Pub Date : 2022-07-04DOI: 10.1080/24745332.2022.2096914
R. Leigh
{"title":"President’s message","authors":"R. Leigh","doi":"10.1080/24745332.2022.2096914","DOIUrl":"https://doi.org/10.1080/24745332.2022.2096914","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"31 1","pages":"211 - 212"},"PeriodicalIF":0.8,"publicationDate":"2022-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82918435","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 : 2022-07-01DOI: 10.1080/24745332.2022.2087123
Nikytha Antony, K. Chaput, Mark Anselmo
Abstract RATIONALE AND OBJECTIVE: Bronchopulmonary dysplasia (BPD) is defined as the persistent need for oxygen at 36 weeks post menstrual age or 28 days of postnatal life in premature infants. Close to half of all premature infants with BPD are discharged from hospital with supplemental home oxygen and pediatric respirologists are commonly involved in the decision of discontinuing supplemental oxygen use. Our objective was to assess whether there is variability among Canadian pediatric respirologists on when to discontinue supplemental oxygen given the lack of evidence-based guidelines shaping this decision-making process. METHODS: Ethics approval was obtained and a cross sectional survey study was completed. Online and paper surveys included 4 oximetry test results and clinical vignettes provided in both English and French. Descriptive statistics were obtained for quantitative variables and data were analyzed for significance using the STATA statistical analysis software. RESULTS: The survey response rate was 27%. The decision to discontinue home oxygen did vary based on the province of current work; Alberta had the highest rate of respondents choosing to discontinue home oxygen (47.5%) in comparison to British Columbia and Quebec (18 and 20%, respectively; chi-square 3.97, p = 0.403). The years of experience of the physician was associated with a higher use of a guideline in making decisions on supplemental oxygen use (3.1 vs. 1.8, p = 0.167). CONCLUSION: This project allowed us to gather data on current decision making practices on home oxygen use among Canadian pediatric respirologists and informs that there is variability on care that patients receive across the country.
理由和目的:支气管肺发育不良(BPD)被定义为早产儿在月经后36周或出生后28天持续需要氧气。近一半患有BPD的早产儿出院时需要补充家庭氧气，儿科呼吸科医生通常参与决定是否停止补充氧气的使用。我们的目的是评估加拿大儿科呼吸科医生在何时停止补充氧气方面是否存在差异，因为缺乏基于证据的指导方针来形成这一决策过程。方法:获得伦理批准并完成横断面调查研究。在线和纸质调查包括4个血氧饱和度测试结果和以英语和法语提供的临床小品。定量变量进行描述性统计，采用STATA统计分析软件对数据进行显著性分析。结果:调查回复率为27%。停止家用氧气的决定确实因当前工作的范围而异;与不列颠哥伦比亚省和魁北克省(分别为18%和20%)相比，艾伯塔省选择停止家庭氧气的受访者比例最高(47.5%);卡方3.97,p = 0.403)。在决定是否使用补充氧气时，医生的经验年数与指导方针的较高使用率相关(3.1 vs 1.8, p = 0.167)。结论:该项目使我们能够收集有关加拿大儿科呼吸科医生当前家庭氧气使用决策实践的数据，并告知全国各地患者接受的护理存在差异。
{"title":"Among Canadian Pediatric respirologists, is there variability on decision to discontinue supplemental oxygen in premature patients with bronchopulmonary dysplasia? A cross-sectional survey study","authors":"Nikytha Antony, K. Chaput, Mark Anselmo","doi":"10.1080/24745332.2022.2087123","DOIUrl":"https://doi.org/10.1080/24745332.2022.2087123","url":null,"abstract":"Abstract RATIONALE AND OBJECTIVE: Bronchopulmonary dysplasia (BPD) is defined as the persistent need for oxygen at 36 weeks post menstrual age or 28 days of postnatal life in premature infants. Close to half of all premature infants with BPD are discharged from hospital with supplemental home oxygen and pediatric respirologists are commonly involved in the decision of discontinuing supplemental oxygen use. Our objective was to assess whether there is variability among Canadian pediatric respirologists on when to discontinue supplemental oxygen given the lack of evidence-based guidelines shaping this decision-making process. METHODS: Ethics approval was obtained and a cross sectional survey study was completed. Online and paper surveys included 4 oximetry test results and clinical vignettes provided in both English and French. Descriptive statistics were obtained for quantitative variables and data were analyzed for significance using the STATA statistical