Publications
348 results found
Donaldson GC, Wedzicha JA, 2013, Morbidity And Mortality In COPD During Hot Weather In London, Uk, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Thurston SJ, Garcha DS, Donaldson GC, et al., 2013, Impact Of Antibiotic Exposure On The Development Of Antibiotic Resistance In COPD Patients, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
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Allinson J, Donaldson GC, Wedzicha JA, 2013, The Characteristics Of Exacerbations In "earlier" Versus "later" Chronic Obstructive Pulmonary Disease (COPD), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
George SN, Garcha DS, Patel ARC, et al., 2013, Human Rhinovirus Infection And Secondary Bacterial Infection In COPD Exacerbations, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
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Donaldson GC, Patel ARC, Mackay AJ, et al., 2013, Reduction In The Interval Between Successive COPD Exacerbations And Non Recovered Exacerbations, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Mackay AJ, Donaldson GC, Kowlessar B, et al., 2013, Utility Of The Exacerbations Of Chronic Obstructive Pulmonary Disease Tool ( exact) To Evaluate Severity Of COPD Exacerbations, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Thurston SJ, McHugh TD, Donaldson GC, et al., 2012, PROFILE OF THE AIRWAY MICROBIOME IN COPD USING MALDI-TOF, Winter Meeting of the British-Thoracic-Society 2012, Publisher: BMJ PUBLISHING GROUP, Pages: A13-A14, ISSN: 0040-6376
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Singh R, Chana KK, Wright LL, et al., 2012, ASSOCIATION OF DEFECTIVE MONOCYTE-DERIVED MACROPHAGE PHAGOCYTOSIS WITH CLINICAL PHENOTYPES IN STABLE COPD, Winter Meeting of the British-Thoracic-Society 2012, Publisher: BMJ PUBLISHING GROUP, Pages: A175-A176, ISSN: 0040-6376
Donaldson GC, Kowlessar BS, Patel ARC, et al., 2012, INCREASED INCIDENCE OF COPD EXACERBATIONS FOLLOWING INFLUENZA VACCINATION, Winter Meeting of the British-Thoracic-Society 2012, Publisher: BMJ PUBLISHING GROUP, Pages: A16-A16, ISSN: 0040-6376
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Brill SE, El-Emir E, Singh R, et al., 2012, RECRUITMENT TO COPD CLINICAL TRIALS FROM PRIMARY CARE PATIENTS, Winter Meeting of the British-Thoracic-Society 2012, Publisher: BMJ PUBLISHING GROUP, Pages: A143-A144, ISSN: 0040-6376
George SN, Garcha DS, Patel ARC, et al., 2012, TIME-COURSE OF RHINOVIRUS AND BACTERIAL INFECTION DURING COPD EXACERBATION RECOVERY, Winter Meeting of the British-Thoracic-Society 2012, Publisher: BMJ PUBLISHING GROUP, Pages: A156-A156, ISSN: 0040-6376
Patel ARC, Kowlessar BS, Donaldson GC, et al., 2012, THE PREVALENCE AND IMPACT OF GASTRO-OESOPHAGEAL REFLUX SYMPTOMS IN STABLE COPD PATIENTS, Winter Meeting of the British-Thoracic-Society 2012, Publisher: BMJ PUBLISHING GROUP, Pages: A157-A157, ISSN: 0040-6376
Patel ARC, Kowlessar BS, Sapsford R, et al., 2012, ARTERIAL STIFFNESS AND AIRWAY INFECTION AND INFLAMMATION DURING COPD EXACERBATIONS, Winter Meeting of the British-Thoracic-Society 2012, Publisher: BMJ PUBLISHING GROUP, Pages: A14-A15, ISSN: 0040-6376
Patel ARC, Kowlessar BS, Donaldson GC, et al., 2012, GASTRO-OESOPHAGEAL REFLUX SYMPTOMS DURING COPD EXACERBATIONS, Winter Meeting of the British-Thoracic-Society 2012, Publisher: BMJ PUBLISHING GROUP, Pages: A157-A158, ISSN: 0040-6376
