Publications
348 results found
AlAhmari AD, Mackay AJ, Patel ARC, et al., 2014, Influence Of Weather On Physical Activity In Patients With Chronic Obstructive Pulmonary Disease, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Parekh G, Donaldson GC, Singh R, et al., 2014, Urinary Biomarkers At Exacerbation Of Chronic Obstructive Pulmonary Disease (COPD), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Brill SE, Law M, El-Emir E, et al., 2014, Effect Of Antibiotics On Airway Bacteria In Patients With Chronic Obstructive Pulmonary Disease, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Mohammed S, Mohammed H, Donaldson GC, et al., 2014, Exacerbations Are Related To Depression And Sgrq In West Indian Subjects With COPD, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Brill SE, El-Emir E, Allinson JP, et al., 2014, Recruitment Of Patients With Chronic Obstructive Pulmonary Disease To Clinical Trials, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Donaldson GC, Mackay AJ, Singh R, et al., 2014, Prolonged COPD Exacerbation Recovery Reduces Time To The Next Event, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
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Donaldson GC, Wedzicha JA, 2014, The CODEX index: a collection or digest of laws: a code, Chest, Vol: 145, Pages: 934-935, ISSN: 1931-3543
Allinson JP, Donaldson GC, 2014, Long-term antibiotic therapy reduces exacerbation frequency in patients with COPD but it remains unclear which patients to target, Evid Based Med, Vol: 19, ISSN: 1473-6810
Donaldson GC, 2014, Exacerbations in non-COPD patients: recognition?, Thorax, Vol: 69, Pages: 689-690, ISSN: 1468-3296
George SN, Patel ARC, Mackay AJ, et al., 2013, HUMAN RHINOVIRUS INFECTION AND EXACERBATION FREQUENCY AT COPD EXACERBATION, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A58-A58, ISSN: 0040-6376
Singh R, Such K, Kowlessar BS, et al., 2013, MACROPHAGE PHAGOCYTOSIS IN COPD PATIENTS AT EXACERBATION COMPARED TO STABLE STATE, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A159-A159, ISSN: 0040-6376
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- Citations: 1
Patel ARC, Kowlessar BS, Donaldson GC, et al., 2013, MYOCARDIAL INJURY AND DYSFUNCTION DURING COPD EXACERBATIONS, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A135-A135, ISSN: 0040-6376
Donaldson GC, MacKay AJ, Singh R, et al., 2013, COPD EXACERBATIONS OF LONGER DURATION WORSENS HEALTH RELATED QUALITY OF LIFE, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A204-A205, ISSN: 0040-6376
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Jehn M, Donaldson G, Kiran B, et al., 2013, Tele-monitoring reduces exacerbation of COPD in the context of climate change-a randomized controlled trial, ENVIRONMENTAL HEALTH, Vol: 12, ISSN: 1476-069X
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- Citations: 20
Singh R, Patel A, Mackay A, et al., 2013, The species-specific inflammatory response of colonising bacteria in stable COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Singh R, Mackay A, Patel A, et al., 2013, Concordance between airway inflammation and health status in COPD patients with bacterial colonisation, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Singh R, Chana K, Such K, et al., 2013, Relationship between monocyte-derived macrophage phagocytosis and airway inflammation in stable COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Allinson J, Donaldson G, Patel A, et al., 2013, The effect of exacerbation rate on SGRQ (St Georges respiratory questionnaire) score in earlier and later COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Brill S, El-Emir E, Allinson J, et al., 2013, Medication prescribing for COPD in primary care databases, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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- Citations: 1
Allinson J, Donaldson G, Kowlessar B, et al., 2013, Symptom profile of exacerbations in earlier and later COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
James GD, Petersen I, Nazareth I, et al., 2013, Use of long-term antibiotic treatment in COPD patients in the UK: a retrospective cohort study, Primary Care Respiratory Journal, Vol: 22, Pages: 271-277, ISSN: 1475-1534
BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) are a burden to patients and impose a major cost on health services. Long-term antibiotic therapy may prevent exacerbations, but at present it is not recommended by management guidelines. AIMS: To identify the type and prevalence of long-term oral antibiotic treatments prescribed to patients with COPD and to assess the patient characteristics associated with long-term antibiotic use. METHODS: A retrospective cohort using all eligible practices in The Health Improvement Network (THIN) UK primary care database between 2000 and 2009 was studied. We identified patients with COPD and then those who received a course of long-term antibiotics. Long-term courses were defined as >6 months in duration with <50% concomitant oral corticosteroid treatment. RESULTS: We identified 92,576 patients with COPD, but only 567 patients (0.61%) who received 998 long-term antibiotic courses. Mean follow-up time was 3 years and 10 months. The median long-term antibiotic course length was 280 days (interquartile range 224, 394) and 58 patients (0.06%) were continuously prescribed antibiotics for >2 years. The most commonly used long-term antibiotics were oxytetracycline, doxycycline, and penicillin. Azithromycin, erythromycin, and clarithromycin were less frequently used. There was little evidence of the use of rotating courses of antibiotics. Men, people aged 50-79 years, non-smokers, and patients with poorer lung function were more likely to receive long-term antibiotic treatment. CONCLUSIONS: Relatively few COPD patients are currently prescribed long-term antibiotics. Further clinical trials are required to determine the efficacy of this therapy. If beneficial, the use of such treatments should be incorporated into clinical guidelines.
