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Aaron SD, Montes de Oca M, Celli B, Bhatt SP, Bourbeau J, Criner GJ, DeMeo DL, Halpin DMG, Han MK, Hurst JR, Krishnan JK, Mannino D, van Boven JFM, Vogelmeier CF, Wedzicha JA, Yawn BP, Martinez FJ. Early Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease: The Costs and Benefits of Case Finding. Am J Respir Crit Care Med 2024; 209:928-937. [PMID: 38358788 DOI: 10.1164/rccm.202311-2120pp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/14/2024] [Indexed: 02/16/2024] Open
Affiliation(s)
- Shawn D Aaron
- The Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Maria Montes de Oca
- Universidad Central de Venezuela, Caracas, Venezuela
- Hospital Centro Médico de Caracas, Caracas, Venezuela
| | | | - Surya P Bhatt
- Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jean Bourbeau
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Gerard J Criner
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David M G Halpin
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - MeiLan K Han
- Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, Michigan
| | - John R Hurst
- UCL Respiratory, University College London, London, United Kingdom
| | - Jamuna K Krishnan
- Division of Pulmonary and Critical Care, Weill Cornell Medicine, New York, New York
| | - David Mannino
- College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Job F M van Boven
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, University of Groningen, Groningen, The Netherlands
| | - Claus F Vogelmeier
- Philipps-Universität Marburg, German Center for Lung Research, Marburg, Germany
| | - Jadwiga A Wedzicha
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Barbara P Yawn
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota; and
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Gerstein E, Bierbrier J, Whitmore GA, Aaron SD. Reply to: Asthma-Chronic Obstructive Pulmonary Disease Overlap versus Chronic Obstructive Pulmonary Disease: Comparing Apples and Oranges. Am J Respir Crit Care Med 2024; 209:766-767. [PMID: 38237154 PMCID: PMC10945071 DOI: 10.1164/rccm.202311-2068le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024] Open
Affiliation(s)
- Emily Gerstein
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; and
| | - Jared Bierbrier
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; and
| | - G. Alex Whitmore
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
| | - Shawn D. Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; and
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Kwok C, Thavorn K, Amjadi K, Aaron SD, Kendzerska T. Resource Use and Costs of Indwelling Pleural Catheters vs Pleurodesis for Malignant Pleural Effusions: A Population-based Study. Ann Am Thorac Soc 2024. [PMID: 38381853 DOI: 10.1513/annalsats.202304-333oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 02/20/2024] [Indexed: 02/23/2024] Open
Abstract
RATIONALE Malignant pleural effusions (MPE) are associated with significant health service use and healthcare costs, but the current evidence is limited. OBJECTIVES To compare 12-month post-procedure: (1) health service utilization, and (2) healthcare costs following indwelling pleural catheter (IPC) insertion with at-home drainage performed by homecare nursing services, versus in-hospital chemical pleurodesis. METHODS We performed a retrospective population-based study on a cohort of adults with MPE who underwent IPC insertion or chemical pleurodesis between January 1, 2015 and December 31, 2019 using provincial health administrative data (Ontario, Canada). Patients were followed from the procedure date until death or until 12-month post-procedure. Inverse probability of treatment weighting (IPTW) was performed to adjust for imbalances in baseline characteristics. Differences in length of stay (LOS), readmissions, emergency department visits, home care visits, and healthcare costs were estimated using weighted regression analysis. RESULTS Of 5,752 included individuals, 4432 (77%) underwent IPC insertion and 1320 (23%) had pleurodesis. In the weighted sample, individuals who received an IPC had fewer inpatient days (12.4 days vs 16 days, standardized mean difference 0.229), but a higher proportion of subsequent admissions for empyema (2.7% vs 1.1%, p=0.0002) compared to those undergoing pleurodesis. IPC individuals received more hours of nursing home care (41 hours vs 21.1 hours, standardized mean difference 0.671) but overall had lower average healthcare costs ($40,179 vs $46,640 per patient, standardized mean difference 0.177) than those receiving pleurodesis. CONCLUSIONS IPCs with home nursing drainage are associated with reduced health resource use compared to pleurodesis in adults with MPE even after controlling for important baseline and clinical characteristics. Given that both procedures have similar health outcomes, our findings support the ongoing promotion of IPCs to increase outpatient management of patients with MPEs. Primary source of funding: TOHAMO Innovation Fund grant.
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Affiliation(s)
- Chanel Kwok
- Ottawa Hospital, 27337, Department of Medicine, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, 12365, School of Epidemiology and Public Health, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, 10055, Ottawa, Ontario, Canada;
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, 10055, Ottawa, Canada
- ICES, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, 12365, School of Epidemiology and Public Health, Ottawa, Ontario, Canada
| | - Kayvan Amjadi
- Ottawa Hospital, 27337, Medicine, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, 10055, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, 12365, School of Epidemiology and Public Health, Ottawa, Ontario, Canada
| | - Tetyana Kendzerska
- Ottawa Hospital Research Institute, 10055, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Ottawa Hospital, 27337, Department of Medicine, Ottawa, Ontario, Canada
- University of Ottawa Faculty of Medicine, 12365, School of Epidemiology and Public Health, Ottawa, Ontario, Canada
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Kendzerska T, Zhu DT, Pugliese M, Manuel D, Sadatsafavi M, Povitz M, Stukel TA, To T, Aaron SD, Mulpuru S, Chin M, Kendall CE, Thavorn K, Robillard R, Gershon AS. Trends in outpatient and inpatient visits for separate ambulatory-care-sensitive conditions during the first year of the COVID-19 pandemic: a province-based study. Front Public Health 2023; 11:1251020. [PMID: 38169852 PMCID: PMC10759216 DOI: 10.3389/fpubh.2023.1251020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background The COVID-19 pandemic led to global disruptions in non-urgent health services, affecting health outcomes of individuals with ambulatory-care-sensitive conditions (ACSCs). Methods We conducted a province-based study using Ontario health administrative data (Canada) to determine trends in outpatient visits and hospitalization rates (per 100,000 people) in the general adult population for seven ACSCs during the first pandemic year (March 2020-March 2021) compared to previous years (2016-2019), and how disruption in outpatient visits related to acute care use. ACSCs considered were chronic obstructive pulmonary disease (COPD), asthma, angina, congestive heart failure (CHF), hypertension, diabetes, and epilepsy. We used time series auto-regressive integrated moving-average models to compare observed versus projected rates. Results Following an initial reduction (March-May 2020) in all types of visits, primary care outpatient visits (combined in-person and virtual) returned to pre-pandemic levels for asthma, angina, hypertension, and diabetes, remained below pre-pandemic levels for COPD, and rose above pre-pandemic levels for CHF (104.8 vs. 96.4, 95% CI: 89.4-104.0) and epilepsy (29.6 vs. 24.7, 95% CI: 22.1-27.5) by the end of the first pandemic year. Specialty visits returned to pre-pandemic levels for COPD, angina, CHF, hypertension, and diabetes, but remained above pre-pandemic levels for asthma (95.4 vs. 79.5, 95% CI: 70.7-89.5) and epilepsy (53.3 vs. 45.6, 95% CI: 41.2-50.5), by the end of the year. Virtual visit rates increased for all ACSCs. Among ACSCs, reductions in hospitalizations were most pronounced for COPD and asthma. CHF-related hospitalizations also decreased, albeit to a lesser extent. For angina, hypertension, diabetes, and epilepsy, hospitalization rates reduced initially, but returned to pre-pandemic levels by the end of the year. Conclusion This study demonstrated variation in outpatient visit trends for different ACSCs in the first pandemic year. No outpatient visit trends resulted in increased hospitalizations for any ACSC; however, reductions in rates of asthma, COPD, and CHF hospitalizations persisted.
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Affiliation(s)
- Tetyana Kendzerska
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - David T. Zhu
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Medical Scientist Training Program, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Michael Pugliese
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - Douglas Manuel
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Marcus Povitz
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Therese A. Stukel
- ICES, Ottawa, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Teresa To
- ICES, Ottawa, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital of Sick Children, Toronto, ON, Canada
| | - Shawn D. Aaron
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Melanie Chin
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Claire E. Kendall
- ICES, Ottawa, Toronto, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- The Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kednapa Thavorn
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- ICES, Ottawa, Toronto, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Andrea S. Gershon
- ICES, Ottawa, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital of Sick Children, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Gerstein E, Bierbrier J, Whitmore GA, Vandemheen KL, Bergeron C, Boulet LP, Cote A, Field SK, Penz E, McIvor RA, Lemière C, Gupta S, Hernandez P, Mayers I, Bhutani M, Lougheed MD, Licskai CJ, Azher T, Ezer N, Ainslie M, Alvarez GG, Mulpuru S, Aaron SD. Impact of Undiagnosed Chronic Obstructive Pulmonary Disease and Asthma on Symptoms, Quality of Life, Healthcare Use, and Work Productivity. Am J Respir Crit Care Med 2023; 208:1271-1282. [PMID: 37792953 DOI: 10.1164/rccm.202307-1264oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/04/2023] [Indexed: 10/06/2023] Open
Abstract
Rationale: A significant proportion of individuals with chronic obstructive pulmonary disease (COPD) and asthma remain undiagnosed. Objectives: The objective of this study was to evaluate symptoms, quality of life, healthcare use, and work productivity in subjects with undiagnosed COPD or asthma compared with those previously diagnosed, as well as healthy control subjects. Methods: This multicenter population-based case-finding study randomly recruited adults with respiratory symptoms who had no previous history of diagnosed lung disease from 17 Canadian centers using random digit dialing. Participants who exceeded symptom thresholds on the Asthma Screening Questionnaire or the COPD Diagnostic Questionnaire underwent pre- and post-bronchodilator spirometry to determine if they met diagnostic criteria for COPD or asthma. Two control groups, a healthy group without respiratory symptoms and a symptomatic group with previously diagnosed COPD or asthma, were similarly recruited. Measurements and Main Results: A total of 26,905 symptomatic individuals were interviewed, and 4,272 subjects were eligible. Of these, 2,857 completed pre- and post-bronchodilator spirometry, and 595 (21%) met diagnostic criteria for COPD or asthma. Individuals with undiagnosed COPD or asthma reported greater impact of symptoms on health status and daily activities, worse disease-specific and general quality of life, greater healthcare use, and poorer work productivity than healthy control subjects. Individuals with undiagnosed asthma had symptoms, quality of life, and healthcare use burden similar to those of individuals with previously diagnosed asthma, whereas subjects with undiagnosed COPD were less disabled than those with previously diagnosed COPD. Conclusions: Undiagnosed COPD or asthma imposes important, unmeasured burdens on the healthcare system and is associated with poor health status and negative effects on work productivity.
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Affiliation(s)
- Emily Gerstein
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jared Bierbrier
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | - Celine Bergeron
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia
| | | | - Andreanne Cote
- Centre de recherche, Hôpital Laval, Université Laval, Quebec, Quebec, Canada
| | - Stephen K Field
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Erika Penz
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - R Andrew McIvor
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Lemière
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Samir Gupta
- Department of Medicine and Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Irvin Mayers
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - M Diane Lougheed
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Tanweer Azher
- Department of Medicine, Memorial University, St. John's, Newfoundland, Canada; and
| | - Nicole Ezer
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Martha Ainslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gonzalo G Alvarez
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Magner KMA, Cherian M, Whitmore GA, Aaron SD. Reply to Brusasco and Pellegrino. Am J Respir Crit Care Med 2023; 208:1344-1345. [PMID: 37856837 PMCID: PMC10765397 DOI: 10.1164/rccm.202310-1752le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023] Open
Affiliation(s)
- Kate M. A. Magner
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; and
| | | | - G. Alex Whitmore
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
| | - Shawn D. Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; and
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Shin S, Whitmore GA, Boulet LP, Boulay MÈ, Côté A, Bergeron C, Lemière C, Lougheed MD, Vandemheen KL, Alvarez GG, Mulpuru S, Aaron SD. Anticipating undiagnosed asthma in symptomatic adults with normal pre- and post-bronchodilator spirometry: a decision tool for bronchial challenge testing. BMC Pulm Med 2023; 23:496. [PMID: 38071285 PMCID: PMC10709915 DOI: 10.1186/s12890-023-02806-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Some patients with asthma demonstrate normal spirometry and remain undiagnosed without further testing. OBJECTIVE To determine clinical predictors of asthma in symptomatic adults with normal spirometry, and to generate a tool to help clinicians decide who should undergo bronchial challenge testing (BCT). METHODS Using random-digit dialling and population-based case-finding, we recruited adults from the community with respiratory symptoms and no previous history of diagnosed lung disease. Participants with normal pre- and post-bronchodilator spirometry subsequently underwent BCT. Asthma was diagnosed in those with symptoms and a methacholine provocative concentration (PC20) of < 8 mg/ml. Sputum and blood eosinophils, and exhaled nitric oxide were measured. Univariate analyses identified potentially predictive variables, which were then used to construct a multivariable logistic regression model to predict asthma. Model sensitivity, specificity, and area under the receiver operating curve (AUC) were calculated. RESULTS Of 132 symptomatic individuals with normal spirometry, 34 (26%) had asthma. Of those ultimately diagnosed with asthma, 33 (97%) answered 'yes' to a question asking whether they experienced cough, chest tightness or wheezing provoked by exercise or cold air. Other univariate predictors of asthma included female sex, pre-bronchodilator FEV1 percentage predicted, and percent positive change in FEV1 post bronchodilator. A multivariable model containing these predictive variables yielded an AUC of 0.82 (95% CI: 0.72-0.91), a sensitivity of 82%, and a specificity of 66%. The model was used to construct a nomogram to advise clinicians which patients should be prioritized for BCT. CONCLUSIONS Four readily available patient characteristics demonstrated a high sensitivity and AUC for predicting undiagnosed asthma in symptomatic adults with normal pre- and post-bronchodilator spirometry. These characteristics can potentially help clinicians to decide which individuals with normal spirometry should be investigated with bronchial challenge testing. However, further prospective validation of our decision tool is required.
