M. Fayon

Add-on omalizumab in children with severe allergic asthma: a 1-year real life survey

Omalizumab has been shown to reduce exacerbation rates in moderate to severe allergic asthma. Our aim was to evaluate omalizumab efficacy and safety in a real-life setting in severe asthmatic children. 104 children (aged 6–18 years), followed up in paediatric pulmonary tertiary care centres, were included at the beginning of omalizumab treatment. Asthma control levels, exacerbations, inhaled corticosteroid dose, lung function and adverse events were evaluated over 1 year. Children were characterised by allergic sensitisation to three or more allergens (66%), high IgE levels (mean 1125 kU·L−1), high rate of exacerbations (4.4 per year) and healthcare use during the previous year, and high inhaled corticosteroid dose (mean 703 &mgr;g equivalent fluticasone per day). Asthma control levels defined as good, partial or poor, improved from 0%, 18% and 82% at entry to 53%, 30% and 17% at week 20, and to 67%, 25% and 8% at week 52, respectively (p<0.0001). Exacerbation and hospitalisation rates dropped by 72% and 88.5%, respectively. At 12 months, forced expiratory volume in 1 s improved by 4.9% (p=0.023), and inhaled corticosteroid dose decreased by 30% (p<0.001). Six patients stopped omalizumab for related significant adverse events. Omalizumab improved asthma control in children with severe allergic asthma and was generally well tolerated. The observed benefit was greater than that reported in clinical trials. Omalizumab improves asthma control in children with severe allergic asthma and is generally well tolerated http://ow.ly/oLoBp

La fibroscopie bronchique chez l’enfant: Expertise des centres français de pneumologie pédiatrique

INTRODUCTION Fibreoptic bronchoscopy (FB) is an important diagnostic examination in paediatric pulmonology. In 2002 the Paediatric Pulmonology and Allergy Club undertook a retrospective study to establish the current status of fibreoptic bronchoscopy among its members. METHODS In 2001 sixty five paediatric pulmonologists carried out an average of 116 examinations (+/- 111) in 35 paediatric centres. FB was performed either in an operating theatre (15 centres), a dedicated bronchoscopy suite (6 centres) or an endoscopy suite shared with gastro-enterologists (7 centres). Other examinations were performed in areas dedicated to, or associated with intensive care. General anaesthesia was routinely used in 18 centres. The others used sedation including an equimolar mixture of oxygen and nitrous oxide in 14 centres. Ten centres performed less than 50 examinations, 12 between 51 and 100, 4 between 101 and 200 and 8 centres more than 200 in the year. Seventy two per cent of the children were less than 6 years old. The washing and disinfection procedures were manual in 20 centres and automatic in 15. RESULTS Three principal indications were reported: persistent wheezing, suspicion of a foreign body and ventilatory difficulties. Cough, desaturation and fever were the most frequently reported side effects. CONCLUSIONS This is the first survey in paediatric pulmonology in France. It shows a wide variation in the practice of fibreoptic bronchoscopy in children.Resume Introduction La fibroscopie bronchique est un examen complementaire cle dans la demarche diagnostique en pneumologie pediatrique. Le Club Pediatrique de Pneumologie et d’Allergologie a realise en 2002 une enquete retrospective permettant d’etablir un etat des lieux de la pratique par les pneumopediatres de la fibroscopie bronchique. Methodes Soixante cinq pneumopediatres ont effectues en moyenne 116 examens (± 111) dans 35 centres pediatriques en 2001. Les fibroscopies ont ete realisees soit dans un bloc operatoire (15 centres), soit un bloc dedie a la fibroscopie (6 centres), soit un site partage avec les gastroenterologues (7 centres). Les autres examens ont ete pratiques dans des locaux pediatriques (salle dediee et/ou unite de soins intensifs). L’anesthesie generale a ete systematique dans 18 centres. Les autres centres ont pratique une sedation consciente, avec utilisation de melange gazeux equimolaire oxygene protoxyde d’azote dans 14 centres. Dix centres ont realise moins de 50 examens, 12 entre 51 et 100, 4 entre 101 et 200 et 8 centres plus de 200 fibroscopies dans l’annee. Soixante douze pour cent des enfants avaient moins de 6 ans. Les procedures de lavage desinfection ont ete « manuelles » dans 20 centres et automatisees dans 15 centres. Resultats Trois indications principales ont ete rapportees : respiration sifflante persistante, suspicion de corps etranger et troubles de ventilation. Parmi les effets indesirables, la toux, la desaturation en oxygene et la fievre ont ete le plus souvent rapportees. Conclusion Cette enquete est une premiere en pneumologie pediatrique en France. Elle montre l’heterogeneite des pratiques en matiere de fibroscopie bronchique chez l’enfant.

