Imperial College London

DrWilliamMan

Faculty of MedicineNational Heart & Lung Institute

Reader in Respiratory Medicine
 
 
 
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Contact

 

+44 (0)1895 828 851w.man

 
 
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Location

 

Harefield HospitalHarefield Hospital

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Summary

 

Publications

Publication Type
Year
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221 results found

Brighton LJ, Bristowe K, Bayly J, Ogden M, Farquhar M, Evans CJ, Man WD, Maddocks Met al., 2020, Experiences of pulmonary rehabilitation in people living with COPD and frailty: a qualitative interview study., Annals of the American Thoracic Society, ISSN: 1546-3222

RATIONALE: People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from pulmonary rehabilitation but face challenges completing programmes. However, research to understand ways to optimise participation in this group is lacking. OBJECTIVE: To explore the experiences, needs and preferences of people with COPD and frailty referred for out-patient pulmonary rehabilitation. METHODS: Semi-structured interviews with people with COPD and physical frailty, purposively sampled by age, living status, level of frailty, and completion of pulmonary rehabilitation. Thematic analysis with a critical realist perspective was used, involving relevant stakeholders with clinical, academic and lived experience for interpretive rigour. RESULTS: 19 people with COPD and frailty were interviewed, with a median age of 78 years (range 58-88). Nine did not complete their pulmonary rehabilitation programme. Four themes were identified: striving to adapt to multidimensional loss, tensions of balancing support with independence, pulmonary rehabilitation as a challenge worth facing, and overcoming unpredictable disruptions to participation. Participants described constantly adapting to their changing health and resulting multidimensional losses (e.g. functional abilities, relationships, confidence). This involved traversing between independence and seeking support, set against a mismatch between their needs and what support is available. People with COPD and frailty can be highly motivated to participate in pulmonary rehabilitation, despite the physical and mental demands it entails, and report a range of benefits. Yet in the context of changeable health, they must often overcome multiple unpredictable disruptions to completing rehabilitation programmes. Participant determination and flexibility of services can facilitate ongoing attendance, but for some, these unpredictable disruptions erode their motivation to attend. CONCLUSIONS: People wi

Journal article

Patel S, Maddocks M, Man WD-C, 2020, Exercise training in COPD: FITT for purpose?, Chest, Vol: 158, Pages: 9-10, ISSN: 0012-3692

Journal article

Wynne SC, Patel S, Barker RE, Jones SE, Walsh JA, Kon SS, Cairn J, Loebinger MR, Wilson R, Man WD-C, Nolan CMet al., 2020, Anxiety and depression in bronchiectasis: Response to pulmonary rehabilitation and minimal clinically important difference of the Hospital Anxiety and Depression Scale., Chronic Respiratory Disease, Vol: 17, Pages: 1-9, ISSN: 1479-9723

The aims of the study were to evaluate the responsiveness of Hospital Anxiety and Depression Scale-Anxiety (HADS-A) subscale and HADS-Depression (HADS-D) subscale to pulmonary rehabilitation (PR) in patients with bronchiectasis compared to a matched group of patients with chronic obstructive pulmonary disease (COPD) and provide estimates of the minimal clinically important difference (MCID) of HADS-A and HADS-D in bronchiectasis. Patients with bronchiectasis and at least mild anxiety or depression (HADS-A ≥ 8 or/and HADS-D ≥ 8), as well as a propensity score-matched control group of patients with COPD, underwent an 8-week outpatient PR programme (two supervised sessions per week). Within- and between-group changes were calculated in response to PR. Anchor- and distribution-based methods were used to estimate the MCID. HADS-A and HADS-D improved in response to PR in both patients with bronchiectasis and those with COPD (median (25th, 75th centile)/mean (95% confidence interval) change: HADS-A change: bronchiectasis -2 (-5, 0), COPD -2 (-4, 0); p = 0.43 and HADS-D change: bronchiectasis -2 (-2 to -1), COPD -2 (-3 to -2); p = 0.16). Using 26 estimates, the MCID for HADS-A and HADS-D was -2 points. HADS-A and HADS-D are responsive to PR in patients with bronchiectasis and symptoms of mood disorder, with an MCID estimate of -2 points.

