[The profile of the patients referred by general practitioners to respiratory physicians for assessment of undiagnosed bronchial disease]. / Profil des patients adressés par les médecins généralistes aux pneumologues pour bilan d'une bronchopathie non diagnostiquée - résultats de l'étude Bilan.

INTRODUCTION: In general practice, COPD is often under-diagnosed and inappropriate pharmacological treatment given. OBJECTIVES: To determine the profile of patients over 40 years old, smokers or ex-smokers, referred by general practitioners to respiratory physicians for assessment of undiagnosed bronchial disease. METHODS: Observational study carried-out among 103 respiratory physicians in France in 2007. RESULTS: The diagnosis of COPD was confirmed by the respiratory physicians in 433/486 (89%) patients. COPD patients were aged 61 years on average, male (63%) and often current smokers (46%). Most of them had more than three respiratory symptoms. The diagnosis of COPD was made after a long history of symptoms. We found 148 (34.2%) COPD patients with a FEV(1)/FVC greater than 0.7 and were classified as mild (61 patients), moderate (77 patients) or severe (10 patients). CONCLUSIONS: In patients at risk, smokers or ex-smokers with respiratory symptoms, COPD was the diagnosis most often confirmed by the respiratory physician. A significant proportion of respiratory physicians diagnosed and assessed the severity of COPD, not strictly on the basis of national recommendations, but rather on the association of risk factors, respiratory symptoms and even isolated changes in FEV(1).

Lower respiratory tract infections in adults: non-antibiotic prescriptions by GPs.

BACKGROUND: The AIR II study is a prospective multicentre assessing management of lower respiratory tract infections (LRTIs) in adults by general practitioners (GPs). Epidemiological studies generally address the prescriptions of antibiotics. To our knowledge, little is known about the real impact of non-antibiotic therapeutic prescriptions (defined here as co-prescriptions) in LRTI. Therefore, the aim of the study was to evaluate non-antibiotic prescriptions in LRTIs. METHODS: Two thousand general practitioners (GPs) were randomly selected and asked to participate in each of 30 predefined areas covering mainland France. The patient's sociomedical record was completed by the GP during the consultation and sent to the data processing centre at the same time as an anonymous copy of his prescription. The GP also had to report the inclusion by telephone and agree to a telephone appointment with an interviewer. RESULTS: GPs (n = 3144) reported 5469 evaluable cases. Pneumonia accounted for 9.6% of diagnoses, acute exacerbations of chronic bronchitis 14.9% and acute bronchitis 72.5%. Antibiotics were prescribed to 96.5% of patients. In addition to the 5270 prescriptions of antibiotics, co-prescriptions proved to be twice as numerous as prescriptions of antibiotics (10,027 prescriptions for 5115 patients). Mucomodifiers, steroidal anti-inflammatory drugs and bronchodilators were significantly more prescribed in AECB than others. Non-steroidal anti-inflammatory drugs and antitussives were significantly more prescribed in acute bronchitis than AECB or CAP. CONCLUSIONS: Our results suggest that recommendations of management in LRTIs need to take into account co-prescriptions.

[Air-filled cysts of tracheal origin: nosological problems and actual frequency]. / Kystes aériens d'origine trachéale: problèmes nosologiques et fréquence réelle.

Air-filled paratracheal bronchogenic cysts are extremely rare. They are lined by respiratory epithelium. We have operated on 2 patients whose cysts were diagnosed by CT scan: one presenting with bloody sputum and the other with dysphagia. Both patients had a history of neck surgery. Because such cases are rare in the literature, their exact origin, whether tracheocele, diverticulum or other form of air-filled cyst, remains a matter of debate. However, their frequency is probably underestimated because most cause few symptoms and are well tolerated. In a recent radiologic study their prevalence was found to be 2% in patients undergoing CT scan.

Management of lower respiratory tract infections by French general practitioners: the AIR II study. Analyse Infections Respiratoires.

