Pub Date : 2023-01-02DOI: 10.1080/24745332.2022.2161025
M. MacKinnon, K. Barrick, L. Lévesque, G. Liss, S. Tarlo, M. Lougheed
Abstract RATIONALE: Approximately 15% of all asthma cases are work-related and eligible for workers’ compensation in Ontario. However, compensation rates of work-related asthma (WRA) are far less than predicted, making it difficult to estimate the prevalence of the disease. OBJECTIVES We aimed to estimate prevalence of compensated WRA in Ontario; profile the pattern of compensated WRA by demographic, temporal and geographic factors; and demonstrate the potential for database linkage to monitor rates of compensated WRA cases. METHODS Compensated WRA claims data were linked to asthma cases in the Institute of Clinical Evaluative Sciences (ICES) asthma database via encrypted health card numbers. WRA claims between April 1998 and March 2002 were accessed from: i) the Ontario Workplace Safety and Insurance Board (WSIB) Occupational Disease Information Surveillance System (ODISS); and ii) a University of Toronto research database (RD) created by abstracting the same WSIB ODISS claim files. MAIN RESULTS: The estimated prevalence of WRA among individuals with asthma in the asthma database was less than 1% compared to an expected prevalence of 15-20%. Sensitivity of the Asthma database for including individuals with asthma with WRA was very good but differed significantly based on claims category (p < 0.001) compared to the RD as the gold standard. CONCLUSIONS Our findings suggest WRA is severely under-reported. Approximately 11-15% of compensated WRA claims are not captured by the asthma database. Factors accounting for discordance between databases should be explored in order for administrative data linkage to be used to monitor the rates of compensated WRA cases in Ontario.
{"title":"Linkage of administrative and compensation databases for work-related asthma surveillance in Ontario: A proof of concept study","authors":"M. MacKinnon, K. Barrick, L. Lévesque, G. Liss, S. Tarlo, M. Lougheed","doi":"10.1080/24745332.2022.2161025","DOIUrl":"https://doi.org/10.1080/24745332.2022.2161025","url":null,"abstract":"Abstract RATIONALE: Approximately 15% of all asthma cases are work-related and eligible for workers’ compensation in Ontario. However, compensation rates of work-related asthma (WRA) are far less than predicted, making it difficult to estimate the prevalence of the disease. OBJECTIVES We aimed to estimate prevalence of compensated WRA in Ontario; profile the pattern of compensated WRA by demographic, temporal and geographic factors; and demonstrate the potential for database linkage to monitor rates of compensated WRA cases. METHODS Compensated WRA claims data were linked to asthma cases in the Institute of Clinical Evaluative Sciences (ICES) asthma database via encrypted health card numbers. WRA claims between April 1998 and March 2002 were accessed from: i) the Ontario Workplace Safety and Insurance Board (WSIB) Occupational Disease Information Surveillance System (ODISS); and ii) a University of Toronto research database (RD) created by abstracting the same WSIB ODISS claim files. MAIN RESULTS: The estimated prevalence of WRA among individuals with asthma in the asthma database was less than 1% compared to an expected prevalence of 15-20%. Sensitivity of the Asthma database for including individuals with asthma with WRA was very good but differed significantly based on claims category (p < 0.001) compared to the RD as the gold standard. CONCLUSIONS Our findings suggest WRA is severely under-reported. Approximately 11-15% of compensated WRA claims are not captured by the asthma database. Factors accounting for discordance between databases should be explored in order for administrative data linkage to be used to monitor the rates of compensated WRA cases in Ontario.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"55 1","pages":"28 - 35"},"PeriodicalIF":0.8,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74589145","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 : 2023-01-02DOI: 10.1080/24745332.2022.2156407
A. Kouri, Samir Gupta
