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1. Abnormal Exertional Breathlessness on Cardiopulmonary Cycle Exercise Testing in Relation to Self-Reported and Physiologic Responses in Chronic Airflow Limitation

Author

Bourbeau, Jean, Tan, Wan C., FitzGerald, J. Mark, Sin, Don D., Marciniuk, Darcy D., O’Donnell, Denis E., Hernandez, Paul, Chapman, Kenneth R., Walker, Brandie, Aaron, Shawn, Maltais, François, Samet, Jonathon, Puhan, Milo, Hamid, Qutayba, Hogg, James C., Doiron, Dany, Mancino, Palmina, Li, Pei Zhi, Jensen, Dennis, Baglole, Carolyn, Fortier, Yvan, Sin, Don, Yang, Julia, Road, Jeremy, Comeau, Joe, Png, Adrian, Johnson, Kyle, Coxson, Harvey, Leipsic, Jonathon, Hague, Cameron, Kirby, Miranda, Sadatsafavi, Mohsen, To, Teresa, Gershon, Andrea, Li, Pei-Zhi, Song, Zhi, Benedetti, Andrea, Lo, Christine, Cheng, Sarah, Un, Elena, Fung, Cynthia, Wang, Wen Tiang, Zheng, Liyun, Faroon, Faize, Radivojevic, Olga, Chung, Sally, Zou, Carl, Baril, Jacinthe, Labonte, Laura, Chapman, Kenneth, McClean, Patricia, Audisho, Nadeen, Dumonceaux, Curtis, Machado, Lisette, Fulton, Scott, Osterling, Kristen, Wigerius, Denise, Vandemheen, Kathy, Pratt, Gay, Bergeron, Amanda, O’Donnell, Denis, McNeil, Matthew, Whelan, Kate, Brouillard, Cynthia, Marciniuk, Darcy, Clemens, Ron, Baran, Janet, Leuschen, Candice, Ekström, Magnus, and Lewthwaite, Hayley

Published
2024
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2. Impaired Spirometry and COPD Increase the Risk of Cardiovascular Disease: A Canadian Cohort Study

Author

FitzGerald, J. Mark, Sin, Don D., Marciniuk, Darcy D., O’Donnell, Denis E., Hernandez, Paul, Chapman, Kenneth R., Walker, Brandie, Aaron, Shawn, Maltais, François, Doiron, Dany, Mancino, Palmina, Li, Pei Zhi, Jensen, Dennis, Baglole, Carolyn, Fortier, Yvan, Sin, Don, Yang, Julia, Road, Jeremy, Comeau, Joe, Png, Adrian, Johnson, Kyle, Coxson, Harvey, Leipsic, Jonathon, Hague, Cameron, Kirby, Miranda, Song, Zhi, Benedetti, Andrea, Lo, Christine, Cheng, Sarah, Un, Elena, Fung, Cynthia, Wang, Wen Tiang, Zheng, Liyun, Faroon, Faize, Radivojevic, Olga, Chung, Sally, Zou, Carl, Bourbeau, Jean, Baril, Jacinthe, Labonte, Laura, Chapman, Kenneth, McClean, Patricia, Audisho, Nadeen, Dumonceaux, Curtis, Machado, Lisette, Fulton, Scott, Osterling, Kristen, Wigerius, Denise, Vandemheen, Kathy, Pratt, Gay, Bergeron, Amanda, O’Donnell, Denis, McNeil, Matthew, Whelan, Kate, Brouillard, Cynthia, Marciniuk, Darcy, Clemens, Ron, Baran, Janet, Leuschen, Candace, Krishnan, Suurya, Tan, Wan C., Farias, Raquel, and Aaron, Shawn D.

Published
2023
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3. Impaired Sleep Quality in COPD Is Associated With Exacerbations The CanCOLD Cohort Study

