Jean-paul Janssens - Academia.edu (original) (raw)
Papers by Jean-paul Janssens
CHEST Journal, 2010
Respiratory viruses frequently are recovered in the upper-respiratory tract during acute exacerba... more Respiratory viruses frequently are recovered in the upper-respiratory tract during acute exacerbations of COPD (AECOPD), but their role as contributing pathogens remains unclear. The usefulness of procalcitonin and C-reactive protein as indicators of the presence or absence of viral infection in this setting also needs to be evaluated. The study was of a prospective cohort of patients with COPD admitted to the ED for AECOPD. Reverse transcriptase-polymerase chain reaction (RT-PCR) for 14 respiratory viruses was performed on nasopharyngeal swabs collected at admission and after recovery in stable condition. Eighty-six patients (mean age, 72 years; male, 64%) were included. During AECOPD, upper-respiratory viral infections were detected in 44 (51%) patients: picornavirus in 22, metapneumovirus in seven, coronavirus in eight, influenza A/B in two, parainfluenza in two, and respiratory syncytial virus in three. A dual infection was present in three patients. After recovery, viruses were detected in only eight (11%) of 71 patients (P < .001 compared with AECOPD phase). In five of these patients, no virus had been identified during the initial exacerbation, thus suggesting a new viral infection acquired during follow-up. During AECOPD, procalcitonin and C-reactive protein levels did not differ significantly between patients with or without a proven viral infection. Prevalence of upper-respiratory viral infection, as detected from nasopharyngeal swab by RT-PCR, is high in AECOPD and low after clinical recovery, suggesting that AECOPD frequently are triggered by viral infections initiated in the upper-respiratory tract. In our study, serum procalcitonin and C-reactive protein did not discriminate virus-associated exacerbations from others. clinicaltrials.gov; Identifier: NCT00448604.
0 0 8 ; 1 3 8 ( 3 9 -4 0 ) : 5 8 5 -5 9 3 · w w w . s m w . ch
Sleep medicine, 2011
Hypercapnic ventilatory failure due to restrictive disorders may have a negative impact on sleep ... more Hypercapnic ventilatory failure due to restrictive disorders may have a negative impact on sleep architecture. Non-invasive ventilation (NIV) may improve arterial blood gases but may adversely affect sleep. We assessed sleep structure and blood gases before and during NIV in patients with restrictive disorders in hypercapnic ventilatory failure. Retrospective cohort study. Sleep laboratory of Saint-Luc University Hospital (Belgium). Chart review of all patients with predominantly restrictive disorders and respiratory failure seen between 1987 and 2008 and evaluated with a baseline polysomnography (PSG) and a PSG under NIV. Sixty patients aged (mean±SD) 48±20 years, with total lung capacity of 57±20% of predicted value, PaO(2) of 62±16 mm Hg and PaCO(2) 54±10 mm Hg, were included. At baseline, total sleep time, sleep efficiency, slow wave and rapid-eye movement (REM) sleep were markedly decreased. Conversely, micro-arousals and stage I sleep (N1) were increased. NIV administered with...
Respiratory medicine, 2009
Interferon-gamma (IFN-gamma) production by lymphocytes exposed to antigens specific of Mycobacter... more Interferon-gamma (IFN-gamma) production by lymphocytes exposed to antigens specific of Mycobacterium tuberculosis has been shown to correlate with antigen load and disease activity. To determine whether treatment of tuberculosis (TB) led to a decrease and/or a reversion of results of a IFN-gamma release assay (T-SPOT.TB, Oxford Immunotec, UK) and thus if T-SPOT.TB could be used to monitor response to treatment. Qualitative and quantitative analysis (SFUs: spot-forming units) of T-SPOT.TB in HIV-negative patients with TB, during initial 2 weeks of treatment (T0), at end of treatment (TE) and 6 months later (TE+6). Mean SFU (SD) was 75 (58; n=62) at T0, 46 (55; n=55) at TE, and 33 (46; n=41) at TE+6; positive rate was 98%, 93% and 98%, respectively. SFUs (paired samples, n=36) decreased significantly between T0 and TE; 2 reversions occurred between T0 and TE (6%), but none between TE and TE+6. Of 6 patients (17%) with an increase in SFUs between T0 and TE, 5 had a favourable outcome a...
