Published data on the association between MMP-9 polymorphisms (−1562 C &gt; T, rs3918242; Gln279Arg, rs17576 Arg668Gln, rs17577) and asthma susceptibility are inconclusive. To derive a more precise estimation of this association, a meta-analysis was performed. A literature search was conducted in PubMed, Web of Science, EMBASE, Wanfang, and China National Knowledge Infrastructure (CNKI) databases to identify eligible studies. The pooled odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were used to calculate the strength of association. Sensitivity analysis was performed to evaluate the influence of individual studies on the overall effect estimates, and funnel plots and Egger’s test were inspected for indication of publication bias. Seven studies with 1592 asthma patients and 1987 controls were finally identified. Overall, we found no significant association between −1562 C &gt; T, rs3918242 polymorphism, and asthma susceptibility in any of the genetic model comparisons. After categorizing studies into different subgroups on the basis of ethnicity and age, there is still no significant association. For the Gln279Arg, rs17576 polymorphism, there seems to be a significant association in the allelic genetic model in regard to the <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.0498209pt" id="M1" height="8.68572pt" version="1.1" viewBox="-0.0498162 -8.6359 8.15071 8.68572" width="8.15071pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-81" d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"/></g></svg> value (OR = 1.11, 95% CI = 1.00–1.22, I2 = 0%, <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-4.679501pt" id="M2" height="13.3154pt" version="1.1" viewBox="-0.0498162 -8.6359 62.2786 13.3154" width="62.2786pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0091,0,0,-0.0091,6.656,3.132)"><path id="g50-41" d="M309 -142C211 -61 151 99 151 271S210 601 309 683L288 710C141 611 75 451 75 272V271C75 90 141 -72 288 -169L309 -142Z"/></g><g transform="matrix(.0091,0,0,-0.0091,9.914,3.132)"><path id="g190-91" d="M561 176C543 127 527 95 506 73C478 43 441 36 316 36C247 36 185 38 153 42C290 245 427 439 566 636L559 650H160C130 650 119 652 107 675H83C81 630 76 555 71 492L100 491C112 535 123 560 135 578C152 605 168 614 276 614H449C310 411 169 213 29 15L37 0H554C565 41 583 134 590 170L561 176Z"/></g><g transform="matrix(.0091,0,0,-0.0091,15.422,3.132)"><path id="g50-42" d="M283 271C283 451 220 610 70 710L48 683C146 603 207 443 207 271S149 -59 48 -142L70 -169C220 -67 283 90 283 271Z"/></g><g transform="matrix(.013,0,0,-0.013,22.834,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g><g transform="matrix(.013,0,0,-0.013,34.097,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,40.337,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,43.301,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,49.541,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g><g transform="matrix(.013,0,0,-0.013,55.781,0)"><use xlink:href="#g113-53"/></g></svg>); however, the value of lower 95% CI is 1.0. For the Arg668Gln, rs17577 polymorphism, a high significant association was observed in the dominant model comparison (OR = 1.65, 95% CI = 1.28–2.11, I2 = 22.50%, <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-4.679501pt" id="M3" height="13.3154pt" version="1.1" viewBox="-0.0498162 -8.6359 40.5133 13.3154" width="40.5133pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0091,0,0,-0.0091,6.656,3.132)"><use xlink:href="#g50-41"/></g><g transform="matrix(.0091,0,0,-0.0091,9.914,3.132)"><use xlink:href="#g190-91"/></g><g transform="matrix(.0091,0,0,-0.0091,15.422,3.132)"><use xlink:href="#g50-42"/></g><g transform="matrix(.013,0,0,-0.013,22.834,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.013,0,0,-0.013,34.097,0)"><use xlink:href="#g113-49"/></g></svg>), recessive model comparison (OR = 2.40, 95% CI = 1.23–4.72, I2 = 0%, <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-4.679501pt" id="M4" height="13.3154pt" version="1.1" viewBox="-0.0498162 -8.6359 62.2786 13.3154" width="62.2786pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0091,0,0,-0.0091,6.656,3.132)"><use xlink:href="#g50-41"/></g><g transform="matrix(.0091,0,0,-0.0091,9.914,3.132)"><use xlink:href="#g190-91"/></g><g transform="matrix(.0091,0,0,-0.0091,15.422,3.132)"><use xlink:href="#g50-42"/></g><g transform="matrix(.013,0,0,-0.013,22.834,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.013,0,0,-0.013,34.097,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,40.337,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,43.301,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,49.541,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.013,0,0,-0.013,55.781,0)"><use xlink:href="#g113-50"/></g></svg>), homozygote genotype comparison (OR = 2.69, 95% CI = 1.36–5.33, I2 = 0%, <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-4.679501pt" id="M5" height="13.3154pt" version="1.1" viewBox="-0.0498162 -8.6359 62.2786 13.3154" width="62.2786pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0091,0,0,-0.0091,6.656,3.132)"><use xlink:href="#g50-41"/></g><g transform="matrix(.0091,0,0,-0.0091,9.914,3.132)"><use xlink:href="#g190-91"/></g><g transform="matrix(.0091,0,0,-0.0091,15.422,3.132)"><use xlink:href="#g50-42"/></g><g transform="matrix(.013,0,0,-0.013,22.834,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.013,0,0,-0.013,34.097,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,40.337,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,43.301,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,49.541,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,55.781,0)"><use xlink:href="#g113-53"/></g></svg>), and allelic genetic model (OR = 1.59, 95% CI = 1.29–1.97, I2 = 36.9%, <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-4.679501pt" id="M6" height="13.3154pt" version="1.1" viewBox="-0.0498162 -8.6359 40.5133 13.3154" width="40.5133pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.0091,0,0,-0.0091,6.656,3.132)"><use xlink:href="#g50-41"/></g><g transform="matrix(.0091,0,0,-0.0091,9.914,3.132)"><use xlink:href="#g190-91"/></g><g transform="matrix(.0091,0,0,-0.0091,15.422,3.132)"><use xlink:href="#g50-42"/></g><g transform="matrix(.013,0,0,-0.013,22.834,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.013,0,0,-0.013,34.097,0)"><use xlink:href="#g113-49"/></g></svg>). Sensitivity analysis demonstrated the stability of our results, and publication bias was not evident. The present meta-analysis suggests that MMP-9 Arg668Gln, rs17577 polymorphism may be the risk factor for asthma susceptibility.

