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Sivakumaran S, Alsallakh MA, Lyons RA, et al., 2023, Estimating the contribution of respiratory pathogens to acute exacerbations of COPD using routine data, JOURNAL OF INFECTION, Vol: 86, Pages: 233-238, ISSN: 0163-4453
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McAuley HJC, Evans RA, Bolton CE, et al., 2023, Prevalence of physical frailty, including risk factors, up to 1 year after hospitalisation for COVID-19 in the UK: a multicentre, longitudinal cohort study., EClinicalMedicine, Vol: 57, Pages: 1-13, ISSN: 2589-5370
BACKGROUND: The scale of COVID-19 and its well documented long-term sequelae support a need to understand long-term outcomes including frailty. METHODS: This prospective cohort study recruited adults who had survived hospitalisation with clinically diagnosed COVID-19 across 35 sites in the UK (PHOSP-COVID). The burden of frailty was objectively measured using Fried's Frailty Phenotype (FFP). The primary outcome was the prevalence of each FFP group-robust (no FFP criteria), pre-frail (one or two FFP criteria) and frail (three or more FFP criteria)-at 5 months and 1 year after discharge from hospital. For inclusion in the primary analysis, participants required complete outcome data for three of the five FFP criteria. Longitudinal changes across frailty domains are reported at 5 months and 1 year post-hospitalisation, along with risk factors for frailty status. Patient-perceived recovery and health-related quality of life (HRQoL) were retrospectively rated for pre-COVID-19 and prospectively rated at the 5 month and 1 year visits. This study is registered with ISRCTN, number ISRCTN10980107. FINDINGS: Between March 5, 2020, and March 31, 2021, 2419 participants were enrolled with FFP data. Mean age was 57.9 (SD 12.6) years, 933 (38.6%) were female, and 429 (17.7%) had received invasive mechanical ventilation. 1785 had measures at both timepoints, of which 240 (13.4%), 1138 (63.8%) and 407 (22.8%) were frail, pre-frail and robust, respectively, at 5 months compared with 123 (6.9%), 1046 (58.6%) and 616 (34.5%) at 1 year. Factors associated with pre-frailty or frailty were invasive mechanical ventilation, older age, female sex, and greater social deprivation. Frail participants had a larger reduction in HRQoL compared with before their COVID-19 illness and were less likely to describe themselves as recovered. INTERPRETATION: Physical frailty and pre-frailty are common following hospitalisation with COVID-19. Improvement in frailty was seen between 5 and 12 months although
Bedston S, Lowthian E, Jarvis CI, et al., 2023, COVID-19 booster vaccination uptake and infection breakthrough amongst health care workers in Wales: A national prospective cohort study., Vaccine, Vol: 41, Pages: 1378-1389
BACKGROUND: From September 2021, Health Care Workers (HCWs) in Wales began receiving a COVID-19 booster vaccination. This is the first dose beyond the primary vaccination schedule. Given the emergence of new variants, vaccine waning vaccine, and increasing vaccination hesitancy, there is a need to understand booster vaccine uptake and subsequent breakthrough in this high-risk population. METHODS: We conducted a prospective, national-scale, observational cohort study of HCWs in Wales using anonymised, linked data from the SAIL Databank. We analysed uptake of COVID-19 booster vaccinations from September 2021 to February 2022, with comparisons against uptake of the initial primary vaccination schedule. We also analysed booster breakthrough, in the form of PCR-confirmed SARS-Cov-2 infection, comparing to the second primary dose. Cox proportional hazard models were used to estimate associations for vaccination uptake and breakthrough regarding staff roles, socio-demographics, household composition, and other factors. RESULTS: We derived a cohort of 73,030 HCWs living in Wales (78% female, 60% 18-49 years old). Uptake was quickest amongst HCWs aged 60 + years old (aHR 2.54, 95%CI 2.45-2.63), compared with those aged 18-29. Asian HCWs had quicker uptake (aHR 1.18, 95%CI 1.14-1.22), whilst Black HCWs had slower uptake (aHR 0.67, 95%CI 0.61-0.74), compared to white HCWs. HCWs residing in the least deprived areas were slightly quicker to have received a booster dose (aHR 1.12, 95%CI 1.09-1.16), compared with those in the most deprived areas. Strongest associations with breakthrough infections were found for those living with children (aHR 1.52, 95%CI 1.41-1.63), compared to two-adult only households. HCWs aged 60 + years old were less likely to get breakthrough infections, compared to those aged 18-29 (aHR 0.42, 95%CI 0.38-0.47). CONCLUSION: Vaccination uptake was consistently lower among black HCWs, as well as those from deprived areas. Whilst breakt
