Pub Date : 2023-11-02DOI: 10.1080/24745332.2023.2225997
A. Mounchili, Reshel Perera, Robyn S. Lee, H. Njoo, James D. Brooks
{"title":"Chapitre 1: L’épidémiologie de la tuberculose au Canada","authors":"A. Mounchili, Reshel Perera, Robyn S. Lee, H. Njoo, James D. Brooks","doi":"10.1080/24745332.2023.2225997","DOIUrl":"https://doi.org/10.1080/24745332.2023.2225997","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"1 1","pages":"279 - 292"},"PeriodicalIF":0.8,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139291013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-11DOI: 10.1080/24745332.2023.2255193
Stéphanie Mercier, Stephen Lam, Andrea Bezjak, Charles Butts, Andrew J. E. Seely, Paul Wheatley-Price
AbstractFor over a century, lung cancer has been both the most common and the most lethal cancer in Canada, due to high populational tobacco exposure and other risk factors. Canada has significantly advanced the knowledge and treatment of lung cancer, as evidenced by important contributions to lung cancer screening, surgery, radiotherapy, systemic therapy, palliative and supportive care. There remain ongoing challenges to the provision of optimal lung cancer care in Canada, including: a gender gap in lung cancer rates and potential years of life lost, diagnostic and care inequity for Indigenous and other underrepresented populations, relatively low funding for lung cancer research, complex drug approval processes, restrictive funding structures for new treatments, poor access to palliative care and persistent stigma surrounding cigarette smoking and nicotine addiction. This paper highlights the significant Canadian contributions to the field of lung cancer, current challenges and future directions.Keywords: SCLCNSCLCCanadatobaccosmoking Author contributionsS. Lam, P. Wheatley-Price and S. Mercier were responsible for the conceptualization of the manuscript. S. Mercier and P. Wheatley-Price were responsible for the methodology and project administration. S. Mercier was responsible for investigation and writing of the original draft. P. Wheatley-Price, S. Lam, A. Bezjak, C. Butts and A.J.E. Seely were responsible for the resources. P. Wheatley-Price, S. Lam, A. Bezjak, C. Butts, A.J.E. Seely and S. Mercier were responsible for the review and editing of the manuscript. S. Mercier was responsible for the visualization of the project. The work was supervised by P. Wheatley-Price.Disclosure statementThe authors report no conflicts of interest.Additional informationFundingThe author(s) reported there is no funding associated with the work featured in this article.
摘要一个多世纪以来，肺癌一直是加拿大最常见也是最致命的癌症，这是由于高人群吸烟和其他危险因素造成的。加拿大大大提高了对肺癌的认识和治疗，在肺癌筛查、手术、放射治疗、全身治疗、姑息治疗和支持性护理方面作出了重要贡献。在加拿大，提供最佳的肺癌治疗仍然面临着持续的挑战，包括:肺癌发病率和潜在的生命损失年数方面的性别差距、土著和其他代表性不足的人群在诊断和护理方面的不平等、肺癌研究的资金相对较少、药物审批程序复杂、新疗法的资金结构受限、难以获得姑息治疗以及围绕吸烟和尼古丁成瘾的持续耻辱。本文重点介绍了加拿大在肺癌领域的重要贡献，当前的挑战和未来的方向。关键词:scclc; scclc;加拿大;吸烟;Lam, P. Wheatley-Price和S. Mercier负责手稿的概念化。S. Mercier和P. Wheatley-Price负责方法论和项目管理。S. Mercier负责调查和撰写初稿。P. Wheatley-Price, S. Lam, A. Bezjak, C. Butts和A.J.E. Seely负责资源。P. Wheatley-Price, S. Lam, A. Bezjak, C. Butts, A.J.E. Seely和S. Mercier负责对手稿的审查和编辑。S. Mercier负责这个项目的可视化。这项工作由P.惠特利-普莱斯监督。披露声明作者报告无利益冲突。其他信息资金作者报告没有与本文所述工作相关的资金。
{"title":"A brief history of lung cancer in Canada: Care, contributions and challenges","authors":"Stéphanie Mercier, Stephen Lam, Andrea Bezjak, Charles Butts, Andrew J. E. Seely, Paul Wheatley-Price","doi":"10.1080/24745332.2023.2255193","DOIUrl":"https://doi.org/10.1080/24745332.2023.2255193","url":null,"abstract":"AbstractFor over a century, lung cancer has been both the most common and the most lethal cancer in Canada, due to high populational tobacco exposure and other risk factors. Canada has significantly advanced the knowledge and treatment of lung cancer, as evidenced by important contributions to lung cancer