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Biomedical subjects

A Magnan

Publications and source records attributed to A Magnan.

At least 19 recordsLinked to original sources
PubMed2006

The need to improve inhalation technique in Europe: a report from the Aerosol Drug Management Improvement Team.

Although the principles of asthma management are well established in Europe, the available data indicate that asthma in patients is not well controlled. Many patients derive incomplete benefit from their inhaled medication because they do not use inhaler devices correctly and this may compromise asthma control. The Aerosol Drug Management Improvement Team (ADMIT), incorporating clinicians from the UK, Germany, France, Italy, Spain and The Netherlands, reviewed published evidence to examine ways to improve the treatment of reversible airways disease in Europe. Data indicate that there is a clear need for specific training of patients in correct inhalation technique for the various devices currently available, and this should be repeated frequently to maintain correct inhalation technique. Devices which provide reassurance to patients and their physicians that inhalation is performed correctly should help to improve patient compliance and asthma control. Educational efforts should also focus on primary prescribers of inhaler devices. ADMIT recommends dissemination of information on the correct inhalation technique for each model of device by the use of an accessible dedicated literature base or website which would enable to match the appropriate inhaler to the individual patient. There is also a need for standardisation of prescribing practices throughout Europe. Regular checking of inhalation technique by prescribers is crucial as correct inhalation is one of the keystones of successful asthma management.

Administration, Inhalation↗
PubMed2006

[Hypersensitivity to carboplatin. An effect of generic drugs?].

INTRODUCTION: Carboplatin is a chemotherapeutic agent used frequently in thoracic medicine on account of its relatively good tolerance. Nevertheless hypersensitivity reactions have been described. CASE REPORTS: We report the cases of 2 patients, treated for undifferentiated bronchial carcinoma and carcinoma of the breast, presenting with hypersensitivity reactions to carboplatin developing after 6 and 8 courses respectively. The first patient presented with an irritant maculo-papular rash and the second with severe hypotension and bronchospasm. Neither of these reactions was fatal. Both of these reactions occurred when generic carboplatin was substituted for the propriety preparation. CONCLUSION: Hypersensitivity reactions to carboplatin should be recognised by respiratory physicians on account of their potential seriousness and their occurrence after several courses of treatment. This takes on particular importance at a time when plans for domiciliary treatment of patients are being considered. In addition a national survey of hypersensitivity to carboplatin should be considered by the regional drug safety centres.

Antineoplastic Agents↗
PubMed2006

Ultra-rush venom immunotherapy induces differential T cell activation and regulatory patterns according to the severity of allergy.

BACKGROUND: Venom immunotherapy (VIT) induces immune tolerance to hymenoptera venom antigens in allergic patients and is therefore a helpful model for studying modulation of allergic immune response. The objectives were to assess the early effects of ultra-rush VIT on T lymphocyte activation and regulatory profile induction, in all subjects combined and according to the four severity grades of the Mueller classification. MATERIALS AND METHODS: Blood samples from 30 vespid-allergic patients were taken before and after the first day of treatment, and before day 15 and day 45 booster injections. IFN-gamma and IL-4 levels were assayed by ELISA, in whole-blood supernatants. IFN-gamma and IL-13-producing T cells, but also natural CD4+CD25+high regulatory T cells and acquired regulatory T cell proportions were assessed by flow cytometry. Results were analysed in the whole population and compared between patients with I-II or III-IV allergic reactions. RESULTS: During VIT, IFN-gamma increased in whole blood when IL-4 decreased. Among T cells, the percentage of CD3+IFN-gamma+ cells increased while IL-13-producing T cells decreased. Proportions of CD4+CD25+high cells and IL-10-producing T cells increased with VIT. In I-II subjects, IFN-gamma increased gradually, whereas it remained at low levels in III-IV patients. By contrast, IL-4 decrease was more pronounced in III-IV patients. Increase in CD4+CD25+high T cells occurred early in I-II patients but was delayed in III-IV patients. IL-10-producing T cells increased gradually in both groups but were in a lower proportion in III-IV patients. CONCLUSION: A T helper type 2 (Th2)-to-Th1 switch occurs during ultra-rush VIT, in parallel with natural and acquired regulatory T cell increase. These events occur earlier and at a higher level in less severe subjects, suggesting that VIT tolerance induction is easier to achieve in these patients.