The Analyse Infections Respiratoires (AIR) II study is a prospective, multicentre survey of the management of lower respiratory tract infections in patients aged 15-65 yrs by general practitioners (GPs) in France. To obtain real-time data recording, practitioners were required to submit an anonymous copy of their drug prescriptions. They were then interviewed over the telephone about the patients' sociodemographic data, signs and symptoms, as well as their presumptive diagnosis and the investigations they had decided upon. GPs (n=3,144) reported 5,469 evaluable cases. Pneumonia accounted for 9.6% of diagnoses, acute exacerbations of chronic bronchitis 14.9% and acute bronchitis 72.5%. The symptomatology covered an extremely wide range of clinical features, which, although statistically different in terms of incidence, overlapped to a large extent across diagnoses. By contrast, hospitalization, investigations or referral to a specialist were much more prevalent in pneumonia, although still very infrequent in general terms (0.5, 1.2 and 10.8%, respectively). Antibiotics were prescribed in 96.5% of patients, with minor differences between diagnoses. However, other medications such as nonsteroid, anti-inflammatory drugs, steroids, nonspecific antitussives and bronchial liquefiers accounted for two-thirds of the prescriptions. This study demonstrates the lower respiratory tract infections encountered by general practitioners are usually mild. However, antibiotic prescription was more systematic than in previous studies and the prescription of nonspecific symptomatic treatments was twice as frequent. General practitioners did not perform additional examinations or refer on a regular basis. There was a high prescription rate for symptomatic treatment.

[Management of lower respiratory tract infections by general practitioners in France]. / Prise en charge des infections respiratoires basses en médecine générale en France.

OBJECTIVE: The purpose of this study was to describe the diagnostic and therapeutic strategies used by general practitioners (GPs) in patients with lower respiratory tract infections (LRTI). METHODS: Four hundred fifty GPs practicing in France participated in the study; they included 804 patients. The GP recorded social and demographic data and their prescription on a data sheet and responded to a phone questionnaire about their strategy. RESULTS: Most of the LRTI were acute bronchitis (72%); pneumonia and acute exacerbations of chronic bronchitis were observed respectively in 11% of the patients recruited. Diagnostic criteria used by the GPs were generally auscultation signs in patients with fever, cough and expectoration. Specialized advice (always a chest physician) and hospitalization were exceptional. Prescription of complementary exams was strongly related to the diagnosis of pneumonia (OR = 33.3; CI0.95: 15.48-70.4). Sick leaves were related to general symptoms (fever, asthenia). Antibiotics were prescribed in 95.7% of the patients, mainly aminopenicillin (40.4%) and macrolides (33.2%). Nonsteroidal or steroidal antiinflammatory drugs were prescribed in 72.5% of the patients irrespective of the LRTI diagnosis. DISCUSSION: The fact that GPs do not often refer patients to specialists or order hospitalization confirms their important role in setting up recommendations. It would also be necessary to develop an education program on better use of antibiotics targeted to GPs and patients.

[Methodology for assessing continuing medical education at the first united French congress of pneumology]. / Approche méthodologique évaluative du premier congrès unique de pneumologie de langue française. Paris, La Villette, 5 et 6 février 1997. "Evaluation" de la Société de Pneumologie de Langue Française.

The evaluation of continuing medical education (CME) courses will soon become one of the tools used to assess post-graduate training, particularly in compliance with the recent legislation. In 1997, the organization committee of the French congress of pneumology decided to analyze the different methodologies used to assess the congress CME courses. The analysis was based on a satisfaction questionnaire, a before-after assessment of 4 workshops, and a comparison between participants and non-participants in 3 plenary sessions. Mann-Whitney and Wilcoxon non-parametric tests were used for statistical analysis. Satisfaction scores were high. For the plenary sessions, test results were better for participants than for the non-participant controls and for the workshops, test results were higher after completion. This type of study can only evaluate the level of knowledge acquired and is subject to a selection bias. It cannot analyze the practical impact of the courses nor their effect on patient health. Such assessment methodologies should be used more widely in order to improve future training sessions.