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Oxygénothérapie de longue durée en France, 2006–2011

Objectifs L’objectif était de décrire les caractéristiques des personnes prises en charge par oxygénothérapie de longue durée (OLD) et l’évolution entre 2006 et 2011 de la prévalence et de l’incidence.

Méthodes Les données sont issues de l’échantillon généraliste des bénéficiaires qui couvre 1/97e des bénéficiaires de l’Assurance Maladie. L’analyse a porté sur les adultes assurés du régime général ayant eu au moins un remboursement de prestation d’OLD.

Résultats En 2011, 2,6‰ des adultes bénéficiaient d’une OLD, soit environ 135 000 personnes. L’incidence était de 0,9‰. L’OLD seule représentait 70 % des forfaits hebdomadaires, l’OLD associée à une ventilation assistée 23 %, l’OLD associée à une pression positive continue 7 %. Environ 45 % des personnes étaient prises en charge en affection longue durée pour insuffisance respiratoire chronique grave. Entre 2006 et 2011, la prévalence ajustée sur l’âge a augmenté de 2,9 % par an en moyenne chez les hommes, et 6,7 % par an chez les femmes. L’incidence était stable chez les hommes (+1,6 %/an, p =0,45) et a augmenté chez les femmes (+4,7 %/an, p =0,04). La médiane de survie était de 27 mois.

Conclusion Cette analyse des données de l’Assurance Maladie montre le poids croissant des prises en charge pour OLD en France.

Objective The study aimed to describe the main characteristics of people treated with long-term oxygen therapy (LTOT) and the trends between 2006 and 2011 for prevalence and incidence.

Methods Data were provided from a sample comprising 1/97 of the permanent beneficiaries of the French health insurance. The sample contains anonymous socio-demographic characteristics and data on health care reimbursements. The analyses were carried out among adults aged 20 years and above who had received benefits on account of LTOT.

Results In 2011, 2.6% of adults were treated with LTOT, corresponding to around 135,000 people. The crude incidence rate was 0.9‰. The prescription of LTOT included LTOT alone (70%), LTOT associated with assisted ventilation (23%) and LTOT associated with continuous positive airway pressure (7%). About 45% of the patients were supported financially in the long-term illness program of the French Social Security because of severe chronic respiratory failure. Between 2006 and 2011, the age-adjusted prevalence rates increased by 2.9% per year in men and by 6.7% per year in women. The age-adjusted incidence rates remained stable in men (+1.6% per year, P =0.45) but increased in women (+4.7% per year, P =0.04). The median survival was 27 months.

Conclusion This analysis of the data demonstrates an increasing burden associated with LTOT in France from 2006 to 2011.

Diagnostic du déficit en alpha-1-antitrypsine : les moyens, les indications et la stratégie diagnostique

Le déficit en alpha-1-antitrypsine (α1-AT) est une maladie génétique autosomique récessive dont les manifestations cliniques majeures sont principalement l’emphysème pulmonaire et la cirrhose hépatique. Malgré les recommandations de l’American Thoracic Society et de l’European Respiratory Society, le déficit en α1-AT reste encore sous-diagnostiqué. Enrayer ce sous-diagnostic passe par la mise en place d’une démarche diagnostique adaptée et efficace.

L’α1-AT, glycoprotéine de masse moléculaire 52kDa, de synthèse essentiellement hépatique, est présente dans le plasma humain à une concentration de 0,9 à 2g/L (17 à 39μmol/L). Il existe, pour cette antiprotéase, un polymorphisme génétique important : plus de 100 allèles sont caractérisés à ce jour. L’exploration des déficits en α1-AT fait appel, en première intention, au dosage pondéral de l’α1-AT circulante, éventuellement complété par la mesure de l’activité antiélastasique sérique. Si un déficit pondéral ou fonctionnel est détecté, deux démarches complémentaires peuvent être envisagées : la détermination du phénotype d’α1-AT par isoélectrofocalisation qui permet d’identifier les variants normaux PI M mais aussi un certain nombre de variants déficitaires, dont les plus fréquents, PI S et PI Z, ou le génotypage par PCR allèle-spécifique qui permet de caractériser les allèles déficitaires PI S et PI Z. Le recours au séquençage complet des exons codants du gène SERPINA1 se justifie pour l’identification précise des allèles déficitaires rares et des allèles qualifiés de Null.

Alpha-1-antitrypsin (A1AT) deficiency is an autosomal recessive genetic disorder, which predisposes affected patients to development of pulmonary emphysema or liver cirrhosis.

