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Ancel J, Chen E, Pavot A, Regard L, Le Rouzic O, Guecamburu M, Zysman M, Rapin A, Martin C, Soumagne T, Patout M, Roche N, Deslee G. [Take-home messages from the 2nd COPD 2023 Biennial of the French Society of Respiratory Diseases. Placing the patient at the center of the care pathway]. Rev Mal Respir 2024; 41:331-342. [PMID: 38609767 DOI: 10.1016/j.rmr.2024.03.008] [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] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
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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Affiliation(s)
- J Ancel
- Université de Reims Champagne-Ardenne, Inserm, P3Cell UMR-S1250, SFR CAP-SANTÉ, Reims, France; Service de pneumologie, hôpital Maison Blanche, CHU de Reims, Reims, France
| | - E Chen
- Service de pneumologie, Hôpital universitaire Avicenne, Bobigny, France
| | - A Pavot
- Centre de recherche cardio-thoracique de Bordeaux, université de Bordeaux, Inserm U1045, Bordeaux, France
| | - L Regard
- Service de pneumologie, institut Cochin, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Inserm UMR1016, université Paris Cité, Paris, France
| | - O Le Rouzic
- Institut Pasteur de Lille, U1019 - UMR 9017 - Center for Infection and Immunity of Lille, CHU de Lille, CNRS, Inserm, University Lille, pneumologie et immuno-allergologie, 59000 Lille, France
| | - M Guecamburu
- Service des maladies respiratoires, CHU de Bordeaux, centre François-Magendie, hôpital Haut-Lévêque, avenue de Magellan, 33604 Pessac, France
| | - M Zysman
- Service de pneumologie, CHU de Haut-Lévèque, Bordeaux, France; Centre de recherche cardio-thoracique, University Bordeaux, Inserm U1045, CIC 1401, Pessac, France
| | - A Rapin
- Département de médecine physique et de réadaptation, centre hospitalo-universitaire de Reims, hôpital Sébastopol, CHU de Reims, 51092 Reims, France; Faculté de médecine, VieFra, EA3797, 51097, université de Reims Champagne-Ardenne, Reims, France
| | - C Martin
- Service de pneumologie, institut Cochin, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Inserm UMR1016, université Paris Cité, Paris, France
| | - T Soumagne
- Service de pneumologie et Soins intensifs respiratoires, hôpital européen Georges-Pompidou, Assistance publique-hôpitaux de Paris, Paris, France
| | - M Patout
- Service des pathologies du sommeil (département R3S), groupe hospitalier universitaire AP-HP - Sorbonne université, site Pitié-Salpêtrière, 75013 Paris, France; UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne université, Inserm, 75005 Paris, France
| | - N Roche
- Service de pneumologie, institut Cochin, hôpital Cochin, Assistance publique-Hôpitaux de Paris-Centre, Inserm UMR1016, université Paris Cité, Paris, France
| | - G Deslee
- Université de Reims Champagne-Ardenne, Inserm, P3Cell UMR-S1250, SFR CAP-SANTÉ, Reims, France; Service de pneumologie, hôpital Maison Blanche, CHU de Reims, Reims, France.
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Soumagne T, Chenivesse C, Didier A, Giovannini-Chami L, Magnan A, Taillé C. [Written action plans for asthma control: How are they used by pulmonologists in France?]. Rev Mal Respir 2024; 41:102-109. [PMID: 38228440 DOI: 10.1016/j.rmr.2024.01.001] [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] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/06/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Despite evidence of the benefits of the written asthma action plans (WAP) in asthma control, they remain poorly applied. The aim of our study was to assess the practices of French-speaking pulmonologists and paediatricians in their use of WAP for asthma control and to analyse the contents of several WAPs routinely consulted in treatment of asthma patients. METHODS Members of three French medical societies (SPLF, G2A, SP2A) were requested to share their WAPs for asthma patients and to participate in an online survey about the possible influence of these documents on their practices. RESULTS Most (95%) of the 41 WAPs taken into consideration were symptom-based and 34% included peak expiratory flow measurement. All of these action plans were in full compliance with current guidelines. Among the 110 survey respondents, while 65% systematically provided a WAP to their asthma patients, only 30% often or always supplemented the written document with therapeutic education sessions. In almost every case, it was the doctor who presented the WAP to the patient, generally devoting to less than 10minutes to explanation of what they were handing out. CONCLUSIONS In France, WAPs are generally presented to the patient by the physician, which probably limits the time devoted to explanation of their contents. Furthermore, WAPs are rarely reinforced with therapeutic education. The current study suggests ways of improving the utilization of WAPs in asthma care and treatment.
