BACKGROUND The long-term pulmonary sequelae of COVID-19 are incompletely characterized. Early studies using conventional pulmonary function tests (PFT) identified a predominant restrictive defect that improved over time despite persistent respiratory symptoms. Respiratory oscillometry is a different PFT modality that provides highly sensitive information regarding lung mechanics to complement spirometry. This cross-sectional study aims to characterize spirometry and oscillometry at 6 months post-COVID-19 in patients with mild-moderate acute infections, and assess their associations with respiratory symptoms and functional status using the 6-min walk test (6MWT).METHODS Patients in the Canadian COVID-19 Longitudinal Cohort Study were enrolled between Aug 2020-Mar 2022 for further evaluation with oscillometry and spirometry. Complete data, including 6MWT and Borg Dyspnea scale assessment, at 6 months post-COVID-19 infection were available in 213 of 549 patients for analysis. Patients admitted to the intensive care unit were excluded from analysis.RESULTS The cohort (61.0% women, median age; 44.9 years) comprised of 83.1% outpatients and 16.9% hospitalized ward patients. The overall prevalence of respiratory symptoms was high (54.3%) and similar in the 2 groups. Overall, 42.7% of all patients had abnormal oscillometry while only 16.6% had abnormal spirometry. Notably, 29.8% of patients with normal spirometry had abnormal oscillometry. Oscillometry was associated with the 6MWT, total respiratory symptoms and the change in the Borg dyspnea score pre- and post-6MWT(Delta Borg-dyspnea) in contrast to spirometry where little association was found.CONCLUSIONS Oscillometry detected abnormal lung mechanics that were associated with functional impairment and respiratory symptoms but indiscernible by spirometry. CONTEXTE Les s & eacute;quelles pulmonaires & agrave; long terme de la COVID-19 demeurent incompl & egrave;tement caract & eacute;ris & eacute;es. Les premi & egrave;res & eacute;tudes utilisant des tests de fonction pulmonaire conventionnels ont identifi & eacute; un trouble restrictif pr & eacute;dominant qui s'est am & eacute;lior & eacute; au fil du temps malgr & eacute; des sympt & ocirc;mes respiratoires persistants. L'oscillom & eacute;trie respiratoire est une modalit & eacute; diff & eacute;rente d'& eacute;valuation de la fonction pulmonaire qui fournit des renseignements tr & egrave;s sensibles sur la m & eacute;canique pulmonaire en compl & eacute;ment de la spirom & eacute;trie. Cette & eacute;tude transversale vise & agrave; caract & eacute;riser la spirom & eacute;trie et l'oscillom & eacute;trie six mois apr & egrave;s la COVID-19 chez les patients atteints d'infections aigu & euml;s l & eacute;g & egrave;res & agrave; mod & eacute;r & eacute;es et & agrave; & eacute;valuer leurs associations avec les sympt & ocirc;mes respiratoires et l'& eacute;tat fonctionnel & agrave; l'aide du test de marche de six minutes (TM6M).M & Eacute;THODES Les patients de l'& eacute;tude de cohorte longitudinale canadienne sur la COVID-19 ont & eacute;t & eacute; recrut & eacute;s entre ao & ucirc;t 2020 et mars 2022 pour une & eacute;valuation plus approfondie par oscillom & eacute;trie et spirom & eacute;trie. Des donn & eacute;es compl & egrave;tes, y compris les r & eacute;sultats du test de marche de six minutes (TM6M) et l'& eacute;valuation de la dyspn & eacute;e selon l'& eacute;chelle de Borg, six mois apr & egrave;s la COVID-19, & eacute;taient disponibles chez 213 des 549 patients pour l'analyse. Les patients admis & agrave; l'unit & eacute; de soins intensifs ont & eacute;t & eacute; exclus de l'analyse.R & Eacute;SULTATS La cohorte (61,0 % de femmes; & acirc;ge m & eacute;dian de 44,9 ans) comprenait 83,1 % de