[Lung function during normal pregnancy]. / Particularités de la physiologie respiratoire au cours de la grossesse normale.

Pregnancy is associated with major changes in hormonal status, anatomy and physiology involving all systems of a human organism. This narrative review focuses on the most recent data concerning lung function changes during healthy pregnancy. The major findings are as follows: pregnancy is associated with a reduction in static lung volumes reaching 20% of residual functional capacity; it is also associated with chronic alveolar hyperventilation; lastly, it is not associated with significant changes in variables measured by spirometry such as vital capacity, forced expiratory volume in one second and peak expiratory flow, or airway resistance.

[Pulmonary function test: The testing of children]. / Exploration fonctionnelle respiratoire : explorer l'enfant.

In paediatrics, the pulmonary function test (PFT) is most often performed to support the diagnosis or in follow-up of asthma patients. Whatever the pathology responsible for respiratory symptoms and/or functional impairment, repeated PFTs make it possible to establish a prognosis (pulmonary function trajectories…) and to orient preventive interventions. PFT can be performed routinely from the age of three years, provided that the following requirements are met: suitable techniques and equipment, staff trained to apply the techniques and to receive young children, reference values for each technique indicating the limits of normal values and of between-test significant variation. From the age of three, children can be subjected to tidal breathing measurement of: resistance of the respiratory system (oscillometry, Rrs; airflow interruption, Rint) or of airways specific resistance (sRaw) and functional residual capacity (by applying a dilution technique). With maturity, the child will become capable of mobilizing his or her slow vital capacity to measure total lung capacity (TLC), once again by applying a dilution technique, then later by breathing against a closed shutter (plethysmography TLC and Raw). Finally, the child will be able to carry out forced expiration (forced spirometry) along with all of the other PFTs. It is important to take into account the paediatric adaptations specified in the international recommendations regarding the performance, reproducibility and quality of PFTs targeting this population.

[Survey on hygiene practices after the COVID-19 pandemic in EFR departments]. / Mesures d'hygiène pour les explorations fonctionnelles respiratoires (EFR) après la pandémie de COVID-19 ­ Résultats d'une enquête nationale auprès de 28 centres hospitaliers en 2023.

During the COVID-19 pandemic, airborne transmission of lung disease was a cause for major concern, and scientific societies published strict hygiene guidelines for pulmonary function tests (PFT) and cardiopulmonary exercise testing (CPET). These guidelines led to a major decrease in patient access to PFT and CPET, and their relevance in the 2023 post-pandemic context may be called into question. Under the hypothesis that PFT/CPET expert centers have modified their practices in accordance with the applicable guidelines, a survey was conducted from the 8th through the 23rd of February 2023 in 28 French PFT/CPET hospital departments. An overwhelming majority of the centers (96%) did not limit indications for PFT/CPET, and requested neither a vaccination or recovery certificate (93%) nor a negative diagnostic test (89%). While the use by patients and caregivers of surgical masks and antimicrobial filters was unanimously adopted, only 36% of centers declared that FFP2/N95-filtering face masks were worn. Disinfection of caregivers' hands was carried out by 96%, and a majority of centers reported break time (75%) and disinfection of equipment surfaces (89%) between the testing of two patients. In conclusion: aside from a few modifications, the practices reported by PFT/CPET French expert centers in 2023 were close to those in force prior to the COVID-19 epidemic.

[The FEV1/VC ratio to define bronchial obstruction: Should we use a fixed ratio or the lower limit of normal?] / La définition de l'obstruction bronchique par le rapport VEMS/CV : seuil fixe ou limite inférieure de la normale ?

INTRODUCTION: While the screening of chronic obstructive lung diseases (COPD, asthma, etc.) constitutes a major public health issue in France and worldwide, simple spirometry appears currently as the key to meeting the challenge. Since description of the forced expiratory maneuver by Robert Tiffeneau in 1947, it has been admitted that the FEV1/VC ratio permits diagnosis obstructive pulmonary diseases. However, the diagnostic criteria for this ratio remain uncertain. The long-lasting debate between advocates of a 0.7 "fixed ratio" (FR) of 0.7 and advocates of the "lower limit of normal" (LLN) remains relevant. STATE OF THE ARTS: In this general review, we describe the respective advantages of the FR and LLN criteria according to the most recently published studies, and characterize the conditions associated with discrepancies between these criteria. PERSPECTIVES AND CONCLUSIONS: FR and LLN appear not to share similar diagnosis values and the use of both criteria facilitates proposal of an up-to-date interpretation and diagnosis strategy in the context of first-line spirometry, particularly for patients with FEV1/VC ratio in the "grey zone".

