Imperial College London

DrJohannaFeary

Faculty of MedicineNational Heart & Lung Institute

Senior Clinical Research Fellow
 
 
 
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Contact

 

+44 (0)20 7594 7968j.feary

 
 
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Location

 

G46Emmanuel Kaye BuildingRoyal Brompton Campus

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Summary

 

Publications

Publication Type
Year
to

76 results found

Stone P, Minelli C, Feary J, Roberts CM, Quint J, Hurst JRet al., 2022, NEWS2’ as an objective assessment of hospitalised COPD exacerbation severity, International Journal of COPD, Vol: 17, Pages: 763-772, ISSN: 1176-9106

Introduction: There is currently no accepted way to risk-stratify hospitalised exacerbations of chronic obstructive pulmonary disease (COPD). We hypothesised that the revised UK National Early Warning Score (NEWS2) calculated at admission would predict inpatient mortality, need for non-invasive ventilation (NIV) and length-of-stay.Methods: We included data from 52,284 admissions for exacerbation of COPD. Data were divided into development and validation cohorts. Logistic regression was used to examine relationships between admission NEWS2 and outcome measures. Predictive ability of NEWS2 was assessed using area under receiver operating characteristic curves (AUC). We assessed the benefit of including other baseline data in the prediction models and assessed whether these variables themselves predicted admission NEWS2.Results: 53% of admissions had low risk, 24% medium risk and 23% a high risk NEWS2 in the development cohort. The proportions dying as an inpatient were 2.2%, 3.6% and 6.5% by NEWS2 risk category, respectively. The proportions needing NIV were 4.4%, 9.2% and 18.0%, respectively. NEWS2 was poorly predictive of length-of-stay (AUC: 0.59[0.57– 0.61]). In the external validation cohort, the AUC (95% CI) for NEWS2 to predict inpatient death and need for NIV were 0.72 (0.68– 0.77) and 0.70 (0.67– 0.73). Inclusion of patient demographic factors, co-morbidity and COPD severity improved model performance. However, only 1.34% of the variation in admission NEWS2 was explained by these baseline variables.Conclusion: The generic NEWS2 risk assessment tool, readily calculated from simple physiological data, predicts inpatient mortality and need for NIV (but not length-of-stay) at exacerbations of COPD. NEWS2 therefore provides a classification of hospitalised COPD exacerbation severity.

Journal article

Knox-Brown B, Mulhern O, Feary J, Amaral Aet al., 2022, Spirometry parameters used to define small airways obstruction in population-based studies: Systematic review, Respiratory Research, Vol: 23, Pages: 1-13, ISSN: 1465-9921

BackgroundThe assessment of small airways obstruction (SAO) using spirometry is practiced in population-based studies. However, it is not clear what are the most used parameters and cut-offs to define abnormal results.MethodsWe searched three databases (Medline, Web of Science, Google Scholar) for population-based studies, published by 1 May 2021, that used spirometry parameters to identify SAO and/or provided criteria for defining SAO. We systematically reviewed these studies and summarised evidence to determine the most widely used spirometry parameter and criteria for defining SAO. In addition, we extracted prevalence estimates and identified associated risk factors. To estimate a pooled prevalence of SAO, we conducted a meta-analysis and explored heterogeneity across studies using meta regression.ResultsTwenty-five studies used spirometry to identify SAO. The most widely utilised parameter (15 studies) was FEF25–75, either alone or in combination with other measurements. Ten studies provided criteria for the definition of SAO, of which percent predicted cut-offs were the most common (5 studies). However, there was no agreement on which cut-off value to use. Prevalence of SAO ranged from 7.5% to 45.9%. As a result of high heterogeneity across studies (I2 = 99.3%), explained by choice of spirometry parameter and WHO region, we do not present a pooled prevalence estimate.ConclusionThere is a lack of consensus regarding the best spirometry parameter or defining criteria for identification of SAO. The value of continuing to measure SAO using spirometry is unclear without further research using large longitudinal data.PROSPERO registration number CRD42021250206

Journal article

Barber CM, Cullinan P, Feary J, Fishwick D, Hoyle J, Mainman H, Walters GIet al., 2022, British Thoracic Society Clinical Statement on occupational asthma., Thorax, ISSN: 0040-6376

Journal article

Kabir T, Schofield S, Fitzgerald B, Cannon J, Szram J, Feary Jet al., 2022, Assessment and outcomes of firefighter applicants with possible asthma., Occupational Medicine, Vol: 72, Pages: 118-124, ISSN: 0962-7480

