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C Raherison

Publications and source records attributed to C Raherison.

35 records · Page 2Linked to original sources
PubMed2003

Respiratory symptoms in children and exposure to pesticides.

In Lebanon, childhood asthma is an important disease and pesticides are commonly used. The objective of this study was to evaluate whether exposure to pesticides has chronic effects on the respiratory health of Lebanese children. A cross-sectional study was performed on children from a randomly selected sample of Lebanese public schools. Exposure to pesticides was evaluated by a standardised questionnaire and a residential exposure score, and respiratory symptoms were assessed by using the American Thoracic Society standardised questionnaire. A chronic respiratory disease was reported in 407 (12.4%) out of 3,291 children. The baseline difference in mean age was small but statistically significant. Any exposure to pesticides, including residential, para-occupational and domestic, was associated with respiratory disease and chronic respiratory symptoms (chronic phlegm, chronic wheezing, ever wheezing), except for chronic cough. Exposure to pesticides was associated with chronic respiratory symptoms and disease among Lebanese children.

Adolescent↗
PubMed2003

Asthma phenotypes according to the timing of smoking onset in young adults.

SETTING: Whether and how cigarette smoking influences asthma are still matters of debate. OBJECTIVE: To identify risk factors associated with asthma according to whether individuals began active smoking before or after asthma onset. DESIGN: A sample of 544 individuals was examined using the protocol of the European Community Respiratory Health Status, Phase 1. RESULTS: Current active smoking (43.6%) was associated with wheezing during the past year (15.2%, OR 3.7; 95% CI 1.7-8.4), but not with asthma (17.6%, OR 0.78; 95% CI 0.48-1.26). However, active smoking modulated risk factors for asthma. Asthma that developed before smoking and asthma without smoking were both significantly related to nasal allergy, parental asthma and atopy (as assessed by skin prick test positivity and increased total and specific IgE levels). Only a lower FEV1 level was significantly associated with asthma that initiated after beginning smoking. CONCLUSIONS: Our data put forward different phenotypes of asthma according to the timing of smoking onset and suggest that asthma either never accompanied by smoking or followed by smoking onset might be characterised by an allergic pattern. Longitudinal studies are warranted to further clarify the relationships among asthma phenotypes according to the sequence of disease onset and smoking.

Adult↗
PubMed2003

[Anti-IgE and future treatments for respiratory allergies].

Immediate hypersensitivity remains the fundamental mechanism of respiratory allergy, emphasizing the importance of the antigen-immunoglobulin (IgE) reaction. Development of innovating treatments has naturally centered on a search for compounds inhibiting the IgE response, in particular anti-IgE antibodies. Humanized anti-IgE antibodies have been recently developed for administration in humans. These antibodies are designed to form complexes with circulating IgE which can be eliminated. The first trials have demonstrated an efficacy in allergic asthma, expressed by a significant decrease in consumption of systemic steroids in severe asthma. Other work has also showed a lower number of hospitalizations for acute asthma. Other therapeutic approaches have focused on limiting the production of IgE by an effect on the auxiliary lymphocyte balance, or more generally, by inhibiting the Th2 response while favoring the Th1 response. Early results obtained with anti-IL-5 were disappointing since the decrease in the eosinophilic response was not associated with any alteration in bronchial hyperreactivity. Administration of IL-12 has given similar results but the first trials with nebulized anti-IL-4 are more promising.

Antibodies, Anti-Idiotypic↗
PubMed2003

[Smoking, asthma and associated phenotypes. An epidemiological approach].

INTRODUCTION: The relationship between the respiratory tract and the environment is complex and is based on the dynamic interaction between genetically determined host-defence mechanisms and the toxicity of inhaled pollutants. STATE OF ART: Although the World Health Organisation has decreed that smoking is an avoidable cause of premature death, the epidemiological evaluation of the effects of smoking remains problematical. Indeed, basing assessment on duration of habit and quantity smoked may be miscalculating the true burden of the effects of smoking. Smoking, as a risk factor, is all too often perceived to be confined to development of chronic obstructive pulmonary disease. The consequences of passive smoking on children respiratory health have been established. In adults, active smoking has been related to asthma severity. Recent data demonstrate an effect of passive smoking on the incidence of asthma in adults. PERSPECTIVES: Objective markers of smoking are rarely used in epidemiological studies of asthma. CONCLUSIONS: However, the paucity of published studies linking smoking with asthma should not immediately lead to the conclusion that there is not a causal relationship.

Air Pollutants↗
PubMed2003

[Validation of an asthma knowledge questionnaire].

