BACKGROUND: The Ontario Ministry of Health and Long-Term Care funded the Ontario Lung Association to develop and implement a continuing medical education program to promote implementation of the Canadian asthma guidelines in primary care.OBJECTIVES: To determine baseline knowledge, preferred learning format, satisfaction with the program and reported impact on practice patterns.METHODS: A 3 h workshop was developed that combined didactic presentations and small group case discussions. Outcome measures included a workshop evaluation, baseline assessment of asthma management knowledge and three-month postreflective evaluations.RESULTS: One hundred thirty-seven workshops were delivered to 2783 primary care providers (1313 physicians, 1470 allied health) between September 2002 and March 2005. Of the 2133 participants, 1007 physicians and 1126 allied health professionals submitted workshop evaluations. Most (98&#x25;) of the attendees indicated they would recommend the workshop to a colleague. The majority preferred the combination of didactic lecture plus interactive case discussions. A subset of physicians provided consent to use these data for research (n=298 pediatric and 288 adult needs assessments; n=349 postreflective evaluations). Important needs identified included appropriate medication for chronic asthma and development of written action plans. On the postreflective evaluations, 88.7&#x25; remained very satisfied, 95.5&#x25; reported increased confidence, 91.9&#x25; reported an influence on practice and 67.2&#x25; reported using a written action plan.CONCLUSIONS: This continuing medical education program addresses identified needs of primary care providers. Participants reported improvements in asthma care, including prescribing practices, use of spirometry and written action plans. Similar programs should be considered as part of multifaceted asthma guidelines dissemination and implementation initiatives in other provinces and nationally.

M Diane Lougheed

Dilshad Moosa

Shelagh Finlayson

Wilma M Hopman

Mallory Quinn

Kim Szpiro

Joseph Reisman

Impact of a Provincial Asthma Guidelines Continuing Medical Education Project: The Ontario Asthma Plan of Action&#x2019;s Provider Education in Asthma Care Project

BACKGROUND: The primary objective of asthma management is to help patients establish and maintain optimal disease control. Simple and efficient tools are needed to assess patient-reported symptoms so that they can be used with or without airway function to evaluate asthma control.OBJECTIVE: The objective of the present study was to evaluate the validity of The 30 Second Asthma Test (GlaxoSmithKline Inc, Canada), based on the Canadian Asthma Guidelines, by estimating its relationship with criterion measures of control.RESULTS: The discriminative and diagnostic validity of The 30 Second Asthma Test&#x2122; was examined in a sample of 81 patients with a confirmed diagnosis of asthma. Based on a cut-off score of two or greater on The 30 Second Asthma Test&#x2122;, the overall agreement with specialist ratings was 65&#x25;, and 58&#x25; with per cent predicted forced expiratory volume in 1 s. The 30 Second Asthma Test&#x2122; scores distinguished between groups of patients who were classified based on the change in intensity of therapy.CONCLUSION: The results support the use of The 30 Second Asthma Test&#x2122; as a brief screening tool for asthma control.

Sara Ahmed

Pierre Ernst

Robyn Tamblyn

Neil Colman

Validation of the 30 Second Asthma Test&#x2122; as a Measure of Asthma Control

BACKGROUND: Technical factors relating to processing viscid sputum in cystic fibrosis (CF) and their influence on the reproducibility and validity of cell counts need to be evaluated. In addition, the methods need to be standardized so that they can be applied clinically and in research.OBJECTIVE: To examine the efficiency, reliability and validity of processing small volumes of spontaneously expectorated sputum from subjects with CF.METHODS: Sputum was collected from adults with CF (n=35) and compared with sputum from adults with infective bronchitis or bronchiectasis (IB/B) (n=16), or with asthma or chronic obstructive pulmonary disease (AS/COPD) (n=25). Selected sputum (100 mg to 200 mg) was processed with dithiothreitol (0.1&#x25;) and filtered. Total cell count (TCC) and viability were obtained in a counting chamber and cytospins were prepared and stained with Wright&#x2019;s for a differential cell count. Sputum and filter remnant were processed for TCC, viability and differential cell count, and the efficiency was determined by comparing the mean loss in cell yield to the filter. Two different portions from the same sputum sample were processed for cell counts to determine reproducibility. Results were compared with those from IB/B and AS/COPD groups.RESULTS: Efficiency of cell dispersal was excellent and similar to that in AS/COPD and IB/B groups. Reproducibility of cell counts from two portions of a sputum sample was high (R&#x2265;0.80). CF sputum demonstrated a raised TCC and neutrophilia similar to IB/B but significantly higher than AS/COPD.CONCLUSION: The selection method of evaluating cell counts in viscid CF sputum is efficient, reproducible and valid.

