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Spring 2019 Issue 08

An official publication of the Ontario Respiratory Care Society, a section of
The Lung Association – Ontario

Update on Respiratory Health, Research and Education is a publication of the Ontario Respiratory Care Society, a section of The Lung Association. Update is published three times per year and includes peer-reviewed original articles, clinical practice tools, health news, and communications between the ORCS and its membership.


I’m very excited to be writing my first Chair’s message for Update on Respiratory Health, Research and Education!  Firstly, I’d like to thank Dina Brooks, BScPT, MSc, PhD, our new Past-Chair, for her dedication and commitment to the Ontario Respiratory Care Society (ORCS) for more than 25 years, and to congratulate her on her new role at McMaster as Vice Dean (Health Sciences) and Executive Director, School of Rehabilitation Science.  I also want to acknowledge Ann Bartlett, RN, MSc, BScN, CRE, who is retiring from St. Joseph’s Healthcare, Hamilton after more than 41 years of service.  Ann has been an ORCS member since 2001.  She was very active with ORCS.  She represented the South Central Region on the Provincial Committee and played a leadership role on both the Education Committee and the Respiratory Health Educators Interest Group (RHEIG).  We wish both Dina and Ann all the best for these new directions in their lives. Read More


In my first Editor’s message allow me to express my gratitude and excitement for being part of this wonderful community of caring people. There is nothing I find more empowering, engaging and motivating than learning from passionate individuals in the field of respiratory care, from novice to experts and our patients, who believe in the importance of continuing education. In a world where digital distractions put us all at risk of losing focus, sharing informative and relevant knowledge can and will help us stay the course in our professional quest to improve respiratory care. Read More

Internet-mediated research: Application to Clinical Research

By: Julie Duff Cloutier, RN, MSc, PhD(c)

Laurentian University, School of Nursing, School of Rural and Northern Health

It is estimated that 80% of Canadians use the internet daily in a variety of ways (1). For some, it is used as a means to search for health information, to share experiences of health journeys, or to seek out others that may face similar health challenges. Various online platforms exist for those wanting to access and interact with others, including healthcare professionals. Information and communication technologies have changed how people create and maintain social relationships and networks, how they go about their work and how they go about their daily lives. Such things are of interest to researchers, however, studying them requires methods of communication, ways of harvesting and capturing information, and analytical techniques adapted to the type and volume of data collected (2). This has led to the developing field of internet-mediated research.

Read More

COPD Quality Standards

Submitted by
Sue Jones, RRT, NFCSRT, LSSBB, QI Specialist, Health Quality Ontario

Quality Standards are created for conditions that show large variations in care delivery among care providers and facilities with identified gaps between provincial standards of care and actual care provided.Read More

Medical Assistance in Dying in Ontario: identifying emerging trends within an acute care setting

Dr. Debbie Selby, MD, FRCPC, Staff Physician in the Palliative Care Unit at Sunnybrook Health Sciences Centre.

Sally Bean, JD, MA, Director, Ethics & Policy, Sunnybrook Health Sciences Centre; University of Toronto Joint Centre for Bioethics; Adjunct Lecturer, Dalla Lana School of Public Health; Adjunct Lecturer, Institute of Health Policy Management & Evaluation; Associate Member, School of Graduate Studies.

Medical Assistance in Dying (MAiD) has been a legally available option for patients meeting eligibility requirements since June 2016. In February 2015, the Supreme Court of Canada ruled in Carter v. Canada (Attorney General) that a criminal prohibition on assisted death violated the Canadian Charter of Rights and Freedom (1). Bill C-14, which amended the federal Criminal Code, outlines the eligibility and procedural requirements an individual must satisfy in order to be eligible for MAID (2).  Drawing on our experience in an academic teaching hospital in Ontario, we will provide an overview of the eligibility and procedural requirements, discuss the clinical provision of MAID to eligible persons, highlight some common characteristics of those choosing MAiD, and identify challenges faced by both patients and healthcare practitioners related to access and provision of MAiD. Read More


Better Breathing Conference 2019 Poster Winners

In the Spotlight features winners from the Poster Session at the Better Breathing Conference 2019, which was held January 24 – 26 at the Toronto Marriot Downtown Eaton Centre.

