Let’s read an article a month – February 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 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/56/6/2000556?etoc

Link to the blog post: https://respiratory.blog/lets-read-an-article-a-month-february-2021/

This month I found a great piece to share with you.  This one is a prospective, open-label, single-arm study. The objective of this paper is to “evaluate the feasibility, efficacy and safety of metered cryospray therapy to treat patients with chronic bronchitis in COPD”  p3.


A prospective safety and feasibility study of metered cryospray for patients with chronic bronchitis in COPD

By Justin L. Garner, Tawimas Shaipanich, Jorine E. Hartman, Christopher M. Orton, Cielito Caneja, Karin Klooster, John Thornton, Don D. Sin, Dirk-Jan Slebos and Pallav L. Shah.

Eur Respir J 2020 56:2000556; published ahead of print 2020,

doi:10.1183/13993003.00556-2020
Link to the article: https://erj.ersjournals.com/content/56/6/2000556?etoc


Reasons I found this article interesting 

  • I didn’t know about metered cryospray therapy (MCS) and this article introduced me to its application in chronic bronchitis. Its intent is to “cryoablate abnormal epithelium and excessive mucous-producing goblet cells” p2.
  • The method of application is clearly explained in this article.  On page 3, the authors explain the three treatments and which lobes and airway pathways received the MCS therapy in each of those treatment sessions. 

While I am still unsure about the safety of this therapy until further research and improvements are done, I enjoyed learning about the unique approach.  I say this as the sample was only 34 subjects.  Also, “no definitive histological differences were observed between baseline and day 60 endobronchial biopsies” p10. 

If you were not aware of this therapy, this may be a good article for you to read. If you have applied this therapy in the past, I would love to hear about your thoughts and experiences.  Leave a comment and let me know!

Happy learning!

Farzad Refahi

Feb. 1st, 2021

https://respiratory.blog/lets-read-an-article-a-month-february-2021/

Let’s read an article a month – January 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 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

Link to the article: https://erj.ersjournals.com/content/56/5/2000260


Reasons you may find this article interesting 

  • 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.

Happy learning and reading!

Farzad Refahi

January 1st, 2021

Link to the blog post: https://respiratory.blog/lets-read-an-article-a-month-january-2021

Let’s read an article a month –December 2020

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.

Link to the article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3029208/

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

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

BMJ Case Rep. 2010; 2010: bcr1220092517.

Link to the article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3029208/pdf/bcr.12.2009.2517.pdf

Reasons you may find this article interesting 

  • 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.

Happy learning and reading!

Farzad Refahi

December 1st, 2020https://respiratory.blog/lets-read-an-article-a-month-december-2020/


Happy learning and reading!

Farzad Refahi
December 1st, 2020
https://respiratory.blog/lets-read-an-article-a-month-december-2020/

Think Like A Monk

Photo by Farzad Refahi

Recently I studied Think Like a Monk by Jay Shetty. I liked it so much that recently bought it as a birthday gift for someone.

I purchased this book as I am always looking for ways to improve to become a better version of myself (as a person and a clinician).

These are the top three reasons why I enjoyed this book:

  1. The guidelines provided in this book have helped me reduce decision fatigue. I select my clothes the night before. My mornings have become simpler, more peaceful and more focused on goals I have set myself. A more peaceful mind has given me a much bigger buffer to deal with my daily stressors.
  2. Our training involves many processes, systems and algorithms. These are in place to minimize errors. Despite all that, we make mistakes sometimes. Clinicians are humans after all! This book empowered me to be able to forgive myself. Now I feel lighter, I can trust myself more, and can further improve as a person and as a clinician.
  3. Jay Shetty has helped me to be more present. This has allowed me to enjoy life more fully. I can clean my teeth and actually focus on the task at hand instead of just brushing with my mind all over the place. Have you ever heard of the saying “drink your food and chew your drink”? Jay will go in more detail but I can tell you that now I try to enjoy my food no matter how simple it is. Being in the present has also enabled me to focus on my relationships with important people in my life, such as my wife, family members and patients.

If you want to study this recommended book, use this link. If you decided to purchase through this link, it will support me in to continue producing quality content on my blog.
Happy RTing!

Farzad Refahi
Nov. 07, 2020
https://respiratory.blog/think-like-a-monk/

Let’s read an article a month – November 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.

Link to the article: https://erj.ersjournals.com/content/erj/56/2/2000418.full.pdf

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

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

European Respiratory Journal 2020 56: 2000418; DOI: 10.1183/13993003.00418-2020 https://erj.ersjournals.com/content/56/2/2000418?etoc


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. 

Happy learning and reading!

Farzad Refahi

November 1st, 2020

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