Author

Shorofsky, Matthew, Bourbeau, Jean, Kimoff, John, Jen, Rachel, Malhotra, Atul, Ayas, Najib, Tan, Wan C, Aaron, Shawn D, Sin, Don D, Road, Jeremy, Chapman, Kenneth R, O’Donnell, Denis E, Maltais, François, Hernandez, Paul, Walker, Brandie L, Marciniuk, Darcy, Kaminska, Marta, FitzGerald, J Mark, Sin, DD, Marciniuk, DD, O'Donnell, DE, Cowie, Robert, Aaron, Shawn, Maltais, F, Samet, Jonathon, Puhan, Milo, Hamid, Qutayba, Hogg, James C, Baglole, Carole, Jabet, Carole, Mancino, Palmina, Fortier, Yvan, Sin, Don, Tam, Sheena, Comeau, Joe, Png, Adrian, Coxson, Harvey, Kirby, Miranda, Leipsic, Jonathon, Hague, Cameron, Sadatsafavi, Mohsen, Gershon, Andrea, Li, Pei-Zhi, Duquette, Jean-Francois, Benedetti, Andrea, Jensen, Denis, O'Donnell, Denis, Lo, Christine, Cheng, Sarah, Fung, Cindy, Ferguson, Nancy, Haynes, Nancy, Chuang, Li, Licong, Bayat, Selva, Wong, Amanda, Alavi, Zoe, Peng, Catherine, Zhao, Bin, Scott-Hsiung, Nathalie, Nadirshaw, Tasha, Latreille, David, Baril, Jacinthe, Labonte, Laura, Chapman, Kenneth, McClean, Patricia, Audisho, Nadeen, Walker, Brandie, Cowie, Ann, Dumonceaux, Curtis, Machado, Lisette, Fulton, Scott, Osterling, Kristen, Vandemheen, Kathy, Pratt, Gay, Bergeron, Amanda, McNeil, Matthew, Whelan, Kate, Maltais, Francois, Brouillard, Cynthia, and Clemens, Ron

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Sleep Research, Lung, Behavioral and Social Science, Clinical Research, Chronic Obstructive Pulmonary Disease, Respiratory, Aged, Cohort Studies, Disease Progression, Dyspnea, Female, Health Services, Humans, Male, Middle Aged, Proportional Hazards Models, Prospective Studies, Pulmonary Disease, Chronic Obstructive, Sleep, Sleep Wake Disorders, Sputum, Time Factors, acute exacerbation of chronic bronchitis, COPD, sleep medicine, Canadian Respiratory Research Network, CanCOLD Collaborative Research group, Respiratory System, Cardiovascular medicine and haematology, Clinical sciences
Abstract

BackgroundCOPD increases susceptibility to sleep disturbances, which may in turn predispose to increased respiratory symptoms. The objective of this study was to evaluate, in a population-based sample, the relationship between subjective sleep quality and risk of COPD exacerbations.MethodsData were obtained from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Participants with COPD who had completed 18 months of follow-up were included. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a three-factor analysis. Symptom-based (dyspnea or sputum change ≥ 48 h) and event-based (symptoms plus medication or unscheduled health services use) exacerbations were assessed. Association of PSQI with exacerbation rate was assessed by using negative binomial regression. Exacerbation-free survival was also assessed.ResultsA total of 480 participants with COPD were studied, including 185 with one or more exacerbations during follow-up and 203 with poor baseline sleep quality (PSQI score > 5). Participants with subsequent symptom-based exacerbations had higher median baseline PSQI scores than those without (6.0 [interquartile range, 3.0-8.0] vs 5.0 [interquartile range, 2.0-7.0]; P = .01), and they were more likely to have baseline PSQI scores > 5 (50.3% vs 37.3%; P = .01). Higher PSQI scores were associated with increased symptom-based exacerbation risk (adjusted rate ratio, 1.09; 95% CI, 1.01-1.18; P = .02) and event-based exacerbation risk (adjusted rate ratio, 1.10; 95% CI, 1.00-1.21; P = .048). The association occurred mainly in those with undiagnosed COPD. Strongest associations were with Factor 3 (sleep disturbances and daytime dysfunction). Time to symptom-based exacerbation was shorter in participants with poor sleep quality (adjusted hazard ratio, 1.49; 95% CI, 1.09-2.03).ConclusionsHigher baseline PSQI scores were associated with increased risk of COPD exacerbation over 18 months' prospective follow-up.

