208 results found
Kwan HY, Maddocks M, Nolan CM, et 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
Walsh JA, Patel S, Barker RE, et al., 2019, The minimum clinically important difference of the incremental shuttle walk test in bronchiectasis: a prospective cohort study., Annals of the American Thoracic Society, 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.
Jones A, Evans R, Man W, et 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.
Nolan CM, Kaliaraju D, Jones SE, et 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.
Nolan CM, Birring SS, Maddocks M, et 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.
Maddocks M, Brighton LJ, Farquhar M, et al., 2019, Holistic services for people with advanced disease and chronic or refractory breathlessness: a mixed-methods evidence synthesis
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
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
Brighton LJ, Gao W, Farquhar M, et 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
Brighton LJ, Miller S, Farquhar M, et 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
Patel S, Cole AD, Nolan CM, et 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.
Barker RE, Jones SE, Banya W, et 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
Nolan CM, Maddocks M, Maher T, et 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
Brighton LJ, Tunnard I, Farquhar M, et 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.
Pavitt MJ, Tanner RJ, Lewis AP, et 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
Nolan CM, Maddocks M, Maher TM, et 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.
Jones S, Maddocks M, Nolan C, et 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
Jones S, Nolan C, Patel S, et 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
Jones S, Nolan C, Patel S, et al., 2018, Five-repetition sit-to-stand and mortality in COPD: a prospective cohort study, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Pavitt M, Tanner RJ, Lewis AP, et al., 2018, Late Breaking Abstract - Dietary nitrate supplementation enhances the benefit of pulmonary rehabilitation in people with COPD, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Nolan CM, Delogu V, Maddocks M, et al., 2018, Validity, responsiveness and minimum clinically important difference of the incremental shuttle walk in idiopathic pulmonary fibrosis: a prospective study, International Conference of the American-Thoracic-Society (ATS), Publisher: BMJ PUBLISHING GROUP, Pages: 680-682, ISSN: 0040-6376
Jones SE, Barker RE, Nolan CM, et al., 2018, Pulmonary rehabilitation in patients with an acute exacerbation of chronic obstructive pulmonary disease., Journal of Thoracic Disease, Vol: 10, Pages: S1390-S1399, ISSN: 2072-1439
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are one of the most common causes of emergency hospital admission and place great burden upon healthcare systems. Furthermore, AECOPD represent an important life event for patients, and are associated with significant reductions in physical activity, skeletal muscle function, exercise tolerance and health-related quality of life. Pulmonary rehabilitation, an intervention comprising supervised exercise-training and education, may counteract these negative consequences and target modifiable risk factors for hospital readmission. A recent Cochrane systematic review included 20 randomized controlled trials comparing pulmonary rehabilitation after exacerbation of COPD versus conventional care. Overall, the evidence supports moderate to large effects on health-related quality of life and exercise capacity. However, there is substantial heterogeneity across studies, and more recent studies have been more equivocal, including around hospital readmissions, particularly when rehabilitation is started in the inpatient setting. In this narrative review, we examine the rationale for pulmonary rehabilitation following AECOPD with a particular focus on skeletal muscle function, review the current evidence for pulmonary rehabilitation in the AECOPD setting, and identify areas that require future research, including the structure and nature of the intervention, improving uptake and adherence, and the role of alternative rehabilitation strategies for patients with AECOPD.
Nolan CM, Maddocks M, Canavan JL, et al., 2018, Increasing Physical Activity in Daily Life in Chronic Obstructive Pulmonary Disease: To Solve the Puzzle, Every Piece Counts Reply, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 197, Pages: 1089-1090, ISSN: 1073-449X
Patel S, Kon S, Nolan C, et al., 2018, The Epworth sleepiness scale: minimum clinically important difference in obstructive sleep apnea, American Journal of Respiratory and Critical Care Medicine, Vol: 197, Pages: 961-961, ISSN: 1073-449X
Nolan CM, Maddocks M, Canavan JL, et al., 2018, Are All Steps Created Equal? Revisiting Pedometer Use during Pulmonary Rehabilitation for Individuals Living with Chronic Obstructive Pulmonary Disease Reply, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 197, Pages: 406-+, ISSN: 1073-449X
Wilson KC, Krishnan JA, Sliwinski P, et al., 2018, Pulmonary rehabilitation for patients with COPD during and after an exacerbation-related hospitalisation: back to the future?, European Respiratory Journal, Vol: 51, ISSN: 0903-1936
Guideline recommendation against the initiation of pulmonary rehabilitation during hospitalisation was justified.
Jones SE, Nolan CM, Patel S, et al., 2018, The Minimum Important Difference in Pedometer Step Count in Patients with Chronic Obstructive Pulmonary Disease, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Kwan H, Maddocks M, Nolan CM, et al., 2018, Cachexia and Response to Pulmonary Rehabilitation: A Propensity Matched Analysis, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Patel S, Nolan CM, Jones SE, et al., 2018, Responsiveness and Minimum Important Difference of Quadriceps Maximum Voluntary Contraction in Chronic Obstructive Pulmonary Disease, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Patel S, Nolan CM, Jones SE, et al., 2018, Responsiveness of the Short Physical Performance Battery to Pulmonary Rehabilitation in Patients with Chronic Respiratory Disease and Frailty, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Nolan CM, Maddocks M, Maher TM, et al., 2018, Physical Frailty in Idiopathic Pulmonary Fibrosis, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
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