Journal article

Barker RE, Jones SE, Banya W, Fleming S, Kon SSC, Clarke SF, Nolan CM, Patel S, Walsh JA, Maddocks M, Farquhar M, Bell D, Wedzicha JA, Man WD-Cet al., 2020, The effects of a video intervention on post-hospitalization pulmonary rehabilitation uptake: a randomized controlled trial., American Journal of Respiratory and Critical Care Medicine, Vol: 201, Pages: 1517-1524, ISSN: 1073-449X

RATIONALE: Pulmonary rehabilitation following hospitalizations for exacerbations of chronic obstructive pulmonary disease (COPD) improves exercise capacity and health-related quality of life, and reduces readmissions. However, post-hospitalization pulmonary rehabilitation uptake is low. To date, no trials of interventions to increase uptake have been conducted. OBJECTIVE: Effect of a co-designed education video as an adjunct to usual care on post-hospitalization pulmonary rehabilitation uptake. METHODS: An assessor- and statistician-blinded randomized controlled trial with nested qualitative interviews of participants in the intervention group. Participants hospitalized with COPD exacerbations were assigned 1:1 to receive either usual care (COPD discharge bundle including pulmonary rehabilitation information leaflet) or usual care plus the co-designed education video delivered via a handheld tablet device at discharge. Randomization used minimization to balance age, sex, forced expiratory volume in 1 second (FEV1) % predicted, frailty, transport availability and previous pulmonary rehabilitation experience. MEASUREMENTS AND MAIN RESULTS: The primary outcome was pulmonary rehabilitation uptake within 28 days of hospital discharge. 200 patients were recruited with 196 randomized (51% female, median (interquartile range) FEV1 % predicted 36(27, 48)). Pulmonary rehabilitation uptake was 41% and 34% in the usual care and intervention groups respectively (p=0.37), with no differences in secondary (pulmonary rehabilitation referral and completion) or safety (readmissions and death) endpoints. Six of the fifteen participants interviewed could not recall receiving the video. CONCLUSION: A co-designed education video delivered at hospital discharge did not improve post-hospitalization pulmonary rehabilitation uptake, referral or completion. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0

Journal article

Lewis A, Nolan CM, Man WDC, Kon SSC, Conway Jet al., 2020, Prognostication in COPD using physical function measures: Let's walk before we run away with conclusions., Respir Med, Vol: 167

Journal article

Barker RE, Jones SE, Banya W, Fleming S, Kon SSC, Clarke SF, Nolan CM, Patel S, Walsh JA, Maddocks M, Farquhar M, Bell D, Wedzicha JA, Man WD-Cet al., 2020, Reply to: one step at a time: a phased approach to behavioral treatment development in pulmonary rehabilitation., American Journal of Respiratory and Critical Care Medicine, ISSN: 1073-449X

Journal article

Pavitt M, Tanner RJ, Lewis A, Buttery S, Mehta B, Jefford H, Curtis KJ, Banya W, Husain S, Satkunam K, Shrikrishna D, Man W, Polkey M, Hopkinson Net 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.

Journal article

Polgar O, Aljishi M, Barker RE, Patel S, Walsh JA, Kon SS, Man WD, Nolan CMet al., 2020, Digital habits of PR service-users: Implications for home-based interventions during the COVID-19 pandemic., Chron Respir Dis, Vol: 17

Remote models of pulmonary rehabilitation (PR) are vital with suspension of face-to-face activity during the COVID-19 pandemic. We surveyed digital access and behaviours and PR delivery preferences of current PR service users. There was significant heterogeneity in access to and confidence in using the Internet with 31% having never previously accessed the Internet, 48% confident using the Internet and 29% reporting no interest in accessing any component of PR through a Web-based app. These data have implications for the remote delivery of PR during the COVID-19 pandemic and raise questions about the current readiness of service users to adopt Web-based delivered models of PR.

