Smita Pakhale

Effects of Weight Loss on Airway Responsiveness in Obese Adults With Asthma: Does Weight Loss Lead to Reversibility of Asthma?

BACKGROUNDnThe growing epidemics of obesity and asthma are major public health concerns. Although asthma-obesity links are widely studied, the effects of weight loss on asthma severity measured by airway hyperresponsiveness (AHR) have received limited attention. The main study objective was to examine whether weight reduction reduces asthma severity in obese adults with asthma.nnnMETHODSnIn a prospective, controlled, parallel-group study, we followed 22 obese participants with asthma aged 18 to 75 years with a BMI ≥ 32.5 kg/m2 and AHR (provocative concentration of methacholine causing a 20% fall in FEV1 [PC20] < 16 mg/mL). Sixteen participants followed a behavioral weight reduction program for 3 months, and six served as control subjects. The primary outcome was change in AHR over 3 months. Changes in lung function, asthma control, and quality of life were secondary outcomes.nnnRESULTSnAt study entry, participant mean ± SD age was 44 ± 9 years, 95% were women, and mean BMI was 45.7 ± 9.2 kg/m2. After 3 months, mean weight loss was 16.5 ± 9.9 kg in the intervention group, and the control group had a mean weight gain of 0.6 ± 2.6 kg. There were significant improvements in PC20 (P = .009), FEV1 (P = .009), FVC (P = .010), asthma control (P < .001), and asthma quality of life (P = .003) in the intervention group, but these parameters remained unchanged in the control group. Physical activity levels also increased significantly in the intervention group but not in the control group.nnnCONCLUSIONSnWeight loss in obese adults with asthma can improve asthma severity, AHR, asthma control, lung function, and quality of life. These findings support the need to actively pursue healthy weight-loss measures in this population.

Effect of physical training on airway inflammation in bronchial asthma: a systematic review

BackgroundThe majority of the global population cannot afford existing asthma pharmacotherapy. Physical training as an airway anti-inflammatory therapy for asthma could potentially be a non-invasive, easily available, affordable, and healthy treatment modality. However, effects of physical training on airway inflammation in asthma are currently inconclusive. The main objective of this review is to summarize the effects of physical training on airway inflammation in asthmatics.MethodsA peer reviewed search was applied to Medline, Embase, Web of Science, Cochrane, and DARE databases. We included all observational epidemiological research studies and RCTs. Studies evaluating at least one marker of airway inflammation in asthmatics after a period of physical training were selected. Data extraction was performed in a blinded fashion. We decided a priori to avoid pooling of the data in anticipation of heterogeneity of the studies, specifically heterogeneity of airway inflammatory markers studied as outcome measures.ResultsFrom the initial 2635 studies; 23 studies (16 RCTs and 7 prospective cohort studies) were included. Study sizes were generally small (median sample sizeu2009=u200930). There was a reduction in C-reactive protein, malondialdehyde, nitric oxide, sputum cell counts and IgE in asthmatics with physical training. Mixed results were observed after training for fractional excretion of nitric oxide and bronchial hyperresponsiveness. The data was not pooled owing to significant heterogeneity between studies, and a funnel plot tests for publication bias were not performed because there were less than 10 studies for almost all outcome measures. Physical training intervention type, duration, intensity, frequency, primary outcome measures, methods of assessing outcome measures, and study designs were heterogeneous.ConclusionDue to reporting issues, lack of information and heterogeneity there was no definite conclusion; however, some findings suggest physical training may reduce airway inflammation in asthmatics.

Development and psychometric validation of a cystic fibrosis knowledge scale

Well‐developed and validated measures of cystic fibrosis (CF) knowledge are scarce. The purpose of the present study is to develop and validate a CF knowledge scale that is brief, easy to use, self‐administered and demonstrates clinical utility.

