Clinical standards for diagnosis, treatment and prevention of post-COVID-19 lung disease.

BACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice' care for the diagnosis, treatment and prevention of post-COVID-19 lung disease.METHODS: A panel of international experts representing scientific societies, associations and groups active in post-COVID-19 lung disease was identified; 45 completed a Delphi process. A 5-point Likert scale indicated level of agreement with the draft standards. The final version was approved by consensus (with 100% agreement).RESULTS: Four clinical standards were agreed for patients with a previous history of COVID-19: Standard 1, Patients with sequelae not explained by an alternative diagnosis should be evaluated for possible post-COVID-19 lung disease; Standard 2, Patients with lung function impairment, reduced exercise tolerance, reduced quality of life (QoL) or other relevant signs or ongoing symptoms ≥4 weeks after the onset of first symptoms should be evaluated for treatment and pulmonary rehabilitation (PR); Standard 3, The PR programme should be based on feasibility, effectiveness and cost-effectiveness criteria, organised according to local health services and tailored to an individual patient's needs; and Standard 4, Each patient undergoing and completing PR should be evaluated to determine its effectiveness and have access to a counselling/health education session.CONCLUSION: This is the first consensus-based set of clinical standards for the diagnosis, treatment and prevention of post-COVID-19 lung disease. Our aim is to improve patient care and QoL by guiding clinicians, programme managers and public health officers in planning and implementing a PR programme to manage post-COVID-19 lung disease.

[French practical guidelines for the diagnosis and management of IPF - 2021 update, full version]. / Recommandations pratiques pour le diagnostic et la prise en charge de la fibrose pulmonaire idiopathique ­ Actualisation 2021. Version intégrale.

BACKGROUND: Since the previous French guidelines were published in 2017, substantial additional knowledge about idiopathic pulmonary fibrosis has accumulated. METHODS: Under the auspices of the French-speaking Learned Society of Pulmonology and at the initiative of the coordinating reference center, practical guidelines for treatment of rare pulmonary diseases have been established. They were elaborated by groups of writers, reviewers and coordinators with the help of the OrphaLung network, as well as pulmonologists with varying practice modalities, radiologists, pathologists, a general practitioner, a head nurse, and a patients' association. The method was developed according to rules entitled "Good clinical practice" in the overall framework of the "Guidelines for clinical practice" of the official French health authority (HAS), taking into account the results of an online vote using a Likert scale. RESULTS: After analysis of the literature, 54 recommendations were formulated, improved, and validated by the working groups. The recommendations covered a wide-ranging aspects of the disease and its treatment: epidemiology, diagnostic modalities, quality criteria and interpretation of chest CT, indication and modalities of lung biopsy, etiologic workup, approach to familial disease entailing indications and modalities of genetic testing, evaluation of possible functional impairments and prognosis, indications for and use of antifibrotic therapy, lung transplantation, symptom management, comorbidities and complications, treatment of chronic respiratory failure, diagnosis and management of acute exacerbations of fibrosis. CONCLUSION: These evidence-based guidelines are aimed at guiding the diagnosis and the management in clinical practice of idiopathic pulmonary fibrosis.

[French practical guidelines for the diagnosis and management of IPF - 2021 update, short version]. / Recommandations pratiques pour le diagnostic et la prise en charge de la fibrose pulmonaire idiopathique ­ Actualisation 2021. Version courte.

BACKGROUND: Since the previous French guidelines were published in 2017, substantial additional knowledge about idiopathic pulmonary fibrosis has accumulated. METHODS: Under the auspices of the French-speaking Learned Society of Pulmonology and at the initiative of the coordinating reference center, practical guidelines for treatment of rare pulmonary diseases have been established. They were elaborated by groups of writers, reviewers and coordinators with the help of the OrphaLung network, as well as pulmonologists with varying practice modalities, radiologists, pathologists, a general practitioner, a head nurse, and a patients' association. The method was developed according to rules entitled "Good clinical practice" in the overall framework of the "Guidelines for clinical practice" of the official French health authority (HAS), taking into account the results of an online vote using a Likert scale. RESULTS: After analysis of the literature, 54 recommendations were formulated, improved, and validated by the working groups. The recommendations covered a wide-ranging aspects of the disease and its treatment: epidemiology, diagnostic modalities, quality criteria and interpretation of chest CT, indication and modalities of lung biopsy, etiologic workup, approach to familial disease entailing indications and modalities of genetic testing, evaluation of possible functional impairments and prognosis, indications for and use of antifibrotic therapy, lung transplantation, symptom management, comorbidities and complications, treatment of chronic respiratory failure, diagnosis and management of acute exacerbations of fibrosis. CONCLUSION: These evidence-based guidelines are aimed at guiding the diagnosis and the management in clinical practice of idiopathic pulmonary fibrosis.