Recommandations sur l’utilisation des nouveaux outils diagnostiques étiologiques des infections respiratoires basses de l’enfant de plus de trois mois

Recommendations for the use of diagnostic testing in low respiratory infection in children older than 3 months were produced by the Groupe de Recherche sur les Avancées en Pneumo-Pédiatrie (GRAPP) under the auspices of the French Paediatric Pulmonology and Allergology Society (SP(2)A). The Haute Autorité de santé (HAS) methodology, based on formalized consensus, was used. A first panel of experts analyzed the English and French literature to provide a second panel of experts with recommendations to validate. Only the recommendations are presented here, but the full text is available on the SP(2)A website.

Consensus national sur la prescription de l'azithromycine dans la mucoviscidose

AIM To propose a formalized consensus agreement regarding the prescription of azithromycin in cystic fibrosis (CF). MATERIAL AND METHODS Application of the Delphi method in 5 thematic fields: indications, contra-indications, dosage, precautions for use and treatment follow-up. RESULTS Thirty identified French CF centers participated in the process on 49 (61%), which comprised 3 rounds. Experts validated azithromycin as a long-term anti-inflammatory agent in children aged over 6 years, presenting with the classical form of CF, irrespective of the bacteriological status of the patient (except for non-tuberculous mycobacteria). Azithromycin administration should not be routine in the milder forms of the disease, and avoided in the presence of severe hepatic or renal involvement. In children whose weight is below 40 kg, a strong consensus recommended a single daily oral dose, administered three times weekly. However, in adults, the level of agreement was weaker. Minimal duration of treatment is 6 months, after which the drug should be discontinued if no observable effect is noted on clinical parameters, exacerbation rate and/or FEV1. Clinical monitoring of treatment tolerance is recommended (nausea, diarrhea, skin rash, tinnitus, deafness, arthropathy), without increasing the frequency of surveillance of sputum bacteria. However, it is essential to monitor sputum for fungi (expectoration, Aspergillus, broncho-pulmonary allergic aspergillosis). CONCLUSION This consensus statement defines an area for the prescription of azithromycin in CF, with the aim of better harmonization of its use.

Hallerman-Streiff-like syndrome presenting with laterality and cardiac defects.

We report two patients considered to have an atypical presentation of Hallerman-Streiff syndrome (HSS) associated with laterality and cardiac defects. Clinical features include typical facial gestalt, atrophy of the skin, and hypotrichosis. Ophthalmologic abnormalities, normally present in HSS, are only found in one of the two patients. Both of them have respiratory problems secondary to the classical narrow upper airway described in this syndrome. Both these patients have laterality defects and one has additional structural cardiac malformations. Cardiac defects have occasionally been reported in the HSS literature, but are not considered as a classical feature of the syndrome. Situs inversus has never been reported in this syndrome. Almost all HSS cases have been sporadic and their origin and inheritance pattern remain unknown.

Remodelling and inflammation in preschoolers with severe recurrent wheeze and asthma outcome at school age

The influence of airway remodelling and inflammation in preschoolers with severe recurrent wheeze on asthma outcomes is poorly understood.

