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ObjectiveTo determine whether changes in pulmonary vascular resistance (PVR) and changes in pulmonary artery compliance (Cpa) are associated with changes in exercise capacity assessed either by changes in peak oxygen consumption (V′O2) or by changes in 6-min walk distance (6MWD) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing balloon pulmonary angioplasty (BPA).MethodsInvasive haemodynamic parameters, peakV′O2and 6MWD were measured within 24 h, before and after BPA (interval 3.1±2.4 months) in 34 CTEPH patients without significant cardiac and/or pulmonary comorbidities, of whom 24 received at least one pulmonary hypertension-specific treatment.Cpawas calculated according to the pulse pressure method:Cpa=((SV/PP)/1.76+0.1), where SV is the stroke volume and PP is the pulse pressure. The resistance–compliance (RC)-time of the pulmonary circulation was calculated as the PVR andCpaproduct.ResultsAfter BPA, PVR decreased (562±234versus290±106 dyn·s·cm−5; pCpaincreased (0.90±0.36versus1.63±0.65 mL·mmHg−1; pversus0.321±0.083 s; p=0.75). There were improvements in peakV′O2(1.11±0.35versus1.30±0.33 L·min−1; pversus432±100 m; pV′O2or 6MWD, were significantly associated with changes in PVR, but not with changes inCpa.ConclusionsContrary to what has been reported in CTEPH patients undergoing pulmonary endarterectomy, in CTEPH patients undergoing BPA, changes in exercise capacity were not associated with changes inCpa.

International audience

Excessive ventilation (V̇E) during exercise, ascribed to heightened neural ventilatory drive and/or to increased "wasted" ventilation, is a feature of chronic thromboembolic pulmonary hypertension (CTEPH). In selected CTEPH patients, balloon pulmonary angioplasty (BPA) allows near-normalization of resting haemodynamic parameters but does not allow excess exercise hyperventilation to normalize. Neural ventilatory drive can be estimated by studying how arterial PCO

In patients undergoing balloon pulmonary angioplasty (BPA) for inoperable chronic thromboembolic pulmonary hypertension (CTEPH), single-centre series from expert centres have recognized a learning curve for the magnitude of haemodynamic benefits.To report our 7-year experience with BPA, focusing on haemodynamic effects, complication rates and radiation exposure over time.Patients with CTEPH who were treated with BPA between May 2013 and February 2020 were analysed during the 'initial period' versus the 'recent period' (split date: March 2017).Among 192 patients who underwent at least one BPA procedure, 156 were included in the safety/radiation analysis and 119 were included in the efficacy analysis. During the 'recent period' versus the 'initial period', the median [interquartile range] number of procedures per patient was higher (4.5 [4.0-6.0] vs. 4.0 [3.0-4.0]; P=0.03), as was the number of dilated vessels per procedure (4.0 [3.5-5.0] vs. 3.5 [3.0-4.0]; P=0.002). Changes in haemodynamic parameters were also greater (mean pulmonary artery pressure: -22% [-31% to -14%] vs. -37% [-44% to -29%]; P=0.001; pulmonary vascular resistance: -38% [-51% to -8%] vs. -53% [-69% to -33%]; P=0.002); complication rates were similar (5.7% vs. 9.3% of procedures; P=0.38); and radiation exposure was lower (effective dose per patient: 43.9 [31.6-66.5] vs. 67.8 [47.9-101.9] mSv; P0.001).Our analysis is consistent with a learning curve for the magnitude of haemodynamic improvements. The complication rate was low and did not change over time, but radiation exposure decreased.

To assess the results of endovascular treatment in a large population of patients suffering from post-thrombotic syndrome (PTS) due to iliocaval occlusive disease.In this retrospective multi-center study, 698 patients treated by stenting for PTS in 15 French centers were analyzed. Primary, primary assisted, and secondary patency rates were assessed, and clinical efficacy was evaluated using Villalta and Chronic Venous Insufficiency Questionnaire in 20 questions (CIVIQ-20) scores. Outcomes were compared against pre-operative CT-based severity of the post-thrombotic lesions in the thigh (4 grades).Technical success, defined as successful recanalization and stent deployment restoring rapid anterograde flow in the targeted vessel, was obtained in 668 (95.7%) patients with a complication rate of 3.9%. After a mean follow-up of 21.0 months, primary patency, primary assisted patency, and secondary patency were achieved in 537 (80.4%), 566 (84.7%), and 616 (92.2%) of the 668 patients, respectively. Venous patency was strongly correlated to the grade of post-thrombotic changes in the thigh, with secondary patency rates of 96.0%, 92.9%, 88.4%, and 78.9%, respectively, for grades 0 to 3 (p = .0008). The mean improvements of Villalta and CIVIQ-20 scores were 7.0 ± 4.7 points (p .0001) and 19.1 ± 14.8 points (p .0001), respectively.Endovascular stenting as a treatment option for PTS due to chronic iliocaval venous occlusion generates a high technical success, low morbidity, high midterm patency rate, and clinical improvement. Venous patency was strongly correlated to the severity of post-thrombotic lesions in the thigh.

