BackgroundInterstitial lung disease (ILD) is comprised of a heterogeneous group of pulmonary diseases. Oxygen therapy is used in patients with advanced lung disease; however, there are challenges associated with initiation of oxygen therapy specific to individuals with ILD. The key objectives of this study were to create a common understanding of the facilitators and barriers to oxygen therapy for patients with ILD, and healthcare professionals (HCP) caring for patients with ILD.MethodsThis qualitative study included 1 hour semistructured focus groups/interviews. An iterative and concurrent process was used for data collection and analysis to allow for supplementary development of themes and concepts generated. Data analysis used a three-phase approach: coding, categorising and development of themes.ResultsA total of 20 patients and/or caregivers and 31 HCP took part in 34 focus groups/interviews held over 3 months (November 2022–January 2023). Facilitators to oxygen therapy were identified including support from HCP and support groups, the perseverance and self-advocacy of patients, a straightforward administrative process and vendors/private industry that expedite access to oxygen therapy. There were also several barriers to accessing oxygen therapy for patients with ILD. The themes identified include rural disparity, testing requirements and qualifying for funding and the need for ILD-specific evidence base for oxygen therapy.ConclusionFurther research is needed to facilitate development of specific exertional oxygen criteria for patients with ILD, to create supports for oxygen use and monitoring and to enable providers to tailor therapy to patients. Oxygen therapy education for ILD should address the benefits and risks of oxygen therapy.

Background: Asthma exacerbations are a common cause of emergency department (ED) admissions in Canada. In Alberta, Canada, from 2011-2015, there were on average 10,000 asthma-related ED visits annually. Objective: To better understand the patterns of physician visits, admissions and readmissions of patients with asthma to ED using a provincial health administrative database from Alberta Health Services. Methods: Patients ≥18 years of age that met the case definition of asthma and with at least one asthma-related ED visit were included (Apr 1, 2015 to Mar 31, 2020). Return to ED within 7 and 30 days of the initial admission were considered readmissions. Results: A total of 12,456 patients with a median age (IQR) of 33 (25,44) years had a total of 20,142 ED visits and a mean (SD) of 0.52 (0.83) visits/person/yr. Nearly 28% of patients experienced more than 1 asthma-related ED visit and nearly 20% returned to ED within 30 days, across all severities (Fig 1). In patients with high severity, 72% of ED visits were preceded by an asthma-specific physician visit within the prior 30 days (Fig 1). Conclusions: Nearly 20% of patients with asthma are readmitted to ED within 30 days of initial visit. A large proportion of these patients also visit their physicians in the 30 days prior to initial ED visit. These physician visits may be an opportunity for early intervention to prevent initial and repeat ED visits

Introduction: CSJ117 is a potent neutralizing antibody fragment against human Thymic stromal lymphopoietin (TSLP).

Along the continuum of care for chronic obstructive pulmonary disease (COPD), starting from prevention/smoking cessation to end-stage care, services are often provided in disconnected settings. In order to identify gaps in services, where patients are either lost, services unavailable, or capacity limited, it is necessary to conduct a mapping of patient flow and available COPD services. This information, along with current cost and utilization, is critical for making policy recommendations related to COPD care. An economic surveillance consisting of mapping the market for COPD services available in Alberta, Canada was conducted to analyze health care utilizations and costs associated with each stage of the continuum of COPD respiratory care. We developed a cross-sectional model that identified services provided to a prevalent group who are at-risk or else have been diagnosed with COPD. The model was populated using cost and utilization data for physician services, hospital services, and prescription drugs. Additional province wide- program data were obtained for smoking prevention, smoking cessation, pulmonary rehabilitation, diagnosis, and late stage services. During 2013/2014, an estimated 96,811 prevalent and 11,966 incident cases were identified, and total expenditures on COPD care topped $229 million in Alberta. These expenditures were highly skewed towards services associated with late-stage COPD, notably hospitalizations ($130 million), emergency department visits ($19.5 million), and home oxygen therapy ($27 million). This study maps the entire spectrum of services for all persons who are affected by COPD, and their costs, which may facilitate discussions regarding system-wide appropriateness of the current distribution of health care expenditures. Economic costing studies for chronic conditions do not focus on the entire sweep of services over all stages of the disease. But in the absence of such information, it would be impossible to determine whether current arrangements or policies are targeting the appropriate groups.

BACKGROUND:The OX40/OX40L interaction contributes to an optimal T cell response following allergic stimuli and plays an important role in the maintenance and reactivation of memory T effector cells.OBJECTIVE:We tested whether treatment with an anti-OX40L monoclonal antibody (MAb) would inhibit allergen-induced responses in subjects with asthma.METHODS:Twenty-eight mild, atopic asthmatic subjects were recruited for a double-blind, randomized, placebo-controlled, parallel-group trial (ClinicalTrials.gov identifier NCT00983658) to compare blockade of OX40L using a humanized anti-OX40L MAb to placebo-administered intravenously in 4 doses over 3 months. Allergen inhalation challenges were carried out 56 and 113 days after the first dose of study drug. The primary outcome variable was the late-phase asthmatic response. Other outcomes included the early-phase asthmatic response, airway hyperresponsiveness, serum IgE levels, blood and sputum eosinophils, safety and tolerability.RESULTS:Treatment with anti-OX40L MAb did not attenuate the early- or late-phase asthmatic responses at days 56 or 113 compared with placebo. In the anti-OX40L MAb treatment group, total IgE was reduced 17% from pre-dosing levels, and sputum eosinophils decreased 75% by day 113 (both P = 0.04). There was no effect of anti-OX40L MAb on airway hyperresponsiveness or blood eosinophils. The frequency of AEs was similar in both groups.CONCLUSION AND CLINICAL RELEVANCE:Pharmacological activity of anti-OX40L MAb was observed by decreases in serum total IgE and airway eosinophils at 16 weeks post-dosing, but there was no effect on allergen-induced airway responses. It is possible that the treatment duration or dose of antibody was insufficient to impact the airway responses.

