[Guidelines for the management of chronic cough in adults]. / Recommandations de prise en charge de la toux chronique de l'adulte.

Patients with chronic cough experience major alteration in their quality of life. Given its numerous etiologies and treatments, this disease is a complex entity. To help clinicians involved in patient management of patients, guidelines have been issued by a group of French experts. They address definitions of chronic cough and initial management of patients with this pathology. We present herein the second-line tests that might be considered in patients whose coughing has persisted, notwithstanding initial management. The experts have also put forward a definition of unexplained or refractory chronic cough (URCC), the objective being to more precisely identify those patients whose cough persists despite optimal management. Lastly, these guidelines indicate the pharmacological and non-pharmacological interventions of use in URCC. Amitriptyline, pregabalin, gabapentin or morphine combined with speech and/or physical therapy are mainstays in treatment strategies. Other treatment options, such as P2X3 antagonists, are being developed and have generated high hopes among physicians and patients alike.

Occupational asthma caused by powder paint in the automotive industry

No disponible

[Guidelines for methacholine provocation testing]. / Recommandations pour le test de provocation bronchique à la méthacholine en pratique clinique, à partir de l'âge scolaire.

Bronchial challenge with the direct bronchoconstrictor agent methacholine is commonly used for the diagnosis of asthma. The "Lung Function" thematic group of the French Pulmonology Society (SPLF) elaborated a series of guidelines for the performance and the interpretation of methacholine challenge testing, based on French clinical guideline methodology. Specifically, guidelines are provided with regard to the choice of judgment criteria, the management of deep inspirations, and the role of methacholine bronchial challenge in the care of asthma, exercise-induced asthma, and professional asthma.

Occupational asthma to detergent protease associated with a late-phase neutrophilic cutaneous response

No disponible

Sinusology.

This paper presents a brief history of the successive anatomical, physiological and pathophysiological concepts about the paranasal sinuses. Sinusology, the science of the paranasal sinuses, is founded on scientific work on the production of nitric oxide (NO) by the sinuses and on the evo-devo theory of their formation. The paranasal sinuses seem to develop after regression of the erythropoietic marrow in the maxillary, frontal and sphenoid bones and its replacement by cavities filled with gas, which escapes into the nasal fossae through the ostium. The sinus epithelium synthesizes NO continuously. The paranasal sinus cavities form a compartmentalized reservoir of NO, which is released discontinuously in boli after an opening of the ostium. Ostium opening can be induced by sound vibration, either internal (humming) or external (an acoustic vibration added to the in-breath). NO plays the role of an "aerocrine" messenger between the upper and lower respiratory tracts, reducing pulmonary vascular resistance and facilitating alveolar oxygen transfer into the bloodstream. Its physiological role in arterial blood oxygenation could be involved in speech and singing or be activated by physiological snoring during sleep. Rhinology, the science of the nose, in which the evo-devo concept distinguishes the respiratory and the olfactory nose, is now backed up by sinusology.

First evidence of occupational asthma to argan powder in a cosmetic factory.

BACKGROUND: Argan is used worldwide in numerous cosmetic products, as this fruit is supposed to have many beneficial properties on health. New cases of allergy can be expected with the growing use of argan. We investigated all workers (9) employed by a cosmetic factory and exposed to argan powder to identify possible allergies related to exposure to argan powder. METHODS: Patients were investigated in the occupational disease department and, according to their symptoms, underwent pulmonary function testing, methacholine challenge, specific inhalation challenge to argan powder, skin prick tests, and immunoblotting analysis. RESULTS: We report three cases of occupational asthma to argan powder and a probable case of rhinitis. Fifteen argan proteins were recognized by the patients' IgE. Identification of proteins, cross-reactions to nuts, and ELISA inhibition tests suggested that some argan allergens can cross-react in vitro with hazelnut allergens, including 11S globulin and vicilin. CONCLUSION: High-level exposure to argan powder should be considered to be a potential cause of IgE-mediated allergy, and workers handling argan powder should be carefully investigated.

Occupational Asthma to dried tobacco leaves: a very delayed diagnosis

No disponible

[Sleep and academic performance in young elite athletes]. / Sommeil et résultats scolaires chez les jeunes sportifs de haut niveau.