Background Excessive ventilation (VE) and abnormal gas exchange during exercise are features of chronic thromboembolic pulmonary hypertension (CTEPH). In selected CTEPH patients, balloon pulmonary angioplasty (BPA) improves symptoms and exercise capacity. How BPA affects exercise hyperventilation and gas exchange is poorly understood. Methods In this longitudinal observational study, symptom-limited cardio-pulmonary exercise tests and carbon monoxide lung diffusion (DLCO) were performed before and after BPA (interval, mean (SD): 3.1 (2.4) months) in 36 CTEPH patients without significant cardiac and/or pulmonary comorbidities. Results Peak work rate improved by 20% after BPA whilst VE at peak did not change despite improved ventilatory efficiency (lower VE with respect to CO2 output [VCO2]). At the highest identical work rate pre- and post-BPA (75 (30) watts), VE and the ideal alveolar-arterial oxygen gradient (P(Ai-a)O2) decreased by 17% and 19% after BPA, respectively. The physiological dead space fraction of tidal volume (VD/VT), calculated from measurements of arterial and mixed expired CO2, decreased by 20%. In the meantime, DLCO did not change. The best correlates of P(Ai-a)O2 measured at peak exercise were physiological VD/VT before BPA and DLCO after BPA. Conclusions Ventilatory efficiency, physiological VD/VT and pulmonary gas exchange improved after BPA. The fact that DLCO did not change suggests that the pulmonary capillary blood volume and probably the true alveolar dead space were unaffected by BPA. The correlation between DLCO measured before BPA and P(Ai-a)O2 measured after BPA suggests that DLCO may provide an easily accessible marker to predict the response to BPA in terms of pulmonary gas exchange.

International audience; Background: Allergy, the most frequent immune disorder affecting 30% of the world's population, is the consequence of immunoglobin E (IgE) sensitization to allergens. Among the genetic factors suspected to be involved in allergy, the HLA class-II genomic region is a strong candidate.Objective: To assess the association between HLA class-II alleles and specific IgE (sIgE) sensitization to a large number of respiratory allergen molecules.Methods: The analysis relied on 927 participants of the EGEA cohort, including 497 asthmatics. The study focuses on 26 aeroallergens recognized by sIgE in at least 5% of the study population (determined with the MEDALL chip with sIgE ≥ 0.3 ISU) and 23 imputed HLA class-II alleles. For each sIgE sensitization and HLA class-II allele, we fitted a logistic regression model accounting for familial dependence and adjusted for gender, age, and genetic principal components. p-values were corrected for multiple comparisons (False Discovery Rate).Results: Most of the 19 statistically significant associations observed regard pollen allergens (mugwort Art v 1, olive tree Ole e 1, timothy grass Phl p 2, Phl p 5 and plantain Pla l 1), three were mold allergen (Alternaria Alt a 1), and a single one regards house dust mite allergen (Der p 7). No association was observed with pet allergens. The strongest associations were found with mugwort Art v 1 (OR = 5.42 (95%CI, 3.30; 8.88), 4.14 (2.65; 6.47), 3.16 (1.88; 5.31) with DQB1*05:01, DQA1*01:01 and DRB1*01:01, respectively).Conclusion: Our results support the important role of HLA class-II alleles as immune response genes predisposing their carriers for sensitization to various major pollen allergens.

Background: In idiopathic pulmonary fibrosis (IPF), some physiological parameters measured during a 6-min walk test (6-MWT) impart reliable prognostic information. Sit-to-stand tests (STSTs) are field exercise tests that are easier to implement than the 6-MWT in daily practice. Objectives: The aims of the study were to test the reproducibility and compare 2 STSTs (the 1-min STST [1-STST] and the semi-paced 3-min chair rise test [3-CRT]) in IPF, and to determine if selected physiological parameters (speed of displacement and changes in pulse oxygen saturation [SpO2]) are interchangeable between the STSTs and the 6-MWT. Methods: Thirty-three patients with stable IPF were studied in 3 French expert centers. To test reproducibility, intra-class correlations (ICCs) of parameters measured during tests performed 7–14 days apart were calculated. To test interchangeability, the agreement and correlation of physiological responses measured during STSTs and during 6-MWT were studied. Results: Vertical displacements and changes in SpO2 during both STSTs were reproducible, with ICCs ranging from 0.78 [0.63–0.87] to 0.95 [0.92–0.97]. Vertical displacements during 1-STST and 3-CRT were correlated with 6-MWT distance (correlation coefficients (r) of 0.72 and 0.77, respectively; p < 0.001). Similarly, correlations were found between changes in SpO2 measured during the 2 STSTs and the 6-MWT, with coefficients ranging from 0.73 to 0.91 (p < 0.001). Distance walked and SpO2 during 6-MWT were well estimated from vertical displacement and SpO2 during the 2 STSTs, respectively. Conclusion: The correlations found between the 2 STSTs and the 6-MWT suggest that STSTs may be of interest to assess displacement and exercise-induced changes in SpO2 in IPF patients.