Adult↗
PubMed2006

Variation of T-cell activation in allergic subjects during natural pollen exposure.

BACKGROUND: Allergic inflammation is characterized by a Th2 activation. However, little is known about dynamics of T-cell cytokine production during natural allergen exposure. The aim of this study was to assess the Th1/Th2 balance in cypress allergic patients compared with controls, and variations of this balance over the pollen season. METHODS: Twenty cypress allergic patients and 10 controls were studied, distributed during two consecutive pollen seasons. Cytokine production was assessed by flow cytometry and ELISA. The variation of cytokine production during the pollen season was analyzed among patients in four occasions, and the preseason values were compared with controls. IL-13 and IFN-gamma-containing T cells were assessed among whole blood cells and PBMC. In addition the effect of specific stimulation by Juniperus ashei pollen extract was studied. RESULTS: Compared with controls, IL-13-producing T cells were increased in allergics in any case. By contrast, compared with controls, allergic IFN-gamma-producing T cells were decreased in whole blood, but not in PBMC, and were increased after specific stimulation. During the season, an increase in IFN-gamma- and a decrease in IL-13-producing T cells occurred in patients, whatever the culture conditions. CONCLUSION: These results show that the allergic T-cell activation is not limited to a Th2 profile: allergen-stimulated T cells are able to produce IFN-gamma at baseline, and the Th1/Th2 ratio increases during the pollen season.

Adult↗
PubMed2006

Diesel exhaust particles enhance T-cell activation in severe asthmatics.

Prevalence of asthma is increasing in westernized countries. Epidemiological studies showed the impact of traffic pollution on the triggering of asthma symptoms and exacerbations, and this effect is mainly attributed to the polycyclic aromatic hydrocarbon core of diesel exhaust particles (DEP). However, although DEP induce IgE synthesis, little is known of their role on T-cell activation, the main cells orchestrating asthma inflammation. We assessed the effect of DEP on T-cell activation in severe uncontrolled asthmatics during (n = 13) and outside (n = 19) exacerbations. Results were compared with data obtained in healthy controls (n = 14). Peripheral blood mononuclear cells were cultured in the presence of low-dose DEP. T-cell activation markers, CD69 and CD25, interleukin-4 (IL-4) and interferon (IFN)-gamma production and T-cell proliferation were assessed by flow cytometry. DEP exposure increased the proportion of CD3+CD69+ T cells in all subjects. The proportion of CD25+ T cells increased under DEP stimulation in the exacerbation group only. IFN-gamma- and IL-4-producing T cells increased in both asthmatic groups, especially during exacerbations, but not in controls. This effect was more pronounced for IL-4. In response to DEP stimulation, T-cell proliferation increased in higher proportion in asthmatics compared with controls. These results show that DEP activate T cells in asthmatics only, with a higher effect during exacerbations. This is in keeping with epidemiological data which demonstrated that DEP trigger respiratory symptoms in asthmatics but not in controls. The higher effect of DEP in exacerbated asthmatics suggests that uncontrolled asthma is a risk factor for aggravation under exposure to traffic pollutants.

Adult↗
PubMed2005

[T regulatory lymphocytes, atopy and asthma: a new concept in three dimensions].

BACKGROUND: Allergic inflammation is considered to be the result of a pattern of Th2 lymphocyte activation. However this inflammation, relevant for atopy and infiltration of affected tissues by eosinophils, is insufficient by itself to explain the clinical features of asthma. Several studies have demonstrated that Th2 type inflammation was also associated in asthma with a Th1 response, with production of gamma interferon. It has recently been shown that the regulatory T lymphocytes (Treg) which produce IL-10 and/or TGF-beta and induce tolerance are defective in allergic patients. In addition, these lymphocytes increase during specific immunotherapy. Their decrease could explain the Th2 activation found in atopic patients. PERSPECTIVE: We review the potential importance of Treg cells in atopy and also asthma, and propose a concept whereby the allergic inflammatory response would not be due to a Th1/Th2 imbalance, but rather to a Treg deficiency progressively rising from normal to atopic, from atopy to asthma and from asthma to acute exacerbations. CONCLUSION: Three dimensions of inflammation need therefore to be taken into account: Th1, Th2 and Treg.