Background / Purpose: The aim of this study was to determine whether viral acute exacerbation of ... more Background / Purpose: The aim of this study was to determine whether viral acute exacerbation of COPD (AECOPD) is associated with more frequent exacerbations and higher mortality during the one-year follow-up after an index exacerbation leading to hospitalization.Viral AECOPD is more severe and may be associated with higher mortality and more frequent AECOPD during the one year follow-up after an index exacerbation leading to hospitalization.After one year we reviewed the medical charts of 72 patients enrolled in a prospective cohort study of 86 COPD patients hospitalized at Geneva’s University Hospital with AECOPD. 51% of index AECOPD was related to viral infection. The observed timing of a second exacerbation after the index exacerbation, the frequency of exacerbations and the global mortality were analyzed and compared between both groups. Main conclusion: The Mean number of AECOPD during follow-up was 1.38 (SD+/- 1.5). Factors associated with recurrent AECOPD were severity of ob...
The Open Respiratory Medicine Journal, 2014
Background: There is a growing interest in better defining risk factors associated with increased... more Background: There is a growing interest in better defining risk factors associated with increased susceptibility to exacerbation in patients with COPD.
Thorax, 2011
Complex respiratory events, which may have a detrimental effect on both quality of sleep and cont... more Complex respiratory events, which may have a detrimental effect on both quality of sleep and control of nocturnal hypoventilation, occur during sleep in patients treated with non-invasive ventilation (NIV). Among these events are patient-ventilator asynchrony, increases in upper airway resistance (with or without increased respiratory drive) and leaks. Detection of these events is important in order to select the most appropriate ventilator settings and interface. Simple tools can provide important information when monitoring NIV. Pulse oximetry is important to ensure that adequate oxygen saturation is provided and to detect either prolonged or short and recurrent desaturations. However, the specificity of pulse oximetry tracings during NIV is low. Transcutaneous capnography helps discriminate between hypoxaemia related to ventilation/perfusion mismatch and hypoventilation, documents correction of nocturnal hypoventilation and may detect ventilator-induced hyperventilation, a possible cause for central apnoea/hypopnoea and glottic closure. Data provided by ventilator software help the clinician by estimating ventilation, tidal volume, leaks and the rate of inspiratory or expiratory triggering by the patient, although further validation of these signals by independent studies is indicated. Finally, autonomic markers of sympathetic tone using signals such as pulse wave amplitude of the pulse oximetry signal can provide reliable information of sleep fragmentation.
Scandinavian Journal of Infectious Diseases, 2003
An 81-y-old woman was hospitalized because of persistent cough, fever, fatigue and weight loss. D... more An 81-y-old woman was hospitalized because of persistent cough, fever, fatigue and weight loss. Disseminated tuberculosis (pulmonary, bronchial, lymph node and urinary involvement) associated with human immunodeficiency virus disease, CDC stage C3 was diagnosed. Antiretroviral therapy initiated 2 months after the introduction of tuberculostatic treatment was well tolerated, with a 12 month follow-up.
Respiratory Medicine, 2006
Study objective: To evaluate the contribution of body composition measurements to clinical assess... more Study objective: To evaluate the contribution of body composition measurements to clinical assessment in patients on home nasal positive-pressure ventilation for chronic hypercapnic respiratory failure (CHRF), and their relationship to respiratory impairment. Methods: Patients with CHRF (restrictive lung disease (RLD), n ¼ 37; chronic obstructive pulmonary disease (COPD), n ¼ 19), during elective yearly evaluations underwent pulmonary function testing (forced expiratory volumes, arterial blood gases, maximal inspiratory and expiratory pressure (PI max or PE max )), and bioelectrical impedance analysis to determine fat-free mass (FFM) index (kg/m 2 ) and body fat mass index. Results: When compared with age-and sex-matched healthy controls, RLD patients (OR 5.5, CI 1.9-15.6, Po0:002) and COPD (OR 5.2, CI 1.1-24.9, P ¼ 0:04) were significantly more likely to have a low FFM index. Roughly one-half of patients with RLD and one-third with COPD had abnormally low FFM index. Estimation of nutritional status by body mass index (BMI) alone clearly underestimated the prevalence of FFM index depletion. Muscle mass assessed by FFM index explained 26% of variance of PI max (Po0:001) and 27% of that of PE max (Po0:001). Conclusion: BMI alone clearly underestimated FFM depletion, and presence of a very high body fat mass index. Indeed, normal or high BMI can be associated with FFM depletion. Because of its relationship to respiratory muscle strength, an assessment of FFM appears to be valuable in CHRF.
