Publications
515 results found
Crossley D, Stockley J, Bolton CE, et al., 2020, Relationship of CT densitometry to lung physiological parameters and health status in alpha-1 antitrypsin deficiency: initial report of a centralised database of the NIHR rare diseases translational research collaborative., BMJ Open, Vol: 10, Pages: 1-8, ISSN: 2044-6055
OBJECTIVES: To establish a database network for the study of alpha-1 antitrypsin deficiency (AATD) and compare the results to CT lung density as the most direct measure of emphysema. DESIGN: A central electronic database was established to permit the upload of anonymised patient data from remote sites. Prospectively collected CT data were recorded onto disc, anonymised, analysed at the coordinating centre and compared with the clinical features of the disease. SETTING: Tertiary referral centres with expertise in the management of AATD focused on academic Biomedical Research Units and Wellcome Clinical Research Facilities. PARTICIPANTS: Data were collected from 187 patients over 1 year from eight UK academic sites. This included patient demographics, postbronchodilator physiology, health status and CT. Analysis was undertaken at the coordinating centre in Birmingham. RESULTS: Patient recruitment in the 12 months reached 94% of target (set at 200) covering the whole spectrum of the disease from those with normal lung function to very severe chronic obstructive lung disease. CT scan suitable for analysis was available from 147 (79%) of the patients. CT density, analysed as the threshold for the lowest 15% of lung voxels, showed statistically significant relationships with the objective physiological parameters of lung function as determined by spirometric Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity staging (p<0.001) and carbon monoxide gas transfer (p<0.01). Density also correlated with subjective measures of quality of life (p=0.02). CONCLUSIONS: Establishment of the network for data collection and its transfer was highly successful facilitating future collaboration for the study of this rare disease and its management. CT densitometry correlated well with the objective clinical features of the disease supporting its role as the specific marker of the associated emphysema and its severity. Correlations with subjective measures o
Hopkinson NS, Rossi N, El-Sayed Moustafa J, et al., 2020, Current tobacco smoking and risk from COVID-19: results from a population symptom app in over 2.4 million people, Publisher: Cold Spring Harbor Laboratory
Background The association between current tobacco smoking, the risk of developing COVID-19 and the severity of illness is an important information gap.Methods UK users of the COVID Symptom Study app provided baseline data including demographics, anthropometrics, smoking status and medical conditions, were asked to log symptoms daily from 24th March 2020 to 23rd April 2020. Participants reporting that they did not feel physically normal were taken through a series of questions, including 14 potential COVID-19 symptoms and any hospital attendance. The main study outcome was the association between current smoking and the development of “classic” symptoms of COVID-19 during the pandemic defined as fever, new persistent cough and breathlessness. The number of concurrent COVID-19 symptoms was used as a proxy for severity. In addition, association of subcutaneous adipose tissue expression of ACE2, both the receptor for SARS-CoV-2 and a potential mediator of disease severity, with smoking status was assessed in a subset of 541 twins from the TwinsUK cohort.Results Data were available on 2,401,982 participants, mean(SD) age 43.6(15.1) years, 63.3% female, overall smoking prevalence 11.0%. 834,437 (35%) participants reported being unwell and entered one or more symptoms. Current smokers were more likely to develop symptoms suggesting a diagnosis of COVID-19; classic symptoms adjusted OR[95%CI] 1.14[1.10 to 1.18]; >5 symptoms 1.29[1.26 to 1.31]; >10 symptoms 1.50[1.42 to 1.58]. Smoking was associated with reduced ACE2 expression in adipose tissue (Beta(SE)=-0.395(0.149); p=7.01×10-3).Interpretation These data are consistent with smokers having an increased risk from COVID-19.Funding Zoe provided in kind support for all aspects of building, running and supporting the app and service to all users worldwide. The study was also supported by grants from the Wellcome Trust, UK Research and Innovation and British Heart Foundation.