patients ambulatoires et 16,9 % de patients hospitalis & eacute;s. La pr & eacute;valence globale des sympt & ocirc;mes respiratoires & eacute;tait & eacute;lev & eacute;e (54,3 %) et similaire dans les deux groupes. Dans l'ensemble, 42,7 % des patients pr & eacute;sentaient une oscillom & eacute;trie anormale alors que seulement 16,6 % pr & eacute;sentaient une spirom & eacute;trie anormale. En outre, 29,8 % des patients dont la spirom & eacute;trie & eacute;tait normale pr & eacute;sentaient une oscillom & eacute;trie anormale. L'oscillom & eacute;trie & eacute;tait associ & eacute;e au TM6M, au nombre total de sympt & ocirc;mes respiratoires et & agrave; la variation du score de dyspn & eacute;e de Borg avant et apr & egrave;s le TM6M (Delta dyspn & eacute;e de Borg), alors que peu d'associations ont & eacute;t & eacute; observ & eacute;es avec la spirom & eacute;trie.CONCLUSIONS L'oscillom & eacute;trie a permis de d & eacute;tecter des anomalies de la m & eacute;canique pulmonaire associ & eacute;es & agrave; une atteinte fonctionnelle et & agrave; des sympt & ocirc;mes respiratoires, mais non d & eacute;celables par la spirom & eacute;trie.
RATIONALESevere asthma affects approximately 5% of children with asthma, but accounts for 50% of direct asthma costs. Several knowledge gaps remain in the diagnosis and management of pediatric severe asthma and few evidence-based studies address these needs. Thus, concerted efforts are needed to identify research priorities, conduct collaborative studies and harmonize clinical care.OBJECTIVESIn April 2025, members of the Canadian Pediatric Severe Asthma Research Network and other stakeholders came together at Pediatric Severe Asthma Stakeholders' Forum in Quebec, Canada, to discuss and identify research topics in pediatric severe asthma.METHODSThe Forum comprised the presentation of results from a patient-/caregiver-completed survey on their research priorities, a testimony from a patient and parent-partner and presentations and discussions around three themes: diagnosis and classification, assessment and monitoring and management.MAIN RESULTSSeveral knowledge gaps and related research priorities were identified, including the need for a definition of severe asthma in preschoolers, a better understanding of the true severe asthma endotypes, a pediatric definition of biologics response and severe asthma remission, harmonization of transition care and more data to guide the choice of biologics and predict efficacy in children. Building a hybrid clinical and research database with harmonized variables and the use of novel tools (eg, lung imaging) in collaborative research endeavors could be used to address these knowledge gaps.CONCLUSIONSThis Forum provided an opportunity for stakeholders to discuss and identify priorities in pediatric severe asthma research in Canada, providing a springboard for collaborative, pan-Canadian research in this field. JUSTIFICATIONL'asthme s & eacute;v & egrave;re touche environ 5 % des enfants asthmatiques, mais repr & eacute;sente 50 % des co & ucirc;ts directs li & eacute;s & agrave; l'asthme. Plusieurs lacunes subsistent dans les connaissances concernant le diagnostic et la prise en charge de l'asthme s & eacute;v & egrave;re p & eacute;diatrique, et peu d'& eacute;tudes fond & eacute;es sur des donn & eacute;es probantes y r & eacute;pondent. Ainsi, des efforts concert & eacute;s sont n & eacute;cessaires pour d & eacute;terminer les priorit & eacute;s de recherche, mener des & eacute;tudes collaboratives et harmoniser les soins cliniques.OBJECTIFSEn avril 2025, les membres du R & eacute;seau canadien de recherche sur l'asthme s & eacute;v & egrave;re p & eacute;diatrique et d'autres intervenants se sont r & eacute;unis dans le cadre du Forum des