INTRODUCTION: A patient's knowledge of his disease and its treatment is an essential part of the evaluation of an educational process. It is useful therefore to use a rapid, easy and valid means of collecting the information necessary to produce an educational programme adapted to the needs of the patient. METHODS: Following a review of the literature an initial questionnaire was constructed. It included four domains: biomedical, signs and symptoms of severity, general knowledge and treatment. The questionnaire was administered to 73 asthmatics in order to assess its clarity and comprehensibility. It was then reviewed and modified in both format and content by 10 French experts. The revised questionnaire was completed by 108 asthmatics distributed throughout 10 French respiratory centres, a group of 83 non-asthmatic subjects and 203 sixth year medical students at the Bordeaux University School of Medicine. RESULTS: The mean scores were: 19 for the non-asthmatics (range 2-36), 25.7 for the asthmatics (range 4-38) and 32.9 for the students (range 17-40), p 0.0001. The questionnaire was shown to be discriminating with good reliability and reproducibility: alpha Cronbach coefficient=0.82; intra-class correlation coefficient=0.70. CONCLUSIONS: This study has validated a French language asthma knowledge questionnaire.

Adolescent↗
PubMed2002

Acute asphyxia caused by Gerhardt's syndrome associated with asthma.

Vocal cord dysfunction (VCD) has been frequently discussed as confounding the diagnosis of asthma, and it is recommended to examine vocal cord function in cases of difficult asthma. However, there is also strong evidence that asthma may be associated with VCD, sometimes masquerading as exercise-induced asthma. Gerhardt's syndrome frequently induces severe acute respiratory distress requiring ventilatory support, and this condition might be mistaken for a severe acute asthma attack. Here, a case of bilateral paralysis of the vocal cords, which was associated with asthma, is described.

Acute Disease↗
PubMed2002

Management of lower respiratory tract infections by French general practitioners: the AIR II study. Analyse Infections Respiratoires.

The Analyse Infections Respiratoires (AIR) II study is a prospective, multicentre survey of the management of lower respiratory tract infections in patients aged 15-65 yrs by general practitioners (GPs) in France. To obtain real-time data recording, practitioners were required to submit an anonymous copy of their drug prescriptions. They were then interviewed over the telephone about the patients' sociodemographic data, signs and symptoms, as well as their presumptive diagnosis and the investigations they had decided upon. GPs (n=3,144) reported 5,469 evaluable cases. Pneumonia accounted for 9.6% of diagnoses, acute exacerbations of chronic bronchitis 14.9% and acute bronchitis 72.5%. The symptomatology covered an extremely wide range of clinical features, which, although statistically different in terms of incidence, overlapped to a large extent across diagnoses. By contrast, hospitalization, investigations or referral to a specialist were much more prevalent in pneumonia, although still very infrequent in general terms (0.5, 1.2 and 10.8%, respectively). Antibiotics were prescribed in 96.5% of patients, with minor differences between diagnoses. However, other medications such as nonsteroid, anti-inflammatory drugs, steroids, nonspecific antitussives and bronchial liquefiers accounted for two-thirds of the prescriptions. This study demonstrates the lower respiratory tract infections encountered by general practitioners are usually mild. However, antibiotic prescription was more systematic than in previous studies and the prescription of nonspecific symptomatic treatments was twice as frequent. General practitioners did not perform additional examinations or refer on a regular basis. There was a high prescription rate for symptomatic treatment.

Adult↗
PubMed2002

[Impact of smoking habits on the every day life of asthmatic adolescents].

The impact of asthma on every day life is an important consideration in asthma management. Tobacco use often starts during adolescence, but little is known about its effect on the asthmatic process. The aim of this study is to describe the impact of smoking habits on the every day life of adolescents with asthma. A survey of respiratory symptoms in children aged 13-14 years was conducted in Bordeaux France as part of the International Study of Asthma and Allergies in Childhood (ISAAC). 494 out of the 3.302 adolescents surveyed had a diagnosis of asthma. They filled in a further questionnaire on smoking habits and on the impact asthma had on their every day life. Respiratory symptoms were more frequent among current smoking asthmatic adolescents than non-smoking asthmatic adolescents. The impact of asthma on daily life, with implications for performance at school, family life, psychological status and future job prospects were different for smokers and non-smokers, with problems more prevalent for active smoking asthmatic adolescents. In a multiple regression analysis with confounding factors adjustment, school absence was reported more often in active smokers. Active smoking has an important impact on the every day life of asthmatic adolescents.

Absenteeism↗
PubMed2002

[Does the presence of a pet at home influence the prevalence of asthma and rhinitis?].

