66 results found
Invernizzi R, Wu BG, Barnett J, et al., 2021, The respiratory microbiome in chronic hypersensitivity pneumonitis is distinct from that of idiopathic pulmonary fibrosis, American Journal of Respiratory and Critical Care Medicine, Vol: 203, Pages: 339-347, ISSN: 1073-449X
RATIONALE: Chronic hypersensitivity pneumonitis (CHP) is a condition that arises following repeated exposure and sensitisation to inhaled antigens. The lung microbiome is increasingly implicated in respiratory disease but to date, no study has investigated the composition of microbial communities in the lower airways in CHP. OBJECTIVE: To characterise and compare the airway microbiome in subjects with CHP, idiopathic pulmonary fibrosis (IPF) and controls. METHODS: We prospectively recruited individuals diagnosed with CHP (n=110), IPF (n=45) and controls (n=28). Subjects underwent bronchoalveolar lavage and bacterial DNA was isolated, quantified by qPCR and the 16S rRNA gene was sequenced to characterise the bacterial communities in the lower airways. MAIN MEASUREMENTS AND RESULTS: Distinct differences in the microbial profiles were evident in the lower airways of subjects with CHP and IPF. At the phylum level, the prevailing microbiota of both IPF and CHP subjects included Firmicutes, Bacteroidetes, Proteobacteria and Actinobacteria. However, in IPF, Firmicutes dominated while the percentage of reads assigned to Proteobacteria in the same group was significantly lower compared to CHP subjects. At the genus level, Staphylococcus was increased in CHP and Actinomyces and Veillonella in IPF. The lower airway bacterial burden in CHP subjects was higher than controls but lower than those with IPF. In contrast to IPF, there was no association between bacterial burden and survival in CHP. CONCLUSIONS: The microbial profile of the lower airways in subjects with CHP is distinct from that of IPF and, notably, bacterial burden in individuals with CHP fails to predict survival.
Reynolds C, Feary J, Cullinan P, 2020, Occupational contributions to interstitial lung disease, Clinics in Chest Medicine, Vol: 41, Pages: 697-707, ISSN: 0272-5231
Feary J, Parfrey H, Burge S, et al., 2020, Interstitial Lung Disease (ILD) in aluminium welders, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Feary J, Cannon J, Fitzgerald B, et al., 2020, Follow-up survey of patients with occupational asthma., Occupational Medicine, Vol: 70, Pages: 231-234, ISSN: 0962-7480
BACKGROUND: Occupational asthma (OA) is often associated with a poor prognosis and the impact of a diagnosis on an individual's career and income can be significant. AIMS: We sought to understand the consequences of a diagnosis of OA to patients attending our clinic. METHODS: Using a postal questionnaire, we surveyed all patients attending our specialist occupational lung disease clinic 1 year after having received a diagnosis of OA due to a sensitizer (n = 125). We enquired about their current health and employment status and impact of their diagnosis on various aspects of their life. Additional information was collected by review of clinical records. RESULTS: We received responses from 71 (57%) patients; 77% were referred by an occupational health (OH) provider. The median duration of symptoms prior to referral was 18 months (interquartile range (IQR) 8-48). At 1 year, 79% respondents were no longer exposed to the causal agent. Whilst the unexposed patients reported an improvement in symptoms compared with those still exposed (82% versus 53%; P = 0.023), they had poorer outcomes in terms of career, income and how they felt treated by their employer; particularly those not currently employed. Almost all (>90%) of those still employed had been referred by an OH provider compared with 56% of those currently unemployed (P = 0.002)x. CONCLUSIONS: The negative impact of OA on people's careers, livelihood and quality of life should not be underestimated. However, with early detection and specialist care, the prognosis is often good and particularly so for those with access to occupational health.
Stone P, Sood N, Feary J, et al., 2020, Validation of acute exacerbation of chronic obstructive pulmonary disease (COPD) recording in electronic health records: a systematic review protocol, BMJ Open, Vol: 10, ISSN: 2044-6055
Introduction Many patients with chronic obstructive pulmonary disease (COPD) experience a sustained worsening in symptoms termed an acute exacerbation (AECOPD). AECOPDs impact on patients’ quality of life and lung function, are costly to health services and are an important topic for research. Electronic health records (EHR) are increasingly being used to study AECOPD, requiring accurate detection of AECOPD in EHRs to ensure generalisable results. The aim of this protocol is to provide an overview of studies that validate AECOPD definitions used in EHRs and administrative claims databases.Methods and analysis Medline and Embase will be searched for terms related to COPD exacerbation, EHRs and validation. All studies published between 1 January 1990 and 30 September 2019 written in English that validate AECOPD in EHRs and administrative claims databases will be considered. Inclusion criteria: EHR data must be routinely collected; the AECOPD detection algorithm must be compared against a reference standard; and a measure of validity must be calculable. Two independent reviewers will screen articles for inclusion, extract study details and assess risk of bias using QUADAS-2. Disagreements will be resolved by consensus or arbitration by a third reviewer. This protocol has been developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols checklist.Ethics and dissemination This will be a review of previously published literature therefore no ethical approval is required. Results from this review will be published in a peer-reviewed journal. The results can be used in future research to identify occurrences of AECOPD.
