Management of acute exacerbations of chronic obstructive pulmonary disease (COPD). Guidelines from the Société de pneumologie de langue française (summary).

Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.

Management of acute exacerbations of chronic obstructive pulmonary disease (COPD). Guidelines from the Société de pneumologie de langue française / Prise en charge des exacerbations de la bronchopneumopathie chronique obstructive (BPCO). Recommandations de la Société de pneumologie de langue française

Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.(AU)

La bronchopneumopathie chronique obstructive (BPCO) est la maladie respiratoire chronique dont le poids sur la santé publique est le plus grand par sa morbidité, sa mortalité et les dépenses de santé qu'elle induit. Pour les individus atteints, la BPCO est une source majeure de handicap du fait de la dyspnée, de la limitation d'activité, des exacerbations, du risque d'insuffisance respiratoire chronique et des manifestations extra-respiratoires qu'elle entraîne. Les précédentes recommandations de la Société de pneumologie de langue française (SPLF) sur la prise en charge des exacerbations BPCO date de 2003. Se fondant sur une méthodologie adaptée de GRADE, le présent document propose une actualisation de la question des exacerbations de BPCO en développant un argumentaire couvrant quatre champs d'investigation : (1) épidémiologie, (2) évaluation clinique, (3) prise en charge thérapeutique et (4) prévention. Les modalités spécifiques de la prise en charge hospitalière et ambulatoire y sont discutées, particulièrement les aspects relevant de l'évaluation de la sévérité de l'exacerbation et de la prise en charge pharmacologique.(AU)

[A survey on the performance of the six-minute walk test]. / Enquête sur la réalisation du test de marche de six minutes.

OBJECTIVE: To ascertain, through a national survey, whether the performance of the six-minute walk test (MW6) is in accordance with the recommendations of the American thoracic society (ATS). METHODS: An anonymous questionnaire was sent electronically to 206 departments of respiratory medicine (39 teaching hospitals and 167 general hospitals) and to respiratory rehabilitation departments provided by the Alveolar group of the SLPF (French language respiratory society), and then distributed on a discussion site specialising in respiratory physiotherapy and a professional information site for physiotherapists. RESULTS: One hundred and eleven questionnaires were returned between October 2009 and April 2010, 105 from France. The response rate from hospitals was 30%. The MW6 was performed mainly by physiotherapists and nurses. In 48% there was no precise time for its performance. The site used was a corridor longer than 30 metres in 52% of cases. In 60% the patient was accompanied by the observer. In 35% a familiarisation test was performed, with a delay of 30 minutes or less between the two tests in 62% of these. In 40% encouragement was given. SpO(2) was monitored during the MW6 in 95%. CONCLUSION: For many items the recommendations of the ATS are not followed. The differences found were mainly due to constraints on the services (availability of operators and/or patients).

[Inspiratory muscles strength training in recreational athletes]. / Entraînement de la force des muscles inspiratoires chez le sujet sportif amateur.

INTRODUCTION: Respiratory muscles strength and endurance influence athletic performance. Besides conventional spirometry, sniff test, inspiratory and expiratory maximal pressures can directly assess respiratory muscle strength. Respiratory muscles can be train through a device offering inspiratory and expiratory resistance. METHODS: Nineteen subjects aged 18 to 30 years and practicing leisure sport trained inspiratory muscles on Powerbreathe(®) for eight weeks. Resistance was set at 85% of maximal inspiratory pressure determined during a preliminary session. Evaluation was made trough voluntary and non-invasive methods on Macro 5000(®) (PI max, PE max and sniff test). RESULTS: An increase of 21.77% of the maximum inspiratory pressure, 17% of the maximum expiratory pressure and 18% of the sniff test are recorded after eight weeks of training. CONCLUSIONS: A specific training of inspiratory muscles (Powerbreathe(®) Sports performance) increases the power of these muscles (voluntary and non-invasive tests).

[Practical methods for controlled diaphragmatic breathing in 2009: proposals for a consensus]. / Modalités pratiques de réalisation de la ventilation dirigée abdomino-diaphragmatique en 2009: propositions pour un consensus.

BACKGROUND: This work has been completed at the request of the French Language Society of Pneumology. It is the result of collaboration between the 'Muscles and Respiration Group' and the 'Working Group in Physiotherapy', arriving at a consensus on diaphragmatic breathing. RESULTS: From the literature followed by a formalized consensus methodology, the authors specify the terminology and define the appropriate methods of this technique that should be used. CONCLUSION: Analysis of the literature to date does not allow assessment of the efficacy of this technique. The precise definition of the methods of diaphragmatic breathing as proposed in the present study will be used as a basis for forthcoming studies on this technique.