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L'essentiel de la littérature réçente en Pneumologie

Dans cette rubrique on vous propose une revue de la littérature à travers une sélection d'abstracts d'articles originaux.
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Opioids and adverse outcomes in elderly chronic obstructive pulmonary disease patients Imprimer Envoyer
Dimanche, 01 Janvier 2017 08:36

We thank D. Viglino and M. Maignan for their interest in our manuscript [1] and for their insightful comments. They raise a valid point that our mortality results may have been influenced by the potentially confounding effects of palliative care receipt on or following the index date. While we excluded individuals receiving palliative care in the year prior to the index date, we did not do so on or after the index date for practical methodological reasons. However, several points should be considered. First, Viglino and Maignan write that the decision to palliate in chronic obstructive pulmonary disease (COPD) often arises in the context of an acute respiratory exacerbation. Our propensity score model included whether or not a recent acute respiratory exacerbation occurred in the 30 days prior to the index date, and opioid users and nonusers were well balanced on that variable after propensity score weighting [1]. Second, increased respiratory-related and all-cause mortality were found not only among users of opioid-only agents but also among users of combination opioid/nonopioid formulations [1]. Opioids combined with paracetamol or aspirin are unlikely to be used for purposes of palliation and such agents represent ~90% of incident opioid use among older adults with COPD [2]. Third, while the possible residual inclusion of individuals receiving palliative care among opioid users may potentially explain the finding of increased mortality, this would be unlikely to explain why risks of outpatient respiratory exacerbations and emergency visits for COPD or pneumonia were also greater among opioid users. If there was residual inclusion of individuals with recent end-of-life decisions among opioid users in our study, this would have been likely to bias the intensive care admission outcome towards being significantly decreased among opioid users, and not rendered a nonsignificant association, as Viglino and Maignan propose.

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Management of children with interstitial lung diseases: the difficult issue of acute exacerbations Imprimer Envoyer
Dimanche, 01 Janvier 2017 08:36

Interstitial lung disease (ILD) in children (chILD) is an umbrella term for a wide spectrum of rare diseases affecting the lung parenchyma, the causes of which often remain undetermined. These diffuse lung disorders are chronic, and often have high morbidity and mortality [1–3]. The epidemiology of the various forms of chILD is difficult to establish. Extrapolations from small studies have suggested an approximate incidence of 0.5–0.8 cases per 100 000 children [4, 5] However, this is certainly an underestimation due to the lack of standardised definitions, the inadequacy of organised reporting systems, and the variety of pathological conditions. In addition, clinical presentation is often nonspecific, contributing to a poor recognition of these disorders and confusion with other chronic pulmonary diseases. Insufficient disease-specific knowledge creates particular challenges for medical professionals, caregivers and chILD patients. Within the international community of clinicians and researchers involved in paediatric parenchymal lung diseases, the need for multicentre collaborations has resulted in the formation of networks of expertise to improve and harmonise approaches to diagnosis and management of the various forms of chILD. In this context, the present article reports expert opinions on the definition and diagnosis of acute exacerbations, which are major unpredictable deleterious episodes of acute worsening with significant morbidity that punctuate disease course.

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Smoke-free legislation has potential to reduce the harmful effects of tobacco smoke exposure Imprimer Envoyer
Dimanche, 01 Janvier 2017 08:36

T. Faber and colleagues correctly note that the implementation of smoke-free legislation has great potential to reduce the harmful effects of tobacco smoke exposure in children. A smoke-free environment represents P in the MPOWER programme developed by the World Health Organization (WHO) framework convention on tobacco control which aims to control the tobacco epidemic [1]. The acronym MPOWER stands for M: monitor tobacco use and prevention policies; P: protect people from tobacco smoke; O: offer help to quit tobacco smoking; W: warn about the dangers of tobacco; E: enforce bans on tobacco advertising, promotion and sponsorship; and R: raise taxes on tobacco [1]. Data from the WHO shows that in 2015 only 49 countries, with nearly 20% of the world's population, implemented completely policies for a smoke-free environment, thus showing that it is not easy to establish legislative smoking bans in national or even regional settings. Moreover, evidence regarding the effectiveness of legislative smoking bans in public places for reducing harm from second-hand smoke (SHS) exposure is inconclusive. That fact that studies are limited to the nonrandomised controlled trials available in some countries [2] means that more robust evidence is warranted to evaluate the impact of legislation prohibiting smoking in public places, particularly in developing countries. However, it does not mean that it is impossible to conduct such studies-it is possible as long the countries in question have the intention to change! On a different note, raising taxes on cigarettes and other tobacco products shows a reduction in the number of smokers in some countries, including China and France, although more evidence is needed [1]. Lastly, regardless of which programme is most successful in reducing the harmful effects of tobacco, people should realise that protecting pregnant women and children from the harmful effects of SHS exposure is crucial!

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