), exhaustion/burnout (7.1 %), insomnia (6.2 %), myalgia (6.7 %) and arthralgia (6.3 %). Regardless of SARS-CoV-2 infection, all symptoms were significantly higher in healthcare workers than the general population (n = 3556). SARS-CoV-2 infection in healthcare workers was associated with loss or change in smell, loss or change in taste, palpitations, dyspnea, difficulty concentrating, fatigue, and headache. Functional impairment was more significant in healthcare workers compared to the general population (aOR 2.28; 1.76-2.96), with a positive association with SARS-CoV-2 infection (aOR 3.81; 2.59-5.60). Symptoms and functional impairment in healthcare workers were increased compared to the general population, and potentially related to the pandemic toll as well as post-acute sequelae of SARS-CoV-2 infection. These findings are of concern, considering the essential role of healthcare workers in caring for all patients including and beyond COVID-19.

One-year persistent symptoms and functional impairment in SARS-CoV-2 positive and negative individuals.

BACKGROUND: Persistent symptoms of SARS-CoV-2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS-CoV-2, including lockdown, social, and economic factors. OBJECTIVE: The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS-CoV-2 compared to individuals tested negative. METHODS: From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS-CoV-2 at the Geneva University Hospitals were followed up 12 months after their test date. RESULTS: At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS-CoV-2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS-CoV-2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS-CoV-2 infection was associated with the persistence of symptoms (adjusted odds ratio [aOR] 4.1; 2.60-6.83) and functional impairment (aOR 3.54; 2.16-5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40-59 years, and in individuals with no past medical or psychiatric history. CONCLUSION: SARS-CoV-2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection.

[Pulmonary telerehabilitation†: a new standard†?] / Télé-réhabilitation pulmonaire†: un nouveau standard†?

Pulmonary rehabilitation is effective to improve shortness of breath, health status and exercise capacity. Telerehabilitation uses information and communication technologies to deliver rehabilitation program from a distance. A Cochrane review published in 2021 shows its equivalence to conventional pulmonary rehabilitation. The confinement induced by the COVID-19 pandemic has made patients with respiratory failure even more fragile and vulnerable, promoting the development of telerehabilitation. This article describes its modalities, sets out the scientific evidence for its effectiveness and develops perspectives for its development.

La réhabilitation pulmonaire est efficace pour réduire les symptômes, améliorer l'état de santé et la capacité d'effort. La télé-réhabilitation utilise les technologies de l'information et de la communication pour dispenser des activités de réhabilitation à distance. Une revue Cochrane parue en 2021 montre son équivalence à la réhabilitation pulmonaire conventionnelle. Le confinement induit par la pandémie de Covid-19 a rendu les patients avec insuffisance respiratoire encore plus fragiles et vulnérables, favorisant le développement de la télé-réhabilitation. Cet article en décrit les modalités, énonce les preuves scientifiques de son efficacité et propose des perspectives quant à son développement.

[Novel therapies in respiratory management]. / Pneumologie.

In this review of the recent medical literature, we have identified 4 topics of interest for the readers of Revue Médicale Suisse. Use of antifibrotic drugs in interstitial lung diseases will soon be extended to a phenotype labeled « progressive fibrosing interstitial lung disease ¼ (PF-ILD). While awaiting for evidence-based treatment, consensual recommendations for a treatment algorithm in pulmonary sarcoidosis has been published. New guidance for non-invasive ventilation in COPD and obesity-hypoventilation syndrome are available in Switzerland and are in line with international recommendations. New treatments targeting CFTR protein activity have become available and could become a therapeutic option for up to 85% of cystic fibrosis patients in Switzerland.

Dans cette revue de la littérature médicale récente, nous avons identifié quatre sujets d'intérêts pour les lecteurs de la Revue Médicale Suisse. L'utilisation de médicaments antifibrotiques dans les maladies pulmonaires interstitielles sera bientôt étendue à un phénotype étiqueté « maladie pulmonaire interstitielle fibrosante progressive ¼. Des recommandations consensuelles pour un algorithme de traitement dans la sarcoïdose pulmonaire ont été publiées. De nouvelles directives pour la ventilation non invasive dans la BPCO et le syndrome d'obésité-hypoventilation sont disponibles en Suisse et sont conformes aux recommandations internationales. De nouveaux traitements ciblant l'activité protéique CFTR (Cystic Fibrosic Transmembrane Conductance Regulator) sont disponibles et pourraient devenir une option thérapeutique pour 85 % des patients atteints de mucoviscidose en Suisse.

[COPD and phenotypes]. / Les phénotypes de la BPCO.

Chronic obstructive pulmonary disease (COPD) is a heterogeneous group of chronic respiratory diseases which phenotyping is less codified as for asthma yet as essential. The phenotype helps to better understand the evolution of the disease, punctuated by exacerbations and favors a better targeting for treatments and clinical work-up. The latest studies, mostly based on the ECLIPSE and SPIROMICS cohorts, highlight the importance of the search for eosinophilia and the complete assessment of cardiovascular comorbidities. This article will discuss the role of lung function, exacerbations, biomarkers, and comorbidities in COPD phenotyping.

La bronchopneumopathie chronique obstructive (BPCO) représente un groupe hétérogène de patients atteints d'une maladie respiratoire chronique dont le phénotypage est moins codifié mais autant essentiel que celui de l'asthme. Il permet de mieux comprendre l'évolution de la maladie rythmée par des exacerbations, de mieux cibler les traitements et les examens complémentaires. Les dernières études se basant sur les cohortes ECLIPSE et SPIROMICS soulignent l'importance de la recherche d'une éosinophilie et le bilan complet des comorbidités cardiovasculaires. Cet article aborde le rôle des épreuves fonctionnelles respiratoires, des exacerbations, des biomarqueurs et des comorbidités pour le phénotypage de la BPCO.