RESUMEN
INTRODUCTION: Pesticides are used worldwide, mainly in agriculture as a means of controlling pests and protecting crops. That said, the entire world population is ultimately subject to pesticide exposure (consumption of fruits and vegetables, living near treated fields ), with varying degrees of toxicity involved. STATE OF THE ART: In recent decades, epidemiological studies have contributed to the identification of chemical pesticide families with detrimental effects on human health: cognitive disorders, Parkinson's disease, prostate cancer and impairment in respiratory functioning. Current scientific evidence points to the implication of the active substances in insecticides, herbicides and fungicides in chronic respiratory diseases, two examples being chronic obstructive pulmonary disease (COPD) in exposed workers, and asthmatic wheezing in children during prenatal or postnatal exposure. PERSPECTIVES: The safety of individuals exposed to pesticides is of key importance in public health. Further epidemiological investigations are needed to identify the chemical families affecting certain populations. CONCLUSIONS: The scientific literature suggests strong links between pesticide exposure and respiratory health. Whether it be environmental or occupational, pesticide exposure can lead to respiratory disorders and symptoms of varying severity.
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Exposición a Riesgos Ambientales , Exposición Profesional , Plaguicidas , Enfermedades Respiratorias , Humanos , Plaguicidas/toxicidad , Plaguicidas/efectos adversos , Enfermedad Crónica , Exposición a Riesgos Ambientales/efectos adversos , Exposición Profesional/efectos adversos , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/inducido químicamente , Enfermedades Respiratorias/etiología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/inducido químicamente , Enfermedad Pulmonar Obstructiva Crónica/etiología , Femenino , EmbarazoRESUMEN
INTRODUCTION: The second COPD Biennial organized by the COPD working group of the French Society of Respiratory Diseases took place in Paris (Cochin) on 13th December 2023. STATE OF THE ART: Major trends in 2023 were discussed; they encompassed concepts, definitions, biologics, care pathways, pulmonary rehabilitation and complex situations entailed by respiratory infections, cardiovascular comorbidities and pulmonary hypertension, and modalities of oxygen therapy and ventilation. PERSPECTIVES: The different talks underlined major changes in COPD including the concepts of pre-COPD, etiotypes, health trajectories and new definitions of exacerbation. Recent results in biologics for COPD open the door to new pharmacological options. Assessment of current care pathways in France highlighted some causes for concern. For example, pulmonary rehabilitation is a key but insufficiently practiced element. Respiratory infections require careful assessment and treatments. Diagnosis and treatment of cardiovascular comorbidities and pulmonary hypertension are of paramount importance. As of late, oxygen therapy and ventilation modalities have evolved, and are beginning to afford more personalized options. CONCLUSIONS: As regards COPD, a personalized approach is crucial, placing the patient at the center of the care pathway and facilitating coordination between healthcare providers.
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Vías Clínicas , Enfermedad Pulmonar Obstructiva Crónica , Sociedades Médicas , Humanos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Francia/epidemiología , Vías Clínicas/organización & administración , Vías Clínicas/normas , Vías Clínicas/tendencias , Sociedades Médicas/organización & administración , Sociedades Médicas/normas , Atención Dirigida al Paciente/organización & administración , Atención Dirigida al Paciente/tendencias , Atención Dirigida al Paciente/normas , Neumología/organización & administración , Neumología/tendencias , Neumología/métodos , Neumología/normas , Congresos como AsuntoRESUMEN
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is associated with disabling respiratory symptoms including dyspnea, frequent exacerbations and chronic bronchitis. The currently available pharmacological and non-pharmacological therapies have limited efficacy, necessitating the development of interventional strategies, many of them endoscopic. STATE OF THE ART: Endoscopic lung volume reduction has markedly increased over recent years, principally as regards the endobronchial valves currently used in routine care. Indeed, multiple randomized trials have demonstrated a significant clinical benefit in a selected population identifiable due to the absence of interlobar collateral ventilation. Other endoscopic volume reduction techniques (polymers, thermal vapor, spirals) shall require additional studies before being considered as options in routine care. Targeted lung denervation (TLD) has aroused interest as a means of reducing exacerbations in the early phases of relevant studies. Endobronchial techniques (bronchoscopic cryospray, bronchial rheoplasty) are still at a very early stage of development, which is aimed at reducing the symptoms of chronic bronchitis. OUTLOOK: Aside from endobronchial valves, which are currently employed in routine care, all the above-mentioned endoscopic techniques require additional studies in order to determine their benefit/risk balance and to identify the population that would benefit the most. CONCLUSIONS: Endoscopic treatments constitute a major avenue of research and innovation in the therapeutic management of COPD. Inclusion of patients in disease registries and clinical trials remains essential, the objective being to gauge the interest of these treatments and their future role in everyday COPD management.