International audience; Background: Environmental research on multifactorial health outcomes calls for exposome approaches able to assess the joint effect of multiple exposures.Objective: Our aim was to identify profiles of exposure to lifestyle/environmental factors associated with lung function in adults with asthma using a cluster-based approach.Methods: We used data from 599 adults of the Epidemiological study on the Genetics and Environment of Asthma, bronchial hyperresponsiveness and atopy (EGEA) (mean age 39.0 years, 52% men) who ever had asthma. Exposures to 53 lifestyle/environmental factors were assessed by questionnaires or geographic information systems-based models. A two-step approach was developed: 1) exposome dimension reduction by selecting factors showing association with forced expiratory volume in 1 s (FEV1) (p < 0.20) in an exposome-wide association study (ExWAS), 2) clustering analysis using the supervised Bayesian Profile Regression (sBPR) to group individuals according to FEV1 level and to their profile of exposure to a reduced set of uncorrelated exposures (each paired correlation

Symptom-limited incremental cardiopulmonary exercise test was performed in school-age children with clinically stable cystic fibrosis (CF), all with normal spirometry. Physiological parameters were compared between patients with normal lung clearance index (LCI; n=6) and patients with elevated LCI (n=6). Dyspnoea ratings during exercise were similar in both groups. Although no patient had significant dynamic hyperinflation, end-expiratory lung volumes were higher throughout exercise in patients with elevated LCI. In addition, alveolar-arterial oxygen gradient at peak exercise was higher, and SpO2 was lower in patients with elevated LCI. LCI can thus be regarded as a test performed at rest that predicts some abnormalities appearing at exercise in CF children with normal spirometry.

International audience; Exposure to organic dusts is an independent causative factor of chronic obstructive pulmonary disease (COPD). Unhealthy dietary patterns have been associated with poor lung function in smokers. This study investigated whether dietary patterns were associated with post-bronchodilator airway obstruction, a hallmark of COPD, in dairy farmers exposed to organic dusts. All subjects were identified by screening programs and patients with airflow obstruction were matched with subjects with normal spirometry. Six groups were compared, defined by their exposures (non-smoking dairy farmers, smokers ≥ 10 pack-years with no occupational exposure, and smoking dairy farmers) and the presence or absence of post-bronchodilator airflow obstruction, resulting in 321 study subjects. The Alternative Healthy Eating Index (AHEI) score was calculated based on an adapted food frequency questionnaire. Mean total AHEI scores were similar in all groups. Comparison between smokers with post-bronchodilator airway obstruction and subjects with post-bronchodilator airway obstruction related to occupational exposure found minimal differences in dietary patterns: dairy farmers had lower scores for the ratio of white to red meat and higher scores for cereal fiber consumption. As in previous studies, smokers with post-bronchodilator airway obstruction exhibited higher lipid intakes and lower carbohydrate intakes than their counterparts with normal spirometry. No evidence of any meaningful difference in dietary patterns was found between subjects with post-bronchodilator airway obstruction detected by screening and healthy controls, either in dairy farmers or in smokers with no occupational exposure.

The observation that COPD is an independent risk factor for cardiovascular disease (CVDs) comes from comparisons between smokers with COPD and smokers without COPD. The mechanisms that explain increased risk of CVD in patients with COPD are still unclear.The goal of this study was to assess systemic arterial stiffness (a predictor of CVD mortality) and to evaluate its determinants in a group of patients with mild to moderate COPD secondary to organic dust exposure, tobacco smoking, or both.Systemic arterial stiffness was assessed by using aortic pulse wave velocity (aPWV). Measurements were made in 142 patients with COPD and 155 healthy control subjects matched for age, sex, BMI, and tobacco smoking, exposed to tobacco smoking (n = 56/70 for COPD/control subjects, respectively), organic dusts (n = 44/48), or both (n = 42/37).aPWV was higher in COPD than in healthy controls in subjects exposed to tobacco smoking and to both organic dusts and tobacco smoking. By contrast, among never smokers exposed to organic dusts, patients with COPD and matched control subjects had similar aPWV. Multivariate analysis of the 142 patients with COPD (exposed to tobacco smoking and/or to organic dusts) showed that tobacco smoking was associated with high aPWV. Moreover, soluble suppression of tumorigenicity 2, a marker of major cardiovascular events, was correlated with aPWV in these patients.Analysis of an unselected group of patients with COPD with different causes suggests that: (1) COPD by itself is not sufficient to explain increased aPWV; and (2) tobacco smoking is a risk factor for elevated aPWV in COPD.

