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Bautin N, Ferlin J, Terce G, Ternynck C, Valentin V, Wemeau L, Chenivesse C. Frequency and characteristics of refractory dyspnea in idiopathic fibrosing interstitial pneumonia. Respir Med 2024; 222:107526. [PMID: 38176572 DOI: 10.1016/j.rmed.2023.107526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 01/06/2024]
Abstract
Patients with idiopathic fibrosing interstitial pneumonias (f-IIPs) mainly suffer from dyspnea. Refractory dyspnea, defined as persistent dyspnea despite optimal treatment, could be the signal to prescribe dyspnea relievers. We aimed to examine the prevalence and characteristics of refractory dyspnea in consecutive patients with f-IIPs. Refractory dyspnea was defined by an mMRC≥3 and also by a VAS dyspnea score≥2 at rest. The sensory and affective characteristics of refractory dyspnea (mMRC≥3) and associated quality of life (QoL) anxiety and depression were compared with non-refractory dyspnea (mMRC1-2) using the Multidimensional Dyspnea Profile (MDP), King's Brief Interstitial Lung Disease (KBILD) and Hospital Anxiety and Depression scale (HADs). We included 40 patients (24 men), aged 72 [68-79], FVC of 71 % [59-86] and DLCO 47 % [40-49]. Refractory dyspnea, was found in 38 % (95%CI:23-54) when defined by mMRC≥3 and in 67 % (95%CI:50-81) using a resting VAS dyspnea score ≥2. The agreement between the two definitions was low. Patients with refractory dyspnea (mMRC≥3) were more often women (60 % vs.28 %, p = 0.046), had a lower DLCO (24 % [22-43] vs.47 % [43-51], p = 0.014) and more frequently used oxygen (60 % vs.12 %, p = 0.003); they experience more intense air hunger (5/10 [3-6] vs.2/10 [0-5], p = 0.018)). No significant differences were observed in VAS, MDP, KBILD, or HADs scores between refractory and non-refractory dyspnea patients. Our results indicate a significant frequency of refractory dyspnea in patients with f-IIPs and an association with air hunger but no impact on the affective dimension of dyspnea, anxiety, depression and QoL, suggesting that the mMRC score might not accurately identify patients distressed by their breathlessness.
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Affiliation(s)
- Nathalie Bautin
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017- CIIL - Center for Infection and Immunity of Lille, Lille, France.
| | - Juliette Ferlin
- Univ. Lille, CHU de Lille, Service de Pneumologie et Immuno-allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, F-59000, Lille, France
| | - Gaelle Terce
- CH Béthune, Service de Pneumologie et Réhabilitation Respiratoire, Béthune, France
| | | | - Victor Valentin
- Univ. Lille, CHU de Lille, Service de Pneumologie et Immuno-allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, F-59000, Lille, France
| | - Lidwine Wemeau
- Univ. Lille, CHU de Lille, Service de Pneumologie et Immuno-allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, F-59000, Lille, France
| | - Cecile Chenivesse
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, CRISALIS, F-CRIN Network, INSERM US015, Toulouse, France
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Le Rouzic O, Picaud M, Salvator H, Bautin N, Devillier P, Perez T. Residual reversibility in COPD patients already on long-acting bronchodilator: The OscilloRevers Study. Respir Med Res 2024; 85:101082. [PMID: 38280281 DOI: 10.1016/j.resmer.2023.101082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 11/21/2023] [Accepted: 12/01/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Dyspnea is a complex symptom of chronic obstructive pulmonary disease (COPD) which is not strongly correlated with lung function measures. Long-acting bronchodilators (LAB) may reduce this dyspnea, but some patients report persistent chronic dyspnea despite this treatment. This study aims to assess residual reversibility and clinical response after short-acting bronchodilator (SAB) in COPD patients already treated by LAB and reporting persistent dyspnea. METHODS COPD patients with a persistent dyspnea (modified Medical Research Council scale (mMRC) ≥1) despite current stable treatment with at least one LAB were included. Spirometry, plethysmography and impulse oscillometry (IOS) were performed at peak effect of their LAB and repeat 45 min after the intake of two SAB (400 µg of salbutamol and 80 µg of ipratropium). Dyspnea improvement was assessed at 45 min after SAB through a comparative two-sided VAS (-100 mm for maximal improvement; +100 mm for maximal degradation). RESULTS Twenty-two COPD patients were analyzed, mainly men (59.1 %) with a mean age of 60.6 years and a median FEV1 of 54 % of predicted values. Fifty percent of patients reported a severe basal dyspnea (mMRC ≥2). After SAB, spirometric and plethysmographic measurements were statistically improved. For IOS measurement, reactance at 5 Hz (X5) and area of reactance (AX) were also improved. Fifty percent of patients reported a clinically relevant improvement of their resting dyspnea. However, no correlation was found between dyspnea improvement and functional measures. CONCLUSIONS Fifty percent of COPD patients regularly treated with one or two LAB still report a relevant improvement of resting dyspnea after the adjunctive intake of double short-acting bronchodilators. Physiological mechanisms associated with this improvement remain to be determined. CLINICAL TRIAL REGISTRATION NCT02928744.
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Affiliation(s)
- Olivier Le Rouzic
- CHU Lille, Pneumologie et Immuno-Allergologie, F-59000 Lille, France; Univ. Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France.
| | - Marjorie Picaud
- CH Tourcoing, Respiratory disease department, F-59200 Tourcoing, France
| | - Hélène Salvator
- Hopital Foch, Service de Pneumologie, F-92150 Suresnes, France; Virologie et Immunologie Moléculaire (VIM), V2I, UMR 0892, Université Paris-Saclay, F-92150 Suresnes, France
| | - Nathalie Bautin
- CHU Lille, Pneumologie et Immuno-Allergologie, F-59000 Lille, France; Univ. Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France; CHU Lille, Explorations Fonctionnelles Respiratoires, F-59000 Lille, France
| | - Philippe Devillier
- Hopital Foch, Service de Pneumologie, F-92150 Suresnes, France; Virologie et Immunologie Moléculaire (VIM), V2I, UMR 0892, Université Paris-Saclay, F-92150 Suresnes, France
| | - Thierry Perez
- CHU Lille, Pneumologie et Immuno-Allergologie, F-59000 Lille, France; Univ. Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France; CHU Lille, Explorations Fonctionnelles Respiratoires, F-59000 Lille, France
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Pereira S, Verhille J, Cailliau E, Bonniaud P, Devouassoux G, Fry S, Guilleminault L, Khayath N, Leroyer C, Chenivesse C, Bautin N. Improvement of exertional dyspneoa in patients with chronic obstructive pulmonary disease and severe allergic asthma responding to omalizumab. Clin Exp Allergy 2023; 53:1298-1301. [PMID: 37705326 DOI: 10.1111/cea.14392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/11/2023] [Accepted: 08/19/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Sophie Pereira
- Univ. Lille, Service de Pneumologie Immunologie Allergologie, Lille, France
| | - Juliette Verhille
- Univ. Lille, Service de Pneumologie Immunologie Allergologie, Lille, France
| | | | - Philippe Bonniaud