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Affiliation(s)
- Sheojung Shin
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | | | - Louis-Philippe Boulet
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Marie-Ève Boulay
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Andréanne Côté
- Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Céline Bergeron
- The Lung Center, Vancouver General Hospital, Vancouver, BC, Canada
| | | | | | | | - Gonzalo G Alvarez
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
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Magner KMA, Cherian M, Whitmore GA, Vandemheen KL, Bergeron C, Cote A, Field SK, Lemière C, McIvor RA, Aaron SD. Assessment of Preserved Ratio Impaired Spirometry Using Pre- and Post-Bronchodilator Spirometry in a Randomly Sampled Symptomatic Cohort. Am J Respir Crit Care Med 2023; 208:1129-1131. [PMID: 37413793 DOI: 10.1164/rccm.202305-0805le] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/06/2023] [Indexed: 07/08/2023] Open
Affiliation(s)
- Kate M A Magner
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Mathew Cherian
- Division of Pulmonary Medicine, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada
| | - G A Whitmore
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
| | | | - Celine Bergeron
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andreanne Cote
- Centre de recherche, Hôpital Laval, Université Laval, Quebec, Quebec, Canada
| | - Stephen K Field
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Catherine Lemière
- Department de Pulmonologie, Universite de Montreal, Montreal, Quebec, Canada; and
| | - R Andrew McIvor
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Bourbeau J, Bhutani M, Hernandez P, Aaron SD, Beauchesne MF, Kermelly SB, D'Urzo A, Lal A, Maltais F, Marciniuk JD, Mulpuru S, Penz E, Sin DD, Van Dam A, Wald J, Walker BL, Marciniuk DD. 2023 Canadian Thoracic Society Guideline on Pharmacotherapy in Patients With Stable COPD. Chest 2023; 164:1159-1183. [PMID: 37690008 DOI: 10.1016/j.chest.2023.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2023] Open
Abstract
Chronic obstructive pulmonary disease patient care must include confirming a diagnosis with postbronchodilator spirometry. Because of the clinical heterogeneity and the reality that airflow obstruction assessed by spirometry only partially reflects disease severity, a thorough clinical evaluation of the patient should include assessment of symptom burden and risk of exacerbations that permits the implementation of evidence-informed pharmacologic and nonpharmacologic interventions. This guideline provides recommendations from a comprehensive systematic review with a meta-analysis and expert-informed clinical remarks to optimize maintenance pharmacologic therapy for individuals with stable COPD, and a revised and practical treatment pathway based on new evidence since the 2019 update of the Canadian Thoracic Society (CTS) Guideline. The key clinical questions were developed using the Patients/Population (P), Intervention(s) (I), Comparison/Comparator (C), and Outcome (O) model for three questions that focuses on the outcomes of symptoms (dyspnea)/health status, acute exacerbations, and mortality. The evidence from this systematic review and meta-analysis leads to the recommendation that all symptomatic patients with spirometry-confirmed COPD should receive long-acting bronchodilator maintenance therapy. Those with moderate to severe dyspnea (modified Medical Research Council ≥ 2) and/or impaired health status (COPD Assessment Test ≥ 10) and a low risk of exacerbations should receive combination therapy with a long-acting muscarinic antagonist/long-acting ẞ2-agonist (LAMA/LABA). For those with a moderate/severe dyspnea and/or impaired health status and a high risk of exacerbations should be prescribed triple combination therapy (LAMA/LABA/inhaled corticosteroids) azithromycin, roflumilast or N-acetylcysteine is recommended for specific populations; a recommendation against the use of theophylline, maintenance systemic oral corticosteroids such as prednisone and inhaled corticosteroid monotherapy is made for all COPD patients.
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Affiliation(s)
- Jean Bourbeau
- Department of Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada.
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Shawn D Aaron
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | | | - Sophie B Kermelly
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Anthony D'Urzo
- Primary Care Lung Clinic, University of Toronto, Toronto, ON, Canada
| | - Avtar Lal
- Canadian Thoracic Society, Ottawa, ON, Canada
| | - François Maltais
- Department of Medicine, McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Jeffrey D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Erika Penz
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Don D Sin
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Joshua Wald
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Brandie L Walker
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Darcy D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
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10
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Ross BA, Doiron D, Benedetti A, Aaron SD, Chapman K, Hernandez P, Maltais F, Marciniuk D, O'Donnell DE, Sin DD, Walker BL, Tan W, Bourbeau J. Short-term air pollution exposure and exacerbation events in mild to moderate COPD: a case-crossover study within the CanCOLD cohort. Thorax 2023; 78:974-982. [PMID: 37147124 DOI: 10.1136/thorax-2022-219619] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/05/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Infections are considered as leading causes of acute exacerbations of chronic obstructive pulmonary disease (COPD). Non-infectious risk factors such as short-term air pollution exposure may play a clinically important role. We sought to estimate the relationship between short-term air pollutant exposure and exacerbations in Canadian adults living with mild to moderate COPD. METHODS In this case-crossover study, exacerbations ('symptom based': ≥48 hours of dyspnoea/sputum volume/purulence; 'event based': 'symptom based' plus requiring antibiotics/corticosteroids or healthcare use) were collected prospectively from 449 participants with spirometry-confirmed COPD within the Canadian Cohort Obstructive Lung Disease. Daily nitrogen dioxide (NO2), fine particulate matter (PM2.5), ground-level ozone (O3), composite of NO2 and O3 (Ox), mean temperature and relative humidity estimates were obtained from national databases. Time-stratified sampling of hazard and control periods on day '0' (day-of-event) and Lags ('-1' to '-6') were compared by fitting generalised estimating equation models. All data were dichotomised into 'warm' (May-October) and 'cool' (November-April) seasons. ORs and 95% CIs were estimated per IQR increase in pollutant concentrations. RESULTS Increased warm season ambient concentration of NO2 was associated with symptom-based exacerbations on Lag-3 (1.14 (1.01 to 1.29), per IQR), and increased cool season ambient PM2.5 was associated with symptom-based exacerbations on Lag-1 (1.11 (1.03 to 1.20), per IQR). There was a negative association between warm season ambient O3 and symptom-based events on Lag-3 (0.73 (0.52 to 1.00), per IQR). CONCLUSIONS Short-term ambient NO2 and PM2.5 exposure were associated with increased odds of exacerbations in Canadians with mild to moderate COPD, further heightening the awareness of non-infectious triggers of COPD exacerbations.
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Affiliation(s)
- Bryan A Ross
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Medicine, McGill University Health Centre, Montreal, Québec, Canada
| | - Dany Doiron
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kenneth Chapman
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Paul Hernandez
- Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - François Maltais
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Darcy Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Wan Tan
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Medicine, McGill University Health Centre, Montreal, Québec, Canada
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11
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Krishnan S, Tan WC, Farias R, Aaron SD, Benedetti A, Chapman KR, Hernandez P, Maltais F, Marciniuk DD, O'Donnell DE, Sin DD, Walker B, Bourbeau J. Impaired Spirometry and COPD Increase the Risk of Cardiovascular Disease: A Canadian Cohort Study. Chest 2023; 164:637-649. [PMID: 36871842 DOI: 10.1016/j.chest.2023.02.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Individuals with COPD and preserved ratio impaired spirometry (PRISm) findings in clinical settings have an increased risk of cardiovascular disease (CVD). RESEARCH QUESTION Do individuals with mild to moderate or worse COPD and PRISm findings in community settings have a higher prevalence and incidence of CVD compared with individuals with normal spirometry findings? Can CVD risk scores be improved when impaired spirometry is added? STUDY DESIGN AND METHODS The analysis was embedded in the Canadian Cohort Obstructive Lung Disease (CanCOLD). Prevalence of CVD (ischemic heart disease [IHD] and heart failure [HF]) and their incidence over 6.3 years were compared between groups with impaired and normal spirometry findings using logistic regression and Cox models, respectively, adjusting for covariables. Discrimination of the pooled cohort equations (PCE) and Framingham risk score (FRS) in predicting CVD were assessed with and without impaired spirometry. RESULTS Participants (n = 1,561) included 726 people with normal spirometry findings and 835 people with impaired spirometry findings (COPD Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 1 disease, n = 408; GOLD stage ≥ 2, n = 331; PRISm findings, n = 96). Rates of undiagnosed COPD were 84% in GOLD stage 1 and 58% in GOLD stage ≥ 2 groups. Prevalence of CVD (IHD or HF) was significantly higher among individuals with impaired spirometry findings and COPD compared with those with normal spirometry findings, with ORs of 1.66 (95% CI, 1.13-2.43; P = .01∗) (∗ indicates statistical significane with P < .05) and 1.55 (95% CI, 1.04-2.31; P = .033∗), respectively. Prevalence of CVD was significantly higher in participants having PRISm findings and COPD GOLD stage ≥ 2, but not GOLD stage 1. CVD incidence was significantly higher, with hazard ratios of 2.07 (95% CI, 1.10-3.91; P = .024∗) for the impaired spirometry group and 2.09 (95% CI, 1.10-3.98; P = .024∗) for the COPD group compared to individuals with normal spirometry findings. The difference was significantly higher among individuals with COPD GOLD stage ≥ 2, but not GOLD stage 1. The discrimination for predicting CVD was low and limited when impaired spirometry findings were added to either risk score. INTERPRETATION Individuals with impaired spirometry findings, especially those with moderate or worse COPD and PRISm findings, have increased comorbid CVD compared with their peers with normal spirometry findings, and having COPD increases the risk of CVD developing.
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Affiliation(s)
- Suurya Krishnan
- Respiratory Epidemiology and Clinical Research Unit, Center of Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, ON Canada
| | - Wan C Tan
- Center for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
| | - Raquel Farias
- Respiratory Epidemiology and Clinical Research Unit, Center of Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, ON Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Center of Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, ON Canada
| | - Kenneth R Chapman
- Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada
| | - Paul Hernandez
- Division of Respirology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Darcy D Marciniuk
- Respiratory Research Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Denis E O'Donnell
- Division of Respiratory and Critical Care Medicine, Queens University, Kingston, ON, Canada
| | - Don D Sin
- Center for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
| | - Brandie Walker
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Center of Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, McGill University, Montreal, ON Canada.
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12
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Pratt AJ, Purssell A, Zhang T, Luks VPJ, Bauza X, Mulpuru S, Kirby M, Aaron SD, Cowan J. Complexity in clinical diagnoses of acute exacerbation of chronic obstructive pulmonary disease. BMC Pulm Med 2023; 23:298. [PMID: 37580731 PMCID: PMC10426055 DOI: 10.1186/s12890-023-02587-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a clinical syndrome with various causes. It is not uncommon that COPD patients presenting with dyspnea have multiple causes for their symptoms including AECOPD, pneumonia, or congestive heart failure occurring concurrently. METHODS To identify clinical, radiographic, and laboratory characteristics that might help distinguish AECOPD from another dominant disease in patients with a history of COPD, we conducted a retrospective cohort study of hospitalized patients with admitting diagnosis of AECOPD who were screened for a prospective randomized controlled trial from Sep 2016 to Mar 2018. Clinical characteristics, course in hospital, and final diagnosis at discharge were reviewed and adjudicated by two authors. The final diagnosis of each patient was determined based on the synthesis of all presenting signs and symptoms, imaging, and laboratory results. We adhered to AECOPD diagnosis definitions based on the GOLD guidelines. Univariate and multivariate analyses were performed to identify any associated features of AECOPD with and without other acute processes contributing to dyspnea. RESULTS Three hundred fifteen hospitalized patients with admitting diagnosis of AECOPD were included. Mean age was 72.5 (SD 10.6) years. Two thirds (65.4%) had spirometry defined COPD. The most common presenting symptom was dyspnea (96.5%), followed by cough (67.9%), and increased sputum (57.5%). One hundred and eighty (57.1%) had a final diagnosis of AECOPD alone whereas 87 (27.6%) had AECOPD with other conditions and 48 (15.2%) did not have AECOPD after adjudication. Increased sputum purulence (OR 3.35, 95%CI 1.68-6.69) and elevated venous pCO2 (OR 1.04, 95%CI 1.01 - 1.07) were associated with a diagnosis of AECOPD but these were not associated with AECOPD alone without concomitant conditions. Radiographic evidence of pleural effusion (OR 0.26, 95%CI 0.12 - 0.58) was negatively associated with AECOPD with or without other conditions while radiographic evidence of pulmonary edema (OR 0.31; 95%CI 0.11 - 0.91) and lobar pneumonia (OR 0.13, 95%CI 0.07 - 0.25) suggested against the diagnosis of AECOPD alone. CONCLUSION The study highlighted the complexity and difficulty of AECOPD diagnosis. A more specific clinical tool to diagnose AECOPD is needed.
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Affiliation(s)
| | - Andrew Purssell
- Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tinghua Zhang
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Vanessa P J Luks
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Xavier Bauza
- Department of Physics, Toronto Metropolitan University, Ottawa, ON, Canada
| | - Sunita Mulpuru
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Ottawa, ON, Canada
| | - Shawn D Aaron
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Respirology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Juthaporn Cowan
- Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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13
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Celli BR, Fabbri LM, Aaron SD, Agusti A, Brook RD, Criner GJ, Franssen FME, Humbert M, Hurst JR, Montes de Oca M, Pantoni L, Papi A, Rodriguez-Roisin R, Sethi S, Stolz D, Torres A, Vogelmeier CF, Wedzicha JA. Differential Diagnosis of Suspected Chronic Obstructive Pulmonary Disease Exacerbations in the Acute Care Setting: Best Practice. Am J Respir Crit Care Med 2023; 207:1134-1144. [PMID: 36701677 PMCID: PMC10161746 DOI: 10.1164/rccm.202209-1795ci] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/26/2023] [Indexed: 01/27/2023] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) may suffer from acute episodes of worsening dyspnea, often associated with increased cough, sputum, and/or sputum purulence. These exacerbations of COPD (ECOPDs) impact health status, accelerate lung function decline, and increase the risk of hospitalization. Importantly, close to 20% of patients are readmitted within 30 days after hospital discharge, with great cost to the person and society. Approximately 25% and 65% of patients hospitalized for an ECOPD die within 1 and 5 years, respectively. Patients with COPD are usually older and frequently have concomitant chronic diseases, including heart failure, coronary artery disease, arrhythmias, interstitial lung diseases, bronchiectasis, asthma, anxiety, and depression, and are also at increased risk of developing pneumonia, pulmonary embolism, and pneumothorax. All of these morbidities not only increase the risk of subsequent ECOPDs but can also mimic or aggravate them. Importantly, close to 70% of readmissions after an ECOPD hospitalization result from decompensation of other morbidities. These observations suggest that in patients with COPD with worsening dyspnea but without the other classic characteristics of ECOPD, a careful search for these morbidities can help detect them and allow appropriate treatment. For most morbidities, a thorough clinical evaluation supplemented by appropriate clinical investigations can guide the healthcare provider to make a precise diagnosis. This perspective integrates the currently dispersed information available and provides a practical approach to patients with COPD complaining of worsening respiratory symptoms, particularly dyspnea. A systematic approach should help improve outcomes and the personal and societal cost of ECOPDs.
