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}
Pub Date : 2023-07-04DOI: 10.1080/24745332.2023.2226410
Florence T.H. Wu, Mohammad Diab, R. Myers, C. Ho, Stephen Lam, A. Mcguire
Abstract Lung cancer is the leading cause of cancer deaths in Canada and worldwide. Major scientific advances in the last decade have dramatically changed the way we detect and treat lung cancers. British Columbia, Ontario and Quebec have recently launched lung cancer screening programs for high-risk individuals using evidence-based risk prediction models, and many other provinces are in the active planning phase. This review focuses on non-small cell lung cancer (NSCLC), which comprises 80-85% of lung cancers. For patients diagnosed with advanced or metastatic NSCLC, we now have systemic therapy options—targeted therapies, chemotherapies and immune checkpoint inhibitors (ICIs)—that are tailored to the molecular characterization of individual tumor samples for DNA/RNA alterations and PD-L1 protein expression. Molecular characterization is also becoming increasingly crucial for patients diagnosed with earlier and potentially curable NSCLC, as targeted therapies and ICIs make their way into the adjuvant and neoadjuvant therapy space, partnering with radiation and surgery to improve outcomes for patients receiving multimodality curative-intent treatment.
{"title":"Update on lung cancer","authors":"Florence T.H. Wu, Mohammad Diab, R. Myers, C. Ho, Stephen Lam, A. Mcguire","doi":"10.1080/24745332.2023.2226410","DOIUrl":"https://doi.org/10.1080/24745332.2023.2226410","url":null,"abstract":"Abstract Lung cancer is the leading cause of cancer deaths in Canada and worldwide. Major scientific advances in the last decade have dramatically changed the way we detect and treat lung cancers. British Columbia, Ontario and Quebec have recently launched lung cancer screening programs for high-risk individuals using evidence-based risk prediction models, and many other provinces are in the active planning phase. This review focuses on non-small cell lung cancer (NSCLC), which comprises 80-85% of lung cancers. For patients diagnosed with advanced or metastatic NSCLC, we now have systemic therapy options—targeted therapies, chemotherapies and immune checkpoint inhibitors (ICIs)—that are tailored to the molecular characterization of individual tumor samples for DNA/RNA alterations and PD-L1 protein expression. Molecular characterization is also becoming increasingly crucial for patients diagnosed with earlier and potentially curable NSCLC, as targeted therapies and ICIs make their way into the adjuvant and neoadjuvant therapy space, partnering with radiation and surgery to improve outcomes for patients receiving multimodality curative-intent treatment.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"72 1","pages":"201 - 205"},"PeriodicalIF":0.8,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74824881","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: 10.1080/24745332.2023.2235365
J. Ramsahai, Arsh Randhawa, C. Shephard, A. Foster, Lee Geyer, Phong Manivong, E. Graves, S. McMullen
Abstract RATIONALE A comprehensive understanding of the burden of illness and management strategies for severe asthma (SA), especially by disease control, is lacking in Canada. OBJECTIVES The objectives of this study were to describe treatments, exacerbation outcomes and healthcare resource utilization (HCRU) for patients with controlled and uncontrolled SA in Alberta, Canada. METHODS A retrospective cohort of SA patients 12+ years (April 1, 2011 to March 31, 2020) was identified from administrative health data, based on medication dispensed for controlling asthma symptoms, stratified by disease control at index. Treatment patterns were analyzed for incident SA patients. Annualized exacerbation incidence rate ratios (IRR) were estimated throughout follow-up and stratified by disease control at index. Asthma-specific HCRU and direct costs were calculated. RESULTS The study cohort included 74,134 patients (12.4% of eligible asthma patients) of whom 71,099 (95.5%) were classified as controlled and 3,035 (4.1%) as uncontrolled at index. Inhaled corticosteroid + long-acting beta agonist (ICS + LABA) was the most frequent first-line therapy among incident SA patients (n = 53,084), received by 42.7% of patients. A minority received >2 lines of therapy; few received triple therapy. The uncontrolled (at index) versus controlled (at index) cohort had a 5.5 times higher exacerbation rate (IRR: 5.5, 95% CI: 5.1–5.8; p < 0.001), higher HCRU, and higher associated annual costs (mean [SD]: $3,799 [$6,668] uncontrolled vs $1,339 [$2,515] controlled). CONCLUSIONS SA, whether controlled or uncontrolled at index, was associated with ongoing exacerbations and HCRU despite treatment intensification that identified patients as having SA. Some treatment patterns appeared misaligned with guidelines, suggesting potential need for better recognition of asthma severity and escalating therapies.
