Canadian respiratory journal: journal of the Canadian Thoracic Society (CAN RESPIR J)

Publications in this journal

• Article: The impact of body mass index on inpatient- versus outpatient-treated chronic obstructive pulmonary disease exacerbations.

  Ariane Jacob, Catherine Laurin, Kim L Lavoie, Grégory Moullec, Maxine Boudreau, Catherine Lemière, Simon Bacon
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  ABSTRACT: Background: Increased body weight has been associated with worse prognoses for many chronic diseases, though this relationship seems to be less clear in patients with chronic obstructive pulmonary disease (COPD), with underweight patients having higher morbidity than normal or overweight patients. This study assessed the impact of body mass index (BMI) on risk for COPD exacerbations using a prospective design. Methods: This study included 115 patients with stable COPD (53% women, mean (SD) age = 67 (8) years). Height and weight were measured to calculate BMI. Patients were followed for an average (SD) of 1.8 (0.8) years to assess prospective risk of in-hospital treated exacerbations and out-of-hospital treated exacerbations, all of which were verified by chart review. Results: Cox regression models revealed that underweight patients were at greater risk for in-hospital treated exacerbations (RR=2.93; 95% CI=1.27 to 6.76) relative to normal weight patients. However, overweight (RR=0.59; CI=0.33 to 1.57) and obese (RR=0.99; CI=0.53 to 1.86) patients did not differ from normal weight patients. All analyses were adjusted for age, sex, length of diagnosis, smoking pack-years, forced expiratory volume in one second, and time between recruitment and last exacerbation. BMI did not increase the risk of out-of-hospital exacerbations. Conclusions: This study showed that underweight patients were at greater risk of in-hospital exacerbations. However, BMI did not appear to be a risk factor for out-of-hospital exacerbations. This suggests that the BMI-exacerbation link may differ according to the nature of the exacerbation, the mechanisms for which are not yet known.
  Canadian respiratory journal: journal of the Canadian Thoracic Society 02/2013;
• Article: The times they are a changin'.

  John Granton
  Canadian respiratory journal: journal of the Canadian Thoracic Society 01/2013; 20(1):8.
• Article: Celebrating 55 years of volunteer leadership / Célébrer 55 ans de leadership bénévole.

  Robin G McFadden
  Canadian respiratory journal: journal of the Canadian Thoracic Society 01/2013; 20(1):9.
• Article: Ultrasound finding predictive of malignant pleural effusion.

  Brian Grondin-Beaudoin, Elaine Dumoulin
  Canadian respiratory journal: journal of the Canadian Thoracic Society 01/2013; 20(1):10.
• Article: Diffuse pulmonary lymphangiomatosis.

  Kunal C Kadakia, Sandeep M Patel, Eunhee S Yi, Andrew H Limper
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  ABSTRACT: Diffuse pulmonary lymphangiomatosis (DPL) is a rare disease characterized by infiltration of the lung, pleura and mediastinum with thin-walled lymphangiomas. DPL can result in mass effect from infiltrative disease, restrictive and obstructive pulmonary physiology, chylous effusions and respiratory failure. The present article discusses clinical, radiographic and pathological features, and treatment options for DPL.
  Canadian respiratory journal: journal of the Canadian Thoracic Society 01/2013; 20(1):52-4.
• Article: Sex as an independent prognostic factor in a population-based non-small cell lung cancer cohort.

  Marshall W Pitz, Grace Musto, Srisala Navaratnam
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  ABSTRACT: Males with non-small cell lung cancer (NSCLC) tend to experience worse outcomes, as do those with nonadenocarcinoma histology; however, the independent effects of these factors remain unclear. To evaluate the independent effect of sex and histology on mortality in a population of patients with NSCLC. All patients with NSCLC in Manitoba from 1985 to 2004 were identified from the Manitoba Cancer Registry. Treatment data were extracted from the Manitoba Health administrative databases and linked to the registry. Cox regression analysis was used to determine the independent effect of sex on survival. A total of 10,908 patients (6665 male, 4243 female) with NSCLC were identified. Females had a median overall survival of 9.4 months versus 6.8 months for males (P<0.001). The adjusted HR for death for males compared with females was 1.13 (95% CI 1.04 to 1.23; P=0.004). Sex modified the effect of surgical treatment on survival (HR 1.26 [95% CI 1.13 to 1.40]; P<0.001). Adenocarcinoma histology modified the effect of sex on survival (HR 1.36 [95% CI 1.24 to 1.50]; P<0.001) when treatment was accounted for. Females experienced a significantly better survival rate than males independent of treatment, age, year of diagnosis and histology. This was greatest in surgically treated patients and in those with adenocarcinoma.
  Canadian respiratory journal: journal of the Canadian Thoracic Society 01/2013; 20(1):30-4.
• Article: Role of monoclonal antibodies in the treatment of asthma.