analysis software. RESULTS: The survey response rate was 27%. The decision to discontinue home oxygen did vary based on the province of current work; Alberta had the highest rate of respondents choosing to discontinue home oxygen (47.5%) in comparison to British Columbia and Quebec (18 and 20%, respectively; chi-square 3.97, p = 0.403). The years of experience of the physician was associated with a higher use of a guideline in making decisions on supplemental oxygen use (3.1 vs. 1.8, p = 0.167). CONCLUSION: This project allowed us to gather data on current decision making practices on home oxygen use among Canadian pediatric respirologists and informs that there is variability on care that patients receive across the country.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"19 1","pages":"265 - 269"},"PeriodicalIF":0.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75357034","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 : 2022-07-01DOI: 10.1080/24745332.2022.2086508
B. McLean, Kevan Mehta
Abstract Autoimmune pulmonary alveolar proteinosis (PAP) is a rare disease, especially in pediatrics, but important to consider, as it may avoid unnecessary and/or invasive investigations and delayed diagnosis. This case report highlights an adolescent girl with rapid onset dyspnea but an unremarkable physical exam and initial testing. However, due to a high index of suspicion, a chest computed tomography (CT) scan was done, revealing a “crazy paving” pattern, which then prompted expedited assessment. This finding, however, is not as specific as often discussed and has a broad differential diagnosis, which will be reviewed in detail as part of this case. Furthermore, this report demonstrates a diagnostic approach for PAP that avoids lung biopsy, previously considered to be required for diagnosis of PAP, but is increasingly becoming unnecessary with more advanced blood tests and understanding of their sensitivity and specificity. Additionally, management strategies for PAP will be briefly discussed.
{"title":"Autoimmune pulmonary alveolar proteinosis in an adolescent girl with rapidly progressive dyspnea","authors":"B. McLean, Kevan Mehta","doi":"10.1080/24745332.2022.2086508","DOIUrl":"https://doi.org/10.1080/24745332.2022.2086508","url":null,"abstract":"Abstract Autoimmune pulmonary alveolar proteinosis (PAP) is a rare disease, especially in pediatrics, but important to consider, as it may avoid unnecessary and/or invasive investigations and delayed diagnosis. This case report highlights an adolescent girl with rapid onset dyspnea but an unremarkable physical exam and initial testing. However, due to a high index of suspicion, a chest computed tomography (CT) scan was done, revealing a “crazy paving” pattern, which then prompted expedited assessment. This finding, however, is not as specific as often discussed and has a broad differential diagnosis, which will be reviewed in detail as part of this case. Furthermore, this report demonstrates a diagnostic approach for PAP that avoids lung biopsy, previously considered to be required for diagnosis of PAP, but is increasingly becoming unnecessary with more advanced blood tests and understanding of their sensitivity and specificity. Additionally, management strategies for PAP will be briefly discussed.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"10 1","pages":"36 - 40"},"PeriodicalIF":0.8,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89279140","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 : 2022-06-13DOI: 10.1080/24745332.2022.2081635
Charlenn Skead, K. Carle-Talbot, Diana Ochoa-Gomez, K. Amjadi, Ashish Gupta
Abstract A patient with left upper lobe adenocarcinoma was found to have asymptomatic left lung torsion in the context of a pleural effusion. With drainage of the pleural effusion the mass returned to its original position. Multiple torsion events were documented and found to only occur in presence of a pleural effusion. This case suggests a new possible indication for indwelling pleural catheter (IPC) placement.
