179 results found
Elbehairy A, Quint J, Rogers J, et al., Prevalence of breathlessness and associated consulting behaviour: results of an online surveyŢŢ, Thorax, ISSN: 1468-3296
Jayatunga W, Stone P, Aldridge RW, et al., 2019, Code sets for respiratory symptoms in electronic health records research: a systematic review protocol., BMJ Open, Vol: 9
INTRODUCTION: Asthma and chronic obstructive pulmonary disease (COPD) are common respiratory conditions, which result in significant morbidity worldwide. These conditions are associated with a range of non-specific symptoms, which in themselves are a target for health research. Such research is increasingly being conducted using electronic health records (EHRs), but computable phenotype definitions, in the form of code sets or code lists, are required to extract structured data from these large routine databases in a systematic and reproducible way. The aim of this protocol is to specify a systematic review to identify code sets for respiratory symptoms in EHRs research. METHODS AND ANALYSIS: MEDLINE and Embase databases will be searched using terms relating to EHRs, respiratory symptoms and use of code sets. The search will cover all English-language studies in these databases between January 1990 and December 2017. Two reviewers will independently screen identified studies for inclusion, and key data will be extracted into a uniform table, facilitating cross-comparison of codes used. Disagreements between the reviewers will be adjudicated by a third reviewer. This protocol has been produced in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. ETHICS AND DISSEMINATION: As a review of previously published studies, no ethical approval is required. The results of this review will be submitted to a peer-reviewed journal for publication and can be used in future research into respiratory symptoms that uses electronic healthcare databases. PROSPERO REGISTRATION NUMBER: CRD42018100830.
Nissen F, Quint JK, Morales DR, et al., 2019, How to validate a diagnosis recorded in electronic health records., Breathe (Sheff), Vol: 15, Pages: 64-68, ISSN: 1810-6838
Systematic measurement errors in electronic health record databases can lead to large inferential errors. Validation techniques can help determine the degree of these errors and therefore aid in the interpretation of findings. http://ow.ly/iHQ630np4xU.
campbell J, perry R, papadopoulos N, et al., The REal Life EVidence AssessmeNt Tool (RELEVANT): development of a novel quality assurance asset to rate observational comparative effectiveness research studies, Clinical and Translational Allergy, ISSN: 2045-7022
Lewis A, Axson EL, Potts J, et al., 2019, Protocol for a systematic literature review and network meta-analysis of the clinical benefit of inhaled maintenance therapies in chronic obstructive pulmonary disease., BMJ Open, Vol: 9
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) exacerbations progress the course of disease and impair lung function. Inhaled maintenance therapy reduces exacerbations. It is not yet established which inhaled therapy combination is best to reduce exacerbations, lung function decline and symptom burden. METHODS AND ANALYSIS: MEDLINE, EMBASE and the Cochrane Library will be searched for articles between January 2011 and May 2018 using a pre-specified search strategy. Conference proceedings will be searched. Systematic reviews (with or without meta-analysis), randomised controlled trials (RCTs), cohort studies and case controlled studies comparing six interventions comprising different combinations of long-acting bronchodilators and inhaled corticosteroids in unison or on their own. The primary outcome is the reduction in moderate-to-severe exacerbations. Secondary outcomes include: lung function, quality of life, mortality and other adverse events. Titles and abstracts will screened by the primary researcher. A second reviewer will repeat this on a proportion of records. The Population, Intervention, Comparator, Outcomes and Study framework will be used for data extraction. A network meta-analyses of outcomes from RCTs and real-world evidence will be integrated if feasible. The 95% credible interval will be used to assess the statistical significance of each summary effect. Ranking of interventions will be based on their surface under cumulative ranking area. ETHICS AND DISSEMINATION: COPD exacerbations are burdensome to patients. We aim to report results that provide clinicians with a more informed choice of which inhaled therapy combinations are best to reduce exacerbations, improve disease burden and reduce lung function and exercise capacity decline, compared with the potential harms, in certain populations with COPD. PROSPERO REGISTRATION NUMBER: CRD42018088013.
