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Chronic Obstructive Pulmonary Disease: Official diagnosis and treatment guidelines of the Czech Pneumological and Phthisiological Society; a novel phenotypic approach to COPD with patient-oriented care.

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COPD is a global concern. Currently, several sets of guidelines, statements and strategies to managing COPD exist around the world.

METHODS: The Czech Pneumological and Phthisiological Society (CPPS) has commissioned an Expert group to draft recommended guidelines for the management of stable COPD. Subsequent revisions were further discussed at the National Consensus Conference (NCC). Reviewers' comments contributed to the establishment of the document's final version.

DIAGNOSIS: The hallmark of the novel approach to COPD is the integrated evaluation of the patient's lung functions, symptoms, exacerbations and identifications of clinical phenotype(s). The CPPS defines 6 clinically relevant phenotypes: frequent exacerbator, COPD-asthma overlap, COPD-bronchiectasis overlap, emphysematic phenotype, bronchitic phenotype and pulmonary cachexia phenotype.

TREATMENT: Treatment recommendations can be divided into four steps.

  • 1(st) step = Risk exposure elimination: reduction of smoking and environmental tobacco smoke (ETS), decrease of home and occupational exposure risks.
  • 2(nd) step = Standard treatment: inhaled bronchodilators, regular physical activity, pulmonary rehabilitation, education, inhalation training, comorbidity treatment, vaccination.
  • 3(rd) step = Phenotype-specific therapy: PDE4i, ICS+LABA, LVRS, BVR, AAT augmentation, physiotherapy, mucolytic, ABT.
  • 4(th) step = Care for respiratory insufficiency and terminal COPD: LTOT, lung transplantation, high intensity-NIV and palliative care.

CONCLUSION: Optimal treatment of COPD patients requires an individualised, multidisciplinary approach to the patient's symptoms, clinical phenotypes, needs and wishes. The new Czech COPD guideline reflects and covers these requirements.

European hospital adherence to GOLD recommendations for chronic obstructive pulmonary disease (COPD) exacerbation admissions.

Understanding how European care of chronic obstructive pulmonary disease (COPD) admissions vary against guideline standards provides an opportunity to target appropriate quality improvement interventions.

In 2010-2011 an audit of care against the 2010 'Global initiative for chronic Obstructive Lung Disease' (GOLD) standards was performed in 16 018 patients from 384 hospitals in 13 countries. Clinicians prospectively identified consecutive COPD admissions over a period of 8 weeks, recording clinical care measures on a web-based data tool. Data were analysed comparing adherence to 10 key management recommendations. Adherence varied between hospitals and across countries. The lack of available spirometry results and variable use of oxygen and non-invasive ventilation (NIV) are high impact areas identified for improvement.

Noninvasive ventilation for acute respiratory failure.

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Noninvasive ventilation (NIV) for acute respiratory failure has gained much academic and clinical interest. Despite this, NIV is underutilized. The evidence strongly supports its use in patients presenting with an exacerbation of COPD and in patients with acute cardiogenic pulmonary edema.

As reviewed in this paper, there is now evidence supporting or not supporting the use of NIV in various other presentations of acute respiratory failure. It is important not only to know when to initiate NIV, but also when this therapy is failing. Whether NIV in the setting of acute respiratory failure can be managed appropriately outside the ICU setting is controversial. Although a variety of interfaces are available, the oronasal mask is the best initial interface in terms of leak prevention and patient comfort. Some critical care ventilators have NIV modes that compensate well for leaks, but as a group the ventilators that are designed specifically for NIV have better leak compensation.

NIV should be part of the armamentarium of all clinicians caring from patients with acute respiratory failure.