Daynes E, Baldwin M, Greening NJ, et al., 2023, Correction: The effect of COVID rehabilitation for ongoing symptoms Post HOSPitalisation with COVID-19 (PHOSP-R): protocol for a randomised parallel group controlled trial on behalf of the PHOSP consortium, Trials, Vol: 24, ISSN: 1745-6215
Leavy OC, Allen RJ, Kraven LM, et al., 2023, The use of genetic information to define idiopathic pulmonary fibrosis in UK biobank, Chest, Vol: 163, Pages: 362-365, ISSN: 0012-3692
Calvo RA, Peters D, Moradbakhti L, et al., 2023, Assessing the feasibility of a text-based conversational agent for asthma support: protocol for a mixed methods observational study, JMIR Research Protocols, Vol: 12, Pages: 9-9, ISSN: 1929-0748
BACKGROUND: Despite efforts, the UK death rate from asthma is the highest in Europe, and 65% of people with asthma in the United Kingdom do not receive the professional care they are entitled to. Experts have recommended the use of digital innovations to help address the issues of poor outcomes and lack of care access. An automated SMS text messaging-based conversational agent (ie, chatbot) created to provide access to asthma support in a familiar format via a mobile phone has the potential to help people with asthma across demographics and at scale. Such a chatbot could help improve the accuracy of self-assessed risk, improve asthma self-management, increase access to professional care, and ultimately reduce asthma attacks and emergencies. OBJECTIVE: The aims of this study are to determine the feasibility and usability of a text-based conversational agent that processes a patient's text responses and short sample voice recordings to calculate an estimate of their risk for an asthma exacerbation and then offers follow-up information for lowering risk and improving asthma control; assess the levels of engagement for different groups of users, particularly those who do not access professional services and those with poor asthma control; and assess the extent to which users of the chatbot perceive it as helpful for improving their understanding and self-management of their condition. METHODS: We will recruit 300 adults through four channels for broad reach: Facebook, YouGov, Asthma + Lung UK social media, and the website Healthily (a health self-management app). Participants will be screened, and those who meet inclusion criteria (adults diagnosed with asthma and who use WhatsApp) will be provided with a link to access the conversational agent through WhatsApp on their mobile phones. Participants will be sent scheduled and randomly timed messages to invite them to engage in dialogue about their asthma risk during the period of study. After a data collection period (28
Daynes E, Baldwin M, Greening NJ, et al., 2023, The effect of COVID rehabilitation for ongoing symptoms Post HOSPitalisation with COVID-19 (PHOSP-R): protocol for a randomised parallel group controlled trial on behalf of the PHOSP consortium, Trials, Vol: 24, ISSN: 1745-6215
IntroductionMany adults hospitalised with COVID-19 have persistent symptoms such as fatigue, breathlessness and brain fog that limit day-to-day activities. These symptoms can last over 2 years. Whilst there is limited controlled studies on interventions that can support those with ongoing symptoms, there has been some promise in rehabilitation interventions in improving function and symptoms either using face-to-face or digital methods, but evidence remains limited and these studies often lack a control group.Methods and analysisThis is a nested single-blind, parallel group, randomised control trial with embedded qualitative evaluation comparing rehabilitation (face-to-face or digital) to usual care and conducted within the PHOSP-COVID study. The aim of this study is to determine the effectiveness of rehabilitation interventions on exercise capacity, quality of life and symptoms such as breathlessness and fatigue. The primary outcome is the Incremental Shuttle Walking Test following the eight week intervention phase. Secondary outcomes include measures of function, strength and subjective assessment of symptoms. Blood inflammatory markers and muscle biopsies are an exploratory outcome. The interventions last eight weeks and combine symptom-titrated exercise therapy, symptom management and education delivered either in a face-to-face setting or through a digital platform (www.yourcovidrecovery.nhs.uk). The proposed sample size is 159 participants, and data will be intention-to-treat analyses comparing rehabilitation (face-to-face or digital) to usual care.Ethics and disseminationEthical approval was gained as part of the PHOSP-COVID study by Yorkshire and the Humber Leeds West Research NHS Ethics Committee, and the study was prospectively registered on the ISRCTN trial registry (ISRCTN13293865). Results will be disseminated to stakeholders, including patients and members of the public, and published in appropriate journals.
