Nicolas Roche

Hôpital d'instruction des armées du Val-de-Grâce, Lutetia Parisorum, Île-de-France, France

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Publications (315)527.8 Total impact

  • Revue des Maladies Respiratoires 01/2015; 32. · 0.49 Impact Factor
  • Revue des Maladies Respiratoires 01/2015; 32. · 0.49 Impact Factor
  • Revue des Maladies Respiratoires 01/2015; 32. · 0.49 Impact Factor
  • Isabella Annesi-Maesano, Nicolas Roche
    European Respiratory Review 12/2014; 23(134):410-5.
  • Revue des maladies respiratoires. 11/2014;
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    ABSTRACT: La BPCO est une maladie pulmonaire avec un retentissement systémique dont il est nécessaire d’évaluer la sévérité avant de décider et initier une stratégie thérapeutique.Le sevrage tabagique est primordial quel que soit le stade de la maladie, pour ralentir le déclin de la fonction respiratoire, améliorer les symptômes, réduire la fréquence des exacerbations, améliorer la tolérance à l’effort et diminuer la mortalité globale.Les bronchodilatateurs ont une place essentielle dans la prise en charge médicamenteuse de la BPCO. Les bronchodilatateurs inhalés de longue durée d’action sont indiqués lorsque la symptomatologie persiste (notamment la dyspnée) malgré l’utilisation pluriquotidienne d’un bronchodilatateur de courte durée d’action. Ils modifient l’évolution au long cours de la maladie, notamment en réduisant la fréquence des exacerbations.Le choix entre un β2-adrénergique et un anticholinergique est fonction du bénéfice symptomatique individuel.Les corticoïdes ne sont indiqués que sous forme d’associations fixes avec un β2-adrénergique de longue durée d’action par voie inhalée chez des patients ayant des exacerbations répétées malgré un traitement continu par bronchodilatateur. L’association d’un corticoïde inhalé à un β2-adrénergique de longue durée d’action permet de réduire la fréquence des exacerbations modérées à sévères.La réhabilitation devrait être proposée à tout patient qui a une dyspnée, une intolérance à l’exercice, ou une limitation de ses activités quotidiennes liées à la BPCO malgré un traitement médicamenteux optimal de sa maladie et des éventuelles comorbidités. Par une prise en charge multidisciplinaire et individualisée, elle permet d’optimiser les performances physiques, l’insertion sociale, l’autonomie et diminue la consommation de soins en réduisant les exacerbations, les consultations en urgence et la durée des hospitalisations.Les objectifs de la réhabilitation ne se limitent pas à l’obtention d’une augmentation de la capacité fonctionnelle d’effort mais aussi à des changements durables de comportement nécessaires à une amélioration de l’état de santé et de la qualité de vie du patient. C’est un moment privilégié pour l’éducation thérapeutique, essentielle dans le parcours de soin du patient souffrant de BPCO.
    La Presse Médicale 11/2014; · 1.17 Impact Factor
  • Roger Escamilla, Nicolas Roche
    European Respiratory Journal 11/2014; 44(5):1103-6. · 7.13 Impact Factor
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    ABSTRACT: COPD is a pulmonary disease with a systemic impact. The goals of COPD assessment are to determine the severity of the disease to guide management. Smoking cessation is a prime objective at all the stages of the disease to modify the long-term decline in lung function, reduce the COPD symptoms, and the frequency of exacerbations, improve health status and reduce mortality. The bronchodilators are central in the pharmacologic management of COPD. Long-acting bronchodilators are indicated as maintenance treatment to relieve COPD symptoms (particularly dyspnea) despite regular use of short-acting bronchodilators. Long-acting bronchodilators reduce the exacerbation rate. The choice between a long-acting β2-adrenergic and an anticholinergic depends on the patient's perception of symptom relief. The inhaled corticoids are only indicated in COPD combined with long-acting β2-adrenergic in patients with severe COPD and a history of repeated exacerbations, who have significant symptoms despite therapy with bronchodilators. The combination of an inhaled corticosteroid with a long-acting β2-agonist reduces the exacerbation rate. The rehabilitation should be offered to all patients with dyspnea, exercise intolerance, or limitation in everyday activities related to COPD despite optimal pharmacological therapy and management of co-morbidities. Pulmonary rehabilitation is a multidisciplinary and tailored management of the COPD patients which enable to optimize exercise capacity, social reintegration, autonomy, reduce health care costs by decreasing the exacerbation rate, urgent visits and duration of hospitalisation. The rehabilitation is not just focusing on the improvement of exercise capacity, but also seeks sustained behavioural changes that are needed to achieve real improvement in health status and quality of life. Pulmonary rehabilitation is also an excellent opportunity for education which is critical in the healthcare pathway. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Presse medicale (Paris, France : 1983). 11/2014; 43(12P1):1368-1380.
