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C Marguet

Publications and source records attributed to C Marguet.

At least 19 recordsLinked to original sources
PubMed2006

[Characteristics of mild asthma: clinical signs and medication use. Position statement of the Mild Asthma Working Group (174)].

OBJECTIVE: To update on the state of knowledge in mild asthma (intermittent and persistent mild asthma, according to the GINA classification) review the literature, and the position statement of the French Mild Asthma Working Group. METHODS: The French Mild Asthma Working Group (11 lung specialists, 4 paediatricians, 1 pharmacologist, and 1 general practitioner) selected, analysed, and summarised the literature on the descriptive epidemiology, physiopathology, clinical signs, and management of mild asthma. The position of the working group on the descriptive epidemiology (causal factors excluded) and the nature of the bronchial inflammation has been presented in a previous article. The present article focuses on the clinical features of mild asthma and the use of medication for it. RESULTS: Mild asthma was more frequent, more symptomatic, and less well controlled in children than in adults. Its generally benign evolution may in some (<10%) cases be complicated by severe episodes. Patients with mild persistent asthma require controller medication every day: permanent low-dose inhaled corticosteroid monotherapy is the reference foundation treatment for persistent mild asthma. CONCLUSIONS: The present findings should help clinicians and guide them in their approach to managing this condition.

Administration, Inhalation↗
PubMed2006

[Characteristics of mild asthma: descriptive epidemiology and nature of bronchial inflammation. Position of the Mild Asthma Working Group].

INTRODUCTION: Update on the state of knowledge in the mild asthma (intermittent and persistent mild asthma, according to the GINA classification) literature, and position of a French Mild Asthma Working Group. STATE OF THE ART: The French Mild Asthma Working Group (11 lung specialists, 4 paediatricians, 1 pharmacologist, and 1 general practitioner) selected, analysed, and summarised the literature on the epidemiology, physiopathology, clinical signs, and management of mild asthma. The present article shows the position of the working group on mild asthma descriptive epidemiology (causal factors excluded) and the nature of the bronchial inflammation. Clinical signs and medicinal treatments will be presented in a second article. PERSPECTIVES: Between 50% and 75% of asthma patients, depending on the study, present mild asthma. Childhood-to-adulthood cohort monitoring found severity to be unchanged over developmental time. Its generally benign evolution may in some (<10%) cases be complicated by severe episodes. Inflammation and airway-wall remodelling were always found, although of variable intensity, and non-specific (except for absence of infiltration by polymorphonuclear neutrophils). Corticosteroid therapy by inhalation reduces bronchial inflammation, but with little impact on airway-wall remodelling. CONCLUSION: The present findings should help clinicians in identifying and understanding mild asthma.

Adrenal Cortex Hormones↗
PubMed2004

[Evaluation of varicella complications through a retrospective hospital survey in a paediatric center over 16 years in France].

OBJECTIVE: Evaluation of the varicella severity through a prevalence study of hospital admissions justified by a complication directly related to the onset of an acute episode of varicella. METHODS: Retrospective study in one paediatric center in France with a follow-up of a paediatric cohort from April 1987 to December 2002. This general paediatric hospital recruits children from a 400,000 inhabitants area. Inclusion criterion: diagnosis main or associated of varicella. EXCLUSION CRITERIA: congenital or acquired immunodepression, including long-term oral high dosage steroid therapy. RESULTS: Three hundred and forty-three (343) complications of varicella were reported in 309 children hospitalised for a symptom in relationship with varicella. Most of children (75%) were <2 years of age. The annual number of hospitalisations varied with a maximum of 44. An increase of the number of hospitalisations was reported since 1997 but particularly since 2000. Main complications were gastro-intestinal (75), neurological (68), bronchopulmonary (52), and skin and soft tissue infections (52). Superinfections of soft tissues such as Streptococcus pyogenes cellulitis and life-threatening complications, which occurred in children treated by a short-course of corticosteroïds for an acute episode such as an asthma crisis, were mostly noticed since 1995. Two deaths occurred. CONCLUSION: These data collected over 16 years as part of a retrospective survey of a paediatric cohort show that varicella, often considered as a mild disease, can be responsible for severe complications in young immunocompetent children. The digestive complications (30%) are the main complication in our study with existence of gingivitis-stomatitis but also lower digestive manifestations (erosive gastritis aspect through endoscopy). These data have all the more to be taken into account because a vaccine, developed for healthy children, is now available in France. A national survey of hospitalised varicella has been set up since March 2003.

