Showing papers in "Canadian Respiratory Journal in 1999"
TL;DR: This study shows that the combination of salmeterol and fluticasone propionate in a single inhaler is as efficacious in achieving asthma control and as well tolerated over a 28-week period as the two drugs administered individually.
Abstract: OBJECTIVE: To compare the efficacy and safety of a new combination Diskus inhaler containing both salmeterol 50 μg and fluticasone propionate 250 μg (Seretide) with the two drugs delivered via separate Diskus inhalers.
103 citations
TL;DR: Chronic cough did not respond to treatment with budesonide, perhaps because the cause was not associated with sputum eosinophilia, and patients with nonasthmatic chronic cough enrolled in this study had evidence of a mild neutrophilia and/or microvascular leakage.
Abstract: BACKGROUND: Inhaled corticosteroids are effective in suppressing a chronic cough without asthma associated with sputum eosinophilia.
92 citations
Journal Article•
TL;DR: This first comprehensive national survey ofPR programs in Canada shows that there are similarities in the format, content and staffing of PR programs, which are only able to service a small percentage of patients with chronic respiratory conditions.
Abstract: Objective To characterize pulmonary rehabilitation (PR) programs in terms of their type, size, duration, patient population, content and staffing. Design Surveys were sent to members of the Rehabilitation Committee of the Canadian Thoracic Society, as well as any program identified by members of the Canadian Physiotherapy Cardio-Respiratory Society, by provincial lung associations or by the respondents. Participants Of 51 surveys sent, responses were received from 44 facilities (86% response rate). In-patient or out-patient pulmonary rehabilitation programs were offered by 36 facilities. Results Most programs (97%) admitted out-patients, and 22% had an in-patient capability. Out-patient programs enrolled 13 patients (median 11; range five to 48) at a given time for a duration of 8.3 weeks (range two to 26). In-patient programs enrolled nine patients at a given time (range two to 26) for 4.6 weeks (range one to eight). Programs included patients with chronic obstructive pulmonary disorder (100%), restrictive disease (93%), asthma (82%), adults with cystic fibrosis (46%), patients pre- or postlung transplantation (45%) and patients receiving mechanical ventilatory support (18%). Breathing retraining, education and upper extremity training were incorporated in more than 90% of all programs. Only one-third of programs offered smoking cessation as part of the rehabilitation. Education sessions on medications and inhaler usage were included in most programs, but sexuality was addressed in only half the programs. Conclusions This first comprehensive national survey of PR programs in Canada shows that there are similarities in the format, content and staffing of PR programs. Programs are only able to service a small percentage of patients with chronic respiratory conditions.
65 citations
TL;DR: The in vitro aerosol characteristics, in vivo deposition and clinical data for several HFA pMDIs for which there are data available in the literature are discussed.
Abstract: The removal of chlorofluorocarbon (CFC) propellants from industrial and household products has been agreed to by over 165 countires of which more than 135 are developing countries. The timetable for this process is outlined in the Montreal Protocol on Substances that Deplete the Ozone Layer document and in several subsequent amendments. Pressured metered dose inhalers (pMDIs) for medical use have been granted temporary exemptions until replacement formulations, providing the same medication via the same route, and with the same efficacy and safety profiles, are approved for human use. Hydrofluoroalkanes (HFAs) are the alternative propellants for CFCs-12 and -114. Their potential for damage to the ozone layer is nonexistent, and while they are greenhouse gases, their global warming potential is a fraction (one-tenth) of that of CFCs. Replacement formulations for almost all inhalant respiratory medications have been or are being produced and tested; in Canada, it is anticipated that the transition to these HFA or CFC-free pMDIs will be complete by the year 2005. Initially, an HFA pMDI was to be equivalent to the CFC pMDI being replaced, in terms of aerosol properties and effective clinical dose. However, this will not necessarily be the situation, particularly for some corticosteroid products. Currently, only one CFC-free formulation is available in Canada – Airomir, a HFA salbutamol pMDI. This paper discusses the in vitro aerosol characteristics, in vivo deposition and clinical data for several HFA pMDIs for which there are data available in the literature. Alternative delivery systems to the pMDI, namely, dry powder inhalers and nebulizers, are briefly reviewed.