Fenfang Zou

Jianpeng Zhang

Guoan Xiang

Hongbin Jiao

Hongmei Gao

Association of Matrix Metalloproteinase 9 (MMP-9) Polymorphisms with Asthma Risk: A Meta-Analysis

Chest wall circumference measurements are common evaluation methods in clinical settings by therapists in order to obtain chest wall mobility. Previous published results have been conflicting, and there is a lot of variability in the method of testing, which needs testing in different conditions. Seventy subjects (25 healthy nonsmokers, 25 healthy smokers, and 20 COPD) aged between 18 and 70&#x2009;years participated in the study. Upper and lower chest expansion (CE) measurements (2 levels) are performed with cloth inch tape. Intrarater (between day) and interrater (within-day) reliability of CE measurements was evaluated by two examiners. Lung function parameters, forced expiratory volume in first second (FEV1), forced vital capacity (FVC), FEV1/FVC, and vital capacity (VC) were measured using a computerized spirometer (Spiro lab 3). The intrarater reliability for upper and lower CE showed very good agreement with intraclass correlation (ICC) values between 0.90 and 0.93 for upper CE and 0.85 to 0.86 for lower CE. The interrater reliability for upper CE showed good to very good agreement with ICC values ranging between 0.78 and 0.83, and lower CE showed very good agreement with ICC values ranging between 0.82 and 0.84. Upper and lower CE showed a significant and positive correlation with all lung function parameters, with strong correlation with FEV1/FVC (r&#x2009;&#x3d;&#x2009;0.68). Upper and lower CE measurements with inch tape showed good intra- and interrater reliability and reproducibility in healthy nonsmokers, healthy smokers, and COPD subjects. Compared to upper, lower CE correlated well with the lung function parameters. Upper and lower CE may be more useful in clinical practice to evaluate chest mobility and to give indirect information on lung function but interpretation with caution is required when considering implementation into clinical setting.

