Abstract Objective The aim of the present study was to evaluate whether rheumatoid arthritis (RA) patients followed longitudinally using video‐conferencing and inter‐professional care support have comparable disease control to those followed in traditional in‐person rheumatology clinics. Methods This was a randomized controlled trial for 85 RA patients allocated to either traditional in‐person rheumatology follow‐up or video‐conferenced follow‐up with urban‐based rheumatologists and rural in‐person physical therapist examiners. Follow‐up was every 3 months for 9 months. Outcome measures included disease activity metrics (disease activity in 28 joints with CRP measure score [DAS28‐CRP], and RA disease activity index [RADAI]), modified health assessment questionnaire (mHAQ), quality of life (EuroQOL five dimensions questionnaire [EQ5D]) and patient satisfaction (nine‐item visit‐specific satisfaction questionnaire [VSQ9]). Results Of 85 participants, 54 were randomized to the video‐conferencing team model and 31 to the traditional clinic (control group). Dropout rates were high, with only 31 (57%) from the video‐conferencing and 23 (74%) from the control group completing the study. The mean age for study participants was 56 years; 20% were male. Mean RA disease duration was 13.9 years. There were no significant between‐group differences in DAS28‐CRP, RADAI, mHAQ or EQ5D scores at baseline or over the study period. Satisfaction rates were high in both groups. Conclusions We found no evidence of a difference in effectiveness between inter‐professional video‐conferencing and traditional rheumatology clinic for both the provision of effective follow‐up care and patient satisfaction for established RA patients. High dropout rates reinforce the need for consultation with patients' needs and preferences in developing models of care. While use of video‐conferencing/telehealth technologies may be a distinct advantage for some patients, there may be loss of travel‐related auxiliary benefits for others.
Background: Inhaled corticosteroids (ICS) are a treatment foundation of asthma. Patients may also use short acting beta-2 agonists (SABA) to relieve symptoms but SABA alone does not treat the underlying inflammation. Thus, overreliance on SABA may result in poor asthma control and higher health resource utilization (HRU). Objective: To describe the use of SABA and ICS, and characterize the relationship to HRU in Nova Scotia, Canada, from Oct 2016-Mar 2019. Methods: In this Canadian SABINA (SABA In Asthma) study (Cabrera CS, Eur Respir J 2020), individuals with ≥1 inpatient or ≥2 asthma-related outpatient visits and ≥12 months’ follow-up were identified within an administrative dataset (Health Data Nova Scotia). Poisson regression was used to determine the relationship between SABA use and outpatient visits, adjusted for age and sex. Results: A total of 5,295 patients were identified (mean age 41.7 (SD: 18.4)). Of these, 32.7% (95% CI: 30.4-35.0%) of patients with at least one claim for ICS and 27.8% (26.3-29.3%) of patients with no claims for ICS made ≥3 SABA claims/ year. Asthma-related outpatient visits increased significantly with number of SABA canisters used per year (p<0.01) independent of the number of claims for ICS and adjusted by age and sex (Figure). Conclusion: These data highlight the continued impact of SABA overreliance in Canada. These results support the GINA 2019 statement on the impact of SABA overreliance leading to increased HRU.
In the lower respiratory tract, the alveolar spaces are divided from the bloodstream and the external environment by only a few microns of interstitial tissue. Alveolar macrophages (AMs) defend this delicate mucosal surface from invading infections by regularly patrolling the site. AMs have three behavior modalities to achieve this goal: extending cell protrusions to probe and sample surrounding areas, squeezing the whole cell body between alveoli, and patrolling by moving the cell body around each alveolus. In this study, we found Rho GTPase, cell division control protein 42 (CDC42) expression significantly decreased after berry-flavored e-cigarette (e-cig) exposure. This shifted AM behavior from squeezing to probing. Changes in AM behavior led to a reduction in the clearance of inhaled bacteria,
Rationale: A significant proportion of individuals with chronic obstructive pulmonary disease (COPD) and asthma remain undiagnosed. Objectives: The objective of this study was to evaluate symptoms, quality of life, healthcare use, and work productivity in subjects with undiagnosed COPD or asthma compared with those previously diagnosed, as well as healthy control subjects. Methods: This multicenter population-based case-finding study randomly recruited adults with respiratory symptoms who had no previous history of diagnosed lung disease from 17 Canadian centers using random digit dialing. Participants who exceeded symptom thresholds on the Asthma Screening Questionnaire or the COPD Diagnostic Questionnaire underwent pre- and post-bronchodilator spirometry to determine if they met diagnostic criteria for COPD or asthma. Two control groups, a healthy group without respiratory symptoms and a symptomatic group with previously diagnosed COPD or asthma, were similarly recruited. Measurements and Main Results: A total of 26,905 symptomatic individuals were interviewed, and 4,272 subjects were eligible. Of these, 2,857 completed pre- and post-bronchodilator spirometry, and 595 (21%) met diagnostic criteria for COPD or asthma. Individuals with undiagnosed COPD or asthma reported greater impact of symptoms on health status and daily activities, worse disease-specific and general quality of life, greater healthcare use, and poorer work productivity than healthy control subjects. Individuals with undiagnosed asthma had symptoms, quality of life, and healthcare use burden similar to those of individuals with previously diagnosed asthma, whereas subjects with undiagnosed COPD were less disabled than those with previously diagnosed COPD. Conclusions: Undiagnosed COPD or asthma imposes important, unmeasured burdens on the healthcare system and is associated with poor health status and negative effects on work productivity.
Background: The actual burden of COPD and asthma may be much higher than appreciated, since a large proportion of individuals are not diagnosed.Methods: This cross-sectional case-finding study used data from the Undiagnosed COPD and Asthma Population (UCAP) study. Adult subjects with respiratory symptoms who had no history of diagnosed lung disease were recruited in a two-step case-finding process using random digit-dialling of land lines and cell phones located within a 90-minute radius of 16 Canadian study sites. Participants were assessed for COPD, asthma or no airflow obstruction using pre- and post-bronchodilator spirometry based on American Thoracic Society diagnostic criteria. Our study objective was to compare health care utilization, burden of symptoms and quality of life in subjects with self-reported respiratory symptoms who were subsequently found to have undiagnosed airflow obstruction compared to those having no airflow obstruction.Results: 1660 participants were recruited, of these 1615 had adequate spirometry and 331 (20.5%) subjects met spirometry criteria for asthma or COPD. Subjects with undiagnosed asthma or COPD had increased respiratory symptoms as assessed by the COPD Assessment Test (CAT), and higher St. George’s Respiratory Questionnaire (SGRQ) scores indicating worse health related quality of life, compared to subjects with no airflow obstruction. No between-group differences were found in health care utilization or work or school absenteeism.Conclusion: Undiagnosed asthma and COPD are common in Canadian adults experiencing breathing problems and are associated with a greater burden of symptoms and poorer health-related quality of life.
Although only 5–10% of patients with asthma have severe disease, they account for a disproportionate share of the overall disease burden. Severe asthma is responsible for approximately 50% of all direct asthma-related costs as well as a significant decline in patient quality of life. For such patients, biologic or targeted therapies may be highly effective. However, their role is not widely understood and their use is currently minimal. Both Canadian and international research suggests that the adverse effects of oral corticosteroids in severe asthma are significant and costly but under-recognized. Our review of management of severe asthma in Canada highlights the need for increased recognition of the adverse effects of oral corticosteroids and more awareness of the newer alternative therapies on the part of physicians, as well as access to specialized care for the population with severe asthma including patient education resources, and ongoing monitoring with a severe asthma registry.
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