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Bronquitis Crónica , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Bronquitis Crónica/complicaciones , Bronquitis Crónica/cirugía , Broncoscopía/métodos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/terapia , Pulmón , Neumonectomía/métodosRESUMEN
Chronic obstructive pulmonary disease with disabling co-morbidities can benefit from music therapy devices that are effective on anxiety, dyspnea, depression and quality of life. This complementary support therapy is easy to implement, in hospital or at home, and allows the patient to take ownership of this self-care.
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Musicoterapia , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Calidad de Vida , Enfermedad Pulmonar Obstructiva Crónica/terapia , Ansiedad/terapia , Disnea/terapiaRESUMEN
Smoking is accountable for most of the chronic obstructive pulmonary disease (COPD) cases. COPD, which is characterized by the development of chronic bronchitis, could be associated with emphysema. In active smokers, there is an overexpression of cathepsin S, a cysteine protease, which participates in the development of emphysema via its elastinolytic activity. Likewise, we demonstrated that cathepsin S could degrade one or more protein constituents of cell junctions. This deleterious proteolytic activity leads to an alteration of the integrity of the lung epithelial barrier, which in turn could aggravate chronic inflammation and promote the exacerbation phases associated with infections.
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Enfisema , Enfermedad Pulmonar Obstructiva Crónica , Enfisema Pulmonar , Humanos , Pulmón , Catepsinas/metabolismo , Enfisema/metabolismoRESUMEN
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and is a poorly understood lung disease. It is accompanied by significant psychological co-morbidities (anxiety, depression, identity and body image disorders) which are under-diagnosed and have an impact on quality of life and the frequency of re-hospitalization. The management of COPD is multidisciplinary and its role is to prevent complications, relieve symptoms and slow the progression of the disease. Therapeutic education of the patient brings a real added value in this multidisciplinary management.
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Enfermedad Pulmonar Obstructiva Crónica , Calidad de Vida , Humanos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Ansiedad/psicología , Comorbilidad , Trastornos de Ansiedad , Depresión/diagnósticoRESUMEN
Cigarette smoke (CS) is a risk factor for chronic obstructive pulmonary disease (COPD), which can exacerbate inflammation and oxidative stress. Pristimerin (Pris) is a natural compound with antioxidant and anti-inflammatory effects. We managed to evaluate the protective effects of Pris on CS-induced COPD. The CS-induced COPD mice model and cell model were constructed. The effects of Pris treatment on lung function, inflammatory cell infiltration, myeloperoxidase (MPO), and pathological changes of lung tissues in mice model were evaluated. The impacts of Pris treatment on inflammatory factors, chemokines, and oxidative stress parameters in mice lung tissues and cells were determined by kits. The viability of human bronchial epithelial cells after Pris treatment was tested by CCK-8. The activation of NF-κB pathway was confirmed by Western blot and immunofluorescence. CS treatment impaired lung function, reduced weight of mice, and enhanced inflammatory cell infiltration, MPO, and lung tissue damage, but these effects of CS were reversed by Pris treatment. Furthermore, Pris treatment downregulated the levels of malondialdehyde, IL-6, IL-1ß, TNF-α, CXCL1, and CXLC2, but upregulated superoxide dismutase and catalase levels. Pris treatment could overturn CS-induced activation of the NF-κB pathway. Pris alleviates CS-induced COPD by inactivating NF-κB pathway.