Allergic mechanisms related to environmental and occupational exposure have been suggested to contribute to the development of chronic obstructive pulmonary disease (COPD). Objectives To investigate the relationships between atopy markers, persistent airflow limitation (PAL) and occupational exposure in dairy farmers. Methods Clinical and biological (total IgE and 21 allergen specific IgE) markers of atopy were assessed in 101 dairy farmers with PAL (DF-PAL), 85 non-farmers with PAL (NF-PAL) (both groups were prospectively included from a screening program performed between 2011 and 2015), and matched controls, i.e. 98 farmers without PAL (DF-controls) and 89 non-farming subjects without PAL (NF-controls). Occupational exposure in farmers was estimated using a validated questionnaire. Results Prevalence of allergy history was significantly higher in DF-PAL and in NF-PAL than in controls. Polysensitization, and sensitization to seasonal and food allergens were more frequent in DF-PAL than in DF-controls, respectively: 13.8% vs 1% (adjusted odds ratio (aOR): 17.5 (2.2–134), 11.9% vs 3.1% (aOR: 4.4 (1.2–7.2) and 16.8% vs 4.1% (aOR: 5.2 (1.7–7.2)). The prevalence of atopy markers was similar between NF-PAL patients and NF-controls. Conclusions PAL in farmers is associated with a high rate of markers of atopy, supporting atopy as a risk indicator. Clinical trial registered with ClinicalTrials.gov (NCT02540408). Electronic supplementary material The online version of this article (10.1186/s12931-019-1082-2) contains supplementary material, which is available to authorized users.

Pseudomonas aeruginosa is the main cause of chronic airway infection in cystic fibrosis (CF). However, for unclear reasons some patients are never colonized by P. aeruginosa. The objectives of this study were to better define the clinical, genetic, and microbiological characteristics of such a subpopulation and to identify predictive factors of non-colonization with P. aeruginosa. The French CF patient registry 2013–2014 was used to identify CF patients aged ≥ 20 years. The clinical outcomes, CF Transmembrane conductance Regulator (CFTR) genotypes, and microbiological data of patients reported positive at least once for P. aeruginosa (“Pyo” group, n = 1,827) were compared to those of patients with no history of P. aeruginosa isolation (“Never” group, n = 303). Predictive factors of non-colonization by P. aeruginosa were identified by multivariate logistic regression model with backward selection. Absence of aspergillosis (odds ratio (OR) [95% CI] = 1.64 [1.01–2.66]), absence of diabetes (2.25 [1.21–4.18]), pancreatic sufficiency (1.81 [1.30–2.52]), forced expiratory volume 1 (FEV1) ≥ 80% (3.03 [2.28–4.03]), older age at CF diagnosis (1.03 [1.02–1.04]), and absence of F508del/F508del genotype (2.17 [1.48–3.19]) were predictive clinical factors associated with absence of infection (“Never” group). Microbiologically, this same group was associated with more frequent detection of Haemophilus influenzae and lower rates of Stenotrophomonas maltophilia, Achromobacter xylosoxidans and Aspergillus spp. (all p

International audience; Asthma is a widespread respiratory disease caused by complex contribution from genetic, environmental and behavioral factors. For several decades, its sensitivity to environmental factors has been investigated in single exposure (or single family of exposures) studies, which might be a narrow approach to tackle the etiology of such a complex multifactorial disease. The emergence of the exposome concept, introduced by C. Wild (2005), offers an alternative to address exposure-health associations. After presenting an overview of the exposome concept, we discuss different statistical approaches used to study the exposome-health associations and review recent studies linking multiple families of exposures to asthma-related outcomes. The few studies published so far on the association between the exposome and asthma-related outcomes showed differences in terms of study design, population, exposome definition and statistical methods used, making their results difficult to compare. Regarding statistical methods, most studies applied successively univariate (Exposome-Wide Association Study (ExWAS)) and multivariate (adjusted for co-exposures) (e.g., Deletion-Substitution-Addition (DSA) algorithm) regression-based models. This latest approach makes it possible to assess associations between a large set of exposures and asthma outcomes. However, it cannot address complex interactions (i.e., of order ≥3) or mixture effects. Other approaches like cluster-based analyses, that lead to the identification of specific profiles of exposure at risk for the studied health-outcome, or mediation analyses, that allow the integration of information from intermediate biological layers, could offer a new avenue in the understanding of the environment-asthma association. European projects focusing on the exposome research have recently been launched and should provide new results to help fill the gap that currently exists in our understanding of the effect of environment on respiratory health.

