Browsing by Author "Ford, Gordon T"

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    A Randomized Controlled Trial to Assess the Efficacy of Tiotropium in Canadian Patients with Chronic Obstructive Pulmonary Disease
    (2007-01-01) Chan, Charles KN; Maltais, François; Sigouin, Chris; Haddon, Jennifer M; Ford, Gordon T; on behalf of the SAFE Study Group,
    BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) who smoke have a greater annual rate of decline in forced expiratory volume in 1 s (FEV1) than those patients who have stopped smoking.OBJECTIVES: To assess the effect of tiotropium on pre-dose (trough) FEV1 in patients with COPD followed in Canada.METHODS: A total of 913 patients were randomly assigned to receive either tiotropium 18 μg once daily (n=608) or placebo (usual care minus inhaled anticholinergics) (n=305) for 48 weeks in the present randomized, double-blind, parallel-group study. The effect of tiotropium on measurements of lung function (FEV1, FEV6 and forced vital capacity), symptoms, health-related quality of life (St George’s Respiratory Questionnaire) and exacerbations were examined.RESULTS: Tiotropium improved trough FEV1 in both current and ex-smokers compared with placebo. Baseline FEV1 in smokers and ex-smokers was 1.03 L and 0.93 L, respectively (Pud_less_than0.001). At week 48, the mean difference between the tiotropium and placebo groups was 0.14±0.04 L (Pud_less_than0.001) in the smoker group and 0.08±0.02 L (Pud_less_than0.0001) in the ex-smoker group. Tiotropium also significantly improved trough forced vital capacity and FEV6 compared with placebo throughout the treatment period (Pud_less_than0.05, for all). Furthermore, tiotropium significantly improved the St George’s Respiratory Questionnaire total score compared with placebo at week 48 (40.9 versus 43.7 units, Pud_less_than0.005).CONCLUSIONS: Compared with the placebo group, tiotropium provides sustained improvements in lung function in patients with COPD, with improvements for smokers and ex-smokers.
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    Asthma in Adolescents: A Randomized, Controlled Trial of an Asthma Program for Adolescents and Young Adults with Severe Asthma
    (2002-01-01) Cowie, Robert L; Underwood, Margot F; Little, Cinde B; Mitchell, Ian; Spier, Sheldon; Ford, Gordon T
    BACKGROUND: Asthma is common and is often poorly controlled in adolescent subjects.OBJECTIVE: To determine the impact of an age-specific asthma program on asthma control, particularly on exacerbations of asthma requiring emergency department treatment, and on the quality of life of adolescents with asthma.METHODS: The present randomized, controlled trial included patients who were 15 to 20 years of age and had visited emergency departments for management of their asthma. The interventional group attended an age-specific asthma program that included assessment, education and management by a team of asthma educators, respiratory therapists and respiratory physicians. In the control group, spirometry was performed, and the patients continued to receive usual care from their regular physicians. The outcomes were assessed by a questionnaire six months after entry into the study.RESULTS: Ninety-three subjects entered the study and were randomly assigned to the intervention or control group. Of these, only 62 patients were available for review after six months. Subjects in both the control and the intervention groups showed a marked improvement in their level of asthma control, reflected primarily by a 73% reduction in the rate of emergency department attendance for asthma. Other indexes of disease control, including disease-specific quality of life, as assessed by questionnaires, were improved. There was, however, no discernible difference between the subjects in the two groups, with the exception of an improvement in favour of the intervention group in the symptom (actual difference 0.7, P=0.048) and emotional (actual difference 0.8, P=0.028) domains of the asthma quality of life questionnaire. The overall quality of life score favoured the intervention group by a clinically relevant difference of 0.6, but this difference did not reach statistical significance (P=0.06).CONCLUSIONS: Although all subjects demonstrated a significant improvement in asthma control and quality of life, the improvement attributable to this intervention was limited to two domains in disease-specific quality of life.
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    Benign Teratoma in the Left Pleural Space with Amylase in the Pleural Fluid
    (1996-01-01) Guenter, C Dale; Grant, Gregory A; Walker, Robert H; Ford, Gordon T
    The case of a 28-year-old man who experienced repeated episodes of pleuritic chest pain is reported. Eventual discovery of amylase in the pleural fluid and a supradiaphragmatic mass on computed tomography led to exploratory thoracotomy. A benign cystic teratoma was discovered in the pleural space overlying the left hemidiaphragm and connected by a peduncle to the thymus.