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Affiliation(s)
- Bartolome R. Celli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leonardo M. Fabbri
- Section of Respiratory Medicine, Department of Translational Medicine, and
| | - Shawn D. Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alvar Agusti
- Universitat de Barcelona, Barcelona, Spain
- Institut Clínic Respiratori, Hospital Clínic de Barcelona, Barcelona, Spain
- Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Madrid, Spain
| | - Robert D. Brook
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wayne State University, Detroit, Michigan
| | - Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Frits M. E. Franssen
- Department of Research and Education, CIRO, Horn, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marc Humbert
- Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- Université Paris-Saclay and Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 999, Le Kremlin-Bicêtre, France
| | - John R. Hurst
- UCL Respiratory, University College London, London, United Kingdom
| | - Maria Montes de Oca
- Universidad Central de Venezuela, School of Medicine, Centro Medico de Caracas, Caracas, Venezuela
| | - Leonardo Pantoni
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Alberto Papi
- Section of Respiratory Medicine, University of Ferrara, Ferrara, Italy
- Emergency Department, St. Anna University Hospital, Ferrara, Italy
| | - Roberto Rodriguez-Roisin
- Universitat de Barcelona, Barcelona, Spain
- Institut Clínic Respiratori, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sanjay Sethi
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research and
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Antoni Torres
- Universitat de Barcelona, Barcelona, Spain
- Institut Clínic Respiratori, Hospital Clínic de Barcelona, Barcelona, Spain
- Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats Acadèmia, Centre d’Investigació Biomèdica en Xarxa de Malalties Respiratòries, Barcelona, Spain
| | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps University of Marburg, Member of the German Centre for Lung Research (DZL), Marburg, Germany; and
| | - Jadwiga A. Wedzicha
- Respiratory Division, National Heart and Lung Institute, Imperial College, London, United Kingdom
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14
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Poureslami I, Hohn RE, Kopec JA, Sawatzky R, Aaron SD, Gupta S, Goldstein R, Boulet LP, Tregobov N, Shum J. Evaluation of a New Performance-Based Health Literacy Measurement Tool for Individuals With Chronic Airways Disease. Respir Care 2023; 68:638-648. [PMID: 36411057 PMCID: PMC10171345 DOI: 10.4187/respcare.10441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Low health literacy is a global challenge. Health literacy is positively correlated with chronic airways disease desirable outcomes. Despite the importance of health literacy in disease management, current health literacy measurement tools are suboptimal. As part of a multi-stage project to develop a performance-based, disease-specific Vancouver Airways Health Literacy Tool (VAHLT) for individuals with chronic airways disease, this study assessed the relationships between the VAHLT scores and characteristics of patients with chronic airways disease. The primary aim of the study was to provide preliminary evidence of construct validity of the VAHLT. METHODS A cross-sectional study design was applied. Study subjects were recruited from 6 specialty care clinics to complete the VAHLT measurement tool. Demographic and clinical data, including quality of life and disease control, were collected via validated questionnaires. The study subjects also completed a spirometry test. Inferential analysis was conducted by using mean difference testing and correlational methods. RESULTS A total of 320 subjects were recruited, and, after imputing missing data, 315 were ultimately analyzed. The subjects were predominantly women (61%), white (83%), had a post-high-school education (74%), and a mean ± SD age of 65.2 ± 13.2 y. Age was significantly negatively correlated with the VAHLT scores (P = .004); the subjects with a post-high school education had significantly higher VAHLT scores than those with a high school education or less (P < .001). No significant sex or ethnicity related differences in VAHLT scores were observed. For clinical outcomes, no significant differences were found between the VAHLT scores and disease severity or measures of quality of life and asthma control. CONCLUSIONS We report a chronic airways disease-specific health literacy measurement tool developed with the involvement of patients and professionals. Age and education were highly correlated with health literacy, which emphasizes the importance of addressing these factors in health literacy interventions among patients with chronic airways disease.
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Affiliation(s)
- Iraj Poureslami
- Division of Respiratory Medicine, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
- Canadian Multicultural Health Promotion Society, Burnaby, British Columbia, Canada
| | - Ric E Hohn
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jacek A Kopec
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rick Sawatzky
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
| | - Shawn D Aaron
- Division of Respiratory Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Samir Gupta
- Division of Respiratory Medicine, Department of Medicine, University of Toronto, Unity Health, Toronto, Ontario Canada
| | - Roger Goldstein
- Division of Respiratory Medicine, Department of Medicine, West Park Healthcare Centre, University of Toronto, Toronto, Ontario, Canada
| | - Louis-Philippe Boulet
- Division of Respiratory Medicine, Department of Medicine, Laval University, Quebec, Quebec, Canada
| | - Noah Tregobov
- Division of Respiratory Medicine, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Mulpuru S, Aaron SD. Bronchodilator Responsiveness Over Time: Is This Clinically Meaningful in Tobacco-Exposed Individuals? Chest 2023; 163:736-737. [PMID: 37031975 DOI: 10.1016/j.chest.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 04/11/2023] Open
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16
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Boulet LP, Boulay MÈ, Côté A, FitzGerald JM, Bergeron C, Lemière C, Lougheed MD, Vandemheen KL, Aaron SD. Airway inflammation and hyperresponsiveness in subjects with respiratory symptoms and normal spirometry. Eur Respir J 2023; 61:13993003.01194-2022. [PMID: 36396140 DOI: 10.1183/13993003.01194-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Subjects without a previous history of asthma, presenting with unexplained respiratory symptoms and normal spirometry, may exhibit airway hyperresponsiveness (AHR) in association with underlying eosinophilic (type 2 (T2)) inflammation, consistent with undiagnosed asthma. However, the prevalence of undiagnosed asthma in these subjects is unknown. METHODS In this observational study, inhaled corticosteroid-naïve adults without previously diagnosed lung disease reporting current respiratory symptoms and showing normal pre- and post-bronchodilator spirometry underwent fractional exhaled nitric oxide (F ENO) measurement, methacholine challenge testing and induced sputum analysis. AHR was defined as a provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 s (PC20) <16 mg·mL-1 and T2 inflammation was defined as sputum eosinophils >2% and/or F ENO >25 ppb. RESULTS Out of 132 subjects (mean±sd age 57.6±14.2 years, 52% female), 47 (36% (95% CI 28-44%)) showed AHR: 20/132 (15% (95% CI 9-21%)) with PC20 <4 mg·mL-1 and 27/132 (21% (95% CI 14-28%)) with PC20 4-15.9 mg·mL-1. Of 130 participants for whom sputum eosinophils, F ENO or both results were obtained, 45 (35% (95% CI 27-43%)) had T2 inflammation. 14 participants (11% (95% CI 6-16%)) had sputum eosinophils >2% and PC20 ≥16 mg·mL-1, suggesting eosinophilic bronchitis. The prevalence of T2 inflammation was significantly higher in subjects with PC20 <4 mg·mL-1 (12/20 (60%)) than in those with PC20 4-15.9 mg·mL-1 (8/27 (30%)) or ≥16 mg·mL-1 (25/85 (29%)) (p=0.01). CONCLUSIONS Asthma, underlying T2 airway inflammation and eosinophilic bronchitis may remain undiagnosed in a high proportion of symptomatic subjects in the community who have normal pre- and post-bronchodilator spirometry.
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Affiliation(s)
- Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Marie-Ève Boulay
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Andréanne Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | | | - Céline Bergeron
- The Lung Center, Vancouver General Hospital, Vancouver, BC, Canada
| | | | - M Diane Lougheed
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Shawn D Aaron
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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17
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Cherian M, Magner KMA, Whitmore GA, Vandemheen KL, FitzGerald JM, Bergeron C, Boulet LP, Cote A, Field SK, Penz E, McIvor RA, Lemière C, Gupta S, Mayers I, Bhutani M, Hernandez P, Lougheed MD, Licskai CJ, Azher T, Ainslie M, Ezer N, Mulpuru S, Aaron SD. Patient and physician factors associated with symptomatic undiagnosed asthma or COPD. Eur Respir J 2023; 61:13993003.01721-2022. [PMID: 36328359 DOI: 10.1183/13993003.01721-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND It remains unclear why some symptomatic individuals with asthma or COPD remain undiagnosed. Here, we compare patient and physician characteristics between symptomatic individuals with obstructive lung disease (OLD) who are undiagnosed and individuals with physician-diagnosed OLD. METHODS Using random-digit dialling and population-based case finding, we recruited 451 participants with symptomatic undiagnosed OLD and 205 symptomatic control participants with physician-diagnosed OLD. Data on symptoms, quality of life and healthcare utilisation were analysed. We surveyed family physicians of participants in both groups to elucidate differences in physician practices that could contribute to undiagnosed OLD. RESULTS Participants with undiagnosed OLD had lower mean pre-bronchodilator forced expiratory volume in 1 s percentage predicted compared with those who were diagnosed (75.2% versus 80.8%; OR 0.975, 95% CI 0.963-0.987). They reported greater psychosocial impacts due to symptoms and worse energy and fatigue than those with diagnosed OLD. Undiagnosed OLD was more common in participants whose family physicians were practising for >15 years and in those whose physicians reported that they were likely to prescribe respiratory medications without doing spirometry. Undiagnosed OLD was more common among participants who had never undergone spirometry (OR 10.83, 95% CI 6.18-18.98) or who were never referred to a specialist (OR 5.92, 95% CI 3.58-9.77). Undiagnosed OLD was less common among participants who had required emergency department care (OR 0.44, 95% CI 0.20-0.97). CONCLUSIONS Individuals with symptomatic undiagnosed OLD have worse pre-bronchodilator lung function and present with greater psychosocial impacts on quality of life compared with their diagnosed counterparts. They were less likely to have received appropriate investigations and specialist referral for their respiratory symptoms.
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Affiliation(s)
- Mathew Cherian
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Kate M A Magner
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - G A Whitmore
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada
| | | | - J Mark FitzGerald
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada.,Deceased
| | - Celine Bergeron
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Andreanne Cote
- Centre de Recherche, Hôpital Laval, Université Laval, Quebec City, QC, Canada
| | - Stephen K Field
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Erika Penz
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - R Andrew McIvor
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, ON, Canada
| | - Catherine Lemière
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Samir Gupta
- Department of Medicine and Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Irvin Mayers
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - M Diane Lougheed
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Tanweer Azher
- Department of Medicine, Memorial University, St John's, NL, Canada
| | - Martha Ainslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Nicole Ezer
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Sunita Mulpuru
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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18
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Oostrik L, Bourbeau J, Doiron D, Ross B, Zhi-Li P, Aaron SD, Chapman KR, Hernandez P, Maltais F, Marciniuk DD, O'Donnell D, Tan WC, Sin DD, Walker B, Janaudis-Ferreira T. Physical Activity and Symptom Burden in COPD: The Canadian Obstructive Lung Disease Study. Chronic Obstr Pulm Dis 2023; 10:89-101. [PMID: 36563057 PMCID: PMC9995232 DOI: 10.15326/jcopdf.2022.0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The relationship between symptom burden and physical activity (PA) in chronic obstructive pulmonary disease (COPD) remains poorly understood with limited data on undiagnosed individuals and those with mild to moderate disease. Objective The primary objective was to evaluate the relationship between symptom burden and moderate-to-vigorous intensity PA (MVPA) in individuals from a random population-based sampling mirroring the population at large. Methods Baseline participants of the Canadian Cohort Obstructive Lung Disease (n=1558) were selected for this cross-sectional sub-study. Participants with mild COPD (n=406) and moderate COPD (n=331), healthy individuals (n=347), and those at risk of developing COPD (n=474) were included. The Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire was used to estimate MVPA in terms of energy expenditure. High symptom burden was classified using the COPD Assessment Test ([CAT] ≥10). Results Significant associations were demonstrated between high symptom burden and lower MVPA levels in the overall COPD sample (β=-717.09; 95% confidence interval [CI]=-1079.78, -354.40; p<0.001) and in the moderate COPD subgroup (β=-694.1; 95% CI=-1206.54, -181.66; p=0.006). A total of 72% of the participants with COPD were previously undiagnosed. The undiagnosed participants had significantly higher MVPA than those with physician diagnosed COPD (β=-592.41 95% CI=-953.11, -231.71; p=0.001). Conclusion MVPA was found to be inversely related to symptom burden in a large general population sample that included newly diagnosed individuals, most with mild to moderate COPD. Assessment of symptom burden may help identify patients with lower MVPA, especially for moderate COPD and for relatively inactive individuals with mild COPD.
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Affiliation(s)
- Loes Oostrik
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Netherlands
| | - Jean Bourbeau
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University Health Center, Montreal, Quebec, Canada.,Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Dany Doiron
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University Health Center, Montreal, Quebec, Canada
| | - Bryan Ross
- Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Pei Zhi-Li
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University Health Center, Montreal, Quebec, Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, Ottawa University, Ottawa, Canada
| | - Kenneth R Chapman
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Canada
| | - Paul Hernandez
- Division of Respirology, Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Francois Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Canada
| | - Darcy D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Canada
| | - Denis O'Donnell
- Division of Respiratory and Critical Care Medicine, Queen's University, Kingston, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, Canada
| | - Brandie Walker
- Department of Medicine, University of Calgary, Alberta, Canada
| | - Tania Janaudis-Ferreira
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University Health Center, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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19
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Mulpuru S, Andrew MK, Ye L, Hatchette T, LeBlanc J, El-Sherif M, MacKinnon-Cameron D, Aaron SD, Alvarez GG, Forster AJ, Ambrose A, McNeil SA. Impact of respiratory viral infections on mortality and critical illness among hospitalized patients with chronic obstructive pulmonary disease. Influenza Other Respir Viruses 2022; 16:1172-1182. [PMID: 36069141 PMCID: PMC9530520 DOI: 10.1111/irv.13050] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Seasonal respiratory viral infections are associated with exacerbations and morbidity among patients with COPD. The real‐world clinical outcomes associated with seasonal viral infections are less well established among hospitalized patients. Research Question To estimate the association between seasonal respiratory viral infections, 30‐day mortality, and intensive care unit (ICU) admission among hospitalized COPD patients. Study Design and Methods We conducted an analysis of a national prospective multicenter cohort of COPD patients hospitalized with acute respiratory illness during winter seasons (2011–2015) in Canada. Nasopharyngeal swabs were performed on all patients at the onset of hospital admission for diagnosis of viral infection. Primary outcomes were 30‐day mortality and ICU admissions. Secondary outcomes included invasive/non‐invasive ventilation use. Results Among 3931 hospitalized patients with COPD, 28.5% (1122/3931) were diagnosed with seasonal respiratory viral infection. Viral infection was associated with increased admission to ICU (OR 1.5, 95% CI 1.2–1.9) and need for mechanical ventilation (OR 1.9, 95% CI 1.4–2.5), but was not associated with mortality (OR 1.1, 95% CI 0.8–1.4). Patients with respiratory syncytial virus (RSV) were equally likely to require ICU admission (OR 1.09, 95% CI 0.67–1.78), and more likely to need non‐invasive ventilation (OR 3.1; 95% CI 1.8–5.1) compared to patients with influenza. Interpretation Our results suggest COPD patients requiring hospitalization for respiratory symptoms should routinely receive viral testing at admission, especially for RSV and influenza, to inform prognosis, clinical management, and infection control practices during winter seasons. Patients with COPD will be an important target population for newly developed RSV therapeutics. Clinical Trial Registration ClinicalTrials.gov ID: NCT01517191.
