Canadian Primary Care Today

Essential Interstitial Lung Disease Management for the Primary Care Provider

Amanda Grant-Orser — 2025-06-05

Interstitial lung diseases (ILDs) encompass a diverse group of disorders characterized by inflammation and fibrosis of the lung parenchyma. Despite their classification as rare, increasing evidence suggests ILDs are more prevalent than previously thought. Patients often present with respiratory symptoms such as exertional dyspnea, persistent cough, and fatigue. However, asymptomatic patients with incidental findings on imaging (e.g., interstitial lung abnormalities) are also common. Diagnosis relies on high-resolution CT (HRCT), pulmonary function tests, and detailed clinical evaluation. Respirology consultation is important for comprehensive management. The evolving ILD nomenclature, including progressive pulmonary fibrosis, aids in disease characterization and treatment planning. Management strategies include corticosteroids and steroid-sparing agents for inflammatory subtypes, while antifibrotic therapies (nintedanib, pirfenidone) are used for fibrotic and progressive disease. Non-pharmacological interventions, including pulmonary rehabilitation, smoking cessation, and vaccination, are critical for improving patient outcomes. Primary care providers play a pivotal role in early disease recognition, facilitating diagnostic testing, managing comorbidities, and coordinating specialist care. This review highlights the importance of timely diagnosis, evolving classifications, and emerging therapies, offering a collaborative framework for optimizing ILD care and outcomes.

Chronic Cough, a New Disease, Not Just An Old Problem

Alan Kaplan — 2025-06-05

Chronic cough is defined as a cough persisting for longer than 8 weeks. Chronic cough is common, with an approximate prevalence of 10% of the global population. In Canada, recent estimates indicate that the prevalence of cough is 16% among adults aged 45-85 years. Chronic cough can interrupt work, sleep, and social interactions, making it very troubling for patients, with impacts on physical, social, and psychological health.

Cough is one of the leading causes of visits to primary care practitioners. The peak incidence for presentation to primary care is among individuals in the 50-60 years age group and it is twice as frequent in women.

Currently, most clinicians address cough as a symptom of other medical conditions, which leads to trials of treatments for diseases that may not be present. This approach can lead to unnecessary costs, frustration for both clinicians and patients, and potential harms from the therapies prescribed. Instead, a diagnostic work up needs to be performed to identify refractory chronic cough as a distinct disease entity, resulting from afferent neuronal hypersensitivity and central nervous system dysfunction. The secondary factors that aggravate chronic cough (smoking, asthma, gastro-esophageal reflux, among others) should be considered as treatable traits associated with the primary disease process rather than only the direct causes of the cough.

Menopause Hormone Therapy in 2025

Susan Goldstein — 2025-06-05

Menopause is, in fact, a single day officially marked one year after the cessation of menses. It is followed by post menopause which can last for half of a women’s adult life! Menopause typically occurs between the ages of 46 and 52 years with an average age of 51. It signifies the end of reproductive function, and is marked by fluctuating and declining hormone levels, which can lead to a range of often distressing symptoms. The perimenopause is the transition phase that precedes menopause, lasting up to 10 years. For many women, menopausal symptoms may first appear later in the perimenopause. While we use the term “women”, guidance applies to all patients who experience menopause, even if they do not identify as a woman.

When people use the term “menopause” they are usually referring to the “climacteric”, a period which includes the perimenopause, menopause, and early post menopause stages.

In Canada, over 2.5 million women are between the ages of 45 and 55, and up to 80% of them will experience menopause-related symptoms. There are now over 30 validated symptoms of menopause, some of which can have a significant impact on function and quality of life. A recent study by the Menopause Foundation of Canada reported that up to 10% of women will leave the workforce due to unmanaged menopausal symptoms.

The most impactful symptoms of menopause include vasomotor symptoms (VMS) which include hot flashes and night sweats, sleep and mood disturbances, memory issues, muscle and joint pains, and symptoms of the Genitourinary Syndrome of Menopause (GSM) such as vaginal dryness, bladder issues, and sexual dysfunction. Recent evidence has shown that frequent or severe menopausal vasomotor symptoms are linked to a higher risk for illnesses including cardiovascular disease and diabetes.

The Global Health Compass: Steering Your Patients Through Travel Risks and Pandemic Concerns

Michael Boivin — 2025-06-05

Canadian-resident trips abroad continued to increase in 2024 and surpassed their 2023 levels by 10.0%. Overseas trips by Canadians increased by 30.9% from 2023 and now exceed pre-pandemic numbers.

Although international travellers are an important group for the world economy, they are at increased risk of exposure to infectious diseases while they are outside their home country and may possibly spread these diseases from one country to another. SARS-CoV-2, Ebola, Zika, and antimicrobial resistant pathogens are examples of health threats whose spread has been facilitated by international travellers. Climate change is also impacting infectious disease risk. Rising temperatures are expanding the regions where vector-borne diseases (e.g., dengue, malaria, Chikungunya, Zika) can thrive, as well as increasing the risk of zoonotic (e.g., Avian influenza) and waterborne diseases (e.g., Vibrio, E. coli).

As more Canadians travel, clinicians play a critical role in making travel recommendations. This article will focus on simple recommendations that can be made to reduce travel risks and highlight potential future pandemic concerns.

Risk Prediction for Chronic Kidney Disease: Considerations for Primary Care

Navdeep Tangri — 2025-06-05

Chronic Kidney Disease (CKD) affects more than one in ten Canadians and is largely managed in primary care. Diabetes is the leading cause of CKD, and primary care providers often manage the underlying causes and comorbid conditions related to kidney disease, as well as the adverse consequences of CKD itself.

It is important to recognize that CKD has a variable course. While most adults lose approximately 1 mL/min of kidney function every year after the age of 40, some patients lose kidney function rapidly, leading to hospitalizations due to heart failure and progression to kidney failure, whereas others remain stable for decades, requiring minimal additional intervention. Recent advances in risk prediction for CKD allows all providers to accurately identify high risk individuals. These innovations enable the use of highly effective therapies that slow down, and in many cases, normalize the rate of kidney function loss, leading to potential lifetime risk reduction for kidney failure. (Figure 1).

This review will cover key considerations in screening, risk stratification, and treatment of CKD in primary care, with an emphasis on tools that are readily available in clinical settings. We believe that a screen-triage-treat paradigm for CKD can lead to optimal outcomes for patients and health systems.