Respiratory Medicine, 2004
Objectives: To evaluate primary care physicians' knowledge of guidelines for the management of COPD.
Respiratory Medicine, 2013
Respiratory events occurring under non-invasive ventilation (NIV) may produce sleep fragmentation... more Respiratory events occurring under non-invasive ventilation (NIV) may produce sleep fragmentation. Alternatives to polysomnography (PSG) should be validated for providing simple monitoring tools for patients treated at home with NIV. To study the value of pulse wave amplitude (PWA) reduction as a surrogate marker of cortical micro-arousals associated with respiratory events occurring during NIV. 27 PSG tracings under NIV recorded in 9 stable patients with Obesity Hypoventilation Syndrome (OHS), under 3 different ventilator modes (no back-up rate, low or high back-up rate) were analyzed. For all respiratory events (obstructive, central, or mixed event), the association with EEG-micro-arousals, PWA reduction of more than 30% and the presence of associated SpO2 desaturation ≥ 4% was recorded. 2474 respiratory events during NREM sleep were analyzed. 73.6% were associated with an EEG-MA, 91.4% with a ≥ 4% decrease in SpO2, and 74.9% with a significant PWA reduction. Sensitivity of PWA for the detection of an EEG-micro-arousal related to a respiratory event was 89.1% [95%CI: 76.7-95.3]. Positive predictive value (PPV) was 87.0% [95%CI: 75.0-94.0]. Sensitivity of PWA was highest in the S mode, compared to both other S/T modes, p = <0.001. Sensitivity of PWA was also higher for central and mixed events, compared to obstructive respiratory events, p = <0.05. PWA reduction is a sensitive marker with a high PPV for the detection of EEG-MA associated with respiratory events during NREM sleep in stable OHS patients treated by NIV. In this situation, PWA could be used to improve scoring of hypopneas and allow an appropriate assessment of sleep fragmentation related to respiratory events.
Respiration, 2004
Background: Evaluation of health-related quality of life (HRQL) in chronic respiratory failure (C... more Background: Evaluation of health-related quality of life (HRQL) in chronic respiratory failure (CRF) is an important issue for evaluating the impact of treatment. Objectives: To elaborate a French version of the Maugeri Foundation Respiratory Failure Questionnaire (MRF-28) disease-specific HRQL questionnaire and determine its validity and reliability in patients with CRF treated by home mechanical ventilation (HMV). Methods: Forward-and back-translation of the MRF-28 questionnaire; the final version was submitted to 81 patients treated with HMV for CRF, simultaneously with the St. George's Respiratory Questionnaire (SGRQ), the Short Form 36 (SF-36), and the Hospital Anxiety and Depression scale (HAD). Validi-ty was determined by correlation with previously validated HRQL scores and recorded physiological parameters. Reliability was evaluated by assessing internal consistency and test-retest stability of the MRF-28 scores. Results: The French version of the MRF-28 and its subscores ('daily activity', 'cognitive function', and 'invalidity') were highly significantly correlated with subscores of the SGRQ, the SF-36 and the HAD. Both the MRF-28 and the SGRQ were correlated only with age and the 6-min walk test. The MRF-28 showed high test-retest reliability after 2 weeks (r 2 = 0.80, p ! 0.0001) and high internal consistency (Crohnbachs' · coefficient: 0.91). Conclusion: The French version of the MRF-28 is a valid and reliable disease-specific questionnaire for assessing HRQL in patients with CRF.
PLoS ONE, 2012
Background: In Switzerland and other developed countries, the number of tuberculosis (TB) cases h... more Background: In Switzerland and other developed countries, the number of tuberculosis (TB) cases has been decreasing for decades, but HIV-infected patients and migrants remain risk groups. The aim of this study was to compare characteristics of TB in HIV-negative and HIV-infected patients diagnosed in Switzerland, and between coinfected patients enrolled and not enrolled in the national Swiss HIV Cohort Study (SHCS).