The winner of the Margaret Fitch award for best poster was Mika Nonoyama from the University of Toronto for her poster “Novel Device to Improve Airway Intubation Safety by Providing Apneic Oxygenation and On-demand Suction through the Endotracheal Tube:  Piglet Protocol.” Co-authors were Mark Tessaro, Diane Soares, Cengiz Karsli, Thomas Looi, Alex Gordon.

The Lisa Cicutto award for best poster by a student was presented to Sachi O’Hoski of McMaster University for her poster “Reliability and Validity of a Measure of Participation in People with Chronic Obstructive Pulmonary Disease.” Co-authors were Ayse Kuspinar, Julie Richardson, Joshua Wald, Marla K Beauchamp.

The winner of the Sheila Gordon-Dillane award for best poster for program evaluation was Jacky Au, with co-authors Sarah Isaac, Renee Jensen, Sanja Stanojevic, and Felix Ratjen from The Hospital for Sick Children, for their poster “Improving Multiple Breath Washout Training Evaluation of E-learning Modules.”

Congratulations to all of our poster award winners!

We look forward to seeing you all at Better Breathing 2020!

Mark your calendars for January 23 – 25, 2020.

The Breathe App for Chronic Obstructive Pulmonary Disease (COPD)

Submitted by Aisha Balasubramaniam, MPH, RRT, CRE

COPD’s burden on healthcare and the individuals affected makes it an undeniable priority in regard to development of self-management options for patients, clinicians and medical institutions. Breathe for COPD transforms the current methods for the self-management of COPD, from a generic paper-based approach to one that is dynamic and personalized. The mobile app (currently optimized for iOS) enables patients to manage their exacerbations more efficiently and effectively.

As a “digital educator,” Breathe for COPD empowers patients to independently identify changes in their breathing. When the patient inputs their symptoms, the digital educator helps them detect when they might be having a flare-up.  Within the app, the patient will find their self-management action plan which gives them instant instruction when it detects that they might be starting to flare up. Over time, Breathe will teach the patient how to become more familiar with exacerbation symptoms and how to work through them. The patient will learn to take action earlier, giving them confidence in knowing when they should and shouldn’t seek urgent care.


  • Exacerbation recommendation based on the Canadian Thoracic Society’s action plan.
  • Conversational interface using a chat box that will provide comments and feedback that are digitally programmed into the system.
  • System input: Patient identifies their baseline and changes in breathing and sputum.
  • Location detection, weather information, and hourly air quality prediction.

Download Breathe: If your patient is an iPhone user and has frequent exacerbations, they can download Breathe today. Search for “Breathe for COPD” or “breathe for Asthma” on the App Store and tap the button. They will be able to sign themselves up right away. Hopefully the app will be available for android users soon.


Lazard AJ, Pikowski J, Horrell L, Ross JC, Noar SM, Sutfin EL. Adolescents’ and young adults’ aesthetics and functionality preferences for online tobacco education. J Cancer Educ. 2019. Available from: https://doi.org/10.1007/s13187-019-1475-4.

Submitted by David Higginson, 3rd year BScN student and Julie Duff Cloutier, Assistant Professor, Laurentian University

Although the use of cigarettes are declining, non-cigarette tobacco products (NCTPs) use is high among young adults and adolescents despite the clear evidence of health risks related to NCTP use. Addressing this involves communicating accurate information to adolescents and young adults in a familiar way, on the internet. There is a need for user friendly mobile apps and websites that convey accurate information in an engaging and informative way.

Online tobacco education is a potential solution to discourage use however there is limited information on how online media should look and function. This study aims to address this issue. Using a two-phase qualitative design, researchers examined existing websites and used focus group feedback to guide the design of a new website that discussed the risks of cigarillos, water pipe (hookah), and e-cigarettes. The focus groups consisted of four 90-minute sessions with 8-11 participants (n=39) for both adolescents (16-17 years old) and young adults (18-26 years old). Groups were separated into tobacco users and susceptible non-users. In phase one, focus groups assessed and expressed opinions regarding aesthetics and functionality of the following websites: therealcost.com, thetruth.com, and stillblowingsmoke.org. Phase one results indicated the importance of layout, font/text presentation, colour, visual tone, imagery/information visualization and social media. Results from phase one guided phase two, which involved the design of a NCTPs education website (suckedin.net) that was reviewed by usability interviews (n=16) with participants from phase one. The collective results indicate the need for responsive designs, uncluttered layouts, easy to navigate interfaces, limited colour variety, and the need for important information to be included instead of dramatic facts and images that may have misconstrued meanings. The findings provide guidelines for online tobacco education to increase engagement among adolescents.