- Department of Pulmonary Medicine and Intensive Care Unit, Dijon-Bourgogne University Hospital, Inserm U1231, Constitutive Reference Center for Rare Pulmonary Diseases, University of Bourgogne-Franche Comté, Dijon, France
- CRISALIS, F-CRIN Network, INSERM US015, Toulouse, France
| | - Gilles Devouassoux
- CRISALIS, F-CRIN Network, INSERM US015, Toulouse, France
- Department of Respiratory Diseases, CIERA, HCL, University Claude Bernard Lyon 1, Lyon, France
| | - Stéphanie Fry
- CRISALIS, F-CRIN Network, INSERM US015, Toulouse, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - Laurent Guilleminault
- CRISALIS, F-CRIN Network, INSERM US015, Toulouse, France
- Department of respiratory medicine, Toulouse University Hospital, Faculty of Medicine, Toulouse, France. Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), INSERM UMR1291, CNRS UMR5051, University Toulouse III, Toulouse, France
| | - Naji Khayath
- CRISALIS, F-CRIN Network, INSERM US015, Toulouse, France
- Chest Diseases Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Cécile Chenivesse
- CRISALIS, F-CRIN Network, INSERM US015, Toulouse, France
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - Nathalie Bautin
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, France
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Bousso A, Chuffart C, Leroy M, Gicquello A, Cottereau A, Hennegrave F, Beurnier A, Stoup T, Pereira S, Morelot-Panzini C, Taille C, Bautin N, Fry S, Perez T, Garcia G, Chenivesse C. Severity and phenotypes of dyspnea in asthma: Impact of comorbidities. Respir Med 2023:107276. [PMID: 37217082 DOI: 10.1016/j.rmed.2023.107276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Dyspnea is a common but non-specific symptom of asthma, which in particular may be related to anxiety and hyperventilation syndrome, two frequent comorbidities of asthma. METHODS We conducted a prospective multicentric cohort study in dyspneic asthmatic adults. Dyspnea was assessed using the Multidimensional Dyspnea Profile questionnaire. We described the sensory (QS) and affective (A2) domains of dyspnea and investigated the effect of poor asthma control, hyperventilation and anxiety on each dimension at baseline and after 6 months. RESULTS We included 142 patients (65.5% women, age: 52 years). Dyspnea was severe and predominated on its sensory domain (median QS: 27/50; A2: 15/50). Uncontrolled asthma (ACQ≥1.5), hyperventilation symptoms (Nijmegen≥23) and anxiety (HAD-A≥10) were present in 75%, 45.7% and 39% of cases, respectively. Hyperventilation symptoms were associated with higher QS and A2 scores: QS at 28.4(10.7) vs. 21.7(12.8) (p = 0.001) and A2 at 24(14) vs. 11.3(11) (p < 0.001) in patients with vs. without hyperventilation symptoms. Anxiety was only associated with increased A2 (27(12.3) vs. 10.9(11), p < 0.001). At 6 months, QS and A2 decreased of 7 and 3 points, respectively, in relation with changes in ACQ-6 and Nijmegen scores as well as the HAD-A score for A2. CONCLUSION In breathless asthmatics, dyspnea is severe and worsened but differentially modulated by hyperventilation symptoms and anxiety. A multidimensional phenotyping of dyspnea in asthmatics could be useful to understand its origins and personalize treatment.
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Affiliation(s)
- Awa Bousso
- Univ. Lille, CHU Lille, Service de Pneumologie et Immuno-Allergologie, Lille, France
| | - Celine Chuffart
- Centre Hospitalier de Roubaix, Service de Pneumologie, Roubaix, France
| | - Maxime Leroy
- CHU Lille, Department of Biostatistics, F-59000, Lille, France
| | - Alice Gicquello
- Groupement des Hôpitaux de L'Institut Catholique de Lille, Service de Pneumologie, Lille, France
| | - Aurelie Cottereau
- Groupement des Hôpitaux de L'Institut Catholique de Lille, Service de Pneumologie, Lille, France
| | | | - Antoine Beurnier
- Bicêtre Hospital, Department of Physiology - Lung Function Testing, DMU 5 Thorinno, AP-HP - Paris Saclay University, Inserm UMR_S999, Le Kremlin Bicêtre, France; CRISALIS, F-CRIN Inserm Network, France
| | - Thomas Stoup
- Univ. Lille, CHU Lille, Service de Pneumologie et Immuno-Allergologie, Lille, France
| | - Sophie Pereira
- Univ. Lille, CHU Lille, Service de Pneumologie et Immuno-Allergologie, Lille, France
| | - Capucine Morelot-Panzini
- GHU APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, Service de Pneumologie, Paris, France; UMRS 1158, Inserm-Sorbonne Université, Paris, France
| | - Camille Taille
- Bichat Hospital, Respiratory Diseases Department, Reference Center for Rare Pulmonary Diseases, AP-HP Nord - University of Paris Cité, Inserm 1152, 75018, Paris, France; UMRS 1158, Inserm-Sorbonne Université, Paris, France
| | - Nathalie Bautin
- UMRS 1158, Inserm-Sorbonne Université, Paris, France; Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017- CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - Stephanie Fry
- UMRS 1158, Inserm-Sorbonne Université, Paris, France; Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017- CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - Thierry Perez
- UMRS 1158, Inserm-Sorbonne Université, Paris, France; Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017- CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - Gilles Garcia
- Hopital Privé D'Antony, Service de Pneumologie, Antony, France
| | - Cecile Chenivesse
- UMRS 1158, Inserm-Sorbonne Université, Paris, France; Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017- CIIL - Center for Infection and Immunity of Lille, Lille, France.
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Dégot T, Douvry B, Falque L, Bautin N, Frachon I, Mankikian J, Le Pavec J, Picard C. [Follow-up strategies for lung transplant recipients in France]. Rev Mal Respir 2023; 40:314-323. [PMID: 36868975 DOI: 10.1016/j.rmr.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/24/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Lung transplantation (LT) requires sustained care for a frequently polypathological condition. Follow-up is focused on three main issues: 1/stability of respiratory function; 2/comorbidity management; 3/preventive medicine. About 3000 LT patients in France are treated in 11 LT centers. Given the increased size of the LT recipient cohort, follow-up might be partially shared with peripheral centers. METHODS This paper presents the suggestions of a working group of the SPLF (French-speaking respiratory medicine society) on possible modalities of shared follow-up. RESULTS While the main LT center is tasked with centralizing follow-up, particularly the choice of optimal immunosuppression, an identified peripheral center (PC) may serve as an alternative to deal with acute events, comorbidities and routine assessment. Communication between the different centers should be free-flowing. Shared follow-up may be offered from the 3rd postoperative year to stable and consenting patients, whereas unstable and non-observant patients are poor candidates. CONCLUSION These guidelines may serve as a reference for any pneumologist wishing to effectively contribute to follow-up, even and especially subsequent to lung transplant.
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Affiliation(s)
- T Dégot
- Groupe de transplantation pulmonaire, service de pneumologie, hôpitaux universitaires de Strasbourg, nouvel hôpital Civil, Strasbourg, France.