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Affiliation(s)
- T Soumagne
- Service de pneumologie et de soins intensifs, hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - C Chenivesse
- Service de pneumologie et d'immuno-allergologie, hôpital Albert Calmette, CHRU de Lille, Lille, France; University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017- CIIL - Center for Infection and Immunity of Lille, Lille, France
| | - A Didier
- Service de pneumologie/allergologie, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | | | - A Magnan
- Service de pneumologie, hôpital Foch, Suresnes, université de Versailles Saint-Quentin, Paris-Saclay, France
| | - C Taillé
- Service de pneumologie, Groupe Hospitalier Universitaire AP-HP Nord-Université Paris Cité, Hôpital Bichat, Inserm UMR1152, Paris, France.
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Soumagne T, Barnig C, Perotin-Collard JM, Taillé C. [An action plan for everyone !]. Rev Mal Respir 2023; 40:306-307. [PMID: 36746702 DOI: 10.1016/j.rmr.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 02/05/2023]
Affiliation(s)
- T Soumagne
- Service de pneumologie et de soins intensifs, hôpital européen Georges Pompidou, AP-HP, 20, rue Leblanc, Paris, France.
| | - C Barnig
- Service de pneumologie, oncologie thoracique et allergologie respiratoire, CHU de Besançon, Besançon, France; CRISALIS, F-CRIN Inserm network, France
| | - J-M Perotin-Collard
- CRISALIS, F-CRIN Inserm network, France; Service des maladies respiratoires et allergiques, CHU de Reims, Reims, France
| | - C Taillé
- CRISALIS, F-CRIN Inserm network, France; Service de pneumologie, groupe hospitalier universitaire, AP-HP Nord-Université Paris Cité, Hôpital Bichat, Inserm UMR1152, Paris, France
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Pastissier A, Humbert S, Razanamahery J, Soumagne T, Daguindau E, Piton G, Chirouze C, Magy-Bertrand N. Lymphohistiocytose hémophagocytaire secondaire : comparaison de la présentation au diagnostic et de la survie suivant le caractère malin ou non de l’étiologie. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.254] [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: 11/15/2022]
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Zysman M, Ribeiro Baptista B, Soumagne T, Marques da Silva V, Martin C, Thibault de Menonville C, Boyer L, Degano B, Morelot Panzini C, Burgel PR, Perez T, Bourdin A, Raherison C, Pégliasco H, Piperno D, Zanetti C, Morel H, Delclaux B, Delafosse C, Lorenzo A, Housset B, Chabot F, Devillier P, Deslée G, Roche N. [Pharmacological treatment optimisation in patients with stale COPD. Position of the French-language Respiratory Society. 2021 Update]. Rev Mal Respir 2021; 38:539-561. [PMID: 33985869 DOI: 10.1016/j.rmr.2021.02.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 02/21/2021] [Indexed: 01/19/2023]
Affiliation(s)
- M Zysman
- Université Bordeaux, centre de recherche cardiothoracique de Bordeaux, U1045, CIC 1401, 33604 Pessac, France; Service des maladies respiratoires, CHU Bordeaux, Bordeaux, France.
| | - B Ribeiro Baptista
- Université Paris-Est, UMR S955, UPEC, 94000 Créteil, France; Département de pneumologie, CHRU Nancy, université de Lorraine, Inserm, U1116, université de Lorraine, Nancy/Vandœuvre-lès-Nancy, France
| | - T Soumagne
- Service de pneumologie, oncologie thoracique et allergologie respiratoire, CHU de Besançon, Besançon, France
| | | | - C Martin
- Department of Respir Med, Cochin Hospital, Assistance publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France; INSERM U1016, Institut Cochin, Paris, France
| | | | - L Boyer
- Université Paris-Est, UMR S955, UPEC, 94000 Créteil, France; Département de physiologie-explorations fonctionnelles, AP-HP, hôpital Henri-Mondor, Paris, France
| | - B Degano
- Service hospitalier universitaire pneumologie physiologie, pôle thorax et vaisseaux, CHU Grenoble Alpes, Grenoble, France; Université Grenoble Alpes, Grenoble, France
| | - C Morelot Panzini
- Sorbonne Université, AP-HP, Service de Pneumologie, Médecine Intensive et Réanimation, Pitié-Salpêtrière Hospital, Paris, France
| | - P R Burgel
- Department of Respir Med, Cochin Hospital, Assistance publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France; INSERM U1016, Institut Cochin, Paris, France
| | - T Perez
- Service de pneumologie, CHU Lille, institut Pasteur de Lille, U1019, UMR9017, centre d'infection et d'immunité de Lille (CIIL), Lille, France
