Prise en charge des complications aiguës sévères chez l’adulte mucoviscidosique

Asthma in Adults

Asthma affects approximately 300 million people worldwide and approximately 7.5% of adults in the United States. Asthma is characterized by inflammation of the airways, variable airflow obstruction, and bronchial hyperresponsiveness. The diagnosis of asthma is a clinical one with the history and physical examination being significant, but objective measures, such as pulmonary function testing, can be used to aid in the diagnosis. There are multiple associated comorbidities with asthma, including rhinitis, sinusitis, gastroesophageal reflux disease, obstructive sleep apnea, and depression. There is often an allergic component of asthma, and patient education is vital.

[The respiratory disease of cystic fibrosis, from infancy to childhood]

The respiratory disease of cystic fibrosis, which is secondary to bronchial inflammation and infection, appears from the youngest age and its evolution is made of exacerbations due to acute respiratory infections. In adulthood, complications such as hemoptysis and pneumothorax are more frequent and respiratory insufficiency is more severe, conditioning prognosis. Care is mainly based on physiotherapy and adapted antibiotics.

[Respiratory failure in cystic fibrosis: management in pediatric intensive care unit, lung transplantation recommendation]

Admission to the ICU for respiratory failure of a child with cystic fibrosis is a telltale sign of the severity of the disease. Bronchopulmonary exacerbation, pneumothorax and hemoptysis are the primary causes, for which respiratory assistance is indispensable in these life-threatening situations. Non-invasive ventilation (NIV) has enabled significant progress in improving patient survival. The modalities of NIV must be tailored to both the patient and the cause of respiratory failure. Invasive ventilation, on the other hand, should be a treatment of last resort, because often associated with high mortality. It must be adapted to the therapeutic strategy involving an impending transplantation, including in critical situations where placement on a high emergency list is a possibility. Since admission to ICU is at times the reflection of the terminal evolution of the disease, ongoing treatment must hence be adapted to the comfort of the child.