Lata Jayaram

N Renee Labiris

Ann Efthimiadis

Helen Vlachos-Mayer

Frederick E Hargreave

Andreas P Freitag

The Efficiency of Sputum Cell Counts in Cystic Fibrosis

BACKGROUND: Little is known about the comparative impact of chronic obstructive pulmonary disease (COPD) between women and men and about women&#x2019;s response to pulmonary rehabilitation.OBJECTIVES: To compare lung function, disability, mortality and response to pulmonary rehabilitation between women and men with COPD.METHODS: In the present retrospective study, 68 women (mean age 62.5&#xb1;8.9 years) and 168 men (mean age 66.3&#xb1;8.4 years) were evaluated by means of pulmonary function testing and an incremental symptom-limited cycle exercise test. Forty women and 84 men also participated in a 12-week pulmonary rehabilitation program. A 6 min walking test and the chronic respiratory questionnaire were used to assess the effects of pulmonary rehabilitation. Survival status was also evaluated.RESULTS: Compared with men, women had a smaller tobacco exposure (31&#xb1;24 versus 48&#xb1;27 pack-years, P&#x3c;0.05), displayed better forced expiratory volume in 1 s (44&#xb1;13 versus 39&#xb1;14 &#x25; predicted, P&#x3c;0.05), a higher functional residual capacity (161&#xb1;37 versus 149&#xb1;36 &#x25; predicted, P&#x3c;0.05) and total lung capacity (125&#xb1;20 versus 115&#xb1;19 &#x25; predicted, P&#x3c;0.001). Peak oxygen consumption was not different between women and men when expressed in predicted values but lower in women when expressed in absolute values. Pulmonary rehabilitation resulted in significant improvements in 6 min walking test and quality of life in both sexes, but women had a greater improvement in chronic respiratory questionnaire dyspnea. Survival status was similar between sexes, but predictors of mortality were different between sexes.CONCLUSIONS: Women may be more susceptible to COPD than men. The clinical expression of COPD may differ between sexes with greater degree of hyperinflation in women, who also benefit from pulmonary rehabilitation.

Louis Laviolette

Yves Lacasse

Mari&#xe8;ve Doucet

Miriam Lacasse

Karine Marquis

Didier Saey

Pierre Leblanc

Fran&#xe7;ois Maltais

Chronic Obstructive Pulmonary Disease in Women

BACKGROUND: Pulmonary rehabilitation (PR) is recognized as the prevailing standard of care for patients with chronic respiratory conditions. National surveys of PR programs provide important information regarding the structure, content and organization of these programs.OBJECTIVE: To conduct a national survey to characterize adult PR across Canada, in terms of program distribution, utilization, content and outcome measures.METHODS: A cross-sectional descriptive study in which questionnaires were mailed to PR programs connected with hospitals or identified through the Canadian Lung Association was performed.RESULTS: Of the 98 PR programs identified, over 90&#x25; of patients in the programs had chronic obstructive pulmonary disease (COPD) and 57&#x25; of the programs were outpatient. Inpatient programs accounted for only 10&#x25; of the total. The main program components included supervised lower extremity strength (77&#x25;), cycle (72&#x25;) and treadmill (70&#x25;) training, education (75&#x25;) and breathing retraining (68&#x25;). Over 80&#x25; of patients completed their programs and 90&#x25; of patients were enrolled in a follow-up component. Physical therapists, dieticians, respiratory therapists and respirologists were the most commonly identified health care providers. The most commonly used outcome measures were the 6 min walk test and disease-specific quality of life questionnaires.CONCLUSION: There were similarities in program format, content, staffing, follow-up and funding among Canadian PR programs. The marked shortfall between the national PR capacity and the prevalence of COPD meant that only 1.2&#x25; of the COPD population had access to PR.

Dina Brooks

Rebecca Sottana

Barbara Bell

Mary Hanna

Lisanne Laframboise

Sugi Selvanayagarajah

Roger Goldstein

Characterization of Pulmonary Rehabilitation Programs in Canada in 2005

BACKGROUND: Lung cancer is the leading cause of cancer morbidity and mortality. In addition, lung cancer has a significant economic impact on society.OBJECTIVE: To present an economic analysis of the actual care costs of lung cancer which will allow comparison with, and verification of, cost estimates that were developed through modelling and opinion.METHODS: A chart review was conducted of incident cases (circa 1998) of primary bronchogenic lung cancer. Cases were censored at two years from the date of diagnosis. Relevant clinical and health utilization data were collected. Health utilization data included hospital and institutional outpatient (ie, ambulatory clinic) costs. Cost estimates were derived for over 200 specific health services. The present analysis was performed from the economic perspective of the health care institution.RESULTS: A total of 13,389 health service events were captured with an estimated total cost of $8.4 million. Laboratory tests, diagnostic imaging and ambulatory visits constituted 86&#x25; of the service events while patient admissions and therapy constituted 76&#x25; of the costs. The vast majority of overall costs occurred just before, or within, three months of diagnosis. The median nonsmall cell lung cancer and small cell lung cancer case costs were $10,928 (range $9,234 to $11,047) and $15,350 (range $13,033 to $21,436), respectively.CONCLUSION: The results agree with the literature that the majority of lung cancer case costs are realized around the date of diagnosis (ie, early phase). The present study illustrates Canadian health care system lung cancer case costs based on actual care received versus hypothetical care algorithms.

Sandor J Demeter

Philip Jacobs

Chester Chmielowiec

Wayne Logus

David Hailey

Konrad Fassbender

Alexander McEwan

The Cost of Lung Cancer in Alberta

Nick R Anthonisen

Asthma Questionnaires

Darcy D Marciniuk

After the First Step&#x2026; Imagine

Robert B Kalina

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Canadian Respiratory Journal provides a multidisciplinary forum for research in all areas of respiratory medicine. The journal publishes research related to asthma, allergy, COPD, non-invasive ventilation, therapeutic intervention etc.

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Chief Editor, Dr Alice M Turner, is based at the University of Birmingham, UK. Her main research interests are the clinical aspects of alpha 1 antitrypsin deficiency and chronic obstructive pulmonary disease.

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Canadian Respiratory Journal - Table of contents 2007

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Canadian Respiratory Journal provides a multidisciplinary forum for research in all areas of respiratory medicine. The journal publishes research related to asthma, allergy, COPD, non-invasive ventilation, therapeutic intervention etc.

Canadian Respiratory Journal