[Tracheal lipoma: An exceptional cause of tracheal tumors]. / Lipome trachéal : une cause exceptionnelle de tumeur trachéale.

INTRODUCTION: Tracheal tumors are rare, they are most often malignant and can manifest themselves by a non-specific respiratory symptomatology with progressively increasing dyspnea orienting in the first place towards a COPD or even an asthma. Among them, tracheal lipoma is exceptional. Its management is based on removal by rigid bronchoscopy. OBSERVATION: We report the case of a 73-year-old male patient who presented with non-specific dyspnea that progressively worsened over several months. The EFR showed a flattening of the flow-volume curves, the CT scan showed an anterolateral oval tracheal tumor with fatty density, the bronchial endoscopy showed a tumor lesion with stenosis of about 90% of the airway. Management consisted of a rigid bronchoscopy to delete obtruction with biopsies. Anatomopathology concluded to a tracheal lipoma. CONCLUSION: Progressively worsening dyspnea, especially if there are signs of inspiratory dyspnea, required a systematic bronchial endoscopy to avoid the possibility of a tracheal tumor.

[The forced oscillation technique in the functional evaluation of COPD dyspnea]. / Oscillations forcées et évaluation fonctionnelle de la dyspnée associée à la BPCO.

INTRODUCTION: The goal of the present study is to assess the relationship between functional respiratory parameters measured by the forced oscillation technique (FOT) in COPD patients and (1) dyspnea; (2) inspiratory capacity (IC), along with the variations occurring subsequent to bronchodilation. METHODS: This cross-sectional study analyzed 40 stable COPD patients. Dyspnea was assessed by means of the San Diego Shortness of Breath Questionnaire. Forced oscillations were measured before and after bronchodilation by means of routine pulmonary function tests (PFTs). RESULTS: The reactance parameters measured by the FOT correlated with dyspnea (AX5: r=0.46; P=0.003) similarly to IC (r=-0.46; P=0.003). Changes in AX5 following bronchodilation led to a predicted 12% and 200mL improvement in IC, AX5 (area under the ROC curve=0.85, P<0.001). CONCLUSIONS: Forced oscillation technique (FOT) appears to be an interesting complement to routine PFTs in COPD assessment. Reactance parameters are correlated with dyspnea and their response to bronchodilators is a predictor of significantly improved inspiratory capacity (IC). All in all, FOT may be considered as a functional test with regard to pulmonary hyperinflation, a critical determinant of dyspnea.

[Acute chest syndrome in adult sickle cell patients]. / Syndrome thoracique aigu chez les patients drépanocytaires adultes.

Sickle cell disease is a frequent genetic condition, due to a mutation of the ß-globin gene, leading to the production of an abnormal S hemoglobin and characterized by multiple vaso-occlusive events. The acute chest syndrome is a severe complication associated with a significant disability and mortality. It is defined by the association of one or more clinical respiratory manifestations and a new infiltrate on lung imaging. Its pathophysiology is complex and implies vaso-occlusive phenomena (pulmonary vascular thrombosis, fat embolism), infection, and alveolar hypoventilation. S/S or S/ß0-thalassemia genotype, a history of vaso-occlusive crisis or acute chest syndrome, a low F hemoglobin level (<5%), a high steady-state hemoglobin level (> 10 g/dL), or a high steady-state leukocytosis (>10 G/L) are the main risk factors. Febrile chest pain, dyspnea, sometimes cough with expectorations are its main clinical manifestations, and bi-basal crackles are found at auscultation. Inferior alveolar opacities with or without pleural effusions are identified on chest X-ray or CT-scan. Management of the acute chest syndrome should be prompt and implies, besides the recognition of severity signs, a multimodal analgesia, oxygen supplementation, sometimes a parenteral antibiotic treatment and the frequent use of blood transfusions especially in the most severe cases. Prevention is important and includes a regular monitoring of hospitalized patients and the use of incentive spirometry.

