Let’s read an article a month – October 2020

A cropped screenshot of the first page of the article.

Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.

Link to the article: https://erj.ersjournals.com/content/erj/56/2/1900495.full.pdf

Link to the blog post: https://respiratory.blog/lets-read-an-article-a-month-october-2020/

This month I found a great piece to share with you.  This one falls under original research and Tuberculosis. The objective of this paper is to “ to evaluate the EUROHIS-QOL tool for quantifying QOL in TB-affected people (patients and their contacts) versus healthy community controls, and to assess whether QOL at the time of diagnosis predicts treatment outcome, including survival. ” (p 2).  

Quality of life, tuberculosis and treatment outcome; a case-control and nested cohort study

By: Sumona Datta, Robert H. Gilman, Rosario Montoya, Luz Quevedo Cruz, Teresa Valencia, Doug Huff, Matthew J. Saunders, and Carlton A. Evans.

European Respiratory Journal 2020 56: 1900495;
DOI: 10.1183/13993003.00495-2019

Common abbreviations used in this post and article include Tuberculosis (TB), Quality of Life (QOL), and Activities of daily living (ADL).

Top 3 reasons why I enjoyed reading this article

  • It is a reminder of the impact of this disease.  Infects 10 million people annually with 1.5 million of them passing away because of it (p.2).
  • The authors express that the treatment of a condition is not just the identification and its treatment.  There are psychological and socioeconomic elements that also need to be considered. “It highlights the need to improve TB-related QOL, including the profound dissatisfaction with one’s self, relationships, global QOL, potentially worsened by TB-related distress, stigma and isolation” (p.10). 
    This article also supports the WHO recommendation “such as education and counseling to improve adherence and treatment completion” (p.11)
      
  • The authors were clear about the strengths and weaknesses of their article.
    (-) It was shared that QOL questionnaires are subjective (p12). 
    (+) The authors recognized the diversity in their study: “15 peri-urban shantytowns and 17 urban communities” (p.12).  

Personal thoughts and reflections

In this article, the World Health Organization’s The End TB Strategy was brought up. I located the page on the WHO’s website: https://www.who.int/tb/strategy/en/.
There is a vast amount of information available, including tabs for Strategy Pillars, Strategy Principles, Adapting the Strategy, Measuring Progress, and TB Elimination.  TB is not unique to other countries.  A 2017 Canadian government statistics showed that “4.9 per 100, 000 of the population” has active TB (https://www.canada.ca/en/public-health/services/diseases/tuberculosis/surveillance.html). I encourage you to take a moment and learn more about TB and its impact on people.

What are your thoughts on this article?  Do you have any experience treating patients with TB? 

Happy learning and reading!

Farzad Refahi

October 1st, 2020

https://respiratory.blog/lets-read-an-article-a-month-october-2020/

Let’s read an article a month – September 2020

Cropped screenshot of the first page of the article

Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.

Link to the article: https://doi.org/10.1016/j.chest.2020.03.052

Link to the blog post: https://respiratory.blog/lets-read-an-article-a-month-september-2020/

This month I found a great piece to share with you.  This one falls under Asthma and Original Research. The objective of this paper is to “examine the proportion of participants with negative BDR testing who had a positive MCT (and its predictors) result and characteristics of MCT, including effects of controller medication tapering and temporal variability (and predictors of MCT result change), and concordance between MCT and pulmonologist asthma diagnosis.” (1st page of the article, p.479)

Performance Characteristics of Spirometry With Negative Bronchodilator Response and Methacholine Challenge Testing and Implications for Asthma Diagnosis

By: Janannii Selvanathan BSc, Shawn D. Aaron MD, Jenna R. Sykes, MMath, Katherine L. Vandemheen MScN, J. Mark FitzGerald MD, Martha Ainslie MD, Catherine Lemière MD, Stephen K. Field MD, R. Andrew McIvor MD, Paul Hernandez MD, Irvin Mayers MD, Sunita Mulpuru MD, Gonzalo G. Alvarez MD, Smita Pakhale MD, Ranjeeta Mallick PhD, Louis-Philippe Boulet MD, Samir Gupta MD 

Edition: VOLUME 158, ISSUE 2, P479-490

Link to the article: https://doi.org/10.1016/j.chest.2020.03.052

Common abbreviations used in this study and blog post include PFT= pulmonary function testing, BDR= bronchodilator response and MCT= methacholine challenge testing (p.479).

