Early markers of airways inflammation and occupational asthma: Rationale, study design and follow-up rates among bakery, pastry and hairdressing apprentices

<p>Abstract</p> <p>Background</p> <p>Occupational asthma is a common type of asthma caused by a specific agent in the workplace. The basic alteration of occupational asthma is airways inflammation. Although most patients with occupational asthma are mature adults, there is evidence that airways inflammation starts soon after inception of exposure, including during apprenticeship. Airways hyper responsiveness to methacholine is a valid surrogate marker of airways inflammation, which has proved useful in occupational epidemiology. But it is time-consuming, requires active subject's cooperation and is not readily feasible. Other non-invasive and potentially more useful tests include the forced oscillation technique, measurement of fraction exhaled nitric oxide, and eosinophils count in nasal lavage fluid.</p> <p>Methods and design</p> <p>This study aims to investigate early development of airways inflammation and asthma-like symptoms in apprentice bakers, pastry-makers and hairdressers, three populations at risk of occupational asthma whose work-related exposures involve agents of different nature. The objectives are to (i) examine the performance of the non-invasive tests cited above in detecting early airways inflammation that might eventually develop into occupational asthma; and (ii) evaluate whether, and how, constitutional (e.g. atopy) and behavioural (e.g. smoking) risk factors for occupational asthma modulate the effects of allergenic and/or irritative substances involved in these occupations. This paper presents the study rationale and detailed protocol.</p> <p>Discussion</p> <p>Among 441 volunteers included at the first visit, 354 attended the fourth one. Drop outs were investigated and showed unrelated to the study outcome. Sample size and follow-up participation rates suggest that the data collected in this study will allow it to meet its objectives.</p

Medroxyprogesterone improves nocturnal breathing in postmenopausal women with chronic obstructive pulmonary disease

BACKGROUND: Progestins as respiratory stimulants in chronic obstructive pulmonary disease (COPD) have been investigated in males and during wakefulness. However, sleep and gender may influence therapeutic responses. We investigated the effects of a 2-week medroxyprogesterone acetate (MPA) therapy on sleep and nocturnal breathing in postmenopausal women. METHODS: A single-blind placebo-controlled trial was performed in 15 postmenopausal women with moderate to severe COPD. A 12-week trial included 2-week treatment periods with placebo and MPA (60 mg/d/14 days). All patients underwent a polysomnography with monitoring of SaO(2 )and transcutaneous PCO(2 )(tcCO(2)) at baseline, with placebo, with medroxyprogesterone acetate (MPA 60 mg/d/14 days), and three and six weeks after cessation of MPA. RESULTS: Thirteen patients completed the trial. At baseline, the average ± SD of SaO(2 )mean was 90.6 ± 3.2 % and the median of SaO(2 )nadir 84.8 % (interquartile range, IQR 6.1). MPA improved them by 1.7 ± 1.6 %-units (95 % confidence interval (CI) 0.56, 2.8) and by 3.9 %-units (IQR 4.9; 95% CI 0.24, 10.2), respectively. The average of tcCO(2 )median was 6.0 ± 0.9 kPa and decreased with MPA by 0.9 ± 0.5 kPa (95% CI -1.3, -0.54). MPA improved SaO(2 )nadir and tcCO(2 )median also during REM sleep. Three weeks after cessation of MPA, the SaO(2 )mean remained 1.4 ± 1.8 %-units higher than at baseline, the difference being not significant (95% CI -0.03, 2.8). SaO(2 )nadir was 2.7 %-units (IQR 4.9; 95% CI 0.06, 18.7) higher than at baseline. Increases in SaO(2 )mean and SaO(2 )nadir during sleep with MPA were inversely associated with baseline SaO(2 )mean (r = -0.70, p = 0.032) and baseline SaO(2 )nadir (r = -0.77, p = 0.008), respectively. Treatment response in SaO(2 )mean, SaO(2 )nadir and tcCO(2 )levels did not associate with pack-years smoked, age, BMI, spirometric results or sleep variables. CONCLUSION: MPA-induced respiratory improvement in postmenopausal women seems to be consistent and prolonged. The improvement was greater in patients with lower baseline SaO(2 )values. Long-term studies in females are warranted

Traitement des troubles ventilatoires du sommeil par orthèse d'avancée mandibulaire ajustable (étude bibliographique)

NANCY1-SCD Pharmacie-Odontologie (543952101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Poids de naissance et infection à Chikungunya en début de grossesse lors de l'épidémie en 2005-2006 sur l'île de la Réunion

L'infection par le virus du Chikungunya apparaît avoir une transmission fœtoplacentaire chez les mère infectées qui favoriserait la mortalité néonatale. Cependant, les effets de cette infection sur la trophicité de l'enfant n'ont jamais été analysés. Lors de l'épidémie du Chikungunya sur l'île de la Réunion en 2005-2006, nous avons étudié chez 33 femmes enceintes atteintes par le virus en début de grossesse, les répercutions de l'infection à Chikungunya sur les paramètres biométriques des nouveau-nés à la naissance. Cette étude de cohorte a porté sur toutes les femmes enceintes de moins de 22 semaines d'aménorrhées (SA) consultant à l'Hôpital de Saint-Pierre de la Réunion pour une symptomatologie clinique d'infection à Chikungunya de novembre 2005 à avril 2006, apogée de l'épidémie. Poids de naissance, taille et périmètre crânien de leur enfant ont été comparés à ceux d'un groupe d'enfants dont les mères étaient indemnes de l'infection. Il apparaît près de deux fois plus de petit poids de naissance (< 2500 g) chez les enfants nés de mère infectées (21 % vs 11 % ; RR=1.88 [0.72-4.90]), toujours en rapport normal avec une grossesse courte (<= 38 SA) et une petite taille de naissance <=(47 cm). La différence reste cependant statistiquement non significative en raison du faible nombre de femmes étudiées. Cette tendance devra être confirmée sur un plus grand nombre de cas pour pouvoir conclure à une influence de cette maladie sur la biométrie de ces nouveaux-nés.NANCY1-SCD Medecine (545472101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF