Publications
297 results found
Polkey MI, Man W, 2017, Should we get sniffy about Maximal Inspiratory Pressure?, Chest, Vol: 152, Pages: 6-7, ISSN: 1931-3543
Respiratory muscle weakness either occurs in isolation or as part of a more generalised neuromuscular process. In the former case this is very often self limiting as, for example, after iatrogenic damage to the phrenic nerve or in the case of neuralgic amyotrophy. In the latter case patients will usually have evidence of limb muscle involvement and or a known diagnosis (notable exceptions however being Pompe’s disease and about 3% of amyotrophic lateral sclerosis, ALS, presentations). From this conjecture follow the two main reasons why clinicians request evaluation of inspiratory muscle strength; either to rule-in or rule-out inspiratory muscle weakness as a cause of symptoms or to predict prognosis (or the need for non-invasive ventilation). MIP has also frequently been used as an outcome measure for trials of inspiratory muscle training.
Nolan CM, Maddocks M, Canavan JL, et al., 2017, Pedometer Step Count Targets during Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease A Randomized Controlled Trial, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 195, Pages: 1344-1352, ISSN: 1073-449X
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- Citations: 56
Nolan CM, Kon SSC, Patel S, et al., 2017, Gait speed and pedestrian crossings in COPD., Thorax, Vol: 73, Pages: 191-192, ISSN: 1468-3296
The assumed minimum walking speed at pedestrian crossings is 1.2 m/s. In this prospective cohort study, usual walking speed was measured over a 4 m course in 926 community-dwelling, ambulatory patients with stable COPD. Mean (SD) walking speed was 0.91 (0.24) m/s with only 10.7% walking at a speed equal or greater than 1.2 m/s. In order for 95% of this cohort to safely negotiate a pedestrian cross, traffic lights would have to assume a minimum walking speed of 0.50 m/s (2.4 times longer than current times). The current assumed normal walking speed for pedestrian crossings is inappropriate for patients with COPD.The studies were registered on clinicaltrials.gov and these data relate to the pre-results stage: NCT01649193, NCT01515709 and NCT01507415.
Maddocks M, Delogu V, Jones SE, et al., 2017, Exercise Training Versus Neuromuscular Stimulation in Severe Chronic Obstructive Pulmonary Disease, ARCHIVOS DE BRONCONEUMOLOGIA, Vol: 53, Pages: 357-359, ISSN: 0300-2896
Kon SSC, Jolley CJ, Shrikrishna D, et al., 2017, ACE and response to pulmonary rehabilitation in COPD: two observational studies, BMJ Open Respiratory Research, Vol: 4, ISSN: 2052-4439
IntroductionSkeletal muscle impairment is an important feature of chronic obstructive pulmonary disease (COPD). Renin-angiotensin system activity influences muscle phenotype, so we wished to investigate whether it affects the response to pulmonary rehabilitation.MethodsTwo studies are described; in the first, the response of 168 COPD patients (mean FEV1 51.9%predicted) to pulmonary rehabilitation was compared between different ACE Insertion/Deletion polymorphism genotypes. In a second, independent COPD cohort (n=373), baseline characteristics and response to pulmonary rehabilitation were compared between COPD patients who were or were not taking angiotensin converting enzyme inhibitors (ACE-I) or angiotensin receptor antagonists (ARB).ResultsIn study 1, the incremental shuttle walk distance improved to a similar extent in all three genotypes; DD/ID/II (n=48/91/29) 69(67)m, 61(76)m, 78(78)m respectively (p>0.05). In the second study, fat free mass index was higher in those on ACE-I/ARB (n=130) than those who were not (n=243) 17.8(16.0, 19.8)kgm-2 vs 16.5(14.9,18.4) kgm-2 (p<0.001). However change in fat free mass, walking distance or quality of life in response to pulmonary rehabilitation did not differ between groups.ConclusionWhile these data support a positive association of ACE-I/ARB treatment and body composition in COPD, neither treatment to reduce ACE activity nor ACE(I/D) genotype influence response to pulmonary rehabilitation.