Adolescent↗
PubMed2004

[Flexible bronchoscopy in children. Experience at French centers of pediatric pneumology].

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.

Bronchoscopes↗
PubMed2004

[Adverse events of inhaled steroids in childhood].

The adverse events of the inhaled steroids on growth and bone mineralization concern the pediatricians. From the available current data, we exposed the following conclusions: 1) Inhaled steroids must be preferred to oral steroids; 2) Short, middle and long-term adverse effects of inhaled steroids have to be differentiated. Only the long-term effects reflect possible sequela; 3) The adverse effects are specific from the considered inhaled steroids, the most recent available drugs having less adverse effects on bone and growth; 4) Recent data did not show consequences on the adult height and bone mineralization; 5) Recommendations in the use of inhaled steroids must be known by the practitioners in order to limit the adverse events of these drugs. Growth need to be surveyed in children with inhaled steroids and more studies are still necessary. In addition, we enhanced that local adverse effects should be sought by the physicians. Cough after inhalation was frequent and might be a negative factor of compliance.

Administration, Inhalation↗
PubMed2002

[Inflammatory markers in infant asthma].

After a brief review of airway inflammation mechanisms, the main results concerning the studies on airways inflammation in wheezing infants are commented. Infantile asthma differed from adult asthma by a predominance of neutrophils in airways, but less eosinophils or mastocytes. However, the presence of eosinophil or mastocyte markers does not allow to exclude a contribution of eosinophils in infantile wheeze. Studies on macrophages at cell level showed that a potent inflammation from macrophages exists in asymptomatic asthmatic infants. Lymphocyte subsets studies demonstrated a modulation of CD8 in these infants, suggesting the role of lymphocytes and the contribution of viruses in the pathophysiology of the disease. Lastly, the measurement of various mediators in airways confirmed that airway inflammation is present in infantile wheeze.

Asthma↗
PubMed2001

[Chronic cough, asthma and allergy].

The medical approach of chronic cough suffers from the lack of a standardised definition. The most frequently encountered criterion is a recurrent cough observed during several consecutive months, each episode lasting at least 1 week. The link between recurrent cough and asthma is still discussed. Cough-related asthma diagnosis is facilitated when wheezing is clearly confirmed, or may be reminded by a nonproductive middle night cough, or an exercise-triggered cough, or the presence of personal or familial atopy. Conversely, an early morning and productive cough associated with tobacco exposure do not suggest asthma.

Asthma↗
PubMed2001

Local side-effects of inhaled corticosteroids in asthmatic children: influence of drug, dose, age, and device.

BACKGROUND: The objective was to investigate the local side-effects of inhaled corticosteroids (ICS) in daily life in asthmatic children, particularly the younger ones, by an observational prospective cross-sectional cohort study. METHODS: Asthmatic children (n=639, 75.9+/-48.9 months, 61.3% boys), treated with beclomethasone dipropionate (BDP) (721.0+/-287.3 microg per day) or budesonide (BUD) (835.5+/-684.9 microg per day) for at least 1 month, were recruited at the time of a scheduled visit. Local side-effects were researched by questionnaire (cough during inhalation, hoarseness, dysphonia, and thirsty feeling) and clinical examination (perioral dermatitis, oral candidiasis, and tongue hypertrophy). RESULTS: Exactly 63.3% of the children aged under 6 years and 59.5% of the older ones reported one local side-effect. Cough (39.7%) was dependent on young age, use of BDP, and mainly use of spacer device, with an OR of 4.7 (95% CI: 2.7-8.2). Thirsty feeling (21.9%) and hoarseness (14.1%) occurred in children using ICS and long-acting beta2-agonists. Dysphonia (11.1%) was favored by high doses of BDP and BUD, and by inhalation from spacer devices or nebulizers. No factor favored oral candidiasis (10.7%). Perioral dermatitis (2.9%) and tongue hypertrophy (0.1%) were associated with nebulization. CONCLUSION: Local side-effects of ICS are common in asthmatic children of all ages, and the device used constitutes the most influential factor.

Administration, Inhalation↗
PubMed2001

Eosinophil cationic protein and interleukin-8 levels in bronchial lavage fluid from children with asthma and infantile wheeze.