screening, surgery, radiotherapy, systemic therapy, palliative and supportive care. There remain ongoing challenges to the provision of optimal lung cancer care in Canada, including: a gender gap in lung cancer rates and potential years of life lost, diagnostic and care inequity for Indigenous and other underrepresented populations, relatively low funding for lung cancer research, complex drug approval processes, restrictive funding structures for new treatments, poor access to palliative care and persistent stigma surrounding cigarette smoking and nicotine addiction. This paper highlights the significant Canadian contributions to the field of lung cancer, current challenges and future directions.Keywords: SCLCNSCLCCanadatobaccosmoking Author contributionsS. Lam, P. Wheatley-Price and S. Mercier were responsible for the conceptualization of the manuscript. S. Mercier and P. Wheatley-Price were responsible for the methodology and project administration. S. Mercier was responsible for investigation and writing of the original draft. P. Wheatley-Price, S. Lam, A. Bezjak, C. Butts and A.J.E. Seely were responsible for the resources. P. Wheatley-Price, S. Lam, A. Bezjak, C. Butts, A.J.E. Seely and S. Mercier were responsible for the review and editing of the manuscript. S. Mercier was responsible for the visualization of the project. The work was supervised by P. Wheatley-Price.Disclosure statementThe authors report no conflicts of interest.Additional informationFundingThe author(s) reported there is no funding associated with the work featured in this article.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"312 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136098406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-11DOI: 10.1080/24745332.2023.2254283
Samir Gupta, Simon Couillard, Geneviève Digby, Sze Man Tse, Samantha Green, Raymond Aceron, Chris Carlsten, Jill Hubick, Erika Penz
{"title":"Canadian Thoracic Society Position Statement on Climate Change and Choice of Inhalers for Patients with Respiratory Disease","authors":"Samir Gupta, Simon Couillard, Geneviève Digby, Sze Man Tse, Samantha Green, Raymond Aceron, Chris Carlsten, Jill Hubick, Erika Penz","doi":"10.1080/24745332.2023.2254283","DOIUrl":"https://doi.org/10.1080/24745332.2023.2254283","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136057617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-09DOI: 10.1080/24745332.2023.2255187
Mathieu D. Saint-Pierre
AbstractRATIONALE The Canadian Thoracic Society (CTS) publishes chronic obstructive pulmonary disease (COPD) guidelines with recommendations regarding which inhaled pharmacotherapy to prescribe. A minimal amount is known about the implementation of these guidelines in routine clinical practice.OBJECTIVES The main goals of this review were to assess the adherence to the CTS COPD pharmacotherapy guidelines in a real-world setting of patients with a severe exacerbation, to determine predictors of increased guidelines adoption, and to review if subjects leaving the hospital without recommended inhaled therapy had a higher rate of readmission for COPD within 30 days.METHODS Patients treated in 2022 at Montfort Hospital for a COPD exacerbation (hospitalization or emergency department) were reviewed. Medication lists at the time of presentation and discharge were charted in addition to patient clinical characteristics and COPD admissions up to 30 days after the initial assessment. A comparison of COPD patients with and without recommended inhaled therapy optimization was performed.MEASUREMENTS AND MAIN RESULTS A total of 214 patients were admitted for a COPD exacerbation. From this sample, 111 were candidates for review of their inhaled therapy as per the CTS guidelines; however, only 22 (20%) received recommended optimization. Subjects who were admitted to inpatient units