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Fumar Cigarrillos , Enfermedad Pulmonar Obstructiva Crónica , Animales , Fumar Cigarrillos/efectos adversos , Humanos , Inflamación/inducido químicamente , Inflamación/tratamiento farmacológico , Pulmón/metabolismo , Ratones , FN-kappa B/metabolismo , Triterpenos Pentacíclicos , Enfermedad Pulmonar Obstructiva Crónica/inducido químicamente , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Nicotiana/metabolismoRESUMEN
INTRODUCTION: Respiratory rehabilitation (RR) is a global and interdisciplinary approach designed to improve quality of life of patients with chronic obstructive pulmonary disease (COPD). In France, however it is prescribed in only 10 % of eligible cases. The aim of this study was to find out why general practitioners so seldom include RR in their patient care. METHODS: Semi-structured and individual interviews were conducted between April and July 2018 with general practitioners working in the Upper-Rhine region (France). Verbatims were coded using inductive thematic analysis. RESULTS: Fifteen interviews were conducted. Lack of expert knowledge, available time, and adequate means emerged as the main reasons for not including RR in patient care. General practitioners also described complicated emotional relationships with COPD patients, and admitted to an occasional sense of fatalism or powerlessness. At times they projected these feelings onto their patients, perceiving them as devoid of motivation or compliance. CONCLUSIONS: Negative perceptions of patients and their disease represent an obstacle to optimal COPD management, especially when referring them to RR. Improved medical expertise and comprehension of patients' coping mechanisms would enable general practitioners to better adapt their management, of which motivational interviewing could become a key component.
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Medicina General , Médicos Generales , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Prescripciones , Enfermedad Pulmonar Obstructiva Crónica/psicología , Calidad de VidaRESUMEN
INTRODUCTION: Exacerbations are major events in the course and prognosis of COPD. Following acute exacerbation of COPD (AECOPD), functional recovery is not always complete and the risk of relapse is high, requiring proactive management. STATE OF THE ART: Pulmonary and extrapulmonary consequences of AECOPD require comprehensive and individualized care. Muscle function and nutritional status are key elements to target. Pulmonary rehabilitation is an effective strategy designed to deal with these aspects and to facilitate a comprehensive, patient-centered approach. PERSPECTIVES: Access to pulmonary rehabilitation programs is limited, and existing barriers need to be more precisely identified as a first step toward their possible removal. Long-term exercise maintenance strategies likewise warrant further study. CONCLUSION: The physiotherapist has a major role to assume in per- and post-exacerbation management of people with COPD; it is up to him to assess the patient and to put into place an individualized pulmonary rehabilitation program; it is also up to him to provide long-term support, helping the patient to maintain an active lifestyle while coping with a chronic pathology.
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Enfermedad Pulmonar Obstructiva Crónica , Progresión de la Enfermedad , Ejercicio Físico , Humanos , Pulmón , Masculino , Modalidades de FisioterapiaRESUMEN
INTRODUCTION: Undernutrition is a predictor of mortality in chronic obstructive pulmonary disease (COPD). The objectives of our study were to assess nutritional intake in COPD and to study its relationship with disease severity. METHODS: A cross-sectional study that included 66 patients followed for COPD. Patients included had a body composition study and a respiratory and nutritional assessment. RESULTS: The mean age of the population was 66±9 years. The lean body mass index (LMI) was reduced in 26.1% of patients. It was significantly associated with the GOLD group (P=0.04) and significantly correlated with the forced expiratory volume in the first second (FEV1) (P=0.02) and the distance covered during the six-minute walk test (TM6) (P=0.01). A significant difference was found between the caloric intakes and the different GOLD groups (P=0.04). Mean intakes of calories (P=0.002; r=0.07), protein (P=0.01; r=0.16), carbohydrates (P=0.02; r=0.2) and iron (P=0.01; r=0.13) were significantly correlated with the TM6 results. Caloric intake was significantly correlated with LMI (P=0.01; r=0.16), body mass index (P=0.04; r=0.12), FEV1 (P=0.04; r=-0.12) and GOLD stage (0.002). Similarly, protein intake was significantly correlated with LMI (P=0.001; r=0.11), body mass index (P=0.02; r=0.16), FEV1(%) (P=0.001; r=-0.16) and GOLD stage (P=0.002). CONCLUSION: Undernutrition in COPD is caused by decreased food intake and increased resting energy expenditure. Adequate intakes of glucose, protein, fibers, vitamins and zinc are associated with improved ventilatory function.
