Research

An enormous amount of data are generated through routine NHS encounters. Some of this routinely collected heathcare data is de-identified and can be made available for research purposes. The Respiratory EHR group, led by Professor Jennifer Quint, has developed core expertise in the use of various sources of these types of data, including data collated by the Clinical Practice Research Datalink (CPRD) as well as NHS Digital to support research into the UK’s most common respiratory diseases, such as asthma and COPD.

The Respiratory EHR group brings together people from different backgrounds including clinical medicine, epidemiology and medical statistics, mathematics and computer science, nursing, and the core biological sciences. The result is a multidisciplinary team that has both depth and breadth and the team work on a broad spectrum of projects, spanning basic epidemiology, disease aetiology, safety and effectiveness of medications, investigation of patient pathways, risk factor analysis and prediction modelling, as well as qualitative research on patient–healthcare practitioner interactions and risk communication. Underpinning all of this work is a robust understanding of the strengths and limitations of using routinely-collected health data for research purposes, and in particular, of diagnostic coding practices in clinical settings and how these might then affect research outcomes.

Examples of recent and current projects can be found below:

Our research

COPD

Understanding who is at risk of an exacerbation event, defining frequent exacerbators and investigating how exacerbations are associated with future exacerbations and morbidity as well as understanding how respiratory infections prior to a diagnosis of COPD might be related to future COPD outcomes.

Publications:

Investigating changes in mortality in people with COPD over time, including understanding what patients with COPD are dying of and specifically which subgroups of COPD patients are more likely to die of what causes than other groups of COPD patients to enable targeted interventions.

Publications:

Emulating randomised control trials to investigate whether similar effects can be seen in a more generalisable population of COPD, rather than the specific populations of COPD patients included in randomised control trials. Our studies have included investigating the association between inhaled corticosteroid use and risk of COPD related outcomes such as lung function decline.

 Publications:

Understanding the relationship between cardiovascular disease and COPD

Publications:

Use of hospital audit data to assess the effectiveness of the Best Practice Tariff (a pay-for-performance incentive) in improving outcomes for patients hospitalised with AECOPD.

Publications:

Stone PW, Adamson A, Hurst JR, et al Does pay-for-performance improve patient outcomes in acute exacerbation of COPD admissions? Thorax 2022;77:239-246.

COVID-19

Determining rates of new symptoms, diseases, prescriptions, and healthcare use, recorded in primary care, after acute covid-19 infection among patients admitted to hospital and those patients managed in the community.

Publications

Understanding severity of asthma and COVID-19 outcomes

Publications

Exploring whether specific groups of people with underlying chronic respiratory diseases have a greater risk of post-COVID-19 sequelae, particularly cardiovascular disease and VTE events, compared with others

Asthma

Investigating prescribing patterns of inhalers in people with asthma and how these relate to outcomes such as exacerbations, mortality and healthcare utilisation.

Publications:

Understanding asthma referrals in the UK

Publications:

Asthma phenotypes

Publications:

Predicting asthma attacks

 

Interstitial lung disease (ILD)

Recording of ILD in primary care databases:

We have carried out detailed investigations of how diagnoses of various ILDs, in particular idiopathic pulmonary fibrosis (IPF), are recorded in primary care datasets.

Treatment of comorbidities and potential of risk of adverse respiratory outcomes:

Publications:

Koteci, A., Morgan, A.D., Portas, L. et al. Left-sided heart failure burden and mortality in idiopathic pulmonary fibrosis: a population-based study. BMC Pulm Med 22, 190 (2022). https://doi.org/10.1186/s12890-022-01973-5