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Detection of pathogenic bacteria during rhinovirus infection is associated with increased respiratory symptoms and asthma exacerbations

Background: Detection of either viral or bacterial pathogens is associated with wheezing in children; however, the influence of both bacteria and viruses on illness symptoms has not been described. Objective: We evaluated bacterial detection during the peak rhinovirus season in children with and without asthma to determine whether an association exists between bacterial infection and the severity of rhinovirus-induced illnesses. Methods: Three hundred eight children (166 with asthma and 142 without asthma) aged 4 to 12 years provided 5 consecutive weekly nasal samples during September and scored cold and asthma symptoms daily. Viral diagnostics and quantitative PCR for Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were performed on all nasal samples. Results: Detection rates were 53%, 17%, and 11% for H influenzae, S pneumoniae, and M catarrhalis, respectively, with detection of rhinovirus increasing the risk of detecting bacteria within the same sample (odds ratio [OR], 2.0; 95% CI, 1.4-2.7; P < .0001) or the following week (OR, 1.6; 95% CI, 1.1-2.4; P = .02). In the absence of rhinovirus, S pneumoniae was associated with increased cold symptoms (mean, 2.7 [95% CI, 2.0-3.5] vs 1.8 [95% CI, 1.5-2.2]; P = .006) and moderate asthma exacerbations (18% [95% CI, 12% to 27%] vs 9.2% [95% CI, 6.7% to 12%]; P = .006). In the presence of rhinovirus, S pneumoniae was associated with increased moderate asthma exacerbations (22% [95% CI, 16% to 29%] vs 15% [95% CI, 11% to 20%]; P = .01). Furthermore, M catarrhalis detected alongside rhinovirus increased the likelihood of experiencing cold symptoms, asthma symptoms, or both compared with isolated detection of rhinovirus (OR, 2.0 [95% CI, 1.0-4.1]; P = .04). Regardless of rhinovirus status, H influenzae was not associated with respiratory symptoms. Conclusion: Rhinovirus infection enhances detection of specific bacterial pathogens in children with and without asthma. Furthermore, these findings suggest that M catarrhalis and S pneumoniae contribute to the severity of respiratory tract illnesses, including asthma exacerbations.

The diagnosis and management of acute and chronic urticaria: 2014 update

These parameters were developed by the Joint Task Force on Practice Parameters (JTFPP), representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology.
The AAAAI and ACAAI have jointly accepted responsibility for establishing “The diagnosis and management of acute and chronic urticaria: 2014 update.” This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the JTFPP, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology.The JTFPP understands that the cost of diagnostic tests and therapeutic agents is an important concern that might appropriately influence the work-up and treatment chosen for a given patient. The JTFPP recognizes that the emphasis of our primary recommendations regarding a medication might vary, for example, depending on third-party payer issues and product patent expiration dates. However, because a given test or agent's cost is so widely variable and there is a paucity of pharmacoeconomic data, the JTFPP generally does not consider cost when formulating practice parameter recommendations. In extraordinary circumstances, when the cost/benefit ratio of an intervention is prohibitive, as supported by pharmacoeconomic data, commentary might be provided. These parameters are not designed for use by pharmaceutical companies in drug promotion.The JTFPP is committed to ensuring that the practice parameters are based on the best scientific evidence that is free of commercial bias. To this end, the parameter development process includes multiple layers of rigorous review. These layers include the workgroup convened to draft the parameter, the task force reviewers, and peer review by members of each sponsoring society. Although the task force has the final responsibility for the content of the documents submitted for publication, each reviewer comment will be discussed, and reviewers will receive written responses to comments, when appropriate.To preserve the greatest transparency regarding potential conflicts of interest, all members of the JTFPP and the practice parameter workgroups will complete a standard potential conflict of interest disclosure form, which will be available for external review by the sponsoring organization and any other interested individual. In addition, before confirming the selection of a Work Group chairperson, the Joint Task Force will discuss and resolve all relevant potential conflicts of interest associated with this selection. Finally, all members of parameter workgroups will be provided a written statement regarding the importance of ensuring that the parameter development process is free of commercial bias.Practice parameters are available online at www.jcaai.org and www.allergyparameters.org.

Effects of antioxidant supplements and nutrients on patients with asthma and allergies

Asthma and allergic diseases have become a worldwide public health concern because of their increased prevalence. Despite decades of research on risk factors, the causes of these disorders are poorly understood. They are thought to develop through complex interactions between genetic and environmental factors. Because pulmonary and systemic oxidative stress increase inflammatory responses relevant to asthma and allergy, dietary or vitamin supplementation with antioxidants (a broad and varied category) has been proposed as an approach to reducing asthma incidence or morbidity. Meta-analyses of observational epidemiologic studies of variable methodological quality suggest associations of relatively low dietary intake of antioxidants and higher asthma and allergy prevalence. However, there have been few longitudinal studies of maternal or child dietary or vitamin/supplement antioxidant intake and asthma/allergy development. Moreover, there are no clinical trial data to support the use of dietary antioxidants or supplements to prevent asthma or allergy. A few small clinical trials suggest that specific antioxidants from diet or vitamin supplements might improve asthma control or lung function in asthmatic children or adults. Studies suggest that responses to antioxidants might be modified by life stage, genetic susceptibility, and environmental sources of oxidative stress. Large trials of antioxidant vitamin supplementation to prevent cancer suggest an increase in overall mortality with antioxidant vitamin supplementation, at least in populations with sufficient dietary antioxidant intake. This cautionary experience suggests that future trials to assess whether antioxidants reduce asthma incidence or improve asthma control should focus on supplementation of dietary sources of antioxidants. The potential benefits and risks of trials of vitamin supplements might be considered in special situations in which vulnerable populations have marked deficiency in dietary antioxidants, poor access to dietary antioxidants, and high exposure to environmental sources of oxidants.

