Biomedical subjects
B Lirsac
Publications and source records attributed to B Lirsac.
[Question 4-1. Physical rehabilitation in the patient with chronic obstructive pulmonary disease].
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[Evaluation and symptomatic treatment of surinfectious exacerbations of COPD: preliminary study of antibiotic treatment combined with fenspiride (Pneumorel 80mg) versus placebo].
UNLABELLED: Exacerbations of chronic obstructive pulmonary disease (COPD) have an inflammatory component in addition to the possible infectious component. The antiinflammatory properties of fenspiride (Pneumorel(R) 80 mg) should be evaluated in this frequent clinical situation. OBJECTIVES: Assess the supplementary therapeutic benefit provided by fenspiride administered in combination with antibiotics in COPD patients presenting an episode of bronchial infection. PATIENTS AND METHODS: A preliminary randomized placebo-controlled double-blind study was conduced in 7 centers. Patients under 80 years of age of both sexes were included. All patients had COPD and presented a bronchial infection defined as the presence of at least 2 of the 3 criteria defined by Anthonisen. Patients were randomly assigned to group F or group P. Group F received an antibiotic therapy from day 1 to day 11 plus fenspiride (3 x 80mg/d from day 0 to day 30). Group P received the same antibiotic therapy plus placebo. Amoxicillin 500mg plus clavulanic acid 125, 3 tablets/day, was administered in both groups. RESULTS: Thirty-nine patients were included (group F 19 patients, group P 20 patients; 6 women and 33 men; mean age 61.1 +/- 9.8 years). The 3 Anthonisen criteria were present in 79% and 75% of the patients in group F and P respectively (NS). On day 11, expectoration resolved in 39% and 32% (NS) and cough in 44% and 16% (NS) of the patients in groups F and P respectively. Lung auscultation returned to normal in 83% of the patients in group F compared with 47% in group P (p=0.05). A composite clinical score including expectoration cough and auscultation findings showed that 28% of the patients in group F were symptom-free on day 11 compared with 0% in group P (p=0.04). On day 30, the two groups were comparable. CONCLUSION: In this preliminary study of patients with COPD presenting a bronchial superinfection, there was a significant improvement in lung auscultation and in the composite clinical score in patients given fenspiride. Fenspiride was thus found to provide an early clinical benefit.
[What equipment to be chosen, with what criteria, and what requirements?].
The increasing precision of exercise testing modalities has contributing to making it an excellent means of evaluating functional impairment in dyspnea patients. It has become an indispensable diagnostic tool. Interpretation of data acquired during an exercise test depends on the reliability of data collection and the accuracy of the different calculations. The wide variety of available measurement systems (different principles, different methods for measuring lung volumes and ventilatory flow, canalization systems and valves, analyzers) and data processing systems, and the presence of very simple or on the contrary very complicated systems emphasizes the importance of determining quality requirements used for selecting equipment.
[Cardiopulmonary exercise test in cardiology].
In the cardiopneumologic exercise test, a concomitant analysis of respiratory gas exchange is conducted in addition to the usual cardiologic exercise test: After excluding patients with the habitual contraindications, the test must be conducted with a rigorous methodology, with particular care being given to standardizing the equipment settings before each test and in choosing an individualized protocol allowing a maximal test for a duration of no longer than 10 to 12 minutes. This cardiopneumologic exercise test allows a good assessment of the pneumological pathophysiological factors participating in limited exercise capacity of cardiac origin. It can also help the clinician distinguish cardiac from pulmonary dyspnea, particularly by measuring ventilatory reserves at maximum effort. Most importantly, in clinical practice the test provides an objective and reproducible assessment of the patient's exercise capacity. This allows a functional classification useful for therapeutic decision making, as for example when determining the best moment to propose heart transplantation or when prescribing adapted exercise retraining for a heart failure patient. Finally, the exercise test provides objective evidence of symptom improvement, for example after rehabilitation, an improvement which is one of the mainstay objectives of treatment in patients with cardiac-related exercise intolerance.
[Randomized evaluation of two teaching methods using aerosol dosers].
The administration of antiasthmatic drugs by pressurised aerosols is limited by the difficulties of the inhalation technique. The development of teaching aids may help their use. The aim of this study was to assess and to compare 2 educational methods of inhalation: a standardised inhalation card and a video film. Forty five asthmatic patients who were poor coordinators were separated randomly into 3 groups: education by card, education by video film and a third group served as a positive control and had been educated by video film and also an additional education in a room set aside for teaching inhalation techniques. The FEV1 (VEMS) had been read before the education session and 15 days after, and on each occasion before and after inhalation of a beta-2-mimetic. An inhalation score was measured on the same date. The 2 educational methods enabled an improvement in the score to be shown which was more marked in the video group than in the card group. The VEMS (mean + or - one standard deviation) before inhalation of beta-2-mimetics was significantly superior to J15 in relation to J1 in the video group (2.38 +/- 0.84 and 1.89 +/- 0.61 respectively) and in the control group (2.05 +/- 0.81 and 1.71 +/- 0.66 respectively) whilst the values did not differ in the card group (2.09 +/- 0.63 and 2.01 +/- 0.7 respectively). This study suggests the value of education of these patients and the superiority of video education in relation to reading a standardised card in the optimisation of treatment administered by the inhaled route.