parties prenantes en asthme s & eacute;v & egrave;re p & eacute;diatrique, tenu au Qu & eacute;bec (Canada), afin de discuter des sujets de recherche en asthme s & eacute;v & egrave;re p & eacute;diatrique et d'en identifier les principaux.M & Eacute;THODESLe Forum comprenait la pr & eacute;sentation des r & eacute;sultats d'une enqu & ecirc;te men & eacute;e aupr & egrave;s des patients et des prestataires de soins sur leurs priorit & eacute;s de recherche, un t & eacute;moignage d'un patient partenaire et d'un parent partenaire, ainsi que des pr & eacute;sentations et des discussions autour de trois th & egrave;mes : le diagnostic et la classification, l'& eacute;valuation et le suivi, et la prise en charge.PRINCIPAUX R & Eacute;SULTATSPlusieurs lacunes dans les connaissances et des priorit & eacute;s de recherche connexes ont & eacute;t & eacute; recens & eacute;es, notamment la n & eacute;cessit & eacute; d'une d & eacute;finition de l'asthme s & eacute;v & egrave;re chez les enfants d'& acirc;ge pr & eacute;scolaire, d'une meilleure compr & eacute;hension des v & eacute;ritables endotypes de l'asthme s & eacute;v & egrave;re, d'une d & eacute;finition p & eacute;diatrique de la r & eacute;ponse aux agents biologiques et de la r & eacute;mission de l'asthme s & eacute;v & egrave;re, de l'harmonisation des soins de transition, ainsi que de donn & eacute;es suppl & eacute;mentaires pour guider le choix des agents biologiques et pr & eacute;dire leur efficacit & eacute; chez les enfants. La cr & eacute;ation d'une base de donn & eacute;es hybride, & agrave; la fois clinique et de recherche, comportant des variables harmonis & eacute;es, ainsi que l'utilisation de nouveaux outils (p. ex. l'imagerie pulmonaire) dans le cadre d'efforts de recherche collaborative, pourraient contribuer & agrave; combler ces lacunes en mati & egrave;re de connaissances.CONCLUSIONSCe forum a permis aux parties prenantes de discuter des priorit & eacute;s en mati & egrave;re de recherche sur l'asthme s & eacute;v & egrave;re p & eacute;diatrique au Canada et de les d & eacute;finir. Il constitue un tremplin pour la recherche collaborative pancanadienne dans ce domaine.
RATIONALE Non-resolving pneumonia and pulmonary nodules have a broad differential diagnosis and can present a significant diagnostic challenge. We describe a rare etiology and presentation of pulmonary nodules in a previously healthy patient. CASE PRESENTATION A 31-year-old patient visiting from Japan was admitted to the general surgery service with a bowel perforation of unclear etiology. Incidentally, abdominal imaging revealed extensive bilateral pulmonary nodules and pleural effusions. Despite treatment with broad-spectrum antibiotics, the patient remained persistently hypoxemic with ongoing fevers and chills. INVESTIGATIONS Bronchoscopy with bronchoalveolar lavage and transbronchial biopsy, followed by transthoracic biopsy of pulmonary nodules, were inconclusive due to extensive tissue necrosis. Epstein-Barr virus (EBV) serology and viral load were subsequently found to be markedly elevated. A secondary hematopathology review of the resected bowel specimen, along with repeat bronchoscopy, ultimately established the diagnosis of chronic active EBV infection (CAEBV), which was later revised to extranodal NK/T-cell lymphoma (ENKTL). CONCLUSION EBV is a ubiquitous infection that is rarely associated with lymphoproliferative disorders such as CAEBV infection and ENKTL. These conditions often present with nonspecific features, including infectious mononucleosis-like symptoms, and only rarely involve the lungs or gastrointestinal tract. To our knowledge, this is the first reported case of ENKTL presenting with both gastrointestinal perforation and bilateral pulmonary nodules.
