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L'essentiel de la littérature réçente en Pneumologie

Dans cette rubrique on vous propose une revue de la littérature à travers une sélection d'abstracts d'articles originaux.
On essaiera de vous tenir informé des dernières nouveautés de recherche en matière de Pneumologie. On ne vous fournit que le résumé de l'article et le lien correspondant, pour accéder à l'article en full text vous devez être inscrits à la revue correspondante.
Cliquez ici pour consulter la liste des revues de Pneumologie disponibles en libre accès.

Prevalence and outcomes of diaphragmatic dysfunction assessed by ultrasound technology during acute exacerbation of COPD: A pilot study. Imprimer Envoyer
Lundi, 17 Octobre 2016 06:21

BACKGROUND AND OBJECTIVE: The prevalence and clinical consequences of diaphragmatic dysfunction (DD) during acute exacerbations of COPD (AECOPD) remain unknown. The aim of this study was (i) to evaluate the prevalence of DD as assessed by ultrasonography (US) and (ii) to report the impact of DD on non-invasive mechanical ventilation (NIV) failure, length of hospital stay and mortality in severe AECOPD admitted to respiratory intensive care unit (RICU).

METHODS: Forty-one consecutive AECOPD patients with respiratory acidosis admitted over a 12-month period to the RICU of the University Hospital of Modena were studied. Diaphragmatic ultrasound (DU) was performed on admission before starting NIV. A change in diaphragmatic thickness (ΔTdi) less than 20% during spontaneous breathing was considered to confirm the presence of dysfunction (DD+). NIV failure and other clinical outcomes (duration of mechanical ventilation MV, tracheostomy, length of hospital stay and mortality) were recorded.

RESULTS: A total of 10 out of 41 patients (24.3%) presented DD+, which was significantly associated with steroid use (P = 0.002, R-squared = 0.19). DD+ correlated with NIV failure (P < 0.001, R-squared = 0.27), longer intensive care unit (ICU) stay (P = 0.02, R-squared = 0.13), prolonged MV (P = 0.023, R-squared = 0.15) and need for tracheostomy (P = 0.006, R-squared = 0.20). Moreover, the Kaplan-Meyer survival estimates showed that NIV failure (log-rank test P value = 0.001, HR = 8.09 (95% CI: 2.7-24.2)) and mortality in RICU (log-rank test P value = 0.039, HR = 4.08 (95% CI: 1.0-16.4)) were significantly associated with DD+.

CONCLUSION: In hospitalized AECOPD patients submitted to NIV, severe DD was seen in almost one-quarter of patients. DD may cause NIV failure, and impact the use of clinical resources and on the patient's short-term mortality.

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Mechanisms of lung aging. Imprimer Envoyer
Lundi, 17 Octobre 2016 06:21

Lung aging is associated with structural remodeling, a decline of respiratory function and a higher susceptibility to acute and chronic lung diseases. Individual factors that modulate pulmonary aging include basic genetic configuration, environmental exposure, life-style and biography of systemic diseases. However, the actual aging of the lung takes place in pulmonary resident cells and is closely linked to aging of the immune system (immunosenescence). Therefore, this article reviews the current knowledge about the impact of aging on pulmonary cells and the immune system, without analyzing those factors that may accelerate the aging process in depth.

Hallmarks of aging include alterations at molecular, cellular and cell-cell interaction levels. Because of the great variety of cell types in the lung, the consequences of aging display a broad spectrum of phenotypes. For example, aging is associated with more collagen and less elastin production by fibroblasts, thus increasing pulmonary stiffness and lowering compliance. Decreased sympathetic airway innervation may increase the constriction status of airway smooth muscle cells. Aging of resident and systemic immune cells leads to a pro-inflammatory milieu and reduced capacity of fighting infectious diseases.

The current review provides an overview of cellular changes occurring with advancing age in general and in several cell types of the lung as well as of the immune system. Thereby, this survey not only aims at providing a better understanding of the mechanisms of pulmonary aging but also to identify gaps in knowledge that warrant further investigations.

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Omalizumab Treatment Response in a Severe Allergic Asthma Population with Overlapping COPD. Imprimer Envoyer
Lundi, 17 Octobre 2016 06:21

Asthma and chronic obstructive pulmonary disease (COPD) are common airway diseases. Individuals with overlapping asthma and COPD experience increased health impairment and severe disease exacerbations. Efficacious treatment options are required for this population. Omalizumab (anti-IgE) therapy is effective in patients with severe, persistent asthma, but limited data are available on efficacy in populations with overlapping asthma and COPD.

METHODS: Data from the Australian Xolair Registry (AXR) was used to compare treatment responses in individuals with asthma-COPD overlap to severe asthma alone. Participants were assessed at baseline and after 6 months of omalizumab treatment. We utilised several different definitions of asthma-COPD overlap. First we compared participants with a previous doctor diagnosis of COPD to participants with no COPD diagnosis. We then made comparisons based on baseline lung function, comparing participants with post-bronchodilator FEV1 <80% predicted to >80% predicted. In the FEV1<80% population, analysis was further stratified based on smoking history.

RESULTS: Omalizumab treatment markedly improved asthma control and health related quality of life in all populations assessed, based on ACQ-5 and AQLQ questionnaire scores. Omalizumab treatment did not improve lung function (FEV1, FVC or FEV1/FVC ratio) in populations that were enriched for asthma-COPD overlap (diagnosis of COPD or FEV1<80%/ever smokers).

CONCLUSIONS: Our study suggests that omalizumab improves asthma control and health related quality of life in individuals with severe allergic asthma and overlapping COPD. These findings provide real-world efficacy data for this patient population and suggest omalizumab is useful in the management of severe asthma with COPD overlap.

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