Hopkinson N, 2020, A rational approach to e-cigarettes - challenging ERS policy on tobacco harm reduction, European Respiratory Journal, Vol: 55, Pages: 1-8, ISSN: 0903-1936
Pavitt M, Tanner RJ, Lewis A, et al., 2020, Oral nitrate supplementation to enhance pulmonary rehabilitation in COPD: ON-EPIC a multi-centre, double-blind, placebo-controlled, randomised parallel group study, Thorax, Vol: 75, Pages: 547-555, ISSN: 0040-6376
Rationale Dietary nitrate supplementation has been proposed as a strategy to improve exercise performance, both in healthy individuals and in people with chronic obstructive pulmonary disease (COPD). We aimed to assess whether it could enhance the effect of pulmonary rehabilitation (PR) in COPD.Methods This double-blind, placebo-controlled, parallel group, randomised controlled study performed at four UK centres, enrolled adults with GOLD grade II-IV COPD and MRC dyspnoea score 3-5 or functional limitation to undertake a twice weekly eight week PR programme. They were randomly assigned (1:1) to either 140mls of nitrate-rich beetroot juice (BRJ) (12.9mmol nitrate), or placebo nitrate-deplete BRJ, consumed three hours prior to undertaking each PR session. Allocation used computer generated block randomisation. Measurements The primary outcome was change in incremental shuttle walk test (ISWT) distance. Secondary outcomes included quality of life, physical activity level, endothelial function via flow mediated dilatation, fat free mass index and blood pressure parameters.Main Results 165 participants were recruited, 78 randomised to nitrate-rich BRJ and 87 randomised to placebo. Exercise capacity increased more with active treatment (n=57) than placebo (n=65); median (IQR) change in ISWT distance +60m (10, 85) vs. +30m (0, 70), (p = 0.027). Active treatment also impacted on systolic blood pressure: Treatment group -5.0mmHg (-5.0, -3.0) vs control +6.0mmHg (-1.0, 15.5) (p<0.0005). No significant serious adverse events or side effects were reported.Conclusions Dietary nitrate supplementation appears to be a well-tolerated and effective strategy to augment the benefits of PR in COPD.
Philip K, Hopkinson N, Michael P, et al., 2020, The prevalence and associated mortality of non-anaemic iron deficiency in older adults: a 14 year observational cohort study, British Journal of Haematology, Vol: 189, Pages: 566-572, ISSN: 0007-1048
Background: Iron is central to multiple biological pathways, and treatment of non-anaemic absolute iron deficiency (NAID) is beneficial in certain conditions. However, it is unknown if NAID is associated with increased mortality in older-adults.Methods: A nationally representative sample of 4451 older-adults from the English Longitudinal Study of Ageing was used. NAID was defined as serum ferritin <30μg/L and haemoglobin ≥120g/L (women) or ≥130g/L (men). Cumulative mortality was estimated by Kaplan Meier method. Unadjusted and adjusted hazard ratios (HR) of mortality were calculated using Cox proportional hazards regression models. Results: Baseline NAID prevalence was 8.8% (95%CI 8.0%-9.7%). 10.9% (95% CI of 9.7-12.3%) for women and 6.35% for men (95% CI 5.3%-7.5%). The HR for mortality for individuals with NAID compared with non-anaemic individuals without iron deficiency over 14-year follow-up was 1.58 (95% CI 1.29-1.93). This association was independent of all identified demographic, health-related and biological covariates, and robust in multiple sensitivity analyses. Conclusions: In older-adults in England, NAID is common and associated with an increased mortality rate compared to non-anaemic individuals with normal serum ferritin. The association is principally driven by an excess mortality in women.
Laverty A, Hone T, Vamos EP, et al., 2020, Impact of banning smoking in cars with children on exposure to second-hand smoke: a natural experiment in England and Scotland, Thorax, Vol: 75, Pages: 345-347, ISSN: 0040-6376
England banned smoking in cars carrying children in 2015 and Scotland in 2016. With survey data from three years for both countries (NEngland=3,483-6,920,NScotland=232-319), we used this natural experiment to assess impacts of the English ban using logistic regression within a difference-in-differences framework. Among children aged 13-15 years, self-reported levels of regular exposure to smoke in cars were 3.4% in 2012, 2.2% in 2014 and 1.3% in 2016 for Scotland and 6.3%, 5.9% and 1.6% in England. The ban in England was associated with a -4.1% (95%CI -4.9%;-3.3%) absolute reduction (72% relative reduction) in exposure to tobacco smoke among children.