The Ottawa Citizen Engagement and Action Model (OCEAM): A Citizen engagement Strategy Operationalized Through The Participatory Research in Ottawa, Management and Point-of-care of Tobacco (PROMPT) Study

Plain language summaryPlain language summaryThe PROMPT study is a community-based research project designed to understand the factors which affect smoking as well as ways to manage, reduce and quit smoking among people who use drugs in Ottawa. There is strong medical evidence that smoking tobacco is related to more than two dozen diseases and conditions. Smoking tobacco remains the leading cause of preventable death and has negative health impacts on people of all ages. Although Ottawa has one of the lowest smoking rates in Ontario (12xa0%), major differences exist, with approximately a 96xa0% smoking rate among those who use drugs in the city of Ottawa. To address this inequity, we recruited and trained four community research peers who were representative of the study target population (ex- or currently homeless, insecurely housed or multi-drug users). We designed the ten-step Ottawa Citizen Engagement and Action Model (OCEAM) for the PROMPT study. In this paper we have described this process in a step-by-step fashion, as used in the PROMPT study. The eighty PROMPT participants are being followed for six months and are being provided with free and off-label Nicotine Replacement Therapy (NRT).AbstractObjectives The PROMPT study, Participatory Research in Ottawa, Management and Point-of-care of Tobacco, is a prospective cohort study which utilizes community-based participation and social network-based approaches to address tobacco dependence in inner city Ottawa. The project was designed to: facilitate retention of participants; to understand the barriers and facilitators of smoking; optimize ways to manage, reduce, and quit tobacco use among people who use drugs in Ottawa, Canada. The purpose of this paper is to describe the processes utilized in citizen or patient engagement in academic research, through our tobacco dependence management project in the inner city population in Ottawa, Canada.Background Tobacco smoking is inequitably distributed in Canada with rates at 12xa0% in Ottawa, as compared to 18xa0% in rest of Canada. However, the PROUD Study (Participatory Research in Ottawa: Understanding Drugs) demonstrated that 96xa0% of the inner city population, of Ottawa currently smoke tobacco. This distinct inequity in tobacco use translates into inequitable distribution of health outcomes, such morbidity and mortality in this population. Consequently, a community-based participatory, peer-led research project was conducted in the inner city population of Ottawa.Methods We recruited and trained four community research peers who were representative of the study target population. We conceived, designed and operationalized the ten-step Ottawa Citizen Engagement and Action Model (OCEAM) for the PROMPT study. The peers have co-led all aspects of the project from conceptualizing the study question to participating in knowledge translation. Each step of the project had defined objectives and outcome measures.Discussion The involvement of peers in recruitment ensured representation of tobacco and drug users—individuals truly representative of the intended target population. Peer, participant engagement and trust was established from the conception of the project. For historical and self-evident reasons, trust and engagement is rarely found in this population. Peers successfully participated in all ten steps of the Citizen Engagement and Action model. The PROMPT study utilized the CBPR (Community Based Participatory research) approach to encourage engagement and build trust in a difficult to reach and hard to treat, inner city population. The ten-step OCEAM model was conceived, designed and operationalized and the PROMPT study will continue to follow the eighty PROMPT participants for six months to understand the optimal ways to manage, reduce, and quit smoking within an inner city population.

The role of airway hyperresponsiveness measured by methacholine challenge test in defining asthma severity in asthma-obesity syndrome.

