Long-term Follow-up of Mycobacterium avium Complex Lung Disease in Patients Treated With Regimens Including Clofazimine and/or Rifampin.

Background: Mycobacterium avium complex (MAC) lung disease requires prolonged treatment with multiple antibiotics. Drug intolerances and interactions are common with the current recommended treatment. There is limited information on outcomes with alternative medications.

More than just great quotes: An introduction to the Canadian Tri-Council's qualitative requirements.

Although at times misunderstood by the general research community, qualitative research has developed out of diverse, rich and complex philosophical traditions and theoretical paradigms. In the most recent Canadian Tri-Council policy statement on the ethical conduct of research involving humans, a chapter was devoted to a summary of methods and methodological requirements that characterize robust qualitative research, despite the diversity of approaches. To dispel common misperceptions about qualitative research and introduce the unfamiliar reader to these requirements, the work of a qualitative study on isoniazid preventive therapy for prophylaxis of tuberculosis published in AIDS is critiqued alongside each of the Tri-Council's nine requirements.

New treatment options for multidrug-resistant tuberculosis.

Despite the development of effective treatments, tuberculosis (TB) remains a major health problem. TB continues to infect new victims and kills nearly 2 million people annually. The problem is much greater in resource-limited countries but is present worldwide.

Mometasone furoate: an inhaled glucocorticoid for the management of asthma in adults and children.

Mometasone furoate has been available for clinical use, starting with a dermatologic preparation, for nearly 20 years. An inhaled format of the drug for management of asthma had been in development during the last decade and has been available for clinical use for 6 years as a dry powder inhaler delivering either 100 mcg or 200 mcg per dose. It has a long half-life and is suitable for daily dosing.

Effect of the management of patients with chronic cough by pulmonologists and certified respiratory educators on quality of life: a randomized trial.

Background: The role of certified respiratory educators (CREs) is to educate, assess, and help to manage patients with asthma and COPD in Canada. This study was undertaken to see whether CREs could assist pulmonologists (MDs) in managing patients with chronic cough.

Methods: An 8-week prospective, parallel design, randomized, controlled trial to determine whether CREs using a protocol-driven algorithmic approach could assist in the management of patients referred to a university tertiary care medical center for the assessment and treatment of chronic cough.

The effects of fluticasone with or without salmeterol on systemic biomarkers of inflammation in chronic obstructive pulmonary disease.

Rationale: Small studies have suggested that inhaled corticosteroids can suppress systemic inflammation in chronic obstructive pulmonary disease (COPD).

Objectives: To determine the effect of inhaled corticosteroids with or without long-acting beta(2)-adrenergic agonist on systemic biomarkers of inflammation.

Methods: We conducted a double-blind randomized placebo-controlled trial across 11 centers (n = 289 patients with FEV(1) of 47.

A randomised controlled trial of the Buteyko technique as an adjunct to conventional management of asthma.

Objective: To assess the effectiveness of a non-pharmacological intervention in patients with asthma on conventional therapy including inhaled corticosteroid.

Design: A randomised controlled trial of the Buteyko technique in a group of adults with asthma. The control group was trained by a physiotherapist in breathing and relaxation techniques.

Urban and rural differences in the management of asthma amongst primary care physicians in Alberta.

Background: Inconsistencies in rural and urban health care exist; however, little has been done to evaluate the potential differences in asthma management.

Objective: To compare asthma management in rural versus urban primary care physician practices.

Methods: Forty-two of 136 consenting primary care physicians were randomly selected for chart review.

Asthma symptoms do not predict spirometry.

Background: Asthma is a disease characterized by variable airflow obstruction, but the measurement of airflow is often omitted in the process of diagnosis and management of the disease.

Objectives: Features of asthma severity and control were examined to determine the extent to which objective measurements, including forced expiratory volume in 1 s and forced expiratory volume in 1 s/forced vital capacity, correlated with other manifestations of the disease.

Methods: Subjects were a consecutive sample of patients with asthma attending a university-based asthma clinic.

Tolerability of a salmeterol xinafoate/fluticasone propionate hydrofluoroalkane metered-dose inhaler in adolescent and adult patients with persistent asthma: a 52-week, open-label, stratified, parallel-group, multicenter study.

Background: Many patients with asthma require an inhaled long-acting beta(2)-agonist (LABA) in addition to an inhaled corticosteroid to adequately control their disease.

Objective: The purpose of this study was to assess the long-term tolerability of a salmeterol xinafoate/ fluticasone propionate (SFC) hydrofluoroalkane metered-dose inhaler (MDI) at 3 different doses BID.

Methods: This 52-week, open-label, stratified, parallel-group study assessed SFC in patients with persistent asthma.

Asthma control and management in the community: indices in 1997 compared with indices in 2002.

Objective: To determine whether there was any change in indices of asthma control in population-based samples of patients with asthma between 1997 and 2002.

Design: We examined asthma control and treatment in the community using two cross-sectional studies carried out 5 years apart in 1997 and 2002. Pharmacists handed out the questionnaires to patients with asthma; patients completed the questionnaires themselves.

Lung disease due to the more common nontuberculous mycobacteria.

As the prevalence of tuberculosis (TB) declines in the developed world, the proportion of mycobacterial lung disease due to nontuberculous mycobacteria (NTM) is increasing. It is not clear whether there is a real increase in prevalence or whether NTM disease is being recognized more often because of the introduction of more sensitive laboratory techniques, and that more specimens are being submitted for mycobacterial staining and culture as the result of a greater understanding of the role of NTM in conditions such as cystic fibrosis, posttransplantation and other forms of iatrogenic immunosuppression, immune reconstitution inflammatory syndrome, fibronodular bronchiectasis, and hypersensitivity pneumonitis. The introduction of BACTEC liquid culture systems (BD; Franklin Lakes, NJ) and the development of nucleic acid amplification and DNA probes allow more rapid diagnosis of mycobacterial disease and the quicker differentiation of NTM from TB isolates.

