Effects of a home-based walking training program on cardiorespiratory fitness in breast cancer patients receiving adjuvant chemotherapy: a pilot study.

BACKGROUND: Breast cancer treatment is associated with a decline in measured cardiorespiratory fitness and increased fatigue. There is accumulating evidence that exercise training during adjuvant chemotherapy may contribute to prevent these changes. Additional studies are needed to explore the effectiveness of home-based walking interventions among this population. AIM: The aim of this study was to investigate the effects of a 12-week adapted home-based walking training program (WTP) on clinical rehabilitation in breast cancer patients receiving adjuvant chemotherapy. DESIGN: This was a pilot study using a single-group design. SETTING: Unit Department of Physiology and Medical Oncology, Limoges University Hospital, France. POPULATION: Thirty-nine outpatients predominantly with stage II breast cancer. METHODS: Participants performed 3 home ambulatory aerobic walking sessions per week at 50-60% of their maximum heart rate for 12 weeks. Functional capacity was assessed with an incremental cardiopulmonary exercise test during which peak oxygen consumption (VO(2peak)) was measured. A six-minute walking test (6 MWT) was performed to evaluate physical function. The revised Piper Fatigue Scale (PFS-R) was used to measure self-reported fatigue. RESULTS: Thirty-four patients (87%) completed all study procedures. Per Protocol (PP) analysis indicated that VO(2peak) recorded both before and after a 12-week adapted home-based WTP increased significantly by 2.21 mL.kg-1.min-1 (P=0.008) and 6 MWT distance increased significantly by 42 m (P=0.04). PFS-R score increased by 0.4 points, but not significantly. CONCLUSION: In breast cancer patients receiving adjuvant chemotherapy, home-based WTP is feasible and associated with significant improvements in VO(2peak), with no significant effect on fatigue score. Larger randomized trials are necessary to confirm these findings.

[Review of nutritional and respiratory support in ALS]. / Prise en charge nutritionnelle et respiratoire des patients atteints de Sclérose Latérale Amyotrophique (SLA).

During the evolution of amyotrophic lateral sclerosis (ALS), quality of life and survival of patients are related to respiratory and nutritional status. After diagnosis, a multidisciplinary care has to be promptly organized and coordinated by the referring neurologist. The nutritional and respiratory support imply that neurologists know their specific means of evaluation with their sensitivity and sensibility and be able to recognize clinical risk situations. The informations of patients on assisted-ventilation and nutritional support by using gastrostomy may be done early, precisely and trustfully. Well informed patient's choices must be respected. Nutritional and respiratory supports may be based on recommendations established by the American Academy of Neurology. This review will present and discuss their main aspects in patients with ALS.

[Glycogenesis due to adult phosphorylase kinase deficiency]. / Glycogénose par déficit en phosphorylase kinase chez un adulte.

A 42-year-old man presented exercise-induced muscle pain without myogloburia since the age of 12 years. Histochemistry and electronmicroscopy of a muscle biopsy revealed subsarcolemmal and inter-myofibrillar accumulation of glycogen. Exercise on a bicycle ergometer produced a normal raise of lactate. Biochemical study showed a partial defect in phosphorylase activity.

[Respiratory effects of risperidone? A prospective study]. / Effets respiratoires de la rispéridone? Etude prospective.

Risperidone is an atypical neuroleptic which has been incriminated as a cause of respiratory symptoms. The purpose of this prospective study was to assess over a three-month period the respiratory status of patients free of allergic or respiratory disease treated with risperidone. Thirty-nine patients were enrolled. Twenty dropped out. One patient developed cough very likely related to risperidone but with no change in function. Bronchial hyperreactivity developed in two other patients who had no clinical symptom or sign of respiratory disorder. Despite the small number of patients in this study, risperidone would appear to have secondary respiratory effects. The high frequency of bronchial hyperreactivity observed in patients at inclusin and the nearly constant co-prescription of other psychiatric drugs suggests a potential combination effect (notably with selective seritonin reuptake inhibitors).