Abstract As we near the third year of the COVID-19 pandemic, greater attention is now being paid to the potential long-term consequences of SARS-CoV-2 in the hundreds of millions of people infected globally. A syndrome termed “long COVID” has emerged, which predominantly manifests as persistent fatigue, dyspnea, chest pain, and cognitive dysfunction following acute infection. The incidence of long COVID is in the range of 15% based on current best evidence, and symptoms are likely a result of several different pathophysiological mechanisms including multi-organ injury from acute infection, systemic viral persistence, immune dysregulation, and/or autoimmunity. Pulmonary symptoms represent a significant component of long COVID, and there is a growing body of research describing the epidemiology, risk factors, physiology, and radiology of the respiratory manifestations of long COVID. In this clinical review, we examine the most recent evidence relating to “respiratory long COVID,” discuss how innovative technologies such as Xenon-129 gas transfer magnetic resonance imaging (MRI) and respiratory oscillometry are helping to elucidate its unique pathophysiology, and consider the role of preventative strategies and possible treatments such as adapted pulmonary rehabilitation. The burden of respiratory long COVID is likely to continue to grow, and all healthcare professionals who care for patients with respiratory disease must prepare for this emerging chronic condition. This will require increased resources from healthcare decision makers, inventive approaches to healthcare delivery, further research, and the same spirit of collaboration that has enabled the many success stories to date in the global effort against COVID-19.
{"title":"Respiratory manifestations of long COVID","authors":"A. Kouri, Samir Gupta","doi":"10.1080/24745332.2022.2156407","DOIUrl":"https://doi.org/10.1080/24745332.2022.2156407","url":null,"abstract":"Abstract As we near the third year of the COVID-19 pandemic, greater attention is now being paid to the potential long-term consequences of SARS-CoV-2 in the hundreds of millions of people infected globally. A syndrome termed “long COVID” has emerged, which predominantly manifests as persistent fatigue, dyspnea, chest pain, and cognitive dysfunction following acute infection. The incidence of long COVID is in the range of 15% based on current best evidence, and symptoms are likely a result of several different pathophysiological mechanisms including multi-organ injury from acute infection, systemic viral persistence, immune dysregulation, and/or autoimmunity. Pulmonary symptoms represent a significant component of long COVID, and there is a growing body of research describing the epidemiology, risk factors, physiology, and radiology of the respiratory manifestations of long COVID. In this clinical review, we examine the most recent evidence relating to “respiratory long COVID,” discuss how innovative technologies such as Xenon-129 gas transfer magnetic resonance imaging (MRI) and respiratory oscillometry are helping to elucidate its unique pathophysiology, and consider the role of preventative strategies and possible treatments such as adapted pulmonary rehabilitation. The burden of respiratory long COVID is likely to continue to grow, and all healthcare professionals who care for patients with respiratory disease must prepare for this emerging chronic condition. This will require increased resources from healthcare decision makers, inventive approaches to healthcare delivery, further research, and the same spirit of collaboration that has enabled the many success stories to date in the global effort against COVID-19.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"79 1","pages":"41 - 46"},"PeriodicalIF":0.8,"publicationDate":"2023-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82133095","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 : 2022-11-14DOI: 10.1080/24745332.2022.2137317
Simon A. Houston, Yusing Gu, T. Vandemoortele, Elaine Dumoulin, Ashley-Mae E. Gillson, C. Tyan, L. Sakr, G. Bendiak, Anne V Gonzalez, M. Fortin
adivision of respirology, Qeii-Halifax infirmary, department of Medicine, dalhousie university, Halifax, nova scotia, Canada; bdivision of respiratory Medicine, department of Medicine, university of Montreal, Montreal, Québec, Canada; cdivision of respiratory Medicine, Cumming school of Medicine, university of Calgary, Calgary, alberta, Canada; ddivision of pulmonary Medicine, department of Medicine, university of alberta, edmonton, alberta, Canada; edivision of respirology, Critical Care and sleep Medicine, university of saskatchewan, saskatoon, saskatchewan, Canada; fdivision of respirology, Jewish General Hospital, department of Medicine, McGill university, Montreal, Québec, Canada; gsection of respiratory Medicine, alberta Children’s Hospital, department of pediatrics, university of Calgary, Calgary, alberta, Canada; hdivision of respiratory Medicine, department of Medicine, McGill university Health Centre, Montreal, Québec, Canada; idivision of respirology, institut universitaire de cardiologie et de pneumologie de Québec, department of Medicine, université laval, Québec, Québec, Canada