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    Comparison of Intramuscular Betamethasone and Oral Pprednisone in the Prevention of Relapse of Acute Asthma
    (2001-01-01) Chan, John S; Cowie, Robert L; Lazarenka, Gerald C; Little, Cinde; Scott, Sandra; Ford, Gordon T
    OBJECTIVE: To compare the relapse rate after a single intramuscular injection of a long acting corticosteroid, betamethasone, with oral prednisone in patients discharged from the emergency department (ED) for acute exacerbations of asthma.PATIENTS AND METHODS: Patients with acute exacerbations of asthma who were suitable for discharge from the ED were enrolled in a double-blind, randomized, placebo controlled pilot study. At discharge, patients were randomly assigned to receive either intramuscular betamethasone 12 mg and placebo capsules, or a placebo intramuscular injection and prednisone 50 mg daily for seven days. At days 7 and 21, patients were contacted by telephone to determine relapse. Relapse was defined as an unscheduled visit to a physician for treatment of continuing or worsening symptoms of asthma.RESULTS: One hundred and seventy-one patients were enrolled, of whom 87 were randomly assigned to the betamethasone group and 84 to the prednisone group. Baseline char- acteristics were matched evenly between the groups, with the exception of asthma duration (15.5 versus 21.2 years, respectively) and use of inhaled corticosteroids (46% versus 64.3% respectively) (Pud_less_than0.05). Using intention-to-treat analysis, the relapse rates for betamethasone and prednisone at day 7 were 14.9% (13 of 87 patients) and 25% (21 of 84 patients), respectively (P=0.1), and at day 21, the rates were 36.8% (32 of 87 patients) and 31% (26 of 84 patients), respectively (P=0.4). There were no differences in symptom score, peak flows and adverse effects between the two groups at days 7 and 21.CONCLUSIONS: A single dose of intramuscular betamethasone 12 mg was safe and as efficacious as prednisone in preventing the relapse of acute asthma. There was a trend toward a reduced relapse rate at seven days. In select ED patients discharged for acute asthma, intramuscular betamethasone may be an effective alternative to prednisone.
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    Optimizing Wellness in Chronic Obstructive Pulmonary Disease
    (2007-01-01) Goldstein, Roger S; Brooks, Dina; Ford, Gordon T
    Optimizing wellness in chronic obstructive pulmonary disease (COPD) is an emerging theme, in response to the substantial burden of COPD among Canadians. Population surveillance, from the Public Health Agency of Canada, as well as from international initiatives, such as the Burden of Obstructive Lung Disease (BOLD) study, has revealed the prevalence and regional disparities of a condition in which mortality, morbidity and health care resource use often reflect what was happening in the population more than 20 years previously. As COPD emerges to be an important women’s health issue, it raises questions as to how female mortality from COPD can rise at double the rate of breast cancer, why the COPD patient population is still predominantly male and whether women experience breathlessness differently than men.There is increasing awareness of the frequency and importance of assessing secondary impairments, such as muscle atrophy, an important prognostic indicator. The availability of pulmonary rehabilitation, despite its beneficial effects on exercise and quality of life, remains far behind the demand for services, a care gap unlikely to be filled by institutionally based programs. New models of chronic disease management require the health care system to proactively meet the needs of individuals with chronic conditions, rather than reacting to them through the acute care system. Such approaches occur best in partnership between health authorities and local municipalities. The present supplement includes several examples of this partnership, especially in Alberta and Saskatchewan. An increasing body of evidence supports the importance of exercise training, combined with selfmanagement, as a cornerstone of chronic disease management.
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    Premenstrual Exacerbation of Life-Threatening Asthma: Effect of Gonadotrophin Releasing Hormone Analogue Therapy
    (1996-01-01) Edwards, Alun L; Rose, M Sarah; Donovan, Lois E; Ford, Gordon T
    Variability in the severity of asthma during various phases of the menstrual cycle has been frequently suspected. However, the hormonal changes that might affect mediators of bronchospasm have yet to be elucidated. The case of a 41-year-old woman suffering from longstanding asthma with life-threatening exacerbations is reported. The patient was treated with buserelin, a gonadotropin releasing hormone (GnRH) analogue, which created a temporary chemical menopause and thus permitted diagnosis of a premenstrual exacerbation of asthma and offered insight into potential therapy. GnRH analogues may therefore be of value in assessing women with severe asthma suspected to vary with the menstrual cycle. The addition of estrogens and progestins at the same time as treatment with GnRH analogue may be of value in determining the role of these hormones in the pathogenesis of menstrually related exacerbations of asthma.
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    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.