[Prevalence of exercise-induced asthma in school children]. / Prévalence de l'asthme d'effort en milieu scolaire.

BACKGROUND: Although asthma is the most common pulmonary condition in pediatrics, the incidence of exercise-induced asthma (EIA) in school children is not well documented and few studies have been devoted to the condition. There are considerable variations in morbidity and mortality between countries. This study was designed to evaluate the prevalence of EIA in children in the 6th grade (11-14 year-olds) in one French department (Haute-Vienne) and to identify undiagnosed cases. METHODS: The representative sample was obtained over a period of 28 days (February 2(nd) to April 10(th) 1998) by cluster sampling method, stratified by size of the schools. The number of subjects planned was 891. The selected children filled in a questionnaire on their asthma history and were subjected to an outdoor exercise test (6 minute run). Respiratory function was measured with a peak flow-meter. RESULTS: Seven hundred and eighty two school children were included in this survey. Participation rate was 87.8%. The prevalence of asthma from the questionnaire was 10.7% (CI 95%: 8.7 - 12.8). After exercise, 68 school children presented exercise-induced bronchospasm: the prevalence of the EIA was 8.7% (CI 95%: 6.9 - 10.5). Among these 68 school children, 27 were known asthmatics and 41 were not. With the 10 treated asthmatics, the overall prevalence of EIA was therefore estimated at 9.9% (CI 95%: 8.2 - 11.7). CONCLUSION: The prevalence of asthma and EIA was close to that found in other studies using a similar methodology. EIA remains under-diagnosed since 41 undeclared asthmatic school children were identified in our population. Nurses'information is necessary to initiate the use of systematically testing respiratory function (with a peak flow meter) at least once a year. Efficient management of the asthmatic child requires cooperation between the various professionals dealing with school children.

Study of blood flow parameters measured in femoral artery after exercise: correlation with maximum oxygen uptake.

To study the recovery periods of blood flow parameters in muscles after anaerobic exercise, instantaneous and mean blood flow velocity curves were recorded in the femoral artery in 22 sportsmen at rest and during the first 4 min of recovery after exercise (Ruffier-Dickson test). A flat ultrasonic probe connected to a Doppler system (Flow-Tester) was fixed on the skin at the level of the common femoral artery. From Doppler recordings, we calculated periods of recovery (return to baseline) of femoral blood flow velocity (FBFV RP), heart rate (HR RP) and femoral stroke distance (FSD RP). Also, Ruffier-Dickson index (RDI), VO(2)max in mL/kg(-1)/min(-1) and number of training hours were determined. We observed a high correlation between FBFV RP and VO(2)max (p = 0. 0002), and significant correlation between FSD RP and VO(2)max (p = 0.0238) and RDI (p = 0.0451). In conclusion, there is a excellent correlation between blood flow velocity recovery period in femoral artery after moderate exercise and VO(2)max in high-level sportsmen. The method of testing is simple and based on conventional Doppler technique. It can be used for the follow-up of training levels in sportsmen.

Airway obstruction and rheumatoid arthritis.