Implementing practice guidelines: a workshop on guidelines dissemination and implementation with a focus on asthma and COPD.

The present supplement summarizes the proceedings of the symposium "Implementing practice guidelines: A workshop on guidelines dissemination and implementation with a focus on asthma and COPD", which took place in Quebec City, Quebec, from April 14 to 16, 2005. This international symposium was a joint initiative of the Laval University Office of Continuing Medical Education (Bureau de la Formation Médicale Continue), the Canadian Thoracic Society and the Canadian Network for Asthma Care, and was supported by many other organizations and by industrial partners. The objectives of this meeting were to examine the optimal implementation of practice guidelines, review current initiatives for the implementation of asthma and chronic obstructive pulmonary disease (COPD) guidelines in Canada and in the rest of the world, and develop an optimal strategy for future guideline implementation.

Can inhaled fluticasone alone or in combination with salmeterol reduce systemic inflammation in chronic obstructive pulmonary disease? Study protocol for a randomized controlled trial [NCT00120978].

Background: Systemic inflammation is associated with various complications in chronic obstructive pulmonary disease including weight loss, cachexia, osteoporosis, cancer and cardiovascular diseases. Inhaled corticosteroids attenuate airway inflammation, reduce exacerbations, and improve mortality in chronic obstructive pulmonary disease. Whether inhaled corticosteroids by themselves or in combination with a long-acting beta2-adrenoceptor agonist repress systemic inflammation in chronic obstructive pulmonary disease is unknown.

Management of asthma among community-based primary care physicians.

Background: Despite significant improvements in asthma treatment and the dissemination of national and international guidelines for asthma management, there are ongoing concerns that suboptimal care is being provided for patients with asthma.

Objective: To determine the current practice patterns of asthma care among primary care physicians.

Design: A cross-sectional study.

Inhaled corticosteroid therapy does not control asthma.

Background: Randomized clinical trials demonstrate efficacy and show that inhaled corticosteroid therapy can control asthma, but details concerning their effectiveness in achieving this goal in the community are lacking.

Objectives: To determine whether inhaled corticosteroid therapy is effective in controlling asthma and to examine the rates of asthma control in relation to inhaled corticosteroid use outside the realm of randomized controlled trials.

Methods: Different populations were examined cross-sectionally to determine whether self-reported use of inhaled corticosteroids was associated with control of asthma.

The costs of implementing the 1999 Canadian Asthma Consensus Guidelines recommendation of asthma education and spirometry for the family physician.

Background: National and international asthma guidelines recommend that patients with asthma be provided with asthma education and spirometry as a component of enhanced asthma care. The cost of implementing these interventions in family physician practices is not known.

Objective: The objective of the present study was to determine the cost of providing recommended asthma care to adult patients in the family practice setting.

Mycobacterium avium complex pulmonary disease in patients without HIV infection.

Mycobacterium avium complex (MAC) is ubiquitous. It is found in various freshwater and saltwater sources around the world, including hot water pipes. Although the organism was identified in the 1890s, its potential to cause human disease was only recognized 50 years later.

Alberta Strategy to Help Manage Asthma (ASTHMA): a provincial initiative to improve outcomes for individuals with asthma.

As society struggles with escalating healthcare costs, and a general increase in the prevalence as well as the morbidity of common chronic conditions such as asthma and diabetes, patient health management programs offer new opportunities to improve the process of care, create efficiencies in the healthcare system and enhance the outcomes of patients suffering from these conditions.

Spirometric findings among school-aged First Nations children on a reserve: a pilot study.

Background: Asthma and chronic obstructive pulmonary disease (COPD) are increasing concerns for First Nations peoples in Canada. Although hospital utilization for asthma and COPD among First Nations peoples has been increasing, the prevalence of asthma or wheezing is comparable to national averages.

Objectives: A pilot study was conducted to determine the prevalence of impaired lung function in school-aged First Nations children.

The relationship between birth weight and childhood asthma: a population-based cohort study.

Background: Because obesity promotes inflammation and imposes mechanical constraints to the airways, a high birth weight may be a risk factor for asthma in childhood. However, to our knowledge, few studies have examined this potential relationship.

Objective: To determine the relationship between high birth weight and risk of emergency visits for asthma during childhood.

Treatment of Mycobacterium avium-intracellulare complex lung disease with a macrolide, ethambutol, and clofazimine.

Background: Mycobacterium avium-intracellulare (MAC) causes progressive lung disease. Recommended treatment regimens include a macrolide and a rifamycin, but drug intolerance and relapse after treatment is completed often limit successful therapy.

Methods: Consecutive individuals referred for treatment of MAC lung disease were treated with a regimen that included either clarithromycin, 500 mg bid, or azithromycin, 250 mg/d, on weekdays; ethambutol, 15 mg/kg/d; and clofazimine, 100 mg/d.

Can universal access to health care eliminate health inequities between children of poor and nonpoor families?: A case study of childhood asthma in Alberta.

Study Objective: Children from poor families are much more likely to have emergency visits for asthma than those from nonpoor families, which may be related to financial access barriers to good preventive care for the poor. We sought to determine whether in a health-care system that provides free access to outpatient and hospital services, the disparities in the rates of emergency visits for asthma would be less apparent across the income gradient.

Design: Longitudinal, population-based study.