Maddocks M, Nolan CM, Man WD, 2017, Simple functional tests in COPD: stand up and be counted!, European Respiratory Journal, Vol: 49, ISSN: 0903-1936
Simple functional tests in COPD: sit to stand and gait speed can rapidly assess physical performance in COPD
Spina G, Spruit MA, Alison J, et al., 2017, Analysis of nocturnal actigraphic sleep measures in patients with COPD and their association with daytime physical activity., Thorax, Vol: 72, Pages: 694-701, ISSN: 0040-6376
BACKGROUND: Sleep disturbances are common in patients with chronic obstructive pulmonary disease (COPD) with a considerable negative impact on their quality of life. However, factors associated with measures of sleep in daily life have not been investigated before nor has the association between sleep and the ability to engage in physical activity on a day-to-day basis been studied. AIMS: To provide insight into the relationship between actigraphic sleep measures and disease severity, exertional dyspnoea, gender and parts of the week; and to investigate the association between sleep measures and next day physical activity. METHODS: Data were analysed from 932 patients with COPD (66% male, 66.4±8.3 years, FEV1% predicted=50.8±20.5). Participants had sleep and physical activity continuously monitored using a multisensor activity monitor for a median of 6 days. Linear mixed effects models were applied to investigate the factors associated with sleep impairment and the association between nocturnal sleep and patients' subsequent daytime physical activity. RESULTS: Actigraphic estimates of sleep impairment were greater in patients with worse airflow limitation and worse exertional dyspnoea. Patients with better sleep measures (ie, non-fragmented sleep, sleeping bouts ≥225 min, sleep efficiency ≥91% and time spent awake after sleep onset <57 min) spent significantly more time in light (p<0.01) and moderate-to-vigorous physical activity (p<0.01). CONCLUSIONS: There is a relationship between measures of sleep in patients with COPD and the amount of activity they undertake during the waking day. Identifying groups with specific sleep characteristics may be useful information when designing physical activity-enhancing interventions.
Steiner MC, Lowe D, Beckford K, et al., 2017, Socioeconomic deprivation and the outcome of pulmonary rehabilitation in England and Wales, Thorax, Vol: 72, Pages: 530-537, ISSN: 0040-6376
BACKGROUND: Pulmonary rehabilitation (PR) improves exercise capacity and health status in patients with COPD, but many patients assessed for PR do not complete therapy. It is unknown whether socioeconomic deprivation associates with rates of completion of PR or the magnitude of clinical benefits bequeathed by PR. METHODS: PR services across England and Wales enrolled patients to the National PR audit in 2015. Deprivation was assessed using Index of Multiple Deprivation (IMD) derived from postcodes. Study outcomes were completion of therapy and change in measures of exercise performance and health status. Univariate and multivariate analyses investigated associations between IMD and these outcomes. RESULTS: 210 PR programmes enrolled 7413 patients. Compared with the general population, the PR sample lived in relatively deprived neighbourhoods. There was a statistically significant association between rates of completion of PR and quintile of deprivation (70% in the least and 50% in the most deprived quintiles). After baseline adjustments, the risk ratio (95% CI) for patients in the most deprived relative to the least deprived quintile was 0.79 (0.73 to 0.85), p<0.001. After baseline adjustments, IMD was not significantly associated with improvements in exercise performance and health status. CONCLUSIONS: In a large national dataset, we have shown that patients living in more deprived areas are less likely to complete PR. However, deprivation was not associated with clinical outcomes in patients who complete therapy. Interventions targeted at enhancing referral, uptake and completion of PR among patients living in deprived areas could reduce morbidity and healthcare costs in such hard-to-reach populations.