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Estado Nutricional , Enfermedad Pulmonar Obstructiva Crónica , Anciano , Estudios Transversales , Ingestión de Alimentos , Volumen Espiratorio Forzado , Humanos , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/epidemiologíaRESUMEN
INTRODUCTION: There are many mechanisms for improving the clinical and blood gas status of patients with the obesity hypoventilation syndrome (OHS) or chronic obstructive pulmonary disease (COPD) by non-invasive ventilation (NIV) at home. Our objective was to set up a pilot study to evaluate the potential modification of the sensitivity of the respiratory centers to CO2 by NIV in paired new COPD and OHS patients. METHODS: We assessed the sensitivity of the respiratory centers to CO2 by the Read method in 3 COPD patients and 3 OHS patients newly treated by NIV and again 3 months later. We compared their results to those of 6 control subjects. RESULTS: All the patients included had altered ventilatory responses to CO2 with slopes of less of than 1 L.min-1.mmHg-1. Mean coefficients of variation were significantly higher in patients than in healthy subjects (P=0.007). Patients who improved their CO2 sensitivity slope were those most observant of NIV. CONCLUSION: This work showed significant changes in the ventilatory response to hypercapnia in patients with either OHS or COPD after NIV therapy. The significance of these changes deserves to be studied.
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Ventilación no Invasiva , Síndrome de Hipoventilación por Obesidad , Dióxido de Carbono , Humanos , Hipercapnia , Síndrome de Hipoventilación por Obesidad/terapia , Proyectos PilotoRESUMEN
INTRODUCTION: Testosterone level has been shown to be associated with respiratory function and loss of lean body mass in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess the relationship between testosterone level and functional respiratory parameters during COPD. METHODS: We conducted a cross-sectional study that included 95 male patients with stable COPD. Functional tests (body plethysmography, six-minute walk test (6MWT), arterial blood gas) were performed in all patients and serum levels of testosterone, prolactin, FSH, LH and C-reactive protein were determined. Lean body mass was measured using bioelectric impedance. RESULTS: The average age was 63.78±8.90years. COPD was classified as stage 3 in 38% of cases and stage 4 in 11% of cases, group C in 10% of cases and group D in 18% of cases. The average testosterone was 20.87±8.60nmol/L. A significant positive correlation was found between FEV1 (P=0.005), FVC (P=0.005), FEV1/FVC ratio (P=0.001), lean mass index (P=0.021), and testosterone. However, testosterone was not correlated with 6MWT or blood gas parameters. Similarly, it was not correlated with FSH, LH, prolactin and C-reactive protein. CONCLUSION: This study found that serum testosterone level was associated with lung function and lean mass during COPD. Further investigations are required to better evaluate the relationship between COPD and serum testosterone levels and the effect of androgen substitution in lung function.
