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Winter 2019 ISSUE 07

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

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CHAIR’S MESSAGE – Winter 2019

Happy New Year! It really is hard to believe that another year has gone by. And, with this year’s passing, my second year as Chair of the ORCS has gone by completing my term. It’s been a busy two years. Some milestones we’ve achieved together include the re-alignment of some of the regional planning committees to more closely match The Lung Association regions; the evolution of this electronic publication from two former hard copy newsletters, Update and Connections; and the launch of the membership portal that streamlines membership management, communications and event registration. Read More


Editor’s Message – Winter 2019

As respiratory health professionals, an important part of our job is education. Not only the education of patients, ourselves, and our colleagues, but also the education of future health care professionals. It is so satisfying to work with students and to see that glimmer in their eyes when they are truly inspired and interested in learning, particularly in the field of respiratory health and wellness. As busy clinicians, working with students is very rewarding but can also be a hard job at times. We encourage all health professionals to continue to accept this important challenge of educating our future colleagues and hope that some of the articles in this winter 2019 edition of Update on Respiratory Health, Research, and Education will inspire you to continue this work. Read More


BBC 2019

The Lung Association – Ontario invites you to our 36th annual Better Breathing Conference running from January 24-26, 2019 at the Toronto Marriott Downtown Eaton Centre. Read More

 

 


RESEARCH AND FELLOWSHIP AWARDS

ORCS Research and Fellowship Committee Chair, Mika Nonoyama, PhD, Assistant Professor, Registered Respiratory Therapist

Research Grants and Fellowship Awards support research and graduate study by health-care providers in the field of respiratory care. The objective of this fund is to promote research regarding any field of acute or chronic lung disease. Research may include investigation of any phenomenon pertinent to illness assessment, management, or responses of the individual with a respiratory condition. Research may also be aimed at health promotion, education and prevention issues. Studies may use quantitative or qualitative methodologies. Read More


Strategies Health Professional Students Can Use to Ensure Success in an Experiential Placement

Lawrence Jackson provides advice to help health professional students ensure success in an experiential placement. Read More


Human Airway Branch Variation and Chronic Obstructive Pulmonary Disease

Submitted by: Kayla Kok
Fanshawe student Kayla Kok reviews and summarizes a published article on a previously unknown genetically-inherited risk factor for COPD. The full article can be found at DOI: 10.1073/pnas.1715564115 Read More



EYE ON

Unique Funding Model for Pulmonary Rehabilitation in North Bay and Vaughn, Ontario
Tammy Draper looks at a unique funding model for pulmonary rehabilitation. Read More

 

 


Tool Box

Be Open to Alternate Forms of Exercise for your Patients
Submitted by: Jane Lindsay, BScPT, CRE

When educators are encouraging patients to attend pulmonary rehabilitation, it is essential that they carefully evaluate each patient’s needs and preferences. A recent study, published online in Chest, was reviewed by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). The study is a randomly controlled comparison of “standard” pulmonary rehabilitation (PR) and Tai Chi. Both groups of COPD patients were naive to rehabilitation, and attended sessions for 12 weeks: three times per week for the PR group, and five times per week for the Tai Chi group. While some limitations exist, as in almost every study, the short version of the result is that both groups demonstrated very similar improvements in exercise tolerance and in quality of life. Read More


IN THE SPOTLIGHT

Therese Hawn, BScPT

Throughout her career, Therese has contributed to the mission of the ORCS by furthering excellence in respiratory care through education, research, collaboration and professional expertise.

Submitted by: Lisa Wickerson, BScPT, MSc, PhD (Candidate)

Throughout her career, Therese has contributed to the mission of the ORCS by furthering excellence in respiratory care through education, research and interprofessional collaborations. Therese is a physiotherapist and an American College of Sports Medicine exercise specialist within the Peter Munk Cardiac Program at the University Health Network (UHN) in Toronto and the clinical physical therapy practice leader for cardiac, transplant, advanced medicine and surgery, and surgical oncology programs. Read More


RESPIRATORY ARTICLES OF INTEREST

Respiratory article of interest

Study one

Castro M, Corren J, Pavord ID, Maspero J, Wenzel S, Rabe KF, et al. Dupilumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma. The New England journal of medicine. 2018;378(26):2486-96.