Medicine & Science in Sports & Exercise, 1997
Nutrition assessment is important during chronic respiratory insufficiency to evaluate the level ... more Nutrition assessment is important during chronic respiratory insufficiency to evaluate the level of malnutrition or obesity and should include body composition measurements. The appreciation of fat-free and fat reserves in patients with chronic respiratory insufficiency can aid in designing an adapted nutritional support, e.g., nutritional support in malnutrition and food restriction in obesity. The purpose of the present study was to cross-validate fat-free and fat mass obtained by various bioelectric impedance (BIA) formulas with the fat-free and fat mass measured by dual-energy X-ray absorptiometry (DXA) and determine the formulas that are best suited to predict the fat-free and fat mass for a group of patients with severe chronic respiratory insufficiency. Seventy-five patients (15 women and 60 men) with chronic obstructive and restrictive respiratory insufficiency aged 45-86 y were included in this study. Body composition was calculated according to 13 different BIA formulas for women and 12 for men and compared with DXA. Because of the variability, calculated as 2 standard deviations, of 25.0 kg fat-free mass for women and 26.4 kg for men for the best predictive formula, the use of the various existing BIA formulas was considered not clinically relevant. Therefore disease-specific formulas for patients with chronic respiratory insufficiency should be developed to improve the prediction of fat-free and fat mass by BIA in these patients.
The Lancet Infectious Diseases, 2004
Pneumonia is a major medical problem in the very old. The increased frequency and severity of pne... more Pneumonia is a major medical problem in the very old. The increased frequency and severity of pneumonia in the elderly is largely explained by the ageing of organ systems (in particular the respiratory tract, immune system, and digestive tract) and the presence of comorbidities due to age-associated diseases. The most striking characteristic of pneumonia in the very old is its clinical presentation: falls and confusion are frequently encountered, while classic symptoms of pneumonia are often absent. Communityacquired pneumonia (CAP) and nursing-home acquired pneumonia (NHAP) have to be distinguished. Although there are no fundamental differences in pathophysiology and microbiology of the two entities, NHAP tends to be much more severe, because milder cases are not referred to the hospital, and residents of nursing homes often suffer from dementia, multiple comorbidities, and decreased functional status. The immune response decays with age, yet pneumococcal and influenza vaccines have their place for the prevention of pneumonia in the very old. Pneumonia in older individuals without terminal disease has to be distinguished from end-of-life pneumonia. In the latter setting, the attributable mortality of pneumonia is low and antibiotics have little effect on life expectancy and should be used only if they provide the best means to alleviate suffering. In this review, we focus on recent publications relative to CAP and NHAP in the very old, and discuss predisposing factors, microorganisms, diagnostic procedures, specific aspects of treatment, prevention, and ethical issues concerning end-of-life pneumonia.
Journal of Cardiopulmonary Rehabilitation, 2003
Current Opinion in Clinical Nutrition and Metabolic Care, 2004
Loss of body mass and exercise intolerance are common findings in chronic obstructive pulmonary d... more Loss of body mass and exercise intolerance are common findings in chronic obstructive pulmonary disease and are often difficult to reverse despite optimal nutritional intake. Similar findings have been reported in healthy individuals during high-altitude exposure. The role of hypoxia in modulating metabolism has been largely investigated in vitro and in animal studies. More fragmentary is the knowledge regarding hypoxia effects on in-vivo human metabolism. This paper reviews recent literature regarding the effects of chronic exposure to hypoxia on metabolism, particularly comparing chronic obstructive pulmonary disease patients with humans exposed to high altitude. Hypoxia has important metabolic effects. Many oxygen-sensitive regulatory mechanisms work through hypoxia inducible factor 1, and recent literature regarding the hypoxic stimulus and its pathological implications deals largely with hypoxia inducible factor 1-related findings. Hypoxia inducible factor 1 is pivotal in the adaptation to chronic hypoxia: it induces gene expression for fructose-2-6-biphosphatase, an enzyme switching glucose metabolism towards glycolysis, allowing energy production in anaerobic conditions. Hypoxia inducible factor 1 is also involved in the development of anorexia because it induces the promoter of the leptin gene. Particularly important for future therapeutic implications are findings related to hypoxia inducible factor 1 polymorphism and interaction with other molecules, especially estrogens, in the clinical evolution of disease. Malnutrition is a worsening factor in chronic obstructive pulmonary disease. Similarities between chronic obstructive pulmonary disease and altitude exposure point to the importance of hypoxia in this regard. A better understanding of the underlying mechanisms will help to find alternative therapeutic approaches.
BMC Infectious Diseases, 2009
Background: The incidence of tuberculosis (TB) in developed countries has decreased since the 199... more Background: The incidence of tuberculosis (TB) in developed countries has decreased since the 1990s, reflecting worldwide efforts to identify and treat TB according to WHO recommendations. However TB remains an important public health problem in industrialized countries with a high proportion of cases occurring among subjects originating from high prevalence countries. The aim of this study was to describe clinical and social characteristics of patients with TB and their outcome in a low incidence area with a high immigration rate.