| | - A Bourdin
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France; Department of Respiratory Diseases, University of Montpellier, CHU Montpellier, Montpellier, France
| | - C Raherison
- Service des maladies respiratoires, CHU Bordeaux, Bordeaux, France; Bordeaux Population Health Research Center, université Bordeaux, INSERM, Team EPICENE, UMR 1219, Bordeaux, France
| | - H Pégliasco
- Service de pneumologie, hôpital européen, Marseille, France
| | | | - C Zanetti
- Cabinet de pneumologie, 62300 Lens, France
| | - H Morel
- Service de pneumologie d'allergologie et d'oncologie thoracique, CHR d'Orléans, 45067 Orléans, France
| | - B Delclaux
- Service de pneumologie, centre hospitalier de Troyes, 10003 Troyes, France
| | - C Delafosse
- Centre hospitaliser Simone-Veil, 95602 Eaubonne, France
| | - A Lorenzo
- Médecine Sorbonne université, département de médecine générale, Paris, France
| | - B Housset
- Département de pneumologie, CHI de Créteil, University Paris Est Créteil, Créteil, France
| | - F Chabot
- Département de pneumologie, CHRU Nancy, université de Lorraine, Inserm, U1116, université de Lorraine, Nancy/Vandœuvre-lès-Nancy, France
| | - P Devillier
- Department of Airway Diseases, VIM-Suresnes, UMR0892, Foch Hospital, Paris-Saclay University, Suresnes, France
| | - G Deslée
- Service de pneumologie, Inserm U1250, CHU Reims, université Reims Champagne Ardenne, Reims, France
| | - N Roche
- Department of Respir Med, Cochin Hospital, Assistance publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France; INSERM U1016, Institut Cochin, Paris, France
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Razanamahery J, Caubet M, Gassian N, Echalier C, Soumagne T. Concurrent diagnosis of oropharynx cancer and bone sarcoidosis mimicking metastasis. Cancer Radiother 2020; 25:51-54. [PMID: 33376045 DOI: 10.1016/j.canrad.2020.06.025] [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: 05/25/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 10/22/2022]
Abstract
Bone location is uncommon in both sarcoidosis and in neck cancer (HNC). Diagnosis of a bone lesion is therefore challenging to distinguish its nature in a patient suffering from both diseases. We report the case of a 69-years-old woman referred for P16 positive HPV-HNC. Magnetic Resonance Imaging (MRI) showed T2 hypo-signal on iliac crest and spine. 18FDG-PET demonstrated radiotracer uptake on these locations suggesting bone metastasis. However, bone biopsy showed epithelioid granuloma without malignant cells compatible with sarcoidosis location. The diagnosis of both localized advanced HPV-HNC and systemic sarcoidosis (bone, central nervous system) were retained. The patient received corticosteroid regimen at 0.5mg/kg/day and Methotrexate for sarcoidosis and radiation and chemotherapy with platins for carcinoma. As granulomatous bone marrow infiltration may have an uptake on 18FDG-PET, bone sarcoidosis can mimic metastatic disease. In addition, MRI often fails to distinguish sarcoidosis lesions from metastatic lesion in bones. As no reliable imaging test can decipher both diseases, the description of our case reinforces the necessity to perform bone biopsy in a patient suffering from both conditions to expertise the nature of bone lesions.
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Affiliation(s)
- J Razanamahery
- Service de médecine interne, centre hospitalier universitaire de Besançon, Besançon, France.
| | - M Caubet
- Institut de cancérologie de Bourgogne, Auxerre, France
| | - N Gassian
- Service d'oncologie médicale, centre hospitalier universitaire de Besançon, Besançon, France
| | - C Echalier
- Service de chirurgie orthopédique, centre hospitalier universitaire de Besançon, Besançon, France
| | - T Soumagne
- Service de pneumologie, centre hospitalier universitaire de Besançon, Besançon, France
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Soumagne T, Winiszewski H, Besch G, Mahr N, Senot T, Costa P, Grillet F, Behr J, Mouhat B, Mourey G, Fournel A, Meneveau N, Samain E, Capellier G, Piton G, Pili-Floury S. Pulmonary embolism among critically ill patients with ARDS due to COVID-19. Respir Med Res 2020; 78:100789. [PMID: 33022510 PMCID: PMC7494436 DOI: 10.1016/j.resmer.2020.100789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023]
Affiliation(s)
- T Soumagne
- Medical Intensive Care Unit, Besançon University Hospital, Besançon, France.
