Respiratory Therapy

Let’s read an article a month – May 2022

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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. I share the title and associated link with my followers to encourage clinicians to read more articles, stay up to date, and continue to grow.

The objective of this month’s paper is to “to conduct a nationwide cohort study of the effect of exposure to immunosuppressants on the risk of hospital admission, intensive care unit (ICU) admission and death among all SARS-CoV-2 test-positive patients in Denmark from February 2020 to October 2020” (p2).

The effect of immunosuppressants on the prognosis of SARS-CoV-2 infection

By: Daniel Ward, Sanne Gørtz, Martin Thomson Ernst, Nynne Nyboe Andersen, Susanne K. Kjær, Jesper Hallas, Steffen Christensen, Christian Fynbo Christiansen, Simone Bastrup Israelsen, Thomas Benfield, Anton Pottegård, and Tine Jess.

European Respiratory Journal 2022 59: 2100769; DOI: 10.1183/13993003.00769-2021

Link to the article: https://erj.ersjournals.com/content/erj/59/4/2100769.full.pdf

Just a few quotes from the article to get you thinking and started:

“A composite immunosuppressant exposure was associated with a significantly increased risk of death, which was mainly driven by a doubling of risk associated with systemic glucocorticoids. Glucocorticoids were also associated with a 34% increased risk of hospital admission, while the risk of ICU admission was not significantly increased”.

Page 6

 “Glucocorticoids were associated with increased risk of ICU admission or death in patients with comorbid inflammatory bowel diseases; glucocorticoids were associated with greater risk of hospital admission in patients with comorbid rheumatic diseases”.

Page 6

“While other pharmacological interventions remain relevant research candidates, evidence from multiple sources indicates the importance of glucocorticoids on prognosis, the effect of which may depend on timing in the disease course. Our findings that other immunosuppressants were not significantly associated with severe outcomes are tentative, but in context they support the continued use of steroid-sparing immunosuppressants for a broad patient population with ongoing healthcare needs during the pandemic.” (pp 7-8).

Pages 7 to 8

Happy reading and learning,

Farzad Refahi

March 27, 2022

https://respiratory.blog/lets-read-an-article-a-month-may-2022/

Let’s read an article a month – April 2022

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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. I share the title and associated link with my followers to encourage clinicians to read more articles, stay up to date, and continue to grow.

The objective of this month’s paper is to  “discover whether there is any difference for Trelegy as compared with multiple inhalers use for adherence, symptoms, medication beliefs, and medication attitudes” (p45).

Chronic obstructive pulmonary disease patients’ experience using Trelegy as compared with other inhalers

By Hyfaa Mashaal, Joshua Fogel, Najia Sayedy, Ruchi Jalota Sahota and Jagadish Akella.

Can J Respir Ther Vol 58. Published online at https://www.cjrt.ca on 25 March 2022

Link to the article: https://www.cjrt.ca/wp-content/uploads/cjrt-2021-041.pdf

A few notes about this article

  • This article provides a quick review of COPD and Trelegy ( Fluticasone furotate, umeclidinium and vilanterol) (pp 44-45).
  • I was surprised to see that there was an increased reported symptoms with Trelegy, and no difference with inhaler adherence when compared to the other medication groups (p 46).  
  • Very important to mention that this is a small sample study. The authors do state that different findings were observed with larger sample size studies;  Check out number 27 and 28 items under the reference list:
    • 27. Yu AP, Guérin A, Ponce de Leon D, et al. Therapy persistence and adherence in patients with chronic obstructive pulmonary disease: multiple versus single long-acting maintenance inhalers. J Med Econ 2011;14(4):486–96. doi: 10.3111/13696998.2011.594123.
    • 28. Brandstetter S, Finger T, Fischer W, et al. Differences in medication adherence are associated with beliefs about medicines in asthma and COPD. Clin Transl Allergy 2017;7:39. Doi: 10.1186/s13601- 017-0175-6. 

Happy reading and learning,

Farzad Refahi

April 1st, 2022

https://respiratory.blog/lets-read-an-article-a-month-april-2022/

Let’s read an article a month – March 2022

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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. I share the title and associated link with my followers to encourage clinicians to read more articles, stay up to date, and continue to grow.

The objective of this month’s paper is to [conduct a comprehensive systematic review, critical appraisal and meta-analysis of all prognostic factories in patients with COVID-19] (p2).

Prognostic factors for adverse outcomes in patients with COVID-19: a field-wide systematic review and meta-analysis

By Vanesa Bellou, Ioanna Tzoulaki, Maarten van Smeden, Karel G.M. Moons, Evangelos Evangelou and Lazaros Belbasis

European Respiratory Journal 2022 59: 2002964; DOI: 10.1183/13993003.02964-2020 https://erj.ersjournals.com/content/59/2/2002964

Link to the article: https://erj.ersjournals.com/content/erj/59/2/2002964.full.pdf

The reasons I found this article interesting

  • The authors emphasized the importance of “adequate and transparent reporting of methodology and findings in future studies to improve the applicability of the evidence” (p8).   More on that under the ‘Recommendations and policy implications’ on page eight. 
  • This study address many prognostic factors and narrow down to a few such as age, sex and smoking history (p7).
  • The authors further discuss some of the predictors such as dyspnea and hospitality rate, oxygen saturation and mortality, and smoking and clinical deterioration (p7).  
  • Also, some of the medications and their prognostic factors were highlighted.  E.g. ACEi, ARBs, immunosuppressive medications etc. 

Happy reading and learning,

Farzad Refahi

March 2, 2022

Let’s read an article a month – March 2022

Let’s read an article a month – February 2022

by
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. I share the title and associated link with my followers to encourage clinicians to read more articles, stay up to date, and continue to grow.
 
This month I found an interesting piece to share with you.  This one falls under the innovation category and is about a product called CleanSweep.  The objective of this paper is to introduce CleanSweep and assess “whether the CleanSweep suction catheter is more efficient for secretion removal than the standard suction catheter” (p.138).  To give a quick description, CleanSweep is a “closed-system suctioning device with an integrated inflatable balloon at its tip. … The balloon is not designed to be inflated with the catheter beyond the distal end of the ETT, and it is only inflated during catheter withdrawal thus “sweeping” the secretions off the interior wall of the ETT” (p.138)
Before you continue, I would like to add a quick disclaimer that this is not an endorsement or a sponsored blog post. Please continue to use products that have been approved by your employer.

Evaluation of a novel endotracheal tube suctioning system incorporating an inflatable sweeper 

By John D. Davies, MA, RRT, Yuh Chin Huang, MD, MHS, and Neil R. MacIntyre, MD.

Can J Respir Ther 2021;57:138–142. doi: 10.29390/cjrt-2021-02

Link to the article: https://www.cjrt.ca/wp-content/uploads/cjrt-2021-026.pdf

Reasons I found this article interesting

  • The device has a physical “sweeping” method for removing secretions in the ETT versus just a suction method.
  • It is a closed suction system and the valve provides three options of ‘locked, suction only mode and suction and balloon mode (p139). 
  • It was published on CJRT, a publication I trust.
  • The authors were clear and transparent about their conflict of interests, on page 141, and also clear about the limitations of their study:
    • “Neither our study nor other studies on mechanical ETT cleaners have been designed to be long enough nor large enough to demonstrate improved clinical outcomes linked to improved secretion removal. To do this will require large expensive randomized controlled trials following many patients over long periods assessing such outcomes as hospital length of stay and even mortality. “ (p141)

Happy reading and learning,

Farzad Refahi

Feb. 6, 2022

https://respiratory.blog/lets-read-an-article-a-month-february-2022/