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Affiliation(s)
- Sunita Mulpuru
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Melissa K Andrew
- Department of Medicine (Geriatrics), Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Todd Hatchette
- Department of Medicine (Infectious Diseases), Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Jason LeBlanc
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - May El-Sherif
- Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Shawn D Aaron
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Gonzalo G Alvarez
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Alan J Forster
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Shelly A McNeil
- Department of Medicine (Infectious Diseases), Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Center for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health, Halifax, Nova Scotia, Canada
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20
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Kendzerska T, Zhu DT, Pugliese M, Manuel D, Sadatsafavi M, Povitz M, Stukel TA, To T, Aaron SD, Mulpuru S, Chin M, Kendall CE, Thavorn K, Robillard R, Gershon AS. Trends in all-cause mortality and inpatient and outpatient visits for ambulatory care sensitive conditions during the first year of the COVID-19 pandemic: A population-based study. J Hosp Med 2022; 17:726-737. [PMID: 35929531 PMCID: PMC9539068 DOI: 10.1002/jhm.12920] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on the management of ambulatory care sensitive conditions (ACSCs) remains unknown. OBJECTIVES To compare observed and expected (projected based on previous years) trends in all-cause mortality and healthcare use for ACSCs in the first year of the pandemic (March 2020 to March 2021). DESIGN, SETTING AND PARTICIPANTS We conducted a population-based study using provincial health administrative data on general adul population (Ontario, Canada). OUTCOMES AND MEASURES Monthly all-cause mortality, and hospitalizations, emergency department (ED) and outpatient visit rates (per 100,000 people at-risk) for seven combined ACSCs (asthma, chronic obstructive pulmonary disease, angina, congestive heart failure, hypertension, diabetes, and epilepsy) during the first year were compared with similar periods in previous years (2016-2019) by fitting monthly time series autoregressive integrated moving-average models. RESULTS Compared to previous years, all-cause mortality rates increased at the beginning of the pandemic (observed rate in March to May 2020 of 79.98 vs. projected of 71.24 [66.35-76.50]) and then returned to expected in June 2020-except among immigrants and people with mental health conditions where they remained elevated. Hospitalization and ED visit rates for ACSCs remained lower than projected throughout the first year: observed hospitalization rate of 37.29 versus projected of 52.07 (47.84-56.68); observed ED visit rate of 92.55 versus projected of 134.72 (124.89-145.33). ACSC outpatient visit rates decreased initially (observed rate of 4299.57 vs. projected of 5060.23 [4712.64-5433.46]) and then returned to expected in June 2020.
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Affiliation(s)
- Tetyana Kendzerska
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
- ICESOntarioCanada
| | - David T. Zhu
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of Social and Behavioral SciencesYale School of Public HealthNew HavenConnecticutUSA
| | - Michael Pugliese
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- ICESOntarioCanada
| | - Douglas Manuel
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- ICESOntarioCanada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical SciencesThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Marcus Povitz
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Therese A. Stukel
- ICESOntarioCanada
- Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoOntarioCanada
| | - Teresa To
- ICESOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Research InstituteThe Hospital of Sick ChildrenTorontoOntarioCanada
| | - Shawn D. Aaron
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Sunita Mulpuru
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Melanie Chin
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- Department of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Claire E. Kendall
- ICESOntarioCanada
- Bruyère Research InstituteOttawaOntarioCanada
- Department of Family MedicineUniversity of OttawaOttawaOntarioCanada
| | - Kednapa Thavorn
- The Ottawa Hospital Research InstituteOttawaOntarioCanada
- ICESOntarioCanada
- School of Epidemiology and Public Health, Faculty of MedicineUniversity of OttawaOntarioCanada
| | | | - Andrea S. Gershon
- ICESOntarioCanada
- Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoOntarioCanada
- Institute of Health Policy, Management and EvaluationUniversity of TorontoOntarioCanada
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
- Research InstituteThe Hospital of Sick ChildrenTorontoOntarioCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
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21
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Sadatsafavi M, Aaron SD, Gershon AS, Puhan M, Adibi A, Sin DD. The Hidden and Unchecked Judgement Calls When Using Exacerbation History for Managing COPD. Arch Bronconeumol 2022; 58:629-631. [PMID: 35312573 DOI: 10.1016/j.arbres.2021.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 11/02/2022]
Affiliation(s)
- Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada.
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Andrea S Gershon
- Institute of Clinical Evaluation Sciences, University of Toronto, Toronto, Canada
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Amin Adibi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
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22
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Jiang L, Kendzerska T, Aaron SD, Stukel TA, Stanbrook MB, Tan W, Pequeno P, Gershon AS. Prescription Pathways from Initial Medication Use to Triple Therapy in Older COPD Patients: A Real-World Population Study. COPD 2022; 19:315-323. [PMID: 35946353 DOI: 10.1080/15412555.2022.2087616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Triple therapy with an inhaled corticosteroid (ICS), a long-acting β2-agonist bronchodilator (LABA) and a long-acting muscarinic antagonist (LAMA) is recommended as step-up therapy for chronic obstructive pulmonary disease (COPD) patients who continue to have persistent symptoms and increased risk of exacerbation despite treatment with dual therapy. We sought to evaluate different treatment pathways through which COPD patients were escalated to triple therapy. METHODS We used population health databases from Ontario, Canada to identify individuals aged 66 or older with COPD who started triple therapy between 2014 and 2017. Median time from diagnosis to triple therapy was estimated using the Kaplan-Meier method. We classified treatment pathways based on treatments received prior to triple therapy and evaluated whether pathways differed by exacerbation history, blood eosinophil counts or time period. RESULTS Among 4108 COPD patients initiating triple therapy, only 41.2% had a COPD exacerbation in the year prior. The three most common pathways were triple therapy as initial treatment (32.5%), LAMA to triple therapy (29.8%), and ICS + LABA to triple therapy (15.4%). Median time from diagnosis to triple therapy was 362 days (95% confidence interval:331-393 days) overall, but 14 days (95% CI 12-17 days) in the triple therapy as initial treatment pathway. This pathway was least likely to contain patients with frequent or severe exacerbations (22.0% vs. 31.5%, p < 0.001) or with blood eosinophil counts ≥300 cells/µL (18.9% vs. 22.0%, p < 0.001). CONCLUSION Real-world prescription of triple therapy often does not follow COPD guidelines in terms of disease severity and prior treatments attempted.
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Affiliation(s)
- Lili Jiang
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,ICES, Toronto, Ottawa, Ontario, Canada
| | - Tetyana Kendzerska
- ICES, Toronto, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Therese A Stukel
- ICES, Toronto, Ottawa, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Matthew B Stanbrook
- ICES, Toronto, Ottawa, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wan Tan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Andrea S Gershon
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,ICES, Toronto, Ottawa, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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23
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Bourbeau J, Doiron D, Biswas S, Smith BM, Benedetti A, Brook JR, Aaron SD, Chapman KR, Hernandez P, Maltais F, Marciniuk DD, O’Donnell D, Sin DD, Walker B, Dsilva L, Nadeau G, Coats V, Compton C, Miller BE, Tan WC. Ambient Air Pollution and Dysanapsis: Associations with Lung Function and Chronic Obstructive Pulmonary Disease in the Canadian Cohort Obstructive Lung Disease Study. Am J Respir Crit Care Med 2022; 206:44-55. [PMID: 35380941 PMCID: PMC9954329 DOI: 10.1164/rccm.202106-1439oc] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Outdoor air pollution is a potential risk factor for lower lung function and chronic obstructive pulmonary disease (COPD). Little is known about how airway abnormalities and lung growth might modify this relationship. Objectives: To evaluate the associations of ambient air pollution exposure with lung function and COPD and examine possible interactions with dysanapsis. Methods: We made use of cross-sectional postbronchodilator spirometry data from 1,452 individuals enrolled in the CanCOLD (Canadian Cohort Obstructive Lung Disease) study with linked ambient fine particulate matter (PM2.5) and nitrogen dioxide (NO2) air pollution estimates. Dysanapsis, or the ratio of the airway-to-lung volume calculated from thoracic computed tomography images, was used to examine possible interactions. Measurements and Main Results: In adjusted models, 101.7 ml (95% confidence interval [CI], -166.2 to -37.2) and 115.0 ml (95% CI, -196.5 to -33.4) lower FEV1 were demonstrated per increase of 2.4 ug/m3 PM2.5 and 9.2 ppb NO2, respectively. Interaction between air pollution and dysanapsis was not statistically significant when modeling the airway-to-lung ratio as a continuous variable. However, a 109.8 ml (95% CI, -209.0 to -10.5] lower FEV1 and an 87% (95% CI, 12% to 213%) higher odds of COPD were observed among individuals in the lowest, relative to highest, airway-to-lung ratio, per 2.4 μg/m3 increment of PM2.5. Conclusions: Ambient air pollution exposure was associated with lower lung function, even at relatively low concentrations. Individuals with dysanaptic lung growth might be particularly susceptible to inhaled ambient air pollutants, especially those at the extremes of dysanapsis.
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Affiliation(s)
- Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada;,Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Dany Doiron
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Sharmistha Biswas
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Benjamin M. Smith
- Department of Medicine, McGill University, Montreal, Québec, Canada;,Department of Medicine, Columbia University Medical Center, New York, New York
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada;,Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Jeffrey R. Brook
- Southern Ontario Centre for Atmospheric Aerosol Research, Department of Chemical Engineering and Applied Chemistry,,Dalla Lana School of Public Health, and
| | - Shawn D. Aaron
- Ottawa Hospital Research Institute, Ottawa University, Ottawa, Ontario, Canada
| | - Kenneth R. Chapman
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Paul Hernandez
- Division of Respirology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada
| | - Darcy D. Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Denis O’Donnell
- Division of Respiratory and Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Don D. Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brandie Walker
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | | | | | - Wan C. Tan
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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24
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Alhabeeb FF, Whitmore G, Vandemheen KL, FitzGerald JM, Bergeron C, Lemière C, Boulet LP, Field SK, Penz E, McIvor RA, Gupta S, Mayers I, Bhutani M, Hernandez P, Lougheed D, Licskai CJ, Azher T, Cote A, Ainslie M, Fraser I, Mahdavian M, Aaron SD. Disease burden in individuals with symptomatic undiagnosed asthma or COPD. Respir Med 2022; 200:106917. [DOI: 10.1016/j.rmed.2022.106917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/20/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022]
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25
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Phillips DB, Elbehairy AF, James MD, Vincent SG, Milne KM, de-Torres JP, Neder JA, Kirby M, Jensen D, Stickland MK, Guenette JA, Smith BM, Aaron SD, Tan WC, Bourbeau J, O'Donnell DE. Impaired Ventilatory Efficiency, Dyspnea and Exercise Intolerance in Chronic Obstructive Pulmonary Disease: Results from the CanCOLD Study. Am J Respir Crit Care Med 2022; 205:1391-1402. [PMID: 35333135 DOI: 10.1164/rccm.202109-2171oc] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Impaired exercise ventilatory efficiency (high ventilatory requirements for CO2 [V̇E/V̇CO2]) provides an indication of pulmonary gas exchange abnormalities in chronic obstructive pulmonary disease (COPD). OBJECTIVES To determine: 1) the association between high V̇E/V̇CO2 and clinical outcomes (dyspnea and exercise capacity) and its relationship to lung function and structural radiographic abnormalities; and 2) its prevalence in a large population-based cohort. METHODS Participants were recruited randomly from the population and underwent clinical evaluation, pulmonary function, cardiopulmonary exercise testing and chest computed tomography (CT). Impaired exercise ventilatory efficiency was defined by a nadir V̇E/V̇CO2 above the upper limit of normal (V̇E/V̇CO2>ULN), using population-based normative values. MEASUREMENTS AND MAIN RESULTS Participants included 445 never-smokers, 381 ever-smokers without airflow obstruction, 224 with GOLD 1 COPD, and 200 with GOLD 2-4 COPD. Participants with V̇E/V̇CO2>ULN were more likely to have activity-related dyspnea (Medical Research Council dyspnea scale≥2, odds ratio=1.77[1.31-2.39]) and abnormally low peak oxygen uptake (V̇O2peak<LLN, odds ratio=4.58[3.06-6.86]). The carbon monoxide transfer coefficient (KCO) had a stronger correlation with nadir V̇E/V̇CO2 (r=-0.38, p<0.001) than other relevant lung function and CT metrics. The prevalence of V̇E/V̇CO2>ULN was 24% in COPD (similar in GOLD 1 and 2-4), which was greater than in never-smokers (13%) and ever-smokers (12%). CONCLUSIONS V̇E/V̇CO2>ULN was associated with greater dyspnea and low VO2peak and was present in 24% of all participants with COPD, regardless of GOLD stage. The results show the importance of recognizing impaired exercise ventilatory efficiency as a potential contributor to dyspnea and exercise limitation, even in mild COPD.
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Affiliation(s)
| | - Amany F Elbehairy
- Queen's University and Kingston General Hospital, Medicine, Kingston, Ontario, Canada.,Alexandria University, Department of Chest Diseases, Faculty of Medicine, Alexandria, Egypt
| | - Matthew D James
- Queen's University, 4257, Medicine, Kingston, Ontario, Canada
| | | | - Kathryn M Milne
- The University of British Columbia, 8166, Medicine, Vancouver, British Columbia, Canada
| | | | - J Alberto Neder
- Queen's University, 4257, Medicine, Kingston, Ontario, Canada
| | - Miranda Kirby
- Ryerson University, Physics, Toronto, Ontario, Canada
| | - Dennis Jensen
- McGill University, Kinesiology & Physical Education, Montreal, Quebec, Canada
| | | | | | - Benjamin M Smith
- McGill University, Respiratory Medicine, Montreal, Quebec, Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Wan C Tan
- Providence Heart & Lung Institute, University of British Columbia, St Paul's Hospital, UBC James Hogg Research Centre, Vancouver, British Columbia, Canada
| | - Jean Bourbeau
- Montreal Chest Institute, CORE, Montreal, Quebec, Canada.,McGill University Health Centre, 54473, Montreal, Quebec, Canada
| | - Denis E O'Donnell
- Queen's University, Division of Respiratory and Critical Care Medicine, Department of Medicine, Kingston, Ontario, Canada;
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Huynh C, Whitmore GA, Vandemheen KL, FitzGerald JM, Bergeron C, Boulet LP, Cote A, Field SK, Penz E, McIvor RA, Lemière C, Gupta S, Mayers I, Bhutani M, Hernandez P, Lougheed MD, Licskai CJ, Azher T, Ainslie M, Fraser I, Mahdavian M, Alvarez GG, Kendzerska T, Aaron SD. Derivation and Validation of the UCAP-Q Case-finding Questionnaire to Detect Undiagnosed Asthma and COPD. Eur Respir J 2022; 60:13993003.03243-2021. [PMID: 35332067 DOI: 10.1183/13993003.03243-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Many people with asthma and COPD remain undiagnosed. We developed and validated a new case-finding questionnaire to identify symptomatic adults with undiagnosed obstructive lung disease. METHODS Adults in the community with no prior history of physician-diagnosed lung disease who self-reported respiratory symptoms were contacted via random-digit dialing. Pre- and post-bronchodilator spirometry was used to confirm asthma or COPD. Predictive questions were selected using multinomial logistic regression with backward elimination. Questionnaire performance was assessed using sensitivity, predictive values, and area under the receiver operating curve (AUC). The questionnaire was assessed for test-retest reliability, acceptability, and readability. External validation was prospectively conducted in an independent sample and predictive performance re-evaluated. RESULTS A 13-item UCAP-Q case-finding questionnaire to predict undiagnosed asthma or COPD was developed. The most appropriate risk cut-off was determined to be 6% for either disease. Applied to the derivation sample (N=1615), the questionnaire yielded a sensitivity of 92% for asthma and 97% for COPD, specificity of 17%, with an AUC of 0.69 (95% CI: 0.64-0.74) for asthma and 0.82 (95% CI: 0.78-0.86) for COPD. Prospective validation using an independent sample (n=471) showed sensitivities of 93% and 92% for asthma and COPD, respectively, specificity of 19%, with AUC's of 0.70 (95% CI: 0.62-0.79) for asthma and 0.81 (95% CI: 0.74-0.87) for COPD. AUC's for UCAP-Q were higher compared to AUC's for currently recommended case-finding questionnaires for asthma or COPD.Conclusions:The UCAP-Q demonstrated high sensitivities and AUC's for identifying undiagnosed asthma or COPD. A web-based calculator allows for easy calculation of risk probabilities for each disease.