  Paul M O'Byrne
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  ABSTRACT: Patients with severe refractory asthma represent a small subset of the asthmatic population (between 5% and 10% of all patients) but are the greatest burden to the health care system. New treatment approaches developed to manage some of the phenotypes of severe refractory asthma have included humanized monoclonal antibodies (hMabs). To review the evidence and ascertain whether hMabs provide clinical benefit to patients with severe refractory asthma. Methods: Studies that examined the efficacy of hMabs against immunoglobulin (Ig) E, tumour necrosis factor-alpha, interleukin (IL)-5, and IL-4⁄IL-13 in patients with severe refractory asthma were reviewed and summarized. Treatment with anti-IgE improved asthma control and reduced severe exacerbations in patients with severe asthma and elevated serum IgE levels. Treatments with hMabs that block tumour necrosis factor-alpha are unlikely to be useful in asthma treatment. In contrast, hMabs that block IL-5 have consistently shown benefit in reducing severe exacerbations in patients with severe refractory asthma with persistent eosinophilia. Finally, hMabs that block IL-13 may provide benefit in patients with elevated blood periostin levels. hMabs that block IgE are approved for the treatment of allergic asthma. It is likely that blocking IL-5 will also provide benefit in patients with severe asthma with persistent eosinophilia. These studies have emphasized the importance of careful phenotyping of patients with severe refractory asthma before embarking on treatment with hMabs.
  Canadian respiratory journal: journal of the Canadian Thoracic Society 01/2013; 20(1):23-5.
• Article: The effect of inhaled menthol on upper airway resistance in humans: A randomized controlled crossover study.

  Effie Justin Pereira, Lauren Sim, Helen Driver, Christopher Parker, Michael Fitzpatrick
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  ABSTRACT: Menthol (l-menthol) is a naturally-occurring cold receptor agonist commonly used to provide symptomatic relief for upper airway congestion. Menthol can also reduce the sensation of dyspnea. It is unclear whether the physiological action of menthol in dyspnea reduction is through its cold receptor agonist effect or whether associated mechanical changes occur in the upper airway. To determine whether menthol inhalation alters upper airway resistance in humans. A randomized, sham-controlled, single-blinded crossover study of inhaled menthol on upper airway resistance during semirecumbent quiet breathing in healthy subjects was conducted. Ten healthy participants (eight female) with a mean (± SD) age of 21±1.6 years completed the study. Nasal resistance before testing was similar on both occasions. No differences were found in respiratory frequency (mean ± SEM) (menthol 17.0±1.1 cmH2O⁄L⁄s; sham 16.9±0.9 cmH2O⁄L⁄s), minute ventilation (menthol 7.7±0.5 cmH2O⁄L⁄s; sham 7.9±0.5 cmH2O⁄L⁄s) or total inspiratory time⁄total breath time (menthol 0.4±0.1 cmH2O⁄L⁄s; sham 0.4±0.1 cmH2O⁄L⁄s). The upper airway resistance was similar during menthol (3.47±0.32 cmH2O⁄L⁄s) and sham (3.27±0.28 cmH2O⁄L⁄s) (P=0.33) inhalation. Inhalation of menthol does not alter upper airway resistance in awake human subjects.
  Canadian respiratory journal: journal of the Canadian Thoracic Society 01/2013; 20(1):e1-4.
• Article: Quantitative sputum cell counts to monitor bronchitis: A qualitative study of physician and patient perspectives.