[Spirometry in the Medical Practice - Part 2: Interpretation]. / Die Spirometrie in der ärztlichen Praxis ­ Teil 2: Die Interpretation.

Spirometry in the Medical Practice - Part 2: Interpretation Abstract. The way in which spirometry should be assessed correctly was defined internationally in 2005. Compared to before, it was newly defined that the FEV1/VC ratio is used as a parameter to detect an obstruction. An obstruction is of significance if this measured value is below the 5 % percentile, which is usually indicated as a Z-Score of minus 1,645 in the automatically generated protocol. To generate this value, the software must contain the modern GLI standard values and the patient data (gender, age, height). A proven obstruction shows significant reversibility if bronchospasmolysis improves FEV1 by at least 12 % and 200 ml absolute. The determination of the severity of obstruction is based on the extent of the reduction in FEV1 relative to the individual norm. Even after reading both parts of this publication, ambiguities will still arise in individual cases when performing spirometry in clinical practice. In such cases, it is worthwhile to present these findings to the local pulmonologist for co-assessment. This results in a learning effect that will consolidate expertise.

[Spirometry in the Medical Practice - Part 1: Measuring]. / Die Spirometrie in der ärztlichen Praxis ­ Teil 1: Die Messung.

Spirometry in the Medical Practice - Part 1: Measuring Abstract. Today, every practitioner, as well as every hospital emergency, should be able to perform spirometry. However, the measurement requires solid basic knowledge as well as a certain amount of experience so that consistent and reproducible measurements are possible. Since the measurement depends heavily on the cooperation of the patient, typical errors must be recognised and corrected immediately. A rounded forced expiratory flow volume curve, or a sudden drop of the curve towards zero at the end of exhalation as well as clearly deviating curves or values in the minimum required three measurement manoeuvres are clear hints for an insufficiently forced expiration or an expiration that was stopped too early. Pulmonary function assistants need instructions as to when application of a rapid acting beta agonist with repeated spirometry to detect possible reversibility is necessary. This includes knowing how long therapeutic bronchodilators must be stopped prior to the test.

PneumoLaus: Prévalence de troubles respiratoires fonctionnels dans un échantillon de la population lausannoise.

PneumoLaus: Prevalence of Lung Function Abnormalities in a Sample of the General Population of Lausanne Abstract. Reduced lung function predicts increased mortality. The prevalence of spirometric abnormalities depends on their definition, the references values used and the use or not of bronchodilation. In the PneumoLaus study, conducted between 2014 and 2017 in a sample of the general population of Lausanne, prevalence of chronic obstruction was 3,8 %, of reversible obstruction 2,5 % and of possible restriction 2,2 %. These numbers are lower than in other population studies. Men had more abnormal spirometry results than women, and ever-smokers more than never-smokers. Two thirds of participants with chronic obstruction, most of which without respiratory symptoms, were not aware of any lung disease.

Résumé. Une fonction pulmonaire réduite s'associe à une mortalité accrue. La prévalence de troubles respiratoires fonctionnels dépend de sa définition, des références employées et de l'utilisation ou non de bronchodilatateur. Dans l'étude PneumoLaus, conduite entre 2014 et 2017 dans un échantillon de la population de Lausanne, la prévalence d'obstruction chronique était de 3,8 %, d'obstruction réversible de 2,5 % et de possible restriction de 2,2 %, proportions plus basses que dans d'autres études populationnelles. Les hommes présentaient plus souvent des anomalies spirométriques comparé aux femmes et les fumeurs plus souvent que les non-fumeurs. Deux tiers des sujets avec obstruction chronique, pour la plupart sans symptômes respiratoires, ne se connaissaient pas de maladie pulmonaire.

[Pack-years threshold and HAS self-questionnaire for COPD early diagnosis]. / Seuil de paquets-années et auto-questionnaire HAS pour la recherche de bronchopneumopathie chronique obstructive.