44 citations
TL;DR: Supportive therapy in ARDS improved in the past decade; mechanical ventilation with lung protective strategies and patient positioning are gaining interest, but the indications for corticosteroids for ARDS are still debated.
Abstract: Acute respiratory distress syndrome (ARDS) was first described about 30 years ago. Modern definitions and statements have recently been proposed to describe ARDS accurately, but none is perfect. Diffuse alveolar damage is the basic pathological pattern most commonly observed in ARDS, and the term includes permeability edema. The alveolar epithelium of the alveolar-capillary barrier is clearly a key component requiring repair, given its multipotent functional activity. Lung inflammation and neutrophil accumulation are essential markers of disease in ARDS, and a wide variety of pro- and anti-inflammatory cytokines have been described in the alveolar fluid and blood of patients. These molecules still have to prove their value as diagnostic or prognostic biomarkers of ARDS. Supportive therapy in ARDS improved in the past decade; mechanical ventilation with lung protective strategies and patient positioning are gaining interest, but the indications for corticosteroids for ARDS are still debated. Nitric oxide may have a place in the treatment of one-third of patients. Novel approaches, such as surfactant replacement and liquid ventilation, may further improve supportive therapy. Innovative interventions may be on the horizon in treatments that help to resolve or modulate common pathways of ARDS, such as inflammation (eg, granulocyte-colony stimulating factor) or epithelial repair (eg, keratinocyte growth factor).
42 citations
TL;DR: A case of a postcolectomy ulcerative colitis in a patient who has both large airway involvement, tracheobronchitis and bronchiectasis, and constrictive bronchiolitis is presented.
Abstract: Pulmonary complications occur in an estimated 021% of patients with inflammatory bowel disease The most common presentation of pulmonary manifestations is large airway disease, such as tracheobronchitis, chronic bronchitis or bronchiectasis Small airway disease, such as constrictive bronchiolitis or bronchiolitis obliterans with organizing pneumonia, is less frequently reported, and is described as occurring in isolation from large airway disease A case of a postcolectomy ulcerative colitis in a patient who has both large airway involvement, tracheobronchitis and bronchiectasis, and constrictive bronchiolitis is presented
38 citations
TL;DR: This article discusses asthma education, reviews the current literature and attempts to challenge some of the dogma that is associated with this area, and addresses salient issues related to psychological issues and adherence.
Abstract: This article deals with four separate but not disparate topics. The first section discusses asthma education, reviews the current literature and attempts to challenge some of the dogma that is associated with this area. Knowledge alone does not guarantee appropriate behaviour, due to a variety of adverse socioeconomic and psychological factors that need to be considered for each patient. Action plans and peak flow monitoring have both been disappointing in terms of reducing asthma morbidity; the former needs to be individualized, and the latter may be useful in specific situations. Space precludes an in-depth discussion of psychological issues and adherence, but an attempt has been made to address salient issues, particularly related to the first two topics. Psychological factors, especially anxiety, play an important role in asthma outcome. Adherence to medication prescriptions and other management strategies need to be taken into account when an individual's treatment program is planned.
37 citations
TL;DR: Individual coaching in inhaler technique produces greater improvement in inhaled device knowledge among hospital pharmacists than provision of written materials, however, the advantage of the more intensive intervention was short-lived.
Abstract: OBJECTIVE: To compare the effectiveness of a more intensive educational intervention with a less intensive intervention on the ability of hospital pharmacists to be prepared to educate patients regarding inhaled device technique.
34 citations
TL;DR: Formoterol is similarly effective when used as a dry powder when given by either Aerolizer or the Turbuhaler, and the improvement in FEV1 with formoterol 12 mg versus placebo was highly significant for both devices.