La fibroscopie bronchique chez l’enfant

INTRODUCTION Fibreoptic bronchoscopy (FB) is an important diagnostic examination in paediatric pulmonology. In 2002 the Paediatric Pulmonology and Allergy Club undertook a retrospective study to establish the current status of fibreoptic bronchoscopy among its members. METHODS In 2001 sixty five paediatric pulmonologists carried out an average of 116 examinations (+/- 111) in 35 paediatric centres. FB was performed either in an operating theatre (15 centres), a dedicated bronchoscopy suite (6 centres) or an endoscopy suite shared with gastro-enterologists (7 centres). Other examinations were performed in areas dedicated to, or associated with intensive care. General anaesthesia was routinely used in 18 centres. The others used sedation including an equimolar mixture of oxygen and nitrous oxide in 14 centres. Ten centres performed less than 50 examinations, 12 between 51 and 100, 4 between 101 and 200 and 8 centres more than 200 in the year. Seventy two per cent of the children were less than 6 years old. The washing and disinfection procedures were manual in 20 centres and automatic in 15. RESULTS Three principal indications were reported: persistent wheezing, suspicion of a foreign body and ventilatory difficulties. Cough, desaturation and fever were the most frequently reported side effects. CONCLUSIONS This is the first survey in paediatric pulmonology in France. It shows a wide variation in the practice of fibreoptic bronchoscopy in children.Resume Introduction La fibroscopie bronchique est un examen complementaire cle dans la demarche diagnostique en pneumologie pediatrique. Le Club Pediatrique de Pneumologie et d’Allergologie a realise en 2002 une enquete retrospective permettant d’etablir un etat des lieux de la pratique par les pneumopediatres de la fibroscopie bronchique. Methodes Soixante cinq pneumopediatres ont effectues en moyenne 116 examens (± 111) dans 35 centres pediatriques en 2001. Les fibroscopies ont ete realisees soit dans un bloc operatoire (15 centres), soit un bloc dedie a la fibroscopie (6 centres), soit un site partage avec les gastroenterologues (7 centres). Les autres examens ont ete pratiques dans des locaux pediatriques (salle dediee et/ou unite de soins intensifs). L’anesthesie generale a ete systematique dans 18 centres. Les autres centres ont pratique une sedation consciente, avec utilisation de melange gazeux equimolaire oxygene protoxyde d’azote dans 14 centres. Dix centres ont realise moins de 50 examens, 12 entre 51 et 100, 4 entre 101 et 200 et 8 centres plus de 200 fibroscopies dans l’annee. Soixante douze pour cent des enfants avaient moins de 6 ans. Les procedures de lavage desinfection ont ete « manuelles » dans 20 centres et automatisees dans 15 centres. Resultats Trois indications principales ont ete rapportees : respiration sifflante persistante, suspicion de corps etranger et troubles de ventilation. Parmi les effets indesirables, la toux, la desaturation en oxygene et la fievre ont ete le plus souvent rapportees. Conclusion Cette enquete est une premiere en pneumologie pediatrique en France. Elle montre l’heterogeneite des pratiques en matiere de fibroscopie bronchique chez l’enfant.

Erratum à l’article « Recommandations sur l’utilisation des nouveaux outils diagnostiques étiologiques des infections respiratoires basses de l’enfant de plus de trois mois » [Arch. Pediatr. 21(4) (2014) 418–423]

V. Houdouina,*,1, G. Pouesselb,s,1, F. Angoulvantc,1, J. Brouardd,1, J. Derellee, M. Fayonf,1, A. Ferronig,1, J.-P. Gangneuxh,1, I. Haui,1, M. Le Bourgeoisj,1, M. Lorrotk,1, J. Menottil,1, N. Nathanm,1, A. Vabretn,1, F. Walleto,1, S. Bonacorsip,2, R. Cohenq,2, J. de Blicr,2, A. Deschildres,2, V. Gandemert,2, I. Pinu,2, A. Labbev,2, P. Le Rouxw,2, A. Martinotx,2, B. Rammaerty,2, Groupe de recherche sur les avancees en pneumo-pediatrie (GRAPP), J.-C. Dubusz, C. Delacourtaa, C. Marguetab Recu le : 27 mai 2014 Accepte le : 27 mai 2014 Disponible en ligne 1er juillet 2014

SFP-08 – Pathologie infectieuse – Couverture vaccinale grippe chez les enfants asthmatiques, saison 2006-2007