RATIONALE Idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) are interstitial lung diseases with high morbidity and mortality. Pirfenidone and nintedanib are the only available antifibrotic treatments for these conditions. In Ontario, antifibrotic approval is accessed via the Exceptional Access Program, which has traditionally relied on fax-based applications. In recent years, an electronic application portal was introduced to streamline the process, but its impact remains uncertain. OBJECTIVE The objectives of this study were to compare the efficiency of electronic versus fax-based antifibrotic drug applications through Ontario's Exceptional Access Program by evaluating time to approval, administrative burden and physician adoption. METHODS We conducted a retrospective observational study using application data from the Ontario Ministry of Health between March 1, 2020, and April 1, 2024. Metrics analyzed included submission method (fax vs. electronic), time to approval, additional communications required and rejection rates. Subgroup analyses were conducted for physicians who used both methods. RESULTS Among 11,240 applications (4,173 new; 7,067 renewal), 22.5% were submitted electronically. For new applications, the median approval time was 1.0 day with the online portal versus 3.0 days with fax (p < 0.001); similar differences were observed for renewals (1.0 vs. 2.0 days, p < 0.001). Applications requiring >= 30 days for approval were significantly less frequent with electronic submissions (new: 4.3% vs. 9.3%; renewals: 0.9% vs. 5.9%; both p < 0.001). Additionally, electronic submissions required fewer additional communications (new: 17.9% vs. 42.0%; renewals: 4.7% vs. 12.3%; both p < 0.001), while rejection rates were comparable. Although electronic applications increased over time, they comprised only 43.6% of applications in 2024. CONCLUSION An online portal significantly improved approval times and administrative burden for antifibrotic medications, underscoring its potential to enhance drug access and improve patient care.
OBJECTIVESFew studies have explored inhaled corticosteroid (ICS) utilization in asthmatics treated with biological therapies. We sought to assess the ICS adherence in subjects with severe asthma before and after initiation of an interleukin (IL)-5/IL-5 receptor (IL-5R) antagonist in a real-world setting; and to assess the response to treatment and the achievement of asthma remission after 1 year of treatment with IL-5/IL-5R antagonists according to ICS adherence and to identify potential predictors of response and remission.METHODSWe conducted a retrospective cohort study of adult asthmatics covered by the RAMQ's public drug insurance plan that had been treated with mepolizumab or benralizumab between 2016 and 2020. Adherence to ICS was measured 1 year before and 1 year after treatment with IL-5/IL-5R antagonists.RESULTSA total of 626 subjects were included. Adherence to ICS in the year before initiation of IL-5/IL-5R antagonists was 73.1% +/- 23.7 compared to 74.3% +/- 24.8 in the following year. A positive response to treatment was observed in 339 (54.2%) subjects regardless of adherence to ICS. The remission rate of asthma was higher in subjects with poor adherence to ICS (24.4%) than in those with a good adherence to ICS (13.6%) (p = 0.02).CONCLUSIONThe ICS adherence profile was similar before and after initiation of an IL-5/IL-5R antagonist. The response to a biological therapy was not affected by the adherence to ICS, but the subjects who achieved remission on treatment had a lower adherence to ICS after IL-5/IL-5R antagonist initiation than those who did not achieve remission. OBJECTIFSPeu d'& eacute;tudes ont examin & eacute; l'utilisation des corticost & eacute;ro & iuml;des inhal & eacute;s chez les patients asthmatiques trait & eacute;s par des th & eacute;rapies biologiques. Nous avons cherch & eacute; & agrave; & eacute;valuer l'observance aux corticost & eacute;ro & iuml;des inhal & eacute;s chez des patients atteints d'asthme s & eacute;v & egrave;re avant et apr & egrave;s l'instauration d'un antagoniste de l'interleukine 5 (IL-5)/ des r & eacute;cepteurs