Alahmari AD, Donaldson GC, Patel ARC, et al., 2012, THE EFFECT OF OUTSIDE TEMPERATURE ON DAILY PHYSICAL ACTIVITY IN COPD PATIENTS, Winter Meeting of the British-Thoracic-Society 2012, Publisher: BMJ PUBLISHING GROUP, Pages: A97-A97, ISSN: 0040-6376
Alahmari AD, Donaldson GC, Patel ARC, et al., 2012, QUANTIFYING PHYSICAL ACTIVITY FOR 30 DAYS VIA PEDOMETRY IN COPD PATIENTS, Winter Meeting of the British-Thoracic-Society 2012, Publisher: BMJ PUBLISHING GROUP, Pages: A98-A98, ISSN: 0040-6376
Patel ARC, Donaldson GC, Kowlessar BS, et al., 2012, The impact of airway infection on cardiovascular risk during COPD exacerbations, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Quint JK, Donaldson GC, Wassef N, et al., 2012, 25-hydroxyvitamin D deficiency, exacerbation frequency and human rhinovirus exacerbations in chronic obstructive pulmonary disease, BMC Pulmonary Medicine, Vol: 12, ISSN: 1471-2466
ABSTRACT: BACKGROUND: 25-hydroxyvitamin D deficiency is associated with COPD and increased susceptibility to infection in the general population. METHODS: We investigated whether COPD patients deficient in 25-hydroxyvitamin D were more likely to be frequent exacerbators, had reduced outdoor activity and were more susceptible to human rhinovirus (HRV) exacerbations than those with insufficient and normal levels. We also investigated whether the frequency of FokI, BsmI and TaqIalpha 25-hydroxyvitamin D receptor (VDR) polymorphisms differed between frequent and infrequent exacerbators. RESULTS: There was no difference in 25-hydroxyvitamin D levels between frequent and infrequent exacerbators in the summer; medians 44.1nmol/L (29.1 - 68.0) and 39.4nmol/L (22.3 - 59.2) or winter; medians 24.9nmol/L (14.3 - 43.1) and 27.1nmol/L (19.9 - 37.6). Patients who spent less time outdoors in the 14 days prior to sampling had lower 25-hydroxyvitamin D levels (p = 0.02). Day length was independently associated with 25-hydroxyvitamin D levels (p = 0.02). There was no difference in 25-hydroxyvitamin D levels between baseline and exacerbation; medians 36.2nmol/L (IQR 22.4-59.4) and 33.3nmol/L (23.0-49.7); p = 0.43. HRV positive exacerbations were not associated with lower 25-hydroxyvitamin D levels at exacerbation than exacerbations that did not test positive for HRV; medians 30.0nmol/L (20.4 - 57.8) and 30.6nmol/L (19.4 - 48.7). There was no relationship between exacerbation frequency and any VDR polymorphisms (all p > 0.05). CONCLUSIONS: Low 25-hydroxyvitamin D levels in COPD are not associated with frequent exacerbations and do not increase susceptibility to HRV exacerbations. Independent of day length, patients who spend less time outdoors have lower 25-hydroxyvitamin D concentration.
Aaron SD, Donaldson GC, Whitmore GA, et al., 2012, Time course and pattern of COPD exacerbation onset, COPD: Journal of Chronic Obstructive Pulmonary Disease, Vol: 9, ISSN: 1541-2555
Patel AR, Donaldson GC, Mackay AJ, et al., 2012, The impact of ischemic heart disease on symptoms, health status, and exacerbations in patients with COPD, Chest, Vol: 141, Pages: 851-857, ISSN: 1931-3543
Comorbid ischemic heart disease (IHD) is a common and important cause of morbidity and mortality in patients with COPD. The impact of IHD on COPD in terms of a patient's health status, exercise capacity, and symptoms is not well understood.
