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Alpha1-antitrypsin deficiency: a position statement of the Canadian Thoracic Society.

https://arctichealth.org/en/permalink/ahliterature194922
Source
Can Respir J. 2001 Mar-Apr;8(2):81-8
Publication Type
Article
Author
R T Abboud
G T Ford
K R Chapman
Author Affiliation
University of British Columbia, Vancouver, Canada. rtabboud@interchange.ubc.ca
Source
Can Respir J. 2001 Mar-Apr;8(2):81-8
Language
English
Publication Type
Article
Keywords
Canada
Fibrosis - etiology
Humans
Infant, Newborn
Lung Diseases, Obstructive - etiology - prevention & control
Neonatal Screening - standards
Randomized Controlled Trials as Topic
Registries
Smoking - adverse effects
alpha 1-Antitrypsin - genetics - therapeutic use
alpha 1-Antitrypsin Deficiency - complications - diagnosis - drug therapy
Abstract
To prepare new guidelines for the Canadian Thoracic Society (CTS) regarding severe alpha1-antitrypsin (AAT) deficiency and AAT replacement therapy.
Previously published guidelines and the medical literature about AAT deficiency and AAT replacement were reviewed. The prepared statement was reviewed and approved by the CTS Standards and Executive Committees.
Three studies evaluated AAT replacement. The National Heart, Lung and Blood Institute's AAT Registry was a nonrandomized comparison of patients receiving and not receiving AAT replacement, and evaluated the decline in forced expiratory volume in 1 s (FEV1) in 927 subjects. The rate of FEV1 decline was significantly less in those receiving AAT treatment (66 +/- SE 5 mL/year versus 93 +/- SE 11 mL/year; P=0.03) only in the subgroup with FEV1 35% to 49% predicted. In another study comparing 198 German patients receiving weekly AAT infusions and 97 untreated Danish patients, the mean annual decline in FEV1 was significantly less in treated patients only in the subgroup with FEV1 31% to 65% predicted (62 mL versus 83 mL, P=0.04). Neither of these studies was a randomized, controlled study and, thus, cannot be taken as proof of efficacy. A randomized, double-blind, placebo controlled trial of monthly replacement therapy over three years in 56 exsmokers with severe AAT deficiency and moderate emphysema showed a trend (P=0.07) favouring slower progression of emphysema by computed tomography scan in the group receiving AAT replacement.
AAT replacement therapy has not been proven definitively to be clinically effective in reducing the progression of disease in AAT-deficient patients, but there is a possible benefit to selected patients. A placebo controlled, randomized clinical trial of AAT replacement therapy is required. The authors recommend reserving AAT replacement therapy for AAT-deficient patients with impaired FEV1 of 35% to 50% predicted who have quit smoking and are on optimal medical therapy but continue to show a rapid decline in FEV1, and participation of all AAT-deficient subjects in the Canadian AAT Registry.
PubMed ID
11320399 View in PubMed
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Asthma--prognostic implications in the 1990s re: morbidity-mortality evaluation.

https://arctichealth.org/en/permalink/ahliterature103847
Source
Med Sect Proc. 1990;:83-94
Publication Type
Article
Date
1990
Author
G T Ford
Author Affiliation
Department of Medicine, University of Calgary.
Source
Med Sect Proc. 1990;:83-94
Date
1990
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Asthma - drug therapy - epidemiology - etiology - mortality
Canada
Child
Female
Humans
Life Style
Male
Prognosis
Risk factors
PubMed ID
2103957 View in PubMed
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Multipatient use of prefilled disposable oxygen humidifiers for up to 30 days: patient safety and cost analysis.

https://arctichealth.org/en/permalink/ahliterature221299
Source
Respir Care. 1993 Apr;38(4):343-7
Publication Type
Article
Date
Apr-1993
Author
S D Golar
L L Sutherland
G T Ford
Author Affiliation
Calgary General Hospital, Alberta, Canada.
Source
Respir Care. 1993 Apr;38(4):343-7
Date
Apr-1993
Language
English
Publication Type
Article
Keywords
Alberta
Bacteria, Aerobic - isolation & purification
Cost-Benefit Analysis - statistics & numerical data
Cross Infection - transmission
Data Collection
Disposable Equipment - economics - standards - statistics & numerical data
Equipment Contamination - statistics & numerical data
Equipment Reuse - standards
Evaluation Studies as Topic
Humans
Humidity
Nebulizers and Vaporizers - economics - standards - statistics & numerical data
Research Design
Abstract
Prefilled disposable oxygen humidification units have been shown to decrease the likelihood of contamination when compared to reusable oxygen humidification units. However, prefilled disposable humidifiers are expensive when used for single patients, especially in areas of high turnover, and it is not known whether these units need to be routinely changed before they are empty. The number of patients safely using a prefilled disposable humidifier has not been documented in previously reported work. Are patients at risk of nosocomial infections due to cross-contamination when prefilled disposable oxygen humidifiers are applied to multi-patient use? What are the cost benefits of multiple patient use of prefilled disposable oxygen humidifiers? When local practice or physician preference dictates the use of humidification for low-flow oxygen, these questions need to be answered.
Data were collected over two time periods to address changes due to seasonal variations and include area of use, number of patients, and quantitative cultures for aerobic microorganisms (including Legionella). Each disposable humidifier was monitored for a period of 1 month or until only 1 inch of water remained. Costs of using reusable humidifiers and prefilled humidifiers and therapist/nurse time to initiate therapy with both units were compared. During this period, 60 reusable humidifiers were also cultured for aerobic microorganisms and Legionella.
We report results on 1,311 of the 1,315 disposable prefilled oxygen humidifiers used. We saw no significant growth in any of the prefilled disposable humidifiers for periods of up to 30 days, with > 100 humidifiers having been used by > 20 patients.
Our results show that prefilled disposable oxygen humidifiers can be used without cross-contamination, on multiple patients, for a period of 1 month. The use of prefilled humidifiers in this way represents a substantial cost saving when compared to reusable humidifiers.
PubMed ID
10145893 View in PubMed
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