INTRODUCTION: The Haute Autorité de santé (HAS) in France offers a patient self-questionnaire to optimize targeted chronic obstructive pulmonary disease (COPD) screening among at-risk patients in primary care. It includes smoking but does not have a threshold for pack-years (PY) smoked. The objective of this study was to compare the positive predictive values (PPV) of the HAS self-questionnaire alone and with the addition of a PY threshold. METHODS: This was a prospective pilot study conducted in a multi-professional health centre. Identification among smoking or former smoking patients without a COPD diagnosis of subjects with a positive HAS self-questionnaire, a positive PY threshold, or both. We performed spirometry after bronchodilatation. RESULTS: Thirty-five people were included in the study. All 35 had a positive PY threshold. The HAS questionnaire was positive for 22 of them (62.9%). Spirometry diagnosed 18 participants with COPD (51%). The PPV for the HAS questionnaire was 0.41 and the PPV for the HAS+PY questionnaire was 0.51. There was no statistically significant difference between these two PPVs (P=0.3692). CONCLUSIONS: The addition of a PY threshold to the HAS self-questionnaire may allow better targeting of the population at risk of developing COPD.

[Targeted screening of COPD in primary care: Feasibility and effectiveness]. / Détection précoce de la BPCO en soins primaires : un essai contrôlé randomisé.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a common but under-diagnosed pathology in primary care. The objective was to study the feasibility of a randomized controlled trial in general practice to detect new cases of COPD at an earlier stage. METHODS: A cluster randomized, controlled, multicenter intervention study comparing, according to a 2×2 factorial plan, two case finding strategies: a systematic GOLD-HAS hetero-questionnaire and coordination of the patient's path to facilitate access to spirometry. The PIL-DISCO pilot study took place in 2017. Patients between 40 and 80 years old, with no previous history of COPD, consulting their GP on a given day regardless of the reason, were included. RESULTS: 176 patients were included in 1.5 days. Spirometry was performed in none of the control arm, in 13 (29.5%) of the questionnaire arm, in 22 (50%) in the coordination arm and in 32 (72.7%) with the combination of the two strategies. Two cases of stage 2 COPD and thirteen other respiratory diseases were diagnosed. CONCLUSIONS: This study confirms the feasibility of the protocol in primary care in terms of speed of inclusion and acceptability. An extension phase aiming to include 3200 patients will assess the diagnostic value of the two strategies tested in general practice.

[Feasibility and benefits of training to screen for chronic obstructive pulmonary disease]. / Faisabilité et bénéfices de la formation au dépistage du trouble ventilatoire obstructif.

INTRODUCTION: Though still under-diagnosed, chronic obstructive pulmonary disease (COPD) currently affects nearly 3.5 million people in France. The present study presents the results of continuing medical education sessions on COPD screening by electronic mini-spirometry. METHODS: From April 2013 to December 2015, the sessions involved 73 health professionals. The study analysed three questionnaires administered before, after, and long after sessions led by experts within a professional associative network. RESULTS: The sessions proved efficient in increasing the participants' theoretical knowledge. It increased the percentage of correct answers regarding the nature of COPD (90 % vs. 81%), the functions, features, and outputs of mini-spirometers, and the treatment recommendations. The sessions led to non-negligible changes in everyday medical practice regarding the acquisition of a mini-spirometer (+13 devices), the presentation of COPD to the patients (+33 practitioners), the dialogue on tobacco use (+32 practitioners), vaccination (+33 practitioners), and compliance with the treatment recommendations (+43 practitioners). CONCLUSION: These results encourage both holding and following up such sessions. The specialized professional environment ensures knowledge updates and offers subsequent assistance. Further improving these sessions will increase their benefits in terms of diagnosis, treatment, and health economy.

[Study of the feasibility of spirometry in general practice]. / Étude de faisabilité de la spirométrie en médecine générale.