{"title":"Bronchoscopy during the COVID-19 pandemic: A Canadian Thoracic Society Position Statement update","authors":"Simon A. Houston, Yusing Gu, T. Vandemoortele, Elaine Dumoulin, Ashley-Mae E. Gillson, C. Tyan, L. Sakr, G. Bendiak, Anne V Gonzalez, M. Fortin","doi":"10.1080/24745332.2022.2137317","DOIUrl":"https://doi.org/10.1080/24745332.2022.2137317","url":null,"abstract":"adivision of respirology, Qeii-Halifax infirmary, department of Medicine, dalhousie university, Halifax, nova scotia, Canada; bdivision of respiratory Medicine, department of Medicine, university of Montreal, Montreal, Québec, Canada; cdivision of respiratory Medicine, Cumming school of Medicine, university of Calgary, Calgary, alberta, Canada; ddivision of pulmonary Medicine, department of Medicine, university of alberta, edmonton, alberta, Canada; edivision of respirology, Critical Care and sleep Medicine, university of saskatchewan, saskatoon, saskatchewan, Canada; fdivision of respirology, Jewish General Hospital, department of Medicine, McGill university, Montreal, Québec, Canada; gsection of respiratory Medicine, alberta Children’s Hospital, department of pediatrics, university of Calgary, Calgary, alberta, Canada; hdivision of respiratory Medicine, department of Medicine, McGill university Health Centre, Montreal, Québec, Canada; idivision of respirology, institut universitaire de cardiologie et de pneumologie de Québec, department of Medicine, université laval, Québec, Québec, Canada","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"7 1","pages":"337 - 343"},"PeriodicalIF":0.8,"publicationDate":"2022-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87224854","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 : 2022-11-14DOI: 10.1080/24745332.2022.2117471
R. Leigh
{"title":"President’s message","authors":"R. Leigh","doi":"10.1080/24745332.2022.2117471","DOIUrl":"https://doi.org/10.1080/24745332.2022.2117471","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"54 1","pages":"279 - 280"},"PeriodicalIF":0.8,"publicationDate":"2022-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89194542","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 : 2022-11-02DOI: 10.1080/24745332.2022.2139578
R. Leigh
{"title":"President’s message","authors":"R. Leigh","doi":"10.1080/24745332.2022.2139578","DOIUrl":"https://doi.org/10.1080/24745332.2022.2139578","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"518 1","pages":"331 - 332"},"PeriodicalIF":0.8,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77167202","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 : 2022-11-02DOI: 10.1080/24745332.2022.2133030
D. Menzies
On World Tuberculosis (TB) Day 2022, the 8th edition of the Canadian Tuberculosis Standards (at: https://www.tandfonline.com/toc/ucts20/6/sup1) was published by the Canadian Thoracic Society in collaboration with Association of Medical Microbiology and Infectious Disease (AMMI) Canada and the support of the Public Health Agency of Canada. Written by a large and diverse group from across Canada, with expertise in clinical, epidemiologic, pathogenetic, microbiologic and public health aspects of TB, and with important input from community partners, notably from indigenous communities, the TB standards is intended to provide comprehensive and practical guidance for front line providers. After decades of neglect between 1970 and 2000, the last 20 years has seen a surge in new diagnostics, new treatments, and new control strategies for TB. These advances are reflected in the new TB Standards, with major changes in recommendations in many sections. See Table 1 for a summary of some of the most important changes. However, these advances have not yet impacted TB rates—which have barely changed over the last two decades—globally1 and in Canada.2 In fact, as detailed in the first chapter of the Standards, the number of persons diagnosed with TB disease each year in Canada has increased over the last 3 years.2 Clearly, new diagnostics, treatments and strategies are needed, not only as recommendations but in practice. For the diagnosis of TB disease, rapid molecular tests can be used3—to accelerate detection of the disease, and are recommended for the rapid identification of drug resistant strains—such that appropriate and effective therapy can be started promptly. The technology has been available for close to a decade, but implementation has been slow due to cost considerations. Given the risks to patients,4 increased transmission5 and high costs to health systems of delayed or missed diagnoses, the investment to implement these rapid and highly accurate tests seems modest. Isoniazid (INH) has been the mainstay of TB prevention since the first edition