Ravi S. Reddy

Khalid A. Alahmari

Paul S. Silvian

Irshad A. Ahmad

Venkata Nagaraj Kakarparthi

Kanagaraj Rengaramanujam

Reliability of Chest Wall Mobility and Its Correlation with Lung Functions in Healthy Nonsmokers, Healthy Smokers, and Patients with COPD

Background and Objectives. Despite its’ proven benefits, oxygen therapy may be complicated with potential adverse events such as hypoxemia or hyperoxia-driven hypercapnia. Automated oxygen delivery systems may aid in avoiding these complications. The scope of the present study is to test the efficacy and safety of a new automated oxygen delivery device. Methods. This study included 23 patients with acute respiratory failure (ARF) hospitalized in the Respiratory Medicine Department of the University Hospital of Larissa. Both patients with purely hypoxemic or hypercapnic ARF were included. Automated oxygen administration was performed with Digital Oxygen Therapy, a new closed-loop system designed to automatically adjust oxygen flow according to target oxygen saturation (SpO2) of 88–92% for hypercapnic patients and 92–96% for purely hypoxemic patients with ARF. The device was applied for 4 hours. Arterial blood gas analysis was performed at 1 hour and 3 hours following the device application. Results. Mean age was 72.91 ± 13.91 years. Twelve patients were male, and 11 were female. The majority of patients suffered from hypercapnic respiratory failure (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2063904pt" id="M1" height="8.55521pt" version="1.1" viewBox="-0.0498162 -8.34882 34.1002 8.55521" width="34.1002pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-111" d="M495 86L479 114C446 82 419 66 409 66C401 66 401 72 406 97C420 166 436 231 453 297C489 435 454 448 428 448C406 448 384 439 354 422C305 394 222 327 161 247H159L183 345C200 415 194 448 173 448C143 448 82 410 23 351L38 325C64 349 95 371 105 371C111 371 116 365 109 336L25 -4L31 -12C50 -4 77 3 107 9C119 69 132 122 145 168C197 254 321 381 370 381C387 381 393 374 378 305L329 95C309 17 320 -12 345 -12C372 -12 430 19 495 86Z"/></g><g transform="matrix(.013,0,0,-0.013,10.158,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g><g transform="matrix(.013,0,0,-0.013,21.421,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.013,0,0,-0.013,27.661,0)"><path id="g113-52" d="M285 378C315 398 338 416 353 432C373 451 384 474 384 503C384 579 325 635 236 635H235C182 635 136 610 108 579L65 516L85 496C110 533 150 575 205 575C258 575 300 543 300 481C300 407 232 369 141 339L147 310C163 315 188 321 211 321C268 321 338 284 338 192C338 94 288 40 217 40C160 40 119 68 93 91C85 98 77 97 69 91C60 84 47 71 46 58C44 46 48 35 62 22C75 10 116 -12 162 -12C234 -12 424 62 424 224C424 297 373 359 285 376V378Z"/></g></svg>, 56.5%). At 1 hour and 3 hours, SpO2 and PaO2 displayed excellent correlation (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42938pt" id="M2" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 50.7895 11.7782" width="50.7895pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g><g transform="matrix(.013,0,0,-0.013,22.605,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,44.289,0)"><use xlink:href="#g113-50"/></g></svg>, r = 0.943, and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42938pt" id="M3" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 50.7895 11.7782" width="50.7895pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-113"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><use xlink:href="#g117-91"/></g><g transform="matrix(.013,0,0,-0.013,22.605,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,44.289,0)"><use xlink:href="#g113-50"/></g></svg>, r = 0.954, respectively). We did not observe any adverse events associated with the device. Conclusions. Our results indicate that automated oxygen treatment is feasible and safe in hospitalized patients with acute respiratory failure. Further studies are required in order to assess the long-term effects of automated oxygen delivery systems.