Hopkinson NS, 2020, The path to a smoke-free England by 2030 We know what to do, and the tobacco industry should be made to pay for it, BMJ: British Medical Journal, Vol: 368, ISSN: 0959-535X
Whitty JA, Rankin J, Visca D, et al., 2020, Cost-effectiveness of Ambulatory Oxygen in improving quality of life in fibrotic lung disease: Preliminary evidence from the AmbOx Trial., European Respiratory Journal, Vol: 55, ISSN: 0903-1936
Ambulatory oxygen may be cost-effective in improving quality of life in fibrotic lung disease. To be more conclusive, we need to understand societal willingness to pay for quality of life improvements and whether improvements are sustained. http://bit.ly/2pAiBJi
Whittaker H, Connell O, Campbell J, et al., 2020, Eligibility for lung volume reduction surgery in chronic obstructive pulmonary disease patients identified in a UK primary care setting, Chest, Vol: 157, Pages: 276-285, ISSN: 0012-3692
BackgroundAlthough lung volume reduction surgery (LVRS) improves survival in appropriately selected patients with Chronic Obstructive Pulmonary Disease (COPD), few procedures are performed. The National Institute for Clinical and Healthcare Excellence recently recommended a more systematic approach to identifying potential candidates. We investigated LVRS referrals from a UK primary care population and aimed to establish an accurate estimate of eligible patients and determine a strategy for identifying potential candidates systematically.MethodsClinical Practice Research Datalink (CPRD) GOLD (a primary care database), linked Hospital Episode Statistics (HES) inpatient and Diagnostic Imaging Dataset (DID) were used. COPD patients who had undergone LVRS, patients who met basic eligibility criteria for further screening for LVRS, and patients meeting a more stringent eligibility criteria were identified from April 2012 to September 2015. Thoracic CT, pulmonary rehabilitation status, referral to respiratory outpatient clinics, and AECOPD requiring hospitalisation were compared between actual LVRS recipients and potentially eligible patients. ResultsAmong 73,697 COPD patients included, 36 (0.05%) received LVRS, 5,984 (8.1%) met basic eligibility criteria, and 159 (0.2%) met more stringent eligibility criteria. LVRS recipients were younger (mean(SD) age: 64(9.2) years) compared to the stringently eligible patients (69(8.9) years) (p=0.01). Few patients meeting stringent eligibility criteria (6.9%) had a CT thorax in the preceding 3 years or been referred for assessment in secondary care. ConclusionsA substantial unmet need exists among COPD patients who could potentially benefit from a lung volume reduction procedure but who are not being investigated or referred to consider this possibility.
Brakema EA, van der Kleij RM, Vermond D, et al., 2020, Let's stop dumping cookstoves in local communities. It's time to get implementation right, npj Primary Care Respiratory Medicine, Vol: 30, ISSN: 2055-1010
We most welcome the comment by Thakur, van Schayck and Boudewijns on our article on the effects and acceptability of implementing improved cookstoves. Adoption rates of improved cookstoves by local communities are often strikingly low. The authors underline the urge to advance cookstove implementation strategies, and reinforce the approach used in the FRESH AIR project. They highlight several important factors to increase adoption success and call for further research on the topic. We want to build on this comment by reflecting on decades of substantial discrepancies between the disappointing adoption rates of improved cookstoves, and the subsequent failure to adapt implementation strategies accordingly. We argue that it is not necessarily the lack of evidence that impedes the success of implementation strategies for improved cookstoves. Moreover, it is the lack of use of the evidence by implementors. We propose several ideas for overcoming this evidence-to-practice gap.