Dolby T, Nafilyan V, Morgan A, et al., 2023, Relationship between asthma and severe COVID-19: a national cohort study, Thorax, Vol: 78, Pages: 120-127, ISSN: 0040-6376
Background: We aimed to determine whether children and adults with poorly controlled or more severe asthma have greater risk of hospitalisation and/or death from COVID-19. Methods: We used individual-level data from the Office for National Statistics Public Health Data Asset, based on the 2011 census in England, and the General Practice Extraction Service (GPES) data for pandemic planning and research linked to death registration records and Hospital Episode Statistics admission data. Adults were followed from 1 January 2020 until 30 September 2021 for hospitalisation or death from COVID-19. For children, only hospitalisation was included. Results: Our cohort comprised 35,202,533 adults and 2,996,503 children aged 12–17 years. After controlling for socio-demographic factors, pre-existing health conditions and vaccine status, the risk of death involving COVID-19 for adults with asthma prescribed low dose ICS was not significantly different from those without asthma. Adults with asthma prescribed medium and high dosage ICS had an elevated risk of COVID-19 death; hazard ratios (HRs) 1.18 [1.14–1.23] and 1.36 [1.28–1.44] respectively. A similar pattern was observed for COVID-19 hospitalisation; fully adjusted HRs 1.53 [1.50–1.56] and 1.52 [1.46–1.56] for adults with asthma prescribed medium and high dosage ICS respectively. Risk of hospitalisation was greater for children with asthma prescribed one (2.58 [1.82–3.66]) or two or more (3.80 [2.41–5.95]) courses of OCS in the year prior to the pandemic.Discussion: People with mild and/or well-controlled asthma are neither at significantly increased risk of hospitalisation with nor more likely to die from COVID-19 than adults without asthma. What is already known on this topic?It is not clear if children or adults with asthma are at greater risk of hospitalisation and/or death from COVID-19 compared with the general population.What this study addsAdults and children with poorly contr
Daines L, Zheng B, Elneima O, et al., 2023, Characteristics and risk factors for post-COVID-19 breathlessness after hospitalisation for COVID-19, ERJ Open Research, Vol: 9, Pages: 1-15, ISSN: 2312-0541
BACKGROUND: Persistence of respiratory symptoms, particularly breathlessness, after acute coronavirus disease 2019 (COVID-19) infection has emerged as a significant clinical problem. We aimed to characterise and identify risk factors for patients with persistent breathlessness following COVID-19 hospitalisation. METHODS: PHOSP-COVID is a multicentre prospective cohort study of UK adults hospitalised for COVID-19. Clinical data were collected during hospitalisation and at a follow-up visit. Breathlessness was measured by a numeric rating scale of 0-10. We defined post-COVID-19 breathlessness as an increase in score of ≥1 compared to the pre-COVID-19 level. Multivariable logistic regression was used to identify risk factors and to develop a prediction model for post-COVID-19 breathlessness. RESULTS: We included 1226 participants (37% female, median age 59 years, 22% mechanically ventilated). At a median 5 months after discharge, 50% reported post-COVID-19 breathlessness. Risk factors for post-COVID-19 breathlessness were socioeconomic deprivation (adjusted OR 1.67, 95% CI 1.14-2.44), pre-existing depression/anxiety (adjusted OR 1.58, 95% CI 1.06-2.35), female sex (adjusted OR 1.56, 95% CI 1.21-2.00) and admission duration (adjusted OR 1.01, 95% CI 1.00-1.02). Black ethnicity (adjusted OR 0.56, 95% CI 0.35-0.89) and older age groups (adjusted OR 0.31, 95% CI 0.14-0.66) were less likely to report post-COVID-19 breathlessness. Post-COVID-19 breathlessness was associated with worse performance on the shuttle walk test and forced vital capacity, but not with obstructive airflow limitation. The prediction model had fair discrimination (concordance statistic 0.66, 95% CI 0.63-0.69) and good calibration (calibration slope 1.00, 95% CI 0.80-1.21). CONCLUSIONS: Post-COVID-19 breathlessness was commonly reported in this national cohort of patients hospitalised for COVID-19 and is likely to be a multifactorial problem with physical and emotional components.
