[Effectiveness of therapeutic education against "nicotinophobia" in smokers hospitalized for cardiovascular and pulmonary rehabilitation]. / Efficacité de l'éducation thérapeutique contre la « nicotinophobie ¼ de patients fumeurs hospitalisés en soins de suite et réadaptation cardiovasculaire et pulmonaire.

INTRODUCTION: Nicotine replacement therapies remain the main validated treatment to stop smoking. Nevertheless, treatment acceptance deals with patients negative representations. This "nicotinophobia" could be the main barrier to treatment acceptance and as a consequence would be at the origin of numerous failures of smoking cessation. MATERIALS AND METHODS: We estimated the efficiency of an educational collective workshop to fight against nicotinophobia in patients smokers hospitalized for cardiovascular and pulmonary rehabilitation. RESULTS: Smoking cessation was significantly improved in patients who participated at the workshop (81 vs. 48 %), associated with a significant decrease of anxiety-depression scores, and without significant weight gain (average loss of 2.8kg). CONCLUSION: Educational approaches seem to help a majority of patient smokers to stop smoking, without anxiety and without weight gain. These results encourage the creation of a real therapeutic educational program dedicated to smoking cessation.

[Barriers to referral to pulmonary rehabilitation in COPD patients from the perspective of general practitioners]. / Identification des freins à la prescription de la réhabilitation respiratoire pour les patients atteints de BPCO en médecine générale.

INTRODUCTION: In spite of recommendations of the highest level of proof (rank A), the respiratory rehabilitation remains very widely sub-prescribed by general practitioners, who are nevertheless in the front line in the care and the follow-up of the patients affected by BPCO. MATERIAL AND METHODS: Semi-qualitative study with the general practitioners installed in the city of Montauban (Tarn-et-Garonne). RESULTS: The rate of answer was 57%. Eighty-six percent of the patients BPCO followed in general medicine have never participated in a respiratory rehabilitation program. Eighty percent of the questioned general practitioners declared not to know the last recommendations of the HAS. A total of 66.7% of the questioned general practitioners considered that prescription of respiratory rehabilitation comes within their remit. Eighty seven percent of the general practitioners declare not to know the existing respiratory programs of rehabilitation in their region. CONCLUSION: The main barrier for prescription of respiratory rehabilitation for patients BPCO in general medicine could be the misunderstanding of the local existing programs. The distribution of existing tools such as the map of the programs of respiratory rehabilitation established by the group Alvéole of the Society of Pneumology of French language (SPLF) could so be a facilitating factor.

[Oxygen therapy by a portable concentrator with a demand valve: a randomised controlled study of its effectiveness in patients with COPD]. / L'oxygénothérapie par concentrateur portable à valve à la demande : étude randomisée et contrôlée de son efficacité clinique chez des patients BPCO.

INTRODUCTION: There is doubt concerning the clinical effectiveness of portable oxygen concentrators with a control valve (PCDV) and their appreciation by patients. Objectives. To compare the effectiveness and appreciation of oxygen therapy by PCDV and liquid oxygen by continuous f low (O(2)Liq). METHODS: Nineteen patients with COPD were randomised to receive PCDV or O(2)Liq at rest and during a 6 minute walk test (6MWT). For each mechanism they assessed, by visual analogue scales, the convenience and portability, the noise, and the discomfort of the nasal oxygen delivery. RESULTS: The 6MW distance was 315 ± 120 m with PCDV and 325 ± 114 m with O(2)Liq (P>0.05). Dyspnoea and the desaturation induced by the 6MWT were identical with both systems (P>0.05). The time spent with a SaO(2)<90 % was 289 ± 69 s with PCDV and 242 ± 130 s with O(2)Liq (P=0.08). PCDV was noisier than O(2)Liq (P<0.05); there was no difference in convenience and portability or in nasal discomfort. CONCLUSION: The PCDV model that we tested was equally effective to O(2)Liq. However, the prescription of this type of system is a matter of personal choice.

[Home-based pulmonary rehabilitation: the evidence, practical issues and medico-economics]. / La réhabilitation respiratoire à domicile: données de la littérature, aspects pratiques et médico-économiques.

INTRODUCTION: Pulmonary rehabilitation is an established part of the management of chronic obstructive airway disease. For longer-term effects, extending rehabilitation into domiciliary care settings may be necessary. There are few studies evaluating precisely this modality of management in a home setting. STATE OF THE ART: This review analyses the current literature on home based rehabilitation. The benefits of pulmonary rehabilitation, the practical aspects of its application, and its advantages and limitations are detailed. The few data on economic aspects of home rehabilitation are also discussed. PERSPECTIVES: Home-based pulmonary rehabilitation is effective with positive short-term effects on quality of life, breathlessness and effort tolerance. Its practical application needs to be defined. CONCLUSION: Home-based pulmonary rehabilitation appears to be an effective intervention in patients with COPD but more studies are necessary to evaluate it fully.