and those with spirometry results on file were more likely to receive appropriate pharmacotherapy at discharge (both p = 0.02). Patients not optimized as per the guidelines were at higher risk of readmission for a COPD exacerbation within 30 days (p = 0.02).CONCLUSIONS Adherence to the CTS COPD pharmacotherapy guidelines was low in a real-world hospital setting. Interventions that would help increase their adoption would result in improved patient outcomes.RÉSUMÉJUSTIFICATIONLa Société canadienne de thoracologie (SCT) publie des lignes directrices sur la maladie pulmonaire obstructive chronique (MPOC) comprenant des recommandations concernant la pharmacothérapie inhalée à prescrire. On sait peu de choses sur la mise en œuvre de ces lignes directrices dans la pratique clinique de routine.OBJECTIFSLes principaux objectifs de cette revue étaient d'évaluer le respect des directives de pharmacothérapie de la SCT sur la MPOC dans un contexte réel de patients présentant une exacerbation sévère, de déterminer les facteurs prédictifs d'une adoption accrue des directives et de déterminer si les sujets quittant l'hôpital sans recommandation de traitement inhalé présentaient un taux de réadmission plus élevé pour la MPOC dans les 30 jours.METHODESLes patients traités en 2022 à l'hôpital Montfort pour une exacerbation de MPOC (hospitalisation ou service des urgences) ont été étudiés. Les listes de médicaments au moment de la présentation et de la sortie ont été consignées en plus des caractéristiques cliniques des patients et des admissions pour MPOC jusqu'à 30 jours après l'évaluation initiale. U
加拿大胸科学会(CTS)发布了慢性阻塞性肺疾病(COPD)指南，并推荐了哪些吸入药物治疗处方。对于这些指南在常规临床实践中的实施情况，我们所知甚少。本综述的主要目的是评估现实环境中严重加重患者对CTS COPD药物治疗指南的依从性，确定指南采用率增加的预测因素，并评估未推荐吸入治疗的受试者出院后30天内是否有更高的COPD再入院率。方法回顾了2022年在Montfort医院因COPD加重(住院或急诊)而接受治疗的患者。除了初步评估后30天的患者临床特征和COPD入院情况外，还绘制了就诊和出院时的药物清单。对COPD患者进行了吸入治疗优化和不推荐吸入治疗优化的比较。测量和主要结果共214例患者因COPD加重入院。根据CTS指南，从这个样本中，有111个是吸入治疗的候选者;然而，只有22个(20%)得到了推荐的优化。入住住院病房的受试者和存档肺活量测定结果的受试者更有可能在出院时接受适当的药物治疗(p = 0.02)。未按照指南进行优化的患者在30天内COPD加重再入院的风险更高(p = 0.02)。结论:在现实世界的医院环境中，CTS COPD药物治疗指南的依从性较低。有助于提高其采用率的干预措施将改善患者的治疗效果。RÉSUMÉJUSTIFICATIONLa加拿大胸科协会(SCT)关于慢性阻塞性肺疾病(MPOC)的公共医疗指南，符合关于药物治疗的建议。在这条路上，我选择了一条路，一条路，一条路，一条路，一条路。目的:主要目的是确定患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况、患者的健康状况和患者的健康状况。方法:观察患者在2022年 l'hôpital Montfort pour une acute de MPOC(住院或服务紧急情况)的症状，并将其与其他患者的症状进行比较。leslistes de massicdiments au moment de la pracementement et de la sortie ont samacresdanci.9cha.com samacresdanci.9cha.com加上des caracresdanci.cliniques des patients和des admissions pour MPOC仅为' 30 jours apresdanci.l ' samacresvalue initial。一种比较患者对MPOC的治疗方案，并对其进行了优化治疗，建议使用一种改良的呼吸机。方法及主要结果214例患者均未确诊为MPOC急性加重。111名应聘人员，应聘人员:应聘人员:应聘人员:应聘人员:应聘人员:应聘人员:应聘人员:应聘人员方案22(20%)不建议进行优化。3 .受影响者分为三个类别，分别是:行政人员、单位人员、医院人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员、医疗人员(p = 0.02)。不乐观的患者与不乐观的患者相比，不乐观的患者与不健康的患者相比，不乐观的患者与不健康的患者相比，不乐观的患者与不健康的患者相比，MPOC的一次恶化时间为30小时(p = 0.02)。结论遵守药械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械械。干预措施，如辅助治疗，辅助治疗，辅助治疗，辅助治疗，辅助治疗，辅助治疗，辅助治疗。关键词:慢性阻塞性肺疾病指南;坚持吸入治疗;加拿大胸科学会;圣皮埃尔是这份手稿的唯一作者。披露声明作者未报告潜在的利益冲突。经费由蒙特福特医院提供。
{"title":"Adherence to the Canadian Thoracic Society Chronic Obstructive Pulmonary Disease Pharmacotherapy Guidelines in a real-world hospital setting","authors":"Mathieu D. Saint-Pierre","doi":"10.1080/24745332.2023.2255187","DOIUrl":"https://doi.org/10.1080/24745332.2023.2255187","url":null,"abstract":"AbstractRATIONALE The Canadian Thoracic Society (CTS) publishes chronic obstructive pulmonary disease (COPD) guidelines with recommendations regarding which inhaled pharmacotherapy to prescribe. A minimal amount is known about the implementation of these guidelines in routine clinical practice.OBJECTIVES The main goals of this review were to assess the adherence to the CTS COPD pharmacotherapy guidelines in a real-world