Traitements néoadjuvants : évaluation d’une pratique couramment indiquée en RCP

Publication date: February–April 2014 Source:Revue de Pneumologie Clinique, Volume 70, Issues 1–2

Author(s): P. Mordant , É. Fabre , L. Gibault , A. Arame , C. Pricopi , A. Dujon , F. Le Pimpec-Barthes , M. Riquet

La prise en charge du cancer bronchique non à petites cellules (CBNPC) a évolué vers un recours croissant aux traitements néoadjuvants, que le cancer soit localisé, envahisse les structures contiguës, ou présente une atteinte lymphatique médiastinale. Cependant, les conséquences respectives de la chimiothérapie et de la radiochimiothérapie préopératoire restent débattues. Méthode Nous avons mené une étude rétrospective incluant tous les patients opérés d’un CBNPC dans deux centres français entre 1980 et 2009. Nous avons comparé l’histologie et la survie des patients en fonction de la nature de leur traitement néoadjuvant, chimiothérapie (groupe CT, n =733) ou radiochimiothérapie (groupe RCT, n =126). Résultats Dans le groupe CT, 669 patients (91 %) ont bénéficié d’une chimiothérapie comprenant un sel de platine, pour 2 à 3 cycles dans 564 cas (77 %). Dans le groupe RCT, la radiochimiothérapie était concomitante chez 68 patients (54 %), et séquentielle chez 58 patients (46 %). Par comparaison avec le groupe CT, le groupe RCT était caractérisé par un âge plus jeune (59,8±9,5 vs 56,4±9,6, p &lt;0,001), plus de tumeurs jugées initialement non résécables (25 % vs 44 %, p &lt;0,001), plus de cT4 (25 % vs 44 %, p &lt;0,001) et de cN2 (56 % vs 69 %, p =0,005). Le type de résection, les suites postopératoires et la mortalité postopératoire étaient similaires. Par comparaison avec le groupe CT, le groupe RCT était caractérisé par plus de pN0-pN1 (N0 : 43 % vs 58 %, p =0,002 ; N1 : 22 % vs 10 %, p =0,002) alors que le taux de pN2 était identique (34 % vs 32 %, p =ns). Les survies médianes à 5ans et à 10ans étaient estimées à 28 mois, 35 %, et 21 % pour le groupe CT, et 29 mois, 36 %, et 23 % pour le groupe RCT (p =ns). Conclusion Dans cette série rétrospective, par comparaison avec la chimiothérapie, les traitements néoadjuvants par radiochimiothérapie ont été réservés à des patients présentant des tumeurs plus avancées, et ont été associés à un meilleur downstaging, des suites similaires, et une survie à long terme identique après résection d’un CBNPC. The management of localized non-small cell lung cancer (NSCLC) has been modified over the last decades, with induction therapies being increasingly recommended as a prerequisite to surgical resection. However, the relative impact of chemo- and chemoradiotherapy on tumours’ pathology and patients’ survival is still discussed. Methods We set a retrospective study including every patient who underwent surgical resection for NSCLC in 2 French centres from 1980 to 2009. We then compared the tumours’ pathology and patients’ survival according to the use of induction chemotherapy (group 1) or induction chemoradiotherapy (group 2). Results There were 733 patients in group 1 and 126 patients in group 2. In group 1, 669 patients (91%) had platinum-based chemotherapy, for 2 to 3 cycles in 564 cases (77%). In group 2, chemoradiotheray was concomitant in 68 patients (54%), and sequential in 58 patients (46%). As compared with group 1, group 2 was characterized by younger age (mean 59.8±9.5 vs 56.4±9.6, respectively, P &lt;.001), a higher rate of tumours deemed unresectable before induction treatment (25% vs 44%, P &lt;.001), and a higher proportion of T4 (25% vs 44%, P &lt;.001) or N2 diseases (56% vs 69%, P =.005). The type of resection, postoperative complications, and postoperative mortality were not significantly different between groups. On final pathologic report, as compared with group 1, there were more N0 and N1 disease in group 2 (N0: 43% vs 58%, P =.002; N1: 22% vs 10%, P =.002) while the rate of N2 disease was comparable (34% vs 32%, P =ns). The median, 5-, and 10-year survivals were 28 months, 35%, and 21% for group 1, and 29 months, 36%, and 23% for group 2, respectively (P =ns). Conclusion As compared with induction chemotherapy, induction chemoradiotherapy was performed in more advanced NSCLC, and resulted in better downstaging, similar postoperative course, and comparable long-term outcome after surgical resection.





Tumeurs carcinoïdes typiques du poumon : évolution, critères de malignité et indications du curage ganglionnaire

Publication date: February–April 2014 Source:Revue de Pneumologie Clinique, Volume 70, Issues 1–2

Author(s): P. Bagan , J.C. Das-Neves-Pereira , C. Rivera , L. Gibault , A. Badia , P. Mordant , M. Riquet , F. Le Pimpec Barthes

Les carcinoïdes typiques bronchopulmonaires sont souvent considérés comme des néoplasies non-métastatiques. L’apparition de métastases est observée dans 10 % des cas. Nous détaillons ici les études basées sur l’identification des facteurs de risques de survenue de métastases afin d’adapter le traitement chirurgical et le curage ganglionnaire au risque individuel de chaque patient. The bronchopulmonary typical carcinoid tumors are often considered as non-metastatic neoplasia. The appearance of metastases is observed in 10% of the cases. We detail here studies based on the identification of the risk factors of metastases occurrence to adapt the lung surgery and lymph node dissection to the individual patient risk.





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