The key pathophysiological feature of chronic obstructive pulmonary disease (COPD) is an abnormal inflammatory bronchial reaction after inhalation of toxic substances. The priority is the avoidance of such toxic inhalations, but the use of anti-inflammatory drugs also seems appropriate, especially corticosteroids that are the sole anti-inflammatory drug available for this purpose in France. The risks associated with the prolonged use of these parenteral drugs are well known. Inhalation is therefore the optimal route, but inhaled drugs may also lead to adverse consequences. In COPD, there is an inhaled corticosteroids overuse, and a non-satisfactory respect of the guidelines. Consequently, their withdrawal should be considered. We reviewed seven clinical studies dealing with inhaled corticosteroids withdrawal in patients with COPD and found that included populations were heterogenous with different concomitant treatments. In non-frequent exacerbators receiving inhaled corticosteroids outside the recommendations, withdrawal appears to be safe under a well-managed bronchodilator treatment. In patients with severe COPD and frequent exacerbations, the risk of acute respiratory event is low when they receive concomitant optimal inhaled bronchodilators. However, other risks may be observed (declining lung function, quality of life) and a discussion of each case should be performed, especially in case of COPD and asthma overlap.

Introduction. Clinical trials have provided some evidence of a favorable effect of inhaled corticosteroids on the frequency of exacerbations and on the quality of life of patients with chronic obstructive pulmonary disease (COPD). In contrast, ICS have little or no impact on lung function decline and on mortality.State of the art. Inhaled corticosteroids are recommended only in a minority of COPD patients, those with severe disease and repeated exacerbations and probably those with the COPD and asthma overlap syndrome. However, surveys indicate that these drugs are inappropriately prescribed in a large population of patients with COPD. Overtreatment with inhaled corticosteroids exposes these patients to an increased risk of potentially severe side-effects such as pneumonia, osteoporosis, and oropharyngeal candidiasis. Moreover, it represents a major waste of health-care spending.Conclusion. Primary care physicians as well as pulmonologists should be better aware of the benefits as well as the side-effects and costs of inhaled corticosteroids. (C) 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.

The objective of this study was to describe the relationship between age at onset, with no age limits, and glycaemic control evolution from the time of onset in patients with type 1 diabetes (T1D).This observational retrospective follow-up study included 716 patients with T1D onset between 1990 and 2008 treated at the Navarre Hospital Complex. The mean (SD) follow-up lasted 10.1 (5.3) years. Information on their HbA1c levels was collected at onset and every year thereafter. Generalized additive mixed models and linear models were used, with patients’ annual HbA1c levels as the response variable and the number of years since onset together with age at onset as covariates.The evolution of glycaemic control is not linear and differs across all age groups. Children reach their highest values in adolescence, while patients with onset at ages 10–15 years stabilize their HbA1c values after 7 or 8 years. In adults, it is notable that an age of onset ≥ 45 years is associated with the worst control.A non-linear increase in HbA1c levels can be observed from the time of T1D diagnosis, with significant differences across all age groups.L’objectif de cette étude est de décrire la relation entre l’âge d’apparition de la maladie, sans limite d’âge, et l’évolution du contrôle glycémique, dès le diagnostic, chez les patients atteints de diabète type 1.Il s’agit d’une étude d’observation rétrospective. Au total, nous avons étudié 716 patients ayant développé la maladie pendant la période 1980–2008. Tous ces patients ont été traités dans le complexe hospitalier de Navarre. Le suivi à long terme a été en moyenne de 10,1 ± 5,3 années. Les taux d’HbA1c ont été obtenus au début de la maladie et annuellement. Nous avons utilisé des modèles mixtes additifs généralisés (GAMM) et des modèles linéaires, en choisissant d’utiliser les taux annuels d’HbA1c des patients comme variable réponse et le nombre d’années écoulées depuis le début de la maladie ainsi que l’âge des patients au début de la maladie comme covariables.L’évolution du contrôle glycémique ne présente pas de linéarité et elle est différente dans tous les groupes d’âge. Les enfants atteignent leurs taux les plus élevés lors de l’adolescence. Les patients tombés malade entre les dix et les 15 ans, stabilisent leurs taux d’HbA1c après sept à huit ans. À noter que, quand la maladie apparaît chez les adultes ayant dépassé 45 ans, cette apparition est liée, notamment, à un mauvais contrôle.Une altération de non-linéarité des taux d’HbA1c peut être observée dès le diagnostic avec des différences significatives entre les différents groupes d’âge.