Published
2019

4. Impaired Sleep Quality in COPD Is Associated With Exacerbations: The CanCOLD Cohort Study

Author

Bourbeau, Jean, Tan, Wan C., FitzGerald, J. Mark, Sin, D.D., Marciniuk, D.D., O'Donnell, D.E., Hernandez, Paul, Chapman, Kenneth R., Cowie, Robert, Aaron, Shawn, Maltais, F., Samet, Jonathon, Puhan, Milo, Hamid, Qutayba, Hogg, James C., Baglole, Carole, Jabet, Carole, Mancino, Palmina, Fortier, Yvan, Sin, Don, Tam, Sheena, Road, Jeremy, Comeau, Joe, Png, Adrian, Coxson, Harvey, Kirby, Miranda, Leipsic, Jonathon, Hague, Cameron, Sadatsafavi, Mohsen, Gershon, Andrea, Li, Pei-Zhi, Duquette, Jean-Francois, Benedetti, Andrea, Jensen, Denis, O'Donnell, Denis, Lo, Christine, Cheng, Sarah, Fung, Cindy, Ferguson, Nancy, Haynes, Nancy, Chuang, Junior, Li, Licong, Bayat, Selva, Wong, Amanda, Alavi, Zoe, Peng, Catherine, Zhao, Bin, Scott-Hsiung, Nathalie, Nadirshaw, Tasha, Latreille, David, Baril, Jacinthe, Labonte, Laura, Chapman, Kenneth, McClean, Patricia, Audisho, Nadeen, Walker, Brandie, Cowie, Ann, Dumonceaux, Curtis, Machado, Lisette, Fulton, Scott, Osterling, Kristen, Vandemheen, Kathy, Pratt, Gay, Bergeron, Amanda, McNeil, Matthew, Whelan, Kate, Maltais, Francois, Brouillard, Cynthia, Marciniuk, Darcy, Clemens, Ron, Baran, Janet, Shorofsky, Matthew, Kimoff, John, Jen, Rachel, Malhotra, Atul, Ayas, Najib, Aaron, Shawn D., Sin, Don D., O’Donnell, Denis E., Maltais, François, Walker, Brandie L., and Kaminska, Marta

Published
2019
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6. The COPD Assessment Test: Can It Discriminate Across COPD Subpopulations?

Author

Bourbeau, Jean, Tan, Wan C., FitzGerald, J. Mark, Sin, D.D., Marciniuk, D.D., O'Donnell, D.E., Hernandez, Paul, Chapman, Kenneth R., Cowie, Robert, Aaron, Shawn, Maltais, F., Samet, Jonathon, Puhan, Milo, Hamid, Qutayba, Hogg, James C., Baglole, Carole, Jabet, Carole, Mancino, Palmina, Fortier, Yvan, Sin, Don, Tam, Sheena, Road, Jeremy, Comeau, Joe, Png, Adrian, Coxson, Harvey, Kirby, Miranda, Leipsic, Jonathon, Hague, Cameron, Sadatsafavi, Mohsen, To, Teresa, Gershon, Andrea, Li, Pei-Zhi, Duquette, Jean-Francois, Benedetti, Andrea, Jensen, Denis, O'Donnell, Denis, Lo, Christine, Cheng, Sarah, Fung, Cindy, Haynes, Nancy, Chuang, Junior, Zheng, Liyun, Latreille, David, Baril, Jacinthe, Labonte, Laura, Chapman, Kenneth, McClean, Patricia, Audisho, Nadeen, Cowie, Ann, Dumonceaux, Curtis, Machado, Lisette, Fulton, Scott, Osterling, Kristen, Vandemheen, Kathy, Pratt, Gay, Bergeron, Amanda, McNeil, Matthew, Whelan, Kate, Maltais, Francois, Brouillard, Cynthia, Marciniuk, Darcy, Clemens, Ron, Baran, Janet, Gupta, Nisha, Pinto, Lancelot, Li, Pei Zhi, Aaron, Shawn D., Marciniuk, Darcy D., Maltais, François, O'Donnell, Denis E., and Walker, Brandie L.

Published
2016
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9. Prevention of Acute Exacerbations of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline

Author

Criner, Gerard J., Bourbeau, Jean, Diekemper, Rebecca L., Ouellette, Daniel R., Goodridge, Donna, Hernandez, Paul, Curren, Kristen, Balter, Meyer S., Bhutani, Mohit, Camp, Pat G., Celli, Bartolome R., Dechman, Gail, Dransfield, Mark T., Fiel, Stanley B., Foreman, Marilyn G., Hanania, Nicola A., Ireland, Belinda K., Marchetti, Nathaniel, Marciniuk, Darcy D., Mularski, Richard A., Ornelas, Joseph, Road, Jeremy D., and Stickland, Michael K.

