Papers by Jean-Paul Janssens
Sleep and Breathing, 2011
Respiration, 2019
Background: Despite their poor prognosis, patients with severe chronic obstructive pulmonary dise... more Background: Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life. Objectives: To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL). Methods: Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months. Results: Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the contro...
The European respiratory journal, 2017
Revue médicale suisse, Jan 3, 2016
The most common presentation of bone tuberculosis (TB) is called spondylodiscitis, or "Pott&... more The most common presentation of bone tuberculosis (TB) is called spondylodiscitis, or "Pott's disease", which is a difficult diagnosis due to its low prevalence in Switzerland. It should be considered in patients with persistent back pain, who are at high risk, such as migrant population and immunocompromised patients. Diagnosis is based on imaging and the detection of M. tuberculosis in biopsy of affected vertebra orparaspinal abscess, or even if active tuberculosis is proven in any other site. It's essential to initiate appropriate treatment as quickly as possible in order to avoid neurological complications and spinal deformity and to identify cases that will require a surgical therapy.
Revue Medicale Suisse, 2011
Tuberculosis (TB) is the most frequent opportunistic infection in patients infected by the Human ... more Tuberculosis (TB) is the most frequent opportunistic infection in patients infected by the Human immunodeficiency virus (HIV). The mortality related to this co-infection can be reduced by the early introduction of an antiretroviral treatment. However, when treating subjects with TB and HIV, interactions between antiretroviral and tuberculostatic treatments can be problematic; also, these patients may develop, under treatment, an immune reconstitution inflammatory syndrome (IRIS). This review aims to summarize the necessary therapeutic adjustments which should be performed when treating patients co-infected with TB and HIV, the most important interactions between HIV and TB treatments, and the medical management of the IRIS.
Respiration, 2015
A 61-year-old patient with alcohol use disorder (AUD) was referred for suspicion of sleep apnea s... more A 61-year-old patient with alcohol use disorder (AUD) was referred for suspicion of sleep apnea syndrome (SAS). He had incurred three road accidents attributed to sleepiness over the previous year, shortly after initiation of high-dose (100 mg b.i.d.) treatment with baclofen, a molecule increasingly used in the management of AUD. Polysomnography revealed a severe central SAS (CSAS) with an apnea-hypopnea index (AHI) of 81.6/h. Baclofen was suggested as a possible cause of the CSAS, and after its withdrawal, a second polysomnography was done, showing the disappearance of the central apneas and a shift to severe obstructive SAS (AHI 43.9/h), for which a positive airway pressure (CPAP) treatment was initiated. A third polysomnography was performed under CPAP after reintroduction of baclofen (50 mg b.i.d.) by the patient, showing reappearance of the CSAS (AHI 42.1/h). This case report illustrates the deleterious effect of baclofen on breathing physiology during sleep. Since it is typica...
D73. SLEEP BEYOND APNEA, 2010
Revue médicale suisse, Jan 15, 2014
We discuss here three recent applications of high technology in pulmonary medicine. GeneXpert has... more We discuss here three recent applications of high technology in pulmonary medicine. GeneXpert has considerably improved the diagnosis of active tuberculosis. However, the test has also its limits so that clinical assessment, radiology, and sputum microscopy remain fundamental. Treatment of severe emphysema by lung volume reduction is no longer confined to surgical approach, but is now possible by bronchoscopy. Implantation of Nitinol coils in the most diseased parts of the emphysematous lung is a promising technique. Finally, several clinical trials on bronchial thermoplasty have been reported for intractable asthma. The recent publication of the long term effects of this technique is the occasion to update on this matter.
Revue médicale suisse, Jan 15, 2010
Non-invasive mechanical ventilation in patients with chronic neuromuscular disorders is an effect... more Non-invasive mechanical ventilation in patients with chronic neuromuscular disorders is an effective tool for treating dyspnea or sleep disturbances often observed in such patients. So, NIV has to be considered as a palliative treatment and it must systematically be offered to these patients. Mechanical ventilation, non-invasive or invasive (via a trachesotomy) have to be considered systematically with patients and families at an earlier stages of these diseases in order to design a strategy in case of acute respiratory failure. In a second parent paper of this issue, we discuss the medico-legal implications of mechanical ventilation in neuromuscular failure, particularly the end-of-life aspects.