  Liesel D'silva, Helen Neighbour, Amiram Gafni, Katherine Radford, Freddy Hargreave, Parameswaran Nair
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  ABSTRACT: Many common diseases affecting the airways are characterized by airway inflammation. The measurement of this inflammation has a significant role in the management of these diseases. Quantitative sputum cell counts provide a measurement of the type and severity of inflammation present. Sputum cell counts are used in routine clinical practice in some centres but their use is not widespread. The present study used a standardized questionnaire to determine both patients' and physicians' attitudes toward the use of sputum cell counts. The use of sputum cell counts was well accepted by patients and physicians. Ninety per cent of patients were satisfied with the test. Sixty per cent of family physicians were satisfied with the test and 80% were in favour of it being funded by the government. The authors recommend more widespread use of sputum cell counts to guide the management of airway diseases.
  Canadian respiratory journal: journal of the Canadian Thoracic Society 01/2013; 20(1):47-51.
• Article: Loud snoring is a risk factor for occupational injury in farmers.

  James A Dosman, Louise Hagel, Robert Skomro, Xiaoqun Sun, Andrew Day, William Pickett
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  ABSTRACT: Loud snoring is a common symptom in the general population. The evidence-based literature indicates that snoring may be associated with sleep fragmentation and sleep apnea, which may affect cognitive function and predispose to occupational injury. High rates of occupational injury occur on farms and may be related to personal and health factors. Thus, loud snoring may not be a trivial symptom and should be considered as important in medical assessments. A prospective cohort study was conducted in Saskatchewan. Baseline questionnaires were completed for 5502 individuals by representatives from 2390 farms. Sleep patterns at baseline were categorized as the following: no reported sleep disorders; physician-diagnosed sleep apnea (treatment unknown); and loud snoring. Survival analyses were used to relate sleep patterns with subsequent injury. A total of 6.7% (369 of 5502) of participants reported a possible sleep disorder. Of these, 69.4% (256 of 369) reported loud snoring only. Loud snoring was only associated with a consistent increase in risk (eg, HR 1.45 [95 CI 1.07 to 1.99 for work-related injury]) for five farm injury outcomes. Relationships between physician-diagnosed sleep apnea and time to first injury were not significant, presumably because a diagnosis of sleep apnea implied treatment for sleep apnea. Sleep disorders are an important potential risk factor for occupational injury on farms. Substantial proportions of farm residents report loud snoring and this is related to subsequent injury. Some of these cases may represent sleep fragmentation or undiagnosed obstructive sleep apnea. Identification and clinical management of sleep disorders related to snoring should be part of health assessments conducted by physicians.
  Canadian respiratory journal: journal of the Canadian Thoracic Society 01/2013; 20(1):42-6.
• Article: Spirometry in primary care.

  Allan L Coates, Brian L Graham, Robin G McFadden, Colm McParland, Dilshad Moosa, Steeve Provencher, Jeremy Road
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  ABSTRACT: Canadian Thoracic Society (CTS) clinical guidelines for asthma and chronic obstructive pulmonary disease (COPD) specify that spirometry should be used to diagnose these diseases. Given the burden of asthma and COPD, most people with these diseases will be diagnosed in the primary care setting. The present CTS position statement was developed to provide guidance on key factors affecting the quality of spirometry testing in the primary care setting. The present statement may also be used to inform and guide the accreditation process for spirometry in each province. Although many of the principles discussed are equally applicable to pulmonary function laboratories and interpretation of tests by respirologists, they are held to a higher standard and are outside the scope of the present statement.
  Canadian respiratory journal: journal of the Canadian Thoracic Society 01/2013; 20(1):13-21.
• Article: Local and systemic oxidative stress status in chronic obstructive pulmonary disease patients.

  Mian Zeng, Yue Li, Yujie Jiang, Guifang Lu, Xiaomei Huang, Kaipan Guan
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  ABSTRACT: Previous studies have indicated that oxidative stress plays an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD). To study local and systemic oxidative stress status in COPD patients, and to clarify the relationship between local and systemic oxidative stress. Lipid peroxide malondialdehyde (MDA), glutathione (GSH), superoxide dismutase (SOD) and GSH peroxidase (GSH-PX) levels in induced sputum and plasma, as well as glucocorticoid receptor (GR) levels in peripheral blood leukocytes were examined in 43 acute exacerbation of COPD patients (group A), 35 patients with stable COPD (group B) and 28 healthy controls (14 smokers [group C]; 14 nonsmokers [group D]). MDA levels in induced sputum and plasma decreased progressively in groups A to D, with significant differences between any two groups (P<0.001). GSH, SOD and GSH-PX levels in both induced sputum and plasma increased progressively in groups A to D, with significant differences between any two groups (P<0.001). GR levels in peripheral blood leukocytes decreased progressively in groups D to A (all comparisons P<0.001). Pearson analysis revealed strong correlations between MDA, GSH, SOD and GSH-PX levels in plasma and induced sputum. The activity of SOD in plasma and sputum were both positively correlated with GR levels (partial correlation coefficients 0.522 and 0.574, respectively [P<0.001]). Oxidative stress levels were elevated in COPD patients. There was a correlation between local and systemic oxidative status in COPD, and between decreased SOD activity and decreased GR levels in COPD patients.
  Canadian respiratory journal: journal of the Canadian Thoracic Society 01/2013; 20(1):35-41.
• Article: Twenty-four hour noninvasive ventilation in Duchenne muscular dystrophy: A safe alternative to tracheostomy.