| | - B Douvry
- Service de pneumologie, centre hospitalier intercommunal, centre des maladies respiratoires rares (RESPIRARE®), CRCM, Créteil, France; Inserm, IMRB, université Paris-Est Créteil, 94010 Créteil, France
| | - L Falque
- Pôle thorax et vaisseaux, service hospitalier universitaire pneumologie physiologie, CHU de Grenoble-Alpes, Grenoble, France
| | - N Bautin
- Inserm, CHU de Lille, université de Lille, CNRS, institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - I Frachon
- Service de pneumologie, CHU, hôpital Cavale Blanche, Brest, France
| | - J Mankikian
- Service de pneumologie et d'explorations fonctionnelles respiratoires, CHU, hôpital Bretonneau, Tours, France
| | - J Le Pavec
- Service de pneumologie et transplantation pulmonaire, groupe hospitalier Marie-Lannelongue - Saint-Joseph, Le Plessis-Robinson, France; Université Paris-Saclay, Le Kremlin-Bicêtre, France; Inserm, UMR_S 999, université Paris-Sud, groupe hospitalier Marie-Lannelongue - Saint-Joseph, Le Plessis-Robinson, France
| | - C Picard
- Groupe de transplantation pulmonaire, service de pneumologie, hôpital Foch, Suresnes, France
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Grosbois JM, Détrée A, Pierache A, Bautin N, Pérez T, Wallaert B, Chenivesse C, Le Rouzic O. Impact of Cardiovascular and Metabolic Comorbidities on Long-term Outcomes of Home-based Pulmonary Rehabilitation in COPD. Int J Chron Obstruct Pulmon Dis 2023; 18:155-167. [PMID: 36860514 PMCID: PMC9969866 DOI: 10.2147/copd.s381744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/31/2022] [Indexed: 02/24/2023] Open
Abstract
Background Cardiovascular and metabolic comorbidities in chronic obstructive pulmonary disease (COPD) are associated with higher symptoms burden. Few center-based studies have evaluated the impact of these comorbidities on short-term pulmonary rehabilitation outcomes with contrasting results. Research Question This study aimed to determine whether cardiovascular diseases and metabolic comorbidities impacted long-term outcomes of a home-based PR program in COPD patients. Study Design and methods Data of 419 consecutive COPD patients addressed to our pulmonary rehabilitation program between January 2010 and June 2016 were retrospectively analyzed. Our program consisted of once-weekly supervised home sessions, including therapeutic education and self-management support, with unsupervised retraining exercises and physical activities the other days for 8 weeks. Exercise capacity (6-min stepper test [6MST]), quality of life (visual simplified respiratory questionnaire), and anxiety and depression (hospital anxiety and depression scale) were assessed respectively, before (M0) and at the end (M2) of the pulmonary rehabilitation program, and at 6 (M8) and 12 months (M14) after its achievement. Results Patients (mean age 64.1±11.2 years, 67% males, mean forced expiratory volume in one second (FEV1) 39.2±17.0% predicted) were classified as having cardiovascular comorbidities (n=195), only metabolic disorders (n=122) or none of these comorbidities (n=102). After adjustment, all outcomes appeared similar between groups at baseline and improved after pulmonary rehabilitation with a greater effect at M14 for patients with only metabolic disorders on anxiety and depression score (-5.0±0.7 vs -2.9±0.8 and -2.6±0.6, p=0.021). Quality of life and exercise capacity improvements were not significantly different between the three groups at M2 and M14. Conclusion Cardiovascular and metabolic comorbidities do not preclude COPD patients from obtaining clinically meaningful improvements in exercise capacity, quality of life and anxiety-depression up to 1 year after a home-based pulmonary rehabilitation.
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Affiliation(s)
| | - Axelle Détrée
- Groupe Hospitalier Loos Haubourdin, Réhabilitation Respiratoire, Loos, F-59120, France
| | - Adeline Pierache
- Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France,CHU Lille, Department of Biostatistics, Lille, F-59000, France
| | - Nathalie Bautin
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Thierry Pérez
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Benoit Wallaert
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Cécile Chenivesse
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France
| | - Olivier Le Rouzic
- Université de Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, Lille, F-59000, France,CHU Lille, Pneumologie et Immuno-Allergologie, Centre de référence constitutif pour les maladies pulmonaires rares, Lille, F-59000, France,Correspondence: Olivier Le Rouzic, Pneumologie et Immuno-Allergologie, Institut Cœur Poumon, 1 boulevard Jules Leclercq, CHU de Lille, Lille, 59037, France, Tel +33 3 20 44 59 48, Fax +33 3 20 44 57 68, Email
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Gantois N, Lesaffre A, Durand-Joly I, Bautin N, Le Rouzic O, Nseir S, Reboux G, Scherer E, Aliouat EM, Fry S, Gosset P, Fréalle E. Factors associated with Pneumocystis colonization and circulating genotypes in chronic obstructive pulmonary disease patients with acute exacerbation or at stable state and their homes. Med Mycol 2021; 60:6420247. [PMID: 34734270 DOI: 10.1093/mmy/myab070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/20/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Pneumocystis jirovecii colonization is frequent during chronic obstructive pulmonary disease (COPD) and patients constitute potential contributors to its interhuman circulation. However, the existence of an environmental reservoir cannot be excluded. We assessed the prevalence and factors associated with Pneumocystis colonization during COPD, and studied circulation between patients and their domestic environment. Pneumocystis molecular detection and mtLSU genotyping were performed in oro-pharyngeal washes (OPW) sampled in 58 patients with COPD acute exacerbation, and in indoor dust, sampled in patients' homes using electrostatic dust collectors (EDCs). Lung and systemic inflammation was assessed. Pneumocystis carriage was evaluated in 28 patients after 18 months at stable state. Pneumocystis was detected in 11/58 OPWs during exacerbation (19.0%). Colonized patients presented a significantly lower body mass index, and higher serum IL-17 and CD62P. One patient presented positive detection of typable isolates in both OPW and EDC, with both isolates harboring mtLSU genotype 3. Pneumocystis genotype 1 was further detected in EDCs from three non-colonized patients and one colonized patient with non-typable isolate. Genotypes 1 and 2 were predominant in clinical isolates (both 42%), with genotype 3 representing 16% of isolates. Pneumocystis was detected in 3/28 patients at stable state (10.7%). These data suggest that Pneumocystis colonization could be facilitated by a lower BMI and be related to acute alteration of lung function during COPD exacerbation. It also suggests Th17 pathway and platelet activation could be involved in the anti-Pneumocystis response during colonization. Last, Pneumocystis detection in EDCs supports its potential persistence in indoor dust. LAY SUMMARY Chronic obstructive pulmonary disease patients tend to be more frequently colonized by Pneumocystis during exacerbation (19.0%) than at stable state (10.7%). Factors associated with colonization include lower BMI, higher IL-17, and CD62P. Pneumocystis detection in patients' dwellings suggests potential persistence in indoor dust.
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Affiliation(s)
- Nausicaa Gantois
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Aymerick Lesaffre
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | | | - Nathalie Bautin
- CHU Lille, Clinique des Maladies Respiratoires, F-59000 Lille, France
| | - Olivier Le Rouzic
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France.,CHU Lille, Clinique des Maladies Respiratoires, F-59000 Lille, France
| | - Saad Nseir
- CHU Lille, Pôle de Réanimation, F-59000 Lille, France
| | - Gabriel Reboux
- Chrono-Environnement UMR 6249 CNRS, Université de Bourgogne Franche-Comté & Service de Parasitologie-Mycologie, CHU de Besançon, F-25030 Besançon, France
| | - Emeline Scherer
- Chrono-Environnement UMR 6249 CNRS, Université de Bourgogne Franche-Comté & Service de Parasitologie-Mycologie, CHU de Besançon, F-25030 Besançon, France
| | - El Moukhtar Aliouat
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Stéphanie Fry
- CHU Lille, Clinique des Maladies Respiratoires, F-59000 Lille, France
| | - Philippe Gosset
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France
| | - Emilie Fréalle
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France.,CHU Lille, Laboratoire de Parasitologie-Mycologie, F-59000 Lille, France
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Remy-Jardin M, Duthoit L, Perez T, Felloni P, Faivre JB, Fry S, Bautin N, Chenivesse C, Remy J, Duhamel A. Assessment of pulmonary arterial circulation 3 months after hospitalization for SARS-CoV-2 pneumonia: Dual-energy CT (DECT) angiographic study in 55 patients. EClinicalMedicine 2021; 34:100778. [PMID: 33817609 PMCID: PMC8008988 DOI: 10.1016/j.eclinm.2021.100778] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND During COVID-19, the main manifestations of the disease are not only pneumonia but also coagulation disorders. The purpose of this study was to evaluate pulmonary vascular abnormalities 3 months after hospitalization for SARS-CoV-2 pneumonia in patients with persistent respiratory symptoms. METHODS Among the 320 patients who participated in a systematic follow-up 3 months after hospitalization, 76 patients had residual symptoms justifying a specialized follow-up in the department of pulmonology. Among them, dual-energy CT angiography (DECTA) was obtained in 55 patients. FINDINGS The 55 patients had partial (n = 40; 72.7%) or complete (n = 15; 27.3%) resolution of COVID-19 lung infiltration. DECTA was normal in 52 patients (52/55; 94.6%) and showed endoluminal filling defects in 3 patients (3/55; 5.4%) at the level of one (n = 1) and two (n = 1) segmental arteries of a single lobe and within central and peripheral arteries (n = 1). DECT lung perfusion was rated as non-interpretable (n = 2;3.6%), normal (n = 17; 30.9%) and abnormal (n = 36; 65.5%), the latter group comprising 32 patients with residual COVID-19 opacities (32/36; 89%) and 4 patients with normal lung parenchyma (4/36; 11%). Perfusion abnormalities consisted of (a) patchy defects (30/36; 83%), (b) PE-type defects (6/36; 16.6%) with (n = 1) or without proximal thrombosis (n = 5); and (c) focal areas of hypoperfusion (2/36; 5.5%). Increased perfusion was seen in 15 patients, always matching GGOs, bands and/or vascular tree-in- bud patterns. INTERPRETATION DECT depicted proximal arterial thrombosis in 5.4% of patients and perfusion abnormalities suggestive of widespread microangiopathy in 65.5% of patients. Lung microcirculation was abnormal in 4 patients with normal lung parenchyma.