It has been shown previously that airway eosinophils characterize childhood asthma and neutrophils contribute to the pathophysiology of both infantile wheezing and asthma. Therefore, eosinophil cationic protein (ECP) and interleukin-8 (IL-8) levels in bronchoalveolar lavage fluid (BALF) from asthmatics (n = 16) and infantile wheezers (n = 30) were analyzed as markers of eosinophil- and neutrophil-mediated inflammation. To aid the interpretation, a control group of children (n = 10) with no lower airway pathology were included. Disease severity was assessed by using a symptom score. Surprisingly, no significant difference was found in IL-8 or ECP levels among asthma, infantile wheeze, and control groups. Asthma was characterized by: a correlation between ECP levels and eosinophil counts (r = 0.618, p = 0.014); a correlation between neutrophil number and IL-8 levels (r = 0.747, p = 0.002); and increasing IL-8 levels with symptom score (p = 0.03). In infantile wheezers, IL-8 levels were poorly related to neutrophil number but were significantly increased when neutrophils were > 10%. Although detectable levels were found in all but one symptomatic infant, IL-8 concentrations did not reflect the symptom score in infantile wheeze. ECP was unexpectedly correlated to neutrophil percentages (Rho = 0.832, p = 0.001), and a threshold of ECP>20 ng/ml was associated with persistent symptoms in these infantile wheezers. Hence, in accordance with BALF cellularity, activation of eosinophils was suggested by raised levels of ECP in childhood asthma, but not in infantile wheeze. Neutrophil-mediated inflammation appeared to better reflect the severity of asthma than that of infantile wheeze. Although its meaning remains to be elucidated, ECP was suggested to be a helpful indicator of persistent infantile wheeze. However, its utility as a marker predicting ongoing asthma remains to be established.

Adolescent↗
PubMed2001

Inhalation treatment: errors in application and difficulties in acceptance of the devices are frequent in wheezy infants and young children.

The recent availability of small-volume spacers has facilitated the general use of inhaled treatment in infants. The purpose of this study was to evaluate any errors made by parents when using this new inhalation technique and the child's behavior during the inhalation. Ninety-four young children (61% boys) under 5 years of age were enrolled in the study. Inhalation treatment was recommended either by a general practitioner or by a pediatrician. Data concerning treatment regimens, the ability of parents to use the spacer and metered-dose inhalers (MDIs), and the acceptance of the devices, were collected by means of a demonstration and questionnaire. Unexpectedly, the doses, administration times, and duration of the treatments varied from one child to the next. No explanation or training in administering the treatment via the spacers was given to 12% and 47% of the parents, respectively. Fourteen per cent of parents did not shake the MDIs, 12% did not monitor the valves, and 22% allowed too short a time for inhalation. The lack of explanation increased the occurrence of errors in manipulation of the devices. The procedure was judged to be easy to follow by 78% of the parents, but the face mask was accepted with difficulty by 22% of the children. Repeated crying during administration of the treatment was observed in 38% of the patients, particularly the youngest. Crying influenced the acceptance of the face mask, reduced parental compliance, and made the use of the devices more difficult. Errors altering the efficiency of inhalation treatment in infants are frequent. Most of these errors could be avoided by spending more time to inform the parents about correct usage. Furthermore, repeated crying during inhalation is common in young children and this problem should to be taken into consideration in the evaluation of treatment.

Administration, Inhalation↗
PubMed2000

Issues in understanding childhood asthma.

Asthma and related allergic disorders in childhood have increased considerably in prevalence over the last few decades. During the same period of increasing morbidity from childhood asthma in the community, there have been dramatic advances in understanding of the basic immunopathologic features of the disease and consequently the development of a far more rational approach to its treatment. The immunopathologic condition of eosinophil-mediated airway inflammation is established very early in the evolution of asthma in childhood. It may even antedate the onset of symptoms. The present state of the art dictates that early intervention with potent therapies cannot be justified on the basis of symptoms alone and may in any case have no influence on the natural history of the condition. This means that current cautious therapeutic guidelines should continue to be followed. However, with the development of more accurate markers predicting ongoing disease, it will be possible to evaluate a whole range of early interventions in the future. Much evidence, though indirect, points to the possibility that the only true prophylaxis that will affect the natural history of asthma will need to be commenced before clinical features are manifest.

Asthma↗
PubMed2000

[Lyme disease in Upper Normandy: report of a hospital survey].