  Doug A McKim, Nadia Griller, Carole Leblanc, Andrew Woolnough, Judy King
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  ABSTRACT: Almost all patients with Duchenne muscular dystrophy (DMD) eventually develop respiratory failure. Once 24 h ventilation is required, either due to incomplete effectiveness of nocturnal noninvasive ventilation (NIV) or bulbar weakness, it is common practice to recommend invasive tracheostomy ventilation; however, noninvasive daytime mouthpiece ventilation (MPV) as an addition to nocturnal mask ventilation is also an alternative. The authors' experience with 12 DMD patients who used 24 h NIV with mask NIV at night and MPV during daytime hours is reported. The mean (± SD) age and vital capacity (VC) at initiation of nocturnal (only) NIV subjects were 17.8±3.5 years and 0.90±0.40 L (21% predicted), respectively; and, at the time of MPV, 19.8±3.4 years and 0.57 L (13.2% predicted), respectively. In clinical practice, carbon dioxide (CO2) levels were measured using different methods: arterial blood gas analysis, transcutaneous partial pressure of CO2 and, predominantly, by end-tidal CO2. While the results suggested improved CO2 levels, these were not frequently confirmed by arterial blood gas measurement. The mean survival on 24 h NIV has been 5.7 years (range 0.17 to 12 years). Of the 12 patients, two deaths occurred after 3.75 and four years, respectively, on MPV; the remaining patients continue on 24 h NIV (range two months to 12 years; mean 5.3 years; median 3.5 years). Twenty-four hour NIV should be considered a safe alternative for patients with DMD because its use may obviate the need for tracheostomy in patients with chronic respiratory failure requiring more than nocturnal ventilation alone.
  Canadian respiratory journal: journal of the Canadian Thoracic Society 01/2013; 20(1):e5-9.
• Article: Oxidative stress in chronic obstructive pulmonary disease: A lung and systemic process.

  Stephan F van Eeden, Don D Sin
  Canadian respiratory journal: journal of the Canadian Thoracic Society 01/2013; 20(1):27-9.
• Article: A brief review of chronic obstructive pulmonary disease.

  James C Hogg
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  ABSTRACT: A recent study, based on a combination of multidetector computed tomography scanning of an intact specimen with microcomputed tomography and histological analysis of lung tissue samples, reported that the number of terminal bronchioles were reduced from approximately 44,500⁄lung pair in control (donor) lungs to approximately 4800⁄lung pair in lungs donated by individuals with very severe (Global initiative for chronic Obstructive Lung Disease stage 4) chronic obstructive pulmonary disease (COPD) treated by lung transplantation. The present short review discusses the hypothesis that a rapid rate of terminal bronchiolar destruction causes the rapid decline in lung function leading to advanced COPD. With respect to why the terminal bronchioles are targeted for destruction, the postulated mechanisms of this destruction and the possibility that new treatments are able to either prevent or reverse the underlying cause of airway obstruction in COPD are addressed.
  Canadian respiratory journal: journal of the Canadian Thoracic Society 11/2012; 19(6):381-4.
• Article: Prevalence of asthma and chronic obstructive pulmonary disease in Aboriginal and non-Aboriginal populations: A systematic review and meta-analysis of epidemiological studies.