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Affiliation(s)
- Martine Remy-Jardin
- Univ.Lille, CHU Lille, Department of Thoracic Imaging, ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, F-59000 LILLE, France
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
| | - Louise Duthoit
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
- Univ.Lille, CHU Lille, Department of Pulmonology, Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq, F-59000 LILLE, France
| | - Thierry Perez
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
- Department of Pulmonary Function Testing, Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq, F-59000 LILLE, France
| | - Paul Felloni
- Univ.Lille, CHU Lille, Department of Thoracic Imaging, ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, F-59000 LILLE, France
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
| | - Jean-Baptiste Faivre
- Univ.Lille, CHU Lille, Department of Thoracic Imaging, ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, F-59000 LILLE, France
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
| | - Stéphanie Fry
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
- Univ.Lille, CHU Lille, Department of Pulmonology, Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq, F-59000 LILLE, France
| | - Nathalie Bautin
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
- Univ.Lille, CHU Lille, Department of Pulmonology, Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq, F-59000 LILLE, France
| | - Cécile Chenivesse
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
- Univ.Lille, CHU Lille, Department of Pulmonology, Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq, F-59000 LILLE, France
| | - Jacques Remy
- Univ.Lille, CHU Lille, Department of Thoracic Imaging, ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, F-59000 LILLE, France
- Hospital Calmette, University Hospital Center of Lille, Blvd Jules Leclercq F-59000 LILLE, France
| | - Alain Duhamel
- Univ.Lille, CHU Lille, Department of Biostatistics, ULR 2694 METRICS Evaluation des technologies de santé et des pratiques médicales, F-59000 LILLE, France
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Fréalle E, Reboux G, Le Rouzic O, Bautin N, Willemin MC, Pichavant M, Delourme J, Sendid B, Gosset P, Nseir S, Fry S. Impact of domestic mould exposure on Aspergillus biomarkers and lung function in patients with chronic obstructive pulmonary disease. Environ Res 2021; 195:110850. [PMID: 33577771 DOI: 10.1016/j.envres.2021.110850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are frequently colonised or sensitised by Aspergillus, but clinical significance remains unclear. Furthermore, little is known on the impact of indoor mould exposure during COPD. In this study, we assessed the relationship between domestic mould exposure, Aspergillus biomarkers and COPD severity during acute exacerbation and at stable state. Aspergillus section Fumigati culture in sputum and anti-Aspergillus antibodies detection (IgG and precipitins) were followed up in COPD patients that were prospectively recruited during exacerbation (n = 62), and underwent a visit at stable state after 18 months (n = 33). Clinical characteristics were collected at inclusion. Electrostatic dust collectors (EDCs) were used to measure domestic mould contamination. Aspergillus section Fumigati was more frequently detected during exacerbation (16.9%) than at stable state (4.0%), but the frequency of patients presenting with anti-Aspergillus antibodies was similar (32.2% and 33.3%, respectively). Aspergillus section Fumigati detection was associated with a higher body-mass index (BMI) during exacerbation, whereas patients with anti-Aspergillus antibodies presented a lower BMI and forced expiratory volume in 1 s, as well as a higher frequency of inhaled corticoids and higher total mould and Penicillium exposure at final visit (P < 0.05). The frequency of patients with anti-Aspergillus antibodies was higher for total mould counts >30 CFU/cm2 (P = 0.03). Aspergillosis was diagnosed in 2 patients (6.1%) who presented increased levels of antibodies. Our data suggest that anti-Aspergillus antibodies are associated with chronic lung function alteration and/or domestic mould exposure, thereby supporting the consideration of indoor mould contamination and anti-Aspergillus antibodies kinetics in COPD management.
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Affiliation(s)
- Emilie Fréalle
- CHU Lille, Laboratoire de Parasitologie-Mycologie, 59000, Lille, France; Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR9017 - CIIL - Center for Infection and Immunity of Lille, 59000, Lille, France.
| | - Gabriel Reboux
- Chrono-Environnement UMR 6249 CNRS, Université de Bourgogne Franche-Comté & Service de Parasitologie-Mycologie, CHU de Besançon, France
| | - Olivier Le Rouzic
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR9017 - CIIL - Center for Infection and Immunity of Lille, 59000, Lille, France; CHU Lille, Clinique des Maladies Respiratoires, 59000, Lille, France
| | - Nathalie Bautin
- CHU Lille, Clinique des Maladies Respiratoires, 59000, Lille, France
| | | | - Muriel Pichavant
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR9017 - CIIL - Center for Infection and Immunity of Lille, 59000, Lille, France
| | - Julie Delourme
- CHU Lille, Clinique des Maladies Respiratoires, 59000, Lille, France
| | - Boualem Sendid
- CHU Lille, Laboratoire de Parasitologie-Mycologie, 59000, Lille, France; Inserm U995, Université de Lille, France
| | - Philippe Gosset
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR9017 - CIIL - Center for Infection and Immunity of Lille, 59000, Lille, France
| | - Saad Nseir
- CHU Lille, Pôle de Réanimation, 59000, Lille, France
| | - Stéphanie Fry
- CHU Lille, Clinique des Maladies Respiratoires, 59000, Lille, France
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Dangers L, Giovannelli J, Mangiapan G, Alves M, Bigé N, Messika J, Morawiec E, Neuville M, Cracco C, Béduneau G, Terzi N, Huet I, Dhalluin X, Bautin N, Quiot JJ, Appere-de Vecchi C, Similowski T, Chenivesse C. Antiplatelet Drugs and Risk of Bleeding After Bedside Pleural Procedures: A National Multicenter Cohort Study. Chest 2020; 159:1621-1629. [PMID: 33290789 DOI: 10.1016/j.chest.2020.10.092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 09/10/2020] [Accepted: 10/29/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The decision-making on antiplatelet drug withdrawal or continuation before performing a pleural procedure is based on the balance between the risk of bleeding associated with the antiplatelet therapy and the risk of arterial thrombosis due to its interruption. Knowledge on antiplatelet therapy-associated risk of bleeding after pleural procedures is lacking. RESEARCH QUESTION Is the risk of bleeding associated with antiplatelet drugs increased in patients undergoing pleural procedures? STUDY DESIGN AND METHODS We conducted a French multicenter cohort study in 19 centers. The main outcome was the occurrence of bleeding, defined as hematoma, hemoptysis, or hemothorax, during the 24 h following a pleural procedure. Serious bleeding events were defined as bleeding requiring blood transfusion, respiratory support, endotracheal intubation, embolization, or surgery, or as death. RESULTS A total of 1,124 patients was included (men, 66%; median age, 62.6 ± 27.7 years), of whom 182 were receiving antiplatelet therapy and 942 were not. Fifteen patients experienced a bleeding event, including eight serious bleeding events. The 24-h incidence of bleeding was 3.23% (95% CI, 1.08%-5.91%) in the antiplatelet group and 0.96% (95% CI, 0.43%-1.60%) in the control group. The occurrence of bleeding events was significantly associated with antiplatelet therapy in univariate analysis (OR, 3.44; 95% CI, 1.14-9.66; P = .021) and multivariate analysis (OR, 4.13; 95% CI, 1.01-17.03; P = .044) after adjusting for demographic data and the main risk factors for bleeding. Likewise, antiplatelet therapy was significantly associated with serious bleeding in univariate analysis (OR, 8.61; 95% CI, 2.09-42.3; P = .003) and multivariate analysis (OR, 7.27; 95% CI, 1.18-56.1; P = .032) after adjusting for the number of risk factors for bleeding. INTERPRETATION Antiplatelet therapy was associated with an increased risk of post-pleural procedure bleeding and serious bleeding. Future guidelines should take into account these results for patient safety.