Maddocks M, Nolan CM, Delogu V, et al., 2017, Sarcopenia And Frailty In Patients With Idiopathic Pulmonary Fibrosis, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Patel S, Nolan CM, Delogu V, et al., 2017, Daily Physical Activity Levels In Idiopathic Pulmonary Fibrosis (ipf) And Chronic Obstructive Pulmonary Disease (COPD): A Propensity Matched Analysis, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Barker RE, Nolan CM, Delogu V, et al., 2017, The King's Brief Interstitial Lung Disease Questionnaire: Response To Pulmonary Rehabilitation And Minimal Important Difference, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
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- Citations: 4
Nolan CM, Maddocks M, Delogu V, et al., 2017, Responsiveness And Minimum Clinically Important Difference (mcid) Of The 4 Metre Gait Speed (4mgs) In Fibrotic Interstitial Lung Disease, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
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- Citations: 1
Nolan CM, Maddocks M, Canavan JL, et al., 2016, Pedometer step count targets during pulmonary rehabilitation in COPD: a randomized controlled trial, American Journal of Respiratory and Critical Care Medicine, Vol: 195, Pages: 1344-1352, ISSN: 1535-4970
RATIONALE: Increasing physical activity is a key therapeutic aim in COPD. Pulmonary rehabilitation (PR) improves exercise capacity, but there is conflicting evidence regarding its ability to improve physical activity levels. OBJECTIVE: To determine whether using pedometers as an adjunct to PR can enhance time spent in at least moderate intensity physical activity (time ≥ 3METs) in people with COPD. METHODS: In this single-blinded randomized controlled trial, participants were assigned 1:1 to receive control (PR comprising 8 weeks, two supervised sessions/week) or intervention (PR plus pedometer-directed step targets, reviewed weekly for 8 weeks). The randomisation process used minimisation to balance groups for age, sex, FEV1 % predicted, and baseline exercise capacity and physical activity levels. Outcome assessors and PR therapists were blinded to group allocation. The primary analysis was by intention-to-treat and the trial registered with clinicaltrials.gov (Ref. NCT01719822). MEASUREMENTS: The primary outcome was change from baseline to 8 weeks in accelerometer-measured daily time ≥3METs. MAIN RESULTS: 152 participants (72% male; mean (SD) FEV1 % predicted 50.5 (21.2); median (Q1, Q3) time ≥3METS 46 (21, 92) minutes) were enrolled to intervention (n=76) or control (n=76). There was no significant difference in change in time ≥3METs between the intervention and control groups at 8 weeks (median (Q1, Q3) difference 0.5 (-1.0, 31.0) minutes; p=0.87) or at the 6 month follow-up (7.0 (-9, 27) minutes; p=0.16). CONCLUSION: Pedometer-directed step count targets during an outpatient PR program did not enhance moderate intensity physical activity levels in people with COPD. Clinical trial registration available at www.clinicaltrials.gov, ID NCT01719822.
Curtis KJ, Meyrick VM, Mehta B, et al., 2016, Angiotensin-converting enzyme inhibition as an adjunct to pulmonary rehabilitation in COPD, American Journal of Respiratory and Critical Care Medicine, Vol: 194, Pages: 1349-1357, ISSN: 1535-4970
Rationale: Epidemiological studies in older individuals have found an association between use of ACE-inhibition (ACE-I) therapy and preserved locomotor muscle mass, strength and walking speed. ACE-I therapy might therefore have a role in the context of pulmonary rehabilitation. Objectives: We investigated the hypothesis that enalapril, an ACE-inhibitor, would augment the improvement in exercise capacity seen during pulmonary rehabilitation. Methods: We performed a double-blind, placebo-controlled, parallel-group randomised controlled trial. COPD patients, with at least moderate airflow obstruction and taking part in pulmonary rehabilitation, were randomised to either 10 weeks therapy with an ACE-inhibitor (10mg enalapril) or placebo. Measurements: The primary outcome measurement was the change in peak power (assessed using cycle ergometry) from baseline. Main Results: Eighty patients were enrolled, seventy-eight randomised (age 67±8years, FEV1 48±21% predicted), and sixty-five completed the trial (34 placebo, 31 ACE-inhibitor). The ACE-inhibitor treated group demonstrated a significant reduction in systolic blood pressure (Δ-16mmHg, 95% CI -22 to -11) and serum ACE activity (Δ-18IU/L, 95% CI -23 to -12) versus placebo (between group differences p<0.0001). Peak power increased significantly more in the placebo group (placebo Δ+9 Watts, 95% CI 5 to 13 vs. ACE-I Δ+1 Watt, 95% CI -2 to 4, between group difference 8 Watts, 95% CI 3 to 13, p=0.001). There was no significant between group difference in quadriceps strength or health-related quality of life. Conclusion: Use of the ACE-inhibitor enalapril alongside a programme of pulmonary rehabilitation, in patients without an established indication for ACE-inhibition, reduced the peak work rate response to exercise training in COPD patients. Clinical trial registration available at www.controlled-trials.com, ID ISRCTN79038750.