| | - H Winiszewski
- Medical Intensive Care Unit, Besançon University Hospital, Besançon, France
| | - G Besch
- Anaesthesiology and Surgical Intensive Care Unit, Besançon University Hospital, Besançon, France
| | - N Mahr
- Medical Intensive Care Unit, Besançon University Hospital, Besançon, France
| | - T Senot
- Anaesthesiology and Surgical Intensive Care Unit, Besançon University Hospital, Besançon, France
| | - P Costa
- Surgical and Medical Vascular Unit, Besançon University Hospital, Besançon, France
| | - F Grillet
- Department of Radiology, Besançon University Hospital, Besançon, France
| | - J Behr
- Department of Radiology, Besançon University Hospital, Besançon, France
| | - B Mouhat
- Cardiology Unit, Besançon University Hospital, Besançon, France
| | - G Mourey
- Hematology Unit, Besançon University Hospital, Besançon, France
| | - A Fournel
- Hematology Unit, Besançon University Hospital, Besançon, France
| | - N Meneveau
- Cardiology Unit, Besançon University Hospital, Besançon, France
| | - E Samain
- Anaesthesiology and Surgical Intensive Care Unit, Besançon University Hospital, Besançon, France
| | - G Capellier
- Medical Intensive Care Unit, Besançon University Hospital, Besançon, France
| | - G Piton
- Medical Intensive Care Unit, Besançon University Hospital, Besançon, France
| | - S Pili-Floury
- Anaesthesiology and Surgical Intensive Care Unit, Besançon University Hospital, Besançon, France
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Plion M, Dalphin JC, Soumagne T. [Adenopathy and mammary carcinoma: It is sometimes in the details that one encounters hypersensitivity pneumonitis!]. Rev Mal Respir 2020; 37:752-755. [PMID: 32888731 DOI: 10.1016/j.rmr.2020.07.004] [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] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hypersensitivity pneumonitis (HP) is an interstitial lung disease due to an immunological reaction to exposure, by inhalation, to a large variety of antigens. The patho-physiological mechanism remains poorly understood. The diagnosis can be challenging and requires a detailed medical history taking especially when the clinical presentation is atypical or when the causal agent remains unknown. CASE REPORT We report the case of a 75-year-old woman with a history of mammary carcinoma who presented with recently identified intramammary adenopathy. Biopsy of the adenopathy revealed non-necrotising, giant cell epithelioid granuloma. A diagnosis of hot tub lung with extra-pulmonary granulomatous lymph node involvement was made based on the clinical, functional, radiological and microbiological investigations. The evolution was favorable following antigen avoidance. CONCLUSION Extrapulmonary lymph node involvement is rare in HP, suggesting a systemic inflammatory involvement.
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Affiliation(s)
- M Plion
- Service de pneumologie, oncologie thoracique et allergologie respiratoire, CHU de Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France.
| | - J-C Dalphin
- Service de pneumologie, oncologie thoracique et allergologie respiratoire, CHU de Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - T Soumagne
- Service de pneumologie, oncologie thoracique et allergologie respiratoire, CHU de Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France
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Razanamahery J, Soumagne T, Humbert S, Brunel AS, Lepiller Q, Daguindau E, Mansi L, Chirouze C, Bouiller K. Does type of immunosupression influence the course of Covid-19 infection? J Infect 2020; 81:e132-e135. [PMID: 32504741 PMCID: PMC7834486 DOI: 10.1016/j.jinf.2020.05.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 05/30/2020] [Indexed: 12/21/2022]
Abstract
Coronavirus disease 19 (Covid-19) is a new emerging virus responsible for pandemic and death. High blood pressure, diabetes, obesity have been described as poor prognosis factors. Few data have been reported in patient with immunocompromised status (solid tumor, hematological malignancy, rheumatoid conditions or organ transplant). We evaluated the characteristics of patients, including the outcome, with immunodepression hospitalized in Besancon University hospital (East of France). We wanted to identify if a type of immunosupression influences the course of Covid-19. In a cohort of 80 patients with immunosupression (42 solid tumors, 20 hematological malignancy and 18 non neoplastic immunosupression), poor outcomes (Intensive care unit hospitalization and or deaths) was frequent (38%) and tended to be more frequent in patients with hematological malignancy.