Journal article

Walsh JA, Patel S, Barker RE, Jones SE, Wynne SC, Kon SS-C, Cairn J, Loebinger MR, Wilson R, Man WD-C, Nolan CMet al., 2020, The minimum clinically important difference of the incremental shuttle walk test in bronchiectasis: a prospective cohort study., Annals of the American Thoracic Society, Vol: 17, ISSN: 1546-3222

The incremental shuttle walk test (ISW) is an externally-paced field walking test thatmeasures maximal exercise capacity1 and is widely used in patients with chronic obstructivepulmonary disease (COPD) undergoing pulmonary rehabilitation (PR). Its psychometricproperties, including reliability, construct validity2 and responsiveness to intervention,2-5have been demonstrated in patients with bronchiectasis, but little data exist on theminimum clinically important difference (MCID). Although two studies have investigated theMCID of ISW in patients with bronchiectasis, the generalisability of these data is limitedbecause of the study sample characteristics,6 or did not involve an exercise-basedintervention.2 The MCID enables clinicians and researchers to understand the clinicalsignificance of change data and forms an important part of the evidence required byregulatory agencies for approval for use in clinical trials. Accordingly, the aim of this studywas to provide MCID estimates of the ISW in response to intervention, namely PR, inpatients with bronchiectasis.

Journal article

Brighton LJ, Evans CJ, Man WDC, Maddocks Met al., 2020, Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review., Int J Chron Obstruct Pulmon Dis, Vol: 15, Pages: 841-855

Background: People living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from exercise-based interventions, including pulmonary rehabilitation, but face challenges completing them. Research to understand ways to optimise exercise-based interventions in this group is lacking. We aimed to understand how exercise-based interventions might improve outcomes for people living with both COPD and frailty. Methods: This realist review used database searches and handsearching until October 2019 to identify articles of relevance to exercise-based interventions for people living with COPD and frailty. A scoping search explored what is important about the context of living with COPD and frailty, and what mechanisms might be important in how exercise-based interventions result in their intended outcomes. Through discussion with stakeholders, the review scope was refined to areas deemed pertinent to improving care. We retained articles within this refined scope and identified additional articles through targeted handsearching. Data were extracted and synthesised in a narrative, prioritised by relevance and rigour. Results: Of 344 records identified, 35 were included in the review and 20 informed the final synthesis. Important contextual factors to consider included: negative beliefs about themselves and exercise-based interventions; heterogenous presentation and comorbidities; decreased reserves and multidimensional loss; and experiencing unpredictable health and disruptions. In these circumstances, mechanisms that may help maximise outcomes from exercise-based interventions included: trusting relationships; creating a shared understanding of needs; having the capacity to address multidimensional concerns; being able to individualise approaches to needs and priorities; and flexible approaches to intervention delivery. Mixed-methods research and explicit theorising were often absent. Conclusion: Building trusting relationships, und

Journal article

Kwan HY, Maddocks M, Nolan CM, Jones SE, Patel S, Barker RE, Kon SSC, Polkey MI, Cullinan P, Man WD-Cet al., 2019, The prognostic significance of weight loss in chronic obstructive pulmonary disease-related cachexia: a prospective cohort study., Journal of Cachexia, Sarcopenia and Muscle, Vol: 10, Pages: 1330-1338, ISSN: 2190-6009