Animals↗
PubMed2005

[IgE and respiratory disease].

INTRODUCTION: IgE is known to provide the biological basis for allergy and immediate hypersensitivity. However, recent data provide some evidence that IgE responses are involved in other inflammatory processes apart from allergy, including several respiratory diseases. STATE OF THE ART: IgE binds to mast cells and basophils but also to other inflammatory cells, which are involved in non-allergic processes. IgE has a role in antigen presentation and is implicated in a number of other immune mechanisms. In the airways, IgE plays an important role in bronchial hyperactivity, even in the absence of an allergen. Epidemiological studies have demonstrated that IgE response is related not only to allergy but also to asthma symptoms, in the presence or absence of atopy, as well as exposure to cigarette smoke. IgE response is altered in several respiratory diseases including extrinsic and intrinsic asthma and allergic bronchopulmonary aspergillosis. CONCLUSION AND PERSPECTIVES: Since anti-IgE monoclonal antibodies are now available for administration to humans, a better understanding of the IgE response may allow the identification of novel therapeutic targets in the field of respiratory disease.

Adolescent↗
PubMed2005

Dog factor differences in Can f 1 allergen production.

BACKGROUND: The clinical importance of dog allergy is well known, but it is unknown if all types of dogs represent the same risk for allergic patients. The purpose of this work was to evaluate among 288 healthy dogs if the levels of Can f 1 on fur vary between breeds (German Shepherd, Pyrenean Shepherd, Poodle, Cocker spaniel, Spaniel, Griffon, Labrador retriever and Yorkshire terrier), gender, hormonal status, hair length, and according to the presence of seborrhea. METHODS: Each dog was shaved in a limited area and Can f 1 concentrations were measured in mug/g fur by ELISA. The results (geometric mean values and 95% confidence intervals) were analyzed using analysis of variance and with nonparametric tests. RESULTS: A wide variability in Can f 1 levels was found between dog breeds, from Labradors [1.99 (0.03-129.91)] to Yorkshires [16.72 (3.67-76.16)] and Poodles [17.04 (2.79-103.94)] but only the Labrador levels were significantly different from each other breed. Males produced more Can f 1 than females, 11.75 (1.27-108.40) vs 8.89 (0.91-86.39). No difference was found according to hair length or hormonal status. The seborrheic status highly (P = 0.0019) influenced the presence of Can f 1 on hair: 16.66 (1.59-173.96) vs 9.40 (1.03-85.70). CONCLUSION: Breeds (Labrador retriever), sex and seborrhea seem to influence the levels of Can f 1 on fur.

Allergens↗
PubMed2005

[Young people's perceptions of tobacco-related cancer].

An anthropological study was conducted on the island of Reunion between March and September 2004 within the framework of a project called "The non-smoking generation" carried out by the Regional Committee for Health Education. The primary objective was to provide field workers with a basis for reflection which they could incorporate into their tobacco prevention activities aimed at young people. The perceptions of youth on tobacco-use related cancer were explored using a sample population group of 37 young people aged between 14 and 25 years old (girls and boys, smokers and non-smokers, those who attend school and those who don't) from across the island. Interviews were conducted using an anthropological analysis grid and completed through observational sessions in their homes, schools and neighborhoods. The results, set within the context of time and the places where tobacco is consumed, demonstrate that their relationship to cigarettes symbolises some of the inherent characteristics of adolescence, namely, the difficulty in finding and establishing one's own limits, in integrating oneself into society and in envisioning one's potential future. An interesting observation was also made regarding their views on the one hand of a paradoxical approach relating the development of cancer and tobacco consumption behaviour, and the real, concrete physical and psychological impact of the disease on the other. The young people often expressed a certain fatality and a feeling of control ("I can quit whenever I want to!"). The team also found within their remarks a sense of being unfortunate as opposed to that of being in control, coupled with fear as opposed to feeling invincible ("cancer only happens to other people"). Finally, the study has allowed for reflections on youth tobacco prevention interventions to be nurtured with respect to how individual young people position the consequences of tobacco use and smoking, mainly with regard to their own personal responsibility.