Mackay AJ, Donaldson GC, Patel AR, et al., 2012, Usefulness of the Chronic Obstructive Pulmonary Disease Assessment Test to Evaluate Severity of COPD Exacerbations, Am J Respir Crit Care Med, Vol: 185, Pages: 1218-1224, ISSN: 1535-4970
Rationale: The Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) is an eight-item questionnaire designed to assess and quantify the impact of COPD symptoms on health status. COPD exacerbations impair quality of life and are characterized by worsening respiratory symptoms from the stable state. We hypothesized that CAT scores at exacerbation relate to exacerbation severity as measured by exacerbation duration, lung function impairment, and systemic inflammation. Objectives: To evaluate the usefulness of the CAT to assess exacerbation severity. Methods: One hundred sixty-one patients enrolled in the London COPD cohort completed the CAT at baseline (stable state), exacerbation, and during recovery between April 2010 and June 2011. Measurements and Main Results: Frequent exacerbators had significantly higher baseline CAT scores than infrequent exacerbators (19.5 ± 6.6 vs. 16.8 ± 8.0, P = 0.025). In 152 exacerbations, CAT scores rose from an average baseline value of 19.4 ± 6.8 to 24.1 ± 7.3 (P < 0.001) at exacerbation. Change in CAT score from baseline to exacerbation onset was significantly but weakly related to change in C-reactive protein (rho = 0.26, P = 0.008) but not to change in fibrinogen (rho = 0.09, P = 0.351) from baseline to exacerbation. At exacerbation, rises in CAT score were significantly associated with falls in FEV(1) (rho = -0.20, P = 0.032). Median recovery time as judged by symptom diary cards was significantly related to the time taken for the CAT score to return to baseline (rho = 0.42, P = 0.012). Conclusions: The CAT provides a reliable score of exacerbation severity. Baseline CAT scores are elevated in frequent exacerbators. CAT scores increase at exacerbation and reflect severity as determined by lung function and exacerbation duration.
Garcha DS, Thurston SJ, Patel AR, et al., 2012, Changes in prevalence and load of airway bacteria using quantitative PCR in stable and exacerbated COPD, Thorax, ISSN: 1468-3296
BACKGROUND: Prevalence and load of airway bacteria in stable and exacerbated chronic obstructive pulmonary disease (COPD) has been previously studied using microbiological culture. Molecular techniques, such as quantitative PCR (qPCR), may be more informative. METHODS: In this study, 373 sputum samples from 134 COPD outpatients were assessed for prevalence and load of typical airway bacteria (Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis) by multiplex qPCR, with 176 samples analysed for atypical bacteria. Paired stable and exacerbation typical bacteria data were compared in 52 patients. We compared routine culture with qPCR in 177/373 samples. RESULTS: Typical bacteria were more prevalent in exacerbation than stable-state paired samples: 30/52 (57.7%) vs. 14/52 (26.9%); p=0.001. In patients who were bacteria-positive at both time points, mean (±1 SEM) load was significantly higher at exacerbation than stable state (108.5(±0.3) vs. 107.2(±0.5) cfu/ml), constituting a 20-fold increase (p=0.011). qPCR was more discriminatory at detecting typical bacteria than microbiological culture (prevalence 59.3% vs. 24.3%; p<0.001). At stable state, higher airway bacterial load correlated with more severe airflow limitation (FEV(1)%predicted) (r=-0.299; p=0.033) and higher inhaled corticosteroid dosage (r=0.382; p=0.008). Mean C-reactive protein was higher in bacterial-associated exacerbations (35.0 Vs 25.1 mg/L; p=0.032). CONCLUSIONS: Airway bacterial prevalence and load increase at COPD exacerbations and are an aetiological factor. qPCR is more discriminatory than culture, identifying higher airway bacterial prevalence. Exacerbations associated with bacterial detection showed a higher mean C-reactive protein level. In the stable state, airway bacterial load is related to more severe airflow limitation and higher inhaled corticosteroid dosage used.
Donaldson GC, Seemungal TA, Hurst JR, et al., 2012, Detrended fluctuation analysis of peak expiratory flow and exacerbation frequency in COPD, Eur Respir J, ISSN: 1399-3003
We investigated whether exacerbation frequency in COPD was related to an exponent α which quantifies self-similarity in daily peak expiratory flow (PEF) and is calculated using detrended fluctuation analysis (DFA).We examined data from COPD patients who recorded increase in respiratory symptoms and post-bronchodilator PEF on daily diary cards. We also investigated PEF data from a double blind, placebo controlled trial of the anti-cholinergic agent, Tiotropium.In the observational study there were 308 patients with COPD (195 male; mean (SD) age 68.3 years (8.4), FEV1 1.12 l (0.46), FEV1 % predicted 44.5 % (16.4)). The mean α over the first year was 0.944 (SD 0.19) and it was positively related to exacerbations per year (p=0.009). In the clinical trial, α was lower in COPD patients randomized to tiotropium, mean 0.87 (0.21, n=48) than on placebo, mean 0.95 (0.19, n=52; p=0.035). Power analysis showed that fewer patients would be required for clinical studies with α as the outcome measure than exacerbation frequency.DFA shows that daily PEF in COPD has long-term correlations which is related to exacerbation frequency. Monitoring of PEF and use of α may result in smaller COPD patient sample sizes in trials.