Demeyer H, Waschki B, Furlanetto KC, et al., 2020, The Association Between Physical Activity and Mortality in Patients with COPD: Do Bouts Matter?, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Brakema EA, Tabyshova A, van der Kleij RMJJ, et al., 2019, The socioeconomic burden of chronic lung disease in low-resource settings across the globe – an observational FRESH AIR study, Respiratory Research, Vol: 20, Pages: 1-10, ISSN: 1465-9921
BackgroundLow-resource settings are disproportionally burdened by chronic lung disease due to early childhood disadvantages and indoor/outdoor air pollution. However, data on the socioeconomic impact of respiratory diseases in these settings are largely lacking. Therefore, we aimed to estimate the chronic lung disease-related socioeconomic burden in diverse low-resource settings across the globe. To inform governmental and health policy, we focused on work productivity and activity impairment and its modifiable clinical and environmental risk factors.MethodsWe performed a cross-sectional, observational FRESH AIR study in Uganda, Vietnam, Kyrgyzstan, and Greece. We assessed the chronic lung disease-related socioeconomic burden using validated questionnaires among spirometry-diagnosed COPD and/or asthma patients (total N = 1040). Predictors for a higher burden were studied using multivariable linear regression models including demographics (e.g. age, gender), health parameters (breathlessness, comorbidities), and risk factors for chronic lung disease (smoking, solid fuel use). We applied identical models per country, which we subsequently meta-analyzed.ResultsEmployed patients reported a median [IQR] overall work impairment due to chronic lung disease of 30% [1.8–51.7] and decreased productivity (presenteeism) of 20.0% [0.0–40.0]. Remarkably, work time missed (absenteeism) was 0.0% [0.0–16.7]. The total population reported 40.0% [20.0–60.0] impairment in daily activities. Breathlessness severity (MRC-scale) (B = 8.92, 95%CI = 7.47–10.36), smoking (B = 5.97, 95%CI = 1.73–10.22), and solid fuel use (B = 3.94, 95%CI = 0.56–7.31) were potentially modifiable risk factors for impairment.ConclusionsIn low-resource settings, chronic lung disease-related absenteeism is relatively low compared to the substantial presenteeism and activity im
Hopkinson NS, 2019, Lung volume reduction - apex treatments and the ecology of COPD care, American Journal of Respiratory and Critical Care Medicine, Vol: 200, Pages: 1329-1331, ISSN: 1073-449X
Philip KEJ, Gaduzo S, Rogers J, et al., 2019, THE QUALITY OF COPD PATIENT CARE - OUTCOMES FROM THE BRITISH LUNG FOUNDATION PATIENT PASSPORT, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A73-A74, ISSN: 0040-6376
Stolk J, Tov N, Chapman KR, et al., 2019, Efficacy and safety of inhaled alpha-1-antitrypsin in patients with severe alpha-1-antitrypsin deficiency and frequent exacerbations of COPD, European Respiratory Journal, Vol: 54, ISSN: 0903-1936
Patients with inherited alpha-1-antitrypsin (AAT) deficiency (ZZ-AATD) and severe chronic obstructive pulmonary disease (COPD) frequently suffer from exacerbations. We postulated that inhalation of nebulised AAT would be an effective treatment.We randomly assigned 168 patients to receive twice daily inhalations of 80 mg AAT solution or placebo for 50 weeks. Patients used an eDiary to capture exacerbations. The primary endpoint was time from randomisation to the first event-based exacerbation. Secondary end-points included change in the nature of the exacerbation by the Anthonisen criteria. Safety was also assessed.Time to first moderate or severe exacerbation was at median 112 days (IQR 40, 211) for AAT and 140 days (IQR 72, 142) for placebo, p=0·0952. The mean yearly rate of all exacerbations in the AAT and placebo groups was 3.12 and 2.67 (p=0.31), respectively. More patients receiving AAT reported treatment-related TEAEs (Treatment Emergent Adverse Events) compared to placebo (57·5% versus 46·9%, respectively) and they were more likely to withdraw from the study. After the first year of the study, the rate of safety events in the AAT treated group dropped to that of the placebo group.We conclude that in AATD patients with severe COPD and frequent exacerbations AAT inhalation for 50 weeks showed no effect on time to first exacerbation but may have changed the pattern of the episodes.