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Affiliation(s)
- Chau Huynh
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - G A Whitmore
- Desautels Faculty of Management, McGill University, Montreal, Canada
| | | | - J Mark FitzGerald
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Celine Bergeron
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | | | - Andreanne Cote
- Centre de recherche, Hôpital Laval, Université Laval, Quebec, Canada
| | - Stephen K Field
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Erika Penz
- Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - R Andrew McIvor
- Firestone Institute for Respiratory Health, McMaster University, Hamilton, Canada
| | | | - Samir Gupta
- Department of Medicine, the Li Ka Shing Knowledge Institute of St. Michael's Hospital University of Toronto, Toronto, Canada
| | - Irvin Mayers
- Department of Medicine, University of Alberta, Alberta, Canada
| | - Mohit Bhutani
- Department of Medicine, University of Alberta, Alberta, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, Canada
| | | | | | - Tanweer Azher
- Department of Medicine, Memorial University, St. John's, Canada
| | - Martha Ainslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - Ian Fraser
- Michael Garron Hospital, Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Gonzalo G Alvarez
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Tetyana Kendzerska
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
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Katz SL, Mah JK, McMillan HJ, Campbell C, Bijelić V, Barrowman N, Momoli F, Blinder H, Aaron SD, McAdam LC, Nguyen TTD, Tarnopolsky M, Wensley DF, Zielinski D, Rose L, Sheers N, Berlowitz DJ, Wolfe L, McKim D. Routine lung volume recruitment in boys with Duchenne muscular dystrophy: a randomised clinical trial. Thorax 2022; 77:805-811. [PMID: 35236763 PMCID: PMC9340020 DOI: 10.1136/thoraxjnl-2021-218196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/25/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Impaired cough results in airway secretion retention, atelectasis and pneumonia in individuals with Duchenne muscular dystrophy (DMD). Lung volume recruitment (LVR) stacks breaths to inflate the lungs to greater volumes than spontaneous effort. LVR is recommended in DMD clinical care guidelines but is not well studied. We aimed to determine whether twice-daily LVR, compared with standard of care alone, attenuates the decline in FVC at 2 years in boys with DMD. METHODS In this multicentre, assessor-blinded, randomised controlled trial, boys with DMD, aged 6-16 years with FVC >30% predicted, were randomised to receive conventional treatment or conventional treatment plus manual LVR twice daily for 2 years. The primary outcome was FVC % predicted at 2 years, adjusted for baseline FVC % predicted, age and ambulatory status. Secondary outcomes included change in chest wall distensibility (maximal insufflation capacity minus FVC) and peak cough flow. RESULTS Sixty-six boys (36 in LVR group, 30 in control) were evaluated (median age (IQR): 11.5 years (9.5-13.5), median baseline FVC (IQR): 85% predicted (73-96)). Adjusted mean difference in FVC between groups at 2 years was 1.9% predicted (95% CI -6.9% to 10.7%; p=0.68) in the direction of treatment benefit. We found no differences in secondary outcomes. CONCLUSION There was no difference in decline in FVC % predicted with use of twice-daily LVR for boys with DMD and relatively normal lung function. The burden associated with routine LVR may outweigh the benefit. Benefits of LVR to maintain lung health in boys with worse baseline lung function still need to be clarified. TRIAL REGISTRATION NUMBER NCT01999075.
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Affiliation(s)
- Sherri L Katz
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada .,CHEO Research Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jean K Mah
- Division of Pediatric Neurology, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatric and Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Hugh J McMillan
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,CHEO Research Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Craig Campbell
- Department of Pediatrics, Epidemiology and Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada.,Department of Pediatrics, London Health Sciences Centre Children's Hospital, London, Ontario, Canada
| | - Vid Bijelić
- CHEO Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- CHEO Research Institute, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Franco Momoli
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Shawn D Aaron
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Respirology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Laura C McAdam
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - The Thanh Diem Nguyen
- Department of Respiratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Mark Tarnopolsky
- Division of Neuromuscular and Neurometabolic Disease, McMaster University, Hamilton, Ontario, Canada
| | - David F Wensley
- Division of Pediatric Respirology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - David Zielinski
- Division of Pediatric Respirology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Louise Rose
- Department of Midwifery and Palliative Care, King's College London Florence Nightingale School of Nursing and Midwifery, London, London, UK.,Critical Care Directorate and Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, London, London, UK
| | - Nicole Sheers
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - David J Berlowitz
- Department of Respiratory and Sleep Medicine, Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Wolfe
- Department of Medicine and Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Respiratory Care, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Doug McKim
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,CANVent Respiratory Rehabilitation Services, Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada
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28
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Alvarez GG, Sullivan K, Pease C, Van Dyk D, Mallick R, Taljaard M, Grimshaw JM, Amaratunga K, Allen C, Brethour K, Mulpuru S, Pakhale S, Aaron SD, Cameron DW, Alsdurf H, Hui C, Zwerling AA. Effect of implementation of a 12 dose once-weekly treatment (3HP) in addition to standard regimens to prevent TB on completion rates: Interrupted time series design. Int J Infect Dis 2022; 117:222-229. [PMID: 35121126 DOI: 10.1016/j.ijid.2022.01.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/07/2022] [Accepted: 01/27/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE We aimed to determine if offering a 12 dose once-weekly treatment (3HP) as an additional treatment option would result in an increase in the overall proportion of patients completing TB preventive treatment (TPT) above the baseline rate. METHODS We analyzed outcomes in consecutive adults referred to a TB clinic from January 2010 to May 2019. Starting December 2016, 3HP was offered as an alternative to standard clinic regimens which included 9 months of daily isoniazid or 4 months of daily rifampin. The primary outcome was the proportion who completed TPT among all patients who started treatment. Using segmented autoregression analysis we compared completion at the end of the study to projected completion had the intervention not been introduced. RESULTS A total of 2803 adults were referred for assessment over the study period. There was an absolute increase in completions among all of those who started a treatment of 19.0% at the end of the study between the observed intervention completion rate and the projected completion rate from the baseline study period (the completion rate had the 3HP intervention not been introduced) (76% observed vs 57% projected, 95% CI 6.6 to 31.4%, p = 0.004) and an absolute increase among those who were offered treatment of 17.3% 95% CI, 2.3 to 32.3%, p = 0.025). INTERPRETATION The introduction of 3HP for TPT as an alternative to the regular regimens offered resulted in a significant increase in the proportion of patients completing treatment. Our study provides evidence to support accelerated use of 3HP in Canada.
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Affiliation(s)
- Gonzalo G Alvarez
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Kathryn Sullivan
- School of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher Pease
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Ranjeeta Mallick
- School of Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jeremy M Grimshaw
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Kanchana Amaratunga
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Crystal Allen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kaitlan Brethour
- School of Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Smita Pakhale
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - D William Cameron
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Hannah Alsdurf
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; McGill International Tuberculosis Centre, McGill University Health Centre, Montreal, Quebec, Canada
| | - Charles Hui
- School of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Alice A Zwerling
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; McGill International Tuberculosis Centre, McGill University Health Centre, Montreal, Quebec, Canada
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29
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Poon M, Pequeno P, Aaron SD, Stanbrook M, Wong H, Cram P, Gershon AS. Trends in non-receipt of recommended chronic obstructive pulmonary disease medication. ERJ Open Res 2022; 8:00584-2021. [PMID: 35479295 PMCID: PMC9035603 DOI: 10.1183/23120541.00584-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/24/2021] [Indexed: 11/05/2022] Open
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30
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Cowan J, Mulpuru S, Abdallah SJ, Chopra A, Purssell A, McGuinty M, Alvarez GG, Giulivi A, Corrales-Medina V, MacFadden D, Boyle L, Hasimja D, Thavorn K, Mallick R, Aaron SD, Cameron DW. A Randomized Double-Blind Placebo-Control Feasibility Trial of Immunoglobulin Treatment for Prevention of Recurrent Acute Exacerbations of COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:3275-3284. [PMID: 34887657 PMCID: PMC8650772 DOI: 10.2147/copd.s338849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Observational studies suggest that immunoglobulin treatment may reduce the frequency of acute exacerbations of COPD (AECOPD). Objective To inform the design of a future randomised control trial (RCT) of intravenous immunoglobulin (IVIG) treatment efficacy for AECOPD prevention. Methods A pilot RCT was conducted. We recruited patients with COPD hospitalized for AECOPD, or from ambulatory clinics with one severe, or two moderate AECOPD in the previous year regardless of their serum IgG level. Patients were allocated in a 1:1 ratio with balanced randomisation to monthly IVIG or normal saline for 1 year. The primary outcome was feasibility defined as pre-specified accrual, adherence, and follow-up rates. Secondary outcomes included safety, tolerance, AECOPD rates, time to first AECOPD, quality of life, and healthcare costs. Results Seventy patients were randomized (37 female; mean age 67.7; mean FEV1 35.1%). Recruitment averaged 4.5±0.9 patients per month (range 0–8), 34 (49%) adhered to at least 80% of planned treatments, and four (5.7%) were lost to follow-up. There were 35 serious adverse events including seven deaths and one thromboembolism. None was related to IVIG. There were 56 and 48 moderate and severe AECOPD in the IVIG vs control groups. In patients with at least 80% treatment adherence, median time to first moderate or severe AECOPD was 275 vs 114 days, favoring the IVIG group (HR 0.76, 95% CI 0.3–1.92). Conclusion The study met feasibility criteria for recruitment and retention, but adherence was low. A trend toward more robust treatment efficacy in adherent patients supports further study, but future trials must address treatment adherence. Trial registration number NCT0290038, registered 24 February 2016, https://clinicaltrials.gov/ct2/show/NCT02690038 and NCT03018652, registered January 12, 2017, https://clinicaltrials.gov/ct2/show/NCT03018652.
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Affiliation(s)
- Juthaporn Cowan
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sara J Abdallah
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Anchal Chopra
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Purssell
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Gonzalo G Alvarez
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Antonio Giulivi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Vicente Corrales-Medina
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Derek MacFadden
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Loree Boyle
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Delvina Hasimja
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Ranjeeta Mallick
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - D William Cameron
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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31
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Chin M, Aaron SD. Disconcerting and Counter-Intuitive Findings from a Trial of Exercise in Cystic Fibrosis- Can Exercise Make our Patients Worse? Am J Respir Crit Care Med 2021; 205:269-270. [PMID: 34856109 PMCID: PMC8887002 DOI: 10.1164/rccm.202110-2446ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Melanie Chin
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada;
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32
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Celli BR, Fabbri LM, Aaron SD, Agusti A, Brook R, Criner GJ, Franssen FME, Humbert M, Hurst JR, O'Donnell D, Pantoni L, Papi A, Rodriguez-Roisin R, Sethi S, Torres A, Vogelmeier CF, Wedzicha JA. An Updated Definition and Severity Classification of Chronic Obstructive Pulmonary Disease Exacerbations: The Rome Proposal. Am J Respir Crit Care Med 2021; 204:1251-1258. [PMID: 34570991 DOI: 10.1164/rccm.202108-1819pp] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Bartolome R Celli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leonardo M Fabbri
- Section of Respiratory Medicine, Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alvar Agusti
- Universitat de Barcelona, Barcelona, Spain.,Institut Clínic Respiratori, Hospital Clínic de Barcelona, Barcelona, Spain.,Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Madrid, Spain
| | | | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, the Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Marc Humbert
- Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.,Université Paris-Saclay and Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 999, Le Kremlin-Bicêtre, France
| | - John R Hurst
- UCL Respiratory, University College London, London, United Kingdom
| | - Denis O'Donnell
- Respiratory Investigation Unit, Queens University and Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Leonardo Pantoni
- "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Alberto Papi
- Section of Respiratory Medicine, University of Ferrara, Ferrara, Italy.,Emergency Department, St. Anna University Hospital, Ferrara, Italy
| | - Roberto Rodriguez-Roisin
- Universitat de Barcelona, Barcelona, Spain.,Institut Clínic Respiratori, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sanjay Sethi
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York
| | - Antoni Torres
- Universitat de Barcelona, Barcelona, Spain.,Institut Clínic Respiratori, Hospital Clínic de Barcelona, Barcelona, Spain.,Instituto de Investigaciones Biomédicas August Pi i Sunyer, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats Acadèmia, Centre d'Investigació Biomèdica en Xarxa de Malalties Respiratòries, Barcelona, Spain
| | - Claus F Vogelmeier
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University Medical Center of Giessen and Marburg, Philipps University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany; and
| | - Jadwiga A Wedzicha
- Respiratory Division, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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33
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Elborn JS, Konstan MW, Taylor-Cousar JL, Fajac I, Horsley A, Sutharsan S, Aaron SD, Daines CL, Uluer A, Downey DG, Lucidi VV, Ahuja S, Springman E, Mershon J, Grosswald R, Rowe SM. Empire-CF study: A phase 2 clinical trial of leukotriene A4 hydrolase inhibitor acebilustat in adult subjects with cystic fibrosis. J Cyst Fibros 2021; 20:1026-1034. [PMID: 34538755 DOI: 10.1016/j.jcf.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is characterized by neutrophilic inflammation in the airways. Leukotriene B4 (LTB4) is a neutrophil chemoattractant and has been implicated in CF pathogenesis. Acebilustat, a novel, synthetic, small-molecule leukotriene A4 hydrolase inhibitor, reduces LTB4 production. We report findings from a randomized placebo-controlled trial of acebilustat in adult subjects with mild-to-moderate lung disease. METHODS Subjects were randomized (1:1:1) to once-daily acebilustat 50 mg, 100 mg or placebo for 48 weeks, concomitantly with their current therapeutic regimen. Subjects were stratified by use of concomitant CF transmembrane conductance regulator (CFTR) modulators, baseline percent predicted forced expiratory volume in 1 second (ppFEV1) 50-75 and >75, and number of pulmonary exacerbations in the past year (1 or >1). Primary endpoints were the change from baseline in ppFEV1 and safety. Secondary endpoints included the rate of pulmonary exacerbations. RESULTS Overall, 199 subjects were randomized and dosed (acebilustat 50 mg, n=67; acebilustat 100 mg, n=66; placebo, n=66). Baseline demographics and disease profile were well balanced among treatment groups. Acebilustat had no statistically significant effect on the primary endpoint of change in ppFEV1 at week 48 or the secondary endpoint pulmonary exacerbations. There was a trend towards reduced pulmonary exacerbations in subjects receiving acebilustat in pre-specified populations with ppFEV1>75 (35% rate reduction) and those on concomitant CFTR modulator therapy (20% rate reduction). Acebilustat was well tolerated. CONCLUSIONS Acebilustat did not improve lung function. A trend towards reduced pulmonary exacerbations in subjects with an earlier stage of lung disease suggests a potential effect in this population.