{"title":"A moving target: Multiples occurrences of left lung torsion secondary to adenocarcinoma and pleural effusion","authors":"Charlenn Skead, K. Carle-Talbot, Diana Ochoa-Gomez, K. Amjadi, Ashish Gupta","doi":"10.1080/24745332.2022.2081635","DOIUrl":"https://doi.org/10.1080/24745332.2022.2081635","url":null,"abstract":"Abstract A patient with left upper lobe adenocarcinoma was found to have asymptomatic left lung torsion in the context of a pleural effusion. With drainage of the pleural effusion the mass returned to its original position. Multiple torsion events were documented and found to only occur in presence of a pleural effusion. This case suggests a new possible indication for indwelling pleural catheter (IPC) placement.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"344 1","pages":"371 - 374"},"PeriodicalIF":0.8,"publicationDate":"2022-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77792114","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 : 2022-06-06DOI: 10.1080/24745332.2022.2071071
B. Petrof
{"title":"In memoriam of Dr. Joseph Milic-Emili","authors":"B. Petrof","doi":"10.1080/24745332.2022.2071071","DOIUrl":"https://doi.org/10.1080/24745332.2022.2071071","url":null,"abstract":"","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"11 1","pages":"283 - 284"},"PeriodicalIF":0.8,"publicationDate":"2022-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90052325","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 : 2022-05-24DOI: 10.1080/24745332.2022.2057883
R. Waseem, Yasser Salama, M. Baltzan, F. Chung
Abstract RATIONALE AND OBJECTIVE: The snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender (STOP-Bang) questionnaire is used widely to screen individuals at high risk of OSA. The objective of the study is to examine the diagnostic performance of the STOP-Bang questionnaire versus the STOP-Bag (without neck circumference) questionnaire. We hypothesized that the diagnostic performance of the STOP-Bang questionnaire would be higher than STOP-Bag questionnaire. METHODS: A retrospective study was conducted that included patients from two preoperative clinics. All participants completed the STOP-Bang questionnaire and underwent polysomnography (PSG). The diagnostic parameters were calculated for the STOP-Bang questionnaire and the STOP-Bag questionnaire versus polysomnography as the reference standard. RESULTS: There were 203 patients with mean age of 57 ± 13 years and 51% were male. The STOP-Bang questionnaire had a significantly higher area under receiver operating curve than the STOP-Bag questionnaire (0.782 vs 0.758, P < 0.05) in detection of mild to severe OSA in surgical patients. Similarly, the STOP-Bang questionnaire had significantly higher sensitivity when compared to the STOP-Bag questionnaire (85.5% vs 81.3%, P < 0.05). The area under the curve for screening moderate-to-severe and severe OSA was not significantly different for STOP-Bang and STOP-Bag questionnaires. CONCLUSION: Compared to the STOP-Bag questionnaire, the STOP-Bang questionnaire has higher diagnostic performance in predicting all OSA, but the 2 questionnaires were similar for moderate-to-severe and severe OSA. The STOP-Bag questionnaire can be used for screening OSA when neck circumference measurement is not feasible.
理由与目的:stopbang (STOP-Bang)问卷广泛用于筛查OSA高危人群，包括打鼾、疲倦、观察到的呼吸暂停、高血压、BMI、年龄、颈围、男性性别。本研究的目的是检查STOP-Bang问卷与STOP-Bag(无颈围)问卷的诊断性能。我们假设STOP-Bang问卷的诊断效能会高于STOP-Bag问卷。方法:对两家术前诊所的患者进行回顾性研究。所有的参与者都完成了STOP-Bang问卷，并进行了多导睡眠描记术(PSG)。计算STOP-Bang问卷和STOP-Bag问卷与多导睡眠图作为参考标准的诊断参数。结果:203例患者平均年龄57±13岁，男性占51%。STOP-Bang问卷在检测手术患者轻至重度OSA时，受试者操作曲线下面积明显高于STOP-Bag问卷(0.782 vs 0.758, P < 0.05)。同样，STOP-Bang问卷比STOP-Bag问卷具有更高的敏感性(85.5% vs 81.3%， P < 0.05)。在STOP-Bang和STOP-Bag问卷中，筛选中重度和重度OSA的曲线下面积差异无统计学意义。结论:与STOP-Bag问卷相比，STOP-Bang问卷在预测所有OSA方面具有更高的诊断效能，但两种问卷对中重度和重度OSA的诊断效果相似。当颈围测量不可行时，STOP-Bag问卷可用于筛查OSA。
{"title":"Comparison of STOP-Bang and STOP-Bag questionnaires in stratifying risk of obstructive sleep apnea","authors":"R. Waseem, Yasser Salama, M. Baltzan, F. Chung","doi":"10.1080/24745332.2022.2057883","DOIUrl":"https://doi.org/10.1080/24745332.2022.2057883","url":null,"abstract":"Abstract RATIONALE AND OBJECTIVE: The snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender (STOP-Bang) questionnaire is used widely to screen individuals at high risk of OSA. The objective of the study is to examine the diagnostic performance of the STOP-Bang questionnaire versus the STOP-Bag (without neck circumference) questionnaire. We hypothesized that the diagnostic performance of the STOP-Bang questionnaire would be higher than STOP-Bag questionnaire. METHODS: A retrospective study was conducted that included patients from two preoperative clinics. All participants completed the STOP-Bang questionnaire and underwent polysomnography (PSG). The diagnostic parameters were calculated for the STOP-Bang questionnaire and the STOP-Bag questionnaire versus polysomnography as the reference standard. RESULTS: There were 203 patients with mean age of 57 ± 13 years and 51% were male. The STOP-Bang questionnaire had a significantly higher area under receiver operating curve than the STOP-Bag questionnaire (0.782 vs 0.758, P < 0.05) in detection of mild to severe OSA in surgical patients. Similarly, the STOP-Bang questionnaire had significantly higher sensitivity when compared to the STOP-Bag questionnaire (85.5% vs 81.3%, P < 0.05). The area under the curve for screening moderate-to-severe and severe OSA was not significantly different for STOP-Bang and STOP-Bag questionnaires. CONCLUSION: Compared to the STOP-Bag questionnaire, the STOP-Bang questionnaire has higher diagnostic performance in predicting all OSA, but the 2 questionnaires were similar for moderate-to-severe and severe OSA. The STOP-Bag questionnaire can be used for screening OSA when neck circumference measurement is not feasible.