Published
2015
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10. Executive Summary: Prevention of Acute Exacerbation of COPD: American College of Chest Physicians and Canadian Thoracic Society Guideline

Author

Criner, Gerard J., Bourbeau, Jean, Diekemper, Rebecca L., Ouellette, Daniel R., Goodridge, Donna, Hernandez, Paul, Curren, Kristen, Balter, Meyer S., Bhutani, Mohit, Camp, Pat G., Celli, Bartolome R., Dechman, Gail, Dransfield, Mark T., Fiel, Stanley B., Foreman, Marilyn G., Hanania, Nicola A., Ireland, Belinda K., Marchetti, Nathaniel, Marciniuk, Darcy D., Mularski, Richard A., Ornelas, Joseph, Road, Jeremy D., and Stickland, Michael K.

Published
2015
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20. Diaphragm pacing in spinal cord injury can significantly decrease mechanical ventilation in multicenter prospective evaluation.

Author

Onders, Raymond P., Khansarinia, Saeid, Ingvarsson, Páll E., Road, Jeremy, Yee, John, Dunkin, Brian, and Ignagni, Anthony R.

Subjects
SPINAL cord injuries, ARTIFICIAL respiration, DIAPHRAGM (Anatomy), PHRENIC nerve, CERVICAL cord, POSITIVE end-expiratory pressure
Abstract

Background: Cervical spinal cord injury (SCI) can lead to dependence on mechanical ventilation (MV) with significant morbidity and mortality. The diaphragm pacing system (DPS) was developed as an alternative to MV. Methods: We conducted a prospective single‐arm study of DPS in MV‐dependent patients with high SCI and intact phrenic nerves. Following device acclimation, pacing effectiveness to provide ventilation was evaluated. The primary endpoint was the number who could use DPS to breathe for 4 continuous hours without MV. Secondary endpoints included the number of patients that could use DPS 24 h/day free of MV and the ability of DPS to maintain clinically acceptable tidal volume (Vt). In addition, we conducted a meta‐analysis that included the prospective study along with data from four recently published studies to evaluate DPS hourly use. Results: Fifty‐three patients were implanted in the prospective study. Most were male (77.4%) with a median time from injury to treatment of 28.3 (IQR: 12.1, 83.3) months. Four‐ and 24‐h use occurred in 96.2% (95% CI: 87.0%, 99.5%) and 58.5% (95% CI: 44.1%, 74.9%), respectively. Four and 24‐h results in the meta‐analysis cohort (n = 196) exhibited similar results 92.2% (95% CI: 82.6%, 96.7%) and 52.7% (95% CI: 36.2%, 68.6%) using DPS for 4 and 24 h, respectively. DPS use significantly exceeded the calculated basal tidal volume requirements by a mean of 48.4% (95% CI: 37.0, 59.9%; p < 0.001). Conclusions: This study demonstrates that in most ventilator‐dependent patients, diaphragm pacing can effectively supplement or completely replace the need for MV and support basal metabolic requirements. [ABSTRACT FROM AUTHOR]

Published
2022
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23. Exacerbation-like respiratory symptoms in individuals without chronic obstructive pulmonary disease: results from a population-based study

Author

Tan, W C, Bourbeau, J, Hernandez, P, Chapman, K R, Cowie, R, FitzGerald, J M, Marciniuk, D D, Maltais, F, Buist, A S, OʼDonnell, D E, Sin, D D, Aaron, S D, Samet, Jonathon, Puhan, Milo, Hamid, Qutayba, Hogg, James C, Bourbeau, Jean, Tan, Wan C, Jabet, Carole, Sedona, Maria, Mancino, Palmina, Fortier, Yvan, Sin, Don, Li, Yuexin, Tam, Sheena, Comeau, Joe, Ng, Adrian, Coxson, Harvey, Candido, Tara, Leipsic, Jonathon, Hague, Cameron, Road, Jeremy, Benedetti, Andrea, Mara, Carlo, Savafi, Mohsen, Gershon, Andrea, To, Teresa, Tan, Wan C, Coxson, Harvey, Bourbeau, Jean, Pei, Zhi L, Jensen, Denis, O’Donnell, Denis, Tan, Wan C, Lo, Christine, Min, Jeong, Moy, Carly, Lau, Anna La, Sran, Ashleigh, Swanson, Ebony, Yuan, Ying, Chen, Daniel, Zheng, Lu, Yang, Tina, Chuang, Junior, Guo, Best, Li, Licong, Chan, Kendall, Khanam, Rahmath, Maslennikova, Daria, Cheng, Sarah, Peng, Catherine, Chiang, Bryan, Guo, Sarah, Payne, Kyrsten, Bourbeau, Jean, Mancino, Palmina, Sedona, Maria, Darauay, Carmen, Costa, Myriam, Chapman, Kenneth, McClean, Patricia, Sporn, Heather, Cowie, Robert, Cowie, Ann, Dumonceaux, Curtis, Moore, Jessica, Hernandez, Paul, Fulton, Scott, Yorke, Maria, Fiorotos, Natalie, Rowe, Ashley, Aaron, Shawn, Vandemheen, Kathy, Pratt, Gay, Srighanthan, Jeevitha, O’Donnell, Denis, Webb, Kathy, Amornputtisathaporn, Naparat, Cheung, Kate, Whelan, Kate, Cheng, Jenny, Maltais, Francois, Couture, Joanie, Garcia Pereira, Luciana, Breton, Marie-Josée, Brouillard, Cynthia, Marciniuk, Darcy, Clemens, Ron, and Baran, Janet