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Affiliation(s)
- J Stuart Elborn
- Faculty of Medicine Health and Life sciences Queens University School of Medicine, Belfast, UK
| | - Michael W Konstan
- Department of Pediatrics, Case Western Reserve University School of Medicine and Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | | | - Isabelle Fajac
- Physiology Department, Cochin Hospital, APHP Centre, Paris, France; Université de Paris, Paris, France
| | - Alexander Horsley
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Sivagurunathan Sutharsan
- Division of Cystic Fibrosis, Department of Pulmonary Medicine, University Medicine EssenRuhrlandklinik, University of DuisburgEssen, Essen, Germany
| | - Shawn D Aaron
- Ottawa Health Research Institute, Ottawa, Ontario, Canada
| | - Cori L Daines
- Department of Pediatrics, University of Arizona, Tucson, AZ, USA
| | - Ahmet Uluer
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Damian G Downey
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Vincenzina V Lucidi
- Cystic Fibrosis Center, Children's Hospital and Research Institute, Bambino Gesu, Rome, Italy
| | | | | | | | | | - Steven M Rowe
- Gregory Fleming James Cystic Fibrosis Research Center and Department of Medicine, University of Alabama at Birmingham, 1918 University Blvd, MCLM 804, Birmingham 35294, AL, USA.
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Sadatsafavi M, Adibi A, Puhan M, Gershon A, Aaron SD, Sin DD. Moving beyond AUC: decision curve analysis for quantifying net benefit of risk prediction models. Eur Respir J 2021; 58:13993003.01186-2021. [PMID: 34503984 DOI: 10.1183/13993003.01186-2021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/31/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Amin Adibi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Andrea Gershon
- Institute of Clinical Evaluation Sciences, University of Toronto, Toronto, ON, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
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Gershon AS, McGihon RE, Luo J, Blazer AJ, Kendzerska T, To T, Aaron SD. Trends in Chronic Obstructive Pulmonary Disease Prevalence, Incidence, and Health Services Use in Younger Adults in Ontario, Canada, 2006-2016. Am J Respir Crit Care Med 2021; 203:1196-1199. [PMID: 33347389 DOI: 10.1164/rccm.202006-2495le] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andrea S Gershon
- Sunnybrook Health Sciences Centre Toronto, Ontario, Canada.,ICES Toronto, Ontario, Canada.,University of Toronto Toronto, Ontario, Canada
| | | | - Jin Luo
- ICES Toronto, Ontario, Canada
| | | | - Tetyana Kendzerska
- ICES Toronto, Ontario, Canada.,University of Ottawa Ottawa, Ontario, Canada
| | - Teresa To
- ICES Toronto, Ontario, Canada.,University of Toronto Toronto, Ontario, Canada.,The Hospital for Sick Children Toronto, Ontario, Canada and
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Guanzhang J, Maclagan LC, To T, Aaron SD, Yao Z, Gershon AS. Smoking and smoking cessation among people with chronic obstructive pulmonary disease (COPD). Canadian Journal of Respiratory, Critical Care, and Sleep Medicine 2021. [DOI: 10.1080/24745332.2019.1692259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jiehui Guanzhang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Laura C. Maclagan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Shawn D. Aaron
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Zhan Yao
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Andrea S. Gershon
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Kendzerska T, Aaron SD, Meteb M, Gershon AS, To T, Lougheed MD, Tavakoli H, Chen W, Kunkel E, Sadatsafavi M. Specialist Care in Individuals With Asthma Who Required Hospitalization: A Retrospective Population-Based Study. J Allergy Clin Immunol Pract 2021; 9:3686-3696. [PMID: 34182160 DOI: 10.1016/j.jaip.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/23/2021] [Accepted: 06/07/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients who are at risk for severe asthma exacerbations should receive specialist care. However, the care pattern for such patients in the real world is unclear. OBJECTIVE To describe the pattern of care among individuals with asthma who required hospitalization, and to identify factors associated with receiving asthma specialist care. METHODS This was a retrospective population-based study using health administrative data from two Canadian provinces. Individuals aged 14 to 45 years who were newly diagnosed with asthma between 2006 and 2016 and had at least one hospitalization for asthma at or within 5 years after the initial asthma diagnosis were included. First, we calculated frequencies of primary and specialist care around the asthma diagnosis: 1 year before and 2 years after in a 6-month period. Next, among individuals diagnosed with asthma by a primary care physician, we used multivariable Cox regressions to identify factors associated with receiving specialist care. RESULTS For 1862 individuals included, we found that most (≥71% per time period) were cared for by primary care physicians 1 year before and 2 years after the asthma diagnosis; the percentage of individuals seen at least once by a specialist for asthma and/or asthma-related respiratory conditions during the first 6 months since the diagnosis did not exceed 40%. Among 1411 of 1862 individuals who were under primary care before the asthma diagnosis (76%), controlling for covariates, living in a rural area or a low-income neighborhood was associated with less likelihood of receiving specialist care. CONCLUSIONS Despite recommendations, more than half of individuals with asthma who required hospitalization did not receive specialist care during the first 2 years since the diagnosis. Identified factors associated with receiving asthma specialist care suggested that access is an important barrier to receiving recommended care.
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Affiliation(s)
- Tetyana Kendzerska
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ontario, Canada; ICES, Ontario, Canada.
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ontario, Canada
| | - Moussa Meteb
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andrea S Gershon
- ICES, Ontario, Canada; Department of Medicine, University of Toronto, Ontario, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Teresa To
- ICES, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Research Institute, The Hospital of Sick Children, Toronto, Ontario, Canada
| | - M Diane Lougheed
- ICES, Ontario, Canada; Kingston General Hospital Research Institute, Kingston, Ontario, Canada; Queen's University, Kingston, Ontario, Canada
| | - Hamid Tavakoli
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Elizabeth Kunkel
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES, Ontario, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
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Alvarez GG, Zwerling AA, Duncan C, Pease C, Van Dyk D, Behr MA, Lee RS, Mulpuru S, Pakhale S, Cameron DW, Aaron SD, Patterson M, Allen J, Sullivan K, Jolly A, Sharma MK, Jamieson FB. Molecular Epidemiology of Mycobacterium tuberculosis To Describe the Transmission Dynamics Among Inuit Residing in Iqaluit Nunavut Using Whole-Genome Sequencing. Clin Infect Dis 2021; 72:2187-2195. [PMID: 32293676 DOI: 10.1093/cid/ciaa420] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the last decade, tuberculosis (TB) incidence among Inuit in the Canadian Arctic has been rising. Our aim was to better understand the transmission dynamics of TB in this remote region of Canada using whole-genome sequencing. METHODS Isolates from patients who had culture-positive pulmonary TB in Iqaluit, Nunavut, between 2009 and 2015 underwent whole-genome sequencing (WGS). The number of transmission events between cases within clusters was calculated using a threshold of a ≤3 single nucleotide polymorphism (SNP) difference between isolates and then combined with detailed epidemiological data using a reproducible novel algorithm. Social network analysis of epidemiological data was used to support the WGS data analysis. RESULTS During the study period, 140 Mycobacterium tuberculosis isolates from 135 cases were sequenced. Four clusters were identified, all from Euro-American lineage. One cluster represented 62% of all cases that were sequenced over the entire study period. In this cluster, 2 large chains of transmission were associated with 3 superspreading events in a homeless shelter. One of the superspreading events was linked to a nonsanctioned gambling house that resulted in further transmission. Shelter to nonshelter transmission was also confirmed. An algorithm developed for the determination of transmission events demonstrated very good reproducibility (κ score .98, 95% confidence interval, .97-1.0). CONCLUSIONS Our study suggests that socioeconomic factors, namely residing in a homeless shelter and spending time in a gambling house, combined with the superspreading event effect may have been significant factors explaining the rise in cases in this predominantly Inuit Arctic community.
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Affiliation(s)
- Gonzalo G Alvarez
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,McGill International Tuberculosis Centre, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alice A Zwerling
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,McGill International Tuberculosis Centre, McGill University Health Centre, Montreal, Quebec, Canada
| | - Carla Duncan
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada
| | - Christopher Pease
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Marcel A Behr
- McGill International Tuberculosis Centre, McGill University Health Centre, Montreal, Quebec, Canada.,The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Robyn S Lee
- McGill International Tuberculosis Centre, McGill University Health Centre, Montreal, Quebec, Canada.,The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sunita Mulpuru
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Smita Pakhale
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - D William Cameron
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Michael Patterson
- Department of Health, Government of Nunavut, Iqaluit, Nunavut, Canada
| | - Jean Allen
- Nunavut Tunngavik Inc, Iqaluit, Nunavut, Canada
| | - Kathryn Sullivan
- School of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Anne Jolly
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Meenu K Sharma
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Frances B Jamieson
- Public Health Ontario Laboratory, Public Health Ontario, Toronto, Ontario, Canada.,Department of Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Kendzerska T, van Walraven C, McIsaac DI, Povitz M, Mulpuru S, Lima I, Talarico R, Aaron SD, Reisman W, Gershon AS. Case-Ascertainment Models to Identify Adults with Obstructive Sleep Apnea Using Health Administrative Data: Internal and External Validation. Clin Epidemiol 2021; 13:453-467. [PMID: 34168503 PMCID: PMC8216743 DOI: 10.2147/clep.s308852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/12/2021] [Indexed: 01/29/2023] Open
Abstract
Background There is limited evidence on whether obstructive sleep apnea (OSA) can be accurately identified using health administrative data. Study Design and Methods We derived and validated a case-ascertainment model to identify OSA using linked provincial health administrative and clinical data from all consecutive adults who underwent a diagnostic sleep study (index date) at two large academic centers (Ontario, Canada) from 2007 to 2017. The presence of moderate/severe OSA (an apnea–hypopnea index≥15) was defined using clinical data. Of 39 candidate health administrative variables considered, 32 were tested. We used classification and regression tree (CART) methods to identify the most parsimonious models via cost-complexity pruning. Identified variables were also used to create parsimonious logistic regression models. All individuals with an estimated probability of 0.5 or greater using the predictive models were classified as having OSA. Results The case-ascertainment models were derived and validated internally through bootstrapping on 5099 individuals from one center (33% moderate/severe OSA) and validated externally on 13,486 adults from the other (45% moderate/severe OSA). On the external cohort, parsimonious models demonstrated c-statistics of 0.75–0.81, sensitivities of 59–60%, specificities of 87–88%, positive predictive values of 79%, negative predictive values of 73%, positive likelihood ratios (+LRs) of 4.5–5.0 and –LRs of 0.5. Logistic models performed better than CART models (mean integrated calibration indices of 0.02–0.03 and 0.06–0.12, respectively). The best model included: sex, age, and hypertension at the index date, as well as an outpatient specialty physician visit for OSA, a repeated sleep study, and a positive airway pressure treatment claim within 1 year since the index date. Interpretation Among adults who underwent a sleep study, case-ascertainment models for identifying moderate/severe OSA using health administrative data had relatively low sensitivity but high specificity and good discriminative ability. These findings could help study trends and outcomes of OSA individuals using routinely collected health care data.
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Affiliation(s)
- Tetyana Kendzerska
- Department of Medicine, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,ICES, Ottawa, Toronto, Ontario, Canada
| | - Carl van Walraven
- Department of Medicine, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,ICES, Ottawa, Toronto, Ontario, Canada
| | - Daniel I McIsaac
- Department of Medicine, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.,ICES, Ottawa, Toronto, Ontario, Canada.,Departments of Anesthesiology & Pain Medicine, University of Ottawa and Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marcus Povitz
- Department of Medicine at Schulich School of Medicine and Dentistry at Western University, London, Ontario, Canada.,Cumming School of Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sunita Mulpuru
- Department of Medicine, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Isac Lima
- Department of Medicine, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.,ICES, Ottawa, Toronto, Ontario, Canada
| | - Robert Talarico
- Department of Medicine, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.,ICES, Ottawa, Toronto, Ontario, Canada
| | - Shawn D Aaron
- Department of Medicine, The Ottawa Hospital Research Institute/The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - William Reisman
- Department of Medicine at Schulich School of Medicine and Dentistry at Western University, London, Ontario, Canada.,Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Andrea S Gershon
- ICES, Ottawa, Toronto, Ontario, Canada.,Faculty of Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Gershon AS, Pequeno P, Machado AA, Aaron SD, Kendzerska T, Luo J, Stanbrook MB, Tan WC, Porter J, To T. FACTORS ASSOCIATED WITH NON-RECEIPT OF RECOMMENDED CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) MEDICATIONS: A POPULATION STUDY. Chest 2021; 160:1670-1680. [PMID: 34144022 DOI: 10.1016/j.chest.2021.05.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/04/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) medications reduce exacerbations and improve quality of life. Despite this, some individuals do not receive medications recommended by practise guidelines. RESEARCH QUESTION How common is non-receipt of recommended medications among people with COPD and what are factors associated with non-receipt? STUDY DESIGN AND METHODS We conducted a population cohort study in Ontario, Canada, a province with universal health care insurance and medication coverage for those aged 65 and older. Health administrative data were used to identify people 66 years of age or older with physician-diagnosed COPD as of 2018 and group them into lower or higher risk for future COPD exacerbation groups. Proportions of patients in each group who did not receive medications recommended by COPD guidelines were determined. Generalized estimating equation modelling was used to determine associations between patient and physician factors and non-receipt of recommended medications. RESULTS About 54% and 88% of people with COPD receoved sufficient recommended medications in the low and high risk of exacerbation groups, respectively. Longer duration of COPD, higher comorbidity, dementia, and older physician age were associated with non-receipt of recommended medications in both groups. People who had a co-diagnosis of asthma and who received care by a pulmonologist and spirometry were more likely to receive recommended medication . INTERPRETATION COPD medications appear underused by the COPD population and various factors are associated with sub-optimal receipt. Targeting these factors would help improve the care and health of people with COPD.