setting of patients with a severe exacerbation, to determine predictors of increased guidelines adoption, and to review if subjects leaving the hospital without recommended inhaled therapy had a higher rate of readmission for COPD within 30 days.METHODS Patients treated in 2022 at Montfort Hospital for a COPD exacerbation (hospitalization or emergency department) were reviewed. Medication lists at the time of presentation and discharge were charted in addition to patient clinical characteristics and COPD admissions up to 30 days after the initial assessment. A comparison of COPD patients with and without recommended inhaled therapy optimization was performed.MEASUREMENTS AND MAIN RESULTS A total of 214 patients were admitted for a COPD exacerbation. From this sample, 111 were candidates for review of their inhaled therapy as per the CTS guidelines; however, only 22 (20%) received recommended optimization. Subjects who were admitted to inpatient units and those with spirometry results on file were more likely to receive appropriate pharmacotherapy at discharge (both p = 0.02). Patients not optimized as per the guidelines were at higher risk of readmission for a COPD exacerbation within 30 days (p = 0.02).CONCLUSIONS Adherence to the CTS COPD pharmacotherapy guidelines was low in a real-world hospital setting. Interventions that would help increase their adoption would result in improved patient outcomes.RÉSUMÉJUSTIFICATIONLa Société canadienne de thoracologie (SCT) publie des lignes directrices sur la maladie pulmonaire obstructive chronique (MPOC) comprenant des recommandations concernant la pharmacothérapie inhalée à prescrire. On sait peu de choses sur la mise en œuvre de ces lignes directrices dans la pratique clinique de routine.OBJECTIFSLes principaux objectifs de cette revue étaient d'évaluer le respect des directives de pharmacothérapie de la SCT sur la MPOC dans un contexte réel de patients présentant une exacerbation sévère, de déterminer les facteurs prédictifs d'une adoption accrue des directives et de déterminer si les sujets quittant l'hôpital sans recommandation de traitement inhalé présentaient un taux de réadmission plus élevé pour la MPOC dans les 30 jours.METHODESLes patients traités en 2022 à l'hôpital Montfort pour une exacerbation de MPOC (hospitalisation ou service des urgences) ont été étudiés. Les listes de médicaments au moment de la présentation et de la sortie ont été consignées en plus des caractéristiques cliniques des patients et des admissions pour MPOC jusqu'à 30 jours après l'évaluation initiale. U","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135094174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-03DOI: 10.1080/24745332.2023.2257105
Mohit Bhutani
{"title":"CTS Guidelines: Setting the standard for care!","authors":"Mohit Bhutani","doi":"10.1080/24745332.2023.2257105","DOIUrl":"https://doi.org/10.1080/24745332.2023.2257105","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"47 1","pages":"225 - 227"},"PeriodicalIF":0.8,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139343036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-16DOI: 10.1080/24745332.2023.2237972
K. Chapman, M. Balter, S. Bhinder, A. Kaplan, A. McIvor, Panayiota Papadopoulos, K. Godbout
Abstract A significant number of patients with asthma have poor control on their current inhaled therapies, typically a combination of inhaled corticosteroids (ICS) and long-acting beta-2 adrenergic bronchodilators (LABA). Adding a long-acting antimuscarinic agent (LAMA) has been shown to improve asthma control and the availability of triple therapy formulations (ICS/LABA/LAMA) in a single inhaler device or single inhaler triple therapy (SITT) mitigates the adherence concerns associated with use of multiple inhaler devices. Here, we provide an overview of the pivotal data concerning the use of triple asthma therapy in patients with poor control on ICS-LABA treatment, and present our expert approach to their application in the routine clinical management of such patients as well the appropriate sequencing of initiating triple therapy and seeking a referral for consideration of more advanced therapies.
