Andrea S. Gershon

Background: Home mechanical ventilation (HMV) is a life-sustaining therapy for individuals with chronic respiratory failure. Despite a high morbidity and mortality of patients using HMV, few clinical trials inform practice. HMV-related research is impacted by the absence of a core outcome set (COS). This scoping review informs the development of a COS to be reported in interventional studies for individuals requiring HMV. Methods: We conducted a scoping review including interventional and cohort studies recruiting adults and children receiving HMV. We searched six databases in March 2026, and conducted citation tracking of relevant studies. Study screening and data extraction were conducted independently in duplicate. We categorised outcomes using the Core Outcome Measures in Effectiveness Trials (COMET) 38-domain taxonomy, and assessed reporting quality using established criteria. Results: Of 21 467 records screened, 287 studies were included: 78% adult, 18% paediatric, and 4% mixed populations. Studies evaluated HMV initiation (56%), patient interventions (31%), caregiver interventions (11%); or a combination of components (2%). We identified 71 distinct primary and 100 distinct secondary outcomes representing all COMET core areas. Primary outcomes were frequently in the respiratory, hospital, and mortality/survival domains, while respiratory, delivery of care, and global quality of life outcomes were predominant among secondary outcomes. Outcome reporting quality was high in 68% of studies. Conclusion: Outcome selection in HMV studies is highly variable, supporting the need for a COS to improve consistency of future research informing clinical decision-making and policy.

Smoking cessation reduces mortality and improves quality of life in chronic obstructive pulmonary disease (COPD). Brief physician counselling is effective

Introduction: Pulmonary exercise testing, including six-minute walk tests, exercise oximetry, and independent exercise assessments, are critical tools for managing chronic respiratory and cardiac conditions, evaluating treatment response, and determining long-term oxygen therapy needs. During the COVID-19 pandemic, testing was reduced to limit viral spread. This study aimed to evaluate post-pandemic trends of pulmonary exercise testing utilization in Ontario overall and across demographic groups. Methods: We conducted a population-based cohort study using Ontario administrative data between April 2015 and December 2023 to evaluate pulmonary exercise testing before, during, and after the COVID-19 pandemic. We used an Auto-Regressive Integrated Moving Average Model (ARIMA) model and incidence rate ratios to evaluate recovery trends. Subgroup analysis examined if trends were similar in different groups. Results: During the study period, 505,902 tests were performed for 362,888 individuals. As of December 2023, testing rates were still 21% below pre-pandemic levels (IRR 0.79, 95%CI 0.70–0.89). Recovery was lower in males (IRR 0.76, 95%CI 0.66–0.86) and individuals living in lower socioeconomic status neighborhoods (IRR 0.71, 95%CI 0.58–0.86). Northern Ontario saw the most pronounced shortfall compared to other regions, with testing rates one-third of pre-pandemic levels (IRR 0.33, 95% CI 0.26–0.43). Conclusion: More than three years after the pandemic began, pulmonary exercise testing rates have yet to return to pre-pandemic levels, with certain groups disproportionately affected. This highlights a significant and ongoing disruption in diagnostic capacity and quality of care for people with respiratory and cardiac diseases.

Objective: The Plasma Exchange and Glucocorticoids in Severe Antineutrophil Cytoplasmic Antibody–Associated Vasculitis (PEXIVAS) trial evaluated plasma exchange (PLEX) and glucocorticoid dose in antineutrophil cytoplasmic antibody–associated vasculitis (AAV). This study reanalyzed the PEXIVAS trial using Bayesian methods to focus on patients with diffuse alveolar hemorrhage (DAH). Methods: In the PEXIVAS trial, adults with AAV and kidney injury and/or DAH were randomized to receive PLEX or no PLEX and reduced- or standard-dose glucocorticoids. This study evaluated 1-year survival and severe infection among participants with DAH, no DAH, and severe DAH (oxygen saturation ≤ 85% on room air or mechanical ventilation) across multiple priors. The secondary outcome was severe infection (leading to hospitalization, intravenous antibiotics, or death). This study calculated mean hazard ratios (HRs) for survival and odds ratios (ORs) for infection, 95% credible intervals (CrIs), and probabilities of survival benefit (HR < 1) and infection (OR > 1). Results: Among 704 participants (191 with DAH and 61 with severe DAH), using noninformative priors, the probability of improved survival was 93% for participants with DAH receiving PLEX (HR 0.52; 95% CrI 0.21-1.26) and 67% for those without DAH (HR 0.86; 95% CrI 0.43-1.71). Participants receiving reduced-dose glucocorticoids had a 98% probability of improved survival without DAH (HR 0.46; 95% CrI 0.22-0.95) but a 12% probability with severe DAH (HR 2.02; 95% CrI 0.64-6.35). Plasma exchange increased the odds of severe infection (OR 1.25; 95% CrI 0.92-1.70; 92% probability of OR > 1), whereas reduced-dose glucocorticoids decreased the odds of infection (OR 0.85; 95% CrI 0.63-1.15; 85% probability of OR < 1). Results were consistent across priors. Conclusion: Patients with AAV and DAH may benefit from PLEX. Reduced-dose glucocorticoids improve survival for individuals without DAH but may be harmful in patients with severe DAH.

Purpose: To understand how the Philips PAP device recall affected patient experiences, clinical practice, and health system responses. Methods: From November 2022 to August 2023, we interviewed individuals with OSA, physicians, respiratory therapists and health system leaders. We also received emailed responses from Health Canada. Interviews explored participants’ experiences with the recall announcement and communication, their own responses and perceptions of actions taken by others, the overall impact of the recall and suggestions for improving future recall processes. Interviews were analyzed using an inductive thematic approach. Results: We interviewed 47 participants (16 individuals with OSA, 10 physicians, 17 public or private respiratory therapists, five health system leaders). Themes were organized into four domains: recall communication, execution, participant experiences, and the policy and regulatory context. Participants were confused due to inadequate information from Philips throughout the process. The burden of notifying patients and tracing devices mostly fell to healthcare providers and vendors, while replacement efforts were disorganized and frustrating. Individuals with OSA experienced emotional distress over therapy decisions and difficulties navigating the recall. Healthcare providers described moral distress from being unable to support patients adequately, and vendors faced additional logistical and financial strain. While regulatory authorities reported that Philips followed standard procedures, participants expressed a loss of trust in both the manufacturer and oversight systems. Conclusions: Interviews revealed that poor communication and execution of the Philips recall caused confusion, frustration and significant emotional and financial burden. Collaborative, context-specific strategies are required to improve future recalls.