BACKGROUND: Cachexia is an important extra-pulmonary manifestation of chronic obstructive pulmonary disease (COPD) presenting as unintentional weight loss and altered body composition. Previous studies have focused on the relative importance of body composition compared with body mass rather than the relative importance of dynamic compared with static measures. We aimed to determine the prevalence of cachexia and pre-cachexia phenotypes in COPD and examine the associations between cachexia and its component features with all-cause mortality. METHODS: We enrolled 1755 consecutive outpatients with stable COPD from two London centres between 2012 and 2017, stratified according to European Respiratory Society Task Force defined cachexia [unintentional weight loss >5% and low fat-free mass index (FFMI)], pre-cachexia (weight loss >5% but preserved FFMI), or no cachexia. The primary outcome was all-cause mortality. We calculated hazard ratios (HRs) using Cox proportional hazards regression for cachexia classifications (cachexia, pre-cachexia, and no cachexia) and component features (weight loss and FFMI) and mortality, adjusting for age, sex, body mass index, and disease-specific prognostic markers. RESULTS: The prevalence of cachexia was 4.6% [95% confidence interval (CI): 3.6-5.6] and pre-cachexia 1.6% (95% CI: 1.0-2.2). Prevalence was similar across sexes but increased with worsening Global Initiative for Chronic Obstructive Pulmonary Disease spirometric stage and Medical Research Council dyspnoea score (all P < 0.001). There were 313 (17.8%) deaths over a median (interquartile range) follow-up duration 1089 (547-1704) days. Both cachexia [HR 1.98 (95% CI: 1.31-2.99), P = 0.002] and pre-cachexia [HR 2.79 (95% CI: 1.48-5.29), P = 0.001] were associated with increased mortality. In multivariable analysis, the unintentional weight loss feature of cachexia was independently associated with mortality [HR 2.16 (95% CI: 1.31-3.08), P&nbs

Journal article

Evans RA, Greening NJ, Bolton CE, Singh SJ, Man WD, Steiner MCet al., 2019, What influences the survival advantage following Pulmonary Rehabilitation in patients with COPD?, European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936

Conference paper

Alotaibi T, Orme M, Nolan C, Ward T, Chaplin E, Horton E, Harvey-Dunstan T, Man W, Stensel D, Singh Set al., 2019, Profiling changes in physical activity and exercise capacity following lifestyle interventions in COPD, European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936

Conference paper

Alotaibi T, Orme M, Nolan C, Ward T, Chaplin E, Horton E, Harvey-Dunstan T, Man W, Stensel D, Singh Set al., 2019, Predicting change in physical activity for individuals with COPD following lifestyle interventions, European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936

Conference paper

Wynne S, Patel S, Barker RE, Jones SE, Walsh JA, Kon SS, Cairn J, Loebinger MR, Wilson R, Man WD, Nolan CMet al., 2019, The Hospital Anxiety and Depression Scale (HADS) in Bronchiectasis: Response to pulmonary rehabilitation (PR) and Minimum Clinically Important Difference (MCID), European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936

Conference paper

Jones A, Evans R, Man W, bolton C, breen S, doherty P, gardiner N, Houchen- Wolloff L, hurst J, maddocks M, Quint J, jolly K, revitt O, sherar L, watt A, wingham J, yorke J, singh Set al., 2019, Outcome measures in a combined exercise rehabilitation programme for COPD and chronic heart failure patients: a stakeholder consensus event, Chronic Respiratory Disease, Vol: 16, ISSN: 1479-9723

Combined exercise rehabilitation for chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) is potentially attractive. Uncertainty remains as to the baseline profiling assessments and outcome measures that should be collected within a programme. Current evidence surrounding outcome measures in cardiac and pulmonary rehabilitation were presented by experts at a stakeholder consensus event and all stakeholders (n = 18) were asked to (1) rank in order of importance a list of categories, (2) prioritise outcome measures and (3) prioritise baseline patient evaluation measures that should be assessed in a combined COPD and CHF rehabilitation programme. The tasks were completed anonymously and related to clinical rehabilitation programmes and associated research. Health-related quality of life, exercise capacity and symptom evaluation were voted as the most important categories to assess for clinical purposes (median rank: 1, 2 and 3 accordingly) and research purposes (median rank; 1, 3 and 4.5 accordingly) within combined exercise rehabilitation. All stakeholders agreed that profiling symptoms at baseline were ‘moderately’, ‘very’ or ‘extremely’ important to assess for clinical and research purposes in combined rehabilitation. Profiling of frailty was ranked of the same importance for clinical purposes in combined rehabilitation. Stakeholders identified a suite of multidisciplinary measures that may be important to assess in a combined COPD and CHF exercise rehabilitation programme.