  Maria B Ospina, Donald C Voaklander, Michael K Stickland, Malcolm King, Ambikaipakan Senthilselvan, Brian H Rowe
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  ABSTRACT: Asthma and chronic obstructive pulmonary disease (COPD) have considerable potential for inequities in diagnosis and treatment, thereby affecting vulnerable groups. To evaluate differences in asthma and COPD prevalence between adult Aboriginal and non-Aboriginal populations. MEDLINE, Embase, specialized databases and the grey literature up to October 2011 were searched to identify epidemiological studies comparing asthma and COPD prevalence between Aboriginal and non-Aboriginal adult populations. Prevalence ORs (PORs) and 95% CIs were calculated in a random-effects meta-analysis. Of 132 studies, eight contained relevant data. Aboriginal populations included Native Americans, Canadian Aboriginals, Australian Aboriginals and New Zealand Maori. Overall, Aboriginals were more likely to report having asthma than non-Aboriginals (POR 1.41 [95% CI 1.23 to 1.60]), particularly among Canadian Aboriginals (POR 1.80 [95% CI 1.68 to 1.93]), Native Americans (POR 1.41 [95% CI 1.13 to 1.76]) and Maori (POR 1.64 [95% CI 1.40 to 1.91]). Australian Aboriginals were less likely to report asthma (POR 0.49 [95% CI 0.28 to 0.86]). Sex differences in asthma prevalence between Aboriginals and their non-Aboriginal counterparts were not identified. One study compared COPD prevalence between Native and non-Native Americans, with similar rates in both groups (POR 1.08 [95% CI 0.81 to 1.44]). Differences in asthma prevalence between Aboriginal and non-Aboriginal populations exist in a variety of countries. Studies comparing COPD prevalence between Aboriginal and non-Aboriginal populations are scarce. Further investigation is needed to identify and account for factors associated with respiratory health inequalities among Aboriginal peoples.
  Canadian respiratory journal: journal of the Canadian Thoracic Society 11/2012; 19(6):355-60.
• Article: Validation of a new questionnaire with generic and disease-specific qualities: The McGill COPD Quality of Life Questionnaire.

  Smita Pakhale, Sharon Wood-Dauphinee, Adriana Spahija, Jean-Paul Collet, Francois Maltais, Sarah Bernard, Marc Baltzan, Michel Rouleau, Jean Bourbeau
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  ABSTRACT: A validated health-related quality of life questionnaire in chronic obstructive pulmonary disease (COPD) with advantages of both generic- and disease-specific questionnaires is needed to capture patients' perspectives of severity and impact of the disease. The McGill COPD questionnaire was created to include these advantages in English and French. It assesses three domains: symptoms, physical function and feelings with 29 items (12 from the 36-item Short-Form Health Survey with 17 from the previously developed COPD-specific module). To evaluate the psychometric properties of this newly developed hybrid questionnaire in subjects with COPD. Data from a multicentre, prospective cohort study involving four hospitals with COPD subjects undergoing pulmonary rehabilitation were used. Patient evaluations included health-related quality of life (the new McGill COPD questionnaire, the St Georges Respiratory Questionnaire and the 36-item Short-Form Health Survey) and pulmonary function tests pre-and postrehabilitation. Reliability, validity and responsiveness were tested. The study included 246 COPD subjects (111 females) with a mean age of 66 years, 87% ex- and 8% current smokers (mean 61 pack-years) and mean forced expiratory volume in 1 s of 1.12 L (Global initiative for chronic Obstructive Lung Disease stages: 2, 27%; 3, 33%; and 4, 37%). Missing data were <2% and floor and ceiling effects were <5%. Internal consistency (Cronbach's alpha) was 0.68 to 0.82. Test-retest reliability (intracorrelation coefficients) ranged from 0.74 to 0.96 for the subscales, and 0.95 for the total score. Correlation with the St George's Respiratory Questionnaire was moderately high (r=-0.88 [95% CI -0.91 to -0.84]), consistent with the a priori hypothesis for convergent validity. The effect size was 0.33 (pre-postrehabilitation mean score difference = 6), suggesting a small to moderate change. The new McGill COPD questionnaire showed high internal consistency, test-retest reliability, validity and moderate responsiveness in COPD subjects.
  Canadian respiratory journal: journal of the Canadian Thoracic Society 11/2012; 19(6):367-72.
• Article: Chronic airways disease in First Nations, Inuit and Métis in Canada.

  Saba Khan, David A Henry, Andrea S Gershon
  Canadian respiratory journal: journal of the Canadian Thoracic Society 11/2012; 19(6):353-4.