Despite the guidelines from the American Thoracic Society and the European Respiratory Society about A1AT deficiency screening, it remains significantly under recognized. So, it seems necessary to propose an efficient and suitable biological approach to improve diagnosis and management of A1AT deficiency.

A1AT is a 52kDa glycoprotein predominantly produced in the liver and its physiological serum concentration for adults’ ranges from 0.9 to 2.0g/L (17 to 39μmol/L). It is encoded by the SERPINA1 gene, which is highly pleomorphic and to date, more than 100 alleles have been identified. A1AT testing would initially involve quantification of serum A1AT concentration with possible complementary measurement of the elastase inhibitory capacity of serum. If the serum A1AT concentration is reduced below the reference value, two strategies for laboratory testing can be used: (i) serum A1AT phenotyping by isoelectric focusing which allows identification of the most common variant designated as the PI M variant but also of various deficient variants besides the predominant PI S and PI Z ones, (ii) genotyping by allele-specific PCR methods which allows only identification of the deficient PI S and PI Z allele.

Identification of the Null alleles or of other rare deficient alleles can be performed by direct sequencing of the whole SERPINA1 gene as a reflex test.

Cannabis et cancer bronchique

Le cannabis est la substance psychoactive illicite la plus fumée dans le monde. S’il peut être consommé seul sous forme d’herbe (marijuana), il est pour l’essentiel fumé mélangé à du tabac.

L’usage associé de tabac et de cannabis est un phénomène devenu banal dans notre société ; il est pourtant responsable de dommages respiratoires sévères. Le rôle propre du cannabis est difficile à distinguer de celui du tabac et à évaluer avec précision. La fumée de cannabis contient une concentration en hydrocarbures aromatiques polycycliques et en carcinogènes plus importante que celle du tabac. Des études cellulaires et tissulaires, chez l’animal et chez l’homme, ainsi que des études épidémiologiques, ont mis en évidence qu’elle était un facteur de risque de cancer bronchique.

L’exposition à la fumée de marijuana multiplie, au moins par deux, le risque de développer un cancer bronchique. Cela doit encourager les praticiens à identifier la consommation de cannabis et à proposer aux consommateurs des prises en charge de sevrage.

Cannabis is the most commonly smoked illicit substance in the world. It can be smoked alone in plant form (marijuana) but it is mainly smoked mixed with tobacco. The combined smoking of cannabis and tobacco is a common-place phenomenon in our society. However, its use is responsible for severe pulmonary consequences.

The specific impact of smoking cannabis is difficult to assess precisely and to distinguish from the effect of tobacco. Marijuana smoke contains polycyclic aromatic hydrocarbons and carcinogens at higher concentration than tobacco smoke. Cellular, tissue, animal and human studies, and also epidemiological studies, show that marijuana smoke is a risk factor for lung cancer.

Cannabis exposure doubles the risk of developing lung cancer. This should encourage clinicians to identify cannabis use and to offer patients support in quitting.

Transbronchial needle aspiration cytology (TBNA) in endobronchial lesions: a valuable technique during bronchoscopy in diagnosing lung cancer and it will decrease repeat bronchoscopy.

Related Articles

Transbronchial needle aspiration cytology (TBNA) in endobronchial lesions: a valuable technique during bronchoscopy in diagnosing lung cancer and it will decrease repeat bronchoscopy.

J Cancer Res Clin Oncol. 2014 Feb 16;