Donaldson GC, Goldring JJ, Wedzicha JA, 2012, Influence of season on exacerbation characteristics in patients with COPD, Chest, Vol: 141, Pages: 94-100, ISSN: 1931-3543
BACKGROUND: Patients with COPD experience more frequent exacerbations in the winter. However, little is known about the impact of the seasons on exacerbation characteristics. METHODS: Between November 1, 1995, and November 1, 2009, 307 patients in the London COPD cohort (196 men; age, mean, 68.1 years [SD, 8.4]; FEV(1), mean, 1.12 L [SD, 0.46]; FEV(1), mean, % predicted, 44.4% [SD, 16.1]) recorded their increase in daily symptoms and time outdoors for a median of 1,021 days (interquartile range [IQR], 631-1,576). Exacerbation was identified as >/= 2 consecutive days with an increase in two different symptoms. RESULTS: There were 1,052 exacerbations in the cold seasons (November to February), of which 42.5% and 50.6% were patients who had coryzal and cough symptoms, respectively, compared with 676 exacerbations in the warm seasons (May to August), of which 31.4% and 45.4% were in patients who had coryzal and cough symptoms, respectively (P < .05). The exacerbation recovery period was longer in the cold seasons (10 days; IQR, 6-19) compared with the warm seasons (9 days; IQR, 5-16; P < .005). The decrease in outdoor activity during exacerbation, relative to a pre-exacerbation period (-14 to -8 days), was greater in the cold seasons (-0.50 h/d; IQR, -1.1 to 0) than in the warm seasons (-0.26 h/d; IQR, -0.88 to 0.18; P = .048). In the cold seasons, 8.4% of exacerbations resulted in patients who were hospitalized, compared with 4.6% of exacerbations in the warm seasons (P = .005). CONCLUSIONS: Exacerbations are more severe between November and February. This contributes to the increased morbidity during the winter seasons.
Aaron SD, Donaldson GC, Whitmore GA, et al., 2012, Time course and pattern of COPD exacerbation onset, Thorax, Vol: 67, Pages: 238-243, ISSN: 0040-6376
Wedzicha JA, Donaldson GC, 2012, Natural history of successive COPD exacerbations, Thorax, Vol: 67, Pages: 935-936, ISSN: 1468-3296
Alahmari AD, Kowlessar BS, Patel ARC, et al., 2011, VALIDATION OF A PEDOMETER TO MEASURE DAILY PHYSICAL ACTIVITIES IN COPD PATIENTS, Winter Meeting of the British-Thoracic-Society, Publisher: B M J PUBLISHING GROUP, Pages: A86-A86, ISSN: 0040-6376
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Patel ARC, Alahmari AD, Donaldson GC, et al., 2011, THE IMPACT OF COMORBID ISCHAEMIC HEART DISEASE ON EXERCISE CAPACITY IN COPD PATIENTS, Winter Meeting of the British-Thoracic-Society, Publisher: B M J PUBLISHING GROUP, Pages: A87-A87, ISSN: 0040-6376
Kowlessar BS, Patel ARC, Donaldson GC, et al., 2011, FACTORS AFFECTING PATIENT SATISFACTION IN A COPD RESEARCH COHORT, Winter Meeting of the British-Thoracic-Society, Publisher: B M J PUBLISHING GROUP, Pages: A156-A156, ISSN: 0040-6376
George SN, Mackay AJ, Patel ARC, et al., 2011, DIFFERENTIATED HUMAN RHINOVIRUS LOADS IN STABLE COPD AND AT EXACERBATION, Winter Meeting of the British-Thoracic-Society, Publisher: B M J PUBLISHING GROUP, Pages: A9-A9, ISSN: 0040-6376
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