Sinha IP, Lee A, Katikireddi SV, et al., 2023, Introduction, ERS Monograph, Vol: 2023, Pages: xi-xiii, ISSN: 2312-508X
Zhang X, Quint JK, Whittaker H, 2023, Inequalities in respiratory health based on sex and gender, ERS Monograph, Vol: 2023, Pages: 40-50, ISSN: 2312-508X
There is a growing body of literature showing that sex and gender affect the incidence, susceptibility, presentation, diagnosis and severity of lung diseases. However, despite the availability of data on differences in health outcomes, current medical practice does not take sex and gender sufficiently into account in relation to disease management. In this chapter, we explore the importance of considering sex and gender relative to outcomes in chronic respiratory diseases to promote disease prevention and better management for respiratory patients.
Humbert M, Kovacs G, Hoeper MM, et al., 2023, 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension., Eur Respir J, Vol: 61
Liew F, Talwar S, Cross A, et al., 2023, SARS-CoV-2-specific nasal IgA wanes 9 months after hospitalisation with COVID-19 and is not induced by subsequent vaccination, EBioMedicine, Vol: 87, Pages: 1-14, ISSN: 2352-3964
Background:Most studies of immunity to SARS-CoV-2 focus on circulating antibody, giving limited insights into mucosal defences that prevent viral replication and onward transmission. We studied nasal and plasma antibody responses one year after hospitalisation for COVID-19, including a period when SARS-CoV-2 vaccination was introduced.Methods:In this follow up study, plasma and nasosorption samples were prospectively collected from 446 adults hospitalised for COVID-19 between February 2020 and March 2021 via the ISARIC4C and PHOSP-COVID consortia. IgA and IgG responses to NP and S of ancestral SARS-CoV-2, Delta and Omicron (BA.1) variants were measured by electrochemiluminescence and compared with plasma neutralisation data.Findings:Strong and consistent nasal anti-NP and anti-S IgA responses were demonstrated, which remained elevated for nine months (p < 0.0001). Nasal and plasma anti-S IgG remained elevated for at least 12 months (p < 0.0001) with plasma neutralising titres that were raised against all variants compared to controls (p < 0.0001). Of 323 with complete data, 307 were vaccinated between 6 and 12 months; coinciding with rises in nasal and plasma IgA and IgG anti-S titres for all SARS-CoV-2 variants, although the change in nasal IgA was minimal (1.46-fold change after 10 months, p = 0.011) and the median remained below the positive threshold determined by pre-pandemic controls. Samples 12 months after admission showed no association between nasal IgA and plasma IgG anti-S responses (R = 0.05, p = 0.18), indicating that nasal IgA responses are distinct from those in plasma and minimally boosted by vaccination.Interpretation:The decline in nasal IgA responses 9 months after infection and minimal impact of subsequent vaccination may explain the lack of long-lasting nasal defence against reinfection and the limited effects of vaccination on transmission. These findings highlight the need to develop vaccines that enhance nasal immunity.Funding:This
Rothnie KJ, Numbere B, Gelwicks S, et al., 2023, Risk Factors Associated with a First Exacerbation Among Patients with COPD Classified as GOLD A and B in Routine Clinical Practice in the UK., Int J Chron Obstruct Pulmon Dis, Vol: 18, Pages: 2673-2685
PURPOSE: Risk factors for exacerbations of chronic obstructive pulmonary disease (COPD) have been previously characterized for patients with more severe cases of COPD. It is unclear how the risk of first exacerbation may best be identified in patients with less severe disease. This study investigated risk factors for first exacerbation among English patients with COPD classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A or B. PATIENTS AND METHODS: A retrospective cohort study using data from the UK Clinical Practice Research Datalink (CPRD) AURUM linked to Hospital Episode Statistics. Patients with COPD aged ≥35 years and classified as GOLD group A or B (2020 criteria) from January 2013-December 2019 were eligible. Patients were required to have 24 months history in CPRD (baseline). Two cohorts were defined: cohort 1 included patients with no severe exacerbations during baseline; cohort 2 included patients with no moderate or severe exacerbations during baseline. Risk factors associated with severe, or combined moderate and severe exacerbation were examined for up to 5 years of follow-up. RESULTS: Overall, 194,948 patients were included in cohort 1 (mean age 66.2 years; 55.2% male), and 148,396 patients in cohort 2 (mean age 66.1 years; 56.6% male). Identified risk factors for exacerbation (and associated 1-year absolute risk of severe, or combined moderate and severe exacerbation, respectively) included: Medical Research Council dyspnea scale score (15.9%/28.4%); COPD Assessment Test score (9.6%/25.3%); GOLD grade of airflow limitation (forced expiratory volume in 1 second % predicted; 13.6%/27.5%); and lung cancer (8.1%/23.6%). After adjustment for risk factors, these factors remained independently associated with severe exacerbation at 1, 3, and 5 years of follow-up. CONCLUSION: The identified risk factors may aid physicians in the early recognition of patients with COPD classified as GOLD group A or B at risk of first exacerbati