of the TB Standards in 1970. Although the long duration (of 6 to 12 months), and potential for serious, even fatal hepato-toxicity were major drawbacks, the evidence for alternate regimens was slow in arriving. However, two rifamycin based regimens have undergone rigorous evaluations in randomized trials and are now recommended as first line regimens for TB prevention.6 One regimen is 4 months daily Rifampin (RIF) (4 R), which has significantly better completion, fewer severe adverse events and noninferior efficacy for TB prevention, compared to 9 months INH (9H) in adults7,8 and children.9 The other is 3 months once weekly INH & Rifapentine (3HP), which has better completion and less hepato-toxicity, and noninferior efficacy compared to 6H or 9H in adults10–12 and children.13 The fact that 3HP has only 12 doses seems appealing, but a drawback is that each dose must be directly observed14; this is not feasible
{"title":"Canadian Tuberculosis Standards 8th edition: What’s new? And what’s next?","authors":"D. Menzies","doi":"10.1080/24745332.2022.2133030","DOIUrl":"https://doi.org/10.1080/24745332.2022.2133030","url":null,"abstract":"On World Tuberculosis (TB) Day 2022, the 8th edition of the Canadian Tuberculosis Standards (at: https://www.tandfonline.com/toc/ucts20/6/sup1) was published by the Canadian Thoracic Society in collaboration with Association of Medical Microbiology and Infectious Disease (AMMI) Canada and the support of the Public Health Agency of Canada. Written by a large and diverse group from across Canada, with expertise in clinical, epidemiologic, pathogenetic, microbiologic and public health aspects of TB, and with important input from community partners, notably from indigenous communities, the TB standards is intended to provide comprehensive and practical guidance for front line providers. After decades of neglect between 1970 and 2000, the last 20 years has seen a surge in new diagnostics, new treatments, and new control strategies for TB. These advances are reflected in the new TB Standards, with major changes in recommendations in many sections. See Table 1 for a summary of some of the most important changes. However, these advances have not yet impacted TB rates—which have barely changed over the last two decades—globally1 and in Canada.2 In fact, as detailed in the first chapter of the Standards, the number of persons diagnosed with TB disease each year in Canada has increased over the last 3 years.2 Clearly, new diagnostics, treatments and strategies are needed, not only as recommendations but in practice. For the diagnosis of TB disease, rapid molecular tests can be used3—to accelerate detection of the disease, and are recommended for the rapid identification of drug resistant strains—such that appropriate and effective therapy can be started promptly. The technology has been available for close to a decade, but implementation has been slow due to cost considerations. Given the risks to patients,4 increased transmission5 and high costs to health systems of delayed or missed diagnoses, the investment to implement these rapid and highly accurate tests seems modest. Isoniazid (INH) has been the mainstay of TB prevention since the first edition of the TB Standards in 1970. Although the long duration (of 6 to 12 months), and potential for serious, even fatal hepato-toxicity were major drawbacks, the evidence for alternate regimens was slow in arriving. However, two rifamycin based regimens have undergone rigorous evaluations in randomized trials and are now recommended as first line regimens for TB prevention.6 One regimen is 4 months daily Rifampin (RIF) (4 R), which has significantly better completion, fewer severe adverse events and noninferior efficacy for TB prevention, compared to 9 months INH (9H) in adults7,8 and children.9 The other is 3 months once weekly INH & Rifapentine (3HP), which has better completion and less hepato-toxicity, and noninferior efficacy compared to 6H or 9H in adults10–12 and children.13 The fact that 3HP has only 12 doses seems appealing, but a drawback is that each dose must be directly observed14; this is not feasible","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"23 1","pages":"333 - 336"},"PeriodicalIF":0.8,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90974530","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 : 2022-10-26DOI: 10.1080/24745332.2022.2133756
L. Krebs, N. Hill, C. Villa‐Roel, P. McLane, B. Rowe, Samir Gupta