COPD is common but is under-diagnosed by general practitioners (GP). GP have a major role in the early diagnosis of this disease. GP could have access to spirometry. The aim of this study was to evaluate the quality and interpretation of spirometry performed by primary care residents following a short education session. Three residents were trained in spirometry for half a day. They then performed spirometry on all smokers over the age of 35 visiting five general practices. The results were reviewed blindly by an independent specialist pulmonologist to assess their quality and interpretation. Among 184 eligible patients, 89% agreed to participate and 66% (n=107) came for the second appointment. The pulmonologist evaluated the quality of spirometry as good in 72% of cases, of suboptimal but acceptable quality in 20% and of poor quality in 8%. Interpretation was accurate in 91% of tests. The Kappa concordance coefficient between GPs and the expert was 0.93. Airflow obstruction was detected in 17.5% of the screened subjects. The average time for a consultation with spirometry was 19minutes. The consultation dedicated to spirometry was well accepted by patients. A short training has to be structured to allow GPs to perform and interpret spirometry properly. This work needs to be extended to better assess reproducibility in cases of abnormal spirometry.

[Spirometric and radiographic profile of patients with pulmonary tuberculosis treated and cured at the Department of Pulmonology of Brazzaville University Hospital]. / Profil spirométrique et radiographique des patients anciens tuberculeux pulmonaires traités et guéris au service de pneumologie du CHU de Brazzaville.

INTRODUCTION: Tuberculosis is a real public health problem in Congo. Pulmonary localization can lead to sequelae of respiratory functional repercussions. OBJECTIVE: Describe the spirometric and radiographic profile of patients treated with pulmonary tuberculosis treated and cured. PATIENTS AND METHODS: This was a cross-sectional study that included 150 patients with previous pulmonary tuberculosis with positive microscopy treated and cured in the Pulmonary Department of Brazzaville University Hospital. In which we performed a functional exploration (Spirometry) and a chest X-ray. The study took place from 1st January 2016 to 31st August 2016. RESULTS: The spirometry performed in all patients was pathological in 68.67% (103 cases/150) of the cases. Among them 74.76% (77 cases/103) had a restrictive profile (FEV1/FVC >70% and CVF <80%), 9.71% (10 cases/103) an obstructive syndrome (FEV1/FVC ≤70% and CVF >80%) and 15.53% (16 cases/103) a mixed syndrome (FVC <80% and FEV1/FVC <70%). Of the 150 chest radiographs performed, 120 or 80% were pathological; the degree of parenchymal stage III destruction represented 28.33%. There was a significant correlation between the degree of parenchymal destruction and the delay in treatment on the one hand and between the degree of parenchymal destruction and the different pulmonary volumes and volumes on the other hand. CONCLUSION: The prevention of these respiratory functional disorders is based on the prophylaxis of tuberculosis on early diagnosis of the disease.

[The role of spirometry in encouraging smoking cessation in general practice. A pilot study using "lung age"]. / Intérêt de la spirométrie en médecine générale pour la motivation au sevrage tabagique. Étude pilote de faisabilité et intérêt de l'« âge pulmonaire ¼.

INTRODUCTION: Our aim was to investigate whether spirometry, performed in general practitioners' offices would change non-motivated smokers' attitudes toward smoking cessation. METHOD: We performed an interventional, prospective, before-after single-center study, approved by a research ethics committee. We included 74 smokers older than 18years old, who reported no intention to quit smoking, whatever they were visiting general practitioners for. We performed spirometry and gave them their results, FEV1/FVC and lung age together with a comment on it. Nine months later, we called them for another assessment. RESULTS: Fifty-six percent were women with an average-age of 46.5, who smoked 26.3 pack-years. Eighty-two percent of them had normal FEV1/FVC but lung age was pathological among 38% of them. Nine months later, 61.1% reported an increased motivation to quit smoking. They smoked 10.9 cigarettes per day versus 13,3 at baseline (P=0.0254). Increase in motivation was not statistically related to age, gender, previous smoking cessations, daily smoking, nicotine dependence or an abnormal FEV1/VC ratio (P>0.75) but was significantly related to the presence of an abnormal lung age status (P<0.03). CONCLUSION: This study suggests that spirometry in general practice, combined with the determination of the lung age, may increase motivation towards smoking cessation in smokers who lack motivation.