CHEST Journal, 2010
Respiratory viruses frequently are recovered in the upper-respiratory tract during acute exacerba... more Respiratory viruses frequently are recovered in the upper-respiratory tract during acute exacerbations of COPD (AECOPD), but their role as contributing pathogens remains unclear. The usefulness of procalcitonin and C-reactive protein as indicators of the presence or absence of viral infection in this setting also needs to be evaluated. The study was of a prospective cohort of patients with COPD admitted to the ED for AECOPD. Reverse transcriptase-polymerase chain reaction (RT-PCR) for 14 respiratory viruses was performed on nasopharyngeal swabs collected at admission and after recovery in stable condition. Eighty-six patients (mean age, 72 years; male, 64%) were included. During AECOPD, upper-respiratory viral infections were detected in 44 (51%) patients: picornavirus in 22, metapneumovirus in seven, coronavirus in eight, influenza A/B in two, parainfluenza in two, and respiratory syncytial virus in three. A dual infection was present in three patients. After recovery, viruses were detected in only eight (11%) of 71 patients (P < .001 compared with AECOPD phase). In five of these patients, no virus had been identified during the initial exacerbation, thus suggesting a new viral infection acquired during follow-up. During AECOPD, procalcitonin and C-reactive protein levels did not differ significantly between patients with or without a proven viral infection. Prevalence of upper-respiratory viral infection, as detected from nasopharyngeal swab by RT-PCR, is high in AECOPD and low after clinical recovery, suggesting that AECOPD frequently are triggered by viral infections initiated in the upper-respiratory tract. In our study, serum procalcitonin and C-reactive protein did not discriminate virus-associated exacerbations from others. clinicaltrials.gov; Identifier: NCT00448604.
0 0 8 ; 1 3 8 ( 3 9 -4 0 ) : 5 8 5 -5 9 3 · w w w . s m w . ch
Sleep medicine, 2011
Hypercapnic ventilatory failure due to restrictive disorders may have a negative impact on sleep ... more Hypercapnic ventilatory failure due to restrictive disorders may have a negative impact on sleep architecture. Non-invasive ventilation (NIV) may improve arterial blood gases but may adversely affect sleep. We assessed sleep structure and blood gases before and during NIV in patients with restrictive disorders in hypercapnic ventilatory failure. Retrospective cohort study. Sleep laboratory of Saint-Luc University Hospital (Belgium). Chart review of all patients with predominantly restrictive disorders and respiratory failure seen between 1987 and 2008 and evaluated with a baseline polysomnography (PSG) and a PSG under NIV. Sixty patients aged (mean±SD) 48±20 years, with total lung capacity of 57±20% of predicted value, PaO(2) of 62±16 mm Hg and PaCO(2) 54±10 mm Hg, were included. At baseline, total sleep time, sleep efficiency, slow wave and rapid-eye movement (REM) sleep were markedly decreased. Conversely, micro-arousals and stage I sleep (N1) were increased. NIV administered with...
Respiratory medicine, 2009
Interferon-gamma (IFN-gamma) production by lymphocytes exposed to antigens specific of Mycobacter... more Interferon-gamma (IFN-gamma) production by lymphocytes exposed to antigens specific of Mycobacterium tuberculosis has been shown to correlate with antigen load and disease activity. To determine whether treatment of tuberculosis (TB) led to a decrease and/or a reversion of results of a IFN-gamma release assay (T-SPOT.TB, Oxford Immunotec, UK) and thus if T-SPOT.TB could be used to monitor response to treatment. Qualitative and quantitative analysis (SFUs: spot-forming units) of T-SPOT.TB in HIV-negative patients with TB, during initial 2 weeks of treatment (T0), at end of treatment (TE) and 6 months later (TE+6). Mean SFU (SD) was 75 (58; n=62) at T0, 46 (55; n=55) at TE, and 33 (46; n=41) at TE+6; positive rate was 98%, 93% and 98%, respectively. SFUs (paired samples, n=36) decreased significantly between T0 and TE; 2 reversions occurred between T0 and TE (6%), but none between TE and TE+6. Of 6 patients (17%) with an increase in SFUs between T0 and TE, 5 had a favourable outcome a...
