[Pneumo-Quest: A standardised self-questionnaire to be completed at home before a first appointment at a respiratory clinic]. / Pneumo-Quest, auto-questionnaire standardisé à compléter au domicile avant une première consultation en pneumologie : étude de validation.

The Pneumo-Quest self-questionnaire was developed to standardize the practice of recollection when welcoming a new patient. It consists of 82 main questions and 34 subsidiary questions to be completed at home by the patients before their first visit to a pulmonologist. This evaluation was carried out on the basis of 137 returned questionnaires. The feasibility (main criterion) was good with 93±5% of the questions answered and an average completion time of 15.1±9.8minutes (mean±SD). The reliability of the responses (secondary criterion) was good with the agreement between the patient's response and the doctor's opinion being excellent or good for the majority of medical histories and treatments, as evidenced by the high values of the kappa coefficient (>0.90; <0.90; <0.75). Patient and physician perception of the questionnaire was good with 99% and 90% positive ratings, respectively. The use of the questionnaire was unhelpful in the course of the consultation in only 2% of cases. Doctors found the tool useful for obtaining a comprehensive history in 87% of cases and patients declared that it helped them "forgot nothing" in 93% of the cases. The questionnaire helped the doctor to identify the patient's problems rapidly in 71% of cases and saved time in 64%. These positive results encourage a wide dissemination of the questionnaire (www.pneumo-quest.com).

[Distrust of vaccination: Why?] / Défiance vis-à-vis de la vaccination : pourquoi ?

Vaccines have saved millions of lives and reduced the severity of many infections. A reduction in vaccination coverage is now reflected in the re-emergence of epidemics of mumps, pertussis, measles and chickenpox. Many people do not recognize the effectiveness of vaccination and fear the side effects. The main concern is the safety of vaccines. Lack of information weighs less than lack of trust in health authorities. The greater responsibility of the individual and the respect for his free will, may lead the authorities to a less vigourous promotion of the "vaccination duty" which is also a social duty. The attitude of individuals is guided by their health beliefs which are often supported by an erroneous perception of risk. In addition, insidious anti-vaccine lobbying plays on fears and uses biased reasoning that the media help to amplify. Thus the analysis of the brakes to vaccination both in the general population and among health professionals, the dismantling of the arguments developed by the anti-vaccine leagues and vigilance with regard to "fake news" should allow a concerted communication, transparent, clear and effective, in order to limit the occurrence of preventable deaths.

[Evaluation of permanent disability levels in occupational pulmonary diseases]. / Comment évaluer en 2019 les taux d'incapacité permanente des pathologies professionnelles pulmonaires ?

Compensation for occupational pulmonary diseases requires the establishment of guidelines based on standardized and objective criteria, in order to provide compensation that is as fair as possible to patients who suffer from them. A review of the elements necessary for the examination of an individual file was carried out by a working group. It is accepted that respiratory functional exploration is the key element in assessing the level of permanent disability in all of these conditions, with the exception of thoracic malignancies. Guiding scales have been developed for the respiratory impairment of three types of conditions: occupational asthma, thoracic malignancy, and other respiratory diseases. Additional criteria for increasing the permanent disability level are also proposed in order to take into account professional prejudice, in particular the possibility or not of continuing the occupational activity, in the same job or after changing to another. For certain respiratory diseases, a periodic reassessment of the initially attributed permanent disability level is recommended as well as the initial one at the time of definitive cessation of occupational activity.

Pharmacological treatment optimization for stable chronic obstructive pulmonary disease. Proposals from the Société de Pneumologie de Langue Française.

The Société de Pneumologie de Langue Française proposes a decision algorithm on long-term pharmacological COPD treatment. A working group reviewed the literature published between January 2009 and May 2016. This document lays out proposals and not guidelines. It only focuses on pharmacological treatments except vaccinations, smoking cessation treatments and oxygen therapy. Any COPD diagnosis, based on pulmonary function tests, should lead to recommend smoking cessation, vaccinations, physical activity, pulmonary rehabilitation in case of activity limitation, and short-acting bronchodilators. Symptoms like dyspnea and exacerbations determine the therapeutic choices. In case of daily dyspnea and/or exacerbations, a long-acting bronchodilator should be suggested (beta-2 agonist, LABA or anticholinergics, LAMA). A clinical and lung function reevaluation is suggested 1 to 3 months after any treatment modification and every 3-12 months according to the severity of the disease. In case of persisting dyspnea, a fixed dose LABA+LAMA combination improves pulmonary function (FEV1), quality of life, dyspnea and decreases exacerbations without increasing side effects. In case of frequent exacerbations and a FEV1≤70%, a fixed dose long-acting bronchodilator combination or a LABA+ inhaled corticosteroids (ICS) combination can be proposed. A triple combination (LABA+LAMA+ICS) is indicated when exacerbations persist despite one of these combinations. Dyspnea in spite of a bronchodilator combination or exacerbations in spite of a triple combination should lead to consider other pharmacological treatments (theophylline if dyspnea, macrolides if exacerbations, low-dose opioids if refractory dyspnea).