Published
2014
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32. Tiotropium in Combination with Placebo, Salmeterol, or Fluticasone–Salmeterol for Treatment of Chronic Obstructive Pulmonary Disease: A Randomized Trial

Author

Aaron, Shawn D., Vandemheen, Katherine L., Fergusson, Dean, Maltais, François, Bourbeau, Jean, Goldstein, Roger, Balter, Meyer, O’Donnell, Denis, McIvor, Andrew, Sharma, Sat, Bishop, Graham, Anthony, John, Cowie, Robert, Field, Stephen, Hirsch, Andrew, Hernandez, Paul, Rivington, Robert, Road, Jeremy, Hoffstein, Victor, Hodder, Richard, Marciniuk, Darcy, McCormack, David, Fox, George, Cox, Gerard, Prins, Henry B., Ford, Gordon, Bleskie, Dominique, Doucette, Steve, Mayers, Irvin, Chapman, Kenneth, Zamel, Noe, and FitzGerald, Mark

Published
2007

41. The Prevalence of Chronic Obstructive Pulmonary Disease (COPD) and the Heterogeneity of Risk Factors in the Canadian Population: Results from the Canadian Obstructive Lung Disease (COLD) Study.

Author

Leung, Clarus, Bourbeau, Jean, Sin, Don D, Aaron, Shawn D, FitzGerald, J Mark, Maltais, François, Marciniuk, Darcy D, O'Donnell, Denis, Hernandez, Paul, Chapman, Kenneth R, Walker, Brandie, Road, Jeremy D, Zheng, Liyun, Zou, Carl, Hogg, James C, and Tan, Wan C

Published
2021
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43. Incorporating remote patient monitoring in virtual pulmonary rehabilitation programs.

Author

Jangalee, Jenna V., Ghasvareh, Pooneh, Guenette, Jordan A., and Road, Jeremy

Abstract

Most pulmonary rehabilitation (PR) programs have had to adapt due to the COVID-19 pandemic and associated restrictions. Current alternative home-based programs have limitations and require modification. In this paper, we outline a novel method to monitor home-based PR programs, which has the potential to improve PR safety and efficacy. This new method is based on a remote patient monitoring (RPM) system with connected smart devices that enables the Respiratory Therapist (RT) to have real-time access to patient data including heart rate and peripheral oxygen saturation during exercise. The RPM system also monitors daily physical activity, sedentary time, sleep quality, rescue inhaler use, and maintenance inhaler adherence, among other variables, which has the added advantage of predicting patterns consistent with symptoms that may require medical intervention. To increase privacy, data are anonymized at all levels and only the RT has access to patient information. RPM systems have the potential to give practitioners a holistic view of the participants' health status to better evaluate them during the entire PR program and to improve self-management. As this is not a formal research study, we cannot make definitive conclusions about the efficacy of the system, and further research is needed to examine safety and to compare our approach to other ways of conducting PR. [ABSTRACT FROM AUTHOR]

Published
2021
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47. Scalene and sternocleidomastoid activation during normoxic and hypoxic incremental inspiratory loading.

