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Biomedical subjects

P Godard

Publications and source records attributed to P Godard.

At least 19 recordsLinked to original sources
PubMed2006

Are overweight asthmatics more difficult to control?

The relationship between asthma and obesity appears to be quite complex. The aim of this study was to assess the effect of excess weight on asthma control evolution in a cohort of asthmatics. A prospective database was set up, which enrolled adult asthmatics with persistent (mild, moderate or severe) asthma. The control of asthma was defined as a binary variable, acceptable or unacceptable. In order to evaluate the effect of body mass index (BMI; <25 or > or =25), data were analysed using a continuous time homogeneous Markov model in which the forces ruling the transition between the two health states were estimated. The following confounding covariates were also evaluated in the model: severity of asthma, current treatment with oral corticosteroids (OCS) and history of OCS over the year preceding inclusion. About 406 asthmatics were included who made a total of 1639 consultations; the median length of follow up was 182 days. Using a univariate model, overweight patients had a lower risk of transiting from the unacceptable to the acceptable health state (RR = 0.45; P < 0.01). The effect of weight remained significant (RR = 0.53; P < 0.01) in the multivariate model including the other covariates. Moreover, transition probabilities stabilized more rapidly for patients with BMI < 25 (200 vs 300 days). In this study, we thus demonstrated that there is an association between excess weight and transition from unacceptable to acceptable control. Because control of asthma clearly drives asthma management, this finding has consequences for defining original new strategies for managing asthma in overweight patients.

Adrenal Cortex Hormones↗
PubMed2006

Nitrogen washout slope in poorly controlled asthma.

Short-term control of asthma is often lacking even though forced expiratory volume in 1 s (FEV1) remains above normal value. Small airways are a potential key site of persistent inflammation and structural modification. Noninvasive assessment of small airways was found to be difficult, but the computerized single breath nitrogen washout test (SBNT) has been recently successfully reintroduced with this aim. Twenty-four asthmatics (13 females) of various severity but with normal FEV1 were compared with 24 healthy volunteers (13 females) and studied at steady-state after bronchodilatation (400 microg salbutamol). Spirometric values, plethysmographic data, phase III (slope of phase III of the SBNT, dN2) and IV [closing volume (CV), with closing capacity (CC) = CV + residual volume (RV)] of the SBNT were checked. Asthma severity, recent control, exacerbation rate, and therapy requirements were assessed on the basis of validated questionnaires (ACQ) and international guidelines. Patients were prospectively pooled into two equal groups according to their exacerbation rate. The reproducibility of the measurements obtained on 2 following days was assessed. All plethysmographic values, except total lung capacity (TLC), differentiated asthmatic patients from controls. The CC/TLC [124 (117-148) vs 117 (112-123), P = 0.04] and dN2 [110 (99-190) vs 94 (75-111), P = 0.02] were increased in asthma. The dN2 was significantly increased in patients with frequent exacerbations [100 (83-105) vs 195 (141-212), P = 0.0005]. A correlation was obtained between dN2 and recent asthma control (rho: 0.62; P = 0.003), number of exacerbations (rho: 0.71, P = 0.0008), and RV/TLC (rho: 0.49, P = 0.026). This study demonstrated that ventilation inequalities assessed by dN2 represent an important indicator of poor asthma control and high exacerbation rate in high symptom perceivers. New therapies focused on small airways should now be developed.

Adolescent↗
PubMed2005

[Asthma control in general practice: a cross-sectional survey of 16,580 patients].

INTRODUCTION: Little information is available about asthma control in patients followed by general practitioners care in France, although such control is one of the essential aims of their treatment. OBJECTIVES: The ER'Asthme survey sought to assess asthma control among patients visiting their general practitioner (GP) and to determine the factors associated with it. METHODS: This cross-sectional included patients with asthma diagnosed at least 12 months earlier, aged more than 6 years, and followed by a GP. It collected data on self-assessed health status, asthma control (assessed by a 3-level composite score based on the Canadian consensus criteria as adapted by ANAES: optimal, acceptable and unacceptable), and compliance. RESULTS: The study included 16,580 patients; 85% were older than 20 years, and 54% were male. Patients answered the question about their asthma control as follows: 53% "excellent" or "fine", 39% "not very good" and 8% "poor". GPs, however, assessed asthma control as optimal in 21% of patients, acceptable in 7% and unacceptable in 72%. Concordance between these two assessments was thus poor: Kappa coefficient 34.5% (95% CI [33.5%; 35.5%]). Only 59% of patients reported complete compliance with their maintenance treatment. Factors associated with optimal control were: use of fixed combination therapy (inhaled corticosteroid+long-acting beta-agonist) (OR: 3.7; 95%CI [3.5; 4.2]) normal BMI (OR: 2.4; 95%CI [2.0; 2.9]), non-smoker status (OR: 2.4; 95%CI [2.1; 2.8]), age<50 (OR: 2.3; 95%CI [2.1; 2.6]) and good compliance (OR: 1.6; 95%CI [1.5; 1.8]). CONCLUSION: Patients with asthma overestimate their asthma control, which often remains inadequate. Maintenance treatment with a fixed combination, BMI, smoking, age and compliance all influence the level of asthma control.

Adolescent↗
PubMed2005

[Economic burden of COPD: the SCOPE study].

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a major health problem. Few data about COPD economic burden are available. METHODS: SCOPE was an observational economical retrospective and prospective study conducted in France in 2001, by 114 general practitioners (GPs) and 57 lung specialists. The aim was to describe the burden of COPD patients and to estimate the annual cost according to severity stages. Health resource utilization was collected by questionnaires over a 12-month period for 285 patients. RESULTS: It was a cost-of-illness analysis. COPD patients followed by a lung specialist were more severe than patients followed by a GP and had a higher level of medical resource consumption. The COPD disease and its complications explained 66% of the total cost. The main cost drivers were inpatient care (35%, or 1509,9 euros/year/patient) and prescription medications (31%, or 1340,6 euros/year/patient). The direct total cost varied according to COPD severity on account of inpatient care and respiratory assistance. DISCUSSION: This study confirmed the economic burden of COPD in France. Actions allowed to slow down the disease's evolution and to anticipate the exacerbation could reduce the cost.

Aged↗
PubMed2005

Effect of endurance training on lung function: a one year study.

OBJECTIVE: To identify in a follow up study airway changes occurring during the course of a sport season in healthy endurance athletes training in a Mediterranean region. METHODS: Respiratory pattern and function were analysed in 13 healthy endurance trained athletes, either during a maximal exercise test, or at rest and during recovery through respiratory manoeuvres (spirometry and closing volume tests). The exercise test was conducted on three different occasions: during basic endurance training and then during the precompetition and competitive periods. RESULTS: During the competitive period, a slight but non-clinically significant decrease was found in forced vital capacity (-3.5%, p = 0.0001) and an increase in slope of phase III (+25%, p = 0.0029), both at rest and after exercise. No concomitant reduction in expiratory flow rates was noticed. During maximal exercise there was a tachypnoeic shift over the course of the year (mean (SEM) breathing frequency and tidal volume were respectively 50 (2) cycles/min and 3.13 (0.09) litres during basic endurance training v 55 (3) cycles/min and 2.98 (0.10) litres during the competitive period; p < 0.05). CONCLUSIONS: This study does not provide significant evidence of lung function impairment in healthy Mediterranean athletes after one year of endurance training.

Adult↗