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    ABSTRACT: Nitric oxide (NO) is both a gas and a ubiquitous inter- and intracellular messenger with numerous physiological functions. As its synthesis is markedly increased during inflammatory processes, NO can be used as a surrogate marker of acute and/or chronic inflammation. It is possible to quantify fractional concentration of NO in exhaled breath (FENO) to detect airway inflammation, and thus improve the diagnosis of asthma by better characterizing asthmatic patients with eosinophilic bronchial inflammation, and eventually improve the management of targeted asthmatic patients. FENO measurement can therefore be viewed as a new, reproducible and easy to perform pulmonary function test. Measuring FENO is the only non-invasive pulmonary function test allowing (1) detecting, (2) quantifying and (3) monitoring changes in inflammatory processes during the course of various respiratory disorders, including corticosensitive asthma.
    Revue des Maladies Respiratoires 11/2014; · 0.49 Impact Factor
  • Revue des Maladies Respiratoires 11/2014; · 0.49 Impact Factor
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    ABSTRACT: Inhaled treatments are essential for respiratory diseases management, including COPD and asthma. Optimal control of the disease largely depends on patient's compliance and proper use of these treatments. Different types of ready-to-use inhaler devices are available: metered dose inhaler, dry powder inhaler or soft mist inhaler. Each of these devices presents specific characteristics and constraints that have to be evaluated and taken into account before prescription. In order to optimize adherence and treatment efficacy, the choice of inhaler device should depend on the specific needs, abilities and preferences of each patient and a specific education to treatment should be provided. Inhaled treatments, even containing the same drug, have different technical constraints and are thus not easily interchangeable. Their substitution without prior medical consent and without proper training can lead to errors in taking treatment, treatment failures and increased health care consumption. In France, substitution by the pharmacist is not authorized. While patient education must be carried out in collaboration with all health professionals, it is preferable that the choice of inhaler device remains the responsibility of the physician.
    Revue des Maladies Respiratoires 11/2014; · 0.49 Impact Factor
  • European Respiratory Journal 10/2014; · 7.13 Impact Factor
  • Nicolas Roche, Marc Humbert
    La Presse Médicale 10/2014; · 1.17 Impact Factor
  • Nicolas Roche, Marc Humbert
    Presse medicale (Paris, France : 1983). 10/2014; 43(12P1):1334-1336.
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    ABSTRACT: Background Few studies have investigated the 24-hour symptom profile in patients with COPD or how symptoms during the 24-hour day are inter-related. This observational study assessed the prevalence, severity and relationship between night-time, early morning and daytime COPD symptoms and explored the relationship between 24-hour symptoms and other patient-reported outcomes.Methods The study enrolled patients with stable COPD in clinical practice. Baseline night-time, early morning and daytime symptoms (symptom questionnaire), severity of airflow obstruction (FEV1), dyspnoea (modified Medical Research Council Dyspnoea Scale), health status (COPD Assessment Test), anxiety and depression levels (Hospital Anxiety and Depression Scale), sleep quality (COPD and Asthma Sleep Impact Scale) and physical activity level (sedentary, moderately active or active) were recorded.ResultsThe full analysis set included 727 patients: 65.8% male, mean¿±¿standard deviation age 67.2¿±¿8.8 years, % predicted FEV1 52.8¿±¿20.5%.In each part of the 24-hour day, >60% of patients reported experiencing ¿1 symptom in the week before baseline. Symptoms were more common in the early morning and daytime versus night-time (81.4%, 82.7% and 63.0%, respectively). Symptom severity was comparable for each period assessed. Overall, in the week before baseline, 56.7% of patients had symptoms throughout the whole 24-hour day (3 parts of the day); 79.9% had symptoms in ¿2 parts of the 24-hour day. Symptoms during each part of the day were inter-related, irrespective of disease severity (all p¿<¿0.001).Early morning and daytime symptoms were associated with the severity of airflow obstruction (p¿<¿0.05 for both). Night-time, early morning and daytime symptoms were all associated with worse dyspnoea, health status and sleep quality, and higher anxiety and depression levels (all p¿<¿0.001 versus patients without symptoms in each corresponding period). In each part of the 24-hour day, there was also an association between symptoms and a patient¿s physical activity level (p¿<¿0.05 for each period).Conclusions More than half of patients experienced COPD symptoms throughout the whole 24-hour day. There was a significant relationship between night-time, early morning and daytime symptoms. In each period, symptoms were associated with worse patient-reported outcomes, suggesting that improving 24-hour symptoms should be an important consideration in the management of COPD.
    Respiratory Research 10/2014; 15(1):122. · 3.13 Impact Factor
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    ABSTRACT: The combination of an inhaled corticosteroid and a long acting beta-2 agonist is indicated for the regular treatment of persistent moderate-to-severe asthmatics whose asthma is not controlled by inhaled corticosteroids and the occasional use of a short acting beta-2 agonist. The aim of this review is to give an overview of the rationale of combining formoterol and fluticasone and to analyze the clinical data concerning a new fixed combination of fluticasone and formoterol in a pressurised metered-dose inhaler with a dose counter (Flutiform®) that was approved for the treatment of asthma in France in 2013. The clinical studies provide evidence that combined fluticasone/formoterol is more efficacious than fluticasone or formoterol given alone, and provides similar improvements in lung function to fluticasone (Flixotide®) and formoterol (Foradil®) administered concurrently. The combination of fluticasone/formoterol gave a more rapid bronchodilatation than the combination fluticasone/salmeterol. As a whole, the combination of fluticasone/formoterol had similar efficacy and tolerability profiles to the combinations of either budesonide/formoterol or fluticasone/salmeterol.