Hopkinson NS, Arnott D, Voulvoulis N, 2019, Environmental consequences of tobacco production and consumption (vol 394, pg 1007, 2019), LANCET, Vol: 394, Pages: 1324-1324, ISSN: 0140-6736
Philip K, Gaduzo S, Rogers J, et al., 2019, Patient experience of COPD care – outcomes from the British Lung Foundation Patient Passport, BMJ Open Respiratory Research, Vol: 6, ISSN: 2052-4439
Introduction The British Lung Foundation COPD Patient Passport (www.blf.org.uk/passport) was developed as a resource to help people with COPD and clinicians to consider the care received and identify essential omissions. We used the online data collected to evaluate the delivery of COPD care in the UK from a patient perspective. MethodsThe patient passport consists of 13 questions relating to key aspects of COPD care including: spirometry confirmation of diagnosis, understanding their diagnosis, support and a written management plan, vaccinations, smoking cessation, physical activity, exercise, eating well, pulmonary rehabilitation, exacerbations, medications, and yearly reviews. Data were presented as proportions with an answer corresponding to good care, and plotted over time to identify trends.ResultsAfter removing identifiable duplicates, data from 41,769 entries, completed online between November 2014 and April 2019, remained (Table 1). 24% reported getting support to manage their care and a written action plan; 53% could spot the signs of an acute exacerbation; 34% had discussed pulmonary rehabilitation; and 41% stated they understood their COPD, and their doctor or nurse had explained where to find information, advice and emotional support. A quarter reported not receiving flu vaccination and a third of those who smoke were not offered support to quit smoking. Even the strongest areas including spirometry-confirmed diagnosis, and knowing the importance of being active and eating well, achieved only around 80%. Response patterns remained stable or worsened over time. DiscussionResponses to the BLF COPD Patient Passport identify substantial gaps in patients’ experience of care, which did not appear to improve during the 5 years covered. These data provide a unique yet commonly overlooked perspec
Apps M, Pavitt M, Lewis A, et al., 2019, Increasing CPAP (Continuous Positive Airway Pressure) leads to increasing trans-pulmonary pressure with increased activity of the abdominal wall muscles to aid Expiration, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Mehta B, Edwards S, Hopkinson N, et al., 2019, Time is Essential for Competant Inhaler Technique Training, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Koreny M, Demeyer H, Arbillaga-Etxarri A, et al., 2019, Physical activity trajectories and their determinants in COPD: A cohort study, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
- Author Web Link
- Cite
- Citations: 1
Boutou A, Raste Y, Demeyer H, et al., 2019, Progression of physical inactivity in COPD patients: the effect of time and climate conditions - a multicentre prospective cohort study, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
- Author Web Link
- Cite
- Citations: 1
Hopkinson NS, Arnott D, Voulvoulis N, 2019, Environmental consequences of tobacco production and consumption, The Lancet, Vol: 394, Pages: 1007-1008, ISSN: 0140-6736
Lewis A, Hopkinson NS, 2019, Tai Chi movements for wellbeing - evaluation of a British Lung Foundation pilot, Perspectives in Public Health, Vol: 140, Pages: 172-180, ISSN: 1466-4240
Aims:In breathless individuals with respiratory disease, pulmonary rehabilitation (PR) can improve exercise capacity, symptoms and ability to cope with their condition. However, access is often limited, and adherence can be poor. Thus, there is interest in developing alternative and complementary forms of exercise intervention and tai chi may be effective in this context.Method:The British Lung Foundation worked in collaboration with ‘Tai Chi Movements for Wellbeing’ Training to train leaders to run community-based tai chi groups in the UK. Leaders received funding to run 3 months of once-a-week classes consisting of a 12 movement sequence of tai chi. Participants completed a questionnaire survey to evaluate the service at the start of their first session and again after 3 months.Results:Ten tai chi groups recruited 128 participants, 65% women, mean (standard deviation (SD)) age 70.1 (7.4) years at baseline. Seventy individuals completed the follow-up questionnaire at 3 months. Participants demonstrated an improvement in Medical Research Council (MRC) Dyspnoea Score pre 3 (interquartile range (IQR) = 1.8), post 2 (IQR = 1), p = .013 and disease burden; chronic obstructive pulmonary disease (COPD) assessment test score pre 19.4 (8.7), post 17.9 (9.4), mean change –1.5 (confidence interval (CI): –2.89 to –0.127), p = .033. Those who completed the programme had a worse baseline COPD assessment test (CAT) score and were more likely to have participated in maintenance exercise previously. Qualitative feedback suggested that participants felt the classes had helped with breathlessness and relaxation.Conclusion:Establishing a tai chi for wellbeing programme for people with respiratory disease is feasible, with a reasonable level of compliance, and is perceived to be helpful by participants.