The aim of this study was to assess the percentage of respiratory disorders and airway obstruction in patients with rheumatoid arthritis by comparing lung function test results between patients with rheumatoid arthritis and control subjects with other rheumatological conditions. A prospective case-control study of respiratory symptoms and lung function abnormalities was performed in a series of 100 patients with rheumatoid arthritis. Eighty eight patients with other rheumatological diseases served as controls. Diagnosis of respiratory disorders was based on clinical, radiological and spirometric findings. Airway obstruction was determined from predicted values. The results were compared using Student's t-test and Chi-squared tests. An explanatory analysis was carried out by linear regression. The number of symptoms, respiratory disorders (including bronchiectasis) and lung function abnormalities was higher in patients with rheumatoid arthritis than in controls. After exclusion of smokers, the proportion of airway obstruction in patients with rheumatoid arthritis was 16% (versus 0% in controls), although the patients with rheumatoid arthritis still had more symptoms and respiratory disorders. The Chi-squared test did not identify any relationship between airway obstruction, duration of rheumatoid arthritis and type of treatment and occurrence of Sjögren's syndrome. In the nonsmokers, different explanatory models for the patients with and without a history of cardiac and respiratory disease emerged from multivariate analysis of indices of obstruction. These models included variables characterizing the severity and course of the rheumatoid arthritis. Respiratory disorders (including bronchiectasis) and airway obstruction are more frequent among patients with rheumatoid arthritis than in rheumatological controls. Although the exact pathophysiology of the link between bronchial obstruction and rheumatoid arthritis is still a matter of debate, explanatory factors for obstruction included variables characterizing the rheumatoid arthritis.

Acoustic properties of the normal chest.

Laënnec invented the stethoscope in 1816 and published a treatise on auscultation in 1819. We then had to wait until the 1950s to observe development of modern devices and methods of recording and signal-processing, which allowed objective studies of lung sounds in time and frequency fields. Tracheobronchial sounds generated by ventilation originate in the upper airways, the frequency content of these sounds has led to extensive research. Consolidated lungs act as more efficient sound conductors to the chest wall (bronchial breathing murmur). Tracheobronchial sounds contain higher frequency components compared to vesicular lung sounds. The origin of vesicular lung sounds has been becoming progressively clear for about 10 yrs. It is at least partly produced locally, deep, and probably intralobular. Clearly, further studies need to be performed in order to elucidate the true mechanisms involved in generating vesicular lung sounds, the redistribution of intrapulmonary gas or vibrations caused by the stretching of lung tissue. The devices developed are already useful for monitoring the state of patients in intensive care. Sooner or later, real time analysis and automated diagnosis will become available.

Work related distal airway obstruction in an agricultural population.

OBJECTIVE: To assess the prevalence of distal airway obstruction and its risk factors in agricultural areas. METHODS: A cross sectional study of respiratory symptoms and lung function was performed among French farmers and their spouses (1122 subjects) who came for preventive medicine examinations. They answered a respiratory questionnaire and performed pulmonary function tests on a portable spirometer. Diagnoses of chronic bronchitis were made on the basis of reported chronic respiratory symptoms. Airway obstruction was determined from predicted values. Odds ratio (OR) and linear regression coefficients were calculated after stratification by smoking and history of cardiac and other respiratory diseases. RESULTS: Of respiratory symptoms prevalence of chronic cough was 8.47%, and chronic bronchitis 7.66%. Prevalence of distal airway obstruction was 11.4%, and overall airflow obstruction 3.2%. Smokers were 20.2% men, and 5.7% women. Linear regressions showed high association between pack-years in smokers or exsmokers and forced expiratory volume in one second/forced vital capacity (FEV1/VC) and forced expiratory flow between 25% and 75% of vital capacity (FEF25-75). In non-smokers without any history of cardiac or respiratory diseases, age and the size of farms had the highest correlations with these variables. OR for distal airway obstruction was 2.1 in subjects > 50 years old v the younger ones and 3.02 in the smaller farms v the larger ones. CONCLUSION: After stratification by smoking and history of cardiac and respiratory diseases, distal airway obstruction is present in agricultural areas. The age, and the size of farm are the highest respiratory risk factors in non-smokers.

[Impact on the quality of life of respiratory symptoms and airway obstruction in an agricultural population]. / Retentissement sur la qualité de vie des symptômes respiratoires et de l'obstruction des voies aériennes dans une population agricole.