Prostacyclin analogues targeting the prostacyclin pathway are used to treat patients with pulmonary arterial hypertension (PAH), and are given either by an intravenous (IV), subcutaneous (SC) or inhaled route [1]. Continuous IV infusion of epoprostenol has received the strongest recommendation for treatment of the most severe forms of PAH [2], mainly because it is the only PAH-specific drug that was demonstrated to give an improvement in survival in a randomised controlled study [3]. Due to drawbacks associated with its IV administration, epoprostenol is preferentially offered to young, high-risk patients [2]. For PAH patients in New York Heart Association (NYHA) functional class (FC) III/IV with severe hemodynamic impairment, epoprostenol can be combined with an endothelin receptor antagonist (ERA) and a phosphodiesterase type-5 (PDE-5) inhibitor to achieve sustained clinical and hemodynamic efficacy [4, 5]. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr Yanaka has nothing to disclose. Conflict of interest: Dr Guillien has nothing to disclose. Conflict of interest: Dr Soumagne has nothing to disclose. Conflict of interest: Dr Benet has nothing to disclose. Conflict of interest: Dr Piliero has nothing to disclose. Conflict of interest: Dr Picard has nothing to disclose. Conflict of interest: Dr Pison reports grants and personal fees from GlaxoSmithKline, personal fees from Novartis Pharma, personal fees from Boehringer Ingelheim, personal fees from Astra Zeneca, outside the submitted work. Conflict of interest: Dr Sitbon reports personal fees from Arena Pharmaceuticals, personal fees and non-financial support from Actelion Pharmaceuticals, personal fees from Acceleron Pharmaceuticals, grants and personal fees from Bayer HealthCare, non-financial support from GlaxoSmithKline, personal fees from Gossamer Bio, grants and personal fees from Merck, outside the submitted work. Conflict of interest: Dr Bouvaist reports grants and non-financial support from GlaxoSmithKline, grants and non-financial support from Bayer HealthCare, personal fees and non-financial support from Actelion Pharmaceuticals, outside the submitted work. Conflict of interest: Dr Degano reports personal fees and non-financial support from Actelion Pharmaceuticals, non-financial support from Bayer HealthCare, grants, personal fees and non-financial support from Novartis Pharma, personal fees from Chiesi, personal fees from GlaxoSmithKline, personal fees from Menarini, outside the submitted work.

GLI equations provide new cut-offs for TLCOfor detection of PH in patients with SSc, either with or without ILDhttp://ow.ly/aCpD30l2zch

Nomograms are statistical models that combine variables to obtain the most accurate and reliable prediction for a particular risk. Fetal heart rate (FHR) interpretation alone has been found to be poorly predictive for fetal acidosis while other clinical risk factors exist. The aim of this study was to create and validate a nomogram based on FHR patterns and relevant clinical parameters to provide a non-invasive individualized prediction of umbilical artery pH during labour.A retrospective observational study was conducted on 4071 patients in labour presenting singleton pregnancies at34 gestational weeks and delivering vaginally. Clinical characteristics, FHR patterns and umbilical cord gas of 1913 patients were used to construct a nomogram predicting an umbilical artery (Ua) pH7.18 (10th centile of the study population) after an univariate and multivariate stepwise logistic regression analysis. External validation was obtained from an independent cohort of 2158 patients. Area under the receiver operating characteristics (ROC) curve, sensitivity, specificity, positive and negative predictive values of the nomogram were determined.Upon multivariate analysis, parity (p 0.01), induction of labour (p = 0.01), a prior uterine scar (p = 0.02), maternal fever (p = 0.02) and the type of FHR (p 0.01) were significantly associated with an Ua pH7.18 (p 0.05). Apgar score at 1, 5 and 10 min were significantly lower in the group with an Ua pH7.18 (p 0.01). The nomogram constructed had a Concordance Index of 0.75 (area under the curve) with a sensitivity of 57%, a specificity of 91%, a negative predictive value of 5% and a positive predictive value of 99%. Calibration found no difference between the predicted probabilities and the observed rate of Ua pH7.18 (p = 0.63). The validation set had a Concordance Index of 0.72 and calibration with a p 0.77.We successfully developed and validated a nomogram to predict Ua pH by combining easily available clinical variables and FHR. Discrimination and calibration of the model were statistically good. This mathematical tool can help clinicians in the management of labour by predicting umbilical artery pH based on FHR tracings.

