[Environment and asthma in children: controversies]. / Environnement et asthme de l'enfant: controverses et jusqu' où aller?

The increase in asthma prevalence over the past 20 years could be due to modification of exposure to environmental factors (environmental theory) or to the lost of protective factors (hygienist theory). Among environmental factors this paper reviewed the controversial role of exposure to house dust mite (HDM). If exposure to HDM is deleterious in asthmatics known to be sensitised to this allergen, the effect of HDM exposure on asthma incidence has been challenged recently, based on longitudinal studies showing no correlation between level of exposure to HDM and asthma incidence. Exposure to animal dander may have protective effects. This review has shown that, even if some studies have shown potential protective effect of early exposure, the protection seems to be better in families with a low risk of atopy; almost all studies tend to show a deleterious effect of current exposure; exposure to dog dander may be more protective than cat. These studies cannot give definite conclusions to change current advices of early eviction of HDM and animal dander, especially in families with a high risk of atopy. The deleterious effect of passive smoking on asthma prevalence and severity is undisputable and our efforts should concentrate on obtaining effective eviction of passive smoking.

[Future prospects in the management of cystic fibrosis]. / Perspectives d'avenir dans la prise en charge de la mucoviscidose.

Basic and clinical research in cystic fibrosis have led to several new hypothesis to improve the management of the disease. The numerous tracks for new therapies may be explained by the lack of firm patho-physiological explanations for the disease and of knowledge of the best targets to get a significant improvement of the patients. After initial great hopes, there has been important limitations and slow down of gene therapy, imposing to go back to research programs on new vectors. New hopes have arisen with protein therapies, including chaperones molecules that can activate mutated CFTR proteins within the cells. New anti-inflammatory therapies are developed, including proteases inhibitors. The prevention of airway colonisation with Pseudomonas aeruginosa is fundamental and could go through the development of specific vaccines, cellular therapies or molecules directly acting on the virulent factors of the bacteria.

[Differential diagnosis of asthma in infants and young children]. / Diagnostic différentiel de l'asthme du nourrisson et du jeune enfant.

Although when an infant or a young child presents with persistent or recurrent wheezing, the probability of asthma is high, one must remain very careful in order not to miss an other etiology. Except for the chest X ray with inspiratory and expiratory studies that is mandatory, the other evaluations should be based on a careful interview and clinical examination. Fiberoptic bronchoscopy may be indicated each time there is a doubt on foreign body aspiration or tracheobronchomalacia.

[Prevention of respiratory syncytial virus infection by SYNAGIS (palivizumab)]. / Prévention de l'infection à virus respiratoire syncytial (VRS) par le SYNAGIS (palivizumab).

Infection with respiratory syncytial virus is frequent but most often benign. The serious forms of the illness, which make necessary hospitalisation or care in an intensive Care Unit, appear in infants of less than 6 weeks and especially in those with underlying pathologies, prematurity, congenital cardiopathies or chronic respiratory illnesses. Palivizumab (SYNAGIS) is mouse humanized monoclonal antibody which is used for prevention by monthly injections before and during the epidemic period. In a pivotal study performed on 1502 infants aged less than 6 months and former prematures of less than 36 weeks gestational age (GA) or aged less than 2 years and preventing a bronchopulmonary dysplasia, 1002 infants received 5 monthly injections, compared with 500 infants treated with placebo. There was a significant reduction of 55% risk of hospitalisation with VRS infections in the treated group, but no significant reduction in the number of stays in intensive care or deaths. The recommendation in France now is to use SYNAGIS in children aged less than 6 months, born with or GA of less then 32 weeks or aged less than 2 years and presenting a bronchopulmonary dysplasia. Questions remain on the cost-benefit ratio of this treatment and the favourable effects of this treatment in children who carry other chronic pulmonary or cardiac pathologies.

[Lymphocytic alveolitis, chronic viral hepatitis C, lipoproteinosis and cryoglobulinemia in a patient]. / Alvéolite lymphocytaire, hépatite virale chronique C, lipoprotéinose et cryoglobulinémie chez un même patient.

Chronic hepatitis C virus (HCV) infection, lipoproteinosis and cryoglobulinemia may all be associated with lymphocyte alveolitis. The pathogenic mechanisms involved would suggest a compromised immune system. We report the first observation of a patient with lipoproteinosis, cryoglobulinemia and hepatitis C virus infection who developed lymphocyte alveolitis. Taken individually, each of these three disease states could explain cellular modifications observed in the lung, but their association aggravated the clinical course.