CRE Renewal

Photo of the CRE certificate

Today I received the renewal confirmation for my Certified Respiratory Educator (CRE). A quick shoutout to the Canadian Network for Respiratory Care (CNRC). Also, a big thank you to Cheryl Connors for helping me with this renewal and answering all my questions! As I reflected in a recent post, proper diagnosis of patients requires skilled clinicians and supportive organizations. Meeting the requirements for CRE is one way to raise the standards. Learn more at

Farzad Refahi

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

Let’s read an article a month– June 2020

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 month I found a great article on June 20th, 2020. I spent a few days with it, and now I share it with you.

Predictors of progression in systemic sclerosis patients with interstitial lung disease

  Oliver Distler, Shervin Assassi, Vincent Cottin, Maurizio Cutolo, Sonye

  K. Danoff, Christopher P. Denton, Jörg H.W. Distler, Anna-Maria

  Hoffmann-Vold, Sindhu R. Johnson, Ulf Müller Ladner, Vanessa Smith,

  Elizabeth R. Volkmann and Toby M. Maher

  Eur Respir J 2020 55:1902026; published ahead of print 2020,

  doi:10.1183/13993003.02026-2019 OPEN ACCESS

Top 3 reasons why I enjoyed reading this article:

-A well-written review of key pathways implicated in systemic sclerosis-associated interstitial lung disease (pp2-4 ). Inflammatory pathways are complex and while I enjoy reviewing them, I never tend to be able to memorize them. There is also a nice diagram that goes along with the description (i.e. Figure 1 on page 3).  

-An insider and expert view of the challenges involved with the disease diagnosis. When it comes to interstitial lung disease, there is so much for me to read and learn about. I am involved with the Pulmonary Diagnostic side of respiratory care, and mostly I see patients with confirmed diagnosis of interstitial lung disease (usually in the later stages). Occasionally I do see patients who have some indications in an imaging test, CXR or Chest-CT, and are visiting the PFT lab for additional information. “One potential barrier to diagnosis a lack of awareness within primary care of SSc, which can lead to late referrals” (p.5). 

-If you are involved with pulmonary diagnostics, you will enjoy this article as there are references to lung function values (with some references to 6MWTs) (found on pp 7-8).

Happy Learning!

Farzad Refahi
June 25, 2020’s-read-an-article-a-month–june-2020/

Let’s read an article a month – May 30, 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.

This month I found a great editorial post on May 15th, 2020. I spent a few days with it, and now I share it with you.

Will children reveal their secret? The coronavirus dilemma
Luca Cristiani, Enrica Mancino, Luigi Matera, Raffaella Nenna, Alessandra Pierangeli, Carolina Scagnolari, Fabio Midulla
European Respiratory Journal 2020
55: 2000749; DOI: 10.1183/13993003.00749-2020

You will be presented by suggestions, ideas and theories such as high angiotensin-converting enzyme 2 (ACE2) receptor concentration, innate immune response as both protective and a destructive mechanism, and constitutional elevated lymphocytes.

Happy Learning!

Farzad Refahi

Lynard Higoy

Lynard Higoy is a Registered Respiratory Therapist (RRT) whose presentation I attended at the 2019 Canadian Society of Respiratory Therapists’ (CSRT) annual conference.  He was energetic and passionate about the topics he presented. He works as a community RT, covering a vast area. His role greatly depends on interprofessional collaboration.  I wanted to find out more about his work, and the work of independent or community RTs, so I connected with him over many emails. Thank you Lynard for sharing your perspective.  Also, a big thank you to CSRT for exposing me to many amazing speakers at your conferences, such as Lynard.

Please join me as I interview Lynard:

I have a great interest in hearing about the spark or series of events that shape people’s decision to study respiratory therapy.  How did you find out about the Respiratory Therapy field? Why did you choose to study RT?

It was pure accidental!  I did not get in to the pharmacy program so I went to U of M’s school of Med Rehab open house. My original plan was to attend the open house for the physiotherapy program. Then I remember seeing different types of ventilators, Intubation kits, Jackson-reese and a pig lung.   It was love at first sight and the rest was history.

You have been practicing for some time now.  Can you share with us some of your memorable roles so far?

First one is when I was invited to be a speaker in the previous CSRT conference held in Niagara Falls. And also, when I was part of the Deer Lodge Centre Pulmonary Rehab Team In Winnipeg that won the 2014 Commitment to Care and Service Award, Collaborative Team Initiative.

I love the rural practice because you can spread your wings and maximize your scope of practice! Everyday is a different challenge! I may not be flying with STARS or part of the transport team, I may not be assisting with intubation in the trauma room but the acknowledgment and appreciation of my clients made me think that I’m a very valuable asset in the community. Since I’m the only respiratory therapist in Vegreville , Two Hills and Lamont employed by Alberta Health services, I have the feeling of accomplishment whenever doctors value my recommendation. The most memorable in my role as a community RT is when I was in doing some grocery shopping and my former pulmonary rehab client approached me with her daughter and told her “ This is the guy that helped me breathe better! Without him and his breathe easy program I won’t be here.”  that is the most memorable moment for me so far as a community RT.

I think most of us go through the RT program thinking of the acute care aspect; Appreciating the immediate life and death decision making that can impact patients. With experience and exposure to patient care, we realize that there are multiple dimensions to patient care.  Each role or setting is unique and vital to patient care. Seems like you have had the opportunity to experience and contribute to patient care in various settings. I have a quick question about the location. How did you end up covering Vegreville, Two Hills and Lamont ? Are you originally from that area or moved there for work?   If you moved there for work, what contributed to that decision?

