Anesthésie de l’asthmatique

The asthmatic patient is at risk of bronchospasm during anaesthesia. The risk increases in severe asthma. Uncontrolled asthma is the main risk factor. The preoperative evaluation of asthma control is therefore necessary and if possible the patient will be prepared with bronchodilators and steroids. Locoregional anaesthesia will always be preferred to a general anaesthesia during which endotracheal intubation can induce bronchospasm. Inhaled anaesthetics are well tolerated, in being bronchodilators. Ketamin and benzodiazepines can be used. Propofol and opioids are usually well tolerated in asthmatics. Among myorelaxants, these without histamine release effect will be preferred. During local anaesthesia, lidocain can be used. Its bronchodilator effects are considered. The preventive and a fortiori curative use of beta-2 agonists agents are the treatment of choice of perioperative bronchospasm, associated to steroids.     

La rhinite allergique au latex : du diagnostic à la prise en charge

In spite of numerous publications on occupational lung diseases, latex allergy, and the relationship of nose-to-bronchi, the particularities of the clinical, epidemiological and therapeutic aspects of latex allergic rhinitis (LAR) are very little considered in the literature. Based on our own experience and on a review of the literature, we will examine the environmental context of LAR and try to define its most important diagnostic and therapeutic criteria. An early diagnosis of LAR and reduction of exposure to latex allergens before its evolution to asthma, can limit the socioeconomic impact of this condition.     

L’asthme professionnel aux poussières de bois

Wood-related work has been recognized during the past thirty years as a source of respiratory diseases. The prevalence of occupational asthma has been estimated to be between 5 and 15% of all asthma, but its frequency is difficult to evaluate because it is underestimated. Indeed, there is no simple, specific diagnostic test, and monitoring of workers is difficult. The pathophysiology of these reactions is diverse and has not been elucidated for certain types of wood. The case that will be presented illustrates the importance of early diagnosis of occupational asthma. It was possible as a result of teamwork between the occupational physician, the respiratory specialist/allergist and the attending physician.     

The diagnosis and management of occupational asthma

INTRODUCTION: Occupational asthma (OA), with a latency period induced by multiple exposures, is characterized by immunological sensitization to the responsible agent, based on both an IgE mediated mechanisms and non specific bronchial hyper responsiveness. DIAGNOSTIC METHODS: In the diagnosis of OA, the medical history is obviously the starting-point. Onset of respiratory symptoms at work and resolution on vacation are indications of the diagnosis. After analysis of several publications, this element appears to have the best level of proof (grade 2+) according to the criteria of evidence-based medicine. A visit of the workplace, with the cooperation of the industrial physician, is essential to characterize the nature of the exposure. Positive immunological tests (skin tests and/or specific IgE) associated with objective criteria of symptoms related to work (modification of PEFR, lung function and/or nonspecific bronchial hyper responsiveness) will confirm the aetiological diagnosis of OA. Specific bronchial provocation tests performed in the laboratory allow the identification of new agents involved in OA and are necessary when other investigations are discordant or unavailable. OA needs a stepwise approach including induced sputum eosinophilic counts and measurements of exhaled nitric oxide. MANAGEMENT OF OA: OA requires removal from the workplace because persistence of exposure to respiratory sensitisers may lead to an increase and prolongation of asthma symptoms. However, removal from the workplace can have tremendous professional, financial and social consequences, and sometimes a compromise must be found with reduction of exposure by various methods combined with adequate treatment. The pharmacological treatment of patients with OA should be the same as for patients with non OA, the use of bronchodilators and corticoids depending on the severity of asthma. Concerning the medico-legal aspects, OA can be recognised as an occupational disease. In France OA is included in several tables of work-related diseases.     

Asthme par inhalation de fumées de cuisson de crevettes

We report a case of allergic asthma induced by professional exposure to shrimp cooking vapors in a 19-year-old patient. The patient's medical history revealed an anaphylactic shock seven years ago caused by ingestion of fish food. The diagnosis of asthma induced by seafood cooking vapors is based on clinical history and the positivity of the allergy work-up. Complete eviction of shrimps and redeployment resulted in clinical improvement.