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"6 1","pages":"359 - 366"},"PeriodicalIF":0.8,"publicationDate":"2022-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80760416","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 : 2022-05-23DOI: 10.1080/24745332.2022.2068461
M. Mullin, A. Mehta, S. V. van Eeden, J. Leung
Abstract We present a case in which the patient had left-sided chest pain and was found to have an enlarged spleen with a necrotic mass and multiple pulmonary nodules. The splenic biopsy was nondiagnostic and repeat imaging showed rapid enlargement of the pulmonary nodules with high standardized uptake value (SUV) uptake. Spindle cells present on the lung pathology initially led to the diagnosis of sarcomatoid lung cancer. However, further review showed CD20 staining on the specimen and the final diagnosis was diffuse large B-cell lymphoma (DLBCL), spindle cell variant. The patient was successfully treated with rituximab, cyclophosphamide, hydroxydaunorubicin hydrochloride, vincristine and prednisone (R-CHOP) after the diagnosis was confirmed. This is a very rare form of DLBCL that is commonly misdiagnosed and is often not on the differential for spindle cell tumors. To our knowledge, DLBCL spindle cell variant has never presented or been diagnosed from pulmonary nodules.
{"title":"The great masquerade: A rapidly growing pulmonary nodule","authors":"M. Mullin, A. Mehta, S. V. van Eeden, J. Leung","doi":"10.1080/24745332.2022.2068461","DOIUrl":"https://doi.org/10.1080/24745332.2022.2068461","url":null,"abstract":"Abstract We present a case in which the patient had left-sided chest pain and was found to have an enlarged spleen with a necrotic mass and multiple pulmonary nodules. The splenic biopsy was nondiagnostic and repeat imaging showed rapid enlargement of the pulmonary nodules with high standardized uptake value (SUV) uptake. Spindle cells present on the lung pathology initially led to the diagnosis of sarcomatoid lung cancer. However, further review showed CD20 staining on the specimen and the final diagnosis was diffuse large B-cell lymphoma (DLBCL), spindle cell variant. The patient was successfully treated with rituximab, cyclophosphamide, hydroxydaunorubicin hydrochloride, vincristine and prednisone (R-CHOP) after the diagnosis was confirmed. This is a very rare form of DLBCL that is commonly misdiagnosed and is often not on the differential for spindle cell tumors. To our knowledge, DLBCL spindle cell variant has never presented or been diagnosed from pulmonary nodules.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"30 1","pages":"367 - 370"},"PeriodicalIF":0.8,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88571559","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 : 2022-05-23DOI: 10.1080/24745332.2022.2063207
Alison V. Love, R. Jen, L. Van Tongeren, C. Ryan
ABSTRACT The syndrome of platypnea-orthodeoxia is a rare disorder characterized by dyspnea and oxygen desaturation in the upright position that improve when supine. Excluding cardiac etiologies, the most common causes are intrapulmonary right-to-left shunt due to either abnormally dilated pulmonary blood vessels in hepatopulmonary syndrome (HPS) or pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia (HHT). Both conditions can cause cutaneous telangiectasia, and both are associated with pulmonary vascular abnormalities identifiable on chest computed tomographic (CT) imaging. Differentiating between them can be challenging, as there is overlap in their clinical and radiographic manifestations. We present a patient with severe refractory hypoxemia, platypnea, orthodeoxia and cutaneous telangiectasia whose subtle clinical and laboratory findings did not initially suggest significant liver disease. Also, refractory hypoxemia in response to a high fraction of inspired oxygen strongly suggested anatomical right-to-left shunt. Thus, the alternative diagnosis of diffuse microvascular pulmonary arteriovenous malformations as a rare manifestation of HHT was entertained. The patient was referred for possible lung transplantation. Further investigations revealed chronic liver disease, confirming the diagnosis of HPS. Liver transplantation resulted in rapid resolution of the severe refractory hypoxemia and disappearance of the cutaneous telangiectasia. Nine months post liver transplant, chest CT imaging showed marked improvement in the pulmonary vascular abnormalities. This patient’s clinical presentation and work-up illustrate: (i) the relevance of subtle clinical and chest CT findings to the differential diagnosis of intrapulmonary right-to-left shunt; and (ii) the importance of a thorough knowledge of the mechanisms of hypoxemia to understanding the pathophysiology of HPS.