Revue médicale suisse, Jan 14, 2009
In 2008, studies on inhaled anticholinergic bronchodilators for chronic obstructive pulmonary dis... more In 2008, studies on inhaled anticholinergic bronchodilators for chronic obstructive pulmonary disease (COPD) were published, some of them with contradictory messages. One study, and a meta-analysis suggested that inhaled ipratropium on the long- term is associated with increased risk for cardiac death. Therefore some caution should be at place when prescribing this drug in patients with coronary or rhythmic cardiac disease. On the other hand, a large randomized, placebo-controlled study on tiotropium did not suggested increased adverse cardio-vascular effects, but rather a diminution, and showed beneficial bronchodilator effect in patients with COPD. However the treatment did not attenuate the annual decline of lung function, and did not decrease mortality in these patients.
Kinésithérapie respiratoire, 2009
Veterinary Medicine International, 2012
A case of pulmonary tuberculosis caused byMycobacterium tuberculosiswas diagnosed in a horse. Cli... more A case of pulmonary tuberculosis caused byMycobacterium tuberculosiswas diagnosed in a horse. Clinical evaluation performed prior to euthanasia did not suggest tuberculosis, but postmortem examination provided pathological and bacteriological evidence of mycobacteriosis. In the lungs, multiple tuberculoid granulomas communicating with the bronchiolar lumen, pleural effusion, and a granulomatous lymphadenitis involving mediastinal and tracheobronchial lymph nodes were found. Serologic response toM. tuberculosisantigens was detected in the infected horse, but not in the group of 42 potentially exposed animals (18 horses, 14 alpacas, 6 donkeys, and 4 dogs) which showed no signs of disease. Diagnosis of tuberculosis in live horses remains extremely difficult. Four of 20 animal handlers at the farm were positive for tuberculous infection upon follow-up testing by interferon-gamma release assay, indicating a possibility of interspecies transmission ofM. tuberculosis.
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
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). Validity 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 (...
Journal of the American Geriatrics Society, 2004
Journal of Rehabilitation Medicine, 2013
Journal of Pain and Symptom Management, 2000
Progression of chronic obstructive pulmonary disease (COPD) is frequently associated with increas... more Progression of chronic obstructive pulmonary disease (COPD) is frequently associated with increasing dyspnea; indeed, patients with severe COPD constitute the largest group of patients with chronic respiratory insufficiency. The sensation of dyspnea in these patients is mostly related to increased work of breathing, a consequence of an increased resistive load, of hyperinflation, and of the deleterious effect of intrinsic positive end-expiratory pressure (PEEP i). Once optimal medical treatment has been provided, pharmacological treatments of dyspnea exist ( 2-agonists, methylxanthines, opiates) but seldom suffice. Nonpharmacological complementary treatments must be envisioned. Patients with severe hyperinflation should be screened as possible candidates for lung reduction surgery. Pulmonary rehabilitationincluding chest therapy, patient education, exercise training-has been established as effective on quality of life (QoL) and dyspnea. Noninvasive positive pressure devices may be effective for symptomatic treatment of severe dyspnea: continuous positive airway pressure (CPAP) counteracts the deleterious effect of PEEP i in patients with severe hyperinflation; intermittent positive pressure breathing (IPPB) may decrease dyspnea and discomfort during nebulized therapy; finally noninvasive positive pressure ventilation (NIPPV) has been shown to be effective on the sensation of dyspnea and QoL in COPD with severe hypercapnia.
Intensive Care Medicine, 2013
Current Opinion in Clinical Nutrition and Metabolic Care, 2004
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Papers by Jean-Paul Janssens