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Affiliation(s)
- J Razanamahery
- Internal Medicine Department, Besancon University Hospital, Besancon, France.
| | - T Soumagne
- Intensive Care Unit Department, Besancon University Hospital, Besancon, France
| | - S Humbert
- Internal Medicine Department, Besancon University Hospital, Besancon, France
| | - A S Brunel
- Infectious and tropical disease Department, Besancon University Hospital, Besancon, France
| | - Q Lepiller
- Laboratory of virology, Besancon University Hospital, Besancon, France
| | - E Daguindau
- Department of Hematology, Besancon University Hospital, Besancon, France
| | - L Mansi
- Oncology Department, Besancon University Hospital, Besancon, France; UMR 1098, Interaction Hôte-Greffon-Tumeurs/Ingénierie Cellulaire et Génique
| | - C Chirouze
- Infectious and tropical disease Department, Besancon University Hospital, Besancon, France; UMR CNRS 6249, Chrono environnement, University of Bourgogne Franche-Comté
| | - K Bouiller
- Infectious and tropical disease Department, Besancon University Hospital, Besancon, France
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Elhage S, Degano B, Soumagne T. [Management of pulmonary arteriovenous malformation with pulmonary hypertension]. Rev Mal Respir 2020; 37:671-676. [PMID: 32675004 DOI: 10.1016/j.rmr.2020.06.012] [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: 03/16/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Pulmonary arteriovenous malformations (PAVM) are abnormal communications between arteries and pulmonary veins without interposition of capillaries. Embolization is effective both in reducing lifetime complications associated with PAVM and in improving arterial oxygenation. Embolization is however not recommended in patients with pulmonary hypertension (PH) as it abolishes low resistance pathways for pulmonary blood flow and therefore might be expected to elevate pulmonary arterial pressure (PAP). CASE REPORT We report the case of a 70-year-old patient with a large PAVM as well as group 3 PH [mean PAP=21mmHg, pulmonary vascular resistance (PVR) at 3.4 Wood units] secondary to stage 2 chronic obstructive pulmonary disease (COPD) with emphysema. According to the measured shunt flow (26% of cardiac output), predicted post-embolization PVR was estimated at 4.6 Wood units. These values were considered compatible with embolization of the PAVM. Dyspnea and gas exchange improved after PAVM embolization, without worsening PH. CONCLUSION Embolization of a PAVM can be considered in patients with stable PH but requires careful prior hemodynamic assessment. The estimation of the shunt flow and predicted post-embolization PVR may guide the therapeutic decision.
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Affiliation(s)
- S Elhage
- Service de pneumologie, oncologie thoracique et allergologie respiratoire, CHU de Besançon, 3, boulevard Fleming, 25030 Besançon cedex, France.
| | - B Degano
- Service hospitalier universitaire pneumologie physiologie, pôle thorax et vaisseaux, CHU Grenoble Alpes, Grenoble, France; Inserm U 1042, université Grenoble Alpes, Grenoble, France
| | - T Soumagne
- Service de réanimation médicale, CHU de Besançon, Besançon, France
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Duprez M, Soumagne T, Maitre J, Reboux G, Dalphin JC. [A case of farmer's lung associated with allergic bronchopulmonary aspergillosis]. Rev Mal Respir 2019; 37:80-85. [PMID: 31870516 DOI: 10.1016/j.rmr.2019.11.642] [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: 03/28/2019] [Accepted: 10/28/2019] [Indexed: 11/25/2022]
Abstract
Hypersensitivity pneumonitis and allergic bronchopulmonary aspergillosis are two forms of lung disease with presumed distinct immunoallergic mechanisms. We report the observation of a 38-year-old French farmer who, for one month, had fever and dyspnoea resistant to antibiotic therapy. A diagnosis of farmer's lung, and allergic bronchopulmonary aspergillosis was made on clinical, biological, functional and radiological evidence and according to the criteria established. The evolution was favorable with antigenic eviction and corticosteroid therapy. This observation is to our knowledge the 5th case that describes the association of hypersensitivity pneumonitis and allergic bronchopulmonary aspergillosis. It suggests the existence of risk factors and immunoallergic mechanisms common to both diseases and discusses the hypothesis that the same antigen(s) is (are) responsible for them.
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Affiliation(s)
- M Duprez
- Service de pneumologie, oncologie et allergologie respiratoires, Hôpital universitaire de Besançon, CHU de Besançon, CHU Jean-Minjoz, 3, boulevard Fleming, 25000 Besançon, France.