INTRODUCTION: Recent epidemiological studies have shown an increase in the prevalence of asthma and allergic diseases. Among aetiological factors, the domestic environment and, in particular, pet ownership may be a part of it. The relationship between severity of asthma and pets is still unclear. The aim of this study was to evaluate the relationship of asthma and rhinitis prevalence in teenagers with pet ownership. PATIENTS AND METHODS: ISAAC I studied 3,303 teenagers (13-14 years old) in Bordeaux in 1994. They completed a written questionnaire about asthma, rhinitis, eczema and their domestic environment. Four groups (asthmatics, asthmatics with rhinitis, teenagers with only rhinitis and a control group without asthma and rhinitis) were studied. RESULTS: 4.6% had only asthma. 43.2% had only rhinitis. 10.3% had asthma and rhinitis, 41.7% had no allergic disease. 34.9% kept a cat and 79.4% allowed the cat to go inside. No difference was found between the four groups with regard cat, dog, bird or other pet ownership irrespective if the pet was kept in-doors or out doors. The prevalence of previous asthma was 45.8% and 50.3% for current asthma. No difference was found between the severity of asthma and pet ownership. CONCLUSIONS: This is an epidemiological study based on a written questionnaire. Furthermore there is no data on the presence of pets during the first year of life. However, our results suggest that pet ownership amongst asthma and rhinitis sufferers is not different to that in the group without allergic disease.

Adolescent↗
PubMed2001

Spontaneous pneumothorax: pragmatic management and long-term outcome.

We prospectively considered 65 patients admitted for a spontaneous pneumothorax (SP) to describe the pragmatic management of SP, the first recurrence-free interval after medical therapeutic procedure and to specify the first recurrence risk factors over a 7-year period in these patients treated medically. The treatment options were observation alone (9%), needle aspiration (6%), small calibre chest tube (Pleurocatheter) drainage (28%) or thoracic tube drainage (49%), and pleurodesis with video-assisted thoracic surgery procedure (8%). Duration of the drainage and length of hospital stay were shorter in the Pleurocatheter group than in the thoracic tube group (P < 0.01). Among the 47 patients (72%) with a first SP and treated medically, nine patients (19%) had a first homolateral recurrence (FHR) during a mean follow-up of 84+/-13 months. Recurrence-free intervals ranged from 1 to 24 months (mean +/- SD: 9.3+/-8.4 months). FHR cases were more frequent in the Pleurocatheter group (P < 0 04). Analysis of potential risk factors showed that the patient's height and a previous homolateral SP episode are independent recurrence risk factors.

Adolescent↗
PubMed2001

[Mediastinal sarcoidosis and vascular thrombosis: a fortuitous association?].

A 43-year-old woman presented with a recent history of intermittent dyspnea with wheezing. The chest x-ray evidenced mediastinal nodes. A CT scan showed vascular embolism. Mediastinoscopy was performed and pathology examination of the node confirmed the diagnosis of sarcoidosis. The patient responded to corticosteroid and anticoagulation therapy. Is this a fortuitous association? A vascular localization of sarcoidosis? Thrombosis by compression?

Adrenal Cortex Hormones↗
PubMed2000

Functional significance of air trapping detected in moderate asthma.

The aim of this study was to evaluate bronchial and lung abnormalities in patients suffering from moderate asthma as defined by international guidelines, with special attention to air trapping on CT in comparison with that detected in smoking and non-smoking normal subjects. Twenty-two patients classified as moderate asthma and control subjects including healthy volunteers, smokers (n = 10) or non-smokers (n = 12) were prospectively explored by high-resolution CT (HRCT) performed at suspended full inspiration and expiration. The same expiratory protocol was performed 15 min after inhalation of 200 microg of salbutamol. Patients underwent pulmonary function tests within the same week and bronchodilator response was assessed following inhalation of salbutamol. Abnormalities of bronchi and lung parenchyma on inspiratory CT and air trapping on expiratory CT, in dependent and non-dependent areas, were assessed and scored semi-quantitatively by two independent observers. Comparison of score mean values between the different groups was performed using Mann-Whitney test and Spearman correlation between CT findings and pulmonary function tests were calculated. Mosaic perfusion was observed in 23% of asthmatics. Air-trapping scores were significantly higher in asthmatic patients than in non-smoking control subjects (p = 0.003), but not than in smokers. This difference was ascribed to non-dependent zones of the lung for which air-trapping scores were also higher in asthmatic patients (p = 0.003) and in smoking subjects (p = 0.004) than in normal controls. In the asthmatic group, a significant positive correlation was found between airways resistance and bronchial dilatation score (p = 0.01), and between small airways obstruction index and mosaic perfusion score (p = 0.05). In addition, both FEV1 and reversibility of small airways obstruction values correlated with air-trapping score (p = 0.03 and p = 0.007, respectively). No change could be detected in air-trapping score following salbutamol inhalation. Patients suffering from moderate asthma present mosaic perfusion and larger areas of air trapping than normal subjects, particularly in non-dependent areas of the lung. These lung abnormalities are related to small airways obstruction.