Abstract: BACKGROUND: In many countries, two dry powder formulations of inhaled formoterol are available for clinical use; one uses a single-dose device (Foradil, Aerolizer), and the other uses a multiple-dose device (Oxis, Turbuhaler).
32 citations
TL;DR: The findings indicate the occurrence of occupational asthma associated with an intense, sterile neutrophilic bronchitis after exposure to metal working fluids.
Abstract: Occupational asthma is typically associated with an eosinophilic bronchitis. The case of a 41-year-old woman who developed symptoms of asthma after occupational exposure to metal working fluids is reported. The diagnosis of asthma was confirmed by an forced expiratory volume in 1 s (FEV1) of 1.7 (59% predicted), with 11% reversibility after inhaled bronchodilator and a provocation concentration of methacholine to cause a fall in FEV1 of 20% (PC20) of 0.4 mg/mL. Induced sputum examination showed a marked neutrophilia. Over the next six months, serial sputum analyses confirmed the presence of a marked sterile neutrophilic bronchitis during periods of occupational exposure to metal working fluids, which resolved when the patient was away from work and recurred when she returned to work. The sputum findings were mirrored by corresponding changes in spirometry and PC20 methacholine. The findings indicate the occurrence of occupational asthma associated with an intense, sterile neutrophilic bronchitis after exposure to metal working fluids.
30 citations
TL;DR: In fatal asthma, lower airway secretions do not show a specific pattern of viral nucleic acid, and results suggest that the lower respiratory tract may act as a potential reservoir for common respiratory viruses.
Abstract: BACKGROUND: There is indirect evidence implicating viral respiratory tract infections in the pathogenesis of fatal asthma. However, it is unknown whether viruses are present within the lower respiratory tract in fatal asthma.
TL;DR: The proportion of all drug-resistant cases that are MDR appears to be increasing, but not because of disease acquired from recent contact with MDR-TB in Canada, which is imported.
Abstract: OBJECTIVE: To describe the extent of the problem of multidrug-resistant tuberculosis (MDR-TB) in Alberta and British Columbia from 1989 to 1998.
TL;DR: The inhaler formulation used produces a microaerosol of sufficiently fine droplet size that mimics the puff-by-puff pulmonary arterial bolus nicotine delivery of tobacco smoke and permits safer nicotine delivery via the inhaler than is possible via smoked tobacco.
Abstract: OBJECTIVE: To measure the droplet size distribution of a nicotine pressurized metered-dose inhaler using a nicotine in ethanol solution formulation with hydrofluoroalkane as propellant.
TL;DR: Comparisons among professions revealed inconsistencies in some areas, such as the use of in-line catheters, gloving procedures, prelubrication and hyperinflation.
Abstract: OBJECTIVE: To assess the current tracheal and oropharyngeal suctioning practice variability within and among the professions of physical therapy, respiratory therapy and nursing.
TL;DR: Reliable measurement of induced sputum cell counts may be useful to guide treatment in clinical practice, and consideration should now be given as to how to make it more available.
Abstract: Airway inflammation is considered to be the primary cause of airway diseases. Its prevention and reversal are the primary aims of treatment. Measurement of the inflammation is now possible relatively noninvasively and reliably by using induced sputum cell counts. The differential count indicates the presence and type of the inflammation (eosinophilic or neutrophilic) and the total cell count the intensity. Sputum eosinophilia responds to treatment with corticosteroid, while there is increasing evidence that an isolated neutrophilia does not. Clinical judgement of airway inflammation is made difficult because of the different types of inflammation and their inconsistent correlation with the clinical features. Hence, reliable measurement of induced sputum cell counts may be useful to guide treatment in clinical practice. Consideration should now be given as to how to make it more available.
Journal Article•
TL;DR: Four major mechanisms of resistance by the bacteria are shown and newly described efflux mechanisms pump the antimicrobial out of the cell before it can reach its target site.