Journal article

Nolan CM, Kaliaraju D, Jones SE, Patel S, Barker R, Walsh JA, Wynne S, Man Wet al., 2019, Home versus outpatient pulmonary rehabilitation in COPD: a propensity-matched cohort study, Thorax, Vol: 74, Pages: 996-998, ISSN: 1468-3296

Home-based exercise has been proposed as an equivalent treatment strategy to supervised outpatient pulmonary rehabilitation (PR), but it is not known whether its implementation into clinical practice produces similar benefits to those observed in trials. We compared the real-world responses of 154 patients with COPD undergoing home-based exercise with a matched group attending supervised PR. We observed smaller improvements in exercise capacity with home-based exercise compared with PR, but similar improvements in quality of life. We propose that supervised PR remains the standard of care, with home-based exercise a less effective alternative for those unable to attend PR.

Journal article

Nolan CM, Birring SS, Maddocks M, Maher TM, Patel S, Barker RE, Jones SE, Walsh JA, Wynne SC, George PM, Man WD-Cet al., 2019, King's Brief Interstitial Lung Disease questionnaire: responsiveness and minimum clinically important difference, European Respiratory Journal, Vol: 54, ISSN: 0903-1936

Health status is increasingly used in clinical practice to quantify symptom burden and as a clinical trial endpoint in patients with interstitial lung disease (ILD). The Kings Brief Interstitial Lung Disease (KBILD) questionnaire is a brief validated 15-item, disease-specific, health-related quality of life questionnaire that is increasingly used in clinical trials, but little data exist regarding the minimum clinically important difference (MCID). Using pulmonary rehabilitation as a model, we aimed to determine responsiveness of the KBILD and provide estimates of the MCID.KBILD, Chronic Respiratory Questionnaire (CRQ), Medical Research Council dyspnoea scale (MRC) and incremental shuttle walk test (ISW) were measured in 209 patients with ILD (105 with idiopathic pulmonary fibrosis (IPF)) before and after an outpatient pulmonary rehabilitation programme. Changes with intervention and Cohen's effect size were calculated. Anchor- (linear regression and Receiver Operating Characteristic plots) or distribution-based approaches (0.5 * standard deviation, standard error of measurement) were used to estimate the MCID of KBILD domain and total scores.KBILD, CRQ, MRC and ISW improved with intervention and the effect sizes of KBILD domain and total scores ranged from 0.28 to 0.38. Using anchor-based estimates, the MCID estimate for KBILD-Psychological, KBILD-Breathlessness and activities and KBILD-Total score were 5.4, 4.4 and 3.9 respectively. Using distribution-based methods, the MCID estimate for KBILD-Chest symptoms was 9.8. The MCID estimates for KBILD in IPF patients were similar.In patients with ILD and IPF, KBILD is responsive to intervention with an estimated MCID of 3.9 for the total score.

Journal article

Maddocks M, Brighton LJ, Farquhar M, Booth S, Miller S, Klass L, Tunnard I, Yi D, Gao W, Bajwah S, Man WD-C, Higginson IJet al., 2019, Holistic services for people with advanced disease and chronic or refractory breathlessness: a mixed-methods evidence synthesis, Health Services and Delivery Research, ISSN: 2050-4349

BACKGROUND:Breathlessness is a common and distressing symptom of many advanced diseases, affecting around 2 million people in the UK. Breathlessness increases with disease progression and often becomes chronic or refractory. Breathlessness-triggered services that integrate holistic assessment and specialist palliative care input as part of a multiprofessional approach have been developed for this group, offering tailored interventions to support self-management and reduce distress. OBJECTIVES:The aim was to synthesise evidence on holistic breathlessness services for people with advanced disease and chronic or refractory breathlessness. The objectives were to describe the structure, organisation and delivery of services, determine clinical effectiveness, cost-effectiveness and acceptability, identify predictors of treatment response, and elicit stakeholders’ evidence-based priorities for clinical practice, policy and research. DESIGN:The mixed-methods evidence synthesis comprised three components: (1) a systematic review to determine the clinical effectiveness, cost-effectiveness and acceptability of holistic breathlessness services; (2) a secondary analysis of pooled individual data from three trials to determine predictors of clinical response; and (3) a transparent expert consultation (TEC), comprising a stakeholder workshop and an online consensus survey, to identify stakeholders’ priorities. RESULTS:Thirty-seven papers reporting on 18 holistic breathlessness services were included in the systematic review. Most studies enrolled people with thoracic cancer, were delivered over 4–6 weeks, and included breathing training, relaxation techniques and psychological support. Meta-analysis demonstrated significant reductions in the Numeric Rating Scale (NRS) distress due to breathlessness, significant reductions in the Hospital Anxiety and Depressions Scale (HADS) depression scores, and non-significant reductions in the Chronic Respiratory Disease Quest