    Revue des Maladies Respiratoires 10/2014; · 0.49 Impact Factor
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    ABSTRACT: Hypothesizing that nutritional status, systemic inflammation and tumoral immune microenvironment play a role as determinants of lung cancer evolution, the purpose of this study was to assess their respective impact on long-term survival in resected non-small cell lung cancers (NSCLC).
    PLoS ONE 09/2014; 9(9):e106914. · 3.53 Impact Factor
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    ABSTRACT: Background The use of a severity score to help orientation decisions could improve the efficiency of care for acute exacerbations of COPD (AECOPD). We previously developed a score (`2008 score¿, based on age, dyspnea grade at steady state and number of clinical signs of severity) predicting in-hospital mortality in patients with AECOPD visiting emergency departments (EDs). External validity of this score remains to be assessed.Objectives To test the predictive properties of the `2008 score¿ in a population of patients hospitalized in medical respiratory wards for AECOPD, and determine whether a new score specifically derived from this population would differ from the previous score in terms of components or predictive performance.Methods Data from a cohort study in 1824 patients hospitalized in a medical ward for an AECOPD were analyzed. Patients were categorized using the 2008 score and its predictive characteristics for in-hospital mortality rates were assessed. A new score was developed using multivariate logistic regression modeling in a randomly selected derivation population sample followed by testing in the remaining population (validation sample). Robustness of results was assessed by case-by-case validation.ResultsThe 2008 score was characterized by a c-statistic at 0.77, a sensitivity of 69% and a specificity of 76% for prediction of in-hospital mortality. The new score comprised the same variables plus major cardiac comorbidities and was characterized by a c-statistic of 0.78, a sensitivity of 77% and specificity of 66%.ConclusionsA score using simple clinical variables has robust properties for predicting the risk of in-hospital death in patients hospitalized for AECOPD. Adding cardiac comorbidities to the original score increased its sensitivity.
    Respiratory research. 08/2014; 15(1):99.
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    ABSTRACT: Introduction The majority of pleural and peritoneal mesotheliomas are linked to asbestos exposure but, in around 20% of cases, no history of such exposure is found. Periodic disease is associated with recurrent serositis, which could favor the development of mesothelioma. Case report We report a case of pleural mesothelioma in a 50-year-old Lebanese woman, with no detectable exposure to asbestos but suffering from periodic disease (familial Mediterranean fever) with recurrent episodes of serositis. Discussion Many cases of peritoneal mesothelioma in patients with FMF are reported in the literature. This is the second reported case of pleural mesothelioma associated with periodic disease. Because of the low incidence of both diseases, further publications are required to support the hypothesis of a causal link. It is important, therefore, that all cases of an association of periodic disease and mesothelioma are reported.
    Revue des Maladies Respiratoires 08/2014; · 0.49 Impact Factor
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    ABSTRACT: Introduction This study evaluated a standardized procedure aiming at early detection of COPD in a consecutive population of employees visiting occupational medicine. Methods A total of 2818 employees were included by 22 occupational physicians in 5 centers. Respiratory symptoms, smoking status, occupational exposures and socioprofessional categories were collected. Subjects with at least one symptom and/or risk factor underwent spirometry. Results In this population aged 39 ± 12 years, 2603 patients were free of known asthma or COPD. The presence of at least one symptom was observed in 23.6 % of employees and was significantly associated with smoking status, occupational exposure to organic dust, gas fumes and vapors, and agriculture (P < 0.0001). Airflow obstruction (FEV1/FVC < 0.70) was detected in 1.7 % of 1605 employees who underwent spirometry. With the inclusion of known COPD subjects (n = 22), the prevalence reached 2.38 %. COPD was significantly associated with smoking intensity. Information on subsequent diagnosis was obtained in only two cases. The quality of spirometry was inadequate in 30 % of cases. Thirty-three percent of detected COPD subjects did not report any respiratory symptoms. Conclusion The strategy used in this study (specific questionnaire plus spirometry) allowed detection of a few cases of previously undiagnosed COPD. Occupational physicians need specific training in spirometry and a better follow-up of care pathways is required to obtain diagnostic confirmation.
    Revue des Maladies Respiratoires 08/2014; · 0.49 Impact Factor

