La Revue du praticien
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La Revue du praticien · Sep 2004
Review[Diagnosis and management of exacerbations and acute respiratory failure in patients with chronic obstructive pulmonary disease].
Acute episode of chronic obstructive pulmonary disease occurs in almost all patients, during which cough, expectoration and dyspnea increase. When the underlying disease is not severe and the acute episode not life-threatening, the term "exacerbation" is appropriate, and the patients can be managed at home. When the underlying disease is advanced and the acute episode possibly life-threatening, the terms of "acute respiratory failure" or "decompensation" can be used. ⋯ In the most severe cases, non-invasive ventilation must be accessible. The prevention of acute episodes of COPD is best achieved through tobacco cessation and influenza vaccine. Finally, an acute episode may be an opportunity to make a diagnosis of COPD if this has not been done before.
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A heat wave of exceptional intensity occurred in France in August 2003, 2003 was the warmest of the last 53 years in terms of minimal, maximal and average temperatures, and in terms of duration. In addition, high temperatures and sunshine, causing the emission of pollutants, significantly increased the atmospheric ozone level. Some epidemiological studies were rapidly implemented during the month of August in order to asses the health impact of this heat wave. ⋯ The public health impact of the heat wave of August 2003 was major. This exceptional event raises questions about anticipating phenomena which are difficult to predict. The collaborative efforts which were developed and the group of actions and studies which were implemented in a context of emergency are now useful for the setting up of early warning strategies and thus efficient prevention.
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The prevention of the health risks linked to the excess of heat comprises 5 axes: the sensitisation of fragile persons, families and health personnel to the danger that extreme heat represents; informing and educating about the measures to take before summer and during the scorching heat, identification of persons at risk, protecting, surveilling and alerting them. Two messages predominate: refresh oneself at least 2 hours per day in a cool place (less than 26 degrees C), and drink before being thirsty and beyond the thirst. The efficacity of the measures depend upon the level of general awareness when faced with the health risk that is associated with extreme heat.