Background / Purpose: The aim of this study was to determine whether viral acute exacerbation of ... more Background / Purpose: The aim of this study was to determine whether viral acute exacerbation of COPD (AECOPD) is associated with more frequent exacerbations and higher mortality during the one-year follow-up after an index exacerbation leading to hospitalization.Viral AECOPD is more severe and may be associated with higher mortality and more frequent AECOPD during the one year follow-up after an index exacerbation leading to hospitalization.After one year we reviewed the medical charts of 72 patients enrolled in a prospective cohort study of 86 COPD patients hospitalized at Geneva’s University Hospital with AECOPD. 51% of index AECOPD was related to viral infection. The observed timing of a second exacerbation after the index exacerbation, the frequency of exacerbations and the global mortality were analyzed and compared between both groups. Main conclusion: The Mean number of AECOPD during follow-up was 1.38 (SD+/- 1.5). Factors associated with recurrent AECOPD were severity of ob...
The Open Respiratory Medicine Journal, 2014
Background: There is a growing interest in better defining risk factors associated with increased... more Background: There is a growing interest in better defining risk factors associated with increased susceptibility to exacerbation in patients with COPD.
Thorax, 2011
Complex respiratory events, which may have a detrimental effect on both quality of sleep and cont... more Complex respiratory events, which may have a detrimental effect on both quality of sleep and control of nocturnal hypoventilation, occur during sleep in patients treated with non-invasive ventilation (NIV). Among these events are patient-ventilator asynchrony, increases in upper airway resistance (with or without increased respiratory drive) and leaks. Detection of these events is important in order to select the most appropriate ventilator settings and interface. Simple tools can provide important information when monitoring NIV. Pulse oximetry is important to ensure that adequate oxygen saturation is provided and to detect either prolonged or short and recurrent desaturations. However, the specificity of pulse oximetry tracings during NIV is low. Transcutaneous capnography helps discriminate between hypoxaemia related to ventilation/perfusion mismatch and hypoventilation, documents correction of nocturnal hypoventilation and may detect ventilator-induced hyperventilation, a possible cause for central apnoea/hypopnoea and glottic closure. Data provided by ventilator software help the clinician by estimating ventilation, tidal volume, leaks and the rate of inspiratory or expiratory triggering by the patient, although further validation of these signals by independent studies is indicated. Finally, autonomic markers of sympathetic tone using signals such as pulse wave amplitude of the pulse oximetry signal can provide reliable information of sleep fragmentation.
Scandinavian Journal of Infectious Diseases, 2003
An 81-y-old woman was hospitalized because of persistent cough, fever, fatigue and weight loss. D... more An 81-y-old woman was hospitalized because of persistent cough, fever, fatigue and weight loss. Disseminated tuberculosis (pulmonary, bronchial, lymph node and urinary involvement) associated with human immunodeficiency virus disease, CDC stage C3 was diagnosed. Antiretroviral therapy initiated 2 months after the introduction of tuberculostatic treatment was well tolerated, with a 12 month follow-up.
Respiratory Medicine, 2006
Study objective: To evaluate the contribution of body composition measurements to clinical assess... more Study objective: To evaluate the contribution of body composition measurements to clinical assessment in patients on home nasal positive-pressure ventilation for chronic hypercapnic respiratory failure (CHRF), and their relationship to respiratory impairment. Methods: Patients with CHRF (restrictive lung disease (RLD), n ¼ 37; chronic obstructive pulmonary disease (COPD), n ¼ 19), during elective yearly evaluations underwent pulmonary function testing (forced expiratory volumes, arterial blood gases, maximal inspiratory and expiratory pressure (PI max or PE max )), and bioelectrical impedance analysis to determine fat-free mass (FFM) index (kg/m 2 ) and body fat mass index. Results: When compared with age-and sex-matched healthy controls, RLD patients (OR 5.5, CI 1.9-15.6, Po0:002) and COPD (OR 5.2, CI 1.1-24.9, P ¼ 0:04) were significantly more likely to have a low FFM index. Roughly one-half of patients with RLD and one-third with COPD had abnormally low FFM index. Estimation of nutritional status by body mass index (BMI) alone clearly underestimated the prevalence of FFM index depletion. Muscle mass assessed by FFM index explained 26% of variance of PI max (Po0:001) and 27% of that of PE max (Po0:001). Conclusion: BMI alone clearly underestimated FFM depletion, and presence of a very high body fat mass index. Indeed, normal or high BMI can be associated with FFM depletion. Because of its relationship to respiratory muscle strength, an assessment of FFM appears to be valuable in CHRF.
Respiratory Medicine, 2004
Objectives: To evaluate primary care physicians' knowledge of guidelines for the management of COPD.
