Browsing by Author "FitzGerald, J Mark"
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Item Open Access Adult Asthma Consensus Guidelines Update 2003(2004-01-01) Lemière, Catherine; Bai, Tony; Balter, Meyer; Bayliff, Charles; Becker, Allan; Boulet, Louis-Philippe; Bowie, Dennis; Cartier, André; Cave, Andrew; Chapman, Kenneth; Cowie, Robert; Coyle, Stephen; Cockcroft, Donald; Ducharme, Francine M; Ernst, Pierre; Finlayson, Shelagh; FitzGerald, J Mark; Hargreave, Frederick E; Hogg, Donna; Kaplan, Alan; Kim, Harold; Kelm, Cheryle; O’Byrne, Paul; Sears, Malcolm; Markham, Andrea White; on behalf of the Canadian Adult Consensus Group of the Canadian Thoracic Society,BACKGROUND: Several sets of Canadian guidelines for the diagnosis and management of asthma have been published over the past 15 years. Since the last revision of the 1999 Canadian Asthma Consensus Report, important new studies have highlighted the need to incorporate new information into the asthma guidelines.OBJECTIVES: To review the literature on adult asthma management published between January 2000 and June 2003; to evaluate the influence of the new evidence on the recommendations made in the 1999 Canadian Asthma Consensus Guidelines and its 2001 update; and to report new recommendations on adult asthma management.METHODS: Three specific topics for which new evidence affected the previous recommendations were selected for review: initial treatment of asthma, add-on therapies in the treatment of asthma and asthma education. The resultant reviews were discussed in June 2003 at a meeting under the auspices of the Canadian Thoracic Society, and recommendations for adult asthma management were reviewed.RESULTS: The present report emphasises the importance of the early introduction of inhaled corticosteroids in symptomatic patients with mild asthma; stresses the benefit of adding additional therapy, preferably long-acting beta2-agonists, to patients incompletely controlled on low doses of inhaled corticosteroids; and documents the essential role of asthma education.CONCLUSION: The present report generally supports many of the previous recommendations published in the 1999 Canadian Asthma Consensus Report and provides higher levels of evidence for a number of those recommendations.Item Open Access Canadian Thoracic Society Asthma Committee Commentary on Long-Acting Beta-2 Agonist Use for Asthma in Canada(2010-01-01) Lougheed, M Diane; Lemiere, Catherine; Dell, Sharon; Ducharme, Francine; FitzGerald, J Mark; Leigh, Richard; Licskai, Chris; Rowe, Brian H; Bowie, Dennis; Becker, Allan; Boulet, Louis-PhilippeItem Open Access Canadian Thoracic Society Asthma Management Continuum – 2010 Consensus Summary for Children Six Years of Age and Over, and Adults(2010-01-01) Lougheed, M Diane; Lemière, Catherine; Dell, Sharon D; Ducharme, Francine M; FitzGerald, J Mark; Leigh, Richard; Licskai, Chris; Rowe, Brian H; Bowie, Dennis; Becker, Allan; Boulet, Louis-PhilippeBACKGROUND/OBJECTIVE: To integrate new evidence into the Canadian Asthma Management Continuum diagram, encompassing both pediatric and adult asthma.METHODS: The Canadian Thoracic Society Asthma Committee members, comprised of experts in pediatric and adult respirology, allergy and immunology, emergency medicine, general pediatrics, family medicine, pharmacoepidemiology and evidence-based medicine, updated the continuum diagram, based primarily on the 2008 Global Initiative for Asthma guidelines, and performed a focused review of literature pertaining to key aspects of asthma diagnosis and management in children six years of age and over, and adults.RESULTS: In patients six years of age and over, management of asthma begins with establishing an accurate diagnosis, typically by supplementing medical history with objective measures of lung function. All patients and caregivers should receive self-management education, including a written action plan. Inhaled corticosteroids (ICS) remain the first-line controller therapy for all ages. When asthma is not controlled with a low dose of ICS, the literature supports the addition of long-acting beta2-agonists in adults, while the preferred approach in children is to increase the dose of ICS. Leukotriene receptor antagonists are acceptable as second-line monotherapy and as an alternative add-on therapy in both age groups. Anti-immunoglobulin E therapy may be of benefit in adults, and in children 12 years of age and over with difficult to control allergic asthma, despite high-dose ICS and at least one other controller.CONCLUSIONS: The foundation of asthma management is establishing an accurate diagnosis based on objective measures (eg, spirometry) in individuals six years of age and over. Emphasis is placed on the similarities and differences between pediatric and adult asthma management approaches to achieve asthma control.Item Open Access Commentaire du Comité sur l’asthme de la Société Canadienne de Thoracologie au Sujet de I’utilisation des Bêta-2 agonistes à Longue durée d’action dans le Traitement l’asthme au Canada(2010-01-01) Lougheed, M Diane; Lemiere, Catherine; Dell, Sharon; Ducharme, Francine; FitzGerald, J Mark; Leigh, Richard; Licskai, Chris; Rowe, Brian H; Bowie, Dennis; Becker, Allan; Boulet, Louis-PhilippeItem Open Access Resource Use Study in COPD (RUSIC): A prospective Study to Quantify the Effects of COPD Exacerbations on Health Care Resource Use Among COPD Patients(2007-01-01) FitzGerald, J Mark; Haddon, Jennifer M; Bradley-Kennedy, Carole; Kuramoto, Lisa; Ford, Gordon T; The RUSIC Study Group,BACKGROUND: There is increasing interest in health care resource use (HRU) in Canada, particularly in resources associated with acute exacerbations of chronic obstructive pulmonary disease (COPD).OBJECTIVE: To identify HRU due to exacerbations of COPD.METHODS: A 52-week, multicentre, prospective, observational study of HRU due to exacerbations in patients with moderate to severe COPD was performed. Patients were recruited from primary care physicians and respirologists in urban and rural centres in Canada.RESULTS: In total, 524 subjects (59% men) completed the study. Their mean age was 68.2±9.4 years, with a forced expiratory volume in 1 s of 1.01±0.4 L. Patients had significant comorbidities. There were 691 acute exacerbations of COPD, which occurred in 53% of patients: 119 patients (23%) experienced one acute exacerbation, 70 patients (13%) had two acute exacerbations and 89 patients (17%) had three or more acute exacerbations. Seventy-five patients were admitted to hospital, with an average length of stay of 13.2 days. Fourteen of the patients spent time in an intensive care unit (average length of stay 5.6 days). Factors associated with acute exacerbations of COPD included lower forced expiratory volume in 1 s (Pud_less_than0.001), high number of respiratory medications prescribed (P=0.037), regular use of oral corticosteroids (OCSs) (P=0.008) and presence of depression (Pud_less_than0.001). Of the 75 patients hospitalized, only 53 received OCSs, four received referral for rehabilitation and 15 were referred for home care.CONCLUSIONS: The present study showed a high prevalence of COPD exacerbations, which likely impacted on HRU. There was evidence of a lack of appropriate management of exacerbations, especially with respect to use of OCSs, and referral for pulmonary rehabilitation and home care.