Journal article

Walsh JA, Maddocks M, Man WD-C, 2019, Supplemental oxygen during exercise training in COPD: full of hot air?, European Respiratory Journal, Vol: 53, Pages: 1-4, ISSN: 0903-1936

Journal article

Brighton LJ, Gao W, Farquhar M, Booth S, Bajwah S, Man WD-C, Reilly CC, Yi D, Higginson IJ, Maddocks Met al., 2019, Predicting outcomes following holistic breathlessness services: A pooled analysis of individual patient data., Palliative Medicine, Vol: 33, Pages: 462-466, ISSN: 0269-2163

BACKGROUND: Holistic breathlessness services have been developed for people with advanced disease and chronic breathlessness, leading to improved psychological aspects of breathlessness and health. The extent to which patient characteristics influence outcomes is unclear. AIM: To identify patient characteristics predicting outcomes of mastery and distress due to breathlessness following holistic breathlessness services. DESIGN: Secondary analysis of pooled individual patient data from three clinical trials. Our primary analysis assessed predictors of clinically important improvements in Chronic Respiratory Questionnaire mastery scores (+0.5 point), and our secondary analysis predictors of improvements in Numerical Rating Scale distress due to breathlessness (-1 point). Variables significantly related to improvement in univariate models were considered in separate backwards stepwise logistic regression models. PARTICIPANTS: The dataset comprised 259 participants (118 female; mean (standard deviation) age 69.2 (10.6) years) with primary diagnoses of chronic obstructive pulmonary disease (49.8%), cancer (34.7%) and interstitial lung disease (10.4%). RESULTS: Controlling for age, sex and trial, baseline mastery remained the only significant independent predictor of improvement in mastery (odds ratio 0.57, 95% confidence intervals 0.43-0.74; p < 0.001), and baseline distress remained the only significant predictor of improvement in distress (odds ratio 1.64; 95% confidence intervals 1.35-2.03; p < 0.001). Baseline lung function, breathlessness severity, health status, mild anxiety and depression, and diagnosis did not predict outcomes. CONCLUSIONS: Outcomes of mastery and distress following holistic breathlessness services are influenced by baseline scores for these variables, and not by diagnosis, lung function or health status. Stratifying patients by levels of mastery and/or distress due to breathlessness appears appropriate fo

Journal article

Brighton LJ, Miller S, Farquhar M, Booth S, Yi D, Gao W, Bajwah S, Man WD-C, Higginson IJ, Maddocks Met al., 2019, Holistic services for people with advanced disease and chronic breathlessness: a systematic review and meta-analysis, Thorax, Vol: 74, Pages: 270-281, ISSN: 0040-6376