Alicia Guillien,1 Lucie Laurent,2 Thibaud Soumagne,3 Marc Puyraveau,4 Jean-Jacques Laplante,5 Pascal Andujar,6 Isabella Annesi-Maesano,7 Nicolas Roche,8,9 Bruno Degano,1,* Jean-Charles Dalphin3,* 1Research Unit EA 3920, Franche-Comté University, Besançon, France; 2Department of Clinical Physiology, University Hospital, Besançon, France; 3Department of Respiratory Diseases, University Hospital, Besançon, France; 4Clinical Methodology Center, University Hospital, Besançon, France; 5Department of Occupational Diseases, Mutualité sociale agricole, Besançon, France; 6University of Medical Sciences, Paris-est Créteil University, Créteil, France; 7Epidemiology of Allergic and Respiratory Diseases Department (EPAR), Saint-Antoine Medical School, Paris, France; 8Respiratory and Intensive Care Medicine, Cochin Hospital (AP-HP), University Paris Descartes, Paris, France; 9Research Unit EA 2511, University Paris Descartes, Paris, France *These authors contributed equally to this work Background: Chronic obstructive pulmonary disease (COPD) and farming are two conditions that have been associated with an increased risk of anxiety and depression. Dairy farming is an independent risk factor for COPD.Objective: To test the hypotheses that the prevalence of anxiety and/or depression is higher in dairy farmers with COPD than in farmers without COPD, and higher in dairy farmers with COPD than in non-farmers with COPD.Methods: Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale in 100 dairy farmers with COPD (DF-COPD), 98 dairy farmers without COPD (DF-controls), 85 non-farming patients with COPD (NF-COPD) and 89 non-farming subjects without COPD (NF-controls), all identified by screening in the Franche-Comté region of France. Anxiety and depression were considered present when the Hospital Anxiety and Depression Scale score was ≥8. COPD was defined by a post-bronchodilator forced expiratory volume in 1 second/forced vital capacity ratio

Screening is important to determine whether patients with systemic sclerosis (SSc) have pulmonary hypertension because earlier pulmonary hypertension treatment can improve survival in these patients. Although decreased transfer factor of the lung for carbon monoxide (TLCO) is currently considered the best pulmonary function test for screening for pulmonary hypertension in SSc, small series have suggested that partitioning TLCO into membrane conductance (diffusing capacity) for carbon monoxide (DMCO) and alveolar capillary blood volume (VC) through combined measurement of TLCO and transfer factor of the lung for nitric oxide (TLNO) is more effective to identify pulmonary hypertension in SSc patients compared with TLCO alone. Here, the objective was to determine whether combined TLCO–TLNO partitioned with recently refined equations could more accurately detect pulmonary hypertension than TLCO alone in SSc.For that purpose, 572 unselected consecutive SSc patients were retrospectively recruited in seven French centres.Pulmonary hypertension was diagnosed with right heart catheterisation in 58 patients. TLCO, TLNO and VC were all lower in SSc patients with pulmonary hypertension than in SSc patients without pulmonary hypertension. The area under the receiver operating characteristic curve for the presence of pulmonary hypertension was equivalent for TLCO (0.82, 95% CI 0.79–0.85) and TLNO (0.80, 95% CI 0.76–0.83), but lower for VC (0.75, 95% CI 0.71–0.78) and DMCO (0.66, 95% CI 0.62–0.70).Compared with TLCO alone, combined TLCO–TLNO does not add capability to detect pulmonary hypertension in unselected SSc patients.

Introduction Appropriate identification of subjects who are candidates for spirometry through case-finding questionnaires may help solve the problem of chronic obstructive pulmonary disease misdiagnosis. The performance of case-finding questionnaires depends at least partially on the characteristics of the population used for their development. The use of an accurate threshold for the forced expiratory volume in 1 second / forced vital capacity ratio to define persistent airway obstruction is also vital in ascertaining chronic obstructive pulmonary disease. Methods Using a population examined between October 2012 and May 2013 that included a large subset of agricultural workers both exposed and unexposed to tobacco smoking, the authors aimed to select a combination of items that would identify persons most likely to have persistent airway obstruction defined as forced expiratory volume in 1 second / forced vital capacity less than the lower limit of normal according to the Global Lung Initiative–2012 equations. Two thirds of the population (n=3,397) were randomly selected to develop a questionnaire, and one third (n=1,698) was reserved for questionnaire validation. Statistical analysis was performed in 2016. Results The selected items were sex, dyspnea, BMI, tobacco smoking habits, age, history of respiratory diseases, and history of occupation at risk. The C-index of the model was 0.84 (95% CI=0.80, 0.88) for the development population and 0.76 (95% CI=0.66, 0.86) for the validation population. Using the selected items in combination, the sensitivity and specificity in identifying persistent airway obstruction were 76% and 77%, respectively, in the development population (and 68% and 73%, respectively, in the validation population) for a threshold value of 2.50%. Conclusions This seven-item questionnaire is the first developed from a population comprising a large subset of agricultural workers and using the Global Lung Initiative–2012 equations.