Abstract Rationale: Asthma is a common reason for emergency department (ED) presentation. Few studies have explored the experiences of adults during asthma exacerbation, particularly those that necessitate ED care. Objectives: This study explored adults experiences during asthma exacerbation. Methods: A photovoice study was conducted. ED patients presenting for asthma care between the ages of 17-55 years were eligible for the study and recruited in the ED. Participants had 3-4 weeks to take photographs and subsequently completed a one-on-one photo-elicitation interview. Interviews were audio recorded, transcribed and thematically analyzed. Measurements and Main Results: Six patients agreed to participate; 2 were lost to follow-up. One primary theme emerged. Specifically, the role of hope and fear, including the tension between them, in their experience of their condition. Hope and fear permeated all aspects of experience, including the following subthemes: 1) participants adopting the roles of advocate and expert, 2) frustration with their health state, 3) loss of freedom and subsequent feelings of failure, 4) barriers to accessing health care, and 5) “good” and “bad” ED care. Asthma was an ever-present consideration in participants lives during times of “good asthma control” and times of exacerbation. Conclusions: Participants’ focus on the roles of hope and fear, both in the ED and beyond, suggests that openly acknowledging and addressing these emotional aspects as a part of the ED interaction could result in a better care experience for some patients. Seeing the whole person as more than their symptoms and sharing decision-making may help clinicians to provide care that supports hopefulness.
{"title":"“Not just the asthma”: Understanding the acute asthma experiences of adult women with asthma presenting to the emergency department through photovoice","authors":"L. Krebs, N. Hill, C. Villa‐Roel, P. McLane, B. Rowe, Samir Gupta","doi":"10.1080/24745332.2022.2133756","DOIUrl":"https://doi.org/10.1080/24745332.2022.2133756","url":null,"abstract":"Abstract Rationale: Asthma is a common reason for emergency department (ED) presentation. Few studies have explored the experiences of adults during asthma exacerbation, particularly those that necessitate ED care. Objectives: This study explored adults experiences during asthma exacerbation. Methods: A photovoice study was conducted. ED patients presenting for asthma care between the ages of 17-55 years were eligible for the study and recruited in the ED. Participants had 3-4 weeks to take photographs and subsequently completed a one-on-one photo-elicitation interview. Interviews were audio recorded, transcribed and thematically analyzed. Measurements and Main Results: Six patients agreed to participate; 2 were lost to follow-up. One primary theme emerged. Specifically, the role of hope and fear, including the tension between them, in their experience of their condition. Hope and fear permeated all aspects of experience, including the following subthemes: 1) participants adopting the roles of advocate and expert, 2) frustration with their health state, 3) loss of freedom and subsequent feelings of failure, 4) barriers to accessing health care, and 5) “good” and “bad” ED care. Asthma was an ever-present consideration in participants lives during times of “good asthma control” and times of exacerbation. Conclusions: Participants’ focus on the roles of hope and fear, both in the ED and beyond, suggests that openly acknowledging and addressing these emotional aspects as a part of the ED interaction could result in a better care experience for some patients. Seeing the whole person as more than their symptoms and sharing decision-making may help clinicians to provide care that supports hopefulness.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"1 1","pages":"10 - 20"},"PeriodicalIF":0.8,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77028036","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 : 2022-10-20DOI: 10.1080/24745332.2022.2130840
D. Cockcroft
Abstract Asthma prevalence in Canada is high and, at least until recently, has been rising. Deaths from asthma have been gradually declining with a small but significant transient increase between about 1975 and 1995, most likely due to the inappropriate use of inhaled ß2 agonists leading to under-treatment with anti-inflammatory agents. Canada has been at the forefront of development of asthma treatments and asthma guidelines. Expressing the spectrum of asthma severity as a continuum rather than a series of steps is unique to the Canadian asthma guidelines. Other Canadian contributions include major participation in GINA, measurement of AHR, measurement of induced sputum cell counts, developments in aerosol science including large volume spacer devices, measurement of asthma quality of life and investigations into occupational asthma.
