Barbara Bell

BACKGROUND: Pulmonary rehabilitation (PR) is recognized as the prevailing standard of care for patients with chronic respiratory conditions. National surveys of PR programs provide important information regarding the structure, content and organization of these programs. OBJECTIVE: To conduct a national survey to characterize adult PR across Canada, in terms of program distribution, utilization, content and outcome measures. METHODS: A cross-sectional descriptive study in which questionnaires were mailed to PR programs connected with hospitals or identified through the Canadian Lung Association was performed. RESULTS: Of the 98 PR programs identified, over 90% of patients in the programs had chronic obstructive pulmonary disease (COPD) and 57% of the programs were outpatient. Inpatient programs accounted for only 10% of the total. The main program components included supervised lower extremity strength (77%), cycle (72%) and treadmill (70%) training, education (75%) and breathing retraining (68%). Over 80% of patients completed their programs and 90% of patients were enrolled in a follow-up component. Physical therapists, dieticians, respiratory therapists and respirologists were the most commonly identified health care providers. The most commonly used outcome measures were the 6 min walk test and disease-specific quality of life questionnaires. CONCLUSION: There were similarities in program format, content, staffing, follow-up and funding among Canadian PR programs. The marked shortfall between the national PR capacity and the prevalence of COPD meant that only 1.2% of the COPD population had access to PR.

Summary Papain is a proteolytic enzyme with elastolytic activity, which produces emphysemalike lesions when introduced into the airways of animals. It is encountered by humans in numerous occupations, medications and domestic products. Sensitization to papain in two subjects in different occupations was confirmed with skin tests with chemical‐grade papain and radioallergosorbent tests (RAST), with a papain which had been chemically inactivated by selective active site blockade. Skin tests and RAST were negative in non‐symptomatic co‐workers. Withdrawal from occupational exposure to papain resulted in an improvement in symptoms. In a survey of 330 subjects at the time they were receiving routine allergy skin tests, seven reacted to papain. Sensitization was confirmed by the RAST. Serum IgG antibodies to papain were detected among sensitized individuals and also in five out of 266 sera obtained from a clinical hospital laboratory. The findings illustrate immune responses to papain in humans in the form of atopic sensitization and serum IgG antibodies. Moreover, recurrent respiratory symptoms in the presenting persons served to illustrate that they and their co‐workers were repeatedly exposed to air‐borne papain. In view of the potential danger from the proteolytic effects of papain, these observations illustrate the need for further investigations of the effects of human exposure to air‐borne papain.