Author

Basoudan, Nada, Rodrigues, Antenor, Gallina, Alessio, Garland, Jayne, Guenette, Jordan A., Shadgan, Babak, Road, Jeremy, and Reid, W. Darlene

Subjects
SQUARE root, MUSCLE fatigue, GAS mixtures, FATIGUE (Physiology), NONINVASIVE ventilation, MYOELECTRIC prosthesis
Abstract

The purpose of this study was to examine scalene (SA) and sternocleidomastoid (SM) activation during normoxic (norm‐ITL; FIO2 = 21%) and hypoxic (hyp‐ITL; FIO2 = 15%) incremental inspiratory threshold loading (ITL). Thirteen healthy participants (33 ± 4 years, 9 female) performed two ITL tests breathing randomly assigned gas mixtures through an inspiratory loading device where the load was increased every two minutes until task failure. SA and SM root mean square (RMS) electromyography (EMG) were calculated and expressed as a percentage of maximum (RMS%max) to reflect muscle activation intensity. Myoelectric manifestations of fatigue were characterized as decreased SA or SM EMG median frequency during maximum inspiratory pressure maneuvers before and after ITL. Dyspnea was recorded at baseline and task failure. Ventilatory parameters and mouth pressure (Pm) were recorded throughout the ITL. SA,RMS%max and SM,RMS%max increased in association with ITL load (p ≤.01 for both). SA,RMS%max was similar between norm‐ITL and hyp‐ITL (p =.17), whereas SM,RMS%max was greater during the latter (p =.001). Neither SA nor SM had a decrease in EMG median frequency after ITL (p =.75 and 0.69 respectively). Pm increased in association with ITL load (p <.001) and tended to be higher during hyp‐ITL compared to norm‐ITL (p =.05). Dyspnea was similar during both conditions (p >.05). There was a trend for higher tidal volumes during hyp‐ITL compared to norm‐ITL (p =.10). Minute ventilation was similar between both conditions (p =.23). RMS,%max of the SA and SM increased linearly with increasing ITL. The presence of hypoxia only increased SM activation. Neither SA nor SM presented myoelectric manifestations of fatigue during both conditions. [ABSTRACT FROM AUTHOR]

Published
2020
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48. Manipulation of mechanical ventilatory constraint during moderate intensity exercise does not influence dyspnoea in healthy older men and women.

Author

Peters, Carli M., Sheel, A. William, Molgat‐Seon, Yannick, Guenette, Jordan A., Dominelli, Paolo B., Ramsook, Andrew H., Schaeffer, Michele R., Romer, Lee M., and Road, Jeremy D.

Subjects
OLDER men, OLDER women, EXERCISE intensity
Abstract

Key points: The perceived intensity of exertional breathlessness (i.e. dyspnoea) is higher in older women than in older men, possibly as a result of sex‐differences in respiratory system morphology.During exercise at a given absolute intensity or minute ventilation, older women have a greater degree of mechanical ventilatory constraint (i.e. work of breathing and expiratory flow limitation) than their male counterparts, which may lead to a greater perceived intensity of dyspnoea.Using a single‐blind randomized study design, we experimentally manipulated the magnitude of mechanical ventilatory constraint during moderate‐intensity exercise at ventilatory threshold in healthy older men and women. We found that changes in the magnitude of mechanical ventilatory constraint within the physiological range had no effect on dyspnoea in healthy older adults.When older men and women perform moderate intensity exercise, mechanical ventilatory constraint does not contribute significantly to the sensation of dyspnoea. We aimed to determine the effect of manipulating mechanical ventilatory constraint during submaximal exercise on dyspnoea in older men and women. Eighteen healthy subjects (aged 60–80 years; nine men and nine women) completed two days of testing. On day 1, subjects were assessed for pulmonary function and performed a maximal incremental cycle exercise test. On day 2, subjects performed three 6‐min bouts of cycling at ventilatory threshold, in a single‐blind randomized manner, while breathing: (i) normoxic helium‐oxygen (HEL) to reduce the work of breathing (Wb) and alleviate expiratory flow limitation (EFL); (ii) through an inspiratory resistance (RES) of ∼5 cmH2O L−1 s−1 to increase Wb; and (iii) ambient air as a control (CON). Oesophageal pressure, diaphragm electromyography, and sensory responses (category‐ratio 10 Borg scale) were monitored throughout exercise. During the HEL condition, there was a significant decrease in Wb (men: –21 ± 6%, women: –17 ± 10%) relative to CON (both P < 0.01). Moreover, if EFL was present during CON (four men and five women), it was alleviated during HEL. Conversely, during the RES condition, Wb (men: 42 ± 19%, women: 50 ± 16%) significantly increased relative to CON (both P < 0.01). There was no main effect of sex on Wb (P = 0.59). Across conditions, women reported significantly higher dyspnoea intensity than men (2.9 ± 0.9 vs. 1.9 ± 0.8 Borg scale units, P < 0.05). Despite significant differences in the degree of mechanical ventilatory constraint between conditions, the intensity of dyspnoea was unaffected, independent of sex (P = 0.46). When older men and women perform moderate intensity exercise, mechanical ventilatory constraint does not contribute significantly to the sensation of dyspnoea. Key points: The perceived intensity of exertional breathlessness (i.e. dyspnoea) is higher in older women than in older men, possibly as a result of sex‐differences in respiratory system morphology.During exercise at a given absolute intensity or minute ventilation, older women have a greater degree of mechanical ventilatory constraint (i.e. work of breathing and expiratory flow limitation) than their male counterparts, which may lead to a greater perceived intensity of dyspnoea.Using a single‐blind randomized study design, we experimentally manipulated the magnitude of mechanical ventilatory constraint during moderate‐intensity exercise at ventilatory threshold in healthy older men and women. We found that changes in the magnitude of mechanical ventilatory constraint within the physiological range had no effect on dyspnoea in healthy older adults.When older men and women perform moderate intensity exercise, mechanical ventilatory constraint does not contribute significantly to the sensation of dyspnoea. [ABSTRACT FROM AUTHOR]