Foteini Malli

Stelios Boutlas

Nick Lioufas

Konstantinos I. Gourgoulianis

Automated Oxygen Delivery in Hospitalized Patients with Acute Respiratory Failure: A Pilot Study

Background. Microaspiration of secretions around the tracheal cuff is a multifactorial process. Tracheal cuff shape might take a major part in its occurrence. The rationale for producing a taper-shaped cuff is established on the assumption that compared to a conventional cuff with a single fixed diameter, a continuum of minimum-to-maximum diameter sections might better fit the tracheal walls. Objectives. The primary objective of this meta-analysis was to compare ventilator-associated pneumonia (VAP) between tapered-cuff intubation and conventional-cuff intubation. The secondary objective was to compare intensive care unit (ICU) mortality between tapered-cuff intubation and conventional-cuff intubation. Methods. We searched the Cochrane Library, Embase, MEDLINE database through the PubMed search engine, and CINAHL from inception to April 2018. Randomized trials comparing VAP and ICU mortality between tapered-cuff intubation and conventional-cuff intubation in intubated adults were included. Two review authors assessed study quality and abstracted databasing on prespecified criteria independently. Results. We pooled summary estimates from 5 trials evaluating tapered-cuff involving 774 participants. Compared to VAP, no statistically significant difference was observed between the tapered-cuff and conventional-cuff groups (OR 0.82, CI 0.61–1.12, z = 1.24, and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42938pt" id="M1" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 44.5261 11.7782" width="44.5261pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g><g transform="matrix(.013,0,0,-0.013,22.605,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g></svg>). No statistically significant difference was observed between the tapered-cuff and conventional-cuff groups with ICU mortality (OR 0.77, CI 0.55–1.08, z = 1.49, and <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42938pt" id="M2" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 44.5261 11.7782" width="44.5261pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-113"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.013,0,0,-0.013,22.605,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g></svg>). Conclusions. In this meta-analysis, the tapered-cuff tracheal tube may not be superior to the standard-cuff tracheal tube in reducing VAP and ICU mortality.

Wei Min Huang

Xu An Huang

Yan Ping Du

Liu Xia Li

Fang Fang Wu

Shao Qing Hong

Fang Xuan Tang

Zhang Qiang Ye

Tapered Cuff versus Conventional Cuff for Ventilator-Associated Pneumonia in Ventilated Patients: A Meta-Analysis of Randomized Controlled Trials

Obstructive sleep apnea (OSA) is the most common sleep-disordered breathing condition. Patients with OSA symptoms are often not diagnosed clinically, which is a concern, given the health and safety risks associated with unmanaged OSA. The availability of fewer practicing medical specialists combined with longer travel distances to access health care services results in barriers to diagnosis and treatment in rural communities. This study aimed to (1) determine whether the proportion of adults reporting OSA symptoms in the absence of a sleep apnea diagnosis in rural populations varied by travel distance to specialist medical care and (2) assess whether any distance-related patterns were attributable to differences in the frequency of diagnosis among adults who likely required this specialist medical care. We used a cross-sectional epidemiologic study design, augmented by analysis of follow-up survey data. Our study base included adults who completed a 2010 baseline questionnaire for the Saskatchewan Rural Health Study. Follow-up occurred until 2015. 6525 adults from 3731 households constituted our sample. Statistical models used log-binomial regression. Rural adults who reported the largest travel distances (&#x2265;250&#x2009;km) to specialist medical care were 1.17 (95&#x0025; CI: 1.07, 1.29) times more likely to report OSA symptoms in the absence of a sleep apnea diagnosis than those who reported the smallest (&#x3c;100&#x2009;km; referent) distances. However, the proportion of sleep apnea diagnoses was low and unaffected by reported travel distance among adults who likely required this specialist medical care. Our findings suggest factors other than travel distance may be contributing to the low sleep apnea diagnostic rate. This remains important as undiagnosed and untreated OSA has serious implications on the health of people and populations, but effective treatments are available. Health care access barriers to the diagnosis and treatment of OSA require evaluation to inform health care planning and delivery.