Publication Stats

2k Citations
527.80 Total Impact Points

Institutions

  • 2014
    • Hôpital d'instruction des armées du Val-de-Grâce
      Lutetia Parisorum, Île-de-France, France
  • 2004–2014
    • Hôtel-Dieu de Paris – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 1997–2014
    • Université René Descartes - Paris 5
      Lutetia Parisorum, Île-de-France, France
  • 2013
    • George Washington University
      Washington, Washington, D.C., United States
  • 2009–2013
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • Institut de veille sanitaire
      Charenton, Île-de-France, France
    • Hôpital Foch
      Lutetia Parisorum, Île-de-France, France
  • 2012
    • CHU de Lyon - Hôpital de la Croix-Rousse
      Lyons, Rhône-Alpes, France
  • 2011
    • University of Aberdeen
      • Academic Primary Care
      Aberdeen, SCT, United Kingdom
    • Centre Hospitalier Régional Universitaire de Lille
      Lille, Nord-Pas-de-Calais, France
    • Hôpital Ambroise Paré – Hôpitaux universitaires Paris Ile-de-France Ouest
      Billancourt, Île-de-France, France
  • 2010
    • Centre Hospitalier de Meaux
      Île-de-France, France
    • Hôpital Bichat - Claude-Bernard (Hôpitaux Universitaires Paris Nord Val de Seine)
      • Service de Pneumologie A
      Paris, Ile-de-France, France
  • 1995–2010
    • Hôpital Cochin (Hôpitaux Universitaires Paris Centre)
      • Service de Pneumologie
      Paris, Ile-de-France, France
  • 2005–2009
    • Hopital Hôtel-Dieu Grace
      Windsor, Ontario, Canada
  • 2008
    • Université Paris-Sud 11
      Orsay, Île-de-France, France
  • 2004–2007
    • Centre Hospitalier Universitaire Rouen
      Rouen, Upper Normandy, France
  • 2003
    • National Heart, Lung, and Blood Institute
      Maryland, United States
  • 2002
    • University of Limoges
      Limages, Limousin, France
  • 1995–1997
    • Hôpital Ambroise Paré Paul Desbief
      Marsiglia, Provence-Alpes-Côte d'Azur, France