{"title":"Triple inhaled therapy for asthma in Canada","authors":"K. Chapman, M. Balter, S. Bhinder, A. Kaplan, A. McIvor, Panayiota Papadopoulos, K. Godbout","doi":"10.1080/24745332.2023.2237972","DOIUrl":"https://doi.org/10.1080/24745332.2023.2237972","url":null,"abstract":"Abstract A significant number of patients with asthma have poor control on their current inhaled therapies, typically a combination of inhaled corticosteroids (ICS) and long-acting beta-2 adrenergic bronchodilators (LABA). Adding a long-acting antimuscarinic agent (LAMA) has been shown to improve asthma control and the availability of triple therapy formulations (ICS/LABA/LAMA) in a single inhaler device or single inhaler triple therapy (SITT) mitigates the adherence concerns associated with use of multiple inhaler devices. Here, we provide an overview of the pivotal data concerning the use of triple asthma therapy in patients with poor control on ICS-LABA treatment, and present our expert approach to their application in the routine clinical management of such patients as well the appropriate sequencing of initiating triple therapy and seeking a referral for consideration of more advanced therapies.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82116057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-27DOI: 10.1080/24745332.2023.2236621
A. Cantin
{"title":"Bronchiectasis: From targets to therapies","authors":"A. Cantin","doi":"10.1080/24745332.2023.2236621","DOIUrl":"https://doi.org/10.1080/24745332.2023.2236621","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"145 1","pages":""},"PeriodicalIF":0.8,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74542631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-04DOI: 10.1080/24745332.2023.2235362
S. Tarlo, André Cartier, M. Chan-Yeung, D. Cockcroft, D. Gautrin, E. Juniper, Jean-Luc Malo
Abstract Canada has a long history of excellence and innovation in occupational asthma (OA). This article reviews its most significant achievements. Several Canadian clinical researchers were trained in part at the Brompton Hospital in London, UK, with Professor Jack Pepys, often referred to as the “father of occupational asthma.” They then settled in Canada in the 1970s and extended the British tradition in the study of OA. Important Canadian contributions as regards clinical aspects of diagnosis include: Improvement in the diagnosis by assessment of nonspecific bronchial responsiveness with pharmacological agents and of airway inflammation by examination of induced sputum, with methods developed and validated by the late Freddy Hargreave and colleagues, at McMaster University in Hamilton. Evaluation of several aspects of measurement of peak expiratory flow recordings. Improvement in the methodology of specific inhalation challenges with occupational agents. Furthermore, the outcome of OA was described, including its psycho-socio-economic aspects, and new scales of assessing impairment/disability proposed, then endorsed by international organizations. Prospective epidemiological studies were carried out, particularly in apprentices. The efficacy of surveillance programs was assessed. Many studies were carried out in workers exposed to Western red cedar on the west coast and snow-crab on the east coast. Irritant-induced asthma (nonimmunological OA) and variants of OA were also examined in original Canadian contributions. Canadian researchers have also played a major role as leaders of international conferences, as well as consensus documents and guidelines.
