Allergic rhinitis (AR) and asthma represent global health problems for all age groups. Asthma and rhinitis frequently coexist in the same subjects. Allergic Rhinitis and its Impact on Asthma (ARIA) was initiated during a World Health Organization workshop in 1999 (published in 2001). ARIA has reclassified AR as mild/moderate-severe and intermittent/persistent. This classification closely reflects patients' needs and underlines the close relationship between rhinitis and asthma. Patients, clinicians, and other health care professionals are confronted with various treatment choices for the management of AR. This contributes to considerable variation in clinical practice, and worldwide, patients, clinicians, and other health care professionals are faced with uncertainty about the relative merits and downsides of the various treatment options. In its 2010 Revision, ARIA developed clinical practice guidelines for the management of AR and asthma comorbidities based on the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system. ARIA is disseminated and implemented in more than 50 countries of the world. Ten years after the publication of the ARIA World Health Organization workshop report, it is important to make a summary of its achievements and identify the still unmet clinical, research, and implementation needs to strengthen the 2011 European Union Priority on allergy and asthma in children.
Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies.
L'aspergillome pulmonaire est une colonisation par Aspergillus d'une cavité pulmonaire préformée. Nos objectifs étaient de définir le profil épidémio-clinique et thérapeutique des aspergillomes pulmonaires et essayer de dégager les facteurs favorisants de cette affection à Madagascar. Nous avons réalisés une étude prospective, descriptive, analytique durant 59 mois sur les aspergillomes pulmonaires à Antananarivo Madagascar. Etaient inclus dans cette étude les malades ayant un diagnostic d'aspergillome pulmonaire. Trente-sept (37) cas d'aspergillome pulmonaire étaient recensés parmi les 8 392 patients hospitalisés dans le service de Pneumologie (0,44%). Il s'agit de 29 hommes (78,38%) et 8 femmes (21,61%), d’âge moyen de 43 ans. Les facteurs prédisposant étaient dominés par la tuberculose pulmonaire (89,19%). Le délai moyen d'apparition de l'aspergillome chez les malades ayant un antécédent de tuberculose pulmonaire à bacilloscopie positive (TPM+) était de 8 ans et 6 mois avec un délai extrême de un mois à 23 ans. L'hémoptysie était le mode de révélation le plus fréquent (91,89%). Le traitement était médical chez 27 patients (72,97%) et médico-chirurgical chez 10 patients (27,03%). Vingt sept patients étaient perdus de vue (72,97%), et pour les 10 patients suivis (27,02%), 70% avaient une évolution favorable avec disparition des signes, et 30% présentaient des hémoptysies récidivantes. Le taux de mortalité postopératoire était de 4% et 50% des patients avaient des complications postopératoires. La surveillance des lésions séquellaires de tuberculose pulmonaire qui constituent les facteurs favorisants prédominant d'aspergillome pulmonaire à Madagascar nécessite une attention particulière. La prise en charge de la tuberculose doit être précoce et adaptée surtout dans les pays à forte prévalence tuberculeuse.
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