Respiratory Medicine, 2013
Respiratory events occurring under non-invasive ventilation (NIV) may produce sleep fragmentation... more Respiratory events occurring under non-invasive ventilation (NIV) may produce sleep fragmentation. Alternatives to polysomnography (PSG) should be validated for providing simple monitoring tools for patients treated at home with NIV. To study the value of pulse wave amplitude (PWA) reduction as a surrogate marker of cortical micro-arousals associated with respiratory events occurring during NIV. 27 PSG tracings under NIV recorded in 9 stable patients with Obesity Hypoventilation Syndrome (OHS), under 3 different ventilator modes (no back-up rate, low or high back-up rate) were analyzed. For all respiratory events (obstructive, central, or mixed event), the association with EEG-micro-arousals, PWA reduction of more than 30% and the presence of associated SpO2 desaturation ≥ 4% was recorded. 2474 respiratory events during NREM sleep were analyzed. 73.6% were associated with an EEG-MA, 91.4% with a ≥ 4% decrease in SpO2, and 74.9% with a significant PWA reduction. Sensitivity of PWA for the detection of an EEG-micro-arousal related to a respiratory event was 89.1% [95%CI: 76.7-95.3]. Positive predictive value (PPV) was 87.0% [95%CI: 75.0-94.0]. Sensitivity of PWA was highest in the S mode, compared to both other S/T modes, p = <0.001. Sensitivity of PWA was also higher for central and mixed events, compared to obstructive respiratory events, p = <0.05. PWA reduction is a sensitive marker with a high PPV for the detection of EEG-MA associated with respiratory events during NREM sleep in stable OHS patients treated by NIV. In this situation, PWA could be used to improve scoring of hypopneas and allow an appropriate assessment of sleep fragmentation related to respiratory events.
Respiration, 2004
Background: Evaluation of health-related quality of life (HRQL) in chronic respiratory failure (C... more Background: Evaluation of health-related quality of life (HRQL) in chronic respiratory failure (CRF) is an important issue for evaluating the impact of treatment. Objectives: To elaborate a French version of the Maugeri Foundation Respiratory Failure Questionnaire (MRF-28) disease-specific HRQL questionnaire and determine its validity and reliability in patients with CRF treated by home mechanical ventilation (HMV). Methods: Forward-and back-translation of the MRF-28 questionnaire; the final version was submitted to 81 patients treated with HMV for CRF, simultaneously with the St. George's Respiratory Questionnaire (SGRQ), the Short Form 36 (SF-36), and the Hospital Anxiety and Depression scale (HAD). Validi-ty was determined by correlation with previously validated HRQL scores and recorded physiological parameters. Reliability was evaluated by assessing internal consistency and test-retest stability of the MRF-28 scores. Results: The French version of the MRF-28 and its subscores ('daily activity', 'cognitive function', and 'invalidity') were highly significantly correlated with subscores of the SGRQ, the SF-36 and the HAD. Both the MRF-28 and the SGRQ were correlated only with age and the 6-min walk test. The MRF-28 showed high test-retest reliability after 2 weeks (r 2 = 0.80, p ! 0.0001) and high internal consistency (Crohnbachs' · coefficient: 0.91). Conclusion: The French version of the MRF-28 is a valid and reliable disease-specific questionnaire for assessing HRQL in patients with CRF.
PLoS ONE, 2012
Background: In Switzerland and other developed countries, the number of tuberculosis (TB) cases h... more Background: In Switzerland and other developed countries, the number of tuberculosis (TB) cases has been decreasing for decades, but HIV-infected patients and migrants remain risk groups. The aim of this study was to compare characteristics of TB in HIV-negative and HIV-infected patients diagnosed in Switzerland, and between coinfected patients enrolled and not enrolled in the national Swiss HIV Cohort Study (SHCS).
