Archive for June, 2013




Background:  Chronic obstructive pulmonary disease (COPD) and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) filling is commonly reported in COPD. The mechanism underlying these observations is uncertain, but may include upstream pulmonary dysfunction causing low LV preload or intrinsic LV dysfunction causing high LV preload. The objective of this study is to determine if COPD and emphysema are associated with reduced pulmonary vein dimensions suggestive of low LV preload.

Methods:  The population-based MESA COPD Study recruited smokers aged 50-79 years who were free of clinical cardiovascular disease. COPD was defined by spirometry. Percent emphysema was defined as regions <-910 Hounsfield units on full-lung computed tomography. Ostial pulmonary vein cross-sectional area was measured by contrast-enhanced cardiac magnetic resonance and expressed as the sum of all pulmonary vein areas. Linear regression was used to adjust for age, gender, race-ethnicity, body size and smoking.

Results:  Among 165 participants, total pulmonary vein area was 558±159mm2 in COPD and 623±145mm2 in controls. Total pulmonary vein area was smaller in COPD (-57mm2 95%CI -106 to -7mm2; p=0.03) and inversely associated with percent emphysema (p<0.001) in fully adjusted models. Significant decrements in total pulmonary vein area were observed among participants with COPD alone, COPD with emphysema on computed tomography, and emphysema without spirometrically defined COPD.

Conclusions:  Pulmonary vein dimensions were reduced in COPD and emphysema. These findings support a mechanism of upstream pulmonary causes of under-filling of the LV in COPD and in patients with emphysema on computed tomography.

Introducing… RTCalc

Along comes a great IOS app that really blows me away in terms of usability AND functionality.

AND, It works on IOS 7!!!!!

As any RT knows, there are times where you just need that 1 equation of calculation at work that you either forgot or just don’t have the time to figure out.

Well, Ronnald Grant has just done that with RTCalc.

Let the developer/programmer introduce the app:



Hello, My name is Ronnald Grant. I have been in the respiratory therapy field for over 25 years. I’ve had the pleasure as a student to work with the guy who invented the inline suction catheter back in 1984 at St. Joseph’s Hospital in Tacoma Wa. Since then I’ve always had the desire to give back to hospitals and to respiratory therapist.

During the last 2.5 years i’ve spent a great deal of time creating an app for respiratory therapist. The app is called RTcalc and is available for the iPhone, with an Android version coming out soon. You can check it out


I accept ideas, requests, and critical reviews which serves to help make RTcalc better. Once you have RTcalc you can enter reviews or requests by clicking on the [ ? ] – help button for an easy to fill out email feedback form.

Ronn Grant RCP/Programmer



Here are some screenshots in action:





 About the App and Developer. Excellent and easy way to send feedback. It opens up your mail app for you to send ideas, equation requests, etc…









Easy Duration of flow calc and timer !



Some great equations


1 Respiratory



2 Cardiac and Tools



3 Respiratory Medications Cheat Sheet




4 Help Menu


I have found this IOS app very easy to use. The developer states in an email that new equations are easy to add, so hopefully updates will come fast and frequent from feedback. Personally, I’d like to see more PFT and neonatal information and I am surprised the the Anoon Gap calculation was NOT included. I did use the internal feedback method to suggest these items earlier today but have not heard back yet.

It is quite pricey compared to the usual $0.99 cents we are accustomed to, however the app does provide such a wealth of info and tools that it would take you many more apps like this to fulfill the majority of your requirements clinically. That is, if they even exist.

Great app, and in retrospect such a good value for the money and an absolute MUST HAVE!!!


Mary Noseworthy, MDCM, FRCPC, Director, Asthma Specialty Clinic, Alberta Children’s Hospital and Medical Co-Leader, Community Pediatric Asthma Service (Calgary Zone), Alberta Health Services
The Canadian Thoracic Society 2012 guideline
update critically evaluated 4 main topics:

1. Asthma control
the role of non-invasive measures of airway inflammation
2. Adjunct controller therapy
which medication to add, at what ICS dose
3. ICS/LABA combination therapy in a single inhaler
used as a reliever, or as both a reliever and a controller
4. Asthma Action Plans
how to adjust controller therapy in the “yellow zone”

blood cell types



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:Physician Update Nov 2012

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