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Affiliation(s)
- Laurence Dangers
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Jonathan Giovannelli
- CHU Lille, Clinique de Pneumologie, Lille, France; Univ Lille, INSERM, LIRIC UMR U995, Lille, France
| | - Gilles Mangiapan
- Centre Hospitalier Intercommunal de Créteil, Service de Pneumologie et Pathologies Professionnelles, Créteil, France
| | - Mikael Alves
- APHP, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France; Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Service de Réanimation, Poissy, France
| | - Naïke Bigé
- Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Service de Réanimation, Poissy, France
| | - Jonathan Messika
- APHP, Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France; Sorbonne Paris Cité, Univ Paris Diderot, INSERM, IAME, UMR 1137, Paris, France
| | - Elise Morawiec
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Mathilde Neuville
- APHP, Hôpital Bichat-Claude Bernard, Service de Pneumologie, Paris, France
| | - Christophe Cracco
- Centre Hospitalier d'Angoulême Saint-Michel, Service de Réanimation Médicale, Saint-Michel, France
| | - Gaëtan Béduneau
- Centre Hospitalier Universitaire de Rouen, Service de Réanimation Médicale, Rouen, France
| | - Nicolas Terzi
- Centre Hospitalier Universitaire de Caen, Service de Réanimation Médicale, Caen, France
| | - Isabelle Huet
- Centre Hospitalier Universitaire de Toulouse, Service de Pneumologie, Toulouse, France
| | | | - Nathalie Bautin
- CHU Lille, Clinique de Pneumologie, Lille, France; Centre Hospitalier de Roubaix, Service de Pneumologie et Allergologie, Roubaix, France
| | - Jean-Jacques Quiot
- Centre Hospitalier Régional Universitaire de Brest, Département de Médecine Interne et de Pneumologie, Brest, France
| | | | - Thomas Similowski
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Cécile Chenivesse
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), Paris, France; CHU Lille, Clinique de Pneumologie, Lille, France; Univ Lille, INSERM, CNRS, Institut Pasteur de Lille, CIIL, U1019, UMR 8204, Lille, France.
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Pamart G, Bautin N, Wemeau-Stervinou L, Valentin V, Audousset C, Perez T, Chenivesse C. Dyspnée sensorielle et affective dans les PID : corrélations avec les EFR. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Béhague P, Deldicque A, Le Rouzic O, Briand J, Paris N, Bautin N, Perez T, Bervar J, Perez M, Décaudin B, Odou P. Intérêt d’une coopération pneumologue/pharmacien dans l’optimisation des traitements inhalés chez les patients BPCO. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Verhille J, Giovannelli J, Fry S, Le Rouzic O, Perez T, Valentin V, Wémeau-Stervinou L, Chenivesse C, Bautin N. Omalizumab chez les patients ayant un asthme sévère allergique associé à une bronchopneumopathie chronique obstructive : une étude de cohorte monocentrique. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dauchy C, Bautin N, Nseir S, Reboux G, Wintjens R, Le Rouzic O, Sendid B, Viscogliosi E, Le Pape P, Arendrup MC, Gosset P, Fry S, Fréalle E. Emergence of Aspergillus fumigatus azole resistance in azole-naïve patients with chronic obstructive pulmonary disease and their homes. Indoor Air 2018; 28:298-306. [PMID: 29082624 DOI: 10.1111/ina.12436] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/19/2017] [Indexed: 06/07/2023]
Abstract
Azole-resistant Aspergillus fumigatus (ARAF) has been reported in patients with chronic obstructive pulmonary disease (COPD) but has not been specifically assessed so far. Here, we evaluated ARAF prevalence in azole-naïve COPD patients and their homes, and assessed whether CYP51A mutations were similar in clinical and environmental reservoirs. Sixty respiratory samples from 41 COPD patients with acute exacerbation and environmental samples from 36 of these patient's homes were prospectively collected. A. fumigatus was detected in respiratory samples from 11 of 41 patients (27%) and in 15 of 36 domiciles (42%). Cyp51A sequencing and selection on itraconazole medium of clinical (n = 68) and environmental (n = 48) isolates yielded ARAF detection in 1 of 11 A. fumigatus colonized patients with COPD (9%) and 2 of 15 A. fumigatus-positive patient's homes (13%). The clinical isolate had no CYP51A mutation. Two environmental isolates from two patients harbored TR34 /L98H mutation, and one had an H285Y mutation. Coexistence of different cyp51A genotypes and/or azole resistance profiles was detected in 3 of 8 respiratory and 2 of 10 environmental samples with more than one isolate, confirming the need for a systematic screening of all clinically relevant isolates. The high prevalence of ARAF in patients with COPD and their homes supports the need for further studies to assess the prevalence of azole resistance in patients with Aspergillus diseases in Northern France.