Donaldson GC, Wedzicha JA, 2013, Deprivation, winter season, and COPD exacerbations, Primary Care Respiratory Journal, Vol: 22, Pages: 264-265, ISSN: 1471-4418
Wedzicha JA, Brill SE, Allinson JP, et al., 2013, Mechanisms and impact of the frequent exacerbator phenotype in chronic obstructive pulmonary disease, BMC Medicine, Vol: 11, Pages: 1-10, ISSN: 1741-7015
Exacerbations of chronic obstructive pulmonary disease (COPD) are important events that carry significant consequences for patients. Some patients experience frequent exacerbations, and are now recognized as a distinct clinical subgroup, the 'frequent exacerbator' phenotype. This is relatively stable over time, occurs across disease severity, and is associated with poorer health outcomes. These patients are therefore a priority for research and treatment. The pathophysiology underlying the frequent exacerbator phenotype is complex, with increased airway and systemic inflammation, dynamic lung hyperinflation, changes in lower airway bacterial colonization and a possible increased susceptibility to viral infection. Frequent exacerbators are also at increased risk from comorbid extrapulmonary diseases including cardiovascular disease, gastroesophageal reflux, depression, osteoporosis and cognitive impairment. Overall these patients have poorer health status, accelerated forced expiratory volume over 1 s (FEV1) decline, worsened quality of life, and increased hospital admissions and mortality, contributing to increased exacerbation susceptibility and perpetuation of the frequent exacerbator phenotype. This review article sets out the definition and importance of the frequent exacerbator phenotype, with a detailed examination of its pathophysiology, impact and interaction with other comorbidities.
Donaldson GC, Mullerova H, Locantore N, et al., 2013, Factors associated with change in exacerbation frequency in COPD, Respiratory Research, Vol: 14, Pages: 79-79, ISSN: 1465-9921
BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) can be categorized as having frequent (FE) or infrequent (IE) exacerbations depending on whether they respectively experience two or more, or one or zero exacerbations per year. Although most patients do not change category from year to year, some will, and the factors associated with this behaviour have not been examined. METHODS: 1832 patients completing two year follow-up in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) study were examined at baseline and then yearly. Exacerbations were defined by health care utilisation. Patient characteristics compared between those patients who did or did not change exacerbation category from year 1 to year 2. FINDINGS: Between years 1 and 2, 221 patients (17%) changed from IE to FE and 210 patients (39%) from FE to IE. More severe disease was associated with changing from IE to FE and less severe disease from FE to IE. Over the preceding year, small falls in FEV1 and 6-minute walking distance were associated with changing from IE to FE, and small falls in platelet count associated with changing from FE to IE. CONCLUSION: No parameter clearly predicts an imminent change in exacerbation frequency category. TRIAL REGISTRATION: SCO104960, clinicaltrials.gov identifier NCT00292552.
