A cross-sectional survey on the effects of ambient temperature and humidity on health outcomes in individuals with chronic respiratory disease

# Rationale Extremes of temperature and humidity are associated with adverse respiratory symptoms, reduced lung function, and increased exacerbations among individuals living with chronic obstructive pulmonary disease (COPD). # Objectives To describe the reported effects of temperature and humidity extremes on the health outcomes, health status and physical activity (PA) in individuals living with COPD. # Methods A cross-sectional self-reported survey collected the effects on health status (COPD Assessment Test $$CAT$$), PA, and health outcomes in 1) moderate/ideal (14 to 21°C, 30 to 50% relative humidity $$RH$$), 2) hot and humid (≥ 25°C, \> 50% RH) and 3) cold and dry (≤ 5°C, \< 30% RH) weather conditions. Participants were ≥ 40 years old with COPD or related chronic respiratory diseases (e.g., asthma, sleep apnea, interstitial lung disease, lung cancer) and residing in Canada for ≥ 1 year. Negative responders to weather extremes were *a priori* defined as having a change of ≥ 2 points in the CAT. # Main Results Thirty-six participants responded; the mean age (SD) was 65 (11) years, and 23 (64%) were females. Compared to ideal conditions, 23 (66%) and 24 (69%) were negatively affected by cold/dry and hot/humid weather, respectively. Health status was significantly lower, and PA amount and difficulty level were reduced in hot/humid and cold/dry conditions compared with ideal conditions. The number of exacerbations in hot/humid was significantly higher compared to ideal conditions. # Conclusions More participants were negatively affected by extremes of weather: health status worsened, PA decreased, and frequency of exacerbations was higher compared to ideal. Future prospective studies should directly and objectively investigate different combinations of extreme temperature and humidity levels on symptoms and PA to understand their long-term health outcomes

Past, Present and Future of Respiratory Research: A Survey of Canadian Health Care Professionals

BACKGROUND: The Canadian Respiratory Health Professionals (CRHP) is the multidisciplinary health care professional group of the Canadian Lung Association. Although the CRHP has a growing number of highly qualified researchers, the landscape of their research in Canada has not been described.OBJECTIVES: To describe the level of respiratory research engagement; identify barriers and facilitators to research engagement; describe the experience and interest in developing research skills; and identify priority areas of future respiratory research among health care professionals.METHODS: An online survey of CRHP members was used to collect demographic information; barriers and facilitators to conducting research; future directions in respiratory research; and research funding and mentorship. Experience with and interest in ‘upskilling’ research skills were also evaluated.RESULTS: A total of 119 surveys were completed (22% response rate), of which 69 (58%) respondents were engaged in respiratory research. Reasons for not being involved in respiratory research were lack of mentorship, support and funding. The top research areas were chronic obstructive pulmonary disease (74%) and asthma (41%). The top facilitators for research engagement were amount of funding (29%) and mentorship (28%). Respondents in research positions rated their experience in research skills as high; those in nonresearch positions as low. However, both groups expressed interest in improving their research skills.CONCLUSIONS: Areas of development, such as research skills, greater funding opportunities and mentorship to increase the research capacity of health care professionals in respiratory health were identified. Health professional researchers have an important role in the national respiratory research strategy to increase interdisciplinary engagement and build collaborative teams.Peer Reviewe

The Role of Respiratory Therapists (RTs) in Caring for Individuals Using Long-term Ventilation in Canadian Non-acute Healthcare Settings

Ventilated assisted individuals (VAIs) require daily ventilator assistance to live, despite being clinically stable. Long-term ventilation may be initiated electively in the community setting when the natural history of their medical condition results in respiratory failure, or post emergency ventilation in an acute-care setting. Ideally, VAIs live in the community such as in complex care facilities or at home. Respiratory therapists (RTs) are specialized healthcare professionals (HCP), with a broad scope of practice in caring for patients across the healthcare continuum. However, their role and impact on managing LTV across these different settings are not well described or documented in the literature. The objective of this scoping review is to describe the RT role and the recommendations of RTs in the HCP team in facilitating the care of VAI

Risk Factors of Extubation Failure in Intubated Preterm Infants at a Tertiary Care Hospital in Oman

Objectives: To determine extubation failure (EF) rate among intubated preterm infants (&lt;37 weeks gestational age [GA]) admitted to a tertiary care neonatal intensive care unit (NICU) in Oman and identify the risk factors associated with EF. Methods: Charts of all intubated preterm infants (&lt;37 weeks GA) from January 2013 to December 2017 were retrospectively reviewed. EF was defined as reintubation within 7 days of planned extubation. Demographics, ventilation parameters, blood gas values and other possible risk factors of EF were collected. Statistical analysis included comparisons between EF and extubation success (ES) groups, and binary logistic regression analysis. Results: A total of 190 preterm infants were intubated during the study period, with 140 eligible for analysis. N=106 were successfully extubated; 34 (24.3%) failed extubation. GA &lt;28 weeks (p=0.029), lower 1-minute APGAR score (p=0.023) and patent ductus arteriosus diagnosis (PDA) (p=0.018) were significantly associated with EF. After the multivariate analysis, only GA &lt;28 weeks predicted EF with adjusted odds ratio (95% confidence interval) of 2.62 (1.17 – 6.15). Conclusions: EF rate in preterm infants admitted at our NICU in Oman, was within international rates. GA &lt;28 weeks was the only predictor of extubation failure identified. Neonatal practitioners need to seriously consider extreme prematurity in extubation process and consider implementing strategies to decrease extubation failure in this group of fragile infants. Keywords: Premature Infants; Neonate; Airway Extubation; Extubation Failure, Risk Factors

Updating the Evidence Base for Suctioning Adult Patients: A Systematic Review

OBJECTIVES: To update a previous clinical practice guideline on suctioning in adult patients, published in the Canadian Respiratory Journal in 2001.METHODS: A primary search of the MEDLINE (from 1998), CINAHL, EMBASE and The Cochrane Library (all from 1996) databases up to November 2007, was conducted. These dates reflect the search limits reached in the previous clinical practice guideline. A secondary search of the reference lists of retrieved articles was also performed. Two reviewers independently appraised each study before meeting to reach consensus. Study quality was evaluated using the Jadad and PEDro scales. When sufficient data were available, a meta-analysis was conducted using a random effects model. Data are reported as ORs, weighted mean differences and 95% CIs. When no comparisons were possible, qualitative analyses of the data were completed.RESULTS: Eighty-one studies were critically appraised from a pool of 123. A total of 28 randomized controlled trials or randomized crossover studies were accepted for inclusion. Meta-analysis was possible for open versus closed suctioning only. Recommendations from 2001 with respect to hyperoxygenation, hyperinflation, use of a ventilator circuit adaptor and subglottic suctioning were confirmed. New evidence was identified with respect to indications for suctioning, open suction versus closed suction systems, use of medications and infection control.CONCLUSIONS: While new evidence continues to be varied in strength, and is still lacking in some areas of suctioning practice, the evidence base has improved since 2001. Members of the health care team should incorporate this evidence into their practice.Peer Reviewe