Barber CM, Burge PS, Feary JR, et al., 2019, Identifying causation in hypersensitivity pneumonitis: a British perspective, BMJ Open Respiratory Research, Vol: 6, Pages: 1-6, ISSN: 2052-4439
Background Establishing whether patients are exposed to a ‘known cause’ is a key element in both the diagnostic assessment and the subsequent management of hypersensitivity pneumonitis (HP).Objective This study surveyed British interstitial lung disease (ILD) specialists to document current practice and opinion in relation to establishing causation in HP.Methods British ILD consultants (pulmonologists) were invited by email to take part in a structured questionnaire survey, to provide estimates of demographic data relating to their service and to rate their level of agreement with a series of statements. A priori ‘consensus agreement’ was defined as at least 70% of participants replying that they ‘Strongly agree’ or ‘Tend to agree’.Results 54 consultants took part in the survey from 27 ILD multidisciplinary teams. Participants estimated that 20% of the patients in their ILD service have HP, and of these, a cause is identifiable in 32% of cases. For patients with confirmed HP, an estimated 40% have had a bronchoalveolar lavage for differential cell counts, and 10% a surgical biopsy. Consensus agreement was reached for 25 of 33 statements relating to causation and either the assessment of unexplained ILD or management of confirmed HP.Conclusions This survey has demonstrated that although there is a degree of variation in the diagnostic approach for patients with suspected HP in Britain, there is consensus opinion for some key areas of practice. There are several factors in clinical practice that currently act as potential barriers to identifying the cause for British HP patients.
Stone PW, Feary JR, Roberts CM, et al., 2019, HOW DO THE UK COUNTRIES COMPARE FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE PRIMARY CARE?, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A72-A73, ISSN: 0040-6376
Barber CM, Burge PS, Feary JR, et al., 2019, S82 How do specialists treat hypersensitivity pneumonitis in britain?, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ Publishing Group, Pages: A54-A54, ISSN: 0040-6376
Background Although immunosuppression is commonly used in HP, there are no studies that compare treatment regimes.Aims and objectives The aim of this study was to survey specialist ILD consultants to determine how HP is treated in Britain.Methods British ILD consultants were provided with clinical scenarios, and asked how they would treat patients with HP. They were also asked to rate their level of agreement with a series of statements. A priori ‘consensus agreement’ and ‘majority agreement’ were defined as at least 70% and 50% respectively of participants replying that they ‘Strongly agree’ or ‘Tend to agree’.Results 54 consultants took part in the survey from 27 centres. The choice of first line immunosuppression in progressive HP was relatively evenly split between dual therapy with corticosteroids plus a ‘steroid-sparing’ immunosuppressant (46%) and monotherapy with oral corticosteroids (39%). On average, the initial starting dose of oral prednisolone (for an 80 kg patient) was 40 mg continued for 6 weeks prior to weaning, aiming for a maintenance of 10 mg. 75% of participants reported that mycophenolate mofetil was their first choice ‘non-corticosteroid immunosuppressant’ for the long-term management of HP. A number of statements relating to the treatment of HP reached consensus or majority agreement (table 1).Conclusions This survey has demonstrated a degree of variation in the treatment of patients with suspected HP in Britain, but has found consensus and majority agreement for some key areas.
Feary J, 2019, Aromatic solvents: the not so sweet side, THORAX, Vol: 74, ISSN: 0040-6376
BACKGROUND: A delayed asthma reaction occurring several hours after exposure is difficult to diagnose. AIMS: To confirm a delayed asthma reaction in five workers following epoxy exposure. CASE REPORT: Working conditions with exposure to epoxy encountered at the workplace were reproduced in a challenge chamber. Specific inhalation challenge (SIC) with epoxy was compared to a control challenge. All five cases had delayed a asthma response 6-15 h after epoxy exposure. CONCLUSIONS: Our study confirms that SIC is a useful tool in diagnosing delayed asthma response.
