Browsing by Author "Kim, Harold"

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    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.
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    Asthma biomarkers in the age of biologics
    (2017-11-17) Kim, Harold; Ellis, Anne K; Fischer, David; Noseworthy, Mary; Olivenstein, Ron; Chapman, Kenneth R; Lee, Jason
    Abstract The heterogeneous nature of asthma has been understood for decades, but the precise categorization of asthma has taken on new clinical importance in the era of specific biologic therapy. The simple categories of allergic and non-allergic asthma have given way to more precise phenotypes that hint at underlying biologic mechanisms of variable airflow limitation and airways inflammation. Understanding these mechanisms is of particular importance for the approximately 10% of patients with severe asthma. Biomarkers that aid in phenotyping allow physicians to “personalize” treatment with targeted biologic agents. Unfortunately, testing for these biomarkers is not routine in patients whose asthma is refractory to standard therapy. Scientific advances in the recognition of sensitive and specific biomarkers are steadily outpacing the clinical availability of reliable and non-invasive assessment methods designed for the prompt and specific diagnosis, classification, treatment, and monitoring of severe asthma patients. This article provides a practical overview of current biomarkers and testing methods for prompt, effective management of patients with severe asthma that is refractory to standard therapy.
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    Canadian multidisciplinary expert consensus on the use of biologics in upper airways: a Delphi study
    (2023-04-24) Thamboo, Andrew V.; Lee, Melissa; Bhutani, Mohit; Chan, Charles; Chan, Yvonne; Chapman, Ken R.; Chin, Christopher J.; Connors, Lori; Dorscheid, Del; Ellis, Anne K.; Gall, Richard M.; Godbout, Krystelle; Janjua, Arif; Javer, Amin; Kilty, Shaun; Kim, Harold; Kirkpatrick, Gordon; Lee, John M.; Leigh, Richard; Lemiere, Catherine; Monteiro, Eric; Neighbour, Helen; Keith, Paul K.; Philteos, George; Quirt, Jaclyn; Rotenberg, Brian; Ruiz, Juan C.; Scott, John R.; Sommer, Doron D.; Sowerby, Leigh; Tewfik, Marc; Waserman, Susan; Witterick, Ian; Wright, Erin D.; Yamashita, Cory; Desrosiers, Martin
    Abstract Background Chronic rhinosinusitis with nasal polyposis (CRSwNP) often coexists with lower airway disease. With the overlap between upper and lower airway disease, optimal management of the upper airways is undertaken in conjunction with that of the lower airways. Biologic therapy with targeted activity within the Type 2 inflammatory pathway can improve the clinical signs and symptoms of both upper and lower airway diseases. Knowledge gaps nevertheless exist in how best to approach patient care as a whole. There have been sixteen randomized, double-blind, placebo-controlled trails performed for CRSwNP targeted components of the Type 2 inflammatory pathway, notably interleukin (IL)-4, IL-5 and IL-13, IL- 5R, IL-33, and immunoglobulin (Ig)E. This white paper considers the perspectives of experts in various disciplines such as rhinology, allergy, and respirology across Canada, all of whom have unique and valuable insights to contribute on how to best approach patients with upper airway disease from a multidisciplinary perspective. Methods A Delphi Method process was utilized involving three rounds of questionnaires in which the first two were completed individually online and the third was discussed on a virtual platform with all the panelists. A national multidisciplinary expert panel of 34 certified specialists was created, composed of 16 rhinologists, 7 allergists, and 11 respirologists who evaluated the 20 original statements on a scale of 1–9 and provided comments. All ratings were quantitively reviewed by mean, median, mode, range, standard deviation and inter-rater reliability. Consensus was defined by relative interrater reliability measures—kappa coefficient ( $$\kappa$$ κ ) value > 0.61. Results After three rounds, a total of 22 statements achieved consensus. This white paper only contains the final agreed upon statements and clear rationale and support for the statements regarding the use of biologics in patients with upper airway disease. Conclusion This white paper provides guidance to Canadian physicians on the use of biologic therapy for the management of upper airway disease from a multidisciplinary perspective, but the medical and surgical regimen should ultimately be individualized to the patient. As more biologics become available and additional trials are published we will provide updated versions of this white paper every few years. Graphical abstract
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    Correction to: The International/Canadian Hereditary Angioedema Guideline
    (2020-05-06) Betschel, Stephen; Badiou, Jacquie; Binkley, Karen; Borici-Mazi, Rozita; Hébert, Jacques; Kanani, Amin; Keith, Paul; Lacuesta, Gina; Waserman, Susan; Yang, Bill; Aygören-Pürsün, Emel; Bernstein, Jonathan; Bork, Konrad; Caballero, Teresa; Cicardi, Marco; Craig, Timothy; Farkas, Henriette; Grumach, Anete; Katelaris, Connie; Longhurst, Hilary; Riedl, Marc; Zuraw, Bruce; Berger, Magdelena; Boursiquot, Jean-Nicolas; Boysen, Henrik; Castaldo, Anthony; Chapdelaine, Hugo; Connors, Lori; Fu, Lisa; Goodyear, Dawn; Haynes, Alison; Kamra, Palinder; Kim, Harold; Lang-Robertson, Kelly; Leith, Eric; McCusker, Christine; Moote, Bill; O’Keefe, Andrew; Othman, Ibraheem; Poon, Man-Chiu; Ritchie, Bruce; St-Pierre, Charles; Stark, Donald; Tsai, Ellie
    An amendment to this paper has been published and can be accessed via the original article.
