Association of obesity with asthma severity, control and quality of life

The association between asthma and obesity is becoming increasingly established but the mechanism that might explain the observed differences in asthma severity, control and quality of life between obese and non-obese adult asthmatics is not clear. The purpose of this study was: 1] to determine asthma severity, control and quality of life in obese asthmatics and 2] to explore, according to the body mass index [BMI], the systemic inflammatory state of asthmatic people. A cross-sectional study was conducted between 2009 and 2010. Two hundred adult asthmatic patients were included. Data analysis consisted of univariate analysis with chi-square comparison test followed by a multivariate logistic regression. Obesity worsens the severity of asthma. This finding was more strongly observed among women than men. Obesity and overweight are associated with a poorer control of asthma. According to BMI, obese asthmatics had 6 times more frequent emergency visits, 5 times more frequent hospitalizations for asthma related complaints, increased missed work days and greater dose of inhaled corticosteroids [1025 micro g/day vs. 759 micro g/day of beclometasone equivalent]. Mean serum level of C-reactive protein [CRP] and leptin was significantly correlated with asthma severity based on GINA classification [5.75 vs. 2.81 mg/l; 20.5 vs. 5.38 ng/ml; respectively]. In summary, it appears that obesity is significantly associated with a greater asthma severity and a poorer asthma control and quality of life. Chronic systemic inflammation state may explain the relationship between obesity and asthma

[Predictive factors of obstructive sleep apnea syndrome in obesity]

Obstructive sleep apnea [OSA] syndrome is frequent, and misdiagnosed. Of this study is to assess the prevalence of OSA syndrome in a Tunisian population of obese [body mass index>or=30 Kg/m[2]] and to determine its predictive factors. It's a transversal study. One hundred patients [63 females, 37 males] were inculded. All patients underwent nocturnal polysomnography or respiratory polygraphy. Sixty-five patients had an OSA syndrome: mild [24.6%], moderate [30.7%] and severe [44.6%]. We compared, by a statistical analysis, the group with OSA syndrome and the group without OSA syndrome. There was a predominance of men [81%of men vs 55.5 of women had OSA]. Age was higher in the group with OSA syndrome [56.8 years +/- 10vs 48.1 +1-12, P=0.04]. Clinical symptoms such as snoring, daytime sleepiness, nocturnal awakening and respiratory pauses were more frequent in the group with OSA syndrome. Morphological abnormalities such as retrognathy and/or short neck were significantly more frequent in the group with OSA syndrome [p=0.05 and 0.02 respectively]. Cardiopathies and diabetes were more frequent in obese with OSA syndrome. In obese persons, male gender, comorbidities and diabetes clinical symptoms such as snoring, daytime sleepiness, nocturnal awakening and respiratory pauses, retrognathy and/or short neck are predictive of OSA syndrome. So, we propose a nocturnal recording in obese presenting at least one of these predictive factors

Last discovery of a congenital broncho-oesophageal fistula

Broncho-oesophageal fistula is rare and occurs mostly in acquired condition. Report of a new case. We report a case of a 58-years-old woman which has, since 38 years ago, a chronic cough, recurrent bronchopulmonary suppurations and hemoptysis. Clinical examination let to the diagnosis of a broncho-oesophageal fistula. Surgical treatment resulted in complete recovery. There was no evidence of any aetiology. Congenital origin of the fistula was deduced

[Asthma in the elderly]

Asthma in elderly is actually well individualized. Two entities are considered: - "Ageing asthmatics" who have had asthma since childhood, adolescence or adulthood and persisting after 65 years old. This situation is the most frequent.- Late-onset asthmatics in persons 65 years old and more. Clinically, asthma in elderly is frequently represented by a dyspnoea at rest during the day. Diagnosis remains difficult because of the non-specifity of clinical symptoms and the frequency of comorbidity. Many differential diagnosis must be considered, dominated by congestive heart failure and COPD. Concerning treatment of asthma in the elderly, a few particularities should be known: prudence in the prescription of beta-2-adrenergic drugs. Anticholinergic drugs have a place in the treatment. contrary to younger asthmatics. A great importance to inhalation devices should be allowed because of their use difficulties in the elderly. The main goal of asthma management in the elderly is to improve the quality of life