Study two

Rabe KF, Nair P, Brusselle G, Maspero JF, Castro M, Sher L, et al. Efficacy and Safety of Dupilumab in Glucocorticoid-Dependent Severe Asthma. The New England journal of medicine. 2018;378(26):2475-85.

Submitted by: Elizabeth Gartner, BScOT

A review of the following two studies involving dupilumab efficacy and safety in patients with asthma:

Study one (S1) and study two (S2) both looked at the efficacy and safety of dupilumab in patients with asthma. Both studies used similar methods and patient populations, although S2 specifically investigated patients with severe asthma who were glucocorticoid-dependent. Both study patient populations consisted of those over 12 years old who had had a diagnosis of asthma, as defined by the Global Initiative for Asthma 2014 guidelines, for one year or longer.

Eligibility criteria in S1 included asthmatic patients receiving medium-to-high dose inhaled glucocorticoid and whose forced expiratory volume in one second (FEV1) before bronchodilator use was 80% or less of predicted normal (adjusted to 90% or less for ages 12-17) and reversibility of 12%. They also had a score of 1.5 or greater on the 5-item Asthma Control Questionnaire (ACQ-5) and worsening of asthma over the previous year. S2 patients differed in that those treated with systemic glucocorticoids in the last six months were eligible. Also, in the four weeks prior to the study their treatment included high-dose inhaled glucocorticoid. Both studies recruited patients with no minimum baseline blood or sputum eosinophil count.

Drug trial design was different in the two studies for randomization and intervention duration. Study 1 ran from May 2015 to September 2016, and involved 1902 patients assigned in a 2:2:1:1 ratio to receive either a 200mg or 300mg dose of dupilumab or the matched volume of placebo, every two weeks over 52 weeks. Study 2 ran from December 2015 to September 2017, and involved 210 patients who were randomized into two groups, either receiving 300mg dose of dupilumab or placebo. Treatments in S2 were also provided every two weeks, but for 24 weeks, and with glucocorticoid doses being adjusted from week 4 to week 20.

Results for both studies demonstrated positive outcomes using dupilumab in similar end points. Primary end points in S1 included severe exacerbations per year and FEV1 absolute change from baseline, before bronchodilator use. Primary efficacy end point for S2 was percentage reduction in glucocorticoid dose, from baseline to end of study with asthma controlled. Other efficacy end points were the same as in S1.

Scores in the ACQ-5 for S1 from two weeks in, until the end of the study showed improvement in asthma control with dupilumab over placebo. The S2 ACQ-5 scores reported at the end also showed improvement in asthma control with dupilumab over placebo. Incident rates of adverse events were similar in both treatment and placebo groups across the studies.

In conclusion, both of these studies indicated that the use of dupilumab in patients with moderate-to-severe asthma as well as in those patients with glucocorticoid-dependent severe asthma, reduced rates of exacerbation, increased FEV1 and improved asthma control.


Respiratory article of interest

Jolly K, Sidhu MS, Hewitt CA, Coventry PA, Daley A, Jordan R, et al. Self management of patients with mild COPD in primary care: randomised controlled trial. BMJ (Clinical research ed). 2018;361:k2241.

Submitted by Julie Duff Cloutier RN, MSc

The study was designed to evaluate the effectiveness of telephone health coaching to support self-management delivered by a nurse in a primary care population with mild symptoms of chronic obstructive pulmonary disease. A multicentre randomised controlled trial was conducted which involved 71 general practices in four areas of England. The 577 patients with a Medical Research Council dyspnea scale score of 1 or 2, were randomised to telephone health coaching (n=289) or usual care (n=288). The intervention consisted of telehealth coaching aimed at supporting self-management in relation to smoking cessation, physical activity, inhaler technique and medication adherence, and was delivered by a nurse, while the usual care group received a standard information leaflet on self-management. The primary outcome was health related quality of life measured at 12 months. Secondary outcomes included dyspnea, self-reported physical activity and psychological morbidity amongst others. No significant differences were noted between the intervention and usual care groups, however, this study is one of few conducted with those who have mild disease. Further research targeted towards this patient group is needed.


Ways to Get Involved

Ontario Respiratory Care Society (ORCS) Committees

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


Upcoming Events Listing

January 10, 2019
Adult Asthma Action Plan OTN
The Lung Association – Ontario’s Provider Education Program will host an Asthma Action Plan OTN. Stay tuned for more information.

