Let’s read an article a month – January 2022

The cropped screenshot of the first page of the article. It also includes the URL or link to the article.

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

The coexistence of asthma and COPD: risk factors, clinical history and lung function trajectories

By: Alessandro Marcon, Francesca Locatelli, Shyamali C. Dharmage, Cecilie Svanes, Joachim Heinrich, Bénédicte Leynaert, Peter Burney, Angelo Corsico, Gulser Caliskan, Lucia Calciano, Thorarinn Gislason, Christer Janson, Deborah Jarvis, Rain Jõgi, Theodore Lytras, Andrei Malinovschi, Nicole Probst-Hensch, Kjell Toren, Lidia Casas, Giuseppe Verlato, Judith Garcia-Aymerich, and Simone Accordini on behalf of the Ageing Lungs in European Cohorts (ALEC) study

European Respiratory Journal 2021 58: 2004656; DOI: 10.1183/13993003.04656-2020

Link to the article: https://erj.ersjournals.com/content/erj/58/5/2004656.full.pdf

The reasons I found this article interesting 

A detailed study with around 20 years of medical history. A large number of individuals [14864, 9251 and 6122, respectively in ECRHS I, II and III who underwent clinical examinations, from 23 centres] (p4).  Useful observations were presented based on past asthma, current asthma, asthma + COPD, and COPD alone. A recommended article to students, new RRTs and even experienced clinicians.  There are many results, findings and conclusions that I cannot cover in a post. As always, I recommend that you read the full article for yourself.

”Lung function decline for subjects with asthma + COPD could have been mitigated by long-term anti-inflammatory treatment. “ (p9).

“The coexistence of asthma and COPD  seems to be a form of severe asthma with severe asthma with origins early in life, as opposed to COPD alone, which is more linked to adult exposures.”  (p10).

”…COPD without concomitant features of asthma seems predominantly linked to adult-life toxic inhalant exposures.  Exposure avoidance (e.g. through smoking cessation and reduction of pollution exposure in occupational settings) may be particularly beneficial against the development of the “pure COPD” phenotype…” (p10).

Happy reading and learning.

Farzad Refahi

January 01, 2022

Link to the blog post: https://respiratory.blog/lets-read-an-article-a-month-January-2022/

Clinical Educator Certificate

“This course has allowed me to understand myself better and shed light on my strengths and weaknesses as a facilitator.  I have also learned about elements that make one a good educator. This knowledge has allowed me to identify my past great preceptors, and look up to them as my role models.  In addition, this course has taught me various coaching approaches, frameworks and tools to implement at work with my students.”

October 22, 2021

The above quote is the summary paragraph from my final assignment submitted for the Clinical Educator certificate provided by The Michener Institute at UHN (PD-813). I greatly value the systematic, useful and real-life coaching and feedback strategies and techniques taught in this class. 

Why am I posting about it? 

I wanted to bring attention to the importance of supporting students and how important it is to do it right.  By posting about this I hope to nudge and remind those who were planning to attain additional training in this topic. 

What was not mentioned in the final assignment is the fact that my father unexpectedly passed away from a massive heart attack 3 days after I enrolled in the course.  There was no way that I would have had the time, priority or concentration to complete the course at that time.  I am thankful to the Continuing Education team at The Michener Institute at UHN who accommodated me by extending the deadline.   Months later I began studying the content again.  Having a newborn made things challenging once again, but I managed to enjoy and complete the course.  If I was able to complete this certificate under my circumstances,  I am sure you can as well. 

Farzad Refahi

Dec 4th, 2021

Let’s read an article a month – December 2021

The cropped screenshot of the first page of the article. It also includes the URL or link to the article.

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

This month’s paper tries to “determine students’ perceived self-efficacy, outcome expectations, barriers, and support to attend a Master of Science in Respiratory Care program” p154.

Students’ perceived self-efficacy, expectations, barriers, and support in enrolling in a master’s degree program in respiratory care

By: Vincent Showalter, MSRC, RRT-RCP, Chris Russian, PhD, RRT, RRT-NPS, RPSGT, RST, FAARC, Joshua Gonzales, DHSc RRT-NPS, RRT-SDS, and Arzu Ari, PhD, RRT, PT, CPFT, FAARC, FCCP  

Canadian Journal of Respiratory Therapy (CJRT) Published online November 29, 2021 

Link to the article: https://www.cjrt.ca/wp-content/uploads/cjrt2021-020.pdf

I like and support the idea of respiratory therapists growing as individuals and, in turn, improving the field of respiratory therapy.  In my mind, RTs graduate, work for some time and then they may acquire their masters if they are seeking new challenges or a new role.  For example, I know a few RTs who after a few years decided to become Anesthesia Assistants to further specialize in airway management or because they preferred ‘office’ working hours. Some RTs naturally work their way to the managerial role while some decide to study a master’s program to more actively land in managerial or leadership roles.   This article presented to me that there are students who are already planning ahead. Why I didn’t think about that? Perhaps I over-emphasized on barriers such as limitations of money and time.  Maybe it is my thinking that students need to work in the role for about a year to consolidate the learned knowledge and skills from their school training.  Of course, it is a possible path. I just didn’t consider it.  I even know successful and intelligent RTs who studied respiratory therapy after completing their Master’s degree.