Respiratory diseases are known to have consequences on health status. The objective of this study was to assess the quality of life of subjects with obstructive respiratory disorders coming for preventive medicine examinations. We conducted a study on a sample of adults living in agricultural areas (n = 1,235). We used two questionnaires: a respiratory questionnaire and the Nottingham Health Profile (NHP), which is a questionnaire designed to capture self-reported morbidity. It has been recently validated in french. Each subject performed a pulmonary function test on a portable spirometer to separate lung function obstructive abnormalities. Statistical analysis was realized by non parametric test. The number of positive responses (which shows bad health status) and the scores of the six dimensions are higher in females than males. According to sex and smoking habits, cough and chronic bronchitis are responsible for bad scores of health profile (for the total number of positive responses and the scores of each dimension). In case of airway obstruction, there is no major consequences on health profile. Subjective health measurements are interesting tools in subjects with non-chronic diseases. They can be associated with medical questionnaires because they give complementary inquiries.

[Pneumopathy induced by pirindopril. A case report]. / Pneumopathie induite par le pirindopril. A propos d'un cas.

Cough is known to be the major respiratory side effect of treatment with angiotensin converting enzyme inhibitors (ACEI). Recently, ACEI have been implicated in drug-induced lung disease. We report a new case of diffuse pneumonitis which occurred during treatment with ACEI. A 73-year-old man was admitted for cough, dyspnea at rest, fever and weight loss. The patient had been treated with the ACEI pirindopril during 6 months for systemic hypertension. Chest radiographs showed reticular infiltrates in the upper lung fields. A CT scan confirmed the infiltrates and showed pleural thickening and airspace opacities. White blood cell counts showed 15,700/mm3 leucocytes with 940 eosinophils/mm3. Transbronchial biopsy was consistent with infiltration of the lung with eosinophils. There was no evidence for another etiology. Once the drug was withdrawn, clinical and radiological abnormalities improved but steroids were required to control symptoms. This report suggests that pirindopril, as captopril, can induce the picture of drug-induced pulmonary disease.

A method for determining the maximal steady state of blood lactate concentration from two levels of submaximal exercise.

The aim of this study was to estimate the characteristic exercise intensity (WCL) which produces the maximal steady state of blood lactate concentration (MLSS) from submaximal intensities of 20 min carried out on the same day and separated by 40 min. Ten fit male adults [maximal oxygen uptake (VO2max) 62 (SD 7) ml.min-1.kg-1] exercised for two 30-min periods on a cycle ergometer at 67% (test 1.1) and 82% of VO2max (test 1.2) separated by 40 min. They exercised 4 days later for 30 min at 82% of VO2max without prior exercise (test 2). Blood lactate was collected for determination of lactic acid concentration every 5 min and heart rate and O2 uptake (VO2) were measured every 30 s. There were no significant differences at the 5th, 10th, 15th, 20th, 25th, or 30th min between VO2, lactacidaemia, and heart rate during tests 1.2 and 2. Moreover, we compared the exercise intensities (WCL) which produced the MLSS obtained during tests 1.1 and 1.2 or during tests 1.1 and 2 calculated from differential values of lactic acid blood concentration ([la-]b) between the 30th and the 5th min or between the 20th and the 5th min. There was no significant difference between the different values of WCL [68 (SD 9), 71 (SD 7, 73 (SD 6), 71 (SD 11)% of VO2max] (ANOVA test, P < 0.05). Four subjects ran for 60 min at their WCL determined from periods performed on the same day (test 1.1 and 1.2) and the difference between the [la-]b at 5 min and at 20 min (delta ([la-]b)) was computed.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison between late onset and childhood asthma.