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Affiliation(s)
- Andrea S Gershon
- Department of Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ICES, Toronto and Ottawa, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
| | | | | | - Shawn D Aaron
- The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, Canada
| | - Tetyana Kendzerska
- ICES, Toronto and Ottawa, ON, Canada; The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, Canada
| | - Jin Luo
- ICES, Toronto and Ottawa, ON, Canada
| | - Matthew B Stanbrook
- ICES, Toronto and Ottawa, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; University Health Network, Toronto, ON, Canada
| | - Wan C Tan
- University of British Columbia, UBC James Hogg Research Laboratories, Providence Heart and Lung Institute, Vancouver, BC, Canada
| | | | - Teresa To
- ICES, Toronto and Ottawa, ON, Canada; The Hospital for Sick Children Research Institute, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Alvarez GG, Van Dyk D, Mallick R, Lesperance S, Demaio P, Finn S, Potvin SE, Patterson M, Pease C, Amaratunga K, Hui C, Cameron DW, Mulpuru S, Aaron SD, Momoli F, Zwerling A. The implementation of rifapentine and isoniazid (3HP) in two remote Arctic communities with a predominantly Inuit population, the Taima TB 3HP study. Int J Circumpolar Health 2021; 79:1758501. [PMID: 32379538 PMCID: PMC7241515 DOI: 10.1080/22423982.2020.1758501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background: The incidence of TB among Inuit is the highest in Canada. A significantly shorter latent TB infection (LTBI) treatment with rifapentine and isoniazid once weekly for 12 weeks (3HP) is now available in limited settings in Canada.Methods: A prospective open-label 2-year observational postmarketing study was conducted introducing 3HP for the first time in Canada in Iqaluit followed by a program rollout in Qikiqtarjuaq, Nunavut.Results: A total of 247 people were offered 3HP, 102 in the Iqaluit postmarketing study and 145 in the Qikiqtarjuaq program roll out. Although statistical significance was not reached, more people who started treatment completed treatment in the 3HP group (Iqaluit, 60/73 (82.2%) and Qikiqtarjuaq, 89/115 (77.4%)) than in the historical control 9INHgroup (306/420 = 72.9%) (p = 0.2). Most of the adverse events in 3HP treated patients were associated with mild discomfort but no disruption of normal daily activity. Not drinking alcohol was associated with increased 3HP completion (OR 13.33, 95% CI, 2.27-78.20) as was not taking concomitant medications (OR 7.19, 95% CI, 1.47-35.30).Conclusions: The present study supports the feasibility and safety profile of 3HP for the treatment of LTBI in Nunavut.
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Affiliation(s)
- G G Alvarez
- Ottawa Hospital Research Institute, Ottawa, Canada.,University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada.,The Ottawa Hospital Department of Medicine, Ottawa, Canada
| | - D Van Dyk
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - R Mallick
- Ottawa Hospital Research Institute, Ottawa, Canada.,University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada
| | | | - P Demaio
- Nunavut Department of Health, Iqaluit, Canada
| | - S Finn
- Nunavut Department of Health, Iqaluit, Canada
| | | | - M Patterson
- Nunavut Department of Health, Iqaluit, Canada
| | - C Pease
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada
| | - K Amaratunga
- The Ottawa Hospital Department of Medicine, Ottawa, Canada
| | - C Hui
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - D W Cameron
- Ottawa Hospital Research Institute, Ottawa, Canada.,University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada.,The Ottawa Hospital Department of Medicine, Ottawa, Canada
| | - S Mulpuru
- Ottawa Hospital Research Institute, Ottawa, Canada.,The Ottawa Hospital Department of Medicine, Ottawa, Canada
| | - S D Aaron
- Ottawa Hospital Research Institute, Ottawa, Canada.,University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada.,The Ottawa Hospital Department of Medicine, Ottawa, Canada
| | - F Momoli
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - A Zwerling
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada
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Cherian M, Jensen D, Tan WC, Mursleen S, Goodall EC, Nadeau GA, Awan AM, Marciniuk DD, Walker BL, Aaron SD, O'Donnell DE, Chapman KR, Maltais F, Hernandez P, Sin DD, Benedetti A, Bourbeau J. Dyspnoea and symptom burden in mild-moderate COPD: the Canadian Cohort Obstructive Lung Disease Study. ERJ Open Res 2021; 7:00960-2020. [PMID: 33898621 PMCID: PMC8053913 DOI: 10.1183/23120541.00960-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 12/31/2022] Open
Abstract
Studies assessing dyspnoea and health-related quality of life (HRQoL) in chronic obstructive pulmonary disease (COPD) have focussed on patients in clinical settings, not the general population. The aim of this analysis was to compare the prevalence and severity of dyspnoea and impaired HRQoL in individuals with and without COPD from the general population, focussing on mild–moderate COPD. Analysis of the 3-year Canadian Cohort Obstructive Lung Disease (CanCOLD) study included four subgroups: mild COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1); moderate COPD (GOLD 2); non-COPD smokers; and non-COPD never-smokers. The primary outcome was dyspnoea (Medical Research Council (MRC) scale), and the secondary outcome was HRQoL (COPD Assessment Test (CAT) score; Saint George's Respiratory Questionnaire (SGRQ) score). Subgroups were analysed by sex, physician-diagnosed COPD status and exacerbations. 1443 participants (mild COPD (n=397); moderate COPD (n=262(; smokers (n=449) and never-smokers (n=335)) were studied. People with mild COPD were more likely to report more severe dyspnoea (MRC 2 versus 1) than those without COPD (OR (95% CI) 1.42 (1.05–1.91)), and non-COPD never-smokers (OR (95%CI) 1.64 (1.07–2.52)). Among people with mild COPD, more severe dyspnoea was reported in women versus men (MRC2 versus 1; OR (95% CI) 3.70 (2.23–6.14)); people with, versus without, physician-diagnosed COPD (MRC2 versus 1; OR (95% CI) 3.27 (1.71–6.23)), and people with versus without recent exacerbations (MRC2 versus 1; ≥2 versus 0 exacerbations: OR (95% CI) 3.62 (1.02–12.86); MRC ≥3 versus 1; 1 versus 0 exacerbation: OR (95% CI): 9.24 (2.01–42.42)). Similar between-group differences were obtained for CAT and SGRQ scores. Careful assessment of dyspnoea and HRQoL could help identify individuals for earlier diagnosis and treatment. Individuals from a population-based study with mild COPD are more symptomatic than non-COPD peers. Worse dyspnoea and quality of life was reported by people with mild COPD who are female, or have a physician diagnosis of COPD or recent exacerbations.https://bit.ly/2XE2B6S
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Affiliation(s)
- Mathew Cherian
- Division of Respiratory Medicine, Dept of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Dennis Jensen
- Clinical Exercise and Respiratory Physiology Laboratory, Dept of Kinesiology and Physical Education, Faculty of Education, McGill University, Montréal, QC, Canada.,Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, QC, Canada.,Research Centre for Physical Activity and Health, Faculty of Education, McGill University, Montréal, QC, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Darcy D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, SK, Canada
| | - Brandie L Walker
- Division of Respirology, Dept of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Denis E O'Donnell
- Dept of Medicine/Physiology, Queens University, Kingston, ON, Canada
| | - Kenneth R Chapman
- Asthma and Airway Centre, University Health Network and University of Toronto, Toronto, ON, Canada
| | - François Maltais
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Paul Hernandez
- Faculty of Medicine, Division of Respirology, Dalhousie University, Halifax, NS, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, Dept of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Benedetti
- Depts of Medicine and of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit, McGill University, Montreal, QC, Canada
| | - Jean Bourbeau
- Division of Respiratory Medicine, Dept of Medicine, McGill University Health Centre, Montreal, QC, Canada.,Research Institute of the McGill University Health Centre, Translational Research in Respiratory Diseases Program and Respiratory Epidemiology and Clinical Research Unit, Montréal, QC, Canada
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43
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Leung C, Bourbeau J, Sin DD, Aaron SD, FitzGerald JM, Maltais F, Marciniuk DD, O'Donnell D, Hernandez P, Chapman KR, Walker B, Road JD, Zheng L, Zou C, Hogg JC, Tan WC. The Prevalence of Chronic Obstructive Pulmonary Disease (COPD) and the Heterogeneity of Risk Factors in the Canadian Population: Results from the Canadian Obstructive Lung Disease (COLD) Study. Int J Chron Obstruct Pulmon Dis 2021; 16:305-320. [PMID: 33603357 PMCID: PMC7886112 DOI: 10.2147/copd.s285338] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the spirometric-based prevalence of COPD across different regions in Canada and to evaluate the site heterogeneity of risk factors. Patients and Methods In this cross-sectional, population-based study, random samples of non-institutionalized adults aged ≥40 years were generated by random digit dialling. Participants answered an interviewer-administered questionnaire and performed spirometry before and after bronchodilator administration. COPD was defined as post-bronchodilator FEV1/FVC <0.70 (fixed ratio, FR) and as FEV1/FVC <5th percentile (lower limits of normal, LLN). Separate logistic regression models were used to compute the risk (adjusted odds ratio, aOR) for COPD. I2 and Tau2 analyses were used to evaluate heterogeneity. Results Out of 5176 (95%) participants, 4893 (47% male with mean age 56.6 years (95% confidence interval, 56.0-57.2)) had spirometry that satisfied ATS criteria. The population prevalence of COPD was 16.2% (95% CI, 14.5-17.8) by FR and 11.2% (95% CI, 9.7-12.6) by LLN. Male predominance in prevalence was shown by FR but not by LLN criteria. Patient characteristics associated with an increased risk of COPD included: age (OR 1.56; 95% CI 1.33-1.84); history of physician-diagnosed asthma (OR 3.30; 95% CI 2.42-4.49); and childhood hospitalization for respiratory illness (OR 1.81; 95% CI 1.17-2.80). In terms of smoking-related risk factors, current smoking status had the highest odds ratio (OR 3.49; 95% CI 2.55-4.80). Variance in prevalence among sites was significantly reduced by adjusting for risk factors in Tau2 analyses. Higher odds of exposure for each risk factor was found in more severe COPD, suggesting that a higher risk could be linked to the development of severe disease. Conclusion This study reports the population prevalence of COPD in nine urban cities which collectively represent the majority of the Canadian population and demonstrates that heterogeneity in prevalence among sites is substantially explained by variation in associated risk factors for COPD.
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Affiliation(s)
- Clarus Leung
- Centre for Heart Lung Innovation, St Pauls Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Jean Bourbeau
- Research Institute McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, St Pauls Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - J Mark FitzGerald
- Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - François Maltais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Darcy D Marciniuk
- Respiratory Research Centre, University of Saskatchewan, Saskatoon, Canada
| | - Denis O'Donnell
- Department of Medicine, Queen's University, Kingston, Canada
| | - Paul Hernandez
- Department of Medicine, Dalhousie University, Halifax, Canada
| | - Kenneth R Chapman
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Canada
| | - Brandie Walker
- Department of Medicine, University of Calgary (BW), Alberta, Canada
| | - Jeremy D Road
- Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Liyun Zheng
- Centre for Heart Lung Innovation, St Pauls Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Carl Zou
- Centre for Heart Lung Innovation, St Pauls Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - James C Hogg
- Centre for Heart Lung Innovation, St Pauls Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Wan C Tan
- Centre for Heart Lung Innovation, St Pauls Hospital, The University of British Columbia, Vancouver, BC, Canada
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44
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Mammen MJ, Charbek E, Alexander PE, Nici L, Aaron SD. Reply to Vozoris: Opioids for Dyspnea in Chronic Obstructive Pulmonary Disease: Short on the Details. Am J Respir Crit Care Med 2021; 203:267-269. [PMID: 33022179 PMCID: PMC7874415 DOI: 10.1164/rccm.202009-3605le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | | | - Linda Nici
- Providence Veterans Affairs Medical Center and The Warren Alpert Medical School of Brown University Providence, Rhode Island and
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45
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Kendzerska T, Aaron SD, To T, Licskai C, Stanbrook MB, Hogan ME, Tan WC, Bourbeau J, Gershon AS. Effect of type and dosage of newly prescribed inhaled corticosteroids on obstructive lung disease and pneumonia hospitalisations in older individuals with asthma, COPD or both: a retrospective study of health administrative data. Eur Respir J 2021; 57:13993003.02585-2020. [PMID: 32703774 DOI: 10.1183/13993003.02585-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/05/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Tetyana Kendzerska
- Dept of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada .,ICES, Ottawa, ON, Canada
| | - Shawn D Aaron
- Dept of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Teresa To
- The Hospital for Sick Children, Research Institute, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Chris Licskai
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Matthew B Stanbrook
- ICES, Toronto, ON, Canada.,Dept of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Wan C Tan
- University of British Columbia, Vancouver, BC, Canada
| | - Jean Bourbeau
- McGill University, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Andrea S Gershon
- The Hospital for Sick Children, Research Institute, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Dalla Lana School of Public Health, Toronto, ON, Canada.,Dept of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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46
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Whitmore GA, Aaron SD. Population-based case-finding to identify airflow obstruction in symptomatic adults at high risk for asthma and COPD. Eur Respir J 2020; 56:56/5/2003574. [PMID: 33214172 DOI: 10.1183/13993003.03574-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 11/05/2022]
Affiliation(s)
- George A Whitmore
- Desautels Faculty of Management, McGill University, Montreal, QC, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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47
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Nici L, Aaron SD. Reply to Mahler et al.: Pharmacotherapy for Chronic Obstructive Pulmonary Disease: Molecules and Delivery Are Equally Important. Am J Respir Crit Care Med 2020; 202:1482-1483. [PMID: 32791006 PMCID: PMC7667900 DOI: 10.1164/rccm.202006-2375le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Linda Nici
- Providence Veterans Affairs Medical Center Providence, Rhode Island.,The Warren Alpert Medical School of Brown University Providence, Rhode Island and
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute at the University of Ottawa Ottawa, Ontario, Canada
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48
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Gershon AS, McGihon RE, Thiruchelvam D, To T, Wu R, Bell CM, Aaron SD. Medication Discontinuation in Adults With COPD Discharged From the Hospital: A Population-Based Cohort Study. Chest 2020; 159:975-984. [PMID: 33011204 DOI: 10.1016/j.chest.2020.09.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 09/21/2020] [Accepted: 09/25/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Patients admitted to the hospital with COPD are commonly managed with inhaled short-acting bronchodilators, sometimes in lieu of the long-acting bronchodilators they take as outpatients. If held on admission, these long-acting inhalers should be re-initiated upon discharge; however, health-care transitions sometimes result in unintentional discontinuation. RESEARCH QUESTION What is the risk of unintentional discontinuation of long-acting muscarinic antagonist (LAMA) and long-acting beta-agonist and inhaled corticosteroid (LABA-ICS) combination medications following hospital discharge in older adults with COPD? STUDY DESIGN AND METHODS A retrospective cohort study was conducted by using health administrative data from 2004 to 2016 from Ontario, Canada. Adults with COPD aged ≥ 66 years who had filled prescriptions for a LAMA or LABA-ICS continuously for ≥ 1 year were included. Log-binomial regression models were used to determine risk of medication discontinuation following hospitalization in each medication cohort. RESULTS Of the 27,613 hospitalization discharges included in this study, medications were discontinued 1,466 times. Among 78,953 patients with COPD continuously taking a LAMA or LABA-ICS, those hospitalized had a higher risk of having medications being discontinued than those who remained in the community (adjusted risk ratios of 1.50 [95% CI, 1.34-1.67; P < .001] and 1.62 [95% CI, 1.39, 1.90; P < .001] for LAMA and LABA-ICS, respectively). Crude rates of discontinuation for people taking LAMAs were 5.2% in the hospitalization group and 3.3% in the community group; for people taking LABA-ICS, these rates were 5.5% in the hospitalization group and 3.1% in the community group. INTERPRETATION In an observational study of highly compliant patients with COPD, hospitalization was associated with an increased risk of long-acting inhaler discontinuation. These Results suggest a likely larger discontinuation problem among less adherent patients and should be confirmed and quantified in a prospective cohort of patients with COPD and average compliance. Quality improvement efforts should focus on safe transitions and patient medication reconciliation following discharge.