RATIONALE: In French law (Code du Sport), the status of elite athlete is allowed for young athletes beginning at the age of 12 years. For these young athletes, the aim is to reach the highest level of performance in their sport without compromising academic performance. Training time is therefore often substantial and sleep patterns appear to play a key role in performance recovery. The aim of this study was to assess sleep patterns and their effects on academic performance in young elite athletes. MATERIAL AND METHODS: Sleep patterns were assessed using questionnaires completed during a specific information-based intervention on sports medicine topics. The academic performance of young elite athletes was assessed by collecting their grades (transmitted by their teachers). RESULTS: Sleep patterns were assessed for 137 young elite athletes (64 females, 73 males; mean age, 15.7 years) and academic performance for 109 of them. Daily sleep duration during school periods (8h22 ± 38 min) were shorter compared to holidays and week-ends (10h02 ± 1h16, P<0.0001). Fifty-six athletes (41 %) subjectively estimated their sleep quality as poor or just sufficient. Poor sleep quality was correlated with poor academic performance in this specific athlete population. DISCUSSION: Sleep is the most important period for recovery from daily activity, but little information is available regarding the specific population of young elite athletes. The results reported herein suggest insufficiency (quantitatively and qualitatively) of sleep patterns in some of the young athletes, possibly leading to detrimental effects on athletic performance. Moreover, disturbed sleep patterns may also impact academic performance in young elite athletes. CONCLUSION: Teachers, athletic trainers, physicians, and any other professionals working with young elite athletes should pay particular attention to this specific population regarding the possible negative repercussions of poor sleep patterns on academic and athletic performance.

Early incidence of occupational asthma is not accelerated by atopy in the bakery/pastry and hairdressing sectors.

SETTING: Occupational asthma (OA) is most likely to develop in the very early years of exposure. OBJECTIVE: To describe the early incidence of OA among bakers/pastry-makers (BP) and hairdressers and to explore the role of atopy. DESIGN: Following a retrospective follow-up design, subjects were invited to undergo telephone interviews. Those who declared work-related respiratory or rhinitis symptoms and a sample group of others were offered a medical visit for OA investigations. Data from interviews and from medical visits were used to estimate the incidence of OA according to increasing durations of exposure. RESULTS: A total of 866 subjects were interviewed (mean age 25.3 years, 43.8% females), of whom 282 underwent a medical visit. Total estimated incidence rates of 'confirmed or probable' OA during the first 12 years of exposure were high in BP (2.63 per 100 person-years [py]) and in hairdressers (0.58/100 py), particularly in the first 4 years. Atopy is a strong risk factor for incidence among BP but, irrespective of the occupational sector, it does not influence the timing of OA symptoms. CONCLUSION: OA symptoms occur soon after the start of exposure. Our results suggest that atopy does not precipitate the occurrence of symptoms in two different allergen exposure settings.

Stimulus response latency of cough and expiration reflex depends on breathing in the rabbit.

Expiration reflex and cough may have distinct afferent pathways and/or central integrative mechanisms that may both result in different stimulus response latencies. A newly described method that uses a punctuate mechanical tracheal stimulus to provoke defensive ventilatory reflexes should allow the stimulus response latency to be calculated with reasonable accuracy. The aim of the study was to test whether cough and expiration reflex have different stimulus response latencies. Four hundred and sixty one mechanical tracheal stimulations (50-300 msec) were performed in 21 anesthetized, tracheotomized rabbits. Twenty three percent stimulations (108) provoked a cough reflex and 37% an expiration reflex (171). The individual mean stimulus response latency was computed for each reflex, calculated from stimulus onset to earliest detectable change in ventilatory flow. Cough reflex latency was significantly shorter in inspiration compared to expiration (257±19 msec vs 391±61 msec; p=0.01). In contrast, the expiration reflex latency was significantly shorter in expiration compared to inspiration (210±11 msec vs 329±29 msec, p=0.003). It is concluded that the within breath dependence of the difference in stimulus response latency between cough and expiration reflex is more likely to express different brainstem mechanisms but difference in afferent fibres may not be excluded.

Knee kinetic pattern during gait and anterior knee pain before and after rehabilitation in patients with patellofemoral pain syndrome.