Reasons you may find this article interesting:

  • It is on asthma which impacts many individuals in the population (“the third most common chronic disease in adults” p.480).
  • This article involves many recognisable and respectable experts.  The authors of this study have also taken part in many other research projects as well.  For my Canadian followers, many of these authors work in Canada!  I have been lucky enough to attend and enjoy talks, in person and virtually, by Dr. Shawn Aaron, Dr. Gonzalo G. Alvarez and Dr. Samir Gupta. 
  • There were follow up testings to assess the accuracy and consistency of the findings.  
  • This article is an excellent reminder for clinicians who order these tests to properly instructs patients to prepare for PFT and MCT.  Variability in MCT results based on seasons, environmental allergies, and impacts of other medications are important considerations.
  • This is a well-written article.  There is a nice flow that guides the reader through the method and the reasoning behind those decisions.  The results, conclusions and reflections are also nicely done.

My reflections and thoughts after reading this article

If you have almost no time to read the full article: Firstly, make time as this is a great article.  Secondly, if you still don’t have time then check out the ‘Take-home Point’ on the second page of the article where authors have included a quick summary and conclusions from this article (p.480).

I am worried that many patients may go undiagnosed or misdiagnosed.  Asthma can be properly managed;  Prolonged uncontrolled asthma can lead to more frequent exacerbations but also permanent changes to the lungs.  

As respiratory health community and excerpts, we need to educate clinicians and patients so they get tested.  Also, we need to raise the minimum standard so testing gets performed by trained individuals who have access to proper, accurate and well-maintained equipment. In addition, we have to make sure these clinicians know how to interpret and follow up with patients correctly.   For example, not to just rely on a pre-spirometry.  In case post-spirometry was done, we need to have knowledgeable clinicians who don’t automatically exclude asthma when no significant improvement was evident.  We need clinicians who know the importance of MCT, and organizations to support the costs related to the testing.  Besides, we want clinicians to understand that there are factors that could impact the MCT outcomes. 6.9% of participants who initially had a negative MCT end up having a positive reaction in the follow-up testing and 55.6% of those who initially had a positive MCT end up having a negative one in the follow-up testing ( Figure 2B, p.484).   On the bigger image, it is essential to understand that PFT and MCT are not the ultimate answers and they are just assessment tools that need to be tied with other clinical assessments and evidence. 

What are your thoughts on this?

Happy learning and reading!

Farzad Refahi

September 1st, 2020

https://respiratory.blog/lets-read-an-article-a-month-september-2020/

Let’s read an article a month – August 2020

Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.

This month I found a great piece under the categories of special communication and clinical review. The objective of this paper is to “formulate a consensus statement of recommendations on determination of BD/DNC based on review of the literature and expert opinion of a large multidisciplinary, international panel” p. E1. A common abbreviation used in this article and this post is Brain Death (BD) and Death by Neurologic Criteria (DNC).

Determination of Brain Death/Death by Neurologic Criteria The World Brain Death Project

by David M. Greer, MD, MA1; Sam D. Shemie, MD2,3; Ariane Lewis, MD4; et al .