BACKGROUND: Firefighter applicants (FFAs) with a history of asthma may be refused entry to the fire service because of potentially putting themselves and others at risk. AIMS: We undertook a service evaluation to identify respiratory and employment outcomes of FFAs with a history of asthma who had undergone additional respiratory assessment at our specialist occupational lung disease clinic during 2005-19. METHODS: We reviewed FFA medical records and categorized them as having either no current asthma or definite/probable asthma at the time of clinic assessment. 'No current asthma' was defined as negative non-specific bronchial hyper-responsiveness (BHR) to histamine/methacholine, and no symptoms or treatment within the 2 years before clinic. 'Definite/probable current asthma' was defined as either positive BHR, or negative BHR with symptoms and/or treatment within the previous 2 years. Around 1 year later, we contacted FFAs to enquire about their application outcome and current respiratory symptoms. RESULTS: Data were available on 116 applicants; of whom, 45% (n = 52) had definite/probable current asthma and were significantly more likely to be older, atopic to common aeroallergens, report atopic disease and have a lower forced expiratory volume in one second/forced vital capacity ratio compared with applicants with no current asthma. Only two individuals' applications were rejected due to asthma. At follow-up, just 2 (2%) of the 90 operational firefighters reported any recent trouble with asthma. CONCLUSIONS: A history of asthma alone is not sufficient to determine current asthma in FFAs. Even with a diagnosis of current asthma, FFAs are mostly successful in their application to join the fire service.

Journal article

Feary J, Cullinan P, 2022, Heavy Metals, Encyclopedia of Respiratory Medicine, Publisher: Elsevier, Pages: 458-469

Book chapter

Feary J, Kabir T, Schofield S, Cullinan Pet al., 2021, S42 Correlation of measurement of small airways indices in a population of firefighters, British Thoracic Society Winter Meeting 2021, Publisher: BMJ Publishing Group, Pages: A31-A31, ISSN: 0040-6376

Background Small airways damage is a plausible response to fire smoke inhalation. In the UK, periodic respiratory health surveillance is carried out using spirometry. Previous studies have suggested the use of impulse oscillometry (IOS) may identify small airways dysfunction in firefighters even in the context of normal spirometry values and it is hypothesised that this may predict future development of asthma or COPD.Methods We measured pre and post-bronchodilator spirometry and IOS using ERS/ATS guidelines on the first 203 individuals recruited to a cohort study of firefighters (Grenfell Firefighter Study). We defined significant bronchodilator response as an improvement in forced expiratory volume in one second (FEV1) of 12% and 200mls following administration of inhaled bronchodilator. We also collected information on smoking and self-reported breathlessness using the Dyspnoea-12 questionnaire (maximum score of 36) and explored correlations between different measurements of small airways function.Results The majority of individuals were male, with a mean age of 45 years; 140 (69%) had never smoked and 12 (6%) had a more than 20 pack year history of smoking. Overall, 32 (16%) had a history of asthma (ever), 15 (8%) had evidence of significant bronchodilator reversibility and 3 (2%) were taking asthma treatment. The majority (73%) reported no breathless (Dyspnoea-12 score of zero). The mean percentage predicted pre-bronchodilator FEV1, forced vital capacity (FVC) and forced expiratory flow at 25–75% of FVC (FEF25–75) were 98%, 102% and 92% respectively using GLI reference equations. The correlation between FEF25–75 and frequency dependence of resistance (R5-R20) was -0.22 (-0.35 to -0.08).

Conference paper

Ge Y, Ming J, Feary J, Hull JH, Patel PHet al., 2021, OUTCOMES IN PANDEMIC ASTHMA DIAGNOSTICS WITH HOME SPIROMETRY, Publisher: BMJ PUBLISHING GROUP, Pages: A109-A109, ISSN: 0040-6376

Conference paper

Invernizzi R, Wu BG, Barnett J, Ghai P, Kingston S, Hewitt RJ, Feary J, Li Y, Chua F, Wu Z, Wells AU, Renzoni EA, Nicholson AG, Rice A, Devaraj A, Segal LN, Byrne AJ, Maher TM, Lloyd CM, Molyneaux PLet 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.

Journal article

Kabir T, Schofield S, Fitzgerald B, Cannon J, Szram J, Cullinan P, Feary Jet al., 2021, S108 Outcomes of firefighter applicants with a history of asthma, British Thoracic Society Winter Meeting, Publisher: BMJ Publishing Group, Pages: A65-A66, ISSN: 0040-6376

Introduction Firefighters work in a ‘safety critical role’ and undergo comprehensive pre-employment screening. Applicants with a history of asthma (often made in childhood) are regularly referred to our specialist occupational lung disease service for additional assessment including measurement of non-specific bronchial hyper-responsiveness (NSBHR).No studies have reported the impact of a pre-existing asthma diagnosis on future employment as a firefighter; most have studied current firefighters1 or others in safety critical roles.2 We sought to identify factors associated with a positive NSBHR test amongst UK firefighter applicants, and to link these to symptoms and employment status around one year later.Methods We reviewed case notes for all firefighter applicants referred between 2005–2019; we defined NSBHR as a fall in FEV1 of at least 20% (provocation concentration (PC)20) following inhalation of <8 mg/ml histamine. Around one year after their initial appointment we contacted them for follow up, including enquiring about their application outcome and current respiratory symptoms.Results Clinical data were available on 120 applicants of whom 19 (16%) had a positive NSBHR test (see table 1).Follow-up data were available on 116 applicants. Those with a positive NSBHR test (n=17; 14.7%) were less likely to be accepted into the fire service than those with a negative test (76.5% vs 95.0% respectively, p=0.026). However, of the 4 with a positive NSBHR and not accepted by the fire service, only 2 were due to asthma. Of the 90 serving firefighters at follow-up, only 2 (2.2%) reported any recent trouble with asthma.