BACKGROUND: The onset of asthma frequently occurs after the age of 50 yr and the severity and causes of this late onset disease are poorly known. METHODS: 25 chronic asthmatics (65.7 +/- 6.5 yr) whose asthma started after the age of 50 yr were compared with 23 chronic asthmatic children (11.6 +/- 2.8 yr) and 24 COPD patients (61.6 +/- 3.4 yr). Both asthmatic groups had a similar apparent duration of asthma. None of the asthmatics was a smoker. All COPD were smokers. The severity of asthma was defined according to the Aas score. FVC, FEV1, MMEFR, Raw were tested and reversibility of bronchial obstruction was determined on Raw after salbutamol inhalation. Allergy was assessed by skin prick tests, RAST and total serum IgE (PRIST). RESULTS: Patients with childhood asthma had: 1) a significantly lower clinical severity of asthma; 2) a significantly less severe bronchial obstruction, and 3) a significantly greater reversibility than old age asthmatics. There was no significant difference between pulmonary function tests pre- and post-bronchodilators between COPD and old-age asthmatics. All asthmatic children and 40% of older patients were allergic. CONCLUSIONS: The occurrence of asthma in old age patients leads to a more severe course of the disease and allergy appears to play a role in many old age patients.

[Blood lactate in the steeplechase horse: triangular and rectangular series of steps during short duration races]. / Lactatémie chez le cheval de concours hippique: enchainements triangulaires et rectangulaires d'échelons de courses de courte durée.

Five steeplechase race horses were observed during incremental and constant-load exercises with the aim of separating effects of work rate and time on blood lactate. Each independent exercise (an incremental and three constant load tests) was a sequence of three two-minute runs, separated by two one-minute rest intervals for jugular blood sampling. The following observations were made: 1. During constant load exercises, in the five horses, blood lactate stabilized below 4 mmol.l-1: lactatemia critical velocity (LVC) = 3.33 +/- 0.16 mmol.l-1. Nevertheless, VCL, critical lactate velocity inducing LVC, was not statistically different from VS4, velocity inducing a 4 mmol.l-1 blood lactate during incremental tests. Remaining reticent on the meaning of "lactate threshold" often attributed to VS4, an incremental exercise thus seemed pertinent for routine long-term surveys of endurance. 2. If delta L is the blood lactate increase within a single short run, delta L increases linearly with running velocity for an incremental test, allowing the calculation of a "null" velocity, the highest velocity for which there is no significant lactate increase. For independent runs, delta L increased exponentially with velocity, with noticeable differences between horses. This individual short-term functional adaptation variability could be considered in assessment and follow-up of race horse fitness.

[The value of respiratory function tests in the surveillance of asthmatic children]. / Intérêt de l'exploration fonctionnelle respiratoire dans la surveillance des enfants asthmatiques.

The purpose of pulmonary function testing in children with asthma is to search for obstructive airway disease. We examined the charts of 169 asthmatic children during intervals between acute exacerbations. The severity of asthma was determined according to VIALATTE classification, with the Tiffeneau ration FEV1/VC (1) and the MMFR/VC ratio serving as obstructive indices. According to these data, children were classified into three groups: normal children (normal FEV1/VC and MMFR/VC), children with probable obstruction of the distal airways (normal FEV1/VC and decreased MMFR/VC), and children with both proximal and distal airway obstruction (decreased FEV1/VC and MMFR/VC). Since suggested normal values vary in the literature, we compared FEV1 and MMFR to determine as accurately as possible the number of children with obstructive disease. The relationship between the degree of clinical involvement and pulmonary function testing results was studied. Clinically, asymptomatic children with suspected normal respiratory function had evidence of obstructive disease in two out of three cases, and would benefit from drug therapy.

[Stability and variation of the maximal ventilation and maximal expiratory volume ratios]. / Stabilité et variation du rapport entre ventilation maximale et VEMS

The level of stability of the ratio (alpha coefficient) of maximal ventilation (MBC) over maximal expiratory volume per second (FEV1) was continued statistically for its practical value in estimating the respiratory functional incapacity. Three observations were made: --the mean value of the alpha coefficient=MBC/FEV1 is independent of the sex, age, size or weight in the normal subject; alpha was slightly higher than that found from theoretical values of MBC (CECA) and FEV1 (BALDWIN and COURNAND); --the alpha coefficient varied with the vital capacity (VC) and with FEV1; --there was a particularly simple relation between alpha and VC: alpha decreased from 38 to 30 when VC increased from 1 to 6 litres.