{"title":"Rapid resolution of refractory hypoxemia and vascular spiders following liver transplantation","authors":"Alison V. Love, R. Jen, L. Van Tongeren, C. Ryan","doi":"10.1080/24745332.2022.2063207","DOIUrl":"https://doi.org/10.1080/24745332.2022.2063207","url":null,"abstract":"ABSTRACT The syndrome of platypnea-orthodeoxia is a rare disorder characterized by dyspnea and oxygen desaturation in the upright position that improve when supine. Excluding cardiac etiologies, the most common causes are intrapulmonary right-to-left shunt due to either abnormally dilated pulmonary blood vessels in hepatopulmonary syndrome (HPS) or pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia (HHT). Both conditions can cause cutaneous telangiectasia, and both are associated with pulmonary vascular abnormalities identifiable on chest computed tomographic (CT) imaging. Differentiating between them can be challenging, as there is overlap in their clinical and radiographic manifestations. We present a patient with severe refractory hypoxemia, platypnea, orthodeoxia and cutaneous telangiectasia whose subtle clinical and laboratory findings did not initially suggest significant liver disease. Also, refractory hypoxemia in response to a high fraction of inspired oxygen strongly suggested anatomical right-to-left shunt. Thus, the alternative diagnosis of diffuse microvascular pulmonary arteriovenous malformations as a rare manifestation of HHT was entertained. The patient was referred for possible lung transplantation. Further investigations revealed chronic liver disease, confirming the diagnosis of HPS. Liver transplantation resulted in rapid resolution of the severe refractory hypoxemia and disappearance of the cutaneous telangiectasia. Nine months post liver transplant, chest CT imaging showed marked improvement in the pulmonary vascular abnormalities. This patient’s clinical presentation and work-up illustrate: (i) the relevance of subtle clinical and chest CT findings to the differential diagnosis of intrapulmonary right-to-left shunt; and (ii) the importance of a thorough knowledge of the mechanisms of hypoxemia to understanding the pathophysiology of HPS.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"112 1","pages":"323 - 328"},"PeriodicalIF":0.8,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87749513","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 : 2022-05-18DOI: 10.1080/24745332.2022.2057882
Ferhan Saleem, S. Vahidy, J. Fleetham, Loretta Pavan, Claire Normandin, J. Guenette, Y. Khor, C. Ryerson
Abstract RATIONALE & OBJECTIVES: Oxygen is prescribed for patients with interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD). This study compared the per capita financial costs of home oxygen therapy in ILD and COPD. METHODS Adults with either ILD or COPD who initiated home oxygen between 2010-2017 at the Vancouver Coastal Health Home Oxygen Program were analyzed retrospectively using a chart review. The monthly cost of oxygen equipment, home visits by oxygen providers and respiratory therapists, as well as overnight oximetry studies, were collected for each year of oxygen utilization, adjusted to 2018 Canadian Dollars. The Wilcoxon Rank Sum Test was used to compare monthly oxygen costs and flow rates between the two diseases. MEASUREMENTS AND RESULTS: A total of 99 patients with ILD and 1017 with COPD initiated oxygen therapy between 2010-2017. Both cohorts had a higher per capita cost of home oxygen in month 1 compared to months 2-24 (ILD: ($202.57 ± $88.88 versus $142.21 ± $59.01, P < 0.001; COPD: $222.85 ± $102.52 versus $156.65 ± $60.50, P < 0.001). COPD was more costly after the initial month, corresponding to greater frequency of using continuous long-term oxygen compared to oxygen only with ambulation. Patients with ILD had higher mean ambulatory oxygen flow rate for all months (P < 0.001). CONCLUSION Per capita costs of home oxygen therapy were comparable between ILD and COPD, with the main difference in costs related to the use of ambulatory versus continuous long-term oxygen. These findings will aid healthcare budget planning for both ILD and COPD.