Raslan AS, Quint J, Cook S, 2023, All-cause, cardiovascular and respiratory mortality in people with Type 2 Diabetes and Chronic Obstructive Pulmonary Disease (COPD) in England: a cohort study using the Clinical Practice Research Datalink (CPRD), The International Journal of Chronic Obstructive Pulmonary Disease, Vol: 18, Pages: 1207-1218, ISSN: 1176-9106
Background: Type 2 diabetes (T2D) and chronic obstructive pulmonary disease (COPD) are common non-communicable diseases. Both have an inflammatory nature and similar risk factors, and there is overlap and interaction between them. To date, there is a lack of research on outcomes in people that have both conditions. The aim of this study was to investigate whether the presence of COPD in people with T2D was associated with an increased risk of all-cause, respiratory-cause and cardiovascular-cause mortality.Methods: A three-year cohort study (2017– 19) was done using the Clinical Practice Research Datalink Aurum database. The study population was 121,563 people with T2D aged ≥ 40. The exposure was COPD status at baseline. Incident rates for all-cause, respiratory-cause and cardiovascular-cause mortality were calculated. Poisson models for each outcome were fitted to estimate rate ratios for COPD status adjusted for age, sex, Index of Multiple Deprivation, smoking status, body mass index, prior asthma and cardiovascular disease.Results: COPD was present in 12.1% people with T2D. People with COPD had a higher all-cause mortality rate (448.7 persons per 1000 person years) compared with people without COPD (296.6 persons per 1000 person years). People with COPD also had substantially higher respiratory mortality incidence rates and moderately raised cardiovascular mortality rates. Fully adjusted Poisson models showed that people with COPD had a 1.23 (95% CI 1.21, 1.24) times higher rate of all-cause mortality as compared with those without COPD and a 3.03 (95% CI 2.89, 3.18) times higher rate of respiratory-cause mortality. There was no evidence of an association with cardiovascular mortality after adjusting for existing cardiovascular disease.Conclusion: Co-morbid COPD in people with T2D was associated with increased mortality overall and particularly from respiratory causes. People with both COPD and T2D are a high-risk group who would benefit from particularly
Gadhvi K, Kandeil M, Raveendran D, et al., 2023, Inhaled corticosteroids and risk of cardiovascular disease in chronic obstructive pulmonary disease: a systematic review and meta-regression, Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, Vol: 10, Pages: 317-327, ISSN: 2372-952X
Background: Previous studies have reported mixed associations between inhaled corticosteroids (ICSs) and cardiovascular disease(CVD) in people with chronic obstructive pulmonary disease (COPD). Using updated literature, we investigated the associationbetween ICS-containing medications and CVD in COPD patients, stratified by study-related factors.Methods: We searched MEDLINE and EMBASE for studies that reported effect estimates for the association between ICS-containingmedications and the risk of CVD in COPD patients. CVD outcomes specifically included heart failure, myocardial infarction, andstroke-related events. We conducted a random-effects meta-analysis and a meta-regression to identify effect-modifying study-relatedfactors.Results: Fifteen studies met inclusion criteria and investigated the association between ICS-containing medications and the risk ofCVD. Pooled results from our meta-analysis showed a significant association between ICS-containing medication and reduced risk ofCVD (hazard ratio 0.87, 95% confidence intervals 0.78 to 0.97). Study follow-up time, non-ICS comparator, and exclusion of patientswith previous CVD modified the association between ICS use and risk of CVD.Conclusions: Overall, we found an association between ICS-containing medications and reduced risk of CVD in COPD patients.Results from the meta-regression suggest that subgroups of COPD patients may benefit from ICS use more than others and furtherwork is needed to determine this.