Authors: Shital P, Rujuta A, Sanjay M

Abstract
BACKGROUND: Lung cancer is the leading cause of cancer deaths around the world. Globally, lung cancer is the largest contributor to new cancer diagnosis and to death from cancer. Various conventional diagnostic techniques (CDTs) such as endobronchial forcep biopsy (FB), bronchial washing (BW) and bronchial brushing (BB), and transbronchial needle aspiration cytology (TBNA) are employed during fiber-optic bronchoscopy.
METHODS: This is a prospective study conducted between June 2012 and September 2013 at Bronchoscopy unit of MIMSR Medical College Latur, India, to find the role of TBNA in exophytic endobronchial lesions in confirming the diagnosis of lung cancer and to find additive yield over other techniques such as BB, BW and FB, and included 150 patients on the basis of clinical and radiological features of malignancy. In exophytic endobronchial lesions, predominant endoscopic findings were cauliflower, polypoidal-like or nodular or multinodular endobronchial growth. TBNA, FB, BB and BW were performed in all the cases during FOB. Histopathological and cytological examinations of specimens were performed at Pathology department. The statistical analysis was done using chi-square test.
RESULTS: Total 150 patients, between age group 24-80 years, mean age was 57.93 years, male population constitutes 86.17 % of total. 76.14 % cases were smoker of them 61.87 % cases having history of >40 pack years. Commoner symptoms were cough (91.33 %), hemoptysis (54.00 %) and chest pain (46.66 %), and mass lesion (40.66 %), hilar opacity (31.33 %) and collapse segmental/lobar (29.33 %) were commoner radiological abnormalities. Yield of TBNA, CDT and TBNA plus CDT in exophytic lesions is 60.66, 79.33 and 84.66 %, respectively, in diagnosis of lung malignancies (P < 0.001). Sensitivity of forcep biopsy and TBNA in diagnosing lung malignancy was 88.18 and 71.65 %, respectively (P < 0.01). FOB-related hypoxemia documented in two cases and minor bleeding in six cases. Other complications such as significant bleeding, pneumothorax and death were not seen. Minor bleeding was seen with forcep biopsy mainly in 4.0 % cases. TBNA has decreased repeat procedure, decreases cost for diagnosis. IHC on TBNA specimens had increased histological-type confirmation.
CONCLUSION: Transbronchial needle aspiration is a beneficial, safe and minimally invasive bronchoscopic technique with insignificant side effect in the diagnosis bronchogenic carcinoma. TBNA considered safe, especially when fleshy vascular endobronchial growth is present and risk of bleeding is high with forcep biopsy. Inadequate tissue sampling due to the presence of necrosis, blood clot over the lesion and formation of crush artifacts by FB makes TBNA valuable in these lesions. TBNA will definitely decrease need for repeat bronchoscopy.

PMID: 24531973 [PubMed - as supplied by publisher]

Network Meta-Analysis of Erlotinib, Gefitinib, Afatinib and Icotinib in Patients with Advanced Non-Small-Cell Lung Cancer Harboring EGFR Mutations.

Related Articles

Network Meta-Analysis of Erlotinib, Gefitinib, Afatinib and Icotinib in Patients with Advanced Non-Small-Cell Lung Cancer Harboring EGFR Mutations.

PLoS One. 2014;9(2):e85245

Authors: Liang W, Wu X, Fang W, Zhao Y, Yang Y, Hu Z, Xue C, Zhang J, Zhang J, Ma Y, Zhou T, Yan Y, Hou X, Qin T, Dinglin X, Tian Y, Huang P, Huang Y, Zhao H, Zhang L

Abstract
BACKGROUND: Several EGFR-tyrosine kinase inhibitors (EGFR-TKIs) including erlotinib, gefitinib, afatinib and icotinib are currently available as treatment for patients with advanced non-small-cell lung cancer (NSCLC) who harbor EGFR mutations. However, no head to head trials between these TKIs in mutated populations have been reported, which provides room for indirect and integrated comparisons.
METHODS: We searched electronic databases for eligible literatures. Pooled data on objective response rate (ORR), progression free survival (PFS), overall survival (OS) were calculated. Appropriate networks for different outcomes were established to incorporate all evidences. Multiple-treatments comparisons (MTCs) based on Bayesian network integrated the efficacy and specific toxicities of all included treatments.
RESULTS: Twelve phase III RCTs that investigated EGFR-TKIs involving 1821 participants with EGFR mutation were included. For mutant patients, the weighted pooled ORR and 1-year PFS of EGFR-TKIs were significant superior to that of standard chemotherapy (ORR: 66.6% vs. 30.9%, OR 5.46, 95%CI 3.59 to 8.30, P<0.00001; 1-year PFS: 42.9% vs. 9.7%, OR 7.83, 95%CI 4.50 to 13.61; P<0.00001) through direct meta-analysis. In the network meta-analyses, no statistically significant differences in efficacy were found between these four TKIs with respect to all outcome measures. Trend analyses of rank probabilities revealed that the cumulative probabilities of being the most efficacious treatments were (ORR, 1-year PFS, 1-year OS, 2-year OS): erlotinib (51%, 38%, 14%, 19%), gefitinib (1%, 6%, 5%, 16%), afatinib (29%, 27%, 30%, 27%) and icotinib (19%, 29%, NA, NA), respectively. However, afatinib and erlotinib showed significant severer rash and diarrhea compared with gefitinib and icotinib.
CONCLUSIONS: The current study indicated that erlotinib, gefitinib, afatinib and icotinib shared equivalent efficacy but presented different efficacy-toxicity pattern for EGFR-mutated patients. Erlotinib and afatinib revealed potentially better efficacy but significant higher toxicities compared with gefitinib and icotinib.

PMID: 24533047 [PubMed - in process]

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