BACKGROUND: Breathlessness is a common, distressing symptom in people with advanced disease and a marker of deterioration. Holistic services that draw on integrated palliative care have been developed for this group. This systematic review aimed to examine the outcomes, experiences and therapeutic components of these services. METHODS: Systematic review searching nine databases to June 2017 for experimental, qualitative and observational studies. Eligibility and quality were independently assessed by two authors. Data on service models, health and cost outcomes were synthesised, using meta-analyses as indicated. Data on recipient experiences were synthesised thematically and integrated at the level of interpretation and reporting. RESULTS: From 3239 records identified, 37 articles were included representing 18 different services. Most services enrolled people with thoracic cancer, involved palliative care staff and comprised 4-6 contacts over 4-6 weeks. Commonly used interventions included breathing techniques, psychological support and relaxation techniques. Meta-analyses demonstrated reductions in Numeric Rating Scale distress due to breathlessness (n=324; mean difference (MD) -2.30, 95% CI -4.43 to -0.16, p=0.03) and Hospital Anxiety and Depression Scale (HADS) depression scores (n=408, MD -1.67, 95% CI -2.52 to -0.81, p<0.001) favouring the intervention. Statistically non-significant effects were observed for Chronic Respiratory Questionnaire (CRQ) mastery (n=259, MD 0.23, 95% CI -0.10 to 0.55, p=0.17) and HADS anxiety scores (n=552, MD -1.59, 95% CI -3.22 to 0.05, p=0.06). Patients and carers valued tailored education, self-management interventions and expert staff providing person-centred, dignified care. However, there was no observable effect on health status or quality of life, and mixed evidence around physical function. CONCLUSION: Holistic services for chronic breathlessness can reduce distress in patients with advanced dis

Journal article

Patel S, Cole AD, Nolan CM, Barker RE, Jones SE, Kon S, Cairn J, Loebinger M, Wilson R, Man WD-Cet al., 2019, Pulmonary rehabilitation in bronchiectasis: a propensity-matched study, European Respiratory Journal, Vol: 53, ISSN: 0903-1936

International guidelines recommend pulmonary rehabilitation for patients with bronchiectasis, supported by small trials and data extrapolated from chronic obstructive pulmonary disease (COPD). However, it is unknown whether real-life data on completion rates and response to pulmonary rehabilitation are similar between patients with bronchiectasis and COPD.Using propensity score matching, 213 consecutive patients with bronchiectasis referred for a supervised pulmonary rehabilitation programme were matched 1:1 with a control group of 213 patients with COPD. Completion rates, change in incremental shuttle walk (ISW) distance and change in Chronic Respiratory Disease Questionnaire (CRQ) score with pulmonary rehabilitation were compared between groups.Completion rate was the same in both groups (74%). Improvements in ISW distance and most domains of the CRQ with pulmonary rehabilitation were similar between the bronchiectasis and COPD groups (ISW distance: 70 versus 63 m; CRQ-Dyspnoea: 4.8 versus 5.3; CRQ-Emotional Function: 3.5 versus 4.6; CRQ-Mastery: 2.3 versus 2.9; all p>0.20). However, improvements in CRQ-Fatigue with pulmonary rehabilitation were greater in the COPD group (bronchiectasis 2.1 versus COPD 3.3; p=0.02).In a real-life, propensity-matched control study, patients with bronchiectasis show similar completion rates and improvements in exercise and health status outcomes as patients with COPD. This supports the routine clinical provision of pulmonary rehabilitation to patients with bronchiectasis.

Journal article

Nolan CM, Maddocks M, Maher T, Patel S, Barker RE, Jones SE, Wynne SC, Walsh JA, George PM, Cullinan P, Man WDCet al., 2019, Single-Versus Multi-Component Physical Performance Measures and Mortality in Idiopathic Pulmonary Fibrosis, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X

Conference paper

Barker RE, Jones SE, Banya W, Kon SSC, Fleming S, Nolan CM, Patel S, Clarke SF, Walsh JA, Wynne S, Maddocks M, Farquhar M, Wedzicha JA, Man Wet al., 2019, A Video Intervention to Increase Pulmonary Rehabilitation Uptake for Patients Hospitalized with Acute Exacerbations of COPD (virtue): A Randomized Controlled Trial, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X

Conference paper

Brighton LJ, Tunnard I, Farquhar M, Booth S, Miller S, Yi D, Gao W, Bajwah S, Man WD, Reilly CC, Ogden M, Bailey S, Ewart C, Higginson IJ, Maddocks Met al., 2019, Recommendations for services for people living with chronic breathlessness in advanced disease: Results of a transparent expert consultation, Chronic Respiratory Disease, Vol: 16, ISSN: 1479-9723