[Acceptability and compliance to long-term continuous positive pressure treatment]. / Acceptation et observance à long terme du traitement par pression positive continue.

INTRODUCTION: Compliance with continuous positive pressure treatment (CPAP) is a determining factor in the management of the obstructive sleep apnea syndrome (OSAS). Long-term compliance has been poorly studied. METHODS: The probability of long-term continuation of CPAP was evaluated retrospectively by an analysis of survival in 252 patients treated by CPAP after a screening of 472 patients during the years 2002 and 2003. RESULTS: Twenty-eight patients fulfilling the criteria for CPAP immediately refused the treatment. The mean follow-up for the 252 treated patients was 76.9±46.4 months, with 38 patients having died and 75 having discontinued treatment during the period. The 136 patients who continued treatment used CPAP for a mean of 7.4±1.6hours daily. The probability of continuing treatment was 71% at 5 years and 68% at 10 years. The severity of OSAS was a predictive factor for long-term CPAP compliance, with a 10-year compliance of 82% in patients having an apnoea/hypopnoea index >60, versus 68% with an index between 30-60 and 44% with an index <30. CONCLUSION: Long-term CPAP treatment is globally well accepted, with a 68% probability of continuing treatment for 10 years, particularly in the most severely affected patients. Long-term daily compliance is very satisfactory.

["Spontaneous" resolution of two severe methotrexate-induced pneumonias]. / Résolution spontanée de deux pneumopathies sévères au méthotrexate.

The beneficial role of corticosteroid therapy for the treatment of methotrexate-induced pneumonia remains controversial. We report two cases of acute severe interstitial pneumonia induced by methotrexate in patients with non-Hodgkin lymphoma given a polychemotherapy protocol (M'BACOD). The first signs appeared on the eleventh day of the first cycle in patient one and on the tenth day of the third cycle in patient two. The causal implication of methotrexate was based on the history, the clinical and radiological presentation, and the negative tests in both patients: lymphocyte alveolitis with granulomatous lesions on the transbronchial biopsy in patient one and positive leukocyte migration test in the presence of methotrexate in patient two. Early acute respiratory failure required high flow rate oxygen therapy with positive expiratory pressure ventilatory assistance. The course was rapidly favorable both for blood gases and radiographic presentation without corticosteroids. These two cases illustrate that pulmonary disease can be cured without corticosteroids despite severe respiratory failure at onset. This provides a further argument on reservations about using corticosteroids for suspected methotrexate-induced pneumonia.

[Management of the sleep apnoea syndrome in a general hospital]. / Prise en charge du syndrome d'apnées du sommeil dans un hôpital général. Étude rétrospective de 1718patients appareillés du 1(er) janvier 1994 au 1(er) janvier 2010.

INTRODUCTION: There are few long-term studies on the management of the sleep apnoea syndrome (SAS). PATIENTS AND METHODS: We report a retrospective analysis of the management of SAS in the respiratory service of a general hospital between 1st January 1994 and 1st January 2010. RESULTS: One thousand seven hundred and eighteen patients were diagnosed with SAS and treated with continuous positive airways pressure (CPAP). One thousand one hundred and seventy-three were still being treated on 1st January 2010, representing 68.3% of the total. Four hundred and thirty-three had stopped treatment, representing 25.2% of the total number of patients treated. Four hundred and fourteen patients had died while being treated. The median daily CPAP use among patients still being treated is 6.44 hours. When CPAP was discontinued 45% occurred in the first 6 months and 91% in the first 3 years. The mean apnoea/hypopnoea index of the patients who discontinued treatment was 44 as opposed to 51 for those still using CPAP. The elderly population adhered well to treatment in the long term. The prevalence of severe SAS requiring longer periods of treatment has increased in recent years, probably as the result of practical developments. CONCLUSION: The numbers of investigations and of patients starting treatment are increasing constantly. Long-term compliance with CPAP is satisfactory. Discontinuation of treatment occurs mainly in the early months and, above all, in the non-compliant group. SAS is less severe in those patients who discontinue treatment. Old age is not an obstacle to treatment with CPAP.