{"title":"A population-based study of the burden of severe asthma in Alberta, Canada","authors":"J. Ramsahai, Arsh Randhawa, C. Shephard, A. Foster, Lee Geyer, Phong Manivong, E. Graves, S. McMullen","doi":"10.1080/24745332.2023.2235365","DOIUrl":"https://doi.org/10.1080/24745332.2023.2235365","url":null,"abstract":"Abstract RATIONALE A comprehensive understanding of the burden of illness and management strategies for severe asthma (SA), especially by disease control, is lacking in Canada. OBJECTIVES The objectives of this study were to describe treatments, exacerbation outcomes and healthcare resource utilization (HCRU) for patients with controlled and uncontrolled SA in Alberta, Canada. METHODS A retrospective cohort of SA patients 12+ years (April 1, 2011 to March 31, 2020) was identified from administrative health data, based on medication dispensed for controlling asthma symptoms, stratified by disease control at index. Treatment patterns were analyzed for incident SA patients. Annualized exacerbation incidence rate ratios (IRR) were estimated throughout follow-up and stratified by disease control at index. Asthma-specific HCRU and direct costs were calculated. RESULTS The study cohort included 74,134 patients (12.4% of eligible asthma patients) of whom 71,099 (95.5%) were classified as controlled and 3,035 (4.1%) as uncontrolled at index. Inhaled corticosteroid + long-acting beta agonist (ICS + LABA) was the most frequent first-line therapy among incident SA patients (n = 53,084), received by 42.7% of patients. A minority received >2 lines of therapy; few received triple therapy. The uncontrolled (at index) versus controlled (at index) cohort had a 5.5 times higher exacerbation rate (IRR: 5.5, 95% CI: 5.1–5.8; p < 0.001), higher HCRU, and higher associated annual costs (mean [SD]: $3,799 [$6,668] uncontrolled vs $1,339 [$2,515] controlled). CONCLUSIONS SA, whether controlled or uncontrolled at index, was associated with ongoing exacerbations and HCRU despite treatment intensification that identified patients as having SA. Some treatment patterns appeared misaligned with guidelines, suggesting potential need for better recognition of asthma severity and escalating therapies.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"4 1","pages":"192 - 200"},"PeriodicalIF":0.8,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91148503","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 : 2023-06-07DOI: 10.1080/24745332.2023.2224109
D. St-Pierre, S. Gagnon, Sophie Bergeron Kermelly, J. Marciniuk, P. Li, B. Ross, J. Bourbeau
Abstract BACKGROUND Dyspnea is an extremely prevalent and debilitating symptom in chronic obstructive pulmonary disease (COPD), affecting up to 74% of patients despite optimal medical therapy. Sublingual fentanyl citrate (SLF) has a fast onset of action and a short half-life, both interesting characteristics to treat acute breakthrough dyspnea without inducing metabolite accumulation. The Montreal Chest Institute (MCI) COPD specialty clinic has been using low-dose SLF for patients with advanced COPD experiencing significant episodic dyspnea despite high intensity inhaled therapy. We present here a retrospective chart review, the largest to date, to report on a “real life” experience. METHODS All included patients had a formal diagnosis of COPD and were seen in the MCI COPD specialty clinic between January 1, 2015 and January 1, 2021. All patients prescribed SLF, irrespective of the duration of use, were enrolled in this chart review. Extent of symptom relief, categorized into either major, intermediate or no improvements, and adverse effects were inferred from in-person or telephone follow-up appointment clinical notes. An exacerbation was defined as a self-reported acute increase in symptoms leading to oral corticosteroid use or hospitalization. Rates of exacerbation and hospitalization in the 12 months before SLF initiation and during SLF use were compared. RESULTS In total, 17 COPD patients were given SLF during the study period. The mean FEV1 was 0.51 L (21% predicted). All participants reported MRC5/5 dyspnea and were prescribed regular low-dose oral morphine for daily breathlessness prior to SLF initiation. Most patients used SLF for more than 6 months, and 76.5% of the study group found intermediate or major improvement in breathlessness episodes. There was no significant change in the rates of exacerbation and admission for acute respiratory failure while on SLF. CONCLUSION In this review, we report real-life, long-term data on severe COPD patients using self-controlled as-needed SLF, showing patient acceptability, an improvement in dyspnea, and limited side effects. Hence, this represents an important step toward the first effective alternative rescue medication for the relief of breakthrough dyspnea since short-acting inhalers. Further study using a randomized trial design is required to confirm the efficacy of this therapy.