| | - T Soumagne
- Service de pneumologie, oncologie et allergologie respiratoires, Hôpital universitaire de Besançon, CHU de Besançon, CHU Jean-Minjoz, 3, boulevard Fleming, 25000 Besançon, France
| | - J Maitre
- Service de pneumologie, hôpital de Haute-Saône, 70000 Vesoul, France
| | - G Reboux
- Service de parasitologie et mycologie, hôpital universitaire de Besançon, CHU Jean-Minjoz, 25000 Besançon, France; UMR-CNRS 6249 Chrono-environnement, université de Franche-Comté, 25000 Besançon, France
| | - J-C Dalphin
- Service de pneumologie, oncologie et allergologie respiratoires, Hôpital universitaire de Besançon, CHU de Besançon, CHU Jean-Minjoz, 3, boulevard Fleming, 25000 Besançon, France; UMR-CNRS 6249 Chrono-environnement, université de Franche-Comté, 25000 Besançon, France
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Guion Dusserre M, Soumagne T, Reboux G, Maitre J, Dalphin JC. Second Hypersensitivity Pneumonitis in the Same Patient Caused by Chinchillas. J Investig Allergol Clin Immunol 2019; 28:441-442. [PMID: 30530399 DOI: 10.18176/jiaci.0319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M Guion Dusserre
- Department of Respiratory Diseases, University Hospital of Besançon, Besançon, France
| | - T Soumagne
- Department of Respiratory Diseases, University Hospital of Besançon, Besançon, France
| | - G Reboux
- Department of Parasitology and Mycology, University Hospital of Besancon, Besançon, France.,UMR/CNRS 6249 Chrono-Environment, University of Franche-Comté Besançon, France
| | - J Maitre
- Department of Respiratory Diseases, Hospital of Haute-Saône, Vesoul, France
| | - J C Dalphin
- Department of Respiratory Diseases, University Hospital of Besançon, Besançon, France.,UMR/CNRS 6249 Chrono-Environment, University of Franche-Comté Besançon, France
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Echalier C, Teboul F, Dubois E, Chevrier B, Soumagne T, Goubier JN. The value of preoperative examination and MRI for the diagnosis of graftable roots in total brachial plexus palsy. Hand Surgery and Rehabilitation 2019; 38:246-250. [DOI: 10.1016/j.hansur.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/19/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
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Abstract
Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by an immune response to a variety of antigens to which patients have been previously sensitised. It can occur at any age. In children, it is a rare disease, probably under-diagnosed, with an estimated prevalence of 4 per million. The paediatric forms are not really different from those of adults but present some particularities. Avian exposure is by far the most frequent cause of HP, accounting for nearly two-thirds of cases. Although there is no current recommendation for the diagnosis of HP, it is commonly considered that the diagnosis can be made with confidence on the combination of (1) compatible respiratory symptoms, (2) exposure to a known offending antigen, (3) lymphocytic alveolitis, (4) decreased transfer factor for carbon monoxide or hypoxia on exertion and (5) compatible radiologic features. The treatment is based on antigen avoidance that must be complete and definitive. Corticosteroids can be necessary in severe forms. The prognosis of HP in children is better than in adults, with a full clinical and functional recovery in the majority of cases after complete antigenic withdrawal.
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Affiliation(s)
- T Soumagne
- Service de pneumologie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France.
| | - M L Dalphin
- Service de pédiatrie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France
| | - J C Dalphin
- Service de pneumologie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France; UMR CNRS 6249, Chrono-environnement, université de Franche-Comté, 25000 Besançon, France.
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Soumagne T, Guillien A, Chambellan A, Hua-Huy T, Dinh-Xuan A, Degano B. Dépistage de l’hypertension pulmonaire dans la sclérodermie systémique : impact des nouvelles équations du GLI. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.053] [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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Soumagne T, Roche N, Guillien A, Hue S, Claudé F, Andujar P, Dalphin J, Degano B. Marqueurs du risque cardiovasculaire dans la BPCO : la contribution respective du tabagisme et de l’exposition aux poussières organiques. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.131] [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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Soumagne T, Rabbat A. [Corticosteroids in community acquired pneumonia: Where are we in 2018?]. Rev Mal Respir 2018; 35:813-827. [PMID: 30217573 DOI: 10.1016/j.rmr.2018.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/05/2017] [Accepted: 01/23/2018] [Indexed: 12/15/2022]
Abstract
Community-acquired pneumonia (CAP) is a common infectious disease and one of the main causes of mortality worldwide. Despite an improvement in management globally, mortality remains high especially in severe forms of CAP. Adequate early antibiotics remain the cornerstone of the treatment but adjuvant corticosteroid administration is being considered to counterbalance the systemic inflammatory reaction and modulate the immune response. In the last ten years, several clinical trials and meta-analyses have been conducted in severe and non-severe CAP to assess the efficacy of corticosteroids. The benefits on the duration of hospitalization and the time to clinical stability are quite small and early mortality does not seem to be improved. Corticosteroids should not, therefore, be used routinely in patients with CAP, even in severe cases. However, new therapeutic trials are currently underway.