Boutou AK, Raste Y, Demeyer H, et al., 2019, Progression of physical inactivity in COPD patients: the effect of time and climate conditions – a multicentre prospective cohort study, International Journal of COPD, Vol: 14, Pages: 1979-1992, ISSN: 1176-9106
Purpose: Longitudinal data on the effect of time and environmental conditions on physical activity (PA) among COPD patients are currently scarce, but this is an important factor in the design of trials to test interventions that might impact on it. Thus, we aimed to assess the effect of time and climate conditions (temperature, day length and rainfall) on progression of PA in a cohort of COPD patients.Patients and methods: This is a prospective, multicentre, cohort study undertaken as part of the EU/IMI PROactive project, in which we assessed 236 COPD patients simultaneously wearing two activity monitors (Dynaport MiniMod and Actigraph GT3X). A multivariable generalised linear model analysis was conducted to describe the effect of the explanatory variables on PA measures, over three time points (baseline, 6- and 12-month). Results: At 12 months (n=157; Forced Expiratory Volume in 1 second (FEV1) %predicted=57.7±21.9) there was a significant reduction in all PA measures (Actigraph step count (4284±3533 vs. 3533±293), Actigraph moderate- to vigorous-intensity physical activity ratio (8.8 (18.8) vs. 6.1(15.7)), Actigraph vector magnitude units (374902.4 (265269) vs. 336240 (214432)), Minimod walking time (59.1(34.9) vs. 56.9(38.7) minutes) and Minimod PA intensity (0.183(0) vs. 0.181(0)). Time had a significant, negative effect on most PA measures in multivariable analysis, after correcting for climate factors, study centre, age, FEV1 %predicted, 6 Minute Walking Distance and other disease severity measures. Rainfall was the only climate factor with a negative effect on most PA parameters. Conclusions:COPD patients demonstrate a significant decrease in physical activity over 1 year follow up, which is further affected by hours of rainfall, but not by other climate considerations.
Gilworth G, Lewin S, Wright AJ, et al., 2019, The lay health worker-patient relationship in promoting pulmonary rehabilitation (PR) in COPD: What makes it work?, Chronic Respiratory Disease, Vol: 16, ISSN: 1479-9723
Lay health workers (LHWs) can improve access to services and adherence to treatment, as well as promoting self-care and prevention. Their effect in promoting uptake and adherence in pulmonary rehabilitation (PR) for chronic obstructive pulmonary disease (COPD) has not been tested. PR is the most effective treatment for the symptoms and disability of COPD, but this effectiveness is undermined by poor rates of completion. Trained LHWs with COPD, who also have first-hand experience of PR, are well placed to help overcome the documented barriers to its completion. The relationship between LHWs and patients may be one of the keys to their effectiveness but it has been little explored. Semi-structured qualitative interviews were used with the aim of examining the LHW-patient partnership in a feasibility study of trained PR-experienced LHWs used to support COPD patients referred to PR. Twelve volunteers with COPD who completed LHW training supported 66 patients referred for PR. All 12 of these LHWs gave end-of-study interviews, 21 COPD patients supported by LHWs were also interviewed. Patients reported that the LHWs were keen to share their experiences of PR, and that this had a positive impact. The enthusiasm of the LHWs for PR was striking. The common bond between LHWs and patients of having COPD together with the LHWs positive, first-hand experience of PR were dominant and recurring themes in their relationship.