Background Farmers are exposed to multiple air contaminants that may interact with tobacco smoking in the development of respiratory diseases. Farmers are currently considered to smoke less than non-farmers, but precise data in different categories of age and farming activities are lacking. Methods Smoking habits were studied in a cross-sectional study involving 4105 farmers and 996 non-farming controls aged 40–74 years in 9 French departments between October 2012 and May 2013. Three age groups were defined (40–54, 55–64 and 65-74years). Farmers were divided into four activity groups, namely cattle breeders, livestock farmers working in confined spaces, crop farmers and others. Smoking prevalence was compared between farmers and controls, and odds ratios (ORs) for smoking adjusted for age were calculated. Results The adjusted OR for ever-smoking was lower among farmers than among non-farmers in all age categories, but the ORs for current smoking were similar in farmers and controls. Smoking prevalence varied according to the type of farming activity, and was lower than in non-farming controls only among cattle breeders and confined livestock farmers. In farmers, the proportion of smokers was higher in the youngest age categories compared with the older age classes. Conclusions Our results confirm that the prevalence of ever-smokers is lower in farmers than in non-farmers. Nevertheless, our data show that active smoking prevalence is similar in farmers and in non-farmers. This suggests that farmers, just like non-farmers, should be targeted by primary prevention campaigns against smoking.

Systematic screening of COPD allows identification of subjects with persistent airway obstruction who do not complain of any symptom. Little is known about subjects with undiagnosed persistent airway obstruction. We aimed to compare some clinical and spirometric data between subjects with spirometrically-defined COPD (i.e., persistent airway obstruction without any COPD symptom [OBS group]) and clinically-defined COPD (i.e., persistent airway obstruction with at least one COPD symptom [COPD group]), all detected by screening. A spirometry was performed in 5095 subjects aged 40-75 years. Persistent airway obstruction was defined as a post-bronchodilator FEV1FVC In total, 138/5095 subjects (2.70%) had persistent airway obstruction. Among them, 78 had at least one COPD-related symptom (COPD group), 52 have none of the COPD-related symptoms (OBS group) and 8 had missing data and were not analyzed. The main characteristics are in Table 1. Mean FVC was normal (z-score>-1.64) in both groups. By contrast, mean FEV1 was abnormal only in the COPD group (mean z-score A significant subset of subjects detected by screening with persistent airway obstruction are asymptomatic; a majority of these asymptomatic subjects have normal FEV1.

Backgroung In moderate to severe COPD patients, ventilation adaptation to metabolic demand during concentric exercise (CONC) is often limited by dynamic hyperinflation that impedes tidal volume (Vt) to increase. According to its low metabolic cost, eccentric exercise (ECC) could be an alternative to CONC with these patients. Aims and objectives To compare ventilatory adaptation during CONC and EXC cycling in moderate to severe COPD patients. Methods On 5 separate days, 13 patients (FEV1: 42±9% pred) performed a symptom-limited incremental CONC cycle exercise test followed by four 30-min sessions of constant-load ECC cycling. Load of ECC exercise was increased by 50% at each session. Vt, breath frequency (BF) and several physiologic parameters were compared at the maximal common minute ventilation (V9E) observed during CONC and ECC (iso-V9E). Results Iso-V9E was 24.9±7.9 L.min -1 duringECC and 24.9±7.8 L.min -1 during CONC (61±21% of maximal estimated ventilation). The power outputs at isoV9E were 37±16 W and 104±18 W for CONC and ECC, respectively. At iso-V9E, Vt was 22% lower in ECC than in CONC (890±220 vs. 1080±320 mL; p =0.005) and BF was 24% higher (28.3±5.6 vs. 22.8±3.1 min -1 ; p 2 ) and Borg dyspnoea score were similar in both conditions (HR: 95.4±13.1 vs. 95.4±12.5 min -1 ; V9O 2 : 0.74±0.23 vs. 0.77±0.26 L; Borg: 2.4±2.4 vs. 1.7±0.9 in ECC and CONC, respectively; p>0.05). Conclusion At an identical V9E of about 60% of maximal estimated ventilation, patients with moderate to severe COPD have a 24% higher breathing frequency during ECC compared with CONC cycling. The mechanisms and consequences of this hyperpnoea deserve further studies.