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Key Words
- Community acquired pneumonia, Severe, Corticosteroids, Mortality, Duration of hospitalization, Side effects
- Pneumopathie aiguë communautaire, Sévère, Corticostéroïdes, Mortalité, Durée d’hospitalisation, Effets secondaires
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Affiliation(s)
- T Soumagne
- Service de pneumologie et soins intensifs respiratoires, hôpital Cochin, hôpitaux universitaires, Paris centre, AP-HP, 75679 Paris cedex 14, France; Service de pneumologie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France; Service de physiologie-explorations fonctionnelles, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France.
| | - A Rabbat
- Service de pneumologie et soins intensifs respiratoires, hôpital Cochin, hôpitaux universitaires, Paris centre, AP-HP, 75679 Paris cedex 14, France
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Bouldoires B, Gil H, Soumagne T, Humbert S, Meaux Ruault N, Magy Bertrand N. [A predictive bacterial infection score according to eosinophil level: An observational study]. Rev Med Interne 2017; 39:10-16. [PMID: 29223347 DOI: 10.1016/j.revmed.2017.10.425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 05/03/2017] [Revised: 10/16/2017] [Accepted: 10/31/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Several studies have shown that eosinopenia less than 0.04g/L is a marker of bacterial infection in the presence of unexplained inflammatory syndrome. The aim of our study was to test this hypothesis and to propose a predictive score for bacterial infection (score CIBLE, C reactive protein, bacterial infections, levels of leucocytes and eosinophils). PATIENTS AND METHODS This was a single-center observational study of patients admitted to an internal medicine department in the year 2015 and presenting with an inflammatory biological syndrome. Patients were divided into 2 groups: bacterial infections (group 1) and nonbacterial inflammatory diseases (group 2). RESULTS One hundred and ninety patients were included: 92 men (48.4 %) and 98 women (51.6 %). Mean age was 73.5±18.2 years [19-104]. Group 1 consisted of 124 patients (65.2 %) and group 2 of 66 patients (34.8 %). ROC analysis confirmed a cut-off level for eosinophils count at 0.04g/L as discriminant to predict bacterial infection. In a multivariate analysis, the eosinophil/neutrophil ratio, a history of COPD, the C reactive protein concentration, patient age and initial temperature were the most significant variables. They were used to build the CIBLE score. For a score higher than or equal to 87, the probability of a bacterial infection is at least 70 %. CONCLUSION The CIBLE score appears to be a relevant and inexpensive tool to establish a probability for bacterial infection.
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Affiliation(s)
- B Bouldoires
- Service de médecine interne, CHU de Besançon, 3 Boulevard Fleming, 25000 Besançon, France.
| | - H Gil
- Service de médecine interne, CHU de Besançon, 3 Boulevard Fleming, 25000 Besançon, France
| | - T Soumagne
- Service de pneumologie, CHU de Besançon, 25000 Besançon, France
| | - S Humbert
- Service de médecine interne, CHU de Besançon, 3 Boulevard Fleming, 25000 Besançon, France
| | - N Meaux Ruault
- Service de médecine interne, CHU de Besançon, 3 Boulevard Fleming, 25000 Besançon, France
| | - N Magy Bertrand
- Service de médecine interne, CHU de Besançon, 3 Boulevard Fleming, 25000 Besançon, France
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Bouldoires B, Gil H, Soumagne T, Bailly B, Payet-Revest C, Méaux-Ruault N, Magy-Bertrand N. Proposition d’un score prédictif d’infection bactérienne selon le taux d’éosinophiles au cours d’un syndrome inflammatoire : étude observationnelle. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.385] [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: 10/18/2022]
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Soumagne T, Caillaud D, Degano B, Dalphin JC. [Differences and similarities between occupational and tobacco induced COPD]. Rev Mal Respir 2017; 34:607-617. [PMID: 28506727 DOI: 10.1016/j.rmr.2016.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 07/02/2016] [Indexed: 10/19/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) most often results from the inhalation of toxic agents. Cigarette smoking still remains the principal cause but the pertinence of occupational COPD is now clearly established. After a brief overview of the epidemiology of this "other COPD", the clinical and functional characteristics are summarized, taking into account recent advances in this field. The combined effects of occupational exposure and tobacco are also considered, providing evidence of the need to continuously reinforce campaigns of education and prevention in occupational COPD.