de l'IL-5 (IL-5R), en conditions de vie r & eacute;elle. Nous avons & eacute;galement & eacute;valu & eacute; la r & eacute;ponse au traitement et l'obtention d'une r & eacute;mission de l'asthme apr & egrave;s un an de traitement par antagonistes de l'IL-5/IL-5R, selon l'observance aux corticost & eacute;ro & iuml;des inhal & eacute;s, et d & eacute;termin & eacute; les pr & eacute;dicteurs potentiels de la r & eacute;ponse et de la r & eacute;mission.M & Eacute;THODESNous avons men & eacute; une & eacute;tude de cohorte r & eacute;trospective aupr & egrave;s de patients asthmatiques adultes couverts par le r & eacute;gime public d'assurance m & eacute;dicaments de la RAMQ et ayant & eacute;t & eacute; trait & eacute;s par m & eacute;polizumab ou benralizumab entre 2016 et 2020. L'observance aux corticost & eacute;ro & iuml;des inhal & eacute;s a & eacute;t & eacute; mesur & eacute;e un an avant et un an apr & egrave;s le traitement par antagonistes de l'IL-5/IL-5R.R & Eacute;SULTATSSix cent vingt-six sujets ont & eacute;t & eacute; inclus. L'observance aux corticost & eacute;ro & iuml;des inhal & eacute;s au cours de l'ann & eacute;e pr & eacute;c & eacute;dant l'instauration des antagonistes de l'IL-5/IL-5R & eacute;tait de 73,1 % +/- 23,7, contre 74,3 % +/- 24,8 l'ann & eacute;e suivante. Une r & eacute;ponse positive au traitement a & eacute;t & eacute; observ & eacute;e chez 339 sujets (54,2 %), ind & eacute;pendamment de l'observance aux corticost & eacute;ro & iuml;des inhal & eacute;s. Le taux de r & eacute;mission de l'asthme & eacute;tait plus & eacute;lev & eacute; chez les sujets ayant une faible observance aux corticost & eacute;ro & iuml;des inhal & eacute;s (24,4 %) que chez ceux ayant une bonne observance (13,6 %) (p = 0,02).CONCLUSIONLe profil d'observance aux corticost & eacute;ro & iuml;des inhal & eacute;s & eacute;tait similaire avant et apr & egrave;s l'instauration d'un antagoniste de l'IL-5/IL-5R. La r & eacute;ponse au traitement biologique n'a pas & eacute;t & eacute; influenc & eacute;e par l'observance aux corticost & eacute;ro & iuml;des inhal & eacute;s. En revanche, les sujets ayant obtenu une r & eacute;mission sous traitement pr & eacute;sentaient une observance plus faible apr & egrave;s l'instauration d'un antagoniste de l'IL-5/IL-5R que ceux n'ayant pas obtenu de r & eacute;mission.
RATIONALE: Idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) are debilitating lung diseases. Their clinical courses are slowed with antifibrotics such as nintedanib and pirfenidone; however, data describing antifibrotic use from publicly funded health care systems is lacking. We aimed to describe antifibrotic prescribing trends, switching behavior, rejection patterns and medication costs in Ontario, Canada. METHODS: A retrospective analysis was performed using Ministry of Health data on antifibrotic approvals from July 1, 2018 to April 1, 2024. New and renewal approvals were analyzed by indication (IPF vs PPF), drug type, and patient demographics. Treatment switching was defined as approval for both pirfenidone and nintedanib for the same patient. RESULTS: Among 14,391 antifibrotic approvals (5,559 new; 8,832 renewals), 68.4% of new approvals were for nintedanib and 31.6% for pirfenidone. A total of 4,129 IPF and 816 PPF patients received antifibrotics; 14.9% of IPF patients switched agents. Women represented a higher proportion of PPF than IPF patients (46.3% vs 30.0%). The use of pirfenidone declined significantly following generic availability in 2021 (39.1% to 27.6%, p < 0.0001). Among IPF renewals, pirfenidone was associated with a higher rejection rate than nintedanib (5.7% vs 4.0%, p = 0.0001). The projected maximum cost of nintedanib and pirfenidone considering both initial and renewal approvals from 2019 to 2023 were $276,064,665.38 and $108,303,064.00, respectively. CONCLUSION: Real-world data demonstrates growing reliance on nintedanib, declining pirfenidone use post-generic availability and frequent treatment switching among IPF patients. Antifibrotics represent significant public expenditure, underscoring the need for continued evaluation of their use and outcomes.
