M. Patout

COPD and perception of the new GOLD document in Europe. Workshop from the Société de pneumologie de langue française (SPLF)

INTRODUCTION The organization of care for chronic non-infectious diseases, notably COPD, is a common preoccupation in developed countries in which this disease is among the main causes of mortality and disability. We report a summary of a workshop organized on this theme in April 2013 by the Société de pneumologie de langue française. BACKGROUND Experts from several European countries presented the organizational practices for the management of COPD in their countries, in particular the detection of the disease and the systems of care. The common objectives were to obtain better motivation to stop smoking, earlier detection of the disease and education in the recognition of the signs of exacerbation and their severity. The experts agreed that mass detection is of little benefit and difficult to organize. Early individual screening is preferable on the basis of precise, easily identified criteria. The classification recommended by the GOLD committee since 2011 does not seem to be adopted universally throughout Europe. If there is a real improvement over the previous classification due to taking into account clinical criteria, quality of life and exacerbations, criticisms have arisen concerning the choice of certain pathways and therapeutic recommendations not based on prospective studies with a high level of evidence. CONCLUSION European experiences concerning the management of COPD are varied and complementary. One remaining question is who to screen: all subjects at risk (all smokers, all occupations at risk), only symptomatic subjects, subjects with severe and disabling symptoms?

A Randomized Controlled Trial on the Effect of Needle Gauge on the Pain and Anxiety Experienced during Radial Arterial Puncture

Background Arterial punctures for assessment of arterial blood-gases can be a painful procedure. Lidocaine can be used to reduce pain prior to needle insertion but it is not a widely accepted practice. The purpose of this study was to determine whether a large size needle induces more pain compared to a smaller size needle for radial arterial puncture and to assess the anxiety associated with radial arterial punctures. Methods We conducted a prospective, double-blind, randomized, controlled, monocentric study including all outpatients who had a planned assessment of arterial blood gas analysis. Patients were randomized to have the arterial puncture performed with a 23 or a 25 G needle. The main judgement criteria was pain during arterial puncture. Visual analogue scale for pain (VAS-P) and visual analogue scale for anxiety (VAS-A) were used to assess pain and anxiety during radial arterial puncture. Results Two hundred consecutive patients were randomized. The 25 G needle was as painful as the 23 G needle (6.63 mm [0–19 mm] vs. 5.21 mm [0–18.49 mm], respectively, p = 0.527). Time for arterial puncture was longer with the 25 G needle than with the 23 G needle (42 s [35–55 s] vs. 33 s [24.5–35 s], respectively, p = 0.002). There was a correlation between the level of anxiety prior to the arterial puncture and the pain experienced by the patients (p: 0.369, p<0.0001). There was a correlation between the pain experienced by patients and the anxiety experienced in anticipation of another arterial puncture (p: 0.5124, p<0.0001). Conclusions The use of 23 G needle allows quicker arterial sampling and is not associated with increased pain and symptoms. Anxiety was correlated with the pain experienced by patients during arterial punctures. Trial Registration Clinicaltrials.gov: NCT02320916

Épidémiologie et dépistage de la BPCO en France. Workshop de la Société de pneumologie de langue française (SPLF)

INTRODUCTION A workshop has been organized in April 2013 by the Société de Pneumologie de Langue Française about COPD epidemiology and COPD screening in France and other European countries. This article deals with epidemiological data and their consequences on the French screening strategy. STATE-OF-THE-ART According to the most recent data, spirometric prevalence of COPD in France is 7.5% in individuals over 45 years old. During 2000-2002, COPD was responsible for 1.4% of all causes of death in France and was mentioned to be an associated cause of death in 3% of all death certificates. The average medical costs for one COPD patient is estimated to be 4366 €/year, until 7502 €/year in very severe COPD patients. All clinical studies that have been performed in France show that COPD screening via mini-spirometry is feasible in general practice or in an ambulatory setting; however, a mass screening proved to be difficult to perform. A simple technique like the Piko-6(®) implies a concomitant formalized training. The non-reimbursement by the French Social Security is also a limiting factor, as the absence of medical and economical validation of this strategy. Therefore, COPD screening should be focused to individuals at risk and should include tobacco issues and cessation. CONCLUSION COPD screening strategies have to be medically evaluated and experiments have to take the specificities of the French health organization into consideration. Any COPD screening strategy should be considered as an overall fight against the tobacco epidemics.

Neural respiratory drive and cardiac function in patients with obesity hypoventilation syndrome following initiation of noninvasive ventilation

Background Chronic hypercapnic respiratory failure (HRF) in obesity hypoventilation syndrome (OHS) is commonly treated using non-invasive ventilation (NIV). We hypothesised that treatment of OHS would improve neural respiratory drive index (NRDI) and cardiac function. Methods Fourteen patients (8 females) with OHS, who were admitted for initiation of domiciliary NIV, were prospectively studied. Patients had (mean ± SD): age (53±10 years), body mass index (BMI) (50.1±10.8 kg/m2), and pCO2 (7.3±0.9 kPa). NRDI was assessed by surface electromyogram of the parasternal intercostals. Cardiac function was assessed by transthoracic echocardiography (TTE). All measurements were performed at baseline, 6 weeks, and 3 months. Results NRDI improved on day one following NIV set-up comparing to baseline (484.2±214.8 vs. 316.5±106.5 AU) and this improvement was maintained at 6 weeks (369.1±173.2 AU) and at 3 months (351.2±167.1 AU) (P=0.004). No significant differences were identified in terms of cardiac function between baseline and 3 months [tricuspid annular plane systolic excursion (TAPSE) (24.6±5.8 vs. 23.0±4.0 mm, P=0.317); systolic pulmonary artery (PA) pressures (36.7±15.2 vs. 44.5±23.9 mmHg, P=0.163]. Conclusions NIV improves NRDI in patients with OHS, while the cardiac function over a three-month period remains unchanged.