Anderson, R. P, & Zechar, K. Lung injury from inhaling butane hash oil mimics pneumonia. Respiratory Medicine Case Reports. 2019; 26:171-173. Available from: doi:10.1016/j.rmcr.2019.01.002 

Submitted by Emily Smith, 3rd year BScN student and Julie Duff Cloutier, Assistant Professor, Laurentian University 

“Dabbing” is becoming an increasingly popular form of consuming tetrahydrocannabinol (THC) that utilizes Butane Hash Oil (BHO), an extraction of dried cannabis containing high levels of butane and terpene by-products. BHO is left as a waxy substance that is heated, vaporized and inhaled, and contains up to 75% of THC, compared to 5-20% THC in conventional smoked cannabis.

The authors reviewed a case of a young 18-year-old female presenting to the emergency department (ED) with pneumonia-like symptoms; shortness of breath for 3-4 days, oxygen saturation of 79% on room air. Her condition did not respond to bronchodilators, steroids or supplemental oxygen therapy. Medical history revealed a 1-pack year smoking history and daily BHO use. She was diagnosed with severe pneumonitis with acute hypoxic respiratory failure, secondary BHO inhalation. The authors suggested that the patient developed an acute lung injury after heating the nail to a temperature above 900o F. It is likely that pulmonary irritants including Methacrolein, Benzene and hot vapour were released at this temperature.

The only other literature on lung injury from inhaling BHO located was of a case with a 19-year-old male in 2016 diagnosed with severe pneumonitis after inhalation of BHO. Similarities in the case were highlighted: young patient with no comorbidities, rare tobacco use, daily THC, BHO approximately 1-week prior to ED presentation, hypoxic respiratory failure, clinical improvement with steroids.

Due to its high percentage of THC, “dabbing” is becoming increasingly popular. The authors proposed that lung injury due to BHO inhalation should be considered with a history of marijuana related drug use when witnessing a pneumonia-like presentation. The authors concluded that further exploration of the topic is required due to the unknown short- and long-term effects of BHO use.


Martínez C, Baena A, Castellano Y, Fu M, Margalef M, Tigova O, Feliu A, Larousse K, Galimany J, Puig M, Bueno A, Lopez A, Fernández E. Prevalence and determinants of tobacco, e-cigarettes, and cannabis use among nursing students: A multicenter cross-sectional study. Nurse Educ Today. 2019; 74:61–68. Available from: https://doi.org/10.1016/j.nedt.2018.11.018

Submitted by Lucas McDougall, 4th year BScN student and Julie Duff Cloutier, Assistant Professor, Laurentian University

Nurses make up the largest group of healthcare providers (HCP) that are often visible to the public. In general, nurses who smoke are less likely to initiate smoking cessation with clients. As such, nursing students hold potential as future HCP to have a role in delivering smoking cessation.

This study examined the prevalence and determinants of tobacco product, cannabis and e-cigarette use in nursing students through a cross sectional multicenter study within 15 nursing schools in Catalonia, Spain. Data collection involved an anonymous self-administered questionnaires (N=4381). The authors calculated the prevalence, odd ratios and confidence levels using a multilevel logistic regression model. Prevalence of cigarette smoking was 29.7% and was 11.5% for cannabis use of all students. Men, and those who were older than 25, were more likely to be smokers (cigarettes and cannabis) than women

Reasons for relapse following cessation included lack of social support, withdrawal symptoms, and the idea that smoking could be controlled. Identified reasons for continued smoking included pleasurable, de-stress, not able to quit, and other smokers in social environment. The authors made it clear that smoking cessation for nursing students must include both a psychological angle, to address stress and social factors, and a pharmacological angle, to address withdrawal. Authors also recommended that cessation programs target younger nursing students as their addiction levels may consolidate along their education.

It is hoped that successful smoking cessation for nursing students will likely result in future nursing staff more willing to support clients in smoking cessation.


Submitted by Peter Glazier, Vice President, Marketing, Development and Public Affairs,
The Lung Association – Ontario

Each year, our partners in industry and government, our donors, volunteers and Breathing Ambassadors, and the members of our professional societies, come together on one special evening…an evening to celebrate research excellence, to network and meet new friends, and to be inspired by some truly remarkable stories.