{"title":"Sublingual fentanyl for refractory episodic acute dyspnea in patients with advanced chronic obstructive pulmonary disease (COPD): A real-world study","authors":"D. St-Pierre, S. Gagnon, Sophie Bergeron Kermelly, J. Marciniuk, P. Li, B. Ross, J. Bourbeau","doi":"10.1080/24745332.2023.2224109","DOIUrl":"https://doi.org/10.1080/24745332.2023.2224109","url":null,"abstract":"Abstract BACKGROUND Dyspnea is an extremely prevalent and debilitating symptom in chronic obstructive pulmonary disease (COPD), affecting up to 74% of patients despite optimal medical therapy. Sublingual fentanyl citrate (SLF) has a fast onset of action and a short half-life, both interesting characteristics to treat acute breakthrough dyspnea without inducing metabolite accumulation. The Montreal Chest Institute (MCI) COPD specialty clinic has been using low-dose SLF for patients with advanced COPD experiencing significant episodic dyspnea despite high intensity inhaled therapy. We present here a retrospective chart review, the largest to date, to report on a “real life” experience. METHODS All included patients had a formal diagnosis of COPD and were seen in the MCI COPD specialty clinic between January 1, 2015 and January 1, 2021. All patients prescribed SLF, irrespective of the duration of use, were enrolled in this chart review. Extent of symptom relief, categorized into either major, intermediate or no improvements, and adverse effects were inferred from in-person or telephone follow-up appointment clinical notes. An exacerbation was defined as a self-reported acute increase in symptoms leading to oral corticosteroid use or hospitalization. Rates of exacerbation and hospitalization in the 12 months before SLF initiation and during SLF use were compared. RESULTS In total, 17 COPD patients were given SLF during the study period. The mean FEV1 was 0.51 L (21% predicted). All participants reported MRC5/5 dyspnea and were prescribed regular low-dose oral morphine for daily breathlessness prior to SLF initiation. Most patients used SLF for more than 6 months, and 76.5% of the study group found intermediate or major improvement in breathlessness episodes. There was no significant change in the rates of exacerbation and admission for acute respiratory failure while on SLF. CONCLUSION In this review, we report real-life, long-term data on severe COPD patients using self-controlled as-needed SLF, showing patient acceptability, an improvement in dyspnea, and limited side effects. Hence, this represents an important step toward the first effective alternative rescue medication for the relief of breakthrough dyspnea since short-acting inhalers. Further study using a randomized trial design is required to confirm the efficacy of this therapy.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"105 1","pages":"144 - 147"},"PeriodicalIF":0.8,"publicationDate":"2023-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80596567","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 : 2023-06-07DOI: 10.1080/24745332.2023.2224110
H. Mansell, M. Fenton, Julian S. Tam, Nicola Rosaasen, Louise Cardinal, Nicole Nelson, Rachel Tang
Abstract RATIONALE: Patients being assessed or listed for a lung transplant face significant challenges, and the impact of the COVID-19 pandemic on this population is unknown. OBJECTIVES A qualitative study was undertaken to explore the impacts of COVID-19 within this context. METHODS Patients who were being assessed or waiting for a lung transplant (n = 22) and their caregivers (n = 3) participated in semi-structured interviews conducted by phone. Interviews were transcribed and imported into NVivo 12 Pro software for the exploration and coding of data to arrive at themes. MAIN RESULTS: The majority of patients (n = 16) described limitations in their access to healthcare, including difficulty seeing their physician, delayed appointments and decreased in-person visits. Physical activity was greatly impacted (n = 15) “diminished,” “restricted” or “limited” or impacted “dramatically” due to COVID-19. Significant limitations were imposed on physical activities (n = 15) and social activities (n = 18), and financial concerns (n = 11) were common amongst this population. For many, these impacts contributed to mental health struggles including increased stress, anxiety and depression. Patients coped using a variety of strategies, including partaking in hobbies, meditation and spirituality, mindset and self-talk, and expressed gratitude for their current situation and hope for the future. CONCLUSION Patients being assessed or listed for lung transplant have been affected by the global pandemic driven by an illness that is respiratory in nature. Patients who continue to struggle should be identified and appropriate supports should be provided. In the event of a future pandemic, the vulnerabilities in this population should be considered.