January 23- 24, 2019
Respiratory Health Forum 2019- Spirometry Interpretation Workshop
Respiratory Health Forum 2019 will be held at the Marriott Toronto Downtown Eaton Centre Hotel. The Lung Association – Ontario’s Provider Education Program will be running a Spirometry Interpretation accredited workshop at the Respiratory Health Forum. Dr. Gupta will also be presenting on Asthma Action Plans- From research to real world usage. Register here

January 24 – 26, 2019
Better Breathing Conference 2019
Better Breathing 2019 will be held at the Marriott Toronto Downtown Eaton Centre Hotel, presented by two professional societies: Ontario Thoracic Society (OTS) & Ontario Respiratory Care Society (ORCS). Click here for more information.

January 29, 2019
Unison Health Services-Spirometry Interpretation Workshop
The Lung Association – Ontario’s Provider Education Program will host a Spirometry workshop at Unison Health Services in Toronto. Stay tuned for more information.

February 06, 2019
The Lung Association – Ontario’s Provider Education Program will host a COPD workshop at the St Mikes Family Health Team. Stay tuned for more information.

February 21, 2019
The Lung Association – Ontario’s Provider Education Program will host a Spirometry workshop in Stratford, Ontario. Please stay tuned for more information.

February 25th to March 8th, 2019.
Breath of Spring Fundraising Campaign
We’re still selling tulips – our signature flower, which is low fragrance and non-allergic, but we’re also selling crispy wave ferns, which have been shown to convert carbon dioxide into oxygen and remove harmful particles from the air. Both are perfect gifts for a family member or a friend – or an easy way to add a breath of spring to your office! Your purchase helps welcome the spring and kick the winter blues to the curb! Learn more or register here

February 26, 2019
The Lung Association – Ontario’s Provider Education Program will host a COPD workshop at Taddlecreek Family Health Team. Stay tuned for more information.

February 27, 2019
Title TBD

The Lung Association – Ontario’s Provider Education Program will host a COPD workshop in Whitby. Stay tuned for more information.

March 21
Title TBD
The Lung Association – Ontario’s Provider Education Program will host a pediatric AAP plan OTN. Stay tuned for more information.

March 28, 2019
Breathe! Bash 2019
Mark your calendars for the prestigious Breathe! Bash, which will be celebrating its 10th anniversary on March 28, 2019 at REBEL Entertainment Complex! Check back regularly for exciting details of this not to be missed celebration! For more information and to purchase tickets please click here.

April 25, 2019
COPD Workshop
The Lung Association – Ontario’s Provider Education Program will host a COPD workshop at Smith Falls. Stay tuned for more information.

May 11, 2019
COPD vs Asthma
The Lung Association – Ontario’s Provider Education Program will host a COPD vs Asthma workshop at PRIMED. Stay tuned for more information.

May 16, 2019
COPD vs Asthma
The Lung Association – Ontario’s Provider Education Program will host a COPD workshop in Markham. Stay tuned for more information.

May 23, 2019
COPD vs Asthma
The Lung Association – Ontario’s Provider Education Program will host a COPD vs Asthma workshop and Respiratory Medication session in Manitoulin Island. Stay tuned for more information.


EDITORIAL Committee
CO-CHAIRS
Jocelyn Carr, BScPT, MSc
Lorelei Samis, BScPT

MEMBERS
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)

RHEIG Executive Team
CO-CHAIRS
Jane Lindsay, BScPT, CRE
Lorelei Samis, BScPT

MEMBERS
Michael Callihoo, RRT, CRE
Rose-Marie Dolinar, RN(EC), MScN, PhD student
Diane Feldman, RRT, CRE
Olivia Ng, BScPhm, RPh, PharmD (Candidate)
Kitty Seager, CRE, CTE, RPN
Maria Willms, RN, CRE

 

CHAIR, ONTARIO RESPIRATORY CARE SOCIETY
Dina Brooks, BScPT, MSc, PhD

PRESIDENT & CEO, THE LUNG ASSOCIATION – ONTARIO
George Habib, BA, BEd, CAE

DIRECTOR, ONTARIO RESPIRATORY CARE SOCIETY
Sherry Zarins

OTS/ORCS Coordinator
Natalie Bennett

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