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Hipogonadismo/sangre , Enfermedad Pulmonar Obstructiva Crónica/sangre , Testosterona/sangre , Anciano , Proteína C-Reactiva/metabolismo , Estudios Transversales , Prueba de Esfuerzo , Tolerancia al Ejercicio , Hormona Folículo Estimulante/sangre , Humanos , Hipogonadismo/complicaciones , Hipogonadismo/epidemiología , Hormona Luteinizante/sangre , Masculino , Persona de Mediana Edad , Atrofia Muscular/sangre , Atrofia Muscular/complicaciones , Atrofia Muscular/epidemiología , Pletismografía , Prolactina/sangre , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Túnez/epidemiologíaRESUMEN
INTRODUCTION: Alpha1-antitrypsin deficiency is a predisposing factor for pulmonary disease and under-diagnosis is a significant problem. The results of a targeted screening in patients with respiratory symptoms possibly indicative of severe deficiency are reported here. METHODS: Data were collected from March 2016 to October 2017 on patients who had a capillary blood sample collected during a consultation with a pulmonologist and sent to the laboratory for processing to determine alpha1-antitrypsin concentration, phenotype and possibly genotype. RESULTS: In 20 months, 3728 test kits were requested by 566 pulmonologists and 718 (19 %) specimens sent: among these, 708 were analyzable and 613 were accompanied by clinical information. Of the 708 samples, 70 % had no phenotype associated with quantitative alpha1- antitrypsin deficiency, 7 % had a phenotype associated with a severe deficiency and 23 % had a phenotype associated with an intermediate deficiency. One hundred and eight patients carried at least one PI*Z allele which is considered to be a risk factor for liver disease. CONCLUSIONS: The results of this targeted screening program for alpha1- antitrypsin deficiency using a dried capillary blood sample reflect improvement in early diagnosis of this deficiency in lung disease with good adherence of the pulmonologists to this awareness campaign.
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Pruebas con Sangre Seca/métodos , Tamizaje Masivo/métodos , Deficiencia de alfa 1-Antitripsina/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bronquiectasia/sangre , Bronquiectasia/diagnóstico , Bronquiectasia/genética , Niño , Análisis Mutacional de ADN/métodos , Análisis Mutacional de ADN/normas , Pruebas con Sangre Seca/normas , Femenino , Francia/epidemiología , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Estudios Longitudinales , Masculino , Tamizaje Masivo/organización & administración , Persona de Mediana Edad , Fenotipo , Evaluación de Programas y Proyectos de Salud , Enfermedad Pulmonar Obstructiva Crónica/sangre , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/genética , Enfisema Pulmonar/sangre , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/genética , Adulto Joven , alfa 1-Antitripsina/análisis , alfa 1-Antitripsina/genética , Deficiencia de alfa 1-Antitripsina/sangre , Deficiencia de alfa 1-Antitripsina/epidemiología , Deficiencia de alfa 1-Antitripsina/genéticaRESUMEN
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.
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Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Fumar/patología , Encuestas y Cuestionarios , Adulto , Anciano , Diagnóstico Precoz , Femenino , Francia/epidemiología , Conductas de Riesgo para la Salud , Humanos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Proyectos Piloto , Valor Predictivo de las Pruebas , Atención Primaria de Salud/métodos , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/etiología , Factores de Riesgo , Índice de Severidad de la Enfermedad , Fumar/efectos adversos , Fumar/epidemiología , Fumar/terapia , EspirometríaRESUMEN
INTRODUCTION: Numerous studies about poor communication and altered quality of life of patients with chronic obstuctive pulmonary disease (COPD) lead to the conclusion that overall palliative management of COPD remains to be improved. The aim of this study was to describe pulmonologists' practice of palliative care for COPD patients in order to identify obstacles to it. MATERIAL AND METHOD: A survey was sent to all pulmonologists whose email appeared in the 2017 French-language Respiratory Medicine Society's directory. RESULTS: A total of 294 responses were obtained, among which 287 were analysed. Overall, 81.6% of the pulmonologists said that they identify a distinct palliative phase from "sometimes to often" in the care of COPD patients. When not identified, the most common reason given (68.8%) was the difficulty of defining when to start palliative care. Aspects of the palliative approach, which were considered the most problematic for pulmonologists, were the discussion of end of life care, and the impression that COPD patients have a low demand for information. 31% of pulmonologists reported that they gathered information about patients' wishes to undergo resuscitation and endotracheal intubation in 61 % to 100% of patients who they judged to have the most severe disease. CONCLUSION: Uncertainty as to when to begin a palliative approach for COPD patients and perceptions around communication in chronic diseases appear to be the main obstacles to a palliative approach.