Catherine M. Spagnuolo

Michael McIsaac

James Dosman

Chandima Karunanayake

Punam Pahwa

William Pickett

Distance to Specialist Medical Care and Diagnosis of Obstructive Sleep Apnea in Rural Saskatchewan

Background. The Aerobika&#xae; oscillating positive expiratory pressure (OPEP) device is a hand-held, drug-free medical device that has been shown to improve lung function and improve health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). We estimated the cost-effectiveness of this device among postexacerbation COPD patients in the Canadian healthcare system. Methods. We performed a cost-utility analysis using a Markov model to compare both costs and outcome of patients with COPD who had recently experienced an exacerbation between 2 treatment arms: patients who used the Aerobika&#xae; device and patients who did not use the Aerobika&#xae; device. This cost-utility analysis included costs based on the Alberta healthcare system perspective as these represent Canadian experience. A one-year horizon with 12 monthly cycles was used. Results. For a patient after 1 year, the use of the Aerobika&#xae; device would save $694 in healthcare costs and produce 0.04 more in quality-adjusted life years (QALYs) in comparison with no positive expiratory pressure (PEP)/OPEP therapy. In other words, the economic outcome of the device was dominant (i.e., more effective and less costly). The probability for this device to be the dominant strategy was 72&#x0025;. With a willingness to pay (WTP) threshold of $50,000 per QALY gained, the probability for the Aerobika&#xae; device to be cost-effective was 77&#x0025;. Conclusions. Given one of the major treatment goals in the GOLD guidelines is to minimize the negative impact of exacerbations and prevent re-exacerbations, the Aerobika&#xae; OPEP device should be viewed as a potential component of a treatment strategy to improve symptom control and reduce the risk of re-exacerbations in patients with COPD.

Nguyen Xuan Thanh

Philip Jacobs

Jason Suggett

Andrew McIvor

Alan Kaplan

Cost-Effectiveness of the Aerobika&#xae; Oscillating Positive Expiratory Pressure Device in the Management of Chronic Obstructive Pulmonary Disease Exacerbations in Canada

Lung cancer is associated with high mortality. It can present as one or more pulmonary nodules identified on computed tomography (CT) chest scans. The National Lung Screening Trial has shown that the use of low-dose CT chest screening can reduce deaths due to lung cancer. High adherence to appropriate follow-up of positive results, including imaging or interventional approaches, is an important aspect of pulmonary nodule management. Our study is one of the first to evaluate the current practice in managing pulmonary nodules and to explore potential causes for nonadherence to follow-up. This is a retrospective analysis at St. Paul&#x2019;s Hospital, a tertiary healthcare center in Vancouver, British Columbia, Canada. We first identified CT chest scans between January 1 to June 30, 2014, that demonstrated one or more pulmonary nodules equal to or greater than 6&#x2009;mm in diameter. We then looked for evidence of interventional (surgical resection or biopsy, or bronchoscopy for transbronchial biopsy and cytology) and radiological follow-up of the pulmonary nodule by searching on the province-wide CareConnect eHealth Viewer patient database. A total of 1614 CT reports were analyzed and 139 (8.6&#x0025;) had a positive finding. Out of the 97 patients who received follow-up, 54.6&#x0025; (N&#x2009;&#x3d;&#x2009;53) was referred for a repeat CT chest scan and 36.1&#x0025; (N&#x2009;&#x3d;&#x2009;35) and 9.3&#x0025; (N&#x2009;&#x3d;&#x2009;9) were referred for interventional biopsy and surgical resection, respectively. In our study, 30.2&#x0025; (N&#x2009;&#x3d;&#x2009;42) of the patients with pulmonary nodules were nonadherent to follow-up. Despite the radiologist&#x2019;s recommendation for follow-up within a certain time interval, only 36&#x0025; had repeat imaging in a timely manner. Our findings reflect the current practice in the management of pulmonary nodules and suggest that there is a need for improvement at our academic center. Adherence to follow-up is important for the potentially near-future implementation of lung cancer screening.

Clarus Leung

Tawimas Shaipanich

Current Practice in the Management of Pulmonary Nodules Detected on Computed Tomography Chest Scans

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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 2019

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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