Abstract: Over the past 60 years, the introduction of new antibiotics has been matched by the development of new mechanisms of resistance by the bacteria. Current antibiotics act at a variety of sites within the target bacteria, including the cross-linking enzymes in the cell wall (beta-lactams), various ribosomal enzymes (macrolides, tetracyclines and aminoglycosides), nucleic acid polymerases (quinolones and rifampin) and folate synthesis (sulphas and trimethoprim). Four major mechanisms of resistance have been shown. Target site alterations, such as changes to the penicillin-binding protein, are common. Inactivation of antimicrobials, as by penicillinases or the new carbapenemases, is often seen. Some bacteria such as Pseudomonas aeruginosa can produce alterations in cell wall permeability that deny access to antimicrobials during the course of therapy. Finally, newly described efflux mechanisms pump the antimicrobial out of the cell before it can reach its target site.
TL;DR: Legislators should consider pollutants emitted from motor vehicle exhausts as a potential pro-allergic hazard, before making important changes in environmental policy.
Abstract: Air pollution generated from motor vehicle exhaust has become a major cause for scientific and public concern worldwide over recent years. The rapid and marked increase in the motor vehicle traffic and its associated emissions in urban areas have paralleled a sharp increase in the prevalence of allergic diseases such as asthma and rhinitis. Epidemiological studies have demonstrated a strong association between people living in close proximity to roads with high traffic density and increased allergic symptoms, reduced lung function and increased sensitization to common aeroallergens. Several laboratory-based studies have demonstrated that pollutants emitted from motor vehicles can induce allergic inflammation and increase airway hyperresponsiveness, which may provide an underlying mechanism for the increasing prevalence of allergic diseases. Although the detrimental effects of air pollution on human health have been brought to public attention, it appears that less attention has been given to the potential role of road traffic fumes in the induction of the allergic state. Legislators should consider pollutants emitted from motor vehicle exhausts as a potential pro-allergic hazard, before making important changes in environmental policy.
TL;DR: TBNA is a high-yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer and altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures.
Abstract: OBJECTIVE: To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy.
TL;DR: In this paper, an emergency department visit for an acute exacerbation of asthma often represents a breakdown in asthma management, which results in significant health care expenditures and reflects a compromised quality of life.
Abstract: BACKGROUND: Asthma can usually be controlled through allergen avoidance and/or appropriate medication. An emergency department visit for an acute exacerbation of asthma often represents a breakdown in asthma management. Emergency department treatment results in significant health care expenditures and reflects a compromised quality of life.
TL;DR: GER is present in a large number of infants presenting with brief apneic episodes, and though the relationship between the two is still not fully established, GER may be a significant risk factor for suchApnea episodes in infants.
Abstract: BACKGROUND: Apnea in an infant can be a diagnostic dilemma for the treating pediatrician. It is suggested that in some infants, gastroesophageal reflux (GER) might be a factor in the pathogenesis of apnea, although its role as a cause of apnea is still controversial.
TL;DR: The Updraft II proved most efficient and cost effective of all the nebulizers evaluated in this study and could not have been predicted from specifications provided by the respective manufacturers.
Abstract: OBJECTIVES: To evaluate the factors that affect nebulizer efficiency and to compare the relative cost effectiveness of nebulized medications used in the treatment of cystic fibrosis (CF), delivered by four types of disposable jet nebulizers that are widely used in hospitals.
TL;DR: To determine the direct and indirect costs associated with the care of acute asthma in an adult teaching hospital, a large number of patients with acute asthma are referred to a single hospital for treatment.
Abstract: OBJECTIVE: To determine the direct and indirect costs associated with the care of acute asthma in an adult teaching hospital.
TL;DR: The literature on the surgical treatment of emphysema is reviewed and preliminary results from a pilot study of lung volume reduction (LVR) surgery are presented.
