Revue des maladies respiratoires最新文献

Inhaled treatments represent a pillar in pneumology management, especially insofar as they allow for optimal local delivery of therapeutic agents. In addition to bronchodilators and corticosteroids, numerous inhalation-based treatments exist. Some of them are little known by clinicians, such as mucolytic drugs, antibiotics, saline solutions, morphine derivatives, prophylactic agents such as pentamidine, etc. Each of these treatments has specific indications and requires specific means of administration according to the nature of the medicine, the type of nebulizer being used, and a given patient's clinical characteristics. The present narrative review of the literature describes and synthesizes the indications and modalities of these different treatments, to the exclusion of asthma, COPD, cystic fibrosis, and ventilated intensive care patients.

Introduction: In 2022, the French National Health Authority launched a task force for experimentation of low-dose chest CT screening in patients at high risk of lung cancer. In 2023, a study was conducted in the Haut-Rhin region (France) to assess the feasibility of a program involving ten general practitioners.

Methods: The patients included were prescribed a low-dose chest CT (<100mGy.cm). If the result was negative, follow-up CT was scheduled after one year and then every other year in the absence of risk factors other than smoking. Indeterminate results necessitated a repeat CT at three months, while positive results led to referral to a pulmonologist. The primary endpoint was the proportion of patients having undergone the first screening CT.

Results: One hundred and twenty-six patients were included (median age 58.5 years, 54.8% women) and 117 patients (92.9%) underwent the first CT. The median time between prescription and CT completion was 14 days, and the median radiation dose was 78.6 mGy.cm. One hundred and eight scans were negative (92.3%), and nine indeterminate (7.6%), all of which were subsequently reclassified as negative after follow-up.

Conclusions: The high completion rate demonstrates good adherence to the program. These encouraging results need confirmation through the analysis of follow-up CTs.

Introduction: Alternaria alternata is a mold commonly found in both indoor and outdoor environments. It can induce IgE-mediated sensitization, leading to symptoms such as rhinitis and, in some cases, severe asthma. However, allergic reactions resulting from the accidental ingestion of food contaminated with Alternaria have only rarely been reported.

Observations: We report two cases of patients with respiratory allergies who were sensitized to Alternariaalternata, with asthma exacerbations in humid environments and during summer thunderstorms. Following the ingestion of mold-contaminated food, both patients experienced anaphylaxis. (1) Male, 33 years old: skin prick-tests (SPT) and sIgE were positive only for Alternariaalternata (sIgE rAlt a1 at 10.5kU/L). Multiplex IgE (ISAC®) revealed strong sensitization to Alt a1 and less sensitization to Thaumatin-Like Protein (TLP) from kiwi. (2) Male, 58 years old: SPTs were are positive for pollen and Alternaria; sIgE was positive only for Alternaria alternaria (sIgE rAlt a1 at 1.59kU/L).

Conclusion: The ingestion of food contaminated with aeroallergens can trigger severe allergic reactions in sensitized patients, as described in "pancake syndrome" associated with dust mite contamination. In the present cases, reactions were related neither to true food allergy nor to cross-reactivity between aeroallergens and food allergens, but rather to food contamination with Alternariaalternata. These findings highlight the importance of comprehensive allergy evaluation in asthmatic patients, including systematic assessment for food-related allergic reactions.

Introduction: Latent tuberculosis infection (LTBI) in children under 18 years of age is a mandatorily notifiable condition for which tuberculosis preventive treatment (TPT) is recommended. However, the comprehensiveness of TPT has yet to be extensively analyzed. We report on the experience of the Alpes-Maritimes Tuberculosis Control Center.

Observation: In 2023 and 2024 in the Alpes-Maritimes department, 284 LTBIs in children under 18 years of age were detected and reported. LTBI was linked to the screening of unaccompanied minor migrants (UMMs) (256 children), to an investigation on the case of a tuberculosis patient (20 children), and to the screening of minor migrants accompanied by their parents (eight children). The median age and sex ratio (M/F) differed between the UMM group and the "case investigation" and "accompanied minors" groups, with respectively 16 years and 9.7 for the UMMs, 11 years and 0.8 for the "case investigation" group, and 12 years and 0.6 for the "accompanied minors" group (P<0.05). TPT completeness was 54% in the UMMs, and 100% in the other two groups (P<0.05).

Conclusion: TPT comprehensiveness was high among minors who were surrounded by their parents, but less satisfactory among UMMs.

Introduction: The complications associated with cystic fibrosis and the daily management of the disease can have significant social, familial, and professional repercussions. The objective of this study was to assess adult patients' knowledge regarding their rights and social support options, along with their access to social care.

Materials and methods: Between May 2021 and December 2023, we conducted a prospective monocentric study at the University Hospital of Reims, including adult patients diagnosed with cystic fibrosis. A questionnaire assessing their knowledge in this area was utilized.

Results: The analysis included 61 patients (64% male; mean age: 29.2 years). In 73% of cases, patients reported being assisted by their social circle in managing administrative tasks. Information sources were diverse, and most patients had already met with a social worker. While the quality of information received was generally rated as good, one-third of the participants felt that the topic of social support was insufficiently addressed. Ten patients were unaware of their being enrolled in the long-term illness coverage program. Half of patients were receiving adult disability benefits.

Conclusion: Adult patients often rely on their social support network for the performance of administrative and social tasks. Improved information on social benefits and the organization of specifically targeted workshops are desired by patients.

Introduction: Active tuberculosis disease (ATB) remains feared in patients treated with TNF inhibitors. For that reason, screening for latent tuberculosis infection (LTBI) is currently performed before the start of treatment. Therapeutic patient education (TPE) should consequently help reduce the risk of infection during treatment.

Observation: We report the case of a 19-year-old female patient hospitalized for disseminated tuberculosis. She had been treated for two years with adalimumab for Crohn's disease. Screening for LTBI had been performed before the initiation of anti-TNF treatment and was negative. Three months after returning from a four-month study trip to South Africa, the patient nevertheless developed disseminated tuberculosis and was repeatedly hospitalized. The disease was at once pulmonary, lymphatic, ocular, and splenic. Antituberculosis treatment consisted of quadruple therapy for two months followed by dual therapy for an additional 10 months. The patient was disabled for one year and suffered some radiological sequelae.

Conclusion: Traveling to a country with high tuberculosis endemicity is a risk factor for ATB in patients undergoing anti-TNF therapy. Antibioprophylaxis may have been considered prior to the trip.

While the SARS-CoV-2 pandemic has left a lasting impression, the long-term effects of this virus, such as persistent symptoms or long COVID, remain unclear. However, recommendations from learned societies for improving these symptoms exist and are being applied by a number of respiratory rehabilitation centers. In this paper, we provide a summary of the specificities of long COVID care in the context of respiratory rehabilitation, particularly as regards respiratory symptoms, fatigue, cognitive disorders, and cardiovascular symptoms and, more specifically, vegetative dysautonomia. The key elements of support are Therapeutic Patient Education (TPE) and activity management and fractionated exercise (PACING). While the effects of respiratory rehabilitation are highly promising, with potential improvement in symptoms and exercise capacity, the level of evidence remains low to moderate. Structured and coordinated multidisciplinary work is of paramount importance as a means of providing for these individuals the best possible support on their road to recovery. Further studies are needed to improve the level of evidence on the effectiveness of rehabilitation in cases of long COVID.