This study presents the results of a hospital survey on Lyme disease in children living in upper Normandy, a region that is quite densely wooded (with 18% forest areas and woods). The aim of this survey was to assess the prevalence of this disease in children from the Seine-Maritime and L'Eure, hospitalized in pediatric wards in the Seine-Maritime department, which includes Rouen, Dieppe, Fécamp, Elbeuf, and Le Havre. Fifteen cases of Lyme disease were diagnosed between September 1988 and June 1997. The children (6 girls and 9 boys) were aged between 5 and 14 years old. Only 7 subjects showed primary symptoms, while secondary symptoms were observed in 12 children. In the study population, a high prevalence (11 out of the 15 children) of neurological disorders was found. The following secondary symptoms were noted: 5 cases of erythema migrans, 2 cases of non-malignant cutaneous lymphocytoma, and 4 cases which in fact had previously displayed primary clinical signs (3 subjects with erythema migrans and 1 subject with non-malignant cutaneous lymphocytoma); 7 cases of uni- or bilateral facial paralysis, the most frequent neurological manifestation with or without lymphocytic meningitis; 1 case of central vestibular syndrome with a hyperalgesic meningoradicular reaction in the vicinity of the tick bite; 1 case of peripheral radicular involvement and intense pain in the left lower limb; 4 cases of ocular disorders (3 diplopias, 1 bilateral conjunctivitis complicated by kerato-uveitis, 1 bilateral complete cecitis). Only 10 child had rheumatological symptoms, i.e., Lyme arthritis of the right knee. Treatment consisted of amoxicillin (10 children) administered at a dosage of 50 to 100 mg/kg/d over a period ranging from 10 days to 1 month, or ceftriaxone (7 children) at a dosage of 50 to 100 mg/kg/d administered intravenously over a period ranging from 8 days to 3 weeks. Two of the children received combined antibiotic therapy, and 5 subjects had adjunct corticotherapy.

Adolescent↗
PubMed2000

[Respiratory distress in pediatric admission and emergency services. Epidemiology and evaluation criteria].

The medical part of the activity in the emergency units increased and has been ascribed to the raised number of infants or children admitted for acute dyspnea. This review is based on the published reports and the experience from the paediatric emergency unit from the Rouen area with 450,000 inhabitants, in France. We put forward the known epidemiological data and discussed the available means for the practitioner, which could help him in the decision to hospitalize. This review suggests that algorithms of treatment and severity evaluations must be set up in paediatric emergency units in order to validate them and specify the children who requires hospitalisation.

Age Factors↗
PubMed2000

Progression from allergic sensitization to asthma.

Asthma is one of the atopic diseases strongly associated with allergy. High aeroallergen exposure in the immediate postnatal period has been associated with higher risk of sensitization and chronic asthma. It is proposed that following in utero allergen sensitization, postnatal high dose allergen exposure localizes inflammation to the airways. In association with adjuvantizing effects of some virus infections, eosinophils and neutrophils are recruited which contribute to epithelial damage and the initiation of the remodelling process. Eventually, the latter processes lead to sufficient airway narrowing to manifest as the first symptoms of asthma. Thus, the immunopathology of asthma is fully established by the time of first symptoms and future strategies will need to identify those at risk of developing the disease before irreversible changes in the airways are established.

Allergens↗
PubMed2000

Long-term outcome of idiopathic pulmonary hemosiderosis in children.

We retrospectively analyzed the long-term outcome of idiopathic pulmonary hemosiderosis (IPH) in 15 children. IPH started at a mean age of 5 years, and the mean duration of follow-up was 17.2 years (range, 10-36 yr). Four patients developed immune disorders, 3 cases of rheumatoid polyarthritis or rheumatoid polyarthritis-like diseases and 1 case of celiac disease. Respiratory outcome showed that 3 patients had severe symptoms: 2 patients developed severe pulmonary fibrosis resulting in major chronic respiratory insufficiency, and 1 patient had severe asthma. Twelve patients (80%) had mild or no respiratory problems and were able to lead a normal life. According to chest X-ray and pulmonary function test data, 4 patients had normal chest X-ray and no evidence of restrictive syndrome, 6 patients had an interstitial pattern on chest X-ray and evidence of restrictive pattern, 1 patient had an interstitial pattern but normal lung function, and 1 patient had a normal chest X-ray but evidence of mixed obstructive and restrictive pattern. Our results show that long-term survival is possible in patients with IPH. Factors of poor prognosis seem to be the presence of antineutrophil cytoplasm antibodies (ANCA) or other autoantibodies. No other clinical or biological predictive factors for prolonged survival were found.

Adolescent↗