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Affiliation(s)
- C Dauchy
- CHU Lille, Laboratoire de Parasitologie-Mycologie, Lille, France
| | - N Bautin
- CHU Lille, Department of Respiratory Diseases, Lille, France
| | - S Nseir
- CHU Lille, Critical Care Center, Lille, France
| | - G Reboux
- Chrono-Environnement UMR 6249 CNRS, Université de Bourgogne Franche-Comté & Laboratoire de Parasitologie-Mycologie, CHU de Besançon, Hôpital Jean-Minjoz, Besançon, France
| | - R Wintjens
- Research in Drug Development, Faculté de Pharmacie, Université Libre de Bruxelles, Bruxelles, Belgium
| | - O Le Rouzic
- CHU Lille, Department of Respiratory Diseases, Lille, France
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - B Sendid
- CHU Lille, Laboratoire de Parasitologie-Mycologie, Lille, France
- Inserm U995, Université de Lille, Lille, France
| | - E Viscogliosi
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - P Le Pape
- EA1155-IICiMed, Institut de Recherche en Santé 2, Université de Nantes, Nantes, France
| | - M C Arendrup
- Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - P Gosset
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - S Fry
- CHU Lille, Department of Respiratory Diseases, Lille, France
| | - E Fréalle
- CHU Lille, Laboratoire de Parasitologie-Mycologie, Lille, France
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille, France
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Nunes D, Bautin N, Perez T, Lerouzic O, Chenivesse C. Impact du syndrome d’hyperventilation sur la productivité au travail. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Morélot-Panzini C, Adler D, Aguilaniu B, Allard E, Bautin N, Beaumont M, Blanc FX, Chenivesse C, Dangers L, Delclaux C, Demoule A, Devillier P, Didier A, Georges M, Housset B, Janssens JP, Laveneziana P, Laviolette L, Muir JF, Ninot G, Perez T, Peiffer C, Schmidt M, Similowski T, Straus C, Taillé C, Van Den Broecke S, Roche N. Breathlessness despite optimal pathophysiological treatment: on the relevance of being chronic. Eur Respir J 2017; 50:50/3/1701159. [DOI: 10.1183/13993003.01159-2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 06/23/2017] [Indexed: 11/05/2022]
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17
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Fréalle E, Reboux G, Le Rouzic O, Bautin N, Sendid B, Nseir S, Gosset P, Fry S. Impact de l’exposition domestique aux moisissures sur le risque de colonisation ou sensibilisation par Aspergillus fumigatus des patients atteints de BPCO. J Mycol Med 2017. [DOI: 10.1016/j.mycmed.2017.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Le Rouzic O, Koné B, Kluza J, Marchetti P, Hennegrave F, Olivier C, Kervoaze G, Vilain E, Mordacq C, Just N, Perez T, Bautin N, Pichavant M, Gosset P. Cigarette smoke alters the ability of human dendritic cells to promote anti-Streptococcus pneumoniae Th17 response. Respir Res 2016; 17:94. [PMID: 27460220 PMCID: PMC4962368 DOI: 10.1186/s12931-016-0408-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/16/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with chronic inflammation and impaired immune response to pathogens leading to bacteria-induced exacerbation of the disease. A defect in Th17 cytokines in response to Streptococcus pneumoniae, a bacteria associated with COPD exacerbations, has been recently reported. Dendritic cells (DC) are professional antigen presenting cells that drive T-cells differentiation and activation. In this study, we hypothesized that exposure to cigarette smoke, the main risk factor of COPD, might altered the pro-Th17 response to S. pneumoniae in COPD patients and human DC. METHODS Pro-Th1 and -Th17 cytokine production by peripheral blood mononuclear cells (PBMC) from COPD patients was analyzed and compared to those from smokers and non-smokers healthy subjects. The effect of cigarette smoke extract (CSE) was analyzed on human monocyte-derived DC (MDDC) from controls exposed or not to S. pneumoniae. Bacteria endocytosis, maturation of MDDC and secretion of cytokines were assessed by flow cytometry and ELISA, respectively. Implication of the oxidative stress was analyzed by addition of antioxidants and mitochondria inhibitors. In parallel, MDDC were cocultured with autologous T-cells to analyze the consequence on Th1 and Th17 cytokine production. RESULTS PBMC from COPD patients exhibited defective production of IL-1β, IL-6, IL-12 and IL-23 to S. pneumoniae compared to healthy subjects and smokers. CSE significantly reduced S. pneumoniae-induced MDDC maturation, secretion of pro-Th1 and -Th17 cytokines and activation of Th1 and Th17 T-cell responses. CSE exposure was also associated with sustained CXCL8 secretion, bacteria endocytosis and mitochondrial oxidative stress. Antioxidants did not reverse these effects. Inhibitors of mitochondrial electron transport chain partly reproduced inhibition of S. pneumoniae-induced MDDC maturation but had no effect on cytokine secretion and T cell activation. CONCLUSIONS We observed a defective pro-Th1 and -Th17 response to bacteria in COPD patients. CSE exposure was associated with an inhibition of DC capacity to activate antigen specific T-cell response, an effect that seems to be not only related to oxidative stress. These results suggest that new therapeutics boosting this response in DC may be helpful to improve treatment of COPD exacerbations.
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Affiliation(s)
- Olivier Le Rouzic
- Univ. Lille, U1019 – UMR 8204 – CIIL – Center for Infection and Immunity of Lille, F-59000 Lille, France
- CNRS, UMR 8204, F-59000 Lille, France
- Inserm, U1019, F-59000 Lille, France
- CHU Lille, Service de Pneumologie Immunologie et Allergologie, F-59000 Lille, France
- Institut Pasteur de Lille, F-59000 Lille, France
| | - Bachirou Koné
- Univ. Lille, U1019 – UMR 8204 – CIIL – Center for Infection and Immunity of Lille, F-59000 Lille, France
- CNRS, UMR 8204, F-59000 Lille, France
- Inserm, U1019, F-59000 Lille, France
- Institut Pasteur de Lille, F-59000 Lille, France
| | - Jerome Kluza
- Univ. Lille, UMR-S 1172 – JPArc – Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, F-59000 Lille, France
- Inserm, UMR-S 1172, F-59000 Lille, France
| | - Philippe Marchetti
- Univ. Lille, UMR-S 1172 – JPArc – Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, F-59000 Lille, France
- Inserm, UMR-S 1172, F-59000 Lille, France
| | - Florence Hennegrave
- CHU Lille, Service de Pneumologie Immunologie et Allergologie, F-59000 Lille, France
| | - Cécile Olivier
- CHU Lille, Service de Pneumologie Immunologie et Allergologie, F-59000 Lille, France
| | - Gwenola Kervoaze
- Univ. Lille, U1019 – UMR 8204 – CIIL – Center for Infection and Immunity of Lille, F-59000 Lille, France
- CNRS, UMR 8204, F-59000 Lille, France
- Inserm, U1019, F-59000 Lille, France
- Institut Pasteur de Lille, F-59000 Lille, France
| | - Eva Vilain
- Univ. Lille, U1019 – UMR 8204 – CIIL – Center for Infection and Immunity of Lille, F-59000 Lille, France
- CNRS, UMR 8204, F-59000 Lille, France
- Inserm, U1019, F-59000 Lille, France
- Institut Pasteur de Lille, F-59000 Lille, France
| | - Clémence Mordacq
- Univ. Lille, U1019 – UMR 8204 – CIIL – Center for Infection and Immunity of Lille, F-59000 Lille, France
- CNRS, UMR 8204, F-59000 Lille, France
- Inserm, U1019, F-59000 Lille, France
- Institut Pasteur de Lille, F-59000 Lille, France
- CHU Lille, Service de Pédiatrie, F-59000 Lille, France
| | - Nicolas Just
- CH Roubaix, Service de Pneumologie, F-59100 Roubaix, France
| | - Thierry Perez
- CHU Lille, Service de Pneumologie Immunologie et Allergologie, F-59000 Lille, France
| | - Nathalie Bautin
- CHU Lille, Service de Pneumologie Immunologie et Allergologie, F-59000 Lille, France
| | - Muriel Pichavant
- Univ. Lille, U1019 – UMR 8204 – CIIL – Center for Infection and Immunity of Lille, F-59000 Lille, France
- CNRS, UMR 8204, F-59000 Lille, France
- Inserm, U1019, F-59000 Lille, France
- Institut Pasteur de Lille, F-59000 Lille, France
| | - Philippe Gosset
- Univ. Lille, U1019 – UMR 8204 – CIIL – Center for Infection and Immunity of Lille, F-59000 Lille, France
- CNRS, UMR 8204, F-59000 Lille, France
- Inserm, U1019, F-59000 Lille, France
- Institut Pasteur de Lille, F-59000 Lille, France
- LI3, CIIL - Institut Pasteur de Lille, F-59000 Lille, France