{"title":"Exploring the impacts of COVID-19 before lung transplantation: A qualitative study","authors":"H. Mansell, M. Fenton, Julian S. Tam, Nicola Rosaasen, Louise Cardinal, Nicole Nelson, Rachel Tang","doi":"10.1080/24745332.2023.2224110","DOIUrl":"https://doi.org/10.1080/24745332.2023.2224110","url":null,"abstract":"Abstract RATIONALE: Patients being assessed or listed for a lung transplant face significant challenges, and the impact of the COVID-19 pandemic on this population is unknown. OBJECTIVES A qualitative study was undertaken to explore the impacts of COVID-19 within this context. METHODS Patients who were being assessed or waiting for a lung transplant (n = 22) and their caregivers (n = 3) participated in semi-structured interviews conducted by phone. Interviews were transcribed and imported into NVivo 12 Pro software for the exploration and coding of data to arrive at themes. MAIN RESULTS: The majority of patients (n = 16) described limitations in their access to healthcare, including difficulty seeing their physician, delayed appointments and decreased in-person visits. Physical activity was greatly impacted (n = 15) “diminished,” “restricted” or “limited” or impacted “dramatically” due to COVID-19. Significant limitations were imposed on physical activities (n = 15) and social activities (n = 18), and financial concerns (n = 11) were common amongst this population. For many, these impacts contributed to mental health struggles including increased stress, anxiety and depression. Patients coped using a variety of strategies, including partaking in hobbies, meditation and spirituality, mindset and self-talk, and expressed gratitude for their current situation and hope for the future. CONCLUSION Patients being assessed or listed for lung transplant have been affected by the global pandemic driven by an illness that is respiratory in nature. Patients who continue to struggle should be identified and appropriate supports should be provided. In the event of a future pandemic, the vulnerabilities in this population should be considered.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"31 1","pages":"148 - 157"},"PeriodicalIF":0.8,"publicationDate":"2023-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82851530","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 : 2023-06-07DOI: 10.1080/24745332.2023.2226411
S. Quach, Marco Zaccagnini, T. Packham, R. Goldstein, D. Brooks
Abstract RATIONALE Respiratory therapists (RTs) are part of the critical care team, dedicated to providing specialized respiratory care. However, their role, regional practice variations and inclusion in the multidisciplinary team are not well described in the literature. OBJECTIVES The aim of this review was to describe: 1) the role and impact of RTs; 2) the recommendations for RT inclusion; and 3) regional differences in RT practices in adult critical care across Canada. METHODS AND MEASUREMENT A scoping review was performed. Eligible studies described the Canadian RT role in adult critical care. Data extraction was informed by the Respiratory Therapy Practice-Based Outcome Initiative Model (RT-PBOI), a conceptual model that outlines 5 domains of how RTs can contribute to patient care and resource utilization. MAIN RESULTS RTs’ roles across 22 studies were categorized into domains of the RT-PBOI model: Technical skills (n = 20), Approach to practice (n = 20), Leveraging capacity (n = 15), Strategic expertise (n = 16) and Growing value for the future (n = 17). The grey literature (n = 26) provided brief descriptions of the RT role across multiple practice settings, but common RT tasks in critical care were mechanical ventilation management and participation in specialized care teams. One grey literature report recommended RTs to participate as critical response team members and two studies briefly mentioned regional differences in RT roles. CONCLUSION There were minimal studies to report on the impact of RTs in Canadian, adult critical care. Future studies are needed to evaluate the RT role and their value in improving patient care and resource utilization. RÉSUMÉ JUSTIFICATION Les inhalothérapeutes font partie de l'équipe de soins intensifs qui se consacre à la prestation de soins