Exercise and spirometry testing are associated with coughing, exhaled respiratory droplets and aerosol generation. The risk of SARS-CoV2 transmission associated with these procedures are unknown. We developed a SARS-CoV2-specific consensus guidance document involving key stakeholders for restoring pulmonary diagnostic services, incorporating a patient and community-level risk stratified approach.
BACKGROUND: Intrathoracic pressure in patients undergoing laparoscopic surgery may be affected by intra-abdominal pressure during surgery. We investigated the relationship between intraabdominal pressure (P abd ) and esophageal pressure (P es ) in mechanically ventilated patients undergoing laparoscopic surgery. METHODS: We prospectively studied 43 consenting patients over 18 y of age who were scheduled for elective laparoscopic surgery with plans for intra-operative intubation and paralysis. After establishing a good level of inter-observer agreement on P es measurements, P es was measured by one observer for each patient using an esophageal catheter. P abd and P es were recorded before and after abdominal insufflation. We used regression analysis to model the relationship between P abd and P
In recent years there has been a proliferation in the practice of vaping to consume nicotine-and cannabis-based products. While evidence on the benefits and risks of electronic cigarettes (e-cigarettes) is evolving, this brief primer highlights important new information about vaping for clinicians, researchers and the public. In 2018, the Canadian government passed legislation to regulate tobacco and vaping products. We discuss evidence comparing e-cigarettes versus nicotine replacement therapy for smoking cessation and highlight limitations of this body of research. While e-cigarettes are felt to contain fewer toxins than cigarettes, the long-term effects of vaping remain unknown. Emerging data demonstrates associations between vaping and acute and chronic lung disease. We discuss the emergence of an outbreak of severe lung injury associated with e-cigarette use in the United States and similar cases in Canada. Finally, we review evidence demonstrating the growing prevalence of vaping and smoking amongst Canadian youth.
RESUMECes dernières années, on a assisté à une prolifération de la pratique de la vaporisation pour consommer des produits à base de nicotine et de cannabis. Alors que les preuves sur les avantages et les risques des cigarettes électroniques (e-cigarettes) évoluent, ce bref aperçu met en lumière de nouvelles informations importantes sur le vaping pour les cliniciens, les chercheurs et le public. En 2018, le gouvernement canadien a adopté une loi pour réglementer les produits du tabac et les produits à base de vapeur. Nous examinons les données comparant les e-cigarettes et les thérapies de remplacement de la nicotine pour le sevrage tabagique et soulignons les limites de ce corpus de recherche. Bien que l’on estime que les e-cigarettes contiennent moins de toxines que les cigarettes, les effets à long terme des vapeurs restent inconnus. Les données émergentes démontrent des associations entre l’inhalation de vapeurs et les maladies pulmonaires aiguës et chroniques. Nous discutons de l’émergence d’une épidémie de lésions pulmonaires graves associées à l’utilisation des e-cigarettes aux États-Unis et de cas similaires au Canada. Enfin, nous passons en revue les preuves démontrant la prévalence croissante des vapeurs et du tabagisme chez les jeunes Canadiens.
In most patients, both adults and children, who have a new diagnosis of asthma and whose symptoms are mild but persistent, treatment with inhaled corticosteroids (ICS) should be recommended as soon as the diagnosis is made. This is a cost-effective and safe treatment. Patients should be cautioned that their asthma will not be cured with short-term treatment and that their symptoms may recur and their lung function may decline again if treatment is discontinued. If patients are reluctant to use ICS daily for long periods of time, it would be reasonable to delay the onset of treatment with ICS. They could subsequently be managed with intermittent therapy with either ICS or in combination with other medications, such as long-acting β-agonists. Initial therapy with leukotriene receptor antagonist is not likely to be as effective as initial therapy with ICS. Since treatment adjustments based on eosinophil counts in sputum can reliably predict short-term responses to corticosteroids and help identify the appropriate add-on therapy, it may be useful to use this measurement, when available, to guide inter mittent therapy.
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