{"title":"History of asthma in Canada","authors":"D. Cockcroft","doi":"10.1080/24745332.2022.2130840","DOIUrl":"https://doi.org/10.1080/24745332.2022.2130840","url":null,"abstract":"Abstract Asthma prevalence in Canada is high and, at least until recently, has been rising. Deaths from asthma have been gradually declining with a small but significant transient increase between about 1975 and 1995, most likely due to the inappropriate use of inhaled ß2 agonists leading to under-treatment with anti-inflammatory agents. Canada has been at the forefront of development of asthma treatments and asthma guidelines. Expressing the spectrum of asthma severity as a continuum rather than a series of steps is unique to the Canadian asthma guidelines. Other Canadian contributions include major participation in GINA, measurement of AHR, measurement of induced sputum cell counts, developments in aerosol science including large volume spacer devices, measurement of asthma quality of life and investigations into occupational asthma.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"24 1","pages":"375 - 382"},"PeriodicalIF":0.8,"publicationDate":"2022-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85911319","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 : 2022-08-29DOI: 10.1080/24745332.2022.2111998
S. Nevison, David Hwang, A. Oikonomou, L. Fidler
Abstract A 57-year-old man developed respiratory symptoms 72 hours after receiving his third dose of the COVID-19 mRNA-1273 vaccine and underwent computed tomography (CT) chest imaging. This showed new diffuse subpleural and peribronchovascular nodular opacities with reverse halo sign. Laboratory investigations demonstrated an eosinophil count of 0.8 x 10E9/L and unremarkable connective tissue disease screen. Bronchoscopy with lavage and transbronchial biopsies demonstrated lymphocytic alveolitis without evidence of infection and histopathology consistent with acute fibrinous and organizing pneumonia (AFOP). He was treated with corticosteroids resulting in resolution of symptoms and CT findings. We present radiographic and histopathologic findings of AFOP following COVID-19 mRNA-1273 vaccination.