Objectif L’objectif est d’evaluer le taux de couverture vaccinale (CV) contre la grippe chez les enfants asthmatiques pour la saison 2006-2007. La vaccination annuelle contre la grippe est recommandee en France pour les patients asthmatiques. Un bon de prise en charge gratuite du vaccin grippe est adresse par la Caisse Nationale d’Assurance Maladie (CNAM) aux patients atteints de certaines affections de longue duree, dont l’asthme severe. En novembre 2006, cette mesure a ete etendue a l’asthme quel que soit son degre de severite. En 2008, l’objectif national de la loi de sante publique est d’atteindre pour les populations a risque, incluant les patients asthmatiques, un taux de CV contre la grippe d’au moins 75 %. Methodes Etude multicentrique, observationnelle, realisee de mars a septembre 2007 dans huit hopitaux repartis sur l’ensemble du territoire francais. Criteres d’inclusion : enfants âges de 6 a 17 ans revolus, consultant un pneumo-pediatre a l’hopital, dont le diagnostic d’asthme datait de plus de 6 mois et disposant d’un carnet de sante ou d’un dossier medical. Le medecin remplissait un questionnaire pour chaque enfant inclus. Resultats Les donnees de 433 enfants ont ete analysees (moyenne : 9,5 ans, 61 % de sexe masculin). Le taux global de CV contre la grippe etait de 15,7 % en 2006-2007. Parmi ces enfants, 39,6 % avaient recu un bon CNAM. La reception du bon CNAM augmentait la CV (31 % de vaccines parmi les enfants ayant recu le bon, versus 5,9 % de vaccines parmi les enfants n’ayant pas recu le bon, p Conclusions En France, en 2006-2007, le taux de CV grippe chez les enfants asthmatiques (15,7 %) est tres inferieur a l’objectif national d’au moins 75 % en 2008. L’extension recente de la prise en charge gratuite du vaccin grippe a tous les patients asthmatiques pourrait ameliorer ce taux. Une information plus importante des patients sur les risques de la grippe en cas de maladie asthmatique et sur les benefices de la vaccination devrait aussi contribuer a l’amelioration de ce taux.

Article originalLa fibroscopie bronchique chez l’enfant: Expertise des centres français de pneumologie pédiatriqueFlexible bronchoscopy in children. Experience of French ists of paediatric pulmonology

INTRODUCTION Fibreoptic bronchoscopy (FB) is an important diagnostic examination in paediatric pulmonology. In 2002 the Paediatric Pulmonology and Allergy Club undertook a retrospective study to establish the current status of fibreoptic bronchoscopy among its members. METHODS In 2001 sixty five paediatric pulmonologists carried out an average of 116 examinations (+/- 111) in 35 paediatric centres. FB was performed either in an operating theatre (15 centres), a dedicated bronchoscopy suite (6 centres) or an endoscopy suite shared with gastro-enterologists (7 centres). Other examinations were performed in areas dedicated to, or associated with intensive care. General anaesthesia was routinely used in 18 centres. The others used sedation including an equimolar mixture of oxygen and nitrous oxide in 14 centres. Ten centres performed less than 50 examinations, 12 between 51 and 100, 4 between 101 and 200 and 8 centres more than 200 in the year. Seventy two per cent of the children were less than 6 years old. The washing and disinfection procedures were manual in 20 centres and automatic in 15. RESULTS Three principal indications were reported: persistent wheezing, suspicion of a foreign body and ventilatory difficulties. Cough, desaturation and fever were the most frequently reported side effects. CONCLUSIONS This is the first survey in paediatric pulmonology in France. It shows a wide variation in the practice of fibreoptic bronchoscopy in children.Resume Introduction La fibroscopie bronchique est un examen complementaire cle dans la demarche diagnostique en pneumologie pediatrique. Le Club Pediatrique de Pneumologie et d’Allergologie a realise en 2002 une enquete retrospective permettant d’etablir un etat des lieux de la pratique par les pneumopediatres de la fibroscopie bronchique. Methodes Soixante cinq pneumopediatres ont effectues en moyenne 116 examens (± 111) dans 35 centres pediatriques en 2001. Les fibroscopies ont ete realisees soit dans un bloc operatoire (15 centres), soit un bloc dedie a la fibroscopie (6 centres), soit un site partage avec les gastroenterologues (7 centres). Les autres examens ont ete pratiques dans des locaux pediatriques (salle dediee et/ou unite de soins intensifs). L’anesthesie generale a ete systematique dans 18 centres. Les autres centres ont pratique une sedation consciente, avec utilisation de melange gazeux equimolaire oxygene protoxyde d’azote dans 14 centres. Dix centres ont realise moins de 50 examens, 12 entre 51 et 100, 4 entre 101 et 200 et 8 centres plus de 200 fibroscopies dans l’annee. Soixante douze pour cent des enfants avaient moins de 6 ans. Les procedures de lavage desinfection ont ete « manuelles » dans 20 centres et automatisees dans 15 centres. Resultats Trois indications principales ont ete rapportees : respiration sifflante persistante, suspicion de corps etranger et troubles de ventilation. Parmi les effets indesirables, la toux, la desaturation en oxygene et la fievre ont ete le plus souvent rapportees. Conclusion Cette enquete est une premiere en pneumologie pediatrique en France. Elle montre l’heterogeneite des pratiques en matiere de fibroscopie bronchique chez l’enfant.