Bévacizumab en oncologie thoracique : résultats et aspects pratiques

Publication date: June 2013 Source:Revue de Pneumologie Clinique, Volume 69, Issue 3

Author(s): É. Dansin , S. Cousin , G. Lauridant , B. Mennecier

Le bévacizumab (Avastin®) est le premier et le seul anti-angiogénique ayant une indication dans le traitement de première ligne du cancer bronchique non à petites cellules (CBNPC) métastatique. Nous proposons de présenter les résultats du bévacizumab en oncologie thoracique et d’aborder les aspects pratiques de sa prescription. Bevacizumab (Avastin®) is the first antiangiogenic therapy approved in non-small cell lung cancer (NSCLC). It is also currently the only agent in this family approved in NSCLC. This review focuses on results of clinical trials assessing bevacizumab in thoracic oncology. It also provides to clinicians practical advices for its prescription.





Pneumopathie infiltrante diffuse (PID) de la sclérodermie. Analyse de la sémiologie radioclinique et fonctionnelle

Publication date: June 2013 Source:Revue de Pneumologie Clinique, Volume 69, Issue 3

Author(s): W. El Khattabi , H. Afif , N. Moussali , A. Aichane , A. Abdelouafi , Z. Bouayad

La sclérodermie (SD) est une maladie systémique qui touche avec prédilection la peau. La pneumopathie infiltrante diffuse (PID) est rare et apparaît le plus souvent dans l’évolution de la maladie. Nous avons analysé sept cas de PID dans le cadre de la SD recensés entre 2003 et 2010 parmi 196 PID (3,6 %). Les signes fonctionnels respiratoires se résumaient à la dyspnée, celle-ci était associée à la dysphagie dans six cas, à un syndrome sec oculaire dans cinq cas et à un phénomène de Raynaud dans quatre cas. L’examen clinique a retrouvé des râles crépitants basithoraciques bilatéraux dans tous les cas et des signes cutanés spécifiques dans six cas. La radiographie thoracique a montré une atteinte interstitielle prédominant au niveau des bases pulmonaires dans tous les cas avec un aspect de grosses artères pulmonaires dans deux cas. Le scanner thoracique a confirmé la prédominance de l’atteinte basale et périphérique avec des signes de fibrose dans six cas. L’exploration fonctionnelle respiratoire a objectivé un trouble ventilatoire restrictif sévère et une capacité de diffusion du monoxyde de carbone (DLCO) abaissée dans tous les cas. La bronchoscopie a montré un aspect macroscopique normal dans tous les cas, le lavage broncho-alvéolaire était fait d’un liquide à prédominance neutrophile dans quatre cas. Les anticorps anti-SCL 70 étaient positifs dans quatre cas. Tous les patients ont été mis sous corticothérapie avec amélioration de la dyspnée et stabilisation des images scanographiques, une patiente était décédée dans un tableau d’insuffisance respiratoire aiguë et une patiente a été perdue de vue. La PID dans le cas de la sclérodermie est rare et révèle rarement la maladie, elle conditionne le pronostic du patient surtout lorsqu’elle s’associe à une HTAP. Scleroderma (SD) is a systemic disease that predominantly affects the skin. Diffuse infiltrative lung disease (DILD) is rare and occurs most often in the course of the disease. We analyzed seven cases of DILO of SD recorded between 2003 and 2010 among 196 PID (3.6%). Functional signs were limited to respiratory dyspnea, it was associated to dysphagia in six cases, dry syndrome in five cases and Raynaud's phenomenon in four cases. Clinical examination found crackles in the bases of the thorax in all cases and specific cutaneous signs in six cases. The chest radiograph showed that interstitial disease predominates at the lung bases in all cases with a large aspect of the pulmonary arteries in two cases. The chest CT scan confirmed the predominance of basal and peripheral damage with signs of fibrosis in six cases. The pulmonary function objectified a severe restrictive ventilatory defect in all cases. Bronchoscopy showed a normal macroscopic appearance in all cases, the broncho-alveolar lavage was predominated by neutrophilic formula in four cases. SCL 70 antibodies were positive in four cases. All patients were treated by steroids with improvement of dyspnea and stabilization of radiographs. A patient had died in an array of acute respiratory failure and one patient was lost to follow-up. DILD in scleroderma is rare and seldom reveals the disease, it affects the patient's prognosis especially when associated with arterial pulmonary hypertension.





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