Wiggans R, Sumner J, Robinson E, et al., 2019, Respiratory symptoms, airway inflammation and lung function in workers at risk of occupational asthma, European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Hull JH, Walsted ES, Feary J, et al., 2019, Continuous laryngoscopy during provocation in the assessment of inducible laryngeal obstruction, Laryngoscope, Vol: 129, Pages: 1863-1866, ISSN: 0023-852X
Brittain HK, Feary J, Rosenthal M, et al., 2019, Biallelic human ITCH variants causing a multisystem disease with dysmorphic features: A second report, AMERICAN JOURNAL OF MEDICAL GENETICS PART A, Vol: 179, Pages: 1346-1350, ISSN: 1552-4825
Feary JR, Schofield SJ, Canizales J, et al., 2019, Laboratory animal allergy is preventable in modern research facilities, European Respiratory Journal, Vol: 53, ISSN: 0903-1936
BACKGROUND: Historical data suggest 15% of laboratory animal workers develop IgE sensitisation and 10% symptoms of laboratory animal allergy (LAA), including occupational asthma. Individually ventilated cages (IVC) are replacing conventional open cages; we sought to evaluate their impact on the development of LAA. METHODS: We surveyed 750 laboratory animal workers and measured airborne Mus m 1 (mouse allergen) levels in seven UK institutions. We compared the prevalence of sensitisation to mouse proteins (by specific IgE assay or skin prick test) and of work-related allergic symptoms in IVC-only and open cage units. MEASUREMENTS AND MAIN RESULTS: Full shift Mus m 1 levels were lower in IVC than open cage units (geometric mean 1.00 ng·m-3 (95% confidence interval: 0.73-1.36) versus8.35 ng·m-3 (6.97-9.95); p<0.001) but varied eight-fold across the IVC units (GM range: 0.33-4.12 ng·m-3). Primary analyses on data from 216 participants with <3 years' exposure to mice revealed a lower prevalence of sensitisation in those working in IVC compared with conventional cage units (2.4% (n=2) versus9.8% (n=13); p=0.052). Sensitisation in IVC units varied from 0% to 12.5%; the use of fitted respiratory protection was less common in IVC units where prevalence of sensitisation was higher. Work-related allergy symptoms were more frequently reported by mouse sensitised individuals (46.7% versus 10.9%, p<0.001); and only by those working in open cage units. CONCLUSION: In contemporary practice, LAA is now largely preventable with the use of IVC systems and the judicious use of appropriate respiratory protection.
Bloom C, Saglani S, Feary J, et al., 2019, Changing prevalence of current asthma and inhaled corticosteroid treatment in the UK: population based cohort 2006 to 2016, European Respiratory Journal, Vol: 53, Pages: 1-8, ISSN: 0903-1936
BACKGROUND:Asthma is the most common respiratory disorder in the UK, yet we have incomplete knowledge on the prevalence of current disease, treatment and exacerbations.METHODS:We used UK electronic healthcare records, 2006 to 2016, to estimate the prevalence of current asthma by year, gender and age (<5, 5-11, 12-17, 18-24, 25-54 and ≥55 years), and the proportion prescribed inhaled corticosteroids (ICS) and additional asthma-therapy, treated for exacerbations and other asthma care markers. RESULTS:Overall current asthma prevalence was 6.5% in 2016 (7.2% in 2006). Prevalence fell in those under 45 years. The lowest prevalence and largest absolute decrease was in children under 5-years. In 2016, 80% of current asthma patients were managed on ICS, (65% in 2006); this increase occurred in all ages, primarily due to an increase in low-dose ICS. During this time there was an increase in all age-groups in the proportion prescribed additional asthma-therapy, treated for an exacerbation within primary care, given an annual asthma review or management plan. Hospitalised exacerbations showed minimal change over time.CONCLUSION:Asthma remains highly prevalent and a significant healthcare burden. In those with a diagnosis, there was an increase in ICS prescriptions and treatment of exacerbations across all age-groups. This may reflect a trend towards more aggressive asthma management within primary care. An apparent decline in prevalence was observed in those aged under 45 years, particularly in children under 5 years.
Vera-Berrios RN, Feary J, Cullinan P, 2019, Basophil activation testing in occupational respiratory allergy to low molecular weight compounds, Current Opinion in Allergy and Clinical Immunology, Vol: 19, Pages: 92-97, ISSN: 1473-6322
Purpose of review There is an unmet need for better immunological tests in cases of suspected occupational asthma to many workplace chemicals; here we consider the basophil activation test (BAT), a potential alternative to the detection of specific IgE antibodies.Recent findings BAT is fairly widely used in general allergy services; and there is increasing experience of its use in the diagnosis of occupational allergy to low molecular weight agents and chemicals including wood dusts, persulphates, antibiotics and latex.Summary There is potential for BAT to become a useful tool in the clinical consideration of occupational asthma and of its mechanisms, and even to take a place in a Bayesian-based diagnostic algorithm. Further development will only occur if specialist centres with appropriate facilities, and preferably in collaboration, contemplate its use.