{"title":"History of occupational asthma in Canada","authors":"S. Tarlo, André Cartier, M. Chan-Yeung, D. Cockcroft, D. Gautrin, E. Juniper, Jean-Luc Malo","doi":"10.1080/24745332.2023.2235362","DOIUrl":"https://doi.org/10.1080/24745332.2023.2235362","url":null,"abstract":"Abstract Canada has a long history of excellence and innovation in occupational asthma (OA). This article reviews its most significant achievements. Several Canadian clinical researchers were trained in part at the Brompton Hospital in London, UK, with Professor Jack Pepys, often referred to as the “father of occupational asthma.” They then settled in Canada in the 1970s and extended the British tradition in the study of OA. Important Canadian contributions as regards clinical aspects of diagnosis include: Improvement in the diagnosis by assessment of nonspecific bronchial responsiveness with pharmacological agents and of airway inflammation by examination of induced sputum, with methods developed and validated by the late Freddy Hargreave and colleagues, at McMaster University in Hamilton. Evaluation of several aspects of measurement of peak expiratory flow recordings. Improvement in the methodology of specific inhalation challenges with occupational agents. Furthermore, the outcome of OA was described, including its psycho-socio-economic aspects, and new scales of assessing impairment/disability proposed, then endorsed by international organizations. Prospective epidemiological studies were carried out, particularly in apprentices. The efficacy of surveillance programs was assessed. Many studies were carried out in workers exposed to Western red cedar on the west coast and snow-crab on the east coast. Irritant-induced asthma (nonimmunological OA) and variants of OA were also examined in original Canadian contributions. Canadian researchers have also played a major role as leaders of international conferences, as well as consensus documents and guidelines.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"115 1","pages":"215 - 224"},"PeriodicalIF":0.8,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89309538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-04DOI: 10.1080/24745332.2023.2228641
Mohit Bhutani
{"title":"The future is now!","authors":"Mohit Bhutani","doi":"10.1080/24745332.2023.2228641","DOIUrl":"https://doi.org/10.1080/24745332.2023.2228641","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"51 1","pages":"171 - 172"},"PeriodicalIF":0.8,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139363156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-04DOI: 10.1080/24745332.2023.2231451
J. Bourbeau, M. Bhutani, P. Hernandez, Shawn D. Aaron, M. Beauchesne, Sophie B. Kermelly, Anthony D’Urzo, Avtar Lal, F. Maltais, J. Marciniuk, S. Mulpuru, E. Penz, Don D. Sin, A. van Dam, J. Wald, B. Walker, D. Marciniuk
Abstract Chronic obstructive pulmonary disease (COPD) patient care must include confirming a diagnosis with postbronchodilator spirometry. Because of the clinical heterogeneity and the reality that airflow obstruction assessed by spirometry only partially reflects disease severity, a thorough clinical evaluation of the patient should include assessment of symptom burden and risk of exacerbations that permits the implementation of evidence-informed pharmacological and nonpharmacological interventions. This guideline provides recommendations from a comprehensive systematic review with a meta-analysis and expert-informed clinical remarks to optimize maintenance pharmacological therapy for individuals with stable COPD, and a revised and practical treatment pathway based on new evidence since the 2019 update of the Canadian Thoracic Society (CTS) Guideline. The key clinical questions were developed using the Patients/Population (P), Intervention(s) (I), Comparison/Comparator (C), and Outcome (O) model for 3 questions that focuses on the outcomes of symptoms (dyspnea)/health status, acute exacerbations and mortality. The evidence from this systematic review and meta-analysis leads to the recommendation that all symptomatic patients with spirometry-confirmed COPD should receive long-acting bronchodilator maintenance therapy. Those with moderate to severe dyspnea (modified Medical Research Council ≥2) and/or impaired health status (COPD Assessment Test ≥10) and a low risk of exacerbations should receive combination therapy with a long-acting muscarinic antagonist/long-acting ẞ2-agonist (LAMA/LABA). For those with a moderate/severe dyspnea and/or impaired health status and a high risk of exacerbations should be prescribed triple combination therapy (LAMA/LABA/ICS) azithromycin, roflumilast or N-Acetylcysteine is recommended for specific populations; a recommendation against the use of theophylline, maintenance systemic oral corticosteroids such as prednisone and mono-ICS is made for all COPD patients.
{"title":"2023 Canadian Thoracic Society Guideline on Pharmacotherapy in Patients with Stable COPD","authors":"J. Bourbeau, M. Bhutani, P. Hernandez, Shawn D. Aaron, M. Beauchesne, Sophie B. Kermelly, Anthony D’Urzo, Avtar Lal, F. Maltais, J. Marciniuk, S. Mulpuru, E. Penz, Don D. Sin, A. van Dam, J. Wald, B. Walker, D. Marciniuk","doi":"10.1080/24745332.2023.2231451","DOIUrl":"https://doi.org/10.1080/24745332.2023.2231451","url":null,"abstract":"Abstract Chronic obstructive pulmonary disease (COPD) patient care must include confirming a diagnosis with postbronchodilator spirometry. Because of the clinical heterogeneity and the reality that airflow obstruction assessed by spirometry only partially reflects disease severity, a thorough clinical evaluation of the patient should include assessment of symptom burden and risk of exacerbations that permits the implementation of evidence-informed pharmacological and nonpharmacological interventions. This guideline provides recommendations from a comprehensive systematic review with a meta-analysis and expert-informed clinical remarks to optimize maintenance pharmacological therapy for individuals with stable COPD, and a revised and practical treatment pathway based on new evidence since the 2019 update of the Canadian Thoracic Society (CTS) Guideline. The key clinical questions were developed using the Patients/Population (P), Intervention(s) (I), Comparison/Comparator (C), and Outcome (O) model for 3 questions that focuses on the outcomes of symptoms (dyspnea)/health status, acute exacerbations and mortality. The evidence from this systematic review and meta-analysis leads to the recommendation that all symptomatic patients with spirometry-confirmed COPD should receive long-acting bronchodilator maintenance therapy. Those with moderate to severe dyspnea (modified Medical Research Council ≥2) and/or impaired health status (COPD Assessment Test ≥10) and a low risk of exacerbations should receive combination therapy with a long-acting muscarinic antagonist/long-acting ẞ2-agonist (LAMA/LABA). For those with a moderate/severe dyspnea and/or impaired health status and a high risk of exacerbations should be prescribed triple combination therapy (LAMA/LABA/ICS) azithromycin, roflumilast or N-Acetylcysteine is recommended for specific populations; a recommendation against the use of theophylline, maintenance systemic oral corticosteroids such as prednisone and mono-ICS is made for all COPD patients.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"2016 1","pages":"173 - 191"},"PeriodicalIF":0.8,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88204342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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