Link to the article: https://ja.ma/2PlPK5p

Reasons you may find this article interesting:

  • It involves many experts from various organizations. The list of these organizations can be found under Methods on page E2 (World Federation of Intensive and Critical Care, World Federation of Pediatric Intensive and Critical Care Societies, World Federation of Neurology, World Federation of Neurosurgery, and the World Federation of Critical Care Nurses).
  • There are notes for the adult and Pediatric/Neonatal populations.
  • The list of ideas and recommendations are nicely organized under their own headings:
    • The Concept of BD/DNC (p. E4),
    • Minimal Clinical Criteria for Determination of BD/DNC (p. E5),
    • Apnea Testing (p. E6),
    • Number of Examinations (p. E8),
    • Pediatric/Neonatal BD/DNC (p.E9),
    • Determination of BD/DNC in Patients Requiring Extracorporeal Membrane Oxygenation (p. E11),
    • Determination of BD/DNC After Treatment With Targeted Temperature Management (p. E11),
    • Documentation of BD/DNC (p. E12),
    • Qualifications for and Education on Determination of BD/DNC (p. E13),
    • Religion and BD/DNC: Managing Requests to Forgo a BD/DNC EValuation or Continue Somatic Support After BD/DNC (p. E15), and
    • BD/DNC and the Law (p. E16).
  • The authors address sensitive issues such as religion and law with detailed notes in the supplementary online documents 12 and 13 that are found on JAMA’s website ( or the following links: Religion and Law).

As I was reading this article, I was reminded of the practices I was taught at my main training hospital. Many of the items on the protocol, from 6 years ago, meet the list mentioned in this article. Working in the greater Toronto area, with its great diversity, reminds me of one of the complexities involved in the determination and the care of BD/DNC patients.

Happy learning and reading!

Farzad Refahi
August 6th 2020

https://respiratory.blog/let’s-read-an-article-a-month-august-2020/

Let’s read an article a month – July, 2020

Screenshot of the first page of the printed article

Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.

This month I found a great case-study in Canadian Journal of Respiratory Therapy (CJRT) .

Helmet CPAP revisited in COVID-19 pneumonia: A case series

by Aniket S. Rali, Christopher Howard, Rachel Miller, Christopher K. Morgan, Dennis Mejia, John Sabo, James P. Herlihy, Sunjay R. Devarajan
Published online on July 21, 2020.
https://www.cjrt.ca/wp-content/uploads/cjrt-2020-019.pdf

Reasons you may find this article interesting:

  • It’s a nice and quick read.
  • We all have seen photos of Helmet CPAPs being used in Italy. If you haven’t had the chance to look into them, this article will provide you will some useful information!
  • It is published in a Canadian Journal so why not! Side note, the authors’ affiliations is in Houston, TX, USA.
  • The authors talk about three cases with various backgrounds and outcomes (pp. 1-2).
  • The authors discuss the benefits and shortcoming of Helmet CPAPs (e.g. “prevention of functional and neuromuscular complications”, minimization of aerosolization, requirement for high flow rates, difficulty with resting the head, and other details pp. 2-3).

This article shares the experience on only 3 cases, so set your expectations accordingly when picking up this article.

Happy learning and reading!

Farzad Refahi
July 24 2020
https://respiratory.blog/lets-read-an-article-a-month-july-2020/

PFT Re-opening

The joint statement from the Canadian Thoracic Society and Canadian Society of Respiratory Therapists on the re-opening of PFT labs during the pandemic is released.

I had the pleasure of working and learning from all the experts in this team!

A special thank you to Carolyn McCoy, Sanja Stanojevic, and Micah Kooperberg for their leadership!
The article can be found both on CSRT and CTS websites:

CSRT: https://www.csrt.com/wp-content/uploads/CTS_CSRT_COVID_PFT_Final-July12_2020.pdf

CTS: https://cts-sct.ca/wp-content/uploads/2020/07/CTS_CSRT_COVID_PFT_Final-July12_2020.pdf

This statement was released on July 12th, 2020, and was based on the available information and data at that time! Please follow the guidelines provided by your organization’s experts and infection control team.

Farzad Refahi
July 13, 2020
https://respiratory.blog/pft-reopening/