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EFFECT OF SPIROMETRY AND MEDICAL REVIEW ON ASTHMA CONTROL IN PATIENTS IN GENERAL PRACTICE : A randomised controlled trial

Conclusions:  Regular spirometry with medical review was associated with improved asthma control in general practice patients, while there was less improvement in either the spirometry only or usual care group. The mechanisms of this improvement may include appropriate adjustment of medication and improved compliance. (Source: Respirology)

Factors Associated with Medication Adherence in Patients with Chronic Obstructive Pulmonary Disease

Predictors of medication adherence are not well known in chronic obstructive pulmonary disease (COPD). It is therefore necessary to identify factors associated with adherence to improve the effectiveness of COPD management within real-world situations.

Objectives: The goals of this study were to estimate adherence to respiratory medication and to identify factors related to adherence in COPD patients.

Methods: This was an observational, cross-sectional study conducted on a sample of COPD outpatients. The following information was obtained: adherence to respiratory therapy (Morisky Medication Adherence Scale), age, gender, smoking status, COPD severity [Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage], lung function [post-bronchodilator forced expiratory volume in 1 s (FEV1)], treatment regimen for COPD, COPD medication costs per month paid by the patient and health-related quality of life (EuroQol 5-dimension questionnaire). A multivariate logistic regression analysis was performed to identify the independent predictors of adherence.

Results: Of the 170 participants (mean age 63.8 years, 41.8% male), 58.2% reported optimal adherence. Adherence to respiratory therapy was associated with age, current smoking status, number of respiratory drugs, number of daily respiratory drug doses and quality of life (p < 0.005). Adherence to respiratory therapy was not related to gender, GOLD stage, FEV1 or COPD medication costs.

Conclusions: Adherence to COPD medication regimens is poor. Less frequent dosing regimens could be an effective method to enhance adherence to respiratory therapy. Quality-of-life monitoring within clinical practice settings could facilitate improved medication adherence.

Management of Parapneumonic Effusion and Empyema: Medical Thoracoscopy and Surgical Approach

Parapneumonic effusions or empyemas are frequently seen in patients with lower respiratory tract infections. The condition is associated with significant morbidity and mortality. Since Gram stains and bacterial cultures are usually negative, treatment focuses on empiric antibiotic treatment and chest tube drainage.

The role of intrapleural fibrinolytics is still a matter of debate. Medical thoracoscopy is a simple and effective therapeutic alternative associated with better outcome and fewer complications than conservative treatment. Furthermore, it can be performed in analgo-sedation in a bronchoscopy suite. Video-assisted thoracic surgery carries the advantage of providing optimal visibility of the pleural cavity, thus allowing better debridement.

Thoracotomy is the treatment of choice when thoracoscopic cleaning is not satisfactory.

Les toux sèches aiguës ont des conséquences sous-estimées sur la vie quotidienne des patients

Publication year: 2011
Source: Revue de Pneumologie Clinique, In Press, Corrected Proof, Available online 17 March 2011

P., Zuck , F.A., Allaert

 Objectif: Décrire les caractéristiques cliniques des toux sèches, leurs conséquences socioprofessionnelles et sur la qualité de vie des patients. Méthode: Étude observationnelle transversale conduite en pratique quotidienne de médecine générale. Résultats: Mille six cent cinq patients âgés de 43ans, du sexe masculin pour 52,2 %, ont été inclus dans l’étude. Une irritation pharyngée était présente chez 95,4 % des patients, une asthénie chez 90,2 %, des céphalées chez 78,3 %, des douleurs musculaires chez 75,8 %, une dysphonie chez 42,3 %, une altération de l’état général chez 23,1 %, une dysphagie chez 19,8 %, et une dyspnée chez 17,4 %. Un syndrome infectieux constituait l’origine probable de la toux de 48,3 % des patients. La...

Les acariens domestiques et leurs allergènes

Publication year: 2011
Source: Revue des Maladies Respiratoires, In Press, Corrected Proof, Available online 24 March 2011

J.-C., Bessot , G., Pauli

 Introduction: Les acariens de la famille des Pyroglyphidae sont la plus importante source des allergènes des acariens. Depuis 1988, leurs connaissances moléculaires se sont considérablement enrichies, leurs structures et leurs fonctions ont pu être précisées pour la majorité d’entre eux. État des connaissances: Vingt-deux allergènes ont été identifiés. Les groupes 1 et 2 ont une homologie de séquence en AA de 85 % et sont des allergènes majeurs. Les groupes 4, 5, 7, 11, 14 et 15 sont également des groupes importants. La liaison aux IgE des groupes 3, 8, 10, 20 est faible. Les groupes 1, 2, 3 ont un polymorphisme élevé. Nombre d’allergènes ont une fonction biochimique : cystéine...

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