Many barriers may prevent students to consider a master’s degree.  An interesting consideration is a comfort in one’s research knowledge. I could see that perspective.  As a practising RT, with a Hons BSc, who tries to read an article a month, I still see an ocean of research related terms, concepts and information to educate myself about. The authors had noted “our results indicate undergraduate research self-efficacy could be improved for the current participants by ensuring early exposure and development of even basic or introductory research abilities and academic writing skills” p157. The authors discuss other solutions that can improve and encourage further education of SRTs.  As always, please take the time to read the article as I cannot touch on all the data and results from the articles.

Happy reading and learning,

Farzad Refahi

December 4th, 2021


Let’s read an article a month – November 2021

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 title and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.

This paper investigated “causal associations to estimate the causal effects of fathers’ smoking initiation in prepuberty (generation G1) and grandmothers’ smoking in pregnancy (generation G0) on offspring’s lung function (generation G2) within the paternal line” (p2).

Prenatal and prepubertal exposures to tobacco smoke in men may cause lower lung function in future offspring: a three-generation study using a causal modelling approach

By: Simone Accordini, Lucia Calciano, Ane Johannessen, Bryndis Benediktsdóttir, Randi Jacobsen Bertelsen, Lennart Bråbäck, Shyamali C. Dharmage, Bertil Forsberg, Francisco Gómez Real, John W. Holloway, Mathias Holm, Christer Janson, Nils O. Jõgi, Rain Jõgi, Andrei Malinovschi, Alessandro Marcon, Jesús Martínez-Moratalla Rovira, José Luis Sánchez-Ramos, Vivi Schlünssen, Kjell Torén, Deborah Jarvis, and Cecilie Svanes.

European Respiratory Journal 2021 58: 2002791; DOI: 10.1183/13993003.02791-2020 

Link to the article: https://erj.ersjournals.com/content/58/4/2002791?etoc

Reasons you may find this article interesting:

  • Perhaps not surprising: “Fathers’ smoking initiation in prepuberty was associated with an increased risk for nonallergic asthma in offspring” (p9).
  • Interesting finding from the analyses of the collected data:  “fathers’ overweight onset before 15 years of age had a direct effect on nonallergic asthma in the next generation” (p9).
  • Lastly, check out one of their conclusions:

“Men who initiated smoking before 15 years of age may have offspring with lower lung function compared with men who had never smoked. Grandmothers’smoking in pregnancy may have a negative impact on their sons’ lung function, an effect that could be carried over to their grandchildren. These results support the concept that lifestyle-related exposures in male prepuberty and in pregnancy influence the health of future generations. ”


As always, I encourage you to read the article to learn about all the details.

Happy reading and learning,

Farzad Refahi

November 5, 2021


Let’s read an article a month – October 2021

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 title and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.

The objective of this paper is to “evaluate respiratory function 4 months after diagnosis in patients who survive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the difference between patients with or without initial lung involvement” (p1).

Medium-term impact of COVID-19 on pulmonary function, functional capacity and quality of life

By: Fabio Anastasio, Sarah Barbuto, Elisa Scarnecchia, Paolo Cosma, Alessandro Fugagnoli, Giulio Rossi, Mirco Parravicini, and Pierpaolo Parravicini.

European Respiratory Journal 2021 58: 2004015; DOI: 10.1183/13993003.04015-2020

Link to the article: https://erj.ersjournals.com/content/58/3/2004015?etoc

Reasons I liked this article

  • The age range for this study was 18 to 80 years old (p2).  Also, a detailed assessment was attained from the subjects, of course post infection, which included SF-12 and IPAQ questionnaires, 6MWT,  and a comprehensive PFT (p2).
  • This study shows “a reduction of respiratory function and exercise capacity secondary to SARS-CoV-2 pneumonia, mostly in patients who developed ARDS during the acute phase” (p9). 
  • The authors suggest that the data may indicate that “respiratory evaluation does not appear to be necessary in patients without pneumonia and without symptoms. DLCO, 6MWT and plethysmography could be avoided in patients without pneumonia, performing only spirometry with bronchodilator responsiveness testing…In contrast, in patients who developed ARDS, DLCO, 6MWT and complete spirometry could uncover presence of residual pulmonary and functional impairment, with need for respiratory rehabilitation and gradual physical activity “ (p10). 

As always, take the time to read this study. There is a lot of information and data covered in the study which I cannot cover here.  As a disclaimer, continue to follow guidelines for ordering PFTs and providing patient care as recommended by your employer and regulatory body.

Happy reading and learning,

Farzad Refahi

October 6th, 2021