Published
2019
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49. Monitoring Cough Effectiveness and Use of Airway Clearance Strategies: A Canadian and UK Survey.

Author

Rose, Louise, McKim, Douglas, Leasa, David, Mika Nonoyama, Tandon, Anu, Kaminska, Marta, O'Connell, Colleen, Loewen, Andrea, Connolly, Bronwen, Murphy, Patrick, Hart, Nicholas, and Road, Jeremy

Subjects
MEDICAL education, AIRWAY (Anatomy), CHI-squared test, COUGH, MEDICAL protocols, PATIENT education, PROFESSIONS, STATISTICAL sampling, SPINAL cord injuries, SURVEYS, CROSS-sectional method, INSUFFLATION, DATA analysis software, DESCRIPTIVE statistics, LUNG volume measurements
Abstract

BACKGROUND: Regular monitoring combined with early and appropriate use of airway clearance can reduce unplanned hospital admissions for patients with neuromuscular disease (NMD) and spinal cord injury (SCI). We aimed to describe and compare knowledge of guidelines, monitoring of cough effectiveness, clinician prescription/provision of airway clearance strategies, and service provision constraints in the United Kingdom and Canada. METHODS: This was a cross-sectional survey of clinicians affiliated with NMD and SCI clinics in Canada, 2016 attendees at the Home Mechanical Ventilation Conference in the United Kingdom, and United Kingdom physiotherapist networks. RESULTS: We received 155 surveys (92 from Canada; 63 from the United Kingdom). More UK respondents (76%) were aware of airway clearance guidelines than Canadian (56%) respondents (P = .02). Routine assessment of cough effectiveness was reported by more UK respondents (59%) than Canadian (42%) respondents (P = .044). Cough peak flow (CPF) was the most common method used in both countries, although it was more commonly used in the UK (96%) than in Canada (81%, P = .02). Fewer Canadian respondents reported using CPF before initiation of airway clearance (81% vs 94%, P = .046), and fewer Canadian respondents showed results to patients for technique feedback (76% vs 97%, P = .007). Similar participant numbers reported using CPF after initiation to ensure adequate technique (73% vs 72%, P = .92). Mechanical insufflation-exsufflation (MI-E) + lung volume recruitment (LVR) + manually assisted cough when CPF ≤ 270 L/min was most routinely recommended (41% overall). Monotherapy was infrequent (LVR 15%, manually assisted cough 7%, and MI-E 4%). More Canadians identified constraints on service provision, specifically insufficient public funding for equipment (68% vs 39%, P = .002) and inadequate community workers' knowledge (56% vs 34%, P = .002). Funding for community support was a common constraint in both countries (49% vs 42%). CONCLUSIONS: The somewhat variable cough effectiveness monitoring and airway clearance practices identified in this survey confirm the need for further work on knowledge translation related to guideline recommendations and the need to address common constraints to optimal service delivery. [ABSTRACT FROM AUTHOR]

Published
2018
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