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Affiliation(s)
- T Soumagne
- Service de pneumologie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France; Service de physiologie-explorations fonctionnelles, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France.
| | - D Caillaud
- Service de pneumologie, université d'Auvergne, CHU Gabriel-Montpied, rue Montalembert, 63003 Clermont-Ferrand, France
| | - B Degano
- Service de physiologie-explorations fonctionnelles, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France; EA 3920, université de Franche-Comté, 25000 Besançon, France
| | - J-C Dalphin
- Service de pneumologie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France; UMR CNRS 6249, chrono-environnement, université de Franche-Comté, 25000 Besançon, France
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Eberst G, Guillien A, Goirand F, Bonniaud P, Burgy O, Soumagne T, Couturier M, Gondouin A, Laurent L, Dalphin J, Perruche S, Degano B. La résolution de l’inflammation dans la fibrose pulmonaire idiopathique avec un nouvel immunomodulateur. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.139] [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: 11/17/2022]
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Soumagne T, Chardon M, Dournes G, Laurent L, Degano B, Laurent F, Dalphin J. Prévalence et caractéristique de l’emphysème dans la maladie de poumon de fermier : une étude prospective. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.134] [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: 10/20/2022]
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Guillien A, Laurent L, Simon H, Soumagne T, Puyraveau M, Mauny F, Barbier A, Laplante J, Dalphin J, Degano B. Anxiété et dépression chez les producteurs laitiers BPCO. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.397] [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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Chelabi R, Soumagne T, Guillien A, Puyraveau M, Eberst G, Dalphin ML, Vieux R, Dalphin JC, Degano B. Dans la mucoviscidose, un indice de clairance pulmonaire élevé est associé à des anomalies de fonction pulmonaire à l’exercice chez des adolescents avec spirométrie normale. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.065] [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: 11/29/2022]
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Degano B, Guillien A, Soumagne T. Quelle place accorder aux symptômes pour le diagnostic de la BPCO ? Rev Mal Respir 2016; 33:648-651. [DOI: 10.1016/j.rmr.2016.05.008] [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] [Received: 01/28/2016] [Accepted: 05/31/2016] [Indexed: 12/01/2022]
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Soumagne T, Degano B, Dalphin J. Forme emphysémateuse de la maladie du poumon de fermier. Rev Mal Respir 2015; 32:275-8. [DOI: 10.1016/j.rmr.2014.04.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
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Soumagne T, Veil-Picard M, Laveneziana P, Dalphin JC, Degano B. Exercise capacities and ventilatory constraints in patients with GOLD stage I chronic obstructive pulmonary disease: Comparison between symptomatic and asymptomatic patients. Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2014.04.020] [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: 10/24/2022]
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Degano B, Soumagne T, Veil-Picard M, Dalphin J. BPCO de stade 1 : pourquoi certains patients sont-ils asymptomatiques ? Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2013.10.023] [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: 11/27/2022]
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Degano B, Perrin F, Soumagne T, Agard C, Chambellan A. [Pulmonary CO/NO transfer: physiological basis, technical aspects and clinical impact]. Rev Med Interne 2013; 35:322-7. [PMID: 24314829 DOI: 10.1016/j.revmed.2013.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/16/2013] [Accepted: 11/03/2013] [Indexed: 10/25/2022]
Abstract
Diseases affecting the alveolar-capillary membrane or the capillary blood vessels can impair pulmonary gas exchanges and lung diffusion. The single-breath transfer factor of the lung for carbon monoxide (TL,CO) is the classical technique for measuring gas transfer from the alveolus to the pulmonary capillary blood. Pulmonary gas exchanges can also be explored by the transfer factor of the lung for nitric oxide (TL,NO). TL,NO represents a better index for the diffusing capacity of the alveolar-capillary membrane whereas TL,CO is more influenced by red blood cell resistance. Membrane diffusing capacity (DM) and pulmonary capillary blood volume (Vc) derivated from TL,CO and TL,NO by the Roughton-Forster equation can give additional insights into pulmonary pathologies. The clinical impact of the CO/NO transfer has still to be precised even if this measurement seems to provide an alternative way of investigating the alveolar membrane and the blood reacting with the gas.
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Affiliation(s)
- B Degano
- Physiologie-explorations fonctionnelles, EA 3920, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France.
| | - F Perrin
- Université de Nantes, 44093 Nantes, France; Inserm UMR 1087, 8, quai Moncousu, 44007 Nantes, France; Service de médecine interne, CHU de Nantes, 44093 Nantes, France
| | - T Soumagne
- Physiologie-explorations fonctionnelles, EA 3920, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France
| | - C Agard
- Université de Nantes, 44093 Nantes, France; Inserm UMR 1087, 8, quai Moncousu, 44007 Nantes, France; Service de médecine interne, CHU de Nantes, 44093 Nantes, France
| | - A Chambellan
- Laboratoire d'explorations fonctionnelles, institut du thorax, CHU de Nantes, 44093 Nantes, France; Université de Nantes, 44093 Nantes, France; Inserm UMR 1087, 8, quai Moncousu, 44007 Nantes, France
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