Purpose of reviewAsthma is a complex disease defined by chronic inflammation of the airways. In research and clinical practice measures used for diagnosis, an assessment of control and severity of asthma are varied and there exists no gold standard. To date, several studies have explored the link between obesity and asthma although the exact mechanism is not yet fully understood. A study undertaken by our research group in 2015, on the effects of weight loss on asthma severity in obese asthmatics, demonstrated that an improvement in airway hyperresponsiveness could be achieved after significant weight reduction with a weight loss program. The objective of this article is to review the current literature for the primary and secondary outcomes studied to estimate the effects of weight loss on asthma severity in adults with obesity and asthma. Recent findingsA review of the most recent research conducted since 2014 demonstrates that effects of weight loss on asthma severity in adults with obesity and asthma has not been the focus of majority of the studies. Apart from our study published in 2015, very few studies used airway hyperresponsiveness as the primary or secondary outcome measure. The literature reveals that significant weight loss does, however, lead to improvement in asthma severity and control in adults with obesity and asthma. SummaryThe current literature suggests that improvement in lung function requires moderate to significant (5–10%) weight loss in adults with obesity and asthma. However, with a few exceptions, the majority of these studies were small and used variable and questionable asthma severity outcome measures. There is an urgent need for standardization of diagnosis of asthma, study inclusion criteria, and outcome measures to assess asthma severity in research setting. Long-term effects of weight loss interventions on asthma severity and control, in adults with obesity and asthma, also remain unanswered.

Pulmonary Langerhans Cell Histiocytosis and Diabetes Insipidus in a Young Smoker

Langerhans cell histiocytosis is characterized by the abnormal nodular proliferation of histiocytes in various organ systems. Pulmonary involvement seen in young adults is nearly always seen in the context of past or current cigarette smoking. Although it tends to be a single-system disease, extrapulmonary manifestations involving the skin, bone, and hypothalamic-pituitary-axis are possible. High resolution CT (HRCT) of the thorax findings includes centrilobular nodules and cysts that are bizarre in shape, variable in size, and thin-walled. Often the diagnosis can be made based on the appropriate clinical presentation and typical imaging findings. Treatment includes smoking cessation and the potential use of glucocorticoids or cytotoxic agents depending on the severity of disease and multisystem involvement.

Breathlessness catastrophizing relates to poorer quality of life in adults with cystic fibrosis

BACKGROUNDnCystic Fibrosis (CF) is the most common genetic disease affecting children and young adults in Canada. It is a multi-system disease, however lung disease is largely responsible for mortality. Treatment advances have resulted in increased life expectancy and a subsequent need to better understand psychosocial issues associated with quality of life in adults living with CF. Emerging research suggests that anxiety and depression are related to poorer health-related quality of life (HRQoL) in CF patients, but there is little research examining cognitive processes, such as breathlessness catastrophizing. The present study addresses this gap in the literature.nnnMETHODSnParticipants in this study are based on a convenience sample of patients recruited during their regular CF clinic appointments at a tertiary care center. Forty-five adults (Mageu202f=u202f30.73u202fyears) completed measures of lung function, depression, anxiety, pain, breathlessness catastrophizing, and HRQoL at one time point.nnnRESULTSnResults of a hierarchical multiple regression indicate that increased breathlessness catastrophizing was related to poorer HRQoL, after controlling for lung function, depression, anxiety, and pain (pu202f<u202f.05). Depression, pain, and breathlessness catastrophizing all emerged as significant unique predictors of HRQoL.nnnCONCLUSIONSnBreathlessness catastrophizing is a potential target for clinical intervention and might impact HRQoL. Further research on breathlessness catastrophizing in CF is warranted including longitudinal studies to examine the mechanisms by which breathlessness catastrophizing relates to HRQoL and treatment outcomes in CF.

Patients as research partners in chronic obstructive pulmonary disease and asthma research: Priorities, challenges and recommendations from asthma and COPD patients

