The excessive carbon footprint of inhalers used in airway disease and its remedies

Abstract : The carbon footprint of human activities is a conversation topic worldwide. Many fields, including healthcare, have attempted to reduce their carbon footprint. For example, in Canada, 4.6% of greenhouse gases are manufactured by healthcare institutions. When it comes to the accountable parties in healthcare, the current treatments for asthma and chronic obstructive pulmonary disease are the main contributors. These highly prevalent diseases affect 11% and 10% of the Western populations, respectively. This editorial aims to discuss the impact of pressurized metered dose inhalers on the environment, alternatives and changes to current diagnostic and therapeutic practices, public awareness, potential changes to regulations and paths forward

Tackling "people remodelling" in corticosteroid-dependent asthma with type-2 targeting biologics and a formal corticosteroid weaning protocol

Abstract : People with severe corticosteroid-dependent asthma have greater morbidity, mortality and corticosteroid side effects than any other people with asthma. Just as type-2 inflammation and recurrent asthma attacks remodel airways, we propose the concept of ‘people remodelling’ to represent the utter disruption of people’s lives by the consequences of severe asthma and its associated corticosteroid treatments. To tackle this important problem, three biologics targeting type-2 inflammation – mepolizumab, benralizumab and dupilumab – have shown efficacy in tapering corticosteroids in dedicated phase III trials. We herein review the literature and propose an evidence-based, dose- and agent-specific corticosteroid weaning protocol for busy clinicians looking to achieve the best outcomes possible for their patients: independence from corticosteroids and reversal of people remodelling

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The controversial role of as-needed short-acting β2-agonist monotherapy in mild asthma: Short review of current guidelines

The controversy surrounding short-acting β2-agonist (SABA) monotherapy for very mild and mild asthma continues in guidelines despite increasing evidence in favor of combined inhaled corticosteroid/reliever therapy. We herein briefly review the findings from two high-quality randomized controlled trials and other safety data to conclude that the efficacy and safety of SABA monotherapy have been overstated, especially in type-2 high or allergic disease

Messages des ministres

Bertrand Xavier, Bas Philippe, Couillard Philippe. Messages des ministres. In: Santé, Société et Solidarité, n°2, 2007. Maîtrise des dépenses de santé ou qualité : faut-il choisir ? pp. 5-6

Messages des ministres

Bertrand Xavier, Bas Philippe, Couillard Philippe. Messages des ministres. In: Santé, Société et Solidarité, n°2, 2007. Maîtrise des dépenses de santé ou qualité : faut-il choisir ? pp. 5-6

Allocution des ministres

Couillard Philippe, Théberge Carole, Bas Philippe. Allocution des ministres. In: Santé, Société et Solidarité, n°1, 2006. Vieillissement et santé : idées reçues, idées nouvelles. pp. 5-9

Identification of Friction Parameters for Limited Relative Displacement Contacts

Damping using dry friction has long been recognized as an effective control method for many vibration problems. However, given the strong nonlinear nature of friction, the theoretical and experimental investigations of associated non-linear control methods are much more difficult than for linear control methods. Moreover, the difficulty of identifying friction models parameters for Limited Relative Displacement (LRD) contacts is still a subject of research. This study first proposes an identification procedure to evaluate the ability of the LuGre friction model to predict small amplitude (30 μm–150 μm) frictionally damped vibrations for a LRD contact. An experimental setup implementing an ideal frictionally damped Single Degree Of Freedom (SDOF) oscillator connected to an electrodynamic shaker is then presented to study friction damping. The simulation results are assessed against the experimental results, demonstrating that the identification procedure is well suited to estimate the parameters of the LuGre friction model and that the model captures very well the friction phenomenon for small amplitude vibrations

Allocution des ministres

Couillard Philippe, Théberge Carole, Bas Philippe. Allocution des ministres. In: Santé, Société et Solidarité, n°1, 2006. Vieillissement et santé : idées reçues, idées nouvelles. pp. 5-9

Exhaled nitric oxide (FeNO): Bridging a knowledge gap in asthma diagnosis and treatment

Abstract: « Fractional exhaled nitric oxide (FeNO) testing has emerged as a valuable tool in assessing people with asthma, offering an objec-tive measure of ongoing type 2 cytokine, chemokine and alarmin signalling in the airways.As a non-invasive and easily accessible biomarker, incorporating FeNO testing into asthma management may improve diagnostic accuracy by complementing clinical symp-toms and spirometry measures. [...]