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with respiratory muscle dysfunction, postural alterations and balance impairment. However, the impact of respiratory muscle weakness on postural control and its relationship with spinal curvature and mobility remain insufficiently clarified. OBJECTIVES: The objectives of this study were to compare postural control in individuals with COPD with and without respiratory muscle weakness; to examine the relationship among spinal curvature, spinal mobility, postural control and respiratory muscle strength; and to determine the effect of respiratory muscle strength on postural control. METHODS: This cross-sectional study included 41 clinically stable individuals with COPD aged 40-75 years. Respiratory muscle strength was assessed using a mouth pressure measurement device. Postural control and balance were evaluated with the Biodex Balance System and functional tests. Higher stability index values indicate greater postural sway and poorer balance performance, whereas lower values reflect better postural stability. Spinal curvature and mobility were assessed using the Spinal Mouse (R). RESULTS: Individuals with respiratory muscle weakness showed significantly higher overall, anterior-posterior and medial-lateral stability indices, as well as worse eyes-open and eyes-closed firm-surface indices compared to those without weakness (p < 0.05). In participants with severe and very severe COPD, thoracic kyphosis angle was significantly associated with MIP, MIP% and multiple balance indices under different surface and visual conditions (p < 0.05). CONCLUSIONS: Respiratory muscle weakness is associated with impaired postural control and balance performance in individuals with COPD, and thoracic spinal curvature appears to be linked to both respiratory muscle strength and balance outcomes.
BACKGROUND: Pulmonary rehabilitation (PR) is the primary, non-pharmacologic treatment for people with chronic lung disease. Access to PR is limited and individuals often face barriers to participation. To increase access, an Alternate Program (AP) with reduced commitment was created. PURPOSE: To evaluate the AP in terms of patient characteristics, within-subject effects on patient reported outcomes, discharge pathways and patient acceptability. METHODS: Participants completed questionnaires and physical tests pre- and post-AP. Data are presented as means and standard deviations, medians and 25th-75th percentiles, or frequencies as appropriate. Differences from pre- to post-program were analyzed with paired t-tests or Wilcoxon signed rank tests. RESULTS : A total of 34 participants were enrolled in the program. Participants were mostly men (65%) with a mean age of 67 years. The majority of participants (62%) had an obstructive lung disease and/or asthma. Statistically significant improvements from pre- to post-program were found for Canadian Occupational Performance Measure (COPM) performance (1.2 +/-- 1.7 points, p < 0.001), COPM satisfaction (1.5 +/- 2.1 points, p < 0.001), 6-Minute Walk Test (6MWT) 36.0 +/- 46.0 m, p < 0.001) and Self-Efficacy for Exercise (SEE) scale (1.1 +/- 2.0 points, p = 0.004). A large percentage (46%) of patients transitioned from AP to full PR; most were satisfied (14%) or very satisfied (79%) with the program. CONCLUSIONS: The AP may be a reasonable alternative when individuals are unable to access traditional PR, allowing increased access to treatment and improve exercise self-efficacy allowing them to gain access to traditional PR.
RATIONALES: pirometry improves after lung transplant, peaking at 6-18 months. Survival decreases when the highest forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) values fall below 80% predicted, a condition called baseline lung allograft dysfunction (BLAD). OBJECTIVES: To determine if lung function in the first 3 months post-transplant can predict BLAD. METHODS:;We built logistic regression models in a prospective cohort of patients enrolled from December 2017 onward. Of the 207/289 patients who had >= 1 year follow-up, 104 had BLAD while 103 patients achieved FEV1 and FVC > 80% predicted (Normal). The primary predictors of interest included lung function metrics in the first 3 months and clinical variables known to affect graft function. The model developed in the prospective cohort was validated in a retrospective cohort of 1169 patients (631 Normal, 538 BLAD; transplanted 1986-2020) using k-fold cross-validation. RESULTS: The best predictive model was a univariable model with %FEV1 at 3-months (sensitivity: 87% and 84%; specificity: 83% and 81%, prospective and validation models, respectively). The odds ratio was 0.056 (95% CI: 0.024-0.112), indicating that a patient whose 3-month %FEV1 is 1 standard deviation below the cohort mean is 17.8-fold (95% CI: 8.94-41.3) more likely to develop BLAD. CONCLUSION: %FEV1 at 3-months post-transplant is a strong predictor of BLAD. Strategies that maximize 3-month FEV1 could improve survival.