respiratoires spécialisés. Cependant, leur rôle, les variations dans les pratiques régionales et leur inclusion dans l'équipe multidisciplinaire ne sont pas bien décrits dans la littérature. OBJECTIFS Le but de cette revue était de décrire : 1) le rôle et l'impact des inhalothérapeutes; 2) les recommandations pour l'inclusion des inhalothérpaeutes; et 3) les différences régionales dans les pratiques d'inhalothérapie en soins intensifs pour adultes à travers le Canada. MÉTHODES ET MESURE Un examen de la portée a été effectué. Les études admissibles décrivaient le rôle de l'inhalothérapie canadienne dans les soins intensifs aux adultes. L'extraction des données a été guidée par le RT-PBOI (Respiratory Therapy Practice-Based Outcome Initiative Model), un modèle conceptuel qui décrit les cinq domaines dans lesquels les inhalothérapeutes peuvent contribuer aux soins aux patients et à l'utilisation des ressources. PRINCIPAUX RÉSULTATS Les rôles des inhalothérapeutes dans 22 études ont été classés en fonction des domaines du modèle RT-PBOI : compétences techniques (n = 20), approche de la pratique (n = 20), capacité d'effet de levier (n = 15), expertise stratégique (n = 16)
{"title":"The Role of Canadian respiratory therapists in adult critical care (ICURT-CAN): A scoping review","authors":"S. Quach, Marco Zaccagnini, T. Packham, R. Goldstein, D. Brooks","doi":"10.1080/24745332.2023.2226411","DOIUrl":"https://doi.org/10.1080/24745332.2023.2226411","url":null,"abstract":"Abstract RATIONALE Respiratory therapists (RTs) are part of the critical care team, dedicated to providing specialized respiratory care. However, their role, regional practice variations and inclusion in the multidisciplinary team are not well described in the literature. OBJECTIVES The aim of this review was to describe: 1) the role and impact of RTs; 2) the recommendations for RT inclusion; and 3) regional differences in RT practices in adult critical care across Canada. METHODS AND MEASUREMENT A scoping review was performed. Eligible studies described the Canadian RT role in adult critical care. Data extraction was informed by the Respiratory Therapy Practice-Based Outcome Initiative Model (RT-PBOI), a conceptual model that outlines 5 domains of how RTs can contribute to patient care and resource utilization. MAIN RESULTS RTs’ roles across 22 studies were categorized into domains of the RT-PBOI model: Technical skills (n = 20), Approach to practice (n = 20), Leveraging capacity (n = 15), Strategic expertise (n = 16) and Growing value for the future (n = 17). The grey literature (n = 26) provided brief descriptions of the RT role across multiple practice settings, but common RT tasks in critical care were mechanical ventilation management and participation in specialized care teams. One grey literature report recommended RTs to participate as critical response team members and two studies briefly mentioned regional differences in RT roles. CONCLUSION There were minimal studies to report on the impact of RTs in Canadian, adult critical care. Future studies are needed to evaluate the RT role and their value in improving patient care and resource utilization. RÉSUMÉ JUSTIFICATION Les inhalothérapeutes font partie de l'équipe de soins intensifs qui se consacre à la prestation de soins respiratoires spécialisés. Cependant, leur rôle, les variations dans les pratiques régionales et leur inclusion dans l'équipe multidisciplinaire ne sont pas bien décrits dans la littérature. OBJECTIFS Le but de cette revue était de décrire : 1) le rôle et l'impact des inhalothérapeutes; 2) les recommandations pour l'inclusion des inhalothérpaeutes; et 3) les différences régionales dans les pratiques d'inhalothérapie en soins intensifs pour adultes à travers le Canada. MÉTHODES ET MESURE Un examen de la portée a été effectué. Les études admissibles décrivaient le rôle de l'inhalothérapie canadienne dans les soins intensifs aux adultes. L'extraction des données a été guidée par le RT-PBOI (Respiratory Therapy Practice-Based Outcome Initiative Model), un modèle conceptuel qui décrit les cinq domaines dans lesquels les inhalothérapeutes peuvent contribuer aux soins aux patients et à l'utilisation des ressources. PRINCIPAUX RÉSULTATS Les rôles des inhalothérapeutes dans 22 études ont été classés en fonction des domaines du modèle RT-PBOI : compétences techniques (n = 20), approche de la pratique (n = 20), capacité d'effet de levier (n = 15), expertise stratégique (n = 16) ","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"11 1","pages":"158 - 170"},"PeriodicalIF":0.8,"publicationDate":"2023-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87634465","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 : 2023-06-07DOI: 10.1080/24745332.2023.2208965