Ioannides AE, Tayal U, Quint JK, 2023, Spirometry in atrial fibrillation: what's the catch?, Expert Rev Respir Med, Vol: 17, Pages: 937-950
INTRODUCTION: People with COPD rarely have COPD alone, and the commonest co-morbidities occurring with COPD are cardiovascular. Whilst multiple studies have explored the association between major cardiovascular events and COPD, less attention has been paid to arrhythmias, specifically atrial fibrillation (AF). AF and COPD frequently occur together, posing challenges in diagnosis and management. In this review, we describe the relationship between AF and COPD epidemiologically and physiologically, demonstrating the role of spirometry as a diagnostic and disease management tool. AREAS COVERED: We provide epidemiological evidence that COPD and AF are independent risk factors for one another, that either disease is highly prevalent amongst people with the other, and that they have shared risk factors; all of which contribute to adverse prognostic. We elucidated common pathophysiological mechanisms implicated in AF-COPD. We ultimately present the epidemiological and physiological evidence with a view to highlight specific areas where we feel spirometry is of value in the management of AF-COPD. EXPERT OPINION: AF and COPD commonly co-occur, there is often diagnostic delay, increased risk of reduced cardioversion success, and missed opportunity to intervene to reduce stroke risk. Greater awareness and timelier diagnosis and guideline directed management may improve outcomes for people with both diseases.
Requena G, Czira A, Banks V, et al., 2023, Comparison of Rescue Medication Prescriptions in Patients with Chronic Obstructive Pulmonary Disease Receiving Umeclidinium/Vilanterol versus Tiotropium Bromide/Olodaterol in Routine Clinical Practice in England, INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, Vol: 18, Pages: 1431-1444, ISSN: 1178-2005
Czira A, Requena G, Banks V, et al., 2023, Comparative Effectiveness of Umeclidinium/Vilanterol versus Inhaled Corticosteroid/Long-Acting β<sub>2</sub>-Agonist in Patients with Chronic Obstructive Pulmonary Disease in a Primary Care Setting in England, INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, Vol: 18, Pages: 643-659, ISSN: 1178-2005
Zheng B, Daines L, Han Q, et al., 2022, Prevalence, risk factors and treatments for post-COVID-19 breathlessness: a systematic review and meta-analysis, European Respiratory Review, Vol: 31, Pages: 1-20, ISSN: 0905-9180
Persistent breathlessness >28 days after acute COVID-19 infection has been identified as a highly debilitating post-COVID symptom. However, the prevalence, risk factors, mechanisms and treatments for post-COVID breathlessness remain poorly understood. We systematically searched PubMed and Embase for relevant studies published from 1 January 2020 to 1 November 2021 (PROSPERO registration number: CRD42021285733) and included 119 eligible papers. Random-effects meta-analysis of 42 872 patients with COVID-19 reported in 102 papers found an overall prevalence of post-COVID breathlessness of 26% (95% CI 23–29) when measuring the presence/absence of the symptom, and 41% (95% CI 34–48) when using Medical Research Council (MRC)/modified MRC dyspnoea scale. The pooled prevalence decreased significantly from 1–6 months to 7–12 months post-infection. Post-COVID breathlessness was more common in those with severe/critical acute infection, those who were hospitalised and females, and was less likely to be reported by patients in Asia than those in Europe or North America. Multiple pathophysiological mechanisms have been proposed (including deconditioning, restrictive/obstructive airflow limitation, systemic inflammation, impaired mental health), but the body of evidence remains inconclusive. Seven cohort studies and one randomised controlled trial suggested rehabilitation exercises may reduce post-COVID breathlessness. There is an urgent need for mechanistic research and development of interventions for the prevention and treatment of post-COVID breathlessness.