The 2025 update to the classification of the interstitial pneumonias presents multiple important advances. The objective of this "Guidelines in Context" document is to review the recent European Respiratory Society (ERS)/American Thoracic Society (ATS) Statement on the Classification of the Interstitial Pneumonias. The most notable advances are the inclusion of idiopathic and secondary disorders in a single adaptable classification framework, distinction between morphologic pattern and multidisciplinary diagnosis, terminology that better represents biology and morphology, identification of clinically relevant subgroups, and establishment of diagnostic confidence for both morphologic pattern and multidisciplinary diagnosis. We encourage readers to familiarize themselves with these updates and incorporate these advances to help support further improvements in patient care and further our understanding of these complex disorders. La mise & agrave; jour de 2025 de la classification des pneumonies interstitielles comporte plusieurs avanc & eacute;es importantes. L'objectif du pr & eacute;sent document, intitul & eacute; & laquo; Lignes directrices en contexte & raquo;, est de passer en revue la r & eacute;cente d & eacute;claration de l'European Respiratory Society (ERS) et de l'American Thoracic Society (ATS) concernant la classification des pneumonies interstitielles. Les avanc & eacute;es les plus marquantes comprennent l'inclusion des troubles idiopathiques et secondaires dans un cadre de classification unique et adaptable, la distinction entre le sch & eacute;ma morphologique et le diagnostic multidisciplinaire, l'adoption d'une terminologie qui refl & egrave;te plus fid & egrave;lement la biologie et la morphologie, l'identification de sous-groupes cliniquement pertinents et l'& eacute;tablissement d'un niveau de confiance diagnostique tant pour le sch & eacute;ma morphologique que pour le diagnostic multidisciplinaire. Les lecteurs sont encourag & eacute;s & agrave; se familiariser avec ces mises & agrave; jour et & agrave; int & eacute;grer ces avanc & eacute;es afin de contribuer & agrave; am & eacute;liorer les soins aux patients et & agrave; mieux comprendre ces troubles complexes.
RATIONALEPatients are often unaware of inhalers' climate impact but are willing to change inhalers for environmental reasons.OBJECTIVESThe objectives of this study were to assess an educational intervention to empower patients (providers by proxy) to change their rescue inhaler for environmental reasons.METHODSThis research used an interventional prospective cohort study. Stable asthmatic patients on metered-dose inhalers MDI (salbutamol) were provided a one-time educational intervention with a pamphlet and a pre-filled dry powder inhalers DPI (terbutaline) prescription.MEASUREMENTSPrimary outcome was rotation from MDI to DPI at 30 days. Secondary outcome was rotation back from DPI to MDI within 90 days. Patient questionnaire included the Asthma Control Test. Patient and provider perspectives were collected. Multivariate logistic regressions were used to compute the odds of inhaler rotation.MAIN RESULTSWe enrolled 54 patients and surveyed 7 providers. Rotation rate from MDI to DPI was 24% (n = 13), of whom 15% (n = 2) switched back to MDI at 90 days. Poor asthma control was associated with increased rotation from MDI to DPI (OR = 7.18; 95% CI, 1.49-45.76). Patients who indicated that they were empowered by knowing that switching their inhaler could decrease their carbon footprint were more likely to change inhalers (OR = 2.35; 95% CI, 