Objectives. - To describe the level of asthma control using the Asthma Control Test (ACT) in real life, and to identify factors associated with poorly controlled asthma (ACT score <20).Methods. - Participating GPs and specialists had to include the first two consecutive patients with a diagnosis of asthma >= 12 months at a consultation for asthma.Results. - Of the 5508 adult patients screened by 987 physicians, 2165 were included in the cohort. They were 47% overweight, 81% nonsmokers, 66% with an asthma diagnosis >= 10 years, and a median ACT score of 18 [5-25]. Asthma was poorly controlled in 62% of patients. Independent factors associated with poorly controlled asthma were: emergency visit for exacerbation of asthma during the past three months (odds ratio [OR]: 4.3; 95% confidence interval [95% CI] [2.9-6.3]), use of short-acting beta2-agonist (OR: 2.8; 95% CI [2.2-3.4]) or theophyllin (OR: 2.6; 95% CI [1.2-5.4]), being a current (OR: 2.1; 95% CI [1.6-2.8]) or a former smoker (OR: 1.4; 95% CI [1.1-1.7]), professionally inactive (OR: 1.9; 95% CI [1.3-2.8]), unemployed (OR: 1.9; 95% CI [0.9-4.0]) or retired (OR: 1.7; 95% CI [1.3-2.2]), being obese (OR: 1.7; 95% CI [1.2-2.2]), no use of combinations of long-acting beta2-agonist and corticosteroid (OR: 1.5; 95% CI [1.2-1.9]), being a woman (OR: 1.4; 95% CI [1.1-1.7]), and presenting an atopic dermatitis (OR: 1.4; 95% CI [1.1-1.8]).Conclusion. - Treated asthma patients are still poorly controlled. Data are useful for patient care as they allow identifying high-risk patients with most prominent factor of having emergency visit for the exacerbation of asthma in the previous 3 months. (C) 2014 Published by Elsevier Masson SAS.

In Europe, there are few data on the impact of chronic obstructive pulmonary disease (COPD) on patients' quality of life. This study, within primary care, addressed health-related quality of life in patients according to stage of COPD severity. The objective was to estimate the impact of the COPD on the quality of life of the patients in seven European countries (France, Belgium, Germany, Italy, the Netherlands, Spain and the United Kingdom) in 2430 patients among whom 573 patients were in France. This cross-sectional, epidemiological and non-randomized study was realized by using two generic quality of life questionnaires and two disease-specific ones. The results in the French subgroup showed an impact on patients' health occurring even in the mild stage of the disease. The differences between the severity stages, as appreciated by the general practitioners, are clinically significant with a strong dispersal of the scores of quality of life within every stage. The impact of COPD on patients' daily activities is a key feature of the disease and it is essential that this is evaluated systematically and recognized as a target for management as much as other manifestations of the disease.

To examine gender differences in the longitudinal relationship between past-month pain interference and incident mood, anxiety, and substance-use disorders, chi-square tests and binomial logistic regression analyses were performed on data obtained from the National Epidemiologic Survey on Alcohol and Related Conditions from 34,465 adult respondents (47.9% men; 52.1% women) who completed waves 1 (2000–2001) and 2 (2004–2005) data collection. Models were adjusted for potentially confounding factors (i.e., age, race, marital status, educational level, employment, household income, number of stressful life events, number of general medical conditions, and wave-1 psychopathology). Respondents were categorized at wave 1 according to their past-month level of pain interference (i.e., no or low pain interference, moderate pain interference, severe pain interference). Moderate and severe pain interference (as compared to no or low pain interference) in male and female respondents was associated with the incidence of several psychiatric disorders. A stronger relationship was observed in male respondents as compared to female ones between past-month moderate pain interference and a new onset of any mood disorder (OR = 1.57, p = 0.03) and major depressive disorder (OR = 1.60, p = 0.03), and between past-month severe pain interference and a new onset of alcohol abuse or dependence (OR = 1.69, p = 0.045) and nicotine dependence (OR = 1.48, p = 0.04). These findings suggest that providers should consider screening patients with past-month moderate or severe pain interference for mood, anxiety, and substance-use problems and monitor the possible development of subsequent comorbid psychiatric disorders.