[Validation of an evaluation questionnaire for COPD acute exacerbations (Exascore)]. / Validation d'un questionnaire d'évaluation de l'exacerbation dans la BPCO : l'Exascore.

BACKGROUND: Early identification of acute exacerbations of COPD facilitates better care. This study was designed to validate a short questionnaire (Exascore) developed to help patients, relatives and carers to diagnose acute exacerbations. METHOD: We first addressed content validity that allowed the elaboration of two questionnaires, one assessing the current status and the other stable status (transition). The second step tested their construction validity, reproducibility and concomitant validity among 126 COPD patients aged 64.4±9.9 years. They included 56 presenting with an exacerbation and 70 in stable state, of whom 57 completed the questionnaire a second time after 7 days. The diagnosis of exacerbation and assessment of severity (gold standard) were established by the treating respiratory physician and confirmed by two independent experts. RESULTS: Factorial analyses established a "current status" questionnaire comprising 8 items and 2 dimensions. Cronbach's alpha coefficients were satisfactory, 0.867 for "respiratory impact", 0.886 for "psychosocial impact" and 0.886 for the total score. Concomitant validity and reproducibility were also adequate. The transition questionnaire did not obtain convincing psychometric results. CONCLUSIONS: The "current status" Exascore questionnaire satisfies psychometric quality criteria while being usable in clinical practice. It helps in diagnosing acute exacerbations and assessing their intensity. Further studies will need to test the adequacy of proposed thresholds, the factorial structure of the score in healthcare professionals and patients' relatives, and its predictive power.

[Non-tuberculous mycobacterial infection of a totally implanted perfusion device]. / Infection à mycobactérie non tuberculeuse d'une chambre implantable pour perfusion.

INTRODUCTION: Catheter-related infection by non-tuberculous mycobacteria is rare but difficult to diagnose and the treatment is not standardized. CASE REPORT: A 64-year-old woman treated for lung cancer with intravenous chemotherapy developed an infection of her totally implanted perfusion device with Mycobacterium chelonae. The infection was cured after surgical removal of the device and treatment with oral clarithromycin. CONCLUSION: Mycobacteria may infect vascular access devices. Rapid diagnosis of such infections allows early treatment.

[Cavitating pulmonary infarcts revealing thromboembolic pulmonary hypertension]. / Infarctus pulmonaires excavés révélant une hypertension pulmonaire post-embolique.

Several etiologies are involved in the pathogenesis of cavitating pulmonary disease including neoplastic, infectious or inflammatory processes. Another is pulmonary infarction associated with venous thromboembolism. The lung cavities tend to be located peripherally and are the result of pulmonary embolism. We report the case of a woman with chronic thromboembolic pulmonary hypertension (CTEPH), associated with familial thrombophilia, revealed by cavitating pulmonary infarcts. CTEPH is sometimes diagnosed during an episode of recurrent pulmonary embolism following previously unnoticed lesions. Thrombophilias such as isolated elevated factor VIII are risk factors for CTEPH.

Swallowing disorders, pneumonia and respiratory tract infectious disease in the elderly.

Swallowing disorders (or dysphagia) are common in the elderly and their prevalence is often underestimated. They may result in serious complications including dehydration, malnutrition, airway obstruction, aspiration pneumonia (infectious process) or pneumonitis (chemical injury caused by the inhalation of sterile gastric contents). Moreover the repercussions of dysphagia are not only physical but also emotional and social, leading to depression, altered quality of life, and social isolation. While some changes in swallowing may be a natural result of aging, dysphagia in the elderly is mainly due to central nervous system diseases such as stroke, parkinsonism, dementia, medications, local oral and oesophageal factors. To be effective, management requires a multidisciplinary team approach and a careful assessment of the patient's oropharyngeal anatomy and physiology, medical and nutritional status, cognition, language and behaviour. Clinical evaluation can be completed by a videofluoroscopic study which enables observation of bolus movement and movements of the oral cavity, pharynx and larynx throughout the swallow. The treatment depends on the underlying cause, extent of dysphagia and prognosis. Various categories of treatment are available, including compensatory strategies (postural changes and dietary modification), direct or indirect therapy techniques (swallow manoeuvres, medication and surgical procedures).

[Pleuropneumonia due to Mycobacterium chelonae]. / Pleuropneumonie à Mycobacterium chelonae.

Mycobacterium chelonae (M. chelonae) is rarely responsible for respiratory infection. This report concerns the case of an 81-year-old man with previously asymptomatic bronchiectasis, colonised by M. chelonae for 3 years. He was hospitalised for acute dyspnoea and fever due to a right hydro-pneumothorax with cavitated alveolar opacities of the right lung. Pleural fluid and bronchial aspiration were positive for M. chelonae and no other microorganisms were detected. The effusion was drained and the patient treated with clarythromycin and amikacin. The radiological abnormalities improved but the patient's general condition remained poor. Treatment was continued for 11 months. Because of the absence of any other bacteria, clinical deterioration following broad-spectrum antibiotics and stabilisation of the lesions after anti-mycobacterial treatment, our diagnosis was severe M. chelonae pleuro-pneumonia in an immunocompetent patient.

[Impact of positron emission tomography on clinical management of potentially resectable non-small-cell lung cancer: a French prospective multicenter study]. / Impact de la tomographie par émission de positons au 18-FDG dans la prise en charge des patients porteurs d'un cancer bronchique non à petites cellules a priori opérable. Etude prospective multicentrique française.

BACKGROUND: Whole-body (18)F-deoxyglucose positron emission tomography (FDG-PET) has the potential to improve the management of non-small-cell lung cancer (NSCLC). We prospectively evaluated the impact of combining FDG-PET with conventional staging methods, including computed tomography (CT), on the staging and management of patients with potentially resectable NSCLC. METHODS: Ninety-four consecutive patients with newly diagnosed/suspected NSCLC were enrolled. Each patient was first staged by using conventional methods, and then by FDG-PET. FDG-PET results were forwarded in a sealed envelope and divulged at the weekly staff meeting on staging and treatment, only after "Decision 1", based on conventional staging, had been reached by consensus; reevaluation taking FDG-PET into account yielded "Decision 2". The validity of these latter decisions was analyzed retrospectively. RESULTS: Eighty-nine patients were eligible. Relative to standard imaging, FDG-PET led to clinical staging changes in 26 (29.2%) patients. The stage was lowered in eight cases (9%) and raised in 18 cases (20.2%). "Decision 2" differed from "Decision 1" in 19 patients, modifying the surgical procedure in four cases, indicating other investigations to confirm FDG-PET evidence of metastases in 12 cases, or modifying the medical treatment in three cases. These modifications were retrospectively justified in 9/19 cases, and consisted of 2/4 modifications of the surgical procedure (one hilar and one adrenal metastasis not confirmed histologically), 4/12 further investigations (axillary and liver biopsies, mediastinoscopy, occult colon cancer) and three indications for palliative treatment, in patients who all died within 3 months after FDG-PET. CONCLUSIONS: Based on FDG-PET, management was modified in 19/89 (21.3%) patients, but these changes were justified in only 9/89 patients (10.1%). FDG-PET can detect asymptomatic local and distant metastases and improves the preoperative assessment of NSCLC, thereby avoiding unnecessary surgery. However, histological verification is required because of the risk of false-positive results.

[Representation of knowledge in respiratory medicine: ontology should help the coding process]. / Représentation des connaissances en pneumologie: l'ontologie doit pouvoir aider au codage.

INTRODUCTION: Access to medical knowledge is a major issue for health professionals and requires the development of terminologies. The objective of the reported work was to construct an ontology of respiratory medicine, i.e. an organized and formalized terminology composed by specific knowledge. The purpose is to help the medico-economical coding process and to represent the relevant knowledge about the patient. METHODS: Our researches cover the whole life cycle of an ontology, from the development of a methodology, to building it from texts, to its use in an operational system. A computerized tool, based on the ontology, allows both a medico-economical coding and a graphical medical one. This second one will be used to index hospital reports. RESULTS: Our ontology counts 1913 concepts and contains all the knowledge included in the PMSI part of the SPLF thesaurus. Our tool has been evaluated and showed a recall of 80% and an accuracy of 85% regarding the medico-economical coding. CONCLUSION: The work presented in this paper justifies the approach that has been used. It must be continued on a large scale to validate our coding principles and the possibility of making enquiries on patient reports concerning clinical research.