Conference paper

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

Journal article

Alif S, Benke G, Kromhout H, Kogevinas M, Jarvis D, Le Moual N, Schluenssen V, Toren K, Norback D, Lytras T, Carsin A-E, Abramson M, Maria Anto J, Svanes C, Olivieri M, Dorado-Arenas S, Urrutia I, Acke S, Bentouhami H, Wieslander G, Muria N, Martinez-Moratalla J, Leynaert B, Radon K, Gerlich J, Nowak D, Villani S, Holm M, Mehta A, Verlato G, D'Errico A, Feary J, Bekke P, Skorge TD, Storaas T, Dahlman-Hoglund A, Svanes O, Hellgren J, Miedinger D, Pascual S, Sigsgaard T, Blanc P, Zock J-Pet al., 2020, Occupational Exposures and Incidence of ASTHMA Over Two Decades in the ECRHS, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936

Conference paper

Feary J, Cannon J, Cullinan P, 2020, Breathing pattern disorder masquerading as occupational asthma, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936

Conference paper

Feary J, Parfrey H, Burge S, Nicholson AG, Devaraj A, Cullinan Pet al., 2020, Interstitial Lung Disease (ILD) in aluminium welders, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936

Conference paper

Feary J, Cannon J, Fitzgerald B, Szram J, Schofield S, Cullinan Pet 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.

Journal article

Stone P, Sood N, Feary J, Roberts CM, Quint Jet 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.

Journal article

Barber CM, Burge PS, Feary JR, Parfrey H, Renzoni EA, Spencer LG, Walters GI, Wiggans RE, Adamali H, Babu S, Barrat S, Basran A, Beirne P, Bianchi S, Chalmers G, Chaudhuri N, Davies S, Dempsey O, Eccles S, Fiddler C, Foley N, Forrest I, Fletcher S, George P, Ghani S, Gibbons M, Greenstone M, Hart S, Hirani N, Hoyle J, Hoyles R, Hutchinson J, Jenkins G, Judge E, Kamath A, Kokosi M, Lee C, Maher T, Marshall B, McAndrew N, Molyneux P, Morrison D, O'Hickey S, Porter J, Renshaw S, Sharp C, Simler N, Spears M, Spiers A, Spinks K, Spiteri M, Stenton C, Sturney S, Warburton C, Wiscombe S, Woodhead Fet 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.

Journal article

Stone PW, Feary JR, Roberts CM, Quint JKet 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

Conference paper

Barber CM, Burge PS, Feary JR, Renzoni EA, Spencer LG, Walters GI, Wiggans REet 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.

Conference paper

Feary J, 2019, Aromatic solvents: the not so sweet side, THORAX, Vol: 74, ISSN: 0040-6376

Journal article

Brock Jacobsen I, Baelum J, Carstensen O, Skadhauge LR, Feary J, Cullinan P, Sherson DLet al., 2019, Delayed occupational asthma from epoxy exposure., Occup Med (Lond), Vol: 69, Pages: 511-514

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.

Journal article

Wiggans R, Sumner J, Robinson E, Codling A, Bradshaw L, Lewis L, Feary J, Barber CMet 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

Conference paper

Hull JH, Walsted ES, Feary J, Cullinan P, Scadding G, Bailey E, Selby Jet al., 2019, Continuous laryngoscopy during provocation in the assessment of inducible laryngeal obstruction, Laryngoscope, Vol: 129, Pages: 1863-1866, ISSN: 0023-852X

Journal article

Brittain HK, Feary J, Rosenthal M, Spoudeas H, Wilson LCet 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

Journal article

Feary JR, Schofield SJ, Canizales J, Fitzgerald B, Potts J, Jones M, Cullinan Pet 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.

Journal article

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.

Journal article

Bloom C, Saglani S, Feary J, Jarvis D, Quint Jet 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.

Journal article

Canizales J, Feary J, Cullinan P, Jones Met 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

Conference paper

Feary J, Cullinan P, 2019, Occupational diseases, ERS Handbook Respiratory Medicine, Publisher: The European Respiratory Society, Pages: 748-752

Book chapter

Bloom CI, Palmer T, Feary J, Quint JK, Cullinan Pet 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.

Journal article

Bloom CI, Feary J, Jarvis D, Saglani S, Quint JKet 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

Conference paper

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