Quint JK, Smith MP, 2019, Paediatric and adult bronchiectasis: Diagnosis, disease burden and prognosis., Respirology
Bronchiectasis is a chronic, debilitating disease with increasing worldwide prevalence and burden. Accurate and early diagnosis is essential for both its management and prognosis. This review will discuss the diagnosis of bronchiectasis, the international burden of the disease and its current prognosis.
Bloom CI, Palmer T, Feary J, et al., 2019, 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
Bloom CI, Saglani S, Feary J, et al., 2019, Changing prevalence of current asthma and inhaled corticosteroid treatment in the UK: population based cohort 2006-2016., Eur Respir J
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, 2006-2016, 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.
Quint JK, Minelli C, 2019, Can't see the wood for the trees: confounders, colliders and causal inference - a clinician's approach., Thorax
Janson C, Accordini S, Cazzoletti L, et al., 2019, Pharmacological treatment of asthma in a cohort of adults during a 20-year period: results from the European Community Respiratory Health Survey I, II and III., ERJ Open Res, Vol: 5, ISSN: 2312-0541
Asthma often remains uncontrolled, despite the fact that the pharmacological treatment has undergone large changes. We studied changes in the treatment of asthma over a 20-year period and identified factors associated with the regular use of inhaled corticosteroid (ICS) treatment. Changes in the use of medication were determined in 4617 randomly selected subjects, while changes in adults with persistent asthma were analysed in 369 participants. The study compares data from three surveys in 24 centres in 11 countries. The use of ICSs increased from 1.7% to 5.9% in the general population and the regular use of ICSs increased from 19% to 34% among persistent asthmatic subjects. The proportion of asthmatic subjects reporting asthma attacks in the last 12 months decreased, while the proportion that had seen a doctor in the last 12 months remained unchanged (42%). Subjects with asthma who had experienced attacks or had seen a doctor were more likely to use ICSs on a regular basis. Although ICS use has increased, only one-third of subjects with persistent asthma take ICSs on a regular basis. Less than half had seen a doctor during the last year. This indicates that underuse of ICSs and lack of regular healthcare contacts remains a problem in the management of asthma.
Roche N, Campbell J, Krishnan J, et al., Quality standards in respiratory real-life effectiveness research: The REal Life EVidence AssessmeNt Tool (RELEVANT). Report from the Respiratory Effectiveness Group – European Academy of Allergy and Clinical Immunology Task Force, Clinical and Translational Allergy, ISSN: 2045-7022
A Task Force was commissioned jointly by the European Academy of Allergy and Clinical Immunology (EAACI) and the Respiratory Effectiveness Group (REG) to develop a quality assessment tool for real-life observational research to identify high-quality real-life asthma studies that could be considered within future guideline development. The resulting REal Life EVidence AssessmeNt Tool (RELEVANT) was achieved through an extensive analysis of existing initiatives in this area. The first version was piloted among 9 raters across 6 articles; the revised, interim, version underwent extensive testing by 22 reviewers from the EAACI membership and REG collaborator group, leading to further revisions and tool finalisation. RELEVANT was validated through an analysis of real-life effectiveness studies identified via systematic review of Medline and Embase databases and relating to topics for which real-life studies may offer valuable evidence complementary to that from randomised controlled trials. The topics were selected through a vote among Task Force members and related to the influence of adherence, smoking, inhaler device and particle size on asthma treatment effectiveness. Although highlighting a general lack of high-quality real-life effectiveness observational research on these clinically important topics, the analysis provided insights into how identified observational studies might inform asthma guidelines developers and clinicians. Overall, RELEVANT appeared reliable and easy to use by expert reviewers. Using such quality appraisal tools is mandatory to assess whether specific observational real-life effectiveness studies can be used to inform guideline development and/or decision-making in clinical practice.