M. Bhutani
{"title":"CTS membership: A cornerstone for career success","authors":"M. Bhutani","doi":"10.1080/24745332.2023.2208965","DOIUrl":"https://doi.org/10.1080/24745332.2023.2208965","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"52 1","pages":"121 - 123"},"PeriodicalIF":0.8,"publicationDate":"2023-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81108418","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 : 2023-06-05DOI: 10.1080/24745332.2023.2214070
{"title":"2023 Canadian Respiratory Conference Abstracts","authors":"","doi":"10.1080/24745332.2023.2214070","DOIUrl":"https://doi.org/10.1080/24745332.2023.2214070","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"20 1","pages":"1 - 52"},"PeriodicalIF":0.8,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74439337","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 : 2023-05-24DOI: 10.1080/24745332.2023.2212339
Katelyn Stuart, Marwa M Ahmad, S. Lok, Ashley-Mae E. Gillson, E. Bédard, A. Tremblay, K. Johannson
Abstract RATIONALE Interstitial lung abnormalities (ILA) are radiographic interstitial findings that are incidentally identified on chest imaging performed for other reasons. ILAs have been identified on chest computed tomography (CT) performed as part of lung cancer screening programs. OBJECTIVES This study characterizes the prevalence and outcomes associated with ILA in a Canadian lung cancer screening cohort. METHODS Patients were identified from the Alberta lung cancer screening trial, a 5-year cohort study. CT reports were screened for terms associated with ILA including specific radiologic features and CT patterns. These were further characterized as non-subpleural, subpleural nonfibrotic and subpleural fibrotic, consistent with published definitions. Retrospective chart review was conducted for those with ILA to define demographics, lung function, and longitudinal outcomes including subsequent investigations for interstitial lung disease (ILD), treatment, and survival. MEASUREMENTS AND MAIN RESULTS Of 806 patients in the lung cancer screening study, 30 (3.7%) were identified as having ILA, with two-thirds (67%) having subpleural fibrotic abnormalities. Half of patients were referred to a Respirologist and underwent pulmonary function testing. Over a median follow-up period of two years, none were diagnosed with an idiopathic interstitial pneumonia, or started on immunomodulatory or antifibrotic therapy. Three of 30 (10%) patients demonstrated disease progression over time, all of whom had subpleural fibrotic ILA on baseline chest CT. CONCLUSIONS The prevalence of ILA in this Canadian lung cancer screening cohort was 3.7%. These data should inform the development of standardized reporting and follow-up for ILA as lung cancer screening programs are implemented. Résumé JUSTIFICATION Les anomalies pulmonaires interstitielles sont des constatations interstitielles radiographiques qui sont repérées fortuitement sur l'imagerie thoracique réalisée pour d'autres raisons. Des anomalies pulmonaires interstitielles ont été repérées sur des tomodensitométries pulmonaires effectuées dans le cadre de programmes de dépistage du cancer du poumon. OBJECTIFS Caractériser la prévalence et les résultats associés aux anomalies pulmonaires interstitielles dans une cohorte canadienne de dépistage du cancer du poumon. MÉTHODES Les patients ont été recrutés dans le cadre de l'essai de dépistage du cancer du poumon en Alberta, une étude de cohorte de cinq ans. Les rapports de tomodensitométrie ont été examinés pour y repérer des termes associés aux anomalies pulmonaires interstitielles, y compris les caractéristiques radiologiques spécifiques et les configurations tomodensitométriques. Ils ont également été caractérisés comme étant non sous-pleuraux, sous-pleuraux non fibrotiques et sous-pleuraux fibrotiques, conformément aux définitions publiées. Un examen rétrospectif des dossiers a été effectué pour les personnes atteintes d’anomalies pulmonaires interstitielles