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Ranohavimparany A, Bautin N, Fiamma MN, Similowski T, Straus C. Source of ventilatory complexity in the postmetamorphic tadpole brainstem, Pelophylax ridibundus: A pharmacological study. Respir Physiol Neurobiol 2016; 224:27-36. [DOI: 10.1016/j.resp.2014.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 10/22/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
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Dangers L, Mangiapan G, Alves M, Bigé N, Messika J, Morawiec E, Neuville M, Cracco C, Beduneau G, Terzi N, Huet I, Dhalluin X, Bautin N, Quiot J, Appere De Vecchi C, Similowski T, Chenivesse C. Risque hémorragique des gestes pleuraux sous antiagrégants plaquettaires : étude multicentrique et prospective. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lesaffre A, Durand-Joly I, Bautin N, Nseir S, Maillard H, Reboux G, Million L, Gantois N, Sendid B, Aliouat EM, Fry S, Dei-Cas E, Frealle E. Circulation de Pneumocystis entre les patients atteints de BPCO et leur environnement domestique. J Mycol Med 2015. [DOI: 10.1016/j.mycmed.2015.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Perez T, Garcia G, Roche N, Bautin N, Chambellan A, Chaouat A, Court-Fortune I, Delclaux B, Guenard H, Jebrak G, Orvoen-Frija E, Terrioux P. Société de pneumologie de langue française. Recommandation pour la pratique clinique. Prise en charge de la BPCO. Mise à jour 2012. Exploration fonctionnelle respiratoire. Texte long. Rev Mal Respir 2014; 31:263-94. [DOI: 10.1016/j.rmr.2013.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Perez T, Garcia G, Roche N, Bautin N, Chambellan A, Chaouat A, Court-Fortune I, Delclaux B, Guenard H, Jebrak G, Orvoen-Frija E, Terrioux P. Société de pneumologie de langue française. Recommandation pour la pratique clinique. Prise en charge de la BPCO. Mise à jour 2012. Thème mis à jour : exploration fonctionnelle respiratoire (Texte court). Rev Mal Respir 2014; 31:85-90. [DOI: 10.1016/j.rmr.2013.10.642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sobanski V, Ajzenberg D, Delhaes L, Bautin N, Just N. Severe toxoplasmosis in immunocompetent hosts: be aware of atypical strains. Am J Respir Crit Care Med 2013; 187:1143-5. [PMID: 23675724 DOI: 10.1164/rccm.201209-1635le] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Adler D, Gottfried SB, Bautin N, Mirkovic T, Schmidt M, Raux M, Pavlovic D, Similowski T, Demoule A. Repetitive magnetic stimulation of the phrenic nerves for diaphragm conditioning: a normative study of feasibility and optimal settings. Appl Physiol Nutr Metab 2011; 36:1001-8. [PMID: 22014178 DOI: 10.1139/h11-095] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Electrical stimulation can enhance muscle function. We applied repetitive cervical magnetic phrenic stimulation (rCMS) to induce diaphragm contractions in 7 healthy subjects (800 ms trains; transdiaphragmatic pressure (Pdi) measurements; tolerance ratings). Each rCMS train produced a sustained diaphragm contraction. Sixty-five percent of the maximal available output at 15 Hz proved the best compromise between Pdi and discomfort with nonfatiguing contractions. rCMS appears feasible and should be investigated for diaphragm conditioning in appropriate clinical populations.
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Affiliation(s)
- Dan Adler
- Service de Pneumologie et Réanimation et Centre de Neurostimulation Respiratoire, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Straus C, Samara Z, Fiamma MN, Bautin N, Ranohavimparany A, Le Coz P, Golmard JL, Darré P, Zelter M, Poon CS, Similowski T. Effects of maturation and acidosis on the chaos-like complexity of the neural respiratory output in the isolated brainstem of the tadpole, Rana esculenta. Am J Physiol Regul Integr Comp Physiol 2011; 300:R1163-74. [PMID: 21325645 DOI: 10.1152/ajpregu.00710.2009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Human ventilation at rest exhibits mathematical chaos-like complexity that can be described as long-term unpredictability mediated (in whole or in part) by some low-dimensional nonlinear deterministic process. Although various physiological and pathological situations can affect respiratory complexity, the underlying mechanisms remain incompletely elucidated. If such chaos-like complexity is an intrinsic property of central respiratory generators, it should appear or increase when these structures mature or are stimulated. To test this hypothesis, we employed the isolated tadpole brainstem model [Rana (Pelophylax) esculenta] and recorded the neural respiratory output (buccal and lung rhythms) of pre- (n = 8) and postmetamorphic tadpoles (n = 8), at physiologic (7.8) and acidic pH (7.4). We analyzed the root mean square of the cranial nerve V or VII neurograms. Development and acidosis had no effect on buccal period. Lung frequency increased with development (P < 0.0001). It also increased with acidosis, but in postmetamorphic tadpoles only (P < 0.05). The noise-titration technique evidenced low-dimensional nonlinearities in all the postmetamorphic brainstems, at both pH. Chaos-like complexity, assessed through the noise limit, increased from pH 7.8 to pH 7.4 (P < 0.01). In contrast, linear models best fitted the ventilatory rhythm in all but one of the premetamorphic preparations at pH 7.8 (P < 0.005 vs. postmetamorphic) and in four at pH 7.4 (not significant vs. postmetamorphic). Therefore, in a lower vertebrate model, the brainstem respiratory central rhythm generator accounts for ventilatory chaos-like complexity, especially in the postmetamorphic stage and at low pH. According to the ventilatory generators homology theory, this may also be the case in mammals.
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Affiliation(s)
- Christian Straus
- Service Central d'Explorations Fonctionnelles Respiratoires, Groupe Hospitalier Pitie-Salpetriere, 47-83 Boulevard de l'Hôpital, Paris Cedex 13, France
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Just N, Bautin N, Perez T. From the authors:. Eur Respir J 2010. [DOI: 10.1183/09031936.00068110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Just N, Bautin N, Danel-Brunaud V, Debroucker V, Matran R, Perez T. The Borg dyspnoea score: a relevant clinical marker of inspiratory muscle weakness in amyotrophic lateral sclerosis. Eur Respir J 2009; 35:353-60. [DOI: 10.1183/09031936.00184908] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bautin N. Rôle du couplage des oscillateurs et effet de la strychnine sur la dynamique chaotique du rythme ventilatoire de tronc cérébral isolé de têtard. Rev Mal Respir 2009. [DOI: 10.1016/s0761-8425(09)70147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Adler D, Gottfried S, Bautin N, Mirkovic T, Similowski T, Demoule A. Stimulation répétitive des nerfs phréniques pour la prévention de la dysfonction diaphragmatique induite par la ventilation mécanique : étude préliminaire chez le sujet sain. Rev Mal Respir 2008. [DOI: 10.1016/s0761-8425(08)75075-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nguyen S, Leroy S, Bautin N, de Tauriac P, Chevalon B, Rey C, Remy-Jardin M, Wallaert B. Fibrose pulmonaire idiopathique et shunt droit-gauche par foramen ovale perméable : amélioration clinique et gazométrique après fermeture percutanée. Rev Mal Respir 2007; 24:631-4. [PMID: 17519816 DOI: 10.1016/s0761-8425(07)91132-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The association between idiopathic pulmonary fibrosis and patent foramen ovale has rarely been described. OBSERVATION We report the cases of two patients, 72 and 59 years old, who presented with refractory hypoxemia in the context of pulmonary fibrosis. The hypoxemia was due to a right-to-left shunt through a patent foramen ovale (PFO), diagnosed by transoesophageal contrast echocardiography. The closure of the PFO allowed a decrease in the oxygen requirement in the first case: from 8 l/min to 3 l/min (PaO2 80 mmHg), and in the second case oxygen therapy could be stopped (PaO2 76 mmHg on room air). Right-to left shunts by PFO are usually associated with pulmonary arterial hypertension (systolic pulmonary arterial pressure at 70 mmHg for case 1), but in some cases the pulmonary artery pressure is normal (case 2), the shunt being due to an anatomical conformation. CONCLUSION These two cases underline the importance of diagnosing right-to-left shunts in patients who have pulmonary fibrosis with severe hypoxemia, in order to reduce their oxygen needs.
