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Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥8 days/month) asthma-like symptoms or recurrent (≥2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.L’asthme fait souvent son apparition avant l’âge de six ans. Cependant, il subsiste des incertitudes relativement à quand et comment un enfant d’âge préscolaire ayant des symptômes de type asthmatique peut être diagnostiqué avec cette condition. Ceci retarde le traitement et contribue à la morbidité à court et à long terme. L’Assemblée clinique sur l’asthme de la Société canadienne de thoracologie s’est associée à la Société canadienne de pédiatrie pour créer un groupe de travail conjoint afin de préparer un document de principes sur le diagnostic et la prise en charge de l’asthme chez les enfants d’âge préscolaire. En l’absence de mesures de la fonction pulmonaire, le diagnostic d’asthme devrait être envisagé chez les enfants de un à cinq ans ayant des symptômes de type asthmatique fréquents (≥8 jours/mois) ou des exacerbations récurrentes (≥2) (épisodes accompagnés de signes compatibles). Le diagnostic nécessite une documentation objective des signes cliniques ou un compte rendu parental convaincant de symptômes d’obstruction des voies respiratoires et de réversibilité de l’ obstruction (amélioration suite à un traitement pour l’asthme), ainsi que l’absence de suspicion clinique de tout autre diagnostic. La respiration sifflante, souvent accompagnée de difficultés respiratoires et de toux, est le signe cardinal de l’obstruction des voies respiratoires. La réversibilité à la suite de la prise de médicaments pour l’asthme se définie par l’observation directe par un professionnel de la santé compétent, d’une amélioration après l’administration de ß

Allergy is a hypersensitivity reaction induced by immunological mechanisms. In asthma, allergy has a complex role and is usually IgE mediated. Allergy must be evaluated during the work up but evidence of IgE sensitivity does not mean that allergens play a role in the pathophysiology of the disease. The clinical relevance of the sensitivity has to be considered. This paper describes current available tools to screen for IgE sensitivity, allergen exposure and their role in asthma.

This paper reports the French data from a post-hoc analysis of the international IDEAL study, which aimed to describe a recent cohort of patients with severe asthma, the impact of the disease on quality of life, as well as the population of patients eligible for treatment with omalizumab, mepolizumab and reslizumab.Eligible patients were≥12 years of age, with severe asthma (GINA steps 4 and 5).A total of 129 patients were included in this post-hoc analysis. Their mean age was 53 years, the majority were overweight, they were mainly women (64%) and had at least one medical comorbidity (85%). More than half had suffered from asthma for more than 25 years and were non-smokers. Lung function was moderately impaired. Blood eosinophil count was≥150 cells/μL in 66% of patients,≥300 cells/μL in 34% of patients, and≥500 cells/μL in 12% of patients. One out of three patients was currently treated with omalizumab and 24% had maintenance oral corticosteroids. Asthma was poorly controlled with a negative impact on quality of life (ACQ≥1.5) in 67% of patients. In this population 40% of patients were eligible for omalizumab, 27% for mepolizumab and 2% for reslizumab.These findings show that a considerable proportion of patients with severe asthma remain uncontrolled and are not eligible for any of the available biological treatments. This underlines the need for therapeutic innovations in this disease.

International audience; The study described in this paper highlighted the participatory design process (PD) in the context of asthma e-learning. First, we described global process to design this tool named KidBreath. Second, we evaluated in two Year 4 classes its efficacy in a motivation way, usability, disease knowledge and interests of children by their system. Results showed, in acceptance with behaviors, high level of intrinsic motivation when using KidBreath, usability and enjoyment of edutainment activities. This pilot study tends to confirm to continue with this approach with asthma kids at home.; L'étude décrite dans cet article met en exergue l'intérêt d'une approche de conception participative (CP) dans le cadre d'un apprentissage en ligne sur l'asthme pour les enfants. Après avoir décrit l'ensemble de la démarche pour la conception de cet e-learning nommé KidBreath, nous évaluons dans 2 classes de CE2 son efficacité au niveau motivationnel, utilisabilité, connaissance sur la maladie et émergence de l'intérêt que les enfants y portent à travers la curiosité qui en émerge. Les résultats, probants aux comportements observés, montrent un haut niveau de motivation intrinsèque pour utiliser l'outil, un fort taux d'utilisabilité et une grande satisfaction des activités ludo-éducatives. Cette étude pilote nous confirme de continuer dans cette approche en testant le système notamment auprès des enfants asthmatiques sur du moyen terme.