This review is the synthesis of a working group on mild asthma. Mild asthma includes intermittent and persistent mild asthma according to the Global Initiative for Asthma (GINA) classification, and affects between 50% and 75% of asthmatic patients. Mild asthma is more frequent, more symptomatic, and less well controlled in children than in adults. Cohort studies from childhood to adulthood show that asthma severity usually remains stable over time. Nevertheless, mild asthma can lead to severe exacerbations, with a frequency ranging from 0.12 to 0.77 per patient-year. Severe exacerbations in mild asthma represent 30-40% of asthma exacerbations requiring emergency consultation. In mild asthma, inflammation and structural remodelling are constant, of varying intensity, but nonspecific. Therapy with inhaled corticosteroids (ICS) decreases bronchial inflammation, but has only a slight effect on structural remodelling, and, when stopped, inflammation immediately recurs. Permanent low-dose ICS therapy is the reference treatment for persistent mild asthma. Effectiveness is to be reassessed at 3 months, and if it is insufficient the patient is no longer considered mildly asthmatic, and treatment has to be stepped up. As mild asthma is the most frequent form of the disease, diagnosis and management require physicians' particular attention.

Update on the state of knowledge in the mild asthma (intermittent and persistent mild asthma, according to the GINA classification) literature, and position of a French Mild Asthma Working Group.The French Mild Asthma Working Group (11 lung specialists, 4 paediatricians, 1 pharmacologist, and 1 general practitioner) selected, analysed, and summarised the literature on the epidemiology, physiopathology, clinical signs, and management of mild asthma. The present article shows the position of the working group on mild asthma descriptive epidemiology (causal factors excluded) and the nature of the bronchial inflammation. Clinical signs and medicinal treatments will be presented in a second article.Between 50% and 75% of asthma patients, depending on the study, present mild asthma. Childhood-to-adulthood cohort monitoring found severity to be unchanged over developmental time. Its generally benign evolution may in some (<10%) cases be complicated by severe episodes. Inflammation and airway-wall remodelling were always found, although of variable intensity, and non-specific (except for absence of infiltration by polymorphonuclear neutrophils). Corticosteroid therapy by inhalation reduces bronchial inflammation, but with little impact on airway-wall remodelling.The present findings should help clinicians in identifying and understanding mild asthma.

Introduction Update on the state of knowledge in the mild asthma (intermittent and persistent mild asthma, according to the GINA classification) literature, and position of a French Mild Asthma Working Group. State of the art The French Mild Asthma Working Group (11 lung specialists, 4 paediatricians, 1 pharmacologist, and 1 general practitioner) selected, analysed, and summarised the literature on the epidemiology, physiopathology, clinical signs, and management of mild asthma. The present article shows the position of the working group on mild asthma descriptive epidemiology (causal factors excluded) and the nature of the bronchial inflammation. Clinical signs and medicinal treatments will be-presented in a second article. Perspectives Between 50% and 75% of asthma patients depending on the study, present mild asthma. Child hood-to-adulthood cohort monitoring found severity to be unchanged over developmental time. Its generally benign evolution may in some (< 10%) cases be complicated by severe episodes. Inflammation and airway-wall remodelling were always found, although of variable intensity, and non-specific (except for absence of infiltration by polymorphonuclear neutrophils). Corticosteroid therapy by inhalation reduces bronchial inflammation, but with little impact on airway-wall remodelling. Conclusion The present findings should help clinicians in identifying and understanding mild asthma.

OBJECTIVE:To update on the state of knowledge in mild asthma (intermittent and persistent mild asthma, according to the GINA classification) review the literature, and the position statement of the French Mild Asthma Working Group.METHODS:The French Mild Asthma Working Group (11 lung specialists, 4 paediatricians, 1 pharmacologist, and 1 general practitioner) selected, analysed, and summarised the literature on the descriptive epidemiology, physiopathology, clinical signs, and management of mild asthma. The position of the working group on the descriptive epidemiology (causal factors excluded) and the nature of the bronchial inflammation has been presented in a previous article. The present article focuses on the clinical features of mild asthma and the use of medication for it.RESULTS:Mild asthma was more frequent, more symptomatic, and less well controlled in children than in adults. Its generally benign evolution may in some (<10%) cases be complicated by severe episodes. Patients with mild persistent asthma require controller medication every day: permanent low-dose inhaled corticosteroid monotherapy is the reference foundation treatment for persistent mild asthma.CONCLUSIONS:The present findings should help clinicians and guide them in their approach to managing this condition.