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Affiliation(s)
- S Nguyen
- Service de pneumologie et immuno-allergologie, Hôpital Calmette, CHRU Lille, France
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Perez T, Denis G, Bautin N, Debroucker V, Launay D, Hatron P, Matran R, Hachulla E. 512 Intérêt du volume capillaire pulmonaire par la technique de la double diffusion CO-NO dans la sclérodermie systémique. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)72889-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chenivesse C, Bautin N, Nevière R, Matran R, Wallaert B, Perez T. 89 Le syndrome d’hyperventilation altère la qualité de vie et la capacité à l’exercice. Rev Mal Respir 2007. [DOI: 10.1016/s0761-8425(07)72465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Neviere R, Catto M, Bautin N, Robin S, Porte H, Desbordes J, Matran R. Longitudinal changes in hyperinflation parameters and exercise capacity after giant bullous emphysema surgery. J Thorac Cardiovasc Surg 2006; 132:1203-7. [PMID: 17059944 DOI: 10.1016/j.jtcvs.2006.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 06/02/2006] [Accepted: 08/07/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Although resection of giant bullae for the purpose of improving the function of underlying compressed lung is an accepted form of surgery for emphysema, there is only limited information regarding long-term improvement in dynamic hyperinflation and exercise tolerance. Our major goal was to investigate the effects of lung resection for giant bullae on pulmonary function, dynamic hyperinflation, and exercise capacity in patients with chronic obstructive pulmonary disease characterized by emphysema. METHODS Pulmonary function and exercise testing were assessed prospectively before and 3, 6, 12, 24, and 48 months after surgery in 12 patients who had chronic obstructive pulmonary disease with emphysema who underwent lung resection of giant bullae. RESULTS Forced expiratory volume, diffusing capacity for carbon monoxide, arterial partial pressure of oxygen, and exercise capacity were significantly increased after resection of surgical bullae. Dynamic hyperinflation, as assessed by reduction in inspiratory capacity and dyspnea Borg scale, were significantly decreased during exercise. Improvement in baseline and exercise functional capacity slightly decreased over time, remaining, however, far above the value before surgery. CONCLUSION Altogether, these findings suggest that surgery for resection of giant bullae is an effective procedure for improving airflow, limiting gas exchange, and limiting exercise dynamic hyperinflation over time.
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Affiliation(s)
- Rémi Neviere
- Explorations Fonctionnelles Respiratoires, Hôpital Calmette, CRHU Lille, France.
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Collet F, Mallart A, Bervar JF, Bautin N, Matran R, Pattou F, Romon M, Perez T. Physiologic correlates of dyspnea in patients with morbid obesity. Int J Obes (Lond) 2006; 31:700-6. [PMID: 17006440 DOI: 10.1038/sj.ijo.0803460] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Mechanisms of dyspnea in obesity remain unclear. This study was undertaken to determine the relationships between dyspnea and pulmonary function including inspiratory muscle endurance (IME) in morbidly obese patients before bariatric surgery. RESEARCH METHODS AND PROCEDURES Fifty-five patients with a mean+/-s.d. body mass index (BMI) of 49.4+/-7.0 kg/m(2) were included. Dyspnea was evaluated by the Baseline Dyspnea Index (BDI; 0-12, 0=maximal dyspnea). Pulmonary function tests included a plethysmography, maximal inspiratory pressure (PImax) and IME was assessed by the incremental threshold loading test, determining the maximal pressure sustained for 2 min (Plim(2)) and Plim(2)/PImax ratio. Patients were classified according to their BMI in two groups: BMI < or =49 (n=27) and >49 kg/m(2) (n=28). RESULTS Breathlessness was higher in the BMI >49 kg/m(2) group compared to the BMI < or =49 kg/m(2) group (BDI score at 6.9+/-2.2 in the BMI >49 kg/m(2) group vs 8.9+/-2.5 in the BMI < or =49 kg/m(2) group, P<0.01). Patients with BMI >49 kg/m(2) had significantly higher PaCO(2) level and significantly lower vital capacity, inspiratory capacity and PImax values compared with the BMI < or =49 kg/m(2) group. Correlations between BDI and lung function were moderate: forced expiratory volume in 1 s (FEV(1))% pred: Rho=0.27; P=0.05; vital capacity % pred: Rho=0.40; P=0.004; and Plim(2)/PImax: Rho=0.40; P=0.003. Higher correlations with dyspnea were found in the BMI < or =49 kg/m(2) group: FEV(1)% pred: Rho=0.38; P=0.05; and Plim(2)/PImax: Rho=0.49; P=0.01. DISCUSSION Inspiratory muscle performance is moderately reduced in morbid obesity. Dyspnea in these patients remains moderately related to lung function and inspiratory muscle performance. However, inspiratory muscles performance correlates more significantly with dyspnea in patients with a BMI < or =49 kg/m(2).
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Affiliation(s)
- F Collet
- Lung Function Department, Calmette Hospital, Lille University, France
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Bautin N, Fournier C, Marie E, Robin S, Neviere R, Wallaert B. [Exercise performance of patients with alveolar proteinosis]. Rev Mal Respir 2005; 22:943-50. [PMID: 16215530 DOI: 10.1019/200530119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Cardiopulmonary exercise testing (CPET) is used to evaluate the severity of interstitial lung diseases, particularly when lung function is normal. The aim of this study was to analyse exercise capacity of patients with alveolar proteinosis. METHODS We studied 7 patients undergoing alveolar proteinosis (aged 38 +/- 5 years), Three patients complained of exertional dyspnoea, 2 had a reduced vital capacity and 5 had a DLCO of less than 75% predicted. CPET was performed on a bicycle ergometer using a standard incremental protocol. RESULTS CPET was symptom limited for all patients.. At peak exercise, VO2 was severely reduced (19.5 +/- 5.2 ml/kg/min, 58 +/- 9%). All patients developed hyperventilation. Ventilatory reserve was 42 +/- 11% of MMV, and dead space ratio (Vd/Vt) reached 0.29 +/- 0.05. Cardio-circulatory adaptation was normal (maximum heart rate 83 +/- 9%; VO2/heart rate 70 +/- 10%). Six patients exhibited gas exchange abnormalities at peak exercise (including 4 patients having a normal vital capacity): P(A-a)O2 56 +/- 18mm Hg; PaO2 65 +/- 18 mm Hg. CONCLUSION Patients undergoing alveolar proteinosis have severe impairment of aerobic capacity and gas exchange on exercise. CPET appears to be useful for therapeutic management.
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Affiliation(s)
- N Bautin
- Clinique des maladies respiratoires, Hôpital Calmette, CHRU Lille, France
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Abstract
INTRODUCTION Inflammatory arthropathies are rare complications of cystic fibrosis (CF). We describe three cases of rheumatoid arthritis (RA) occurring in patients with this disease. OBSERVATIONS Among the 100 patients under the care of the adult CF centre in Lille 3 presented with RA. This developed at the ages of 17, 44 and 19 years with a FEV1 of 53%, 42% and 94% respectively. They were 2 women and 1 man, with CFTR gene mutation delta F508 (1 homozygote and 2 heterozygotes) and positive sweat tests. They were colonised with Staphylococcus aureus, and rheumatoid factor and/or anti CCP antibodies were positive. The appearance and progression of RA were associated with exacerbations of bronchial infection and deterioration of respiratory function. In 2 patients the RA was continuously progressive despite intensive treatment involving high dose cortico-steroids, methotrexate (ineffective) followed by leflunomide (complicated by intractable respiratory infection). CONCLUSION There is an increased incidence of RA in our patient population with CF. The new serum markers of RA including anti CCP are of diagnostic interest. The evolution of the two diseases is related and seems to be dependent on the level of infection leading to therapeutic problems.
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Affiliation(s)
- V Doyen
- Centre de Ressources et Compétences pour la Mucoviscidose, Clinique des maladies respiratoires, Hôpital Calmette, CHRU, Lille, France
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