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Hôpital-Camfrout, France

Bateman E.D.,University of Cape Town | Bousquet J.,Service des Maladies Respiratoires | Aubier M.,Service de Pneumologie Allergologie | Bredenbroker D.,Takeda Pharmaceuticals International GmbH | O'Byrne P.M.,McMaster University
Pulmonary Pharmacology and Therapeutics | Year: 2015

Background: Roflumilast, a phosphodiesterase-4 inhibitor, has an established place in the treatment of chronic obstructive pulmonary disease. Its potential role as a treatment for asthma is unclear. Aim: We report the results from seven double-blind, parallel group, phase II or III studies designed to compare roflumilast with two anti-inflammatory treatments, beclomethasone dipropionate (BDP) and montelukast, in patients with asthma. Methods: The studies of 6-12 week duration were conducted at 309 sites in Europe, North America, South Africa and Australia from 1998 to 2005. Data from 3802 patients, aged 12-70 years who received either roflumilast 100 μg, 250 μg or 500 μg once daily, BDP 400 μg or 500 μg twice daily, or 10 mg montelukast once daily was analyzed. Primary endpoints were mean change and time averaged excess area under the curve in forced expiratory volume in one second (FEV1) over the duration of the study. Secondary endpoints included change in forced vital capacity and peak expiratory flow, asthma symptoms and the concomitant use of rescue medication. Results: Roflumilast was non-inferior to BDP and montelukast and consistently increased FEV1. Use of rescue medication and all asthma symptom scores decreased significantly with all treatments, but no statistically significant between-group differences were observed. Secondary lung function endpoints generally supported the conclusions of the primary outcome measure. Conclusions: Roflumilast improves FEV1 and asthma symptoms in patients with mild to moderate asthma, and is non-inferior compared with both BDP and montelukast. It deserves further study as a potentially effective anti-inflammatory treatment for asthma. © 2015 .

Fillaux J.,Service de Parasitologie mycologie | Fillaux J.,University Paul Sabatier | Bremont F.,Service de Pneumologie Allergologie | Cassaing S.,Service de Parasitologie mycologie | And 4 more authors.
Pediatric Infectious Disease Journal | Year: 2014

BACKGROUND: Aspergillus fumigatus (Af) sensitization and persistent carriage are deleterious to lung function, but no consensus has been reached defining these medical entities. This work aimed to identify possible predictive factors for patients who become sensitized to Af, compared with a control group of non-sensitized Af carriers. METHODS: Between 1995 and 2007, 117 pediatric patients were evaluated. Demographic data, CFTR gene mutations, body mass index and FEV1 were recorded. The presence of Af in sputum, the levels of Af-precipitin, total IgE (t-IgE) and specific IgE to Af (Af-IgE) were determined. Patients were divided into 2 groups: (1) "sensitization": level of Af-IgE > 0.35 IU/mL with t-IgE level < 500 IU/mL and (2) "persistent or transient carriage": Af-IgE level ≤ 0.35 IU/mL with either an Af transient or persistent positive culture. A survival analysis was performed with the appearance of Af-IgE in serum as an outcome variable. RESULTS: Severe mutation (hazard ratio = 3.2), FEV1 baseline over 70% of theoretical value (hazard ratio = 4.9), absence of Pa colonization, catalase activity and previous azithromycin administration (hazard ratio = 9.8, 4.1 and 1.9, respectively) were predictive factors for sensitization. We propose a timeline of the biological events and a tree diagram for risk calculation. CONCLUSIONS: Two profiles of cystic fibrosis patients can be envisaged: (1) patients with nonsevere mutation but low FEV1 baselines are becoming colonized with Af or (2) patients with high FEV1 baselines who present with severe mutation are more susceptible to the Af sensitization and then to the presentation of an allergic bronchopulmonary aspergillosis event. Copyright © 2013 by Lippincott Williams & Wilkins.

While secondary reactions to antituberculosis drugs are frequent, IgE-dependent allergic reactions are rare. The sensitivity and specificity of skin tests for the diagnosis of these reactions have not been evaluated, and positive skin tests reported in some studies were false positives. Here we report four clinical cases who presented with immediate cutaneous reactions after taking Rifater®, the results of their skin tests and management of this allergy through oral desensitization. Rifampycin, a component of Rifater®, was implicated as the cause of the reaction based on positive skin tests with a 1/10,000 dilution (containing 0.006 mg/ml) of that drug. Successful oral desensitization allowed the drug to be continued. © 2009 Elsevier Masson SAS. All rights reserved.

Louzir B.,Service de Pneumologie Allergologie
La Tunisie médicale | Year: 2012

Pulmonary embolism (PE) is a fairly common condition that can be fatal. The variability of presentation sets clinician up for potentially missing the diagnosis. Routine laboratory findings are nonspecific and are not helpful in diagnosis of PE.Diagnosis is based on clinical prediction rule in combination with laboratory tests such as the D-dimers test leading to the realization ofa confirming examination. To precise the confirming examinations of PE and propose analgorithm based on clinical prediction rules in combination with D-Dimers. A Pub Med search was conducted using the following keywords: pulmonary embolism,computed tomogramphy pulmonary angiography, scintigraphy and D Dimer. The study was based on are view of 18 studies including meta analysis, reviews and original articles referring recent strategy diagnosis of pulmonary embolism. Ventilation/perfusion scan is a type of examination that is used less often because it is not a widespread technology. However,it may be useful in patients who have an allergy to iodinated contrast.Ultrasonography of the legs, also known as leg doppler, in search of deep venous thrombosis (DVT) may help the diagnosis approach particularly when other exams are not available or contraindicated.This may be a valid approach in pregnancy. The gold standard for diagnosing PE is pulmonary angiography. It is used less often due to wider acceptance of multi detector CT scans, which are non-invasive.A normal ventilation/perfusion scan rules out the diagnosis of PE with negative predictive value of 97%. There is no consensus in pregnancy. Finally, the MRI has a low and insufficient sensibility to diagnose PE.Conclusion: D Dimers, multidetector CT, ventilation/ perfusion scintigraphy and ultrasonography of the legs are the most useful examinations to diagnose PE. Many algorithms were established depends on medical experience and examination availability

Duysinx B.,Service de Pneumologie Allergologie
Revue des Maladies Respiratoires Actualites | Year: 2013

The PET scanner has its place in the pleura imaging: it can be used in the diagnose of benign and malignant pleural diseases (threshold SUV. = 2.2). It improves the staging of mesothelioma including good efficiency on mediastinal lymph node. It can also be used in therapeutic response and to guide pleural biopsies.So, far from replacing the pleuroscopy, PET scanner fits into the process of exploration of pleural disease and can avoid invasive diagnostic exams. © 2013 Elsevier Masson SAS.

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