[New therapeutic approaches in 2014 in pulmonary medicine: COPD, asthma and lung fibrosis]

In 2014, among new therapeutic approaches in pulmonary medicine, the role of inhaled corticosteroids has to be revaluated after the publication of the WISDOM and other studies. Their prescription should no longer be systematic even for "at risk" groups of patients, as defined by the GOLD consensus, but rather be considered on an individual basis. In the field of asthma, two major studies confirm the efficacy of mepoluzimab for the treatment of severe, eosinophilic asthma. Finally, for idiopathic pulmonary fibrosis, 2014 has taught us that treatment with N-acetylcystein is of no proven benefit, while pirfenidone and nintedanib are two new drugs that may attenuate the downhill course of the disease.

[Management of acute asthma in the emergency room]

Acute asthma is a frequent occurrence in the emergency room. Early care includes gradation of severity and rapid administration of systemic corticosteroid and bronchodilators. After initial treatment, if the patient has no longer criteria for severe asthma, and no poor outcome risk factor, continuation of treatment at home is a possible option. It requires to schedule a close appointment for medical follow-up, establishment of an asthma treatment plan, prescription of a short course of oral corticosteroids together with a combination of inhaled corticosteroid and long acting beta-2-agonist for longer duration of treatment.

[Allergy to penicillins and to cephalosporins: should we fear cross-reactivity?]

The diagnosis of allergy to penicillins is based on a positive history and cutaneous tests. The sensitivity of these tests is around 70%, therefore it is sometimes necessary to supplement them with in vitro tests, more rarely with drug provocation challenges. Among patients allergic to penicillin, 1 to 2% will develop an allergy to cephalosporins in the event of exposure to this antibiotic class. In this paper, we describe options for investigating and treating allergy to penicillins and cephalosporins.

[How to reduce reperfusion time in ST elevation myocardial infarction?]

For patients with ST elevation myocardial infarction (STEMI), most hospitals do not achieve recommended reperfusion time delay. The goal of this article is to discuss the several strategies allowing to reduce delay to reperfusion (e.g., pre-hospital ECG, early activation of catheterisation laboratory), in order to help each institution to develop its own protocol.