DLNO/DLCO ratio evolution under targeted therapy in patients with pulmonary hypertension.

The ratio of the diffusing capacity of the lung for carbon monoxide (DLCO) and for nitric oxide (DLNO) measured simultaneously is modified in patients with precapillary pulmonary hypertension (PH). The potential impact of targeted therapy on the DLCO/DLNO ratio is unknown. Simultaneous measurements of DLNO and DLCO were performed at baseline, 3-4 month follow-up (first evaluation) and 12-month follow-up (second evaluation) after initiation of targeted PH therapies in incident cases of precapillary PH. The main outcome was the change in DLNO/DLCO ratio under treatment between baseline and the first evaluation. Twenty-nine patients were included (mean age: 66.8 years, 62.1% female). No significant change in the DLNO/DLCO ratio was found between baseline and the first evaluation. Similarly, no significant differences were noted with regard to changes in Dm or Vc, the DLNO/DLCO ratio in different patient subgroups, or in the 20 patients evaluated at the second follow-up. Within the limitations of this study, the DLNO/DLCO ratio is not useful in monitoring the response to treatment in PH.

[Managements of chronic cough in general medicine and requirements of general practitioners]. / Prise en charge des toux chroniques difficiles en médecine générale et attente des médecins généralistes.

Chronic cough represents a persistent dilemma, for general practitioner (GP), inducing a lot of medical investigations. Few data are available about French GP practice and their expectancy from cough specialists. We studied management in primary care and impressions of GP of patients with chronic cough. Thirty-four patients were studied. They were mostly women, mean age was above 50 years-old, and the waste majority of patients were non-smokers. Halftime, the symptom was persistent (more than 6 months), had promoted numerous medical consultations (more than five). Drugs were prescribed since the first visit for the majority of patients, principally cough-sedation drugs, steroids and bronchodilatators. A chest radiography was realized in almost all patients. Advices were asked (with a decreasing frequency) to physicians specialized in: ear-nose-throat or respiratory, gastroenterology, allergy, or cardiology. The majority of patients were satisfied of their GP, despite persistent symptoms. From the point of the GP, chronic cough remains a relentless dilemma. Their main purpose, when they addressed their patient to a specialized physician, was to obtain an etiologic diagnosis. When they were asked "which tool will be more adequate for you in the next future?", the preferred response was "a simple etiologic algorithm". Despite persistent symptoms, inducing furthers medical consultations, the main ask from GP was to promote a simple etiologic algorithm.