Gayle A, Axson E, Bloom C, et al., 2019, Changing causes of death for chronic respiratory disease patients in England, 2005-2015, Thorax, ISSN: 1468-3296
Background Chronic respiratory diseases (CRD) are common, are increasing in prevalence, and cause significant morbidity and mortality worldwide. However, we have limited knowledge on causes of death of patients with CRD in the general population.Objective We evaluated mortality rates and causes of death over time in patients with CRD.Methods We used linked primary care and mortality data to determine mortality rates and the most common causes of death in people with CRD (including asthma, bronchiectasis, COPD and interstitial lung diseases (ILD)) during 2005–2015 in England.Results We identified 558 888 patients with CRD (451 830 asthma, 137 709 COPD, 19 374 bronchiectasis, 10 745 ILD). The age-standardised mortality rate of patients with CRD was 1607 per 100 000 persons (asthma=856, COPD=1503, ILD=2609, bronchiectasis=1463). CRD mortality was overall 54% higher than the general population. A third of patients with CRD died from respiratory-related causes. Respiratory-related mortality was constant, while cardiovascular-related mortality decreased significantly over time. COPD accounted for the majority of respiratory-related deaths (66% overall) in all patient groups except ILD.Conclusions Patients with CRD continue to experience substantial morbidity and mortality due to respiratory diseases. Disease-modifying intervention strategies are needed to improve outcomes for patients with CRD.
Lewis A, Dullaghan D, Townes H, et al., An observational cohort study of exercise and education for people with Chronic Obstructive Pulmonary Disease not meeting criteria for formal Pulmonary Rehabilitation Programmes, Chronic Respiratory Disease, ISSN: 1479-9723
Objectives:Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality. Pulmonary Rehabilitation (PR) is offered to patients with functional breathlessness. However, access to PR is limited. The objective of this study was to evaluate whether a four week education and exercise programme offered to COPD patients with Medical Research Council (MRC) dyspnoea 1-2 improves disease self-management. Methods:Patients were recruited by their GP to attend four weekly, two- hour sessions provided by a multidisciplinary team. Patients completed outcome measures before and after the programme.Results:Forty two patients entered The programme and 26 out of 42 (61.9%) completed all sessions. The Bristol COPD Knowledge Questionnaire and Patient Activation Measure improved (both p≤0.001). Disease burden was not reduced according to the COPD Assessment Test. All patients accepted a referral for ongoing exercise. Fourteen current smokers (81.3%) accepted a referral for smoking cessation, 3 patients with anxiety or depression (37.5%) accepted a psychological therapies referral.Discussion:The programme improved COPD disease knowledge, patient activation and stimulated referrals to further services supporting disease management. Randomised controlled trials are warranted for similar interventions for COPD patients with early stage disease.
Bloom CI, Elkin SL, Quint JK, 2019, Changes in COPD inhaler prescriptions in the United Kingdom, 2000 to 2016, INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, Vol: 14, Pages: 279-287, ISSN: 1178-2005
Nissen F, Douglas IJ, Mullerova H, et al., 2019, Clinical profile of predefined asthma phenotypes in a large cohort of UK primary care patients (Clinical Practice Research Datalink), JOURNAL OF ASTHMA AND ALLERGY, Vol: 12, Pages: 7-19, ISSN: 1178-6965
Axson EL, Bual N, Bloom CI, et al., 2019, Risk factors and secondary care utilisation in a primary care population with non-tuberculous mycobacterial disease in the UK, EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, Vol: 38, Pages: 117-124, ISSN: 0934-9723
Nissen F, Quint J, Morales D, et al., Doing science: How to validate a diagnosis recorded in electronic health records, Breathe, ISSN: 2073-4735
Amaral AFS, Quint JK, 2018, Cottage by the sea or house above the trees: which is better for my lungs?, THORAX, Vol: 73, Pages: 1103-1104, ISSN: 0040-6376
Gulea C, Zakeri R, Quint JK, 2018, Effect of beta-blocker therapy on clinical outcomes, safety, health-related quality of life and functional capacity in patients with chronic obstructive pulmonary disease (COPD): a protocol for a systematic literature review and meta-analysis with multiple treatment comparison, BMJ OPEN, Vol: 8, ISSN: 2044-6055