Filippidis F, Gerovasili V, Man W, et al., 2016, Trends in mortality from respiratory system diseases in Greece during the financial crisis, European Respiratory Journal, Vol: 48, Pages: 1487-1489, ISSN: 1399-3003
Man WD, Barker R, Maddocks M, et al., 2016, Outcomes from hospitalised acute exacerbations of COPD: a bundle of optimism?, Thorax, Vol: 72, Pages: 8-9, ISSN: 0040-6376
Fletcher E, Nolan CM, Canavan JL, et al., 2016, COPD and co-existent chronic heart failure (CHF): Response to pulmonary rehabilitation (PR), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Maddocks M, Jones S, Man W, et al., 2016, Neuromuscular electrical stimulation in adults with advanced disease: An updated Cochrane systematic review, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Palmer M, Jones S, Nolan C, et al., 2016, Minimal versus specialist equipment for the delivery of pulmonary rehabilitation in COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Delogu V, Nolan CM, Canavan JL, et al., 2016, The effect of co-existent chronic heart failure (CHF) on lower limb muscle function in COPD: Propensity matched analysis, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Canavan JL, Maddocks M, Kon S, et al., 2016, Normalised quadriceps muscle strength cut-points and mortality in COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Maddocks M, Kon S, Canavan J, et al., 2016, Physical frailty and pulmonary rehabilitation in COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Jones S, Canavan J, Nolan C, et al., 2016, Longitudinal validity of the five-repetition sit-to-stand in COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Labey A, Canavan JL, Nolan CM, et al., 2016, Longitudinal change in ultrasound measurement of rectus femoris cross-sectional area in COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Kon S, Jones S, Schofield S, et al., 2016, Short physical performance battery as a predictor of adverse outcomes following hospitalisation for an acute exacerbation of COPD, ERS International Congress 2016, Publisher: European Respiratory Society, ISSN: 0903-1936
Background: Hospitalisation for acute exacerbations of COPD (AECOPD) is associated with increased mortality, and high risk of readmission. The Short Physical Performance Battery (SPPB), a composite index of 3 lower extremity physical performance measures (score 0-12), is a consistent predictor of adverse outcomes in the geriatric population.Hypothesis: SPPB measured at discharge predicts risk of readmission and death at 1 year in patients hospitalised with AECOPD.Methods: SPPB was measured in 213 patients hospitalised with an AECOPD. Hospitalisations and vital status were recorded at 1 year.Results: Baseline characteristics:mean age 72, FEV1 40%pred, 52% male. Mean(SD) SPPB was 6.3(3.1). 52.1% patients were readmitted and 16.4% died during 1 year of follow-up. Patients with low SPPB scores(0-3) at hospital discharge had significantly increased rates of all-cause readmission and mortality compared with those with the highest scores(10-12):(29.7% vs. 10.8%;p=0.004 and 37.1% vs. 5.7%;p<0.001). Low SPPB scores were associated with greater odds of all cause readmission and mortality at 1 year;crude OR(95% CI) 6.14(2.42-15.55) and 7.68(1.62-36.5) respectively). Each one point increase in SPPB score resulted in lower odds of readmission and mortality at 1 year (OR 0.81(0.74-0.90) and 0.81(0.71-0.93) respectively). Gait speed (a component of SPPB) as a single item was equivalent or better than the SPPB in predicting readmission (c-statistic 0.672vs.0.671) and death (0.698vs.0.666) at 1 year.Conclusion: The SPPB predicts readmission and mortality at 1 year in patients hospitalised with AECOPD, but has no additional prognostic value over its component, gait speed.