Background The relevance of screening for airway obstruction in subjects not complaining of COPD symptoms may depend on the definition of airway obstruction. Response to exercise in asymptomatic subjects with persistent airway obstruction as defined by a postbronchodilator FEV1/FVC

There are conflicting data regarding the magnitude and determinants of chronic obstructive pulmonary disease (COPD) risk in farmers.In a cross-sectional study of 917 nonfarming working controls and 3787 farmers aged 40–75 years, we assessed respiratory symptoms, tobacco exposure, job history (without direct exposure measurement) and lung function. COPD was defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criterion (post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) 1/FVC The prevalence (95% CI) of COPD according to the GOLD criterion was 5.1% (4.4–5.8%) and 2.9% (1.8–4.0%) in farmers and controls, respectively (p=0.005), and 3.1% (2.5–3.6%) and 1.5% (0.7–2.3%), respectively, for the LLN criterion (pThe prevalence of COPD in farmers is higher than in nonfarming working controls, and depends on the farming activity, the region and the criterion used to define COPD.

Introduction La colonisation des voies aeriennes par Pseudomonas aeruginosa ( P. aeruginosa ) est frequente chez les patients atteints de mucoviscidose. Elle contribue a aggraver les signes respiratoires. Toutefois, pour des raisons qui restent encore a explorer, certains patients restent indemnes de cette colonisation jusqu’a l’âge adulte (sujets classes « never »). L’objectif de notre etude, baptisee PYOnever, etait de preciser les caracteristiques cliniques, genetiques et microbiologiques de ces adultes dits « never ». Methodes Les parametres cliniques, genetiques et microbiologiques de 2130 patients âges de plus de 20 ans ont ete analyses retrospectivement a partir des donnees enregistrees dans le registre francais de la mucoviscidose entre janvier 2013 et decembre 2014. Les groupes « never » et « pyo » (sujets ayant des expectorations positives a P. aeruginosa ) ont ete compares par regression logistique. Les parametres avec un p backward ). Resultats Apres analyse multivariee et prise en compte de l’âge, du sexe, de l’insuffisance pancreatique, du diabete et de l’aspergillose broncho-pulmonaire allergique ; l’absence de la mutation F508del a l’etat homozygote sur le gene CFTR et l’âge au diagnostic de la maladie etaient apparus significativement associes a une absence de colonisation par P. aeruginosa a l’âge adulte (OR = 3,75, IC 95 % : [1,4–10,05] ; OR = 1,03, IC 95 % : [1,01–1,05] respectivement). Sur le plan microbiologique, la presence de S. aureus et H. influenzae dans les prelevements respiratoires etait significativement plus elevee dans le groupe « never », apres ajustement sur l’âge au diagnostic et le VEMS. Par contre, concernant A. xylosoxidans , Aspergillus , B. cepacia et S. maltophilia , leur absence etait associee au groupe « never ». Conclusion L’absence de la mutation F508del a l’etat homozygote et l’âge eleve au moment du diagnostic de la mucoviscidose sont des predicteurs independants de l’absence de colonisation pulmonaire par P. aeruginosa .

Introduction Quinze a 20 % des BPCO sont d’origine professionnelle, mais le mecanisme physio-pathogenique de la BPCO agricole est mal identifie. Des etudes ont suggere une relation entre la BPCO agricole et l’atopie personnelle mais aucune n’a explore precisement les mecanismes immuno-allergiques au sein de la population du milieu de la production laitiere. Cette etude intitulee FEE-BALISTIC avait pour objectif de caracteriser la BPCO agricole en etudiant la relation entre la presence de la BPCO et une reponse immuno-allergique, la relation entre la presence de la BPCO et les caracteristiques liees a l’exposition professionnelle et la relation entre la reponse immuno-allergique et l’exposition professionnelle. Methodes Il s’agit d’une etude observationnelle de type cas-temoins portant sur 199 sujets (101 BPCO et 98 temoins) affilies au regime agricole, residant dans la region Franche-Comte, et inclus entre 2011 et 2015 lors d’un depistage systematique. Seuls les sujets âges de 40–75 ans et exercant (ou ayant exerce) la profession de producteur laitier etaient inclus. Les sujets porteurs de BPCO (BA) et les temoins indemnes de BPCO (TA) ont ete compares par regression logistique ou les odds-ratios etaient ajustes sur l’âge, le sexe et le statut tabagique (qui sont des facteurs de risque connus de la BPCO). Les variables etudiees etaient la presence d’indicateurs biologiques d’une sensibilisation (IgE totales et IgE specifiques aux allergenes communs de l’environnement), les signes cliniques d’une atopie et les caracteristiques d’exposition professionnelle. Resultats Apres analyse bivariee, la proportion de sujets declarant des allergies personnelles etait plus elevee chez les BA que chez les TA (59 % vs. 44 % respectivement, p = 0,03), tout comme la presence de sifflements (39 % vs. 14 %, p Conclusion La BPCO agricole en milieu de production laitiere partage des caracteristiques physio-pathogeniques avec l’asthme : elle est associee a une atopie avec sensibilisation aux allergenes communs de l’environnement. Soutiens Novartis Pharma, don du souffle de Franche-Comte, MSA Franche-Comte.