一名57岁男性在接种第三剂COVID-19 mRNA-1273疫苗72小时后出现呼吸道症状，并接受了CT胸部成像。显示新的弥漫性胸膜下和支气管血管周围结节性混浊伴反晕征。实验室检查显示嗜酸性粒细胞计数为0.8 x 10E9/L，结缔组织疾病筛查不明显。支气管镜检查伴灌洗和经支气管活检显示淋巴细胞性肺泡炎，无感染证据，组织病理学符合急性纤维性和组织性肺炎(AFOP)。他接受了皮质类固醇治疗，症状和CT表现得到缓解。我们报告了COVID-19 mRNA-1273疫苗接种后AFOP的放射学和组织病理学结果。
{"title":"Acute fibrinous and organizing pneumonia following the COVID-19 mRNA-1273 vaccine","authors":"S. Nevison, David Hwang, A. Oikonomou, L. Fidler","doi":"10.1080/24745332.2022.2111998","DOIUrl":"https://doi.org/10.1080/24745332.2022.2111998","url":null,"abstract":"Abstract A 57-year-old man developed respiratory symptoms 72 hours after receiving his third dose of the COVID-19 mRNA-1273 vaccine and underwent computed tomography (CT) chest imaging. This showed new diffuse subpleural and peribronchovascular nodular opacities with reverse halo sign. Laboratory investigations demonstrated an eosinophil count of 0.8 x 10E9/L and unremarkable connective tissue disease screen. Bronchoscopy with lavage and transbronchial biopsies demonstrated lymphocytic alveolitis without evidence of infection and histopathology consistent with acute fibrinous and organizing pneumonia (AFOP). He was treated with corticosteroids resulting in resolution of symptoms and CT findings. We present radiographic and histopathologic findings of AFOP following COVID-19 mRNA-1273 vaccination.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"115 1","pages":"329 - 330"},"PeriodicalIF":0.8,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82294850","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 : 2022-08-29DOI: 10.1080/24745332.2022.2108936
L. Fidler, S. Sehdev
Not long after its identification in 1966, the anti-neoplastic medication bleomycin was recognized to cause significant pulmonary toxicity, occurring in roughly 10% of patients.1,2 Its pro-fibrotic properties have established bleomycin as the most common agent used for inducing interstitial lung disease (ILD) in animal models.2 Decades of experience has primed clinicians to monitor for bleomycin related ILD, often prompting baseline pulmonary function testing and screening protocols.3 Anti-neoplastic medications have been reported to be the most common class of medications causing drug-induced lung injury, with ILD being the most frequent manifestation.4 In 2020, Health Canada approved 17 new anti-neoplastic and immunomodulating treatments, more than any other class of medication.5 Maintaining familiarity with the ever-growing list of cancer treatments is challenging, but respirologists working in Canadian cancer centers need to be aware of new treatments with associated pulmonary toxicity. Even when adverse events are rare, the large volume of patients receiving treatment ensures some will suffer adverse events. Breast cancer comprises approximately one-quarter of new cancer diagnoses, making it the most common cancer among Canadian women.6 Roughly 20% of breast cancers demonstrate overexpression of the human epidermal growth factor receptor 2 (HER-2, now termed ERBB2), and is associated with reduced survival.7 The anti-HER-2 monoclonal antibody trastuzumab has been used in first-line treatment regiments for eligible patients for over 20 years, resulting in improved disease response and survival.8 Recent trials have shown new antibody-drug conjugates (ADCs) to be effective in the treatment of refractory metastatic HER-2 positive breast cancer; these ADCs combine trastuzumab and small cytotoxic molecules using covalent linkers, allowing targeted delivery of chemotherapeutic treatments to cancer microenvironments.9,10 The recently published DESTINY-Breast 03 trial, studied the effects of trastuzumab-deruxtecan (T-Dxd) versus trastuzumab-emtansine (T-DM1) in metastatic HER-2 positive breast cancer refractory to trastuzumab and taxane therapy. Interim results show progression-free survival was improved with T-Dxd as compared to T-DM1, the previously recommended treatment in this setting [HR 0.28 (0.22-0.37), P < 0.001].10,11 However, 10.5% of patients receiving T-Dxd experienced ILD, with grade 2 or 3 disease comprising 74% of events. Fatal cases of ILD from T-Dxd were reported in 2.2% of cases in an earlier phase 2 trial in breast cancer.12 Despite this, the survival benefits from T-Dxd are anticipated to result in its widespread prescription in this population. Furthermore, phase 2 studies of T-Dxd have shown positive treatment effects in HER-2 expressing non-small cell lung cancer (NSCLC), colorectal cancer, gastric cancer and breast cancer not overexpressing HER-2, broadening the potential treatment indications.13–16 Grade 2 or higher pneumoniti
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