Administration, Inhalation↗
PubMed2000

Practical evaluation of asthma exacerbation self-management in children and adolescents.

The objective of this study was to describe asthma exacerbation self-management in children and adolescents. We used a cross-sectional study population enrolled in the International Study of Asthma and Allergies in Childhood (ISAAC) in Bordeaux. Subjects answered an additional questionnaire on utilization of health services, self-evaluation of usual asthma exacerbation severity and home management of asthma exacerbation. Criteria used for selecting patients were both having asthma confirmed by a physician and having had suffered from symptoms during the past year. Children and adolescents attended similar health services for managing their asthma but compliance to anti-asthmatic treatment was better in children than in adolescents. Among the children 4.8% had asthma and 6.2% of adolescents had asthma, as diagnosed by a doctor. Of the children, 72.3% and of the adolescents 54.7% had less than one asthma attack per month. In cases of mild asthma exacerbation, 38.7% of adolescents and 9.3% of children waited until the end of exacerbation without taking any medication. The proportion of children not receiving any treatment was lower when symptoms were more severe but this was not the case in adolescents. Although most of the patients used were taking beta2-agonist, we found that 21-43% of children or adolescents did not receive appropriate medication in the event of asthma exacerbation. These results demonstrate that (i) asthma exacerbation self-management is related to self-assessed severity of symptoms and that (ii) a large proportion of asthmatic children in the community, and particularly adolescents, do not therefore receive appropriate treatment in the event of asthma exacerbation.

Acute Disease↗
PubMed2000

[Epidemiology of respiratory allergies: current data].

Respiratory allergic diseases include seasonal allergic rhinitis or hay fever, perennial allergic rhinitis and allergic asthma. Prevalence of asthma is difficult to assess through epidemiological questionnaires. In France hay fever roughly affects 6% of children and 18% of teenagers and nasal allergies, more than one fourth of young adults. Prevalence of asthma is equal to 10 to 15% in teenagers and 7 to 9% in young adults. Risk factors include genetic as well as environmental factors. The role of the former have been exemplified in family studies, especially twin studies, and surveys of inbred populations. Environmental factors can be allergic or non-allergic. The influence of allergenic exposure on sensitization, occurrence and severity of respiratory allergic disease is well documented. The triggering influence of non-allergenic factors on established allergic diseases is also clear. In contrast, their implication in allergic sensitization and occurrence of allergic diseases need to be clarified.

Adult↗
PubMed1999

[Evolution of the management of lung diseases in general medicine in Bordeaux (1992-1995)].

Lower respiratory tract infections (LRTI) are very often managed by General Practitioners (GPs). In France, the 1991 Lille Consensus Conference set out guidelines for the management of respiratory tract infections; in 1994, the Ministry of Health published Official Medical Recommendations (OMR) to be applied to seasonal respiratory infections. The aim of the study is to evaluate the impact of these OMR in 1995 on GPs' attitude when confronted with a community-acquired pneumonia in a previously healthy 40-year-old adult, with no sign of complications. Sixty seven GPs took, part in the same study by questionnaire in 1992 and 1995; we observed an increase in the prescription of aminopenicillin without a beta-lactamase inhibitor (41% in 1992 vs 66% in 1995; p = 0.009), and a reduction in both the use of aminopenicillin with a beta-lactamase inhibitor (35% in 1992 vs 11% in 1995; p = 0.002) and the concomitant prescription of cortico-steroids (43% in 1992 vs 14% vs 14% in 1995; p = 0.0009). Between 1992 and 1995, general practitioners in the Bordeaux region have changed their therapeutic choices in community-acquired pneumonia. In 1995, antibiotic prescriptions followed consensus guidelines more closely.

Adult↗
PubMed1998

[The patient's representation of asthma. Preliminary results of a survey].

There is often a discrepancy between doctors' and patients' points of view on asthma. However, few studies have been devoted to the patients' representation of asthma. In this study 27 subjects, with moderate asthma, had to choose from a list of 35 groups of words and expressions, those which look to them to best evoke asthma. The results of this descriptive study show that "allergy" is the most frequently chosen term associated by patients with "suffocate", "attack", "heredity", and "psychic". Asthmatic patients minimise disease severity and refuse to be categorised as ill; they reject terms stigmatising asthmatic subject and the dangerousness of their disease. However, they recognise that asthma has psychological repercussions and prefer self-care. They consider drugs as dangerous and are afraid of their addiction and toxicity. These results have implications on information and education of asthmatic patients. To identify, for each patient, what is his/her representation of his/her disease would be very useful to provide patients with an adapted and personalized help for the management of his/her disease.

Adult↗