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    The International/Canadian Hereditary Angioedema Guideline
    (2019-11-25) Betschel, Stephen; Badiou, Jacquie; Binkley, Karen; Borici-Mazi, Rozita; Hébert, Jacques; Kanani, Amin; Keith, Paul; Lacuesta, Gina; Waserman, Susan; Yang, Bill; Aygören-Pürsün, Emel; Bernstein, Jonathan; Bork, Konrad; Caballero, Teresa; Cicardi, Marco; Craig, Timothy; Farkas, Henriette; Grumach, Anete; Katelaris, Connie; Longhurst, Hilary; Riedl, Marc; Zuraw, Bruce; Berger, Magdelena; Boursiquot, Jean-Nicolas; Boysen, Henrik; Castaldo, Anthony; Chapdelaine, Hugo; Connors, Lori; Fu, Lisa; Goodyear, Dawn; Haynes, Alison; Kamra, Palinder; Kim, Harold; Lang-Robertson, Kelly; Leith, Eric; McCusker, Christine; Moote, Bill; O’Keefe, Andrew; Othman, Ibraheem; Poon, Man-Chiu; Ritchie, Bruce; St-Pierre, Charles; Stark, Donald; Tsai, Ellie
    Abstract This is an update to the 2014 Canadian Hereditary Angioedema Guideline with an expanded scope to include the management of hereditary angioedema (HAE) patients worldwide. It is a collaboration of Canadian and international HAE experts and patient groups led by the Canadian Hereditary Angioedema Network. The objective of this guideline is to provide evidence-based recommendations, using the GRADE system, for the management of patients with HAE. This includes the treatment of attacks, short-term prophylaxis, long-term prophylaxis, and recommendations for self-administration, individualized therapy, quality of life, and comprehensive care. New to the 2019 version of this guideline are sections covering the diagnosis and recommended therapies for acute treatment in HAE patients with normal C1-INH, as well as sections on pregnant and paediatric patients, patient associations and an HAE registry. Hereditary angioedema results in random and often unpredictable attacks of painful swelling typically affecting the extremities, bowel mucosa, genitals, face and upper airway. Attacks are associated with significant functional impairment, decreased health-related quality of life, and mortality in the case of laryngeal attacks. Caring for patients with HAE can be challenging due to the complexity of this disease. The care of patients with HAE in Canada, as in many countries, continues to be neither optimal nor uniform. It lags behind some other countries where there are more organized models for HAE management, and greater availability of additional licensed therapeutic options. It is anticipated that providing this guideline to caregivers, policy makers, patients, and advocates will not only optimize the management of HAE, but also promote the importance of individualized care. The primary target users of this guideline are healthcare providers who are managing patients with HAE. Other healthcare providers who may use this guideline are emergency and intensive care physicians, primary care physicians, gastroenterologists, dentists, otolaryngologists, paediatricians, and gynaecologists who will encounter patients with HAE and need to be aware of this condition. Hospital administrators, insurers and policy makers may also find this guideline helpful.