Chronic breathlessness is highly distressing for people with advanced disease and their informal carers, yet health services for this group remain highly heterogeneous. We aimed to generate evidence-based stakeholder-endorsed recommendations for practice, policy and research concerning services for people with advanced disease and chronic breathlessness. We used transparent expert consultation, comprising modified nominal group technique during a stakeholder workshop, and an online consensus survey. Stakeholders, representing multiple specialities and professions, and patient/carers were invited to participate. Thirty-seven participants attended the stakeholder workshop and generated 34 separate recommendations, rated by 74 online survey respondents. Seven recommendations had strong agreement and high levels of consensus. Stakeholders agreed services should be person-centred and flexible, should cut across multiple disciplines and providers and should prioritize breathlessness management in its own right. They advocated for wide geographical coverage and access to expert care, supported through skills-sharing among professionals. They also recommended recognition of informal carers and their role by clinicians and policymakers. Overall, stakeholders' recommendations reflect the need for improved access to person-centred, multi-professional care and support for carers to provide or access breathlessness management interventions. Future research should test the optimal models of care and educational strategies to meet these recommendations.

Journal article

Pavitt MJ, Tanner RJ, Lewis AP, Buttery SC, Mehta B, Jefford H, Curtis KJ, Banya W, Husain S, Satkunam K, Shrikrishna D, Man WD-C, Polkey MI, Hopkinson NSet al., 2018, ORAL DIETARY NITRATE SUPPLEMENTATION TO ENHANCE PULMONARY REHABILITATION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A MULTI-CENTRE, DOUBLE BLIND, PLACEBO-CONTROLLED, PARALLEL GROUP STUDY, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A3-A3, ISSN: 0040-6376

Conference paper

Nolan CM, Maddocks M, Maher TM, Banya W, Patel S, Barker RE, Jones SE, George P, Cullinan P, Man WD-Cet al., 2018, Gait speed and prognosis in patients with idiopathic pulmonary fibrosis: a prospective cohort study, European Respiratory Journal, Vol: 53, Pages: 1-10, ISSN: 0903-1936

The four metre gait speed (4 MGS), a simple physical performance measure and surrogate marker of frailty, consistently predicts adverse prognosis in older adults. We hypothesised that 4 MGS could predict all-cause mortality and non-elective hospitalisation in patients with idiopathic pulmonary fibrosis (IPF).4 MGS and lung function were measured at baseline in 130 outpatients newly diagnosed with IPF. Survival status and non-elective hospital admissions were recorded over one year. We assessed the predictive value of 4 MGS (as a continuous variable and as a binary variable: slow versus preserved 4 MGS) by calculating hazard ratios (HR) using Cox proportional regression, adjusting for potential confounding variables. Receiver Operating Characteristic curves assessed discrimination between the multivariable regression models and established prognostic indices.Continuous 4 MGS and slow 4 MGS were independent predictors of all-cause mortality (4 MGS: HR 0.03 (0.01-0.31), p=0.004; slow 4 MGS: 2.63 (1.01-6.87), p=0.049) and hospitalisation (4 MGS: HR 0.02 (0.01-0.14), p<0.001; slow 4 MGS: 2.76 (1.16-6.58), p=0.02). Multivariable models incorporating 4 MGS or slow 4 MGS had better discrimination for predicting mortality than either the Gender Age Physiology index or Composite Physiologic Index.In patients with IPF, 4 MGS is an independent predictor of all-cause mortality and non-elective hospitalisation.

Journal article

Jones S, Maddocks M, Nolan C, Patel S, Barker R, Kon S, Hopkinson N, Man Wet al., 2018, Responsiveness of a short stair climb power test to pulmonary rehabilitation in COPD, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936

Conference paper

Jones S, Nolan C, Patel S, Barker R, Kon S, Polkey M, Hopkinson N, Maddocks M, Man Wet al., 2018, Development of a new prognosis index (BODS) in patients with COPD: a prospective cohort study, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936

Conference paper

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