Abstract: OBJECTIVE: To review the literature on the surgical treatment of emphysema and to present preliminary results from a pilot study of lung volume reduction (LVR) surgery.
Journal Article•
TL;DR: Evidence from the literature supports antibiotic treatment of sinusitis to eradicate infection and to reduce symptoms, but there is insufficient literature evidence to prove that antibiotic treatment reduces serious complications or reduces progression to chronic sinus disease.
Abstract: The paranasal sinuses, normally sterile, are prone to bacterial invasion as a complication of viral illnesses such as the common cold. Using computed tomograms, abnormalities of the sinuses can be seen in 90% of healthy adults with upper respiratory tract infections; only 2% of these patients will develop bacterial sinusitis. Possible rationales for antibiotic treatment of sinusitis include the normal sterility of the sinuses, the clinical morbidity associated with sinusitis, the possibility of serious intracranial and periorbital complications in untreated cases, and the possible progression of acute infections to chronic sinus disease. Evidence from the literature supports antibiotic treatment of sinusitis to eradicate infection and to reduce symptoms. There is insufficient literature evidence to prove that antibiotic treatment reduces serious complications or reduces progression to chronic sinus disease. Treatment should include an antimicrobial with a spectrum likely to cover the important pathogens, including those with high levels of resistance.
TL;DR: The Asthma Consensus Conference Editorial Committee selected the following institutions to represent Canada: Centre de pneumologie, Institut de cardiologie et de pneumology de l’Universite Laval, Hopital Laval and Sainte-Foy.
Abstract: Louis-Philippe Boulet MD FRCPC 1 , Allan Becker MD FRCPC 2 , Denis Berube MD FRCPC 3 , Pierre Ernst MD FRCPC 4 , Robert Beveridge MD FRCPC 5 . Asthma Consensus Conference Editorial Committee 1 Centre de pneumologie, Institut de cardiologie et de pneumologie de l’Universite Laval, Hopital Laval, Sainte-Foy, Quebec; 2 Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba; 3 Service de pneumologie, Hopital Sainte-Justine, Montreal; 4 Division of Clinical Epidemiology, Royal Victoria Hospital, Montreal, Quebec; 5 Atlantic Health Sciences Corporation, Saint John, New Brunswick
TL;DR: Data suggest that the development of three new drugs that modulate the LT pathway are useful in the treatment of a broad range of asthmatic patients and are beneficial in decreasing the dose of inhaled corticosteroids necessary to control more moderate to severe asthma.
Abstract: Leukotrienes (LTs), lipid mediators of inflammation, have proved to be important biochemicals involved in the symptoms and physiological changes of asthma. In the past year and a half, the development of three new drugs that modulate the LT pathway has been completed. The first subclass of these drugs, leukotriene receptor antagonists (LTRA) (zafirlukast and montelukast), blocks the interaction of the cysteinyl form of the LTs with the cell type bearing the receptor. The second subclass, the 5-lipoxygenase (5-LO) inhibitors (zileuton) inhibits the 5-LO enzyme, which prevents the formation of both cysteinyl LTs and LTB4. The LT modulators have shown efficacy in inhibiting the physiological changes occurring after allergen, acetylsalicylic acid and exercise challenge in asthmatics. In addition, they have shown efficacy in improving symptoms, beta-agonist use and forced expiratory volume in 1 s (FEV1) in chronic, 'day-to-day' asthma in patients with mild disease. Comparison studies with low doses of inhaled corticosteroids suggest that LT modulators may have similar effects on symptom scores and beta-agonist use, but have lesser effects on FEV1. Finally, emerging data suggest that these drugs are beneficial in decreasing the dose of inhaled corticosteroids necessary to control more moderate to severe asthma. While long term studies will be helpful in determining the 'disease modifying' effects of these drugs, data suggest that these drugs are useful in the treatment of a broad range of asthmatic patients.