1.08-6.07). Most patients (94%) and providers (71%) reported low awareness of inhalers' climate impact, but valued reducing carbon footprint (70% and 57% respectively) and ease of use (67% and 71% respectively).CONCLUSIONSEmpowering patients to change inhalers allowed transitioning to DPI and reducing the carbon footprint of their inhalers. Poor asthma control was not a barrier of inhaler change. JUSTIFICATIONLes patients sont souvent peu conscients de l'impact des inhalateurs sur le climat, mais sont dispos & eacute;s & agrave; changer d'inhalateur pour des raisons environnementales.OBJECTIFS & Eacute;valuer une intervention & eacute;ducative visant & agrave; autonomiser les patients (prestataires de soins par procuration) afin qu'ils changent leur inhalateur de secours pour des raisons environnementales.M & Eacute;THODES & Eacute;tude de cohorte prospective interventionnelle. Des patients asthmatiques stables trait & eacute;s par inhalateur-doseur pressuris & eacute; (salbutamol) ont re & ccedil;u une intervention & eacute;ducative ponctuelle comprenant une brochure et une ordonnance pr & eacute;remplie d'inhalateur de poudre s & egrave;che (terbutaline).MESURESLe crit & egrave;re de jugement principal & eacute;tait le passage d'un inhalateur-doseur pressuris & eacute; & agrave; un inhalateur de poudre s & egrave;che & agrave; 30 jours. Le crit & egrave;re de jugement secondaire & eacute;tait le retour d'un inhalateur de poudre s & egrave;che & agrave; un inhalateur-doseur pressuris & eacute; dans les 90 jours. Le questionnaire destin & eacute; aux patients comprenait le Test de contr & ocirc;le de l'asthme (Asthma Control Test). Les points de vue des patients et des prestataires de soins ont & eacute;t & eacute; recueillis. Des r & eacute;gressions logistiques multivari & eacute;es ont & eacute;t & eacute; utilis & eacute;es pour estimer les rapports de cotes du passage d'un type d'inhalateur & agrave; l'autre.PRINCIPAUX R & Eacute;SULTATSNous avons recrut & eacute; 54 patients et interrog & eacute; 7 prestataires de soins. Le taux de passage d'un inhalateur-doseur pressuris & eacute; & agrave; un inhalateur de poudre s & egrave;che & eacute;tait de 24 % (n = 13), dont 15 % (n = 2) sont revenus & agrave; l'inhalateur-doseur pressuris & eacute; & agrave; 90 jours. Un mauvais contr & ocirc;le de l'asthme & eacute;tait associ & eacute; & agrave; une probabilit & eacute; accrue de passage d'un inhalateur-doseur pressuris & eacute; & agrave; un inhalateur de poudre s & egrave;che (RC = 7,18; IC & agrave; 95% : 1,49-45,76). Les patients qui ont indiqu & eacute; se sentir davantage autonomis & eacute;s par le fait de savoir qu'un changement d'inhalateur pouvait r & eacute;duire leur empreinte carbone & eacute;taient plus susceptibles de changer d'inhalateur (RC = 2,35; IC & agrave; 95 % : 1,08-6,07). La plupart des patients (94 %) et des prestataires de soins (71 %) ont d & eacute;clar & eacute; & ecirc;tre peu conscients des r & eacute;percussions des inhalateurs sur le climat, mais accordaient de l'importance & agrave; la r & eacute;duction de l'empreinte carbone (70 % et 57 %, respectivement), ainsi qu'& agrave; la facilit & eacute; d'utilisation (67 % et 71 %, respectivement).CONCLUSIONSL'autonomisation des patients & agrave; l'& eacute;gard du changement d'inhalateur a permis le passage & agrave; un inhalateur de poudre s & egrave;che et la r & eacute;duction de l'empreinte carbone associ & eacute;e & agrave; leur utilisation. Un mauvais contr & ocirc;le de l'asthme ne constituait pas une barri & egrave;re au changement d'inhalateur.