Man WD, 2016, Aspects of skeletal muscles in chronic respiratory disease, Chronic Respiratory Disease, Vol: 13, Pages: 295-296, ISSN: 1479-9731
Maddocks M, Kon SS, Canavan JL, et al., 2016, Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study, Thorax, Vol: 71, Pages: 988-995, ISSN: 1468-3296
BACKGROUND: Frailty is an important clinical syndrome that is consistently associated with adverse outcomes in older people. The relevance of frailty to chronic respiratory disease and its management is unknown. OBJECTIVES: To determine the prevalence of frailty among patients with stable COPD and examine whether frailty affects completion and outcomes of pulmonary rehabilitation. METHODS: 816 outpatients with COPD (mean (SD) age 70 (10) years, FEV1% predicted 48.9 (21.0)) were recruited between November 2011 and January 2015. Frailty was assessed using the Fried criteria (weight loss, exhaustion, low physical activity, slowness and weakness) before and after pulmonary rehabilitation. Predictors of programme non-completion were identified using multivariate logistic regression, and outcomes were compared using analysis of covariance, adjusting for age and sex. RESULTS: 209/816 patients (25.6%, 95% CI 22.7 to 28.7) were frail. Prevalence of frailty increased with age, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Medical Research Council (MRC) score and age-adjusted comorbidity burden (all p≤0.01). Patients who were frail had double the odds of programme non-completion (adjusted OR 2.20, 95% CI 1.39 to 3.46, p=0.001), often due to exacerbation and/or hospital admission. However, rehabilitation outcomes favoured frail completers, with consistently better responses in MRC score, exercise performance, physical activity level and health status (all p<0.001). After rehabilitation, 71/115 (61.3%) previously frail patients no longer met case criteria for frailty. CONCLUSIONS: Frailty affects one in four patients with COPD referred for pulmonary rehabilitation and is an independent predictor of programme non-completion. However, patients who are frail respond favourably to rehabilitation and their frailty can be reversed in the short term.
Man WD, Maddocks M, Kon SS, et al., 2016, Physical frailty and pulmonary rehabilitation In COPD, International Conference of the American-Thoracic-Society (ATS), Publisher: American Thoracic Society, ISSN: 1073-449X
Man WD, Chowdhury F, Taylor RS, et al., 2016, Building consensus for provision of breathlessness rehabilitation for patients with chronic obstructive pulmonary disease and chronic heart failure, Chronic Respiratory Disease, Vol: 13, Pages: 229-239, ISSN: 1479-9731
The study aimed to gain consensus on key priorities for developing breathlessness rehabilitation services for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Seventy-four invited stakeholders attended a 1-day conference to review the evidence base for exercise-based rehabilitation in COPD and CHF. In addition, 47 recorded their views on a series of statements regarding breathlessness rehabilitation tailored to the needs of both patient groups. A total of 75% of stakeholders supported symptom-based rather than disease-based rehabilitation for breathlessness with 89% believing that such services would be attractive for healthcare commissioners. A total of 87% thought patients with CHF could be exercised using COPD training principles and vice versa. A total of 81% felt community-based exercise training was safe for patients with severe CHF or COPD, but only 23% viewed manual-delivered rehabilitation an effective alternative to supervised exercise training. Although there was strong consensus that exercise training was a core component of rehabilitation in CHF and COPD populations, only 36% thought that this was the ‘most important’ component, highlighting the need for psychological and other non-exercise interventions for breathlessness. Patients with COPD and CHF face similar problems of breathlessness and disability on a background of multi-morbidity. Existing pulmonary and cardiac rehabilitation services should seek synergies to provide sufficient flexibility to accommodate all patients with COPD and CHF. Development of new services could consider adopting a patient-focused rather than disease-based approach. Exercise training is a core component, but rehabilitation should include other interventions to address dyspnoea, psychological and education needs of patients and needs of carers.
Maddocks M, Nolan C, Man WD, et al., 2016, Neuromuscular electrical stimulation to improve exercise capacity in patients with severe COPD - Authors' reply., Lancet Respiratory Medicine, Vol: 4, Pages: e16-e16, ISSN: 2213-2619
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