肺间质性异常(ILA)是指由于其他原因在胸部影像学上偶然发现的肺间质性病变。作为肺癌筛查项目的一部分，在胸部计算机断层扫描(CT)上发现了ILAs。目的:本研究描述了加拿大肺癌筛查队列中与ILA相关的患病率和结果。方法从阿尔伯塔肺癌筛查试验中确定患者，这是一项为期5年的队列研究。CT报告筛选与ILA相关的术语，包括特定的放射特征和CT模式。这些进一步表征为非胸膜下、胸膜下非纤维化和胸膜下纤维化，与已发表的定义一致。对ILA患者进行回顾性图表回顾，以确定人口统计学、肺功能和纵向结果，包括对间质性肺疾病(ILD)的后续调查、治疗和生存率。在肺癌筛查研究的806例患者中，30例(3.7%)被确定为ILA，三分之二(67%)有胸膜下纤维化异常。一半的患者被转介给呼吸科医生并进行肺功能测试。在中位随访期为两年的时间里，没有人被诊断为特发性间质性肺炎，也没有人开始接受免疫调节或抗纤维化治疗。30例患者中有3例(10%)随着时间的推移表现出疾病进展，他们在基线胸部CT上都有胸膜下纤维化ILA。结论:在加拿大肺癌筛查队列中，ILA的患病率为3.7%。随着肺癌筛查项目的实施，这些数据应该为制定标准化的ILA报告和随访提供信息。理由:肺部异常、间质性便秘、间质性x线照相术、间质性复合体、胸质性复合体、胸质性复合体及其他原因。肺间质异常不能与其他组织相联系，不能与其他组织相联系，不能与其他组织相联系，不能与其他组织相联系，不能与其他组织相联系。目的:研究了一组加拿大人的肺组织间质异常与其他组织间质异常的关系。MÉTHODES将患者与其他组织合并，将患者与其他组织合并，将患者与其他组织合并，将患者与其他组织合并，将患者与其他组织合并，将患者与其他组织合并，将患者与其他组织合并，将患者与其他组织合并，将患者与其他组织合并，将患者与其他组织合并。i - ont samement, samement, samement, samement, samement, samement, samement, samement, samement, samement。由三个部分组成，分别是:a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a、a。研究结果:ET RÉSULTATS PRINCIPAUX Sur 806例患者中，1例为原发性肿瘤，1例为原发性肿瘤，30例为间质性肺异常，30例为两级(67%)为胸小纤维性异常。La moiti患者与其他患者相比，与其他患者相比，与其他患者相比，与其他患者相比，与其他患者相比，更像其他患者。在此基础上，研究人员对原发性肺间质性特发性肺炎的诊断进行了研究，并开始使用免疫调节剂和抗纤维化药物。三名患者中约有10%的人患有先天性疾病，他们没有监测到疾病的进展情况。3例变性胸基底部变性胸基底部变性胸基底部变性胸基底部变性。结论:肺间质异常患者与加拿大其他人群相比，有3.7%的人患有肺间质异常。这些数据devraient eclair l 'elaboration de怎样le suivi正常化et des异常pulmonaires interstitielles盟毛皮等一个de la协定enœuvre des项目de depistage du poumon du癌症。
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Pub Date : 2023-05-24DOI: 10.1080/24745332.2023.2210773
C. Lau, Joel Agarwal, B. Vandermeer, W. T. Allison, T. Jeerakathil, D. Vethanayagam
Abstract RATIONALE/OBJECTIVE: Hereditary Hemorrhagic Telangiectasia (HHT) is an autosomal dominant genetic disorder affecting vascular maturation, with a prevalence of 1 in 3800 people in Alberta. Pulmonary arteriovenous malformations (PAVMs) affect 35–40% of individuals with HHT and can lead to recurrent embolic neurologic conditions, including stroke and transient ischemic attack (TIA), and the development of brain abscess due to intrapulmonary right-to-left shunt (RLS) in conjunction with intermittent bacteremia. METHODS A retrospective review of the Edmonton HHT Registry was conducted, where participants with possible or definite HHT were evaluated for PAVM-related neurologic conditions. RESULTS A total of 218 study subjects were included, of whom 80 had PAVMs. A trend was noted where those HHT subjects with PAVMs had a greater prevalence of stroke, TIA, migraines, seizures and brain abscess compared to those subjects with HHT who did not have PAVMs. However, the association between individual neurologic conditions and PAVMs was not statistically significant. After controlling for potential confounders of age and sex, HHT-PAVM subjects had 1.44 times the odds of associated serious neurologic condition, compared to those who did not have PAVMs (OR = 1.44, 0.74-2.78, p = 0.28). CONCLUSION Although our study did not show statistical significance, the strong positive trends suggest that PAVMs can give rise to neurologic conditions, in line with existing literature. A larger database may provide more definitive evidence. Future work should evaluate the effect of PAVM feeding artery size, architecture and shunt grade on neurologic conditions. RÉSUMÉ JUSTIFICATION/OBJECTIF La télangiectasie hémorragique héréditaire (THH) est un trouble génétique autosomique dominant affectant la maturation vasculaire, dont la prévalence est de 1 sur 3 800 en Alberta. Les malformations artérioveineuses pulmonaires touchent 35 à 40 % des personnes atteintes de THH et peuvent entraîner des affections neurologiques emboliques récurrentes, notamment un accident vasculaire cérébral et un accident ischémique transitoire, ainsi que le développement d'un abcès cérébral dû à un shunt intrapulmonaire de droite à gauche associé à une bactériémie intermittente. MÉTHODES Un examen rétrospectif du registre de la THH d'Edmonton a été effectué, où les participants présentant une THH possible ou définie ont été évalués pour des affections neurologiques liées aux malformations artérioveineuses pulmonaires. RÉSULTATS Un total de 218 sujets ont été inclus dans l'étude, dont 80 avaient des malformations artérioveineuses pulmonaires. Une tendance a été notée où les sujets atteints de THH avec des malformations artérioveineuses pulmonaires avaient une plus grande prévalence d'accident vasculaire cérébral, d’accident ischémique transitoire, de migraines, de convulsions et d’abcès cérébraux par rapport aux sujets atteints de THH qui n'avaient pas de malformations artérioveineuses pulmonaires