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Cuidados Paliativos/psicología , Cuidados Paliativos/estadística & datos numéricos , Percepción , Pautas de la Práctica en Medicina/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Neumólogos , Adulto , Directivas Anticipadas/psicología , Directivas Anticipadas/estadística & datos numéricos , Anciano , Femenino , Francia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/normas , Relaciones Médico-Paciente , Pautas de la Práctica en Medicina/normas , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/psicología , Neumología/normas , Neumología/estadística & datos numéricos , Neumólogos/psicología , Neumólogos/estadística & datos numéricos , Calidad de Vida , Cuidado Terminal/métodos , Cuidado Terminal/psicología , Cuidado Terminal/estadística & datos numéricosRESUMEN
Chronic obstructive pulmonary disease (COPD) is a chronic lung disease leading to irreversible destruction of the terminal bronchioles. Although the precise patho-physiological mechanisms remain to be elucidated, the bronchial epithelium seems to play a pivotal role in the disease. Recent studies have highlighted a great heterogeneity among COPD patients, with various disease courses including, in about half the cases, an origin in childhood. Modelling of COPD is a major goal but currently available models are imperfect. Our work aims to create a new in vitro cellular model to study the pathology of the disease. The differentiation of human induced pluripotential stem cells (hiPSCs) in bronchial epithelium is a step towards a better understanding of the developmental origin and the identification of new therapeutic targets.
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Modelos Animales de Enfermedad , Células Madre Pluripotentes Inducidas/fisiología , Enfermedad Pulmonar Obstructiva Crónica/patología , Mucosa Respiratoria/patología , Animales , Diferenciación Celular/fisiología , Progresión de la Enfermedad , Humanos , Células Madre Pluripotentes Inducidas/patología , Ratones , Ratas , Mucosa Respiratoria/citologíaRESUMEN
INTRODUCTION: In France, only a small number of studies have focused on therapeutic adherence in patients with chronic obstructive pulmonary disease COPD) despite its impact in terms of multimorbidity. The objective of this literature review was a better understanding of adherence as a whole, and the identification of the effects of non-adherence, in order to optimise patient management. METHODS: A search algorithm was developed to identify all publications on therapeutic adherence in COPD published between 2010 and 2017, in English and in French. The databases used were MEDLINE, ScienceDirect, BDSP, Cochrane and CAIRN. RESULTS: Of the 1551 articles initially identified, 94 were included in the review (65 observational studies, 11 interventional studies and 18 reviews or general overviews). Observational studies considered the predictive factors for adherence/non-adherence, and their consequences. Interventional studies evaluated the efficacy of interventions designed to improve adherence. CONCLUSIONS: Despite major therapeutic progress, the essential problems of COPD management remain. While the treatment armamentarium has expanded in recent years, there is still a great deal of work to be done in simplifying treatment regimens, improving the administration of these treatments and motivating patients to be compliant with them. This review also highlights the need for better physician-patient communication.
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Enfermedad Pulmonar Obstructiva Crónica/terapia , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Francia/epidemiología , Humanos , Cumplimiento de la Medicación/estadística & datos numéricos , Motivación , Relaciones Médico-Paciente , Enfermedad Pulmonar Obstructiva Crónica/epidemiologíaRESUMEN
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.
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Educación Médica Continua/métodos , Tamizaje Masivo , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Espirometría , Adulto , Evaluación Educacional , Estudios de Factibilidad , Femenino , Francia/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Tamizaje Masivo/instrumentación , Tamizaje Masivo/métodos , Persona de Mediana Edad , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Espirometría/instrumentación , Espirometría/métodos , Encuestas y CuestionariosRESUMEN
Azithromycin is a macrolide widely used in chronic bronchial diseases due to its anti-inflammatory properties. This treatment is prescribed to patients with bronchiectasis, asthma and severe chronic obstructive pulmonary disease who present more than 3 exacerbations per year or a deterioration of respiratory function despite an optimal treatment. Macrolides decrease the number of exacerbation but azythromycine must be prescribed carefully. Indeed, it involves potential cardiovascular and otological toxicities and the emergence of resistant bacteria. In addition, studies remain insufficient to establish the optimal dosage and duration of azithromycine.
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Azitromicina/uso terapéutico , Enfermedades Bronquiales/tratamiento farmacológico , Azitromicina/efectos adversos , Enfermedad Crónica , Humanos , Selección de PacienteRESUMEN
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.