So I’m originally from Manitoba (U of M alumnus) and practiced there for 3 years. I followed my heart and moved to Alberta to be with back with my then girlfriend and now my Fiancée. It was a challenge to find a fulltime job in Edmonton especially as a community care RRT. I got a job offer in the private sector (Lakeland Respiratory) in Vegreville which is approximately 100 km east of Edmonton. The selling factor for this job was I’m going to run a pulmonary rehab in the town hospital so I said yes and took the offer. Then after 8 months my current position opened and I applied for it. I been in this position for 2 years now and liking it every single day.   : )

Because of my current and previous work settings, I have had in person RT support within seconds to minutes away.  Your experience has been different. Can you tell me about the planning, consideration, thinking framework, challenges and opportunities when working by yourself?  

My piece of advice when you are in rural practice and working by yourself….. Don’t be scared to ask for help! I think this is when Inter professional collaboration comes in as a very important tool to be successful. I don’t work in my own silo anymore, I welcome ideas and expertise from other healthcare professionals such as OT, Physios, Exercise Specialist. Recreation, Social Work, Therapy assistants, Sleep Language Pathologists, Nurses and Admin assistants. At the end of the day, we all wanted one goal and that is to improve the well-being of our clients. My CSRT presentation “Screening for Dysphagia in COPD assessments” was a product of collaborating with our community SLP to reduce the rates of COPD exacerbations due to aspiration Pneumonia. The camaraderie of healthcare professionals working in rural areas are something that I admire, they are always there to help you all the time.  

Also, working alone makes you realized how your research methodology course back when you were an undergrad is not to be discarded. Consider research journals as your friend if you have to work alone. If doctors asked me a respiratory question and I don’t know the answer, I’ll either contact my professional practice lead or search the Web for evidence-based practice research that can support my ideas.    

Interprofessional efforts, communication, collaboration and trust are important part of patient care, as you have already mentioned. Was that the culture in place when you began working there, or was it something that had to be worked on?

The answer is both! The culture was in place before I started working here but just like every other worksite, you have to earn your keep. You have to prove that you are trustworthy, easygoing,  that you value not only your job but the rest of the team and that you are not just there for the money but rather to always put your heart in what you do.

You mentioned articles and journals as one of your references.  Do you have any favourite resources that you can share with us?  Also, how do you support your growth? What’s your approach to continuing education? Beside teaching patients and their families, do you get the opportunity/train other healthcare providers?

Yes, The CJRT, Pubmed, Science direct, and others. I’m a big fan of everything as long as it came from a reliable source. I totally support professional growth and continuing education. I’m currently pursuing my post baccalaureate diploma in Leadership and Management through Athabasca University, Faculty of Business which is one of my prerequisites for the MBA program. If time permits, I attend workshops, read journals, webinars and seminars that will help me with my everyday practice.

Yes, because of the nature of my work since I’m the only Community RT in my rural area, I serve as a respiratory clinical resource and I cross train other healthcare disciplines with RT work such as oxygen therapy, emergency trach changes, lung volume recruitment strategies and many more.

What’s your approach to teaching students and staff?   What advice you have for RTs to be better preceptors? Also…what advice do you have for students to maximize their opportunity to grow and learn?  In your opinion, what are some qualities that makes one a quality RT?

My advice, don’t be a smart aleck! I’m a big advocate of transformational leadership in healthcare. In order for them to succeed, you have to motivate them, inspire them and let them grow away from judgment and intimidation. Also, being a role model for students in order to raise interest and understanding with the stream that you work. Allow them to know their strengths and weaknesses so they would be able to self-reflect on their performance. You know you did a good job if one day they came back and say.. Hey you’re my RT hero and I’m following your footsteps. A quality to say this RT is the best?? I would say……. Being able to look beyond self-interest to the common good.

What has attracted you to the Leadership and Management? What made you decide to pursue MBA?

Management is where I have wanted to be since I was an RT student. I know as a community RT I am helping respiratory clients with my respiratory expertise such as smoking cessation, pulmonary rehab etc., but I think I want to work and be a catalyst for change in the management/senior leadership level. In this level, I would be able to work upstream and be involved in health policies that can substantially improve not only the respiratory health of Canadians but rather the whole Canadian healthcare system.   

How do you see the future of our field?

I want to see more RRTs stepping into management and senior leadership roles. I mean not just respiratory therapy managers but management roles that have been dominated by other healthcare professionals. With our RRT skills such as juggling multiple tasks, time management, grace under pressure and resiliency, I believe we would be successful in these roles.

Outside of work, what do you enjoy doing? What are your hobbies?

If I’m not at work, either you’ll see me at the gym or at the lake. I like working out pretty much every day. I love both fishing and ice fishing. I also love to explore the world with my fiancée.

Any final words?

Keep the Respiratory Therapy Passion burning!

Thank you Lynard for opening my eyes to more unique perspectives.  Also, thank you for your dedication to our field and the interprofessional team that looks after the patients.  By sharing your views and experiences, you have helped to further represent our field and the work of respiratory therapists across all the healthcare settings.  Congratulations on your engagement and good luck with your studies. I expect that the RT community will hear more about your achievements in near future.

A special thank you to the followers of this blog.  Thank you for supporting a stronger RT presence!

Lynard Higoy

Farzad Refahi