Adolescent↗
PubMed2004

[Shrinking lung syndrome and systemic auto-immune disease].

INTRODUCTION: Shrinking lung syndrome usually manifest in dyspnea, decreased lung volume associated with elevated diaphragm. It reports with systemic autoimmune disease and physiopathological mechanism is controversial. EXEGESIS: We report three shrinking lung syndrome observations in which two cases were diagnosed at the time to onset of autoimmune disease. The three patients were treated with corticosteroid, two of them necessitated theophylline. Review of the literature highlight 60 cases and permit to discuss physiopathological mechanisms which remain uncertain. Diaphragmatic dysfunction (because of myositis or neuropathy) represented by abnormal transdiaphragmatic pressures is actually discussed. CONCLUSION: Shrinking lung syndrome is rare but must be considered in patient with autoimmune disease and dyspnea. The diagnosis can be difficult because of clinical, pathological and functional features which are controversial. The optimum treatment is unknown.

Adult↗
PubMed2004

[2000 classification of idiopathic interstitial lung diseases].

OBJECTIVES: Diagnosis of interstitial lung diseases was recently improved by the use of diagnostic tools, such as high-resolution Computed Tomography, and by new insights in their pathogenesis and histology. This led the American Thoracic Society and the European Respiratory Society to propose a new classification of these diseases, in the aim to facilitate early diagnosis and specific care. CURRENT KNOWLEDGE AND KEY POINTS: Standard radiography gives the first suspicion of chronic diffuse infiltrative lung disease, and anamnesis and physical examination are essential steps of etiological diagnosis. High-Resolution computed tomography confirms the diagnosis of diffuse infiltrative lung disease. Longitudinal lung function tests are essential to assess the consequences of the lung disease. Lung biopsies are often, but not systematically, a useful tool. The 2000 classification consists of seven entities of idiopathic interstitial diseases which are defined on clinical, radiological and pathological criteria: idiopathic pulmonary fibrosis, non-specific interstitial pneumonia, cryptogenic organizing pneumonia, acute interstitial pneumonia, respiratory bronchiolitis associated interstitial lung disease, desquamative interstitial pneumonia and lymphoid interstitial pneumonia. The most frequent is Idiopathic Pulmonary Fibrosis, which has a poor prognosis. FUTURE PROSPECT AND PROJECTS: This new classification results from a multidisciplinary confrontation with chest physicians, radiologists and pathologists. A better characterization of anatomoclinical entities should lead to a better pronostic evaluation, more informative comparisons of published studies, and therefore to rational therapeutic approach.

Acute Disease↗
PubMed2004

[Bronchial obstruction by an aberrant left pulmonary artery misdiagnosed as asthma in a 7 year old child].

INTRODUCTION: Wheezing is common symptom in infants and is usually due to asthma. However an alternative diagnosis should be sought if there is no reversibility to B2-agonist. CASE REPORT: This case report describes a 7 years old child who had been treated for poorly controlled asthma for several years. The absence of B2-agonist reversibility, indirect signs of thoracic straining on spirometry and evidence of right heart decompensation raised doubts about the diagnosis. CT angiography demonstrated a pulmonary artery malformation. Formal pulmonary angiography confirmed the diagnosis of pulmonary artery sling. This malformation had been causing intermittent bronchial compression and the symptoms resolved after surgical intervention. CONCLUSION: Wheezing symptoms over two Years in a child, misdiagnosed as asthma, is an unusual presentation of this pulmonary vascular anomaly.