Read More


Joining an ORCS Committee is a great way to get involved! Read More


July 11, 2019
Spirometry Interpretation Workshop

CFPC Mainpro+ Certified
Funded by Ministry of Health and Long Term Care
Registration Coming Soon

September 12, 2019
Spirometry Interpretation Workshop
CFPC Mainpro+ Certified
Funded by Ministry of Health and Long Term Care
Registration Coming Soon

September 13, 2019
Asthma Action Plan Workshop

NPAO Conference
Sheraton Centre Toronto
Funded by Ministry of Health and Long Term Care
More Information (https://npao.org/events-education/npao-conference/)

September 14, 2019
Spirometry Interpretation Workshop
PFT Symposium
Novotel Ottawa
Funded by Ministry of Health and Long Term Care
Register here (www.eventbrite.ca/e/pulmonary-function-testing-symposium-2019-registration-60277112466)

September 26, 2019
Breathing Inspired

ORCS Western Region Evening Seminar
Fanshawe College London
Registration Coming Soon

October 10, 2019
Asthma COPD Overlap Workshop
HHS Respiratory Therapy Educational Retreat
Carmen’s Banquet Centre Hamilton
Funded by Ministry of Health and Long Term Care
More Information (http://events.hamiltonhealth.ca/site/TR?fr_id=1980&pg=entry)

October 27, 2019
COPD – Acute Exacerbation and End-of-Life Workshop
Practical Pearls in Long-Term Care Conference
Sheraton Centre Toronto
Funded by Ministry of Health and Long Term Care
More Information (https://www.oltcc.ca/annual-conference/)

October 29, 2019
Breathing Inspired

ORCS Eastern Region Evening Seminar
Italo-Canadian Club Kingston
Registration Coming Soon

October 2019
Breathing Inspired:
ORCS North Eastern Region Seminar
Details and Registration Coming Soon

October 30, 2019
Breathing Inspired: Pulmonary Rehabilitation and Its Barriers

ORCS Central Region Evening Seminar
The Lung Association Provincial Office
Registration Coming Soon

October 30, 2019
COPD Workshop
Southlake Regional Health Centre Newmarket
CFPC Mainpro+ Certified
Funded by Ministry of Health and Long Term Care
Registration Coming Soon

November 7, 2019
Breathing Inspired: COPD Rehabilitation – Communicating the Diagnosis and Prognosis

ORCS South Central Region Evening Seminar
Registration Coming Soon

RESPTREC® Workshops
Asthma:  Toronto September 26-27, 2019
Ottawa October 25-26, 2019

COPD:  Toronto October 5-6, 2019
Education:  Toronto September 28-29, 2019
Ottawa October 27-28, 2019

Spirometry: Toronto October 4, 2019

September 30, 2019
Notice of New Spirometry Certification Exam
The Canadian Association of Cardio-Pulmonary Technologists membership is composed of technologists employed in the Heart Catheterization Laboratories and/or Pulmonary Function Laboratories.

November 9, 2019
Steeltown Stair Climb


Yvonne Drasovean, RRT
Lorelei Samis, BScPT

Jocelyn Carr, BScPT, MSc
Julie Duff Cloutier, RN, MSc, CAE
Yvonne Drasovean, RRT
Elizabeth Gartner, BScOT
Lawrence Jackson, BScPhm
Rachel McLay, HBSc (Kinesiology)
Shirley Quach, HBsc, RRT
Priscila Robles, BScPT, MSc, PhD
Lily Spanjevic, RN, BScN, MN, GNC(C), CRN(C), CMSN(C)

Miriam Freymond Turnbull, MBA, RRT, COPD Ed.
Vice President  & GM | ProResp Inc.

George Habib, BA, BEd, CAE

Christina Sperling, MScCH, BKin, RRT

OTS/ORCS Coordinator
Natalie Bennett

An official publication of the Ontario Respiratory Care Society, a section of
The Lung Association – Ontario.

RHEIG Committee

Jane Lindsay, BScPT
Lorelei Samis, BScPT

Aisha Balasubramaniam, MPH, BSc, RRT, CRE
Geetika Bhargava, BHSc, RRT, CRE
Michael Callihoo, RRT, CRE
Rose-Marie Dolinar, RN(EC), MScN, PhD student
Kitty Seager, CRE, CTE, RPN
Sylvia Sirarajahkumar, HBSc, BScPharm, ACPR
Maria Willms, RN, CRE