Quint J, 2022, Post-acute sequelae of SARS-CoV-2 among previously hospitalised individuals with COVID-19: a systematic literature review and meta-analysis, European Respiratory Review, ISSN: 0905-9180
Mulick AR, Henderson AD, Prieto-Merino D, et al., 2022, Novel multimorbidity clusters in people with eczema and asthma: a population-based cluster analysis, SCIENTIFIC REPORTS, Vol: 12, ISSN: 2045-2322
Gayle A, Lenoir A, Minelli C, et al., 2022, Are we missing lifetime COPD diagnosis among people with COPD recorded death?, British Journal of General Practice Open, Vol: 6, ISSN: 2398-3795
Background: The British Lung Foundation previously estimated that 2.2 million symptomatic but undiagnosed people with COPD live in the UK. Aim: This study investigates the proportion of patients with a missed COPD diagnosis among those with COPD as the cause of death on their death certificate and how this has changed over the past 17 years. Design and Setting: We linked Clinical Practice Research Datalink Aurum and GOLD primary care data with Office for National Statistics mortality data and Hospital Episode Statistics data. We included adults who died between 2000 and 2017 with COPD as their main cause of death. Method: Using a range of diagnostic COPD criteria, we estimated the proportion of patients with a missed COPD diagnosis, and described the demographic and clinical characteristics of patients with and without prior COPD diagnosis using a mixed effect logistic regression model. Results: Depending on the COPD definition used, between 96% and 27% of the 78,621 patients included received a diagnosis of COPD prior to death. Using presence of a COPD Read or SNOMED CT code and performed spirometry as a main definition, just over half of the patients (52%) had received a COPD diagnosis overall, with a proportion of those who did not decreasing from 91% in 2000 to 31% in 2017 (p-trend <0.001). Conclusion: The proportion of people with COPD-recorded death who had received a diagnosis of COPD has improved over time and currently represents the majority of them, suggesting that few patients are being missed.
Sundaram V, Zakeri R, Witte K, et al., 2022, Development of algorithms for determining heart failure with reduced and preserved ejection fraction using nationwide electronic healthcare records in the UK, Open Heart, Vol: 9, ISSN: 2053-3624
Background: Determining heart failure (HF) phenotypes in routine electronic health records (EHR) is challenging. We aimed to develop and validate EHR algorithms for identification of specific HF phenotypes, using Read codes in combination with selected patient characteristics.Methods: We used The Healthcare Improvement Network (THIN). The study population included a random sample of individuals with HF diagnostic codes (HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF) and non-specific HF) selected from all participants registered in the THIN database between 1 January 2015 and 30 September 2017. Confirmed diagnoses were determined in a randomly selected subgroup of 500 patients via GP questionnaires including a review of all available cardiovascular investigations. Confirmed diagnoses of HFrEF and HFpEF were based on four criteria. Based on these data, we calculated a positive predictive value (PPV) of predefined algorithms which consisted of a combination of Read codes and additional information such as echocardiogram results and HF medication records.Results: The final cohort from which we drew the 500 patient random sample consisted of 10 275 patients. Response rate to the questionnaire was 77.2%. A small proportion (18%) of the overall HF patient population were coded with specific HF phenotype Read codes. For HFrEF, algorithms achieving over 80% PPV included definite, possible or non-specific HF HFrEF codes when combined with at least two of the drugs used to treat HFrEF. Only in non-specific HF coding did the use of three drugs (rather than two) contribute to an improvement of the PPV for HFrEF. HFpEF was only accurately defined with specific codes. In the absence of specific coding for HFpEF, the PPV was consistently below 50%.Conclusions: Prescription for HF medication can reliably be used to find HFrEF patients in the UK, even in the absence of a specific Read code for HFrEF. Algorithms using non-specific coding
Whittaker HR, Wing K, Douglas I, et al., 2022, Inhaled corticosteroid withdrawal and change in lung function in primary care chronic obstructive pulmonary disease patients in England, Annals of the American Thoracic Society, Vol: 19, Pages: 1834-1841, ISSN: 1546-3222