Canizales J, Feary J, Cullinan P, et al., 2019, Investigating discordance between diagnostic tests for laboratory animal allergy, Annual Meeting of the American-Academy-of-Allergy-Asthma-and-Immunology (AAAAI), Publisher: MOSBY-ELSEVIER, Pages: AB193-AB193, ISSN: 0091-6749
Feary J, Cullinan P, 2019, Occupational diseases, ERS Handbook Respiratory Medicine, Publisher: The European Respiratory Society, Pages: 748-752, ISBN: 9781849840798
Feary J, Cullinan P, 2019, Heavy Metals, Reference Module in Biomedical Sciences, Publisher: Elsevier, ISBN: 9780128012383
Bloom CI, Palmer T, Feary J, et al., 2018, Exacerbation patterns in adults with asthma in England: A population based study, American Journal of Respiratory and Critical Care Medicine, Vol: 199, Pages: 446-453, ISSN: 1073-449X
Rationale Asthma is heterogeneous and knowledge on exacerbation patterns is lacking. Previous studies have had a relatively short follow-up or focused on severe disease. Objectives Describe exacerbation patterns over a prolonged follow-up in a population including patients of all disease severity. Methods We used electronic healthcare records to identify asthma patients aged 18-55 years and their exacerbations, 2007-2015. A cohort with ≥7-years of data was used to describe exacerbation patterns by asthma severity defined by medication use. Effect estimates for risk factors were calculated for sporadic (single year of exacerbations) and recurrent (>1 year) exacerbation patterns, using logistic regression. In a nested case-control design, the association between a history of exacerbations, spanning 5-years, and a future exacerbation was examined. Measurements and Main Results 51,462 patients were eligible for the 7-year cohort; 64% had no exacerbations. Of those who exacerbated, 51% did so only once; exacerbation frequency increased with disease severity. Only 370 patients (0.7%) were characterised by a frequent-exacerbator phenotype (yearly exacerbations), of whom 58% had mild/moderate asthma. Exacerbation risk factors were not uniquely associated with a particular exacerbation pattern. A past exacerbation increased the risk of a future exacerbation more than all other factors, although this effect dissipated over 5-years. Conclusions During 7-years of follow-up, exacerbations occur in around one-third of patients. Of those who exacerbate, half do not do so again; the timing of future exacerbations is largely unpredictable. Just 2% exhibit a frequent-exacerbator phenotype. Past exacerbation patterns are the most informative risk factor for predicting future exacerbations.
Bloom CI, Feary J, Jarvis D, et al., 2018, CHANGING PREVALENCE OF CURRENT ASTHMA AND INHALED CORTICOSTEROID TREATMENT IN THE UK: POPULATION BASED COHORT 2006 TO 2016, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A63-A64, ISSN: 0040-6376
Feary J, Potts J, Schofield S, et al., 2018, AEROALLERGEN EXPOSURE ALONE IS NOT RESPONSIBLE FOR SENSITISATION OF WORKERS TO LABORATORY ANIMAL ALLERGENS, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A179-A179, ISSN: 0040-6376
Feary J, Fitzgerald B, Schofield S, et al., 2018, Evidence based Code of Best Practice for animal research facilities: results of the SPIRAL study, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Feary J, Canizales J, Fitzgerald C, et al., 2018, Is 'take-out' allergen detectable in laboratory animal facilities?, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
De Matteis S, Feary J, Macfarlane J, et al., 2018, Update of the British Occupational Health Research Foundation (BOHRF) guidelines on occupational asthma., 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Canizales J, Welch J, Fitzgerald B, et al., 2018, Investigating discordance between diagnostic tests for laboratory animal allergy, Congress of the European-Academy-of-Allergy-and-Clinical-Immunology (EAACI), Publisher: WILEY, Pages: 94-94, ISSN: 0105-4538
De Matteis S, Feary J, Macfarlane J, et al., 2017, UPDATE OF THE BRITISH OCCUPATIONAL HEALTH FOUNDATION (BOHRF) EVIDENCE-BASED GUIDELINES ON THE PREVENTION AND MANAGEMENT OF OCCUPATIONAL ASTHMA, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A205-A205, ISSN: 0040-6376
Feary J, Cannon J, Schofield S, et al., 2017, FOLLOW UP OF PATIENTS DIAGNOSED WITH OCCUPATIONAL ASTHMA OR RHINITIS AT ROYAL BROMPTON HOSPITAL, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A204-A205, ISSN: 0040-6376
Selby J, Cullinan P, Feary J, et al., 2017, FEASIBILITY OF CONTINUOUS LARYNGOSCOPY DURING PROVOCATION IN THE ASSESSMENT OF INDUCIBLE LARYNGEAL OBSTRUCTION, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A143-A143, ISSN: 0040-6376
Feary J, Canizales J, Jones M, et al., 2017, Laboratory animal workers' exposure to mouse allergen in animal research facilities, European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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