The cropped screenshot of the first page of the article. It also includes the URL or link to 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.
This month I found a great piece to share with you. This one falls under asthma and biologic treatments. The objective of this paper is to “ [describe] the effects of alarmins and [discuss] the potential role of anti-alarmins in the context of existing biologics “ (p1 ).
Anti-alarmins in asthma: targeting the airway epithelium with next-generation biologics
By: C. M. Porsbjerg, A. Sverrild, C. M. Lloyd, A. N. Menzies-Gow and E. H. Bel
European Respiratory Journal 2020 56: 2000260; DOI: 10.1183/13993003.00260-2020
Great review of inflammatory pathways in asthma (beginning on page 2).
An in-depth discussion of targeting the alarmins using biological therapies (beginning on page 6).
Useful visualization to help put things in perspective ( Figure 1 on page 3 and Figure 2 on page 7).
While I recommend you check out this article, I need to give you a heads-up. If you are not as familiar with asthma inflammatory pathways, you may need to dedicate more time to this piece. Personally, I had to come back to it a few times.
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 to share with you. This one is a case study. The authors of this paper have tried to “report a case of a middle-aged lady who was initially misdiagnosed as having acute asthma after brief tracheal intubation” (p.1).
Tracheal stenosis mimicking severe acute asthma
Ali Bin Sarwar Zubairi, Babar Dildar, Shahid Javed Husain and Mohammad Faisal Khan
Tracheal stenosis post intubation is rare but it can happen. To make the case even rarer, this lady was intubated for less than 48 hours.
This article includes images that are interesting to view. Two are from the bronchoscopy view of the narrowing (Figures 1 and 2. on pages 2 and 3). The other image is a CT scan of the neck which shows the tracheal stenosis (Figure 3 page 4). I greatly enjoyed seeing the visual aspect of this case!
I enjoyed reading the differential diagnosis from her ER visit: “New-onset severe asthma, bilateral vocal-cord paralysis, foreign-body aspiration, tracheal tumours, post-intubation/tracheostomy tracheal stricture, Wegener’s granulomatosis, obstruction of trachea or mainstem bronchi due to external compression from mediastinal tumours or adenopathy” (p.2).
I encourage you to read this interesting and short case study as the authors also review the potential reasons why this stenosis occurred and also the potential treatment options.
If you enjoyed this article, consider liking this blog post and sharing it with others who may benefit from it.
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 to share with you. This one falls under COPD. The objective of this paper is to “ assess the role of sensitisation on clinical outcomes in COPD using a large Asian cohort recruited across three countries, and, for the first time, assess the influence of environmental allergen exposure using a metagenomics sequencing approach.” (p2).
Environmental fungal sensitisation associates with poorer clinical outcomes in COPD
By: Pei Yee Tiew, Fanny Wai San Ko, Sze Lei Pang, Sri Anusha Matta, Yang Yie Sio, Mau Ern Poh, Kenny J.X. Lau, Micheál Mac Aogáin, Tavleen Kaur Jaggi, Fransiskus Xaverius Ivan, Nicolas E. Gaultier, Akira Uchida, Daniela I. Drautz-Moses, Huiying Xu, Mariko Siyue Koh, David Shu Cheong Hui, Augustine Tee, John Arputhan Abisheganaden, Stephan C. Schuster, Fook Tim Chew, and Sanjay H. Chotirmall
Commonly used abbreviations in this article include home dust mite (HDM) and Global Initiative for Chronic Obstructive Lung Disease (GOLD).
When it comes to restriction to environmental sensitivities, asthma is the first in my mind. This article reminded me that people with COPD may also benefit from the identification of their sensitivities and in turn limiting their exposure to them.
Top 3 Reasons why I enjoyed this article
>> Individual care. There are so many variances in personal experiences with diseases. This article is an example of this. “Sensitisation responses and their respective allergen profiles exhibit geographical variation, largely determined by climate, environment, genetics, cultural and social practices and account, at least in part, for the variable reports in the COPD literature“ (p9).
>> I value the effort by these authors to exclude asthma/ACOS patients as it increases the value and accuracy of their study.
>> How caring for patients, especially those prone to exacerbations may take indoor and outdoor irritants into consideration: “… we observe that the outdoor and indoor (home) environment serves as an important reservoir of fungal allergen exposure translating to sensitisation responses to outdoor air fungi in a subgroup of COPD patients. Indoor (home) environments demonstrating a higher fungal allergen burden associate with greater COPD symptoms and poorer lung function illustrating the importance of environmental exposures on COPD outcomes.” (p9)
This article is a great reminder of how we need to look at each patient as a person with a unique circumstance, genes, environments and living space. With a better understanding of the impact of fungal allergen exposure in some patients with COPD, clinicians have more variables to assess and monitor.
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 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?
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.
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
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.