Adrenergic beta-Agonists↗
PubMed2004

How should nasal symptoms be investigated in asthma? A comparison of radiologic and endoscopic findings.

BACKGROUND: To improve asthma control, the management of rhinosinusitis often leads the physician to perform sinonasal imaging and/or nasal endoscopy, but their respective contributions are still insufficiently understood. OBJECTIVE: To evaluate the potential contribution of a symptoms questionnaire, sinus radiography (SR) and computed tomography (CT) scan to the diagnosis of nasal diseases in asthmatic patients when compared with ENT examination. METHODS: A total of 124 patients completed a questionnaire on nasal symptoms administered by the chest physician. Then, they underwent ENT examination. On the same day, SR and CT scans were performed independently. RESULTS: Patients (80.3%) had nasal symptoms during the month preceding the consultation. The ENT examination was normal in 8.1% (n = 10) and revealed rhinitis in 57.3% (n = 71), rhinosinusitis in 14.5% (n = 18) and nasal polyposis in 20.2% (n = 25). For rhinitis, the negative predictive value of bilateral nasal obstruction was 87.8%. Both SR and CT had low sensitivity and specificity. For rhinosinusitis, the negative predictive value of nasal symptoms varied from 85.4 to 95.2%. Sinus CT was at least as accurate as SR for the diagnosis of rhinosinusitis. In a multivariate analysis, only the CT scan (score > or =12) appeared to be significantly associated with the diagnosis of nasal polyposis. CONCLUSION: In asthmatic patients, physicians need to enquire systematically about the existence of nasal symptoms by using this simple questionnaire which is sensitive for rhinitis, and has good negative predictive value for excluding rhinosinusitis and nasal polyposis.

Adult↗
PubMed2004

Control and exacerbation of asthma: a survey of more than 3000 French physicians.

BACKGROUND: Asthma control and prevention of exacerbations are primary objectives for asthma care. However there is a lack of universal definition of these notions which may therefore have a different meaning according to the physician's practice. METHODS: In the present survey, 1805 general practitioners, 551 pulmonologists, 176 allergologists and 470 resuscitation/emergency care physicians were randomly selected in fall 2001 and asked to answer one question on asthma control and three questions on asthma exacerbation. RESULTS: Regarding asthma control, the presence of minimum symptoms was the primary criterion for asthma specialists (pulmonologists and allergologists), while a normal respiratory function was first considered by nonspecialist physicians (general practitioners and emergency care physicians). The first criterion of mild exacerbation for asthma specialists was the occurrence during at least 2 days of an increase in the frequency of dyspnoea and/or the use of short-acting bronchodilators. For nonspecialist physicians, dyspnoea affecting daily activities and/or sleeping was the preferred notion. Hospitalization was unanimously recognized as the first criterion for severe exacerbations. A decrease in peak expiratory flow of more than 30% below the baseline value on two consecutive days and an episode requiring systemic corticosteroids were the next criteria. CONCLUSIONS: This survey emphasizes the complexity of the notions of asthma control and exacerbation and provides novel informations to orient continuing education programmes.

Asthma↗
PubMed2004

The ARIA/EAACI criteria for antihistamines: an assessment of the efficacy, safety and pharmacology of desloratadine.

BACKGROUND: The definition of allergic rhinitis and the classification of its severity and treatment have advanced in recent years following the publication of the Allergic Rhinitis and its Impact of Asthma (ARIA) document. The ARIA and the European Academy of Allergology and Clinical Immunology (ARIA/EAACI) have published a set of recommendations that outline the pharmacological and clinical criteria to be met by medications commonly used in the treatment of allergic rhinitis. METHODS: An international group of experts met to assess the profile of the antihistamine, desloratadine, under the ARIA/EAACI criteria. Data on desloratadine were collected from peer-reviewed clinical studies and review articles, which were corroborated and augmented by comprehensive public access documents from the European Medicines Evaluation Agency (EMEA). RESULTS AND CONCLUSION: Based on this systematic review, it was concluded that the efficacy, safety and pharmacology of desloratadine broadly meet the ARIA/EAACI criteria for antihistamines.

Animals↗