Hopkinson NS, Molyneux A, Pink J, 2019, Chronic obstructive pulmonary disease: diagnosis and management: summary of updated NICE guidance (vol 40, pg c3134, 2010), BMJ-BRITISH MEDICAL JOURNAL, Vol: 366, ISSN: 1756-1833
Laverty AA, Vamos E, Millett C, et al., 2019, Child awareness of and access to cigarettes – impacts of the point of sale display ban in England, Tobacco Control, Vol: 28, Pages: 526-531, ISSN: 0964-4563
Introduction England introduced a tobacco display ban for shops with >280 m2 floor area (‘partial ban’) in 2012, then a total ban in 2015. This study assessed whether these were linked to child awareness of and access to cigarettes.Methods Data come from the Smoking, Drinking and Drug Use survey, an annual survey of children aged 11–15 years for 2010–2014 and 2016. Multivariate logistic regression models assessed changes in having seen cigarettes on display, usual sources and ease of access to cigarettes in shopsResults During the partial display ban in 2012, 89.9% of children reported seeing cigarettes on display in the last year, which was reduced to 86.0% in 2016 after the total ban (adjusted OR 0.58, 95% CI 0.50 to 0.66). Reductions were similar in small shops (84.1% to 79.3%)%) and supermarkets (62.6% to 57.3%)%). Although the ban was associated with a reduction in the proportion of regular child smokers reporting that they bought cigarettes in shops (57.0% in 2010 to 39.8% in 2016), we did not find evidence of changes in perceived difficulty or being refused sale among those who still did.Discussion Tobacco point-of-sale display bans in England reduced the exposure of children to cigarettes in shops and coincided with a decrease in buying cigarettes in shops. However, children do not report increased difficulty in obtaining cigarettes from shops, highlighting the need for additional measures to tackle tobacco advertising, stronger enforcement of existing laws and measures such as licencing for tobacco retailers.
van Gemert F, de Jong C, Kirenga B, et al., 2019, Effects and acceptability of implementing improved cookstoves and heaters to reduce household air pollution: a FRESH AIR study, npj Primary Care Respiratory Medicine, Vol: 29, ISSN: 2055-1010
The objective was to evaluate the effectiveness and acceptability of locally tailored implementation of improved cookstoves/heaters in low- and middle-income countries. This interventional implementation study among 649 adults and children living in rural communities in Uganda, Vietnam and Kyrgyzstan, was performed after situational analyses and awareness programmes. Outcomes included household air pollution (PM2.5 and CO), self-reported respiratory symptoms (with CCQ and MRC-breathlessness scale), chest infections, school absence and intervention acceptability. Measurements were conducted at baseline, 2 and 6–12 months after implementing improved cookstoves/heaters. Mean PM2.5 values decrease by 31% (to 95.1 µg/m3) in Uganda (95%CI 71.5–126.6), by 32% (to 31.1 µg/m3) in Vietnam (95%CI 24.5–39.5) and by 65% (to 32.4 µg/m3) in Kyrgyzstan (95%CI 25.7–40.8), but all remain above the WHO guidelines. CO-levels remain below the WHO guidelines. After intervention, symptoms and infections diminish significantly in Uganda and Kyrgyzstan, and to a smaller extent in Vietnam. Quantitative assessment indicates high acceptance of the new cookstoves/heaters. In conclusion, locally tailored implementation of improved cookstoves/heaters is acceptable and has considerable effects on respiratory symptoms and indoor pollution, yet mean PM2.5 levels remain above WHO recommendations.
Hopkinson NS, Molyneux A, Pink J, et al., 2019, Chronic obstructive pulmonary disease: diagnosis and management: summary of updated NICE guidance., BMJ, Vol: 366, Pages: 1-7, ISSN: 0959-8138
Elbehairy A, Quint J, Rogers J, et al., 2019, Prevalence of breathlessness and associated consulting behaviour: results of an online survey, Thorax, Vol: 74, Pages: 814-817, ISSN: 1468-3296
The online British Lung Foundation Breath Test provides an opportunity to study the relationship between breathlessness, common sociobehavioural risk factors and interaction with healthcare. We analysed data from 356 799 responders: 71% were ≥50 years old and 18% were smokers. 20% reported limiting breathlessness (Medical Research Council breathlessness score ≥3), and the majority of these (85%) worried about their breathing; of these, 29% had not sought medical advice. Of those who had, 58% reported that the advice received had not helped their breathlessness. Limiting breathlessness was associated with being older, physically inactive, smoking and a higher body mass index. These data suggest a considerable unmet need associated with breathlessness as well as possibilities for intervention.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.