RATIONALE: In COPD, inhaled corticosteroids (ICS) are associated with pneumonia highlighting the importance of investigating subgroups of patients who may benefit from prolonged ICS use. Despite this, the WISDOM trial found a greater decline in forced expiratory volume in 1 second (FEV1) in COPD patients who withdrew from inhaled corticosteroids (ICS) compared to patients who remained on triple therapy (TT). OBJECTIVES: We investigated the association between ICS withdrawal and rate of FEV1 decline in COPD patients using routinely collected electronic healthcare records. METHODS: Using Clinical Practice Research Datalink (CPRD) Aurum and Hospital episode statistics we included COPD patients who had been on TT for at least four months. Patients were categorised into those who withdrew from ICS and those who remained on TT during follow-up. Three cohorts were created: i) patients meeting the WISDOM trial eligibility criteria; ii) patients with COPD not restricted by the WISDOM trial eligibility criteria; and iii) patients who would have been excluded from the WISDOM trial based on their comorbidities. Mixed linear regression was used to model the association between ICS withdrawal and rate of FEV1 decline (ml/year) adjusted for baseline characteristics. RESULTS: 6,008 COPD patients met the WISDOM eligibility criteria, of which 9.0% withdrew from ICS. Mean rates of FEV1 decline -7.8 ml/year (95% CI -19.7 to +4.1) for withdrawers and -15.2 ml/year (95% CI -18.7 to -11.8) for those who remained on TT (difference p=0.264). 60,645 COPD patients were not restricted by the WISDOM eligibility criteria. Mean rate of FEV1 decline was -32.6ml/year (-33.6 to -31.5) for withdrawers and -36.4ml/year (-39.4 to -33.4) for those who remained on TT. 32,882 COPD patients were included in the last population representing those would have been excluded from the WISDOM trial due to their comorbidities. Mean rate of FEV1 decline was -29.4ml/year in withdrawers and -31.3ml/year in those who
Leavy OC, Allen RJ, Kraven LM, et al., 2022, USING GENETIC INFORMATION TO DEFINE IDIOPATHIC PULMONARY FIBROSIS IN UK BIOBANK, Winter Meeting of the British-Thoracic-Society (BTS), Publisher: BMJ PUBLISHING GROUP, Pages: A97-A97, ISSN: 0040-6376
Andresen K, Carreira H, Quint JK, et al., 2022, Respiratory diseases in survivors of adult cancer compared with the general population: a systematic review protocol, BMJ OPEN, Vol: 12, ISSN: 2044-6055
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Loebinger MR, Quint JK, van der Laan R, et al., 2022, A SYSTEMATIC LITERATURE REVIEW AND METAANALYSIS OF PATIENT RISK FACTORS FOR NONTUBERCULOUS MYCOBACTERIAL PULMONARY DISEASE (NTM-PD), Winter Meeting of the British-Thoracic-Society (BTS), Publisher: BMJ PUBLISHING GROUP, Pages: A84-A85, ISSN: 0040-6376
Karsanji U, Lawson CA, Bottle A, et al., 2022, DESCRIBING LONG-TERM OUTCOMES AND THE ASSOCIATION WITH BOTH RECEIVING A DIAGNOSIS AND TIME TO DIAGNOSIS IN ADULTS PRESENTING WITH BREATHLESSNESS: A UK RETROSPECTIVE STUDY USING ELECTRONIC HEALTHCARE RECORDS, Winter Meeting of the British-Thoracic-Society (BTS), Publisher: BMJ PUBLISHING GROUP, Pages: A179-A180, ISSN: 0040-6376
Stone P, Hickman K, Holmes S, et al., 2022, Comparison of COPD primary care in England, Scotland, Wales, and Northern Ireland, npj Primary Care Respiratory Medicine, Vol: 32, ISSN: 2055-1010
Currently the National Asthma and COPD audit programme (NACAP) only undertakes audit of COPD primary care in Wales due to its near complete data coverage. We aimed to determine if the quality of COPD primary care in the other UK nations is comparable with Wales. We found that English, Scottish, and Northern Irish practices were significantly worse than Welsh practices at recording coded lung function parameters used in COPD diagnosis (ORs: 0.51 [0.43–0.59], 0.29 [0.23–0.36], 0.42 [0.31–0.58], respectively) and referring appropriate patients for pulmonary rehabilitation (ORs: 0.10 [0.09–0.11], 0.12 [0.11–0.14], 0.22 [0.19–0.25], respectively). Completing national audits of primary care in Wales only may have led to improvements in care, or at least improvements in the recording of care in Wales that are not occurring elsewhere in the UK. This highlights the potential importance of audit in improving care quality and accurate recording of that care.
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