<p>Cher Confr&egrave;re</p>
<p>J'ai vu ce jour M. PAYET Jean Ren&eacute; n&eacute; le 01/12/1959.</p>
<p>Il a compl&egrave;tement arret&eacute; de fumer par lui meme.Il refuse pour l'instant la r&eacute;habilitation respiratoire.</p>
<p>Il pr&eacute;sente une toux grasse avec expectoration blanchatre.</p>
<p>l'auscultation pulmonaire retrouve ce jour des ronchi.</p>
<p>L'EFR retrouve un trouble ventilatoire obstructif mod&eacute;r&eacute; Gold II avec un VEMS &agrave; 2.02 soit 60% de la norme.Il existe une distension pulmonaire avec VGT &agrave; 160%,CPT &agrave; 113% et VR &agrave; 173%.il existe une augmentation de la resistance des voies a&eacute;riennes avec RVA &agrave; 0.54.On ne retrouve pas de trouble du transfert.</p>
<p>Il poursuivra:Alvesco 1B/j;Spiriva Respimat 2B/j;associ&eacute;es &agrave; Onbrez 300/j .</p>
<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l'assurance de mes sentiments distingu&eacute;s,</p>
<p>Dr. B. TANGUY.</p>
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