Background: Obstructive airway diseases (OADs) are among the leading causes of morbidity and mortality worldwide. Shortness of breath (SOB) is the main symptom associated with OADs. International guidelines from the Global Initiative for Chronic Lung Disease (GOLD) and the Global Initiative for Asthma (GINA) have recommended spirometry as an indispensable tool for the diagnosis of asthma and chronic obstructive pulmonary diseases (COPD), but spirometry is rarely used in family practice. Simple and reliable diagnostic tools are necessary for screening community patients with onset of OADs for timely management. Purpose: This thesis examined screening utility of the PiKo-6 forced expiratory volume in one second (pFEV₁) , in six second (pFEV₆), and the pRatio ( pFEV₁/pFEV₆) in SOB patients for OADs in community pharmacy settings. FEV₆ has recently been suggested an excellent surrogate for Forced Vital Capacity (FVC), which requires maximum exhalation of the lungs. Methods: Patients with SOB symptoms who were prescribed pulmonary inhalers, by their family physicians, were recruited via community pharmacies. Trained pharmacists collected two PiKo-6 tests to assess the repeatability of the PiKo-6 device. All patients performed laboratory spirometry ( FEV₁, FVC and FEV₁/FVC) to obtain physician diagnosis of their OADs. The results of the PiKo-6 spirometer and laboratory spirometer were compared. In addition, the PiKo-6 pRatio and laboratory FEV₁/FVC were assessed against physician diagnosed COPD. Results: Sixty three patients volunteered to perform the PiKo-6 spirometry. Of these, 52.4 % were men (age 53.9 ± 15.3 years; BMI 31.9 ± 7.40 kg/m2). Repeated testing with pFEV₁, pFEV6 and pRatio correlated significantly (within correlation, r = 0.835, p-Value≤ 0.05 ; 0.872, p- Value≤ 0.05; and 0.664, p-Value≤ 0.05). In addition, pFEV₁, pFEV6 and pRatio correlated significantly with FEV₁, FVC and FEV₁/FVC, respectively (between correlation = 0.630, p- Value≤ 0.05 ; 0.660, p-Value≤ 0.05 and 0.580, p-Value≤ 0.05). The cut-off value corresponding to the greatest sum of sensitivity and specificity of pRatio for physician-diagnosed COPD was <0.80, the sensitivity and specificity were 84 % and 50%, respectively. Conclusions The portable PiKo-6 correlates moderately well with the standard spirometry, when delivered by community pharmacists to patients with OADs. The PiKo-6 spirometer may play a role in screening patients suspected of having an OAD in community pharmacies that may benefit from early physician diagnosis and appropriate management.

BACKGROUND:CRTh2 (chemoattractant-receptor homologous molecule expressed on Th2 cells) is expressed by Th2 cells and other cells involved in allergic inflammation. Single nucleotide polymorphisms (SNPs) in CRTh2 (rs11571288, rs545659, rs634681) have been associated with various phenotypes of allergy in ethnically distinct populations. Here, we assessed the association between CRTh2 rs533116 and allergic asthma, expression of CRTh2 and Th2 cytokine production.METHODS:CRTh2 rs533116 was genotyped in an ethnically diverse population (n = 1282). The proportion of cells expressing CRTh2 was determined in peripheral blood from subjects with allergic airways disease and controls as well as with in vitro differentiated Th2 cells. Receptor function was assessed by stimulating Th2 cells with the CRTh2-specific agonist 13,14-dihydro-15-keto-PGD(2) (DK-PGD(2) ) and measuring IL-4 and IL-13 by intracellular staining and ELISA.RESULTS:CRTh2 rs533116 was associated with allergic asthma in White people (2.67 [1.09-6.55], P < 0.05), and expression of CRTh2 was higher in subjects with allergic airways disease compared to controls (P < 0.05). Among allergic individuals, the AA genotype was significantly associated with more eosinophils and higher expression of CRTh2 by both CD4(+) T cells and eosinophils (P < 0.05). In vitro, the AA genotype was associated with a higher proportion of CRTh2(+) cells during Th2 differentiation as well as more IL-4 and IL-13 expression following DK-PGD(2) stimulation (P < 0.05).CONCLUSIONS:These findings show an association between CRTh2 rs533116 and allergic asthma and suggest this may be mediated by elevated expression of CRTh2, leading to higher numbers of circulating eosinophils and Th2 cytokine production.

PURPOSE: Asthma continues to be a major health concern internationally despite improvements in treatment and the introduction of international asthma guidelines. Asthma education and action plans are essential to enhancing asthma knowledge, adherance, quality of life, and control of asthma and these form the basis for all treatment strategies recommended. There are over 90 Internet websites that provide asthma education. These sites did not provide interactive asthma management and the majority did not even meet acceptable educational standards. This study aimed to assess the impact of providing asthma management by a Certified Asthma Educator (CAE) to patients with asthma via the Internet.