TL;DR: Findings are consistent with the hypothesis that either abnormalities in mucus properties may represent a risk factor for the development of lung cancer or that bronchial mucus abnormalities may be associated with products secreted by the tumours that, in turn, may suppress mucus clearance.
Abstract: OBJECTIVE: To compare the biophysical properties of mucus from the left and right mainstem bronchi in patients undergoing diagnostic bronchoscopy because of a unilateral radiological abnormality. It was hypothesized that abnormalities in the properties of mucus would be greater on the side with the lesion and that this would be most obvious in patients with unilateral lung cancer.
TL;DR: Evidence suggests that exercise and the ensuing bronchoconstriction do not contribute to a worsening of asthmatic inflammation and there is encouraging evidence suggesting that modifications of the pattern of exercise can markedly reduce the extent of EIB.
Abstract: Exercise-induced bronchoconstriction (EIB) is a common clinical manifestation of asthma, occurring in 70% to 80% of asthmatics. Evidence suggests that exercise and the ensuing bronchoconstriction do not contribute to a worsening of asthmatic inflammation. Asthmatics should not be discouraged from exercising, and, with adequate management, most patients should be able to exercise regularly with only minor symptoms. The first step in the management of patients with EIB should be to obtain optimum control of the underlying asthma, often requiring regular treatment with inhaled steroids. Regular treatment with inhaled corticosteroids usually reduces the extent of EIB by 50% or more. Frequently, despite optimal management of the underlying asthma, patients develop EIB symptoms requiring additional treatment. Short and long acting inhaled beta2-agonists are highly effective at reducing the magnitude of EIB, although there are concerns that the extent of protection diminishes during periods of regular use of these agents. Inhaled cromolyn and nedocromyl are effective at reducing the extent of EIB in some patients, although this protection does not extend beyond 2 to 3 h after treatment. The recently developed leukotriene receptor antagonists are effective at reducing the extent of EIB by 40% to 70%, and have the advantage that this protection lasts throughout the day and does not appear to diminish with regular use. Other agents, including anticholinergics and antihistamines, have been shown to offer partial protection against EIB, suggesting the possibility of using a combination treatment to manage some patients' symptoms. Finally, there is encouraging evidence suggesting that modifications of the pattern of exercise can markedly reduce the extent of EIB.
Journal Article•
TL;DR: The characteristics of levofloxacin - high oral bioavailability, long duration of effect, activity against key respiratory pathogens and high tolerability - suggest that it will be a useful drug in the treatment of community acquired pneumonia.
Abstract: Levofloxacin is the first fluoroquinolone with enhanced activity against Streptococcus pneumoniae to be released in Canada. In vitro, it is active against more than 99% of isolates of S pneumoniae, even those resistant to penicillin. It is also active against respiratory pathogens such as Haemophilus influenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella species. When given orally, bioavailability is greater than 99%, and the drug is highly concentrated in lung tissue and macrophages. Drug levels are compatible with once-daily dosing. In a large clinical trial, levofloxacin has shown clinical and microbiological superiority compared with ceftriaxone/cefuroxime. The characteristics of levofloxacin - high oral bioavailability, long duration of effect, activity against key respiratory pathogens and high tolerability - suggest that it will be a useful drug in the treatment of community acquired pneumonia.
Journal Article•
TL;DR: Once otitis media has been accurately diagnosed, treatment with antibiotics appears to improve outcomes and to reduce complications, such as mastoiditis, although results from different studies conflict.
Abstract: Acute otitis media affects at least 80% of children younger than two years of age and is responsible for a third of physician visits of children younger than five years of age. Diagnosis must be based on more than an injected tympanic membrane; systemic signs and symptoms such as fever, irritability and reduced appetite are important, as is reduced mobility of the ear drum assessed with pneumatic otoscopy or impedance tympanometry. Once otitis media has been accurately diagnosed, treatment with antibiotics appears to improve outcomes and to reduce complications, such as mastoiditis, although results from different studies conflict.