Pen, spacer, mouth piece and filter, nose clips, Salbutamol on the desk.

Equipment is ready to go before calling in the next person! 
I don’t have many extra or other items on the countertops and desks. This is so things don’t get contaminated with droplet and airborne particles. Also, with  limited items on surfaces, it makes the clinical setting more organized and less distracting for patients.
What are some of your practices?

Farzad Refahi

September 9th, 2020


Respiratory therapy/care is a very rewarding profession. During my journey of becoming an RRT, I experienced joy, excitement, doubt, anxiety, fear, a sense of teamwork, courage, and a better appreciation for life. I have grown, improved, and evolved as a respiratory therapist. If you are curious about this field, feel free to get in touch with me. If you are a new SRT, welcome!

Farzad Refahi

September 2nd 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:

Link to the blog post:

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:

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

Learnings from the clinic that teachers can apply in the classroom.

Back To School graphics

Over the past few weeks, I have spoken to a number of teachers as they prepare for the upcoming school year.   Due to legal reasons, I need to clarify that this blog post is based on my personal thoughts and you should follow the recommendations and guidelines provided by your employer, ministry of labour, and the local and/or national health regulatory bodies. 
I have no comments about how to safely plan, organize and operate a classroom.  However, my experiences as a clinician working in the hospital, and the use of PPE, may be helpful for teachers.  As a respiratory therapist at a Pulmonary Function lab, I coach patients as they perform breathing tests.  Due to the nature of this diagnostic testing, I need to take the appropriate precautions so I not only protect myself, but also the people who are coming for testing.  I am going to focus on what I wear to protect myself.  A surgical mask, a face shield, a gown, and a pair of gloves.  I am guessing that teachers are asked to wear cotton masks, or surgical masks if available.  If you have access to a face shield, it would be a great idea.  Make sure it curves around to cover your face from different angles.  Also, it would be helpful if the shield covers not only the eyes but extends to cover over the mask.   Have a bottle of hand sanitizer nearby to clean your hands as needed, especially before and after touching your mask or face shield.  While I have access to scrubs and gowns, you may be more limited.  One idea is to bring a change of clothes to work so you can change at school.  The clothes that you have worn during the day can be placed inside a plastic bag and transported directly into the laundry machine or basket (depending on whatever system you have in place).  
Since I do not have access to a classroom or teaching experience, these recommendations are based on my conversations with a few teachers.  It is not a perfect system. You need to look at things case by case.  As always, follow the best practices put in place by your employer and local/national health regulatory organizations to protect yourself.

If you found this helpful, please consider sharing it with others.

Be safe.

Farzad Refahi
August 29, 2020