Nissen F, Morales DR, Mullerova H, et al., 2018, Concomitant diagnosis of asthma and COPD: a quantitative study in UK primary care., Br J Gen Pract, Vol: 68, Pages: e775-e782
BACKGROUND: Asthma and chronic obstructive pulmonary disease (COPD) share many characteristics and symptoms, and the differential diagnosis between the two diseases can be difficult in primary care. This study explored potential overlap between both diseases in a primary care environment. AIM: To quantify how commonly patients with COPD have a concomitant diagnosis of asthma, and how commonly patients with asthma have a concomitant diagnosis of COPD in UK primary care. Additionally, the study aimed to determine the extent of possible misdiagnosis and missed opportunities for diagnosis. DESIGN AND SETTING: Patients with validated asthma and patients with validated COPD in primary care were identified from the UK Clinical Practice Research Datalink (CPRD) in separate validation studies, and the diseases were confirmed by review of GP questionnaires. METHOD: The prevalence of concurrent asthma and COPD in validated cases of either disease was examined based on CPRD coding, GP questionnaires, and requested additional information. RESULTS: In total, 400 patients with COPD and 351 patients with asthma in primary care were identified. Of the patients with validated asthma, 15% (n = 52) had previously received a diagnostic COPD Read code, although COPD was only likely in 14.8% (95% confidence interval [CI] = 11.3 to 19.0) of patients with validated asthma. More than half (52.5%, n = 210) of patients with validated COPD had previously received a diagnostic asthma Read code. However, when considering additional evidence to support a diagnosis of asthma, concurrent asthma was only likely in 14.5% (95% CI = 11.2 to 18.3) of patients with validated COPD. CONCLUSION: A concurrent asthma and COPD diagnosis appears to affect a relative minority of patients with COPD (14.5%) or asthma (14.8%). Asthma diagnosis may be over-recorded in people with COPD.
Connell O, Whittaker H, Elbehairy A, et al., 2018, Eligibility for lung volume reduction surgery in COPD patients identified in a UK primary care setting, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Axson E, Bloom C, Obradovic M, et al., 2018, Nontuberculous mycobacterial disease within UK primary care, 2006-2016, 28th International Congress of the European-Respiratory-Society (ERS)
Stone P, Mcmillan V, Holzhauer-Barrie J, et al., 2018, What's in a postcode? Socioeconomic deprivation in the primary care 2015-17 COPD audit, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Gayle A, Axson E, Bloom C, et al., 2018, Changing causes of mortality for people with chronic respiratory diseases, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Garnavos G, McMillan V, Holzhauer-Barrie J, et al., 2018, Severe mental illness in COPD patients: findings from the primary care 2015-17 COPD audit, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Gayle A, Axson E, Bloom C, et al., 2018, Mortality rates of COPD Patients in UK Electronic Health Records (Clinical Practice Research Datalink), 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Whittaker H, Mullerova H, Jarvis D, et al., 2018, Late Breaking Abstract - Inhaled corticosteroids (ICS), blood eosinophils (EOS), and FEV1 decline in patients with Chronic Obstructive Pulmonary Disease in a large UK primary healthcare setting, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Morgan AD, Rothnie KJ, Bhaskaran K, et al., 2018, Chronic obstructive pulmonary disease and the risk of 12 cardiovascular diseases: a population-based study using UK primary care data, THORAX, Vol: 73, Pages: 877-879, ISSN: 0040-6376
Axson EL, Bloom C, Quint JK, 2018, Nontuberculous mycobacterial disease managed within UK primary care, 2006-2016, EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, Vol: 37, Pages: 1795-1803, ISSN: 0934-9723
Axson E, Sundaram V, Gayle A, et al., P67 Temporal trends in heart failure incidence among patients with COPD and all-cause mortality of patients with comorbid COPD and heart failure in UK primary care, 2006–2016, BTS Winter Meeting, Publisher: BMJ Publishing Group, ISSN: 1468-3296
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