{"title":"Costs of oxygen therapy for interstitial lung disease and chronic obstructive pulmonary disease: A retrospective study from a universal healthcare system","authors":"Ferhan Saleem, S. Vahidy, J. Fleetham, Loretta Pavan, Claire Normandin, J. Guenette, Y. Khor, C. Ryerson","doi":"10.1080/24745332.2022.2057882","DOIUrl":"https://doi.org/10.1080/24745332.2022.2057882","url":null,"abstract":"Abstract RATIONALE & OBJECTIVES: Oxygen is prescribed for patients with interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD). This study compared the per capita financial costs of home oxygen therapy in ILD and COPD. METHODS Adults with either ILD or COPD who initiated home oxygen between 2010-2017 at the Vancouver Coastal Health Home Oxygen Program were analyzed retrospectively using a chart review. The monthly cost of oxygen equipment, home visits by oxygen providers and respiratory therapists, as well as overnight oximetry studies, were collected for each year of oxygen utilization, adjusted to 2018 Canadian Dollars. The Wilcoxon Rank Sum Test was used to compare monthly oxygen costs and flow rates between the two diseases. MEASUREMENTS AND RESULTS: A total of 99 patients with ILD and 1017 with COPD initiated oxygen therapy between 2010-2017. Both cohorts had a higher per capita cost of home oxygen in month 1 compared to months 2-24 (ILD: ($202.57 ± $88.88 versus $142.21 ± $59.01, P < 0.001; COPD: $222.85 ± $102.52 versus $156.65 ± $60.50, P < 0.001). COPD was more costly after the initial month, corresponding to greater frequency of using continuous long-term oxygen compared to oxygen only with ambulation. Patients with ILD had higher mean ambulatory oxygen flow rate for all months (P < 0.001). CONCLUSION Per capita costs of home oxygen therapy were comparable between ILD and COPD, with the main difference in costs related to the use of ambulatory versus continuous long-term oxygen. These findings will aid healthcare budget planning for both ILD and COPD.","PeriodicalId":9471,"journal":{"name":"Canadian Journal of Respiratory, Critical Care, and Sleep Medicine","volume":"12 1","pages":"351 - 358"},"PeriodicalIF":0.8,"publicationDate":"2022-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73699043","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 : 2022-05-12DOI: 10.1080/24745332.2022.2048980
Kaitlin Sparrow, E. Wong, Lawrence Cheung, Melissa Wang, D. Vethanayagam, Pen Li
Abstract Rationale: The interpretation of pulmonary function tests (PFTs) is not standardized. Many guidelines exist, both disease specific and physiologically based, which lead to variability in PFT interpretations and may impact patient care. Objectives: We examine how respirologists in Canada interpret PFTs, what content they report and how this compares to current societal guidelines. Methods: An anonymous survey was sent to Canadian respirology training programs and forwarded to respirologists affiliated with their city. Comparisons were made using chi-square testing and variability measured using the index of qualitative variation (IQV). Results: There were 103 respondents; 78 (76%) were staff respirologists, representative of about 10% of practicing adult respirologists. The IQV ranged from 0.64 to 0.95 for defining obstruction and severity, bronchodilator response, lung volumes, and diffusion abnormalities and severity. No significant differences were detected between staff physicians and trainees or those in tertiary versus community practice, when defining obstruction, lung volumes and diffusion abnormalities. Pediatric respirologists were more likely (p < 0.001) to use Canadian Thoracic Society (CTS) asthma guidelines to define an obstructive defect. One specific diagnosis (p = 0.036) and a differential diagnosis (p = 0.027) were more likely to be included in a PFT summary if the ordering physician was a family physician compared to a respirologist or non-respirology specialist compared to a respirologist, respectively. Conclusions: There is large variability in how PFTs are interpreted and summarized by respirologists in Canada. Our study highlights the need for quality assurance and development of a national consensus of reporting PFTs.
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