Medicine & Science in Sports & Exercise, 1997
Nutrition assessment is important during chronic respiratory insufficiency to evaluate the level ... more Nutrition assessment is important during chronic respiratory insufficiency to evaluate the level of malnutrition or obesity and should include body composition measurements. The appreciation of fat-free and fat reserves in patients with chronic respiratory insufficiency can aid in designing an adapted nutritional support, e.g., nutritional support in malnutrition and food restriction in obesity. The purpose of the present study was to cross-validate fat-free and fat mass obtained by various bioelectric impedance (BIA) formulas with the fat-free and fat mass measured by dual-energy X-ray absorptiometry (DXA) and determine the formulas that are best suited to predict the fat-free and fat mass for a group of patients with severe chronic respiratory insufficiency. Seventy-five patients (15 women and 60 men) with chronic obstructive and restrictive respiratory insufficiency aged 45-86 y were included in this study. Body composition was calculated according to 13 different BIA formulas for women and 12 for men and compared with DXA. Because of the variability, calculated as 2 standard deviations, of 25.0 kg fat-free mass for women and 26.4 kg for men for the best predictive formula, the use of the various existing BIA formulas was considered not clinically relevant. Therefore disease-specific formulas for patients with chronic respiratory insufficiency should be developed to improve the prediction of fat-free and fat mass by BIA in these patients.
The Lancet Infectious Diseases, 2004
Pneumonia is a major medical problem in the very old. The increased frequency and severity of pne... more Pneumonia is a major medical problem in the very old. The increased frequency and severity of pneumonia in the elderly is largely explained by the ageing of organ systems (in particular the respiratory tract, immune system, and digestive tract) and the presence of comorbidities due to age-associated diseases. The most striking characteristic of pneumonia in the very old is its clinical presentation: falls and confusion are frequently encountered, while classic symptoms of pneumonia are often absent. Communityacquired pneumonia (CAP) and nursing-home acquired pneumonia (NHAP) have to be distinguished. Although there are no fundamental differences in pathophysiology and microbiology of the two entities, NHAP tends to be much more severe, because milder cases are not referred to the hospital, and residents of nursing homes often suffer from dementia, multiple comorbidities, and decreased functional status. The immune response decays with age, yet pneumococcal and influenza vaccines have their place for the prevention of pneumonia in the very old. Pneumonia in older individuals without terminal disease has to be distinguished from end-of-life pneumonia. In the latter setting, the attributable mortality of pneumonia is low and antibiotics have little effect on life expectancy and should be used only if they provide the best means to alleviate suffering. In this review, we focus on recent publications relative to CAP and NHAP in the very old, and discuss predisposing factors, microorganisms, diagnostic procedures, specific aspects of treatment, prevention, and ethical issues concerning end-of-life pneumonia.
Journal of Cardiopulmonary Rehabilitation, 2003
Current Opinion in Clinical Nutrition and Metabolic Care, 2004
Loss of body mass and exercise intolerance are common findings in chronic obstructive pulmonary d... more Loss of body mass and exercise intolerance are common findings in chronic obstructive pulmonary disease and are often difficult to reverse despite optimal nutritional intake. Similar findings have been reported in healthy individuals during high-altitude exposure. The role of hypoxia in modulating metabolism has been largely investigated in vitro and in animal studies. More fragmentary is the knowledge regarding hypoxia effects on in-vivo human metabolism. This paper reviews recent literature regarding the effects of chronic exposure to hypoxia on metabolism, particularly comparing chronic obstructive pulmonary disease patients with humans exposed to high altitude. Hypoxia has important metabolic effects. Many oxygen-sensitive regulatory mechanisms work through hypoxia inducible factor 1, and recent literature regarding the hypoxic stimulus and its pathological implications deals largely with hypoxia inducible factor 1-related findings. Hypoxia inducible factor 1 is pivotal in the adaptation to chronic hypoxia: it induces gene expression for fructose-2-6-biphosphatase, an enzyme switching glucose metabolism towards glycolysis, allowing energy production in anaerobic conditions. Hypoxia inducible factor 1 is also involved in the development of anorexia because it induces the promoter of the leptin gene. Particularly important for future therapeutic implications are findings related to hypoxia inducible factor 1 polymorphism and interaction with other molecules, especially estrogens, in the clinical evolution of disease. Malnutrition is a worsening factor in chronic obstructive pulmonary disease. Similarities between chronic obstructive pulmonary disease and altitude exposure point to the importance of hypoxia in this regard. A better understanding of the underlying mechanisms will help to find alternative therapeutic approaches.
BMC Infectious Diseases, 2009
Background: The incidence of tuberculosis (TB) in developed countries has decreased since the 199... more Background: The incidence of tuberculosis (TB) in developed countries has decreased since the 1990s, reflecting worldwide efforts to identify and treat TB according to WHO recommendations. However TB remains an important public health problem in industrialized countries with a high proportion of cases occurring among subjects originating from high prevalence countries. The aim of this study was to describe clinical and social characteristics of patients with TB and their outcome in a low incidence area with a high immigration rate.