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Affiliation(s)
- Andrea S Gershon
- Department of Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Rachel E McGihon
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Teresa To
- ICES, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robert Wu
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of General Internal Medicine, University Health Network, Toronto, ON, Canada
| | - Chaim M Bell
- ICES, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Sinai Health System, Toronto, ON, Canada
| | - Shawn D Aaron
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, ON, Canada
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49
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Adibi A, Sin DD, Safari A, Johnson KM, Aaron SD, FitzGerald JM, Sadatsafavi M. The Acute COPD Exacerbation Prediction Tool (ACCEPT): a modelling study. Lancet Respir Med 2020; 8:1013-1021. [PMID: 32178776 DOI: 10.1016/s2213-2600(19)30397-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Accurate prediction of exacerbation risk enables personalised care for patients with chronic obstructive pulmonary disease (COPD). We developed and validated a generalisable model to predict individualised rate and severity of COPD exacerbations. METHODS In this risk modelling study, we pooled data from three COPD trials on patients with a history of exacerbations. We developed a mixed-effect model to predict exacerbations over 1 year. Severe exacerbations were those requiring inpatient care. Predictors were history of exacerbations, age, sex, body-mass index, smoking status, domiciliary oxygen therapy, lung function, symptom burden, and current medication use. Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE), a multicentre cohort study, was used for external validation. RESULTS The development dataset included 2380 patients, 1373 (58%) of whom were men. Mean age was 64·7 years (SD 8·8). Mean exacerbation rate was 1·42 events per year and 0·29 events per year were severe. When validated against all patients with COPD in ECLIPSE (mean exacerbation rate was 1·20 events per year, 0·27 events per year were severe), the area-under-curve (AUC) was 0·81 (95% CI 0·79-0·83) for at least two exacerbations and 0·77 (95% CI 0·74-0·80) for at least one severe exacerbation. Predicted exacerbation and observed exacerbation rates were similar (1·31 events per year for all exacerbations and 0·25 events per year for severe exacerbations vs 1·20 events per year and 0·27 events per year). In ECLIPSE, in patients with previous exacerbation history (mean exacerbation rate was 1·82 events per year, 0·40 events per year were severe), AUC was 0·73 (95% CI 0·70-0·76) for two or more exacerbations and 0·74 (95% CI 0·70-0·78) for at least one severe exacerbation. Calibration was accurate for severe exacerbations (predicted 0·37 events per year vs observed 0·40 events per year) and all exacerbations (predicted 1·80 events per year vs observed 1·82 events per year). INTERPRETATION This model can be used as a decision tool to personalise COPD treatment and prevent exacerbations. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Amin Adibi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Don D Sin
- Division of Respiratory Medicine, Department of Medicine, The UBC Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
| | - Abdollah Safari
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kate M Johnson
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shawn D Aaron
- Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - J Mark FitzGerald
- Institute for Heart and Lung Health, Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada; Institute for Heart and Lung Health, Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver, BC, Canada
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50
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Lacasse Y, Sériès F, Corbeil F, Baltzan M, Paradis B, Simão P, Abad Fernández A, Esteban C, Guimarães M, Bourbeau J, Aaron SD, Bernard S, Maltais F. Randomized Trial of Nocturnal Oxygen in Chronic Obstructive Pulmonary Disease. N Engl J Med 2020; 383:1129-1138. [PMID: 32937046 DOI: 10.1056/nejmoa2013219] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Long-term oxygen therapy improves survival in patients with chronic obstructive pulmonary disease (COPD) and chronic severe daytime hypoxemia. However, the efficacy of oxygen therapy for the management of isolated nocturnal hypoxemia is uncertain. METHODS We designed this double-blind, placebo-controlled, randomized trial to determine, in patients with COPD who have nocturnal arterial oxygen desaturation without qualifying for long-term oxygen therapy, whether nocturnal oxygen provided for a period of 3 to 4 years would decrease mortality or the worsening of disease such that patients meet current specifications for long-term oxygen therapy. Patients with an oxygen saturation of less than 90% for at least 30% of the recording time on nocturnal oximetry were assigned, in a 1:1 ratio, to receive either nocturnal oxygen or ambient air from a sham concentrator (placebo). The primary outcome was a composite of death from any cause or a requirement for long-term oxygen therapy as defined by the Nocturnal Oxygen Therapy Trial (NOTT) criteria in the intention-to-treat population. RESULTS Recruitment was stopped prematurely because of recruitment and retention difficulties after 243 patients, of a projected 600, had undergone randomization at 28 centers. At 3 years of follow-up, 39.0% of the patients assigned to nocturnal oxygen (48 of 123) and 42.0% of those assigned to placebo (50 of 119) met the NOTT-defined criteria for long-term oxygen therapy or had died (difference, -3.0 percentage points; 95% confidence interval, -15.1 to 9.1). CONCLUSIONS Our underpowered trial provides no indication that nocturnal oxygen has a positive or negative effect on survival or progression to long-term oxygen therapy in patients with COPD. (Funded by the Canadian Institutes of Health Research; INOX ClinicalTrials.gov number, NCT01044628.).
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Affiliation(s)
- Yves Lacasse
- From Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, QC (Y.L., F.S., S.B., F.M.), Centre Hospitalier Affilié Universitaire de Trois-Rivières, Trois-Rivières, QC (F.C.), Mount Sinai Hospital, McGill University (M.B.), and Montreal Chest Institute, Research Institute of the McGill University Health Centre and McGill University (J.B.), Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC (B.P.), and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A.) - all in Canada; Hospital Pedro Hispano-Unidade Local de Saúde de Matosinhos, Matosinhos (P.S.), and Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia (M.G.) - both in Portugal; and Hospital Universitario de Getafe, Getafe (A.A.F.), and Hospital Galdakao, Servicio Vasco de Salud-Osakidetza, Bizkaia (C.E.) - both in Spain
| | - Frédéric Sériès
- From Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, QC (Y.L., F.S., S.B., F.M.), Centre Hospitalier Affilié Universitaire de Trois-Rivières, Trois-Rivières, QC (F.C.), Mount Sinai Hospital, McGill University (M.B.), and Montreal Chest Institute, Research Institute of the McGill University Health Centre and McGill University (J.B.), Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC (B.P.), and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A.) - all in Canada; Hospital Pedro Hispano-Unidade Local de Saúde de Matosinhos, Matosinhos (P.S.), and Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia (M.G.) - both in Portugal; and Hospital Universitario de Getafe, Getafe (A.A.F.), and Hospital Galdakao, Servicio Vasco de Salud-Osakidetza, Bizkaia (C.E.) - both in Spain
| | - François Corbeil
- From Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, QC (Y.L., F.S., S.B., F.M.), Centre Hospitalier Affilié Universitaire de Trois-Rivières, Trois-Rivières, QC (F.C.), Mount Sinai Hospital, McGill University (M.B.), and Montreal Chest Institute, Research Institute of the McGill University Health Centre and McGill University (J.B.), Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC (B.P.), and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A.) - all in Canada; Hospital Pedro Hispano-Unidade Local de Saúde de Matosinhos, Matosinhos (P.S.), and Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia (M.G.) - both in Portugal; and Hospital Universitario de Getafe, Getafe (A.A.F.), and Hospital Galdakao, Servicio Vasco de Salud-Osakidetza, Bizkaia (C.E.) - both in Spain
| | - Marc Baltzan
- From Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, QC (Y.L., F.S., S.B., F.M.), Centre Hospitalier Affilié Universitaire de Trois-Rivières, Trois-Rivières, QC (F.C.), Mount Sinai Hospital, McGill University (M.B.), and Montreal Chest Institute, Research Institute of the McGill University Health Centre and McGill University (J.B.), Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC (B.P.), and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A.) - all in Canada; Hospital Pedro Hispano-Unidade Local de Saúde de Matosinhos, Matosinhos (P.S.), and Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia (M.G.) - both in Portugal; and Hospital Universitario de Getafe, Getafe (A.A.F.), and Hospital Galdakao, Servicio Vasco de Salud-Osakidetza, Bizkaia (C.E.) - both in Spain
| | - Bruno Paradis
- From Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, QC (Y.L., F.S., S.B., F.M.), Centre Hospitalier Affilié Universitaire de Trois-Rivières, Trois-Rivières, QC (F.C.), Mount Sinai Hospital, McGill University (M.B.), and Montreal Chest Institute, Research Institute of the McGill University Health Centre and McGill University (J.B.), Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC (B.P.), and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A.) - all in Canada; Hospital Pedro Hispano-Unidade Local de Saúde de Matosinhos, Matosinhos (P.S.), and Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia (M.G.) - both in Portugal; and Hospital Universitario de Getafe, Getafe (A.A.F.), and Hospital Galdakao, Servicio Vasco de Salud-Osakidetza, Bizkaia (C.E.) - both in Spain
| | - Paula Simão
- From Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, QC (Y.L., F.S., S.B., F.M.), Centre Hospitalier Affilié Universitaire de Trois-Rivières, Trois-Rivières, QC (F.C.), Mount Sinai Hospital, McGill University (M.B.), and Montreal Chest Institute, Research Institute of the McGill University Health Centre and McGill University (J.B.), Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC (B.P.), and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A.) - all in Canada; Hospital Pedro Hispano-Unidade Local de Saúde de Matosinhos, Matosinhos (P.S.), and Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia (M.G.) - both in Portugal; and Hospital Universitario de Getafe, Getafe (A.A.F.), and Hospital Galdakao, Servicio Vasco de Salud-Osakidetza, Bizkaia (C.E.) - both in Spain
| | - Araceli Abad Fernández
- From Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, QC (Y.L., F.S., S.B., F.M.), Centre Hospitalier Affilié Universitaire de Trois-Rivières, Trois-Rivières, QC (F.C.), Mount Sinai Hospital, McGill University (M.B.), and Montreal Chest Institute, Research Institute of the McGill University Health Centre and McGill University (J.B.), Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC (B.P.), and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A.) - all in Canada; Hospital Pedro Hispano-Unidade Local de Saúde de Matosinhos, Matosinhos (P.S.), and Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia (M.G.) - both in Portugal; and Hospital Universitario de Getafe, Getafe (A.A.F.), and Hospital Galdakao, Servicio Vasco de Salud-Osakidetza, Bizkaia (C.E.) - both in Spain
| | - Cristóbal Esteban
- From Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, QC (Y.L., F.S., S.B., F.M.), Centre Hospitalier Affilié Universitaire de Trois-Rivières, Trois-Rivières, QC (F.C.), Mount Sinai Hospital, McGill University (M.B.), and Montreal Chest Institute, Research Institute of the McGill University Health Centre and McGill University (J.B.), Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC (B.P.), and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A.) - all in Canada; Hospital Pedro Hispano-Unidade Local de Saúde de Matosinhos, Matosinhos (P.S.), and Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia (M.G.) - both in Portugal; and Hospital Universitario de Getafe, Getafe (A.A.F.), and Hospital Galdakao, Servicio Vasco de Salud-Osakidetza, Bizkaia (C.E.) - both in Spain
| | - Miguel Guimarães
- From Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, QC (Y.L., F.S., S.B., F.M.), Centre Hospitalier Affilié Universitaire de Trois-Rivières, Trois-Rivières, QC (F.C.), Mount Sinai Hospital, McGill University (M.B.), and Montreal Chest Institute, Research Institute of the McGill University Health Centre and McGill University (J.B.), Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC (B.P.), and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A.) - all in Canada; Hospital Pedro Hispano-Unidade Local de Saúde de Matosinhos, Matosinhos (P.S.), and Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia (M.G.) - both in Portugal; and Hospital Universitario de Getafe, Getafe (A.A.F.), and Hospital Galdakao, Servicio Vasco de Salud-Osakidetza, Bizkaia (C.E.) - both in Spain
| | - Jean Bourbeau
- From Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, QC (Y.L., F.S., S.B., F.M.), Centre Hospitalier Affilié Universitaire de Trois-Rivières, Trois-Rivières, QC (F.C.), Mount Sinai Hospital, McGill University (M.B.), and Montreal Chest Institute, Research Institute of the McGill University Health Centre and McGill University (J.B.), Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC (B.P.), and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A.) - all in Canada; Hospital Pedro Hispano-Unidade Local de Saúde de Matosinhos, Matosinhos (P.S.), and Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia (M.G.) - both in Portugal; and Hospital Universitario de Getafe, Getafe (A.A.F.), and Hospital Galdakao, Servicio Vasco de Salud-Osakidetza, Bizkaia (C.E.) - both in Spain
| | - Shawn D Aaron
- From Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, QC (Y.L., F.S., S.B., F.M.), Centre Hospitalier Affilié Universitaire de Trois-Rivières, Trois-Rivières, QC (F.C.), Mount Sinai Hospital, McGill University (M.B.), and Montreal Chest Institute, Research Institute of the McGill University Health Centre and McGill University (J.B.), Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC (B.P.), and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A.) - all in Canada; Hospital Pedro Hispano-Unidade Local de Saúde de Matosinhos, Matosinhos (P.S.), and Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia (M.G.) - both in Portugal; and Hospital Universitario de Getafe, Getafe (A.A.F.), and Hospital Galdakao, Servicio Vasco de Salud-Osakidetza, Bizkaia (C.E.) - both in Spain
| | - Sarah Bernard
- From Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, QC (Y.L., F.S., S.B., F.M.), Centre Hospitalier Affilié Universitaire de Trois-Rivières, Trois-Rivières, QC (F.C.), Mount Sinai Hospital, McGill University (M.B.), and Montreal Chest Institute, Research Institute of the McGill University Health Centre and McGill University (J.B.), Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC (B.P.), and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A.) - all in Canada; Hospital Pedro Hispano-Unidade Local de Saúde de Matosinhos, Matosinhos (P.S.), and Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia (M.G.) - both in Portugal; and Hospital Universitario de Getafe, Getafe (A.A.F.), and Hospital Galdakao, Servicio Vasco de Salud-Osakidetza, Bizkaia (C.E.) - both in Spain
| | - François Maltais
- From Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec, QC (Y.L., F.S., S.B., F.M.), Centre Hospitalier Affilié Universitaire de Trois-Rivières, Trois-Rivières, QC (F.C.), Mount Sinai Hospital, McGill University (M.B.), and Montreal Chest Institute, Research Institute of the McGill University Health Centre and McGill University (J.B.), Montreal, Centre Intégré de Santé et de Services Sociaux de Laval, Laval, QC (B.P.), and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa (S.D.A.) - all in Canada; Hospital Pedro Hispano-Unidade Local de Saúde de Matosinhos, Matosinhos (P.S.), and Centro Hospitalar Vila Nova de Gaia-Espinho, Vila Nova de Gaia (M.G.) - both in Portugal; and Hospital Universitario de Getafe, Getafe (A.A.F.), and Hospital Galdakao, Servicio Vasco de Salud-Osakidetza, Bizkaia (C.E.) - both in Spain
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