Patellofemoral pain is likely due to compressive force acting on the patella related in turn to knee extension moment. The latter variable was assumed to be (i) reduced during short-distance free walking in case of patellofemoral pain syndrome and (ii) increased after therapeutic pain reduction. Peak knee extension moment at beginning of stance phase was recorded by three-dimensional gait analysis in 22 controls and in 23 patients with patellofemoral pain syndrome before and after rehabilitation of knee extensors and flexors to reduce the pain. Pain would occur mainly in stressful activities such as stair negotiation or squatting and was quantified by the anterior knee pain scale. Peak knee extension moment was significantly reduced in all the patients before treatment (n=23) compared to controls, although no one had pain during free walking. In the 17 patients who experienced significant post-rehabilitation pain reduction in their stressful activities, the peak knee extension moment was significantly reduced before treatment compared to controls and significantly increased after treatment, reaching values similar to control values. The peak knee extension moment during free walking appears to be a good kinetic variable related to a compensatory mechanism limiting or avoiding anterior knee pain and may be of interest in assessing knee dynamics alteration in patients with PFPS.

A 38-year-old hairdresser with irritant-associated vocal cord dysfunction.

The present case study reports the first case of a 38-year-old hairdresser with irritant-associated vocal cord dysfunction (VCD) due to alkaline persulfate, who was referred on suspicion of occupational asthma. Several tests were performed, including specific inhalation challenge and upper airway endoscopy. During the specific inhalation challenge to alkaline persulfate, the patient experienced dysphonia and a non-significant decrease in forced expiratory volume in 1 second on spirometry. Upper airway endoscopy was then performed and revealed VCD. A specific inhalation challenge test is therefore essential in cases of VCD to exclude possible concomitant occupational asthma.

Cough threshold and reactivity to mechanical stimulation of the trachea in the rabbit preliminary observations.

OBJECTIVES: The aim of the study was to characterise mechanically induced cough threshold and reactivity by exposing the trachea to stimuli of variable duration in rabbit. BACKGROUND: Long lasting mechanical stimulation is widely used in experimental protocols studying cough reflex. The cough threshold and reactivity to chemical agents is known to change due to e.g. airway inflammation but similar evidence for mechanical stimulation has not been reported. METHODS: The tracheal provocation was realized in two anesthetized tracheotomized rabbits with a rotating probe actuated by a small electrical motor with mechanical stimulus times (ST) lasting 50, 150, 300 and 600 ms. Cough reflex was evaluated from tidal volume and airflow signals. RESULTS: The incidence of cough reflex (single or multiple) increased from 8% (ST 50 ms) to 84% (ST 600 ms). With the lengthening of stimulus, the rate of multiple responses increases. CONCLUSION: The technique developed here may prove useful to standardize the protocols of mechanical cough in the experimental animal using an approach similar to chemical tussigenic agents. The cough threshold could be defined as minimal ST (STmin) capable to elicit 1 cough and cough reactivity obtained by interpolation as ST that provokes 50 % of cough responses (STso) (Tab. 1, Fig. 3, Ref. 27).

[Exercise-induced bronchoconstriction in non-asthmatic athletes]. / Bronchoconstriction induite par l'exercice sans asthme associé chez l'athlète: physiopathologie, diagnostic et prise en charge spécifique.

INTRODUCTION: A new clinical entity, exercise-induced bronchoconstriction (EIB), has been recently defined which describes bronchoconstriction occurring in association with exercise in susceptible non-asthmatic persons. STATE OF ART: There is considerable evidence that the pathogenesis of this condition is related to airway injury, due to prolonged hyperventilation and aggressive environmental factors. If the objective diagnostic tests are identical for the diagnosis of exercise induced asthma and EIB, the diagnoses are established differently, according to the high sensitivity of provocation by exercise "in the field" or the eucapnic voluntary hyperventilation provocation test. PERSPECTIVES: Current pharmacological treatment is based upon the inhalation of ß2-agonists prior to exercise, but to be granted permission to use them, athletes are required to provide documentation of objective evidence of EIB. Therefore, the diagnostic pathway in athletes is essential and respiratory physicians need to know the specific features of this new clinical entity. CONCLUSIONS: EIB distinct from the presence of asthma is prevalent in elite athletes and its determinants should be well known by their health care providers to assure an optimal management of this peculiar disease, in respect to drug doping regulations.