{"title":"Neurologic conditions in Hereditary Hemorrhagic Telangiectasia with pulmonary arteriovenous malformations: Database study","authors":"C. Lau, Joel Agarwal, B. Vandermeer, W. T. Allison, T. Jeerakathil, D. Vethanayagam","doi":"10.1080/24745332.2023.2210773","DOIUrl":"https://doi.org/10.1080/24745332.2023.2210773","url":null,"abstract":"Abstract RATIONALE/OBJECTIVE: Hereditary Hemorrhagic Telangiectasia (HHT) is an autosomal dominant genetic disorder affecting vascular maturation, with a prevalence of 1 in 3800 people in Alberta. Pulmonary arteriovenous malformations (PAVMs) affect 35–40% of individuals with HHT and can lead to recurrent embolic neurologic conditions, including stroke and transient ischemic attack (TIA), and the development of brain abscess due to intrapulmonary right-to-left shunt (RLS) in conjunction with intermittent bacteremia. METHODS A retrospective review of the Edmonton HHT Registry was conducted, where participants with possible or definite HHT were evaluated for PAVM-related neurologic conditions. RESULTS A total of 218 study subjects were included, of whom 80 had PAVMs. A trend was noted where those HHT subjects with PAVMs had a greater prevalence of stroke, TIA, migraines, seizures and brain abscess compared to those subjects with HHT who did not have PAVMs. However, the association between individual neurologic conditions and PAVMs was not statistically significant. After controlling for potential confounders of age and sex, HHT-PAVM subjects had 1.44 times the odds of associated serious neurologic condition, compared to those who did not have PAVMs (OR = 1.44, 0.74-2.78, p = 0.28). CONCLUSION Although our study did not show statistical significance, the strong positive trends suggest that PAVMs can give rise to neurologic conditions, in line with existing literature. A larger database may provide more definitive evidence. Future work should evaluate the effect of PAVM feeding artery size, architecture and shunt grade on neurologic conditions. RÉSUMÉ JUSTIFICATION/OBJECTIF La télangiectasie hémorragique héréditaire (THH) est un trouble génétique autosomique dominant affectant la maturation vasculaire, dont la prévalence est de 1 sur 3 800 en Alberta. Les malformations artérioveineuses pulmonaires touchent 35 à 40 % des personnes atteintes de THH et peuvent entraîner des affections neurologiques emboliques récurrentes, notamment un accident vasculaire cérébral et un accident ischémique transitoire, ainsi que le développement d'un abcès cérébral dû à un shunt intrapulmonaire de droite à gauche associé à une bactériémie intermittente. MÉTHODES Un examen rétrospectif du registre de la THH d'Edmonton a été effectué, où les participants présentant une THH possible ou définie ont été évalués pour des affections neurologiques liées aux malformations artérioveineuses pulmonaires. RÉSULTATS Un total de 218 sujets ont été inclus dans l'étude, dont 80 avaient des malformations artérioveineuses pulmonaires. Une tendance a été notée où les sujets atteints de THH avec des malformations artérioveineuses pulmonaires avaient une plus grande prévalence d'accident vasculaire cérébral, d’accident ischémique transitoire, de migraines, de convulsions et d’abcès cérébraux par rapport aux sujets atteints de THH qui n'avaient pas de malformations artérioveineuses pulmonaires","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"5 1","pages":"133 - 139"},"PeriodicalIF":0.8,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75031324","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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