ABSTRACT RATIONALE: Patients play an important role in improving outcomes of health interventions by actively involved in the research process. However, there is a paucity of empirical data on the extent to which patients assume such a role in Respiratory Research (RR). Thus a framework to guide the engagement of patients needs to be developed to further a patient-centered RR agenda. OBJECTIVE: To explore the perspectives of patients with COPD and asthma re the factors that could affect their engagement in the research process. METHODS: Eight focus groups were conducted (23 asthma and 20 COPD patients) across Canada to discuss: patients willingness to engage as research partners; their research priorities; practical considerations for their involvement in research; desired outcomes from their involvement; and willingness to participate in a patient-oriented network. Focus group data were analyzed using thematic analysis to identify principles of a patient engagement framework. RESULTS: Eight key principles emerged that could affect patient involvement in RR, including: clarify the nature of involvement; integrate patients disease-related knowledge and perspective; engage early and frequently; consider patients views and beliefs; include diverse patient populations; emphasize on meaningful outcomes; conduct patient-oriented knowledge translation; and patient-to-patient dissemination. Also, three broad research priorities were suggested: origins of disease; development of new therapies; and patient education. CONCLUSIONS: Patients showed interest in active involvement in research process and identified key principles to facilitate patient engagement in the RR. Further research is needed to examine the factors influencing patient engagement, the limits and the possible barriers and promoters. RÉSUMÉ JUSTIFICATION: Les patients jouent un rôle important dans lamélioration des résultats des interventions de santé en participant activement au processus de recherche. Toutefois, les données empiriques portant sur la mesure dans laquelle les patients assument un tel rôle dans la recherche respiratoire (RR) sont insuffisantes. Il est donc nécessaire d’élaborer un cadre pour susciter lengagement des patients dans la promotion dun programme de RR axé sur les patients. OBJECTIF: Étudier les perspectives des patients souffrant de MPOC et dasthme en ce qui concerne les facteurs qui pourraient affecter leur engagement dans le processus de recherche. METHODES: Huit groupes de discussion ont été tenus (23 patients souffrant dasthme et 23 patients souffrant de MPOC) au Canada afin de discuter de: la volonté des patients de sengager en tant que partenaires de recherche; leurs priorités en matière de recherche; les résultats souhaités de leur engagement; leur volonté à participer à un réseau axé sur les patients. Les données issues des groupes de discussion ont été analysées à partir dune analyse thématique afin de dégager des principes en vue de l’élaboration dun cadre dengagement du patient. RESULTATS: Huit principes clés pouvant affecter la participation du patient ont été dégagés, dont : la clarification de la nature de la participation; lintégration des connaissances et de la perspective des patients concernant la maladie; limportance que la participation soit précoce et fréquente; la prise en compte des points des vue et des croyances des patients; linclusion de populations de patients diversifiées; la priorisation de résultats significatifs; le transfert des connaissances axé sur le patient; et la diffusion de patient à patient. De plus, trois grandes priorités de recherche ont été suggérées : les origines de la maladie; le développement de nouvelle thérapies; et l’éducation des patients. CONCLUSIONS: Les patients ont démontré de lintérêt pour participer activement au processus de recherche et ont dégagé des principes clés pour faciliter lengagement des patients dans la RR. Dautres études sont nécessaires pour examiner les facteurs qui influencent lengagement des patients, les limites à cet engagement, ainsi que les barrières et les promoteurs possibles.

Management and Point-of-Care for Tobacco Dependence (PROMPT): a feasibility mixed methods community-based participatory action research project in Ottawa, Canada

Objective To determine the feasibility of a Community-Based Participatory Tobacco Dependence Strategy (PROMPT) in the inner city population of Ottawa (Canada). Design A feasibility mixed methods prospective cohort study following principles of community-based participatory action research. Intervention Recruited 80 people whouse drugs, followed them for 6u2009months while providing access to counselling, nicotine replacement therapy and peer-support in a community setting. Setting Community research office in downtown Ottawa, adjacent to low-income housing, shelter services and street-based drug consumption. Primary outcome Retention rate at 6-month follow-up. Secondary outcome Biochemically validated 7-day point prevalence smoking abstinence at 26 weeks, self-reported abstinence in the past 7 days with exhaled carbon monoxide ≤10u2009ppm. Results The average age of participants was 43.8 years. The 6-month follow-up rate was 42.5%. The mean number of smoking years reported was 27.3 years. The participants were 70% male, 33.7% reported less than a high-school education, 21% identified as indigenous and 43.8% reported an income between US

An important cause of non-resolving pneumonia

1000 and US