[Evaluation of quality of life (QOL) of Tunisians patients with COPD]. / Évaluation de la qualité de vie (QDV) des patients tunisiens atteints de bronchopneumopathie chronique obstructive (BPCO).

AIM: To test the Arabic version of the St. George's Hospital Respiratory Questionnaire (SGRQ) in stable Tunisian COPD patients. HYPOTHESES: A correlation coefficient between the post-bronchodilator FEV1 and the "Total" score of SGRQ higher than "-0.40", and QOL scores lower in COPD with "mild to moderate airway obstruction" than in those with "severe to very severe airway obstruction" will be in favor of a possible application of the Arabic version of the SGRQ in Tunisians COPD patients. METHODS: This is a prospective cross-sectional study including 50 clinically stable COPD patients. The Arabic version of the SGRQ was used. Four scores were calculated for the "Symptoms", "Activities", "Impacts" and "Total" components. Patients were divided into two groups according to the severity of their airway obstruction: "mild to moderate, n=30" and "severe to very severe, n=20". The correlation between the QOL "Total" score and postBD FEV1 was evaluated. RESULTS: The mean±SD of age, cigarette smoking and post-bronchodilator FEV1 were, respectively, 60±10, 61±36 pack-years and 55±20 %. The correlation between the post-bronchodilator FEV1 and QOL "Total" score was significant at "-0.65". "Symptoms", "Activities", "Impacts" and "Total" scores were significantly less altered in patients with "mild to moderate airway obstruction" than among those with "severe to very severe airway obstruction" (respectively, 52±24 vs. 77±17, 66±28 vs. 87±18, 48±25 vs. 70±23 and 54±22 vs. 76±17). CONCLUSION: The application of the Arabic version of the SGRQ in stable COPD patients gives reliable results.

[Systemic inflammatory profile of smokers with and without COPD]. / Profil inflammatoire systémique des fumeurs atteints de BPCO comparés aux fumeurs indemnes de BPCO.

INTRODUCTION: Studies comparing the systemic inflammatory profiles of smokers with and without COPD present discordant findings. AIM: To compare the systemic inflammatory profile of smokers with and without COPD. METHODS: This is a cross-sectional comparative study. Two groups of active smokers of more than 10 pack-years were included: 56 consecutives stable COPD (postbronchodilator FEV1/FVC<0.70) and 32 consecutives non-COPD (postbronchodilator FEV1/FVC≥0.70). Smoking and clinical, anthropometric and spirometric data were noted. The following blood biomarkers were identified: leukocytes, hemoglobin, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR). According to the levels (normal/abnormal) of these markers, two groups of smokers were formed. Quantitative and qualitative data were expressed, respectively, as means±SD and percentages. RESULTS: Compared to the non-COPD group, the COPD group was older (56±12 vs. 65±8 years) and had a higher smoking consumption (30±18 vs. 52±31 pack-years). Compared to the non-COPD group, the COPD group had higher values of CRP (2.06±1.24 vs. 11.32±11.03mg/L), of ESR (9.59±8.29 vs. 15.96±11.56), of IL-6 (9.28±4.69 vs. 20.27±5.31ng/L) and of TNF-α (18.38±7.98ng/L vs. 8.62±3.72ng/L). Compared to the non-COPD group, the COPD group included higher percentages of smokers with elevated CRP (0 % vs. 32 %), with leukocytosis (6 % vs. 16 %), with higher levels of IL-6 (81 % vs. 98 %) or TNF-α (91 % vs. 100 %). CONCLUSION: Smokers with COPD, compared to smokers free from COPD, have a marked systemic inflammation.

[Spirometry in the GP-Office]. / Die Spirometrie in der Praxis.

Spirometry is an important diagnostic tool, which, with correct implementation, detects possible obstructive or restrictive lung diseases. However, it is important to note that only part of the lung function is measured by spirometry. For instance, total lung volume and residual volume, both useful in detecting pulmonary emphysema, are not measured. Therefore, in case of pathological spirometry or suspected restrictive lung disease, further tests such as body plethysmography with diffusion measurement should be carried out.