Mackay AJ, Donaldson GC, Patel AR, et al., 2013, Detection and severity grading of COPD exacerbations using the exacerbations of Chronic Obstructive Pulmonary Disease Tool (EXACT), Eur Respir J, Vol: 43, Pages: 735-744, ISSN: 1399-3003
Uncertainty exists over the ability of the Exacerbations of Chronic Obstructive Pulmonary Disease Tool (EXACT) patient-reported outcome diary to quantify exacerbation severity and frequency. To clarify this we investigated the ability of the EXACT to assess severity of exacerbations and examined the relationship between exacerbations diagnosed using London COPD cohort diary cards, physician review and symptom-defined events using the EXACT.58 patients enrolled in the London COPD cohort prospectively completed the EXACT during 128 cohort diary card-defined exacerbations between January 2010 and April 2012.Mean EXACT scores increased from 42.6 (SD 8.6) at baseline to 48.0 (8.6) at exacerbation onset (p<0.001), and rose further to a maximum score of 54.1 (8.9). Maximum EXACT scores were significantly higher in treated than untreated events. Time taken for EXACT scores to return to baseline was significantly related to symptom recovery time as judged by London COPD cohort diary cards, and to PEFR recovery. Approximately 50% of both diary card-defined and HCU exacerbations crossed the EXACT event threshold.However, only 27.9% of diary-card defined and 34.6% of HCU exacerbations fully met the criteria for an EXACT event. Patients exhibited smaller rises in EXACT score at exacerbation as baseline disease severity increased.The EXACT is an effective method of evaluating COPD exacerbation severity. However, concerns remain about the ability of the EXACT to accurately detect exacerbations.
Patel AR, Kowlessar BS, Donaldson GC, et al., 2013, Cardiovascular risk, myocardial injury, and exacerbations of chronic obstructive pulmonary disease, Am J Respir Crit Care Med, Vol: 188, Pages: 1091-1099, ISSN: 1535-4970
RATIONALE: Patients with chronic obstructive pulmonary disease (COPD) have elevated cardiovascular risk, and myocardial injury is common during severe exacerbations. Little is known about the prevalence, magnitude, and underlying mechanisms of cardiovascular risk in community-treated exacerbations. OBJECTIVES: To investigate how COPD exacerbations and exacerbation frequency impact cardiovascular risk and myocardial injury, and whether this is related to airway infection and inflammation. METHODS: We prospectively measured arterial stiffness (aortic pulse wave velocity [aPWV]) and cardiac biomarkers in 98 patients with stable COPD. Fifty-five patients had paired stable and exacerbation assessments, repeated at Days 3, 7, 14, and 35 during recovery. Airway infection was identified using polymerase chain reaction. MEASUREMENTS AND MAIN RESULTS: COPD exacerbation frequency was related to stable-state arterial stiffness (rho = 0.209; P = 0.040). Frequent exacerbators had greater aPWV than infrequent exacerbators (mean +/- SD aPWV, 11.4 +/- 2.1 vs. 10.3 +/- 2.0 ms(-1); P = 0.025). Arterial stiffness rose by an average of 1.2 ms(-1) (11.1%) from stable state to exacerbation (n = 55) and fell slowly during recovery. In those with airway infection at exacerbation (n = 24) this rise was greater (1.4 +/- 1.6 vs. 0.7 +/- 1.3 ms(-1); P = 0.048); prolonged; and related to sputum IL-6 (rho = 0.753; P < 0.001). Increases in cardiac biomarkers at exacerbation were higher in those with ischemic heart disease (n = 12) than those without (n = 43) (mean +/- SD increase in troponin T, 0.011 +/- 0.009 vs. 0.003 +/- 0.006 mug/L, P = 0.003; N-terminal pro-brain natriuretic peptide, 38.1 +/- 37.7 vs. 5.9 +/- 12.3 pg/ml, P < 0.001). CONCLUSIONS: Frequent COPD exacerbators have greater arterial stiffness than infrequent exacerbators. Arterial stiffness rises acutely during COPD exacerbations, particularly with airway infection. Increases in arterial stiffness are related to inflammation
Mackay AJ, Donaldson GC, Kowlessar B, et al., 2013, Baseline Characteristics Of The Exacerbations Of Chronic Obstructive Pulmonary Disease Tool (exact), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Mackay AJ, Donaldson GC, Kowlessar B, et al., 2013, Relationship Between COPD Exacerbations Detected Using Symptom Diary Cards And The Exacerbations Of Chronic Obstructive Pulmonary Disease Tool (exact), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Al Ahmari AD, Patel ARC, Kowlessar BS, et al., 2013, COPD Exacerbation Frequency Phenotype And Exercise Capacity, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Al Ahmari AD, Patel ARC, Kowlessar BS, et al., 2013, Exercise Capacity In COPD Patients During Exacerbation Recovery, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
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