Rhinitis and asthma are common diseases that are strongly linked from both the epidemiological and patho-physiological point of view. A precise aetiological diagnosis is required in order to optimize treatment. Nasal provocation tests (NPT) determine precisely the role of the allergen in the initiation of the symptoms of rhinitis particularly when the history does not produce convincing evidence of the clinical relevance of an allergen. It may also have important consequences for the choice of an allergenic immunotherapy. NPT are not standardized but simple methods based on international recommendations provide us with good diagnostic accuracy. In this paper, we will discuss the practical aspects of NPT as well as the clinical or research situations where they may be useful for the respiratory physician.

Introduction : Asthma is the most common chronic disease in children. Patient education is a key point to improve asthma control, but few of them have access to. We have decided to develop a support for the asthmatic child caregivers to improve their understanding of asthma. This support would be proposed during a visit in an emergency department for asthma exacerbation. The main objective was to ask to health professionals and caregivers to elaborate an adapted support. Material and methods: Qualitative study by semi directive interview. Population was composed with health professionals in contact with asthmatic children and asthmatic children caregivers. Results: inclusion of 18 health professionals with different ages and specialties and 10 caregivers. The most of them was interested in an educational support creation. Caregivers require a digital tool, health professionals were more reserved on the digital and also offer paper. Videos were acclaimed by both categories. The content was to approach asthma symptoms, crisis’ severity signs, a written asthma action plan for both categories. The caregivers asked more help in crisis management. Professionals focused on inhalation techniques and comprehension about physiopathology. A link to the patient education structures was proposed. Conclusion: Considering the technological development and the use of caregivers, a website seems inevitable, especially there are few sites dedicated to asthma for caregivers. This site should target needs’ caregivers and in other hand, respect the professionals’ considerations. This study will help developing a pedagogic support more efficient as the substance and form to asthmatic children caregivers., Introduction : L’asthme est la maladie chronique la plus fréquente chez l’enfant. L’éducation thérapeutique est un point essentiel d’amélioration du contrôle de l’asthme, mais peu d’entre eux y ont accès. Nous avons envisagé de développer un support destiné aux familles d’enfant asthmatique pour améliorer leur compréhension de l’asthme. Cet outil serait proposé pendant une consultation aux urgences pour exacerbation d’asthme. L’objectif principal était de questionner les professionnels de santé et les familles d’enfant asthmatique pour permettre d’élaborer un support adapté. Matériels et méthodes : Étude qualitative par entretiens semi-dirigés. La population cible était composée de professionnels de santé en contact avec des enfants asthmatiques et de familles d’enfant asthmatique. Résultats : Inclusion de 18 professionnels de santé de mode d’exercices et d’âge différent! s, et de 10 familles. La majorité des professionnels et des familles était intéressée par la création d’un support pédagogique. Les familles demandaient un outil numérique, les professionnels étaient plus réservés sur le numérique et proposaient également un support papier. Les vidéos ont été plébiscitées par les deux catégories. Le contenu du support devait aborder les symptômes de l’asthme, les signes de gravité d’une crise, le plan d’action pour les deux catégories. Les familles demandaient une aide supplémentaire à la prise en charge d’une crise. Les professionnels insistaient sur les techniques d’inhalation et la compréhension de la physiopathologie. Un lien vers les structures d’éducation thérapeutique a été proposé. Conclusion : Compte tenu de l’évolution technologique et de l’utilisation des familles, un site internet semble incontournable, d’autant plus qu’il n’existe que peu de sites dédiés à l’asthme destinés aux familles. Ce site devra se tourner vers les besoins des familles tout en prenant compte des observations des professionnels de santé. Cette étude permettra donc de développer un support pédagogique plus adapté autant sur le fond que sur la forme aux familles d’enfants asthmatiques.

Perthes syndrome, or traumatic asphyxia syndrome, is a rare clinical entity, associating cyanosis, cervicofacial petechiae and subconjunctival hemorrhage. It is usually secondary to chest trauma, but can occur in any situation of abrupt rise in intrathoracic pressure with closed glottis. In this paper, we present a case of Perthes syndrome that triggered an asthma attack for a child during surgery.