Publications
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Bloom C, walker S, Quint J, 2019, Inadequate specialist care referrals for high risk asthma patients in the UK: an adult population-based cohort 2006-2017, Journal of Asthma, Vol: 58, Pages: 19-25, ISSN: 0021-9134
Objective: To improve asthma morbidity and mortality in the UK, national asthma guidelines recommend referral to specialist care for the following high risk groups, after a hospital admission for asthma, ≥3 courses of oral corticosteroids (OCS) in 12-months, an incident high-dose inhaled corticosteroid (ICS) prescription or addition of a fourth asthma drug to a patient’s maintenance regimen. We sought to assess the prevalence and temporal change of referrals to identify unmet needs.Methods: We used UK electronic healthcare records, 2006-2017, to identify high risk asthma patients managed within primary care. Referrals to respiratory clinics in secondary care were measured, within 3 months before or 6 months after, an incident ICS, third OCS in a year, or fourth asthma drug; or 12 months after a hospital admission for asthma. A nested case-control and conditional logistic regression was used to evaluate factors associated with receiving a referral.Results: 246,116 asthma patients were eligible. There was a slight increase in secondary care referrals from 2014 onwards but the percentage remained low with <20% in each high risk group referred for specialist care. The factors in the past year that were most strongly associated with receiving a referral were a hospital admission or A&E visit for asthma, ≥3 OCS courses, ≥2 add-on drugs, or high-dose ICS prescription.Conclusion: The majority of high risk asthma patients were not referred for specialist care, as recommended by national guidelines. Compared to other risk factors, those admitted to hospital were most likely to receive a referral.
Gulea C, Zakeri R, Quint JK, 2019, Reply to letter to the editor by Dr. Jolobe, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 292, Pages: 161-161, ISSN: 0167-5273
Cromar KR, Duncan BN, Bartonova A, et al., 2019, Air pollution monitoring for health research and patient care an official American Thoracic Society workshop report, Annals of the American Thoracic Society, Vol: 16, Pages: 1207-1214, ISSN: 1546-3222
Air quality data from satellites and low-cost sensor systems, together with output from air quality models, have the potential to augment high-quality, regulatory-grade data in countries with in situ monitoring networks and provide much-needed air quality information in countries without them. Each of these technologies has strengths and limitations that need to be considered when integrating them to develop a robust and diverse global air quality monitoring network. To address these issues, the American Thoracic Society, the U.S. Environmental Protection Agency, the National Aeronautics and Space Administration, and the National Institute of Environmental Health Sciences convened a workshop in May 2017 to bring together global experts from across multiple disciplines and agencies to discuss current and near-term capabilities to monitor global air pollution. The participants focused on four topics: 1) current and near-term capabilities in air pollution monitoring, 2) data assimilation from multiple technology platforms, 3) critical issues for air pollution monitoring in regions without a regulatory-quality stationary monitoring network, and 4) risk communication and health messaging. Recommendations for research and improved use were identified during the workshop, including a recognition that the integration of data across monitoring technology groups is critical to maximizing the effectiveness (e.g., data accuracy, as well as spatial and temporal coverage) of these monitoring technologies. Taken together, these recommendations will advance the development of a global air quality monitoring network that takes advantage of emerging technologies to ensure the availability of free, accessible, and reliable air pollution data and forecasts to health professionals, as well as to all global citizens.
Snell N, Gibson J, Jarrold I, et al., 2019, Epidemiology of bronchiectasis in the UK: findings from the British Lung Foundation's 'Respiratory Health of the Nation' project, Respiratory Medicine, Vol: 158, Pages: 21-23, ISSN: 0954-6111
Key findings of this national survey of non-cystic fibrosis bronchiectasis epidemiology were that its prevalence, incidence and mortality have all increased over recent years; we estimate that around 212,000 people are currently living with bronchiectasis in the UK, very much higher than commonly quoted figures. Bronchiectasis is more common in females than males; 60% of diagnoses are made in the over-70 age group. Regional differences in prevalence, incidence, mortality, and hospital admission were identified. An intriguing finding was that bronchiectasis is more commonly diagnosed in the least deprived sections of the population, in contrast to other respiratory disorders.
Sinha I, calvert J, Hickman C, et al., 2019, National asthma and COPD audit programme and the NHS long term plan, Lancet Respiratory Medicine, Vol: 7, Pages: 841-841, ISSN: 2213-2600
Respiratory illness features heavily in the NHS Long Term Plan.1 The well described drivers to improve outcomes in the most prevalent respiratory conditions, COPD and asthma, include variation in care standards and outcome2, and higher rates of mortality and hospitalisation than most other European countries3,4. In this paper we discuss how the National Asthma and COPD Audit Programme (NACAP) can support the aspirations within the long term plan to improve outcomes for people with COPD and asthma.
Quint J, O'Leary C, Venerus A, et al., 2019, Triple Therapy Pathways: A Multi-Country, Retrospective Observational Study in Chronic Obstructive Pulmonary Disease (COPD), International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Bloom C, Quint J, Cabrera C, 2019, SABA and ICS use among mild asthma patients in UK primary care, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Bloom C, Walker S, Quint J, 2019, Under-referral of high risk asthma patients to specialist care in England, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Lenoir A, Potts J, Quint J, et al., 2019, Who do we exclude if we only consider subjects with excellent quality spirometry? Analysis of UK Biobank longitudinal data, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Wing K, Williamson E, Carpenter J, et al., 2019, Real World Effects of Medications for COPD - a UK Population-Based Non-Interventional Cohort Study With Validation Against Randomised Trial Results, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Gayle A, Minelli C, Quint J, 2019, Risk of respiratory-related death in individualswith COPD and asthma: a competing risk analysis, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Trung T, King E, Sarkar R, et al., 2019, Oral corticosteroid prescription patterns in asthma care in Italy, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Gulea C, Zakeri R, Quint JK, 2019, Missed opportunity to manage COPD in patients hospitalised for heart failure, European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Bloom C, Quint J, 2019, How common is stepping-down asthma treatment in England?, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Whittaker H, Pimenta J, Kiddle S, et al., 2019, Rate of FVC decline in a primary care UK Chronic Obstructive Pulmonary Disease (COPD) population, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Stone P, Stone R, Mcmillan V, et al., 2019, Does 7-day working improve outcomes for COPD?, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Stone P, Stone R, Mcmillan V, et al., 2019, Does the COPD Best Practice Tariff improve patient outcomes?, International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Jones A, Evans R, Man W, et al., 2019, Outcome measures in a combined exercise rehabilitation programme for COPD and chronic heart failure patients: a stakeholder consensus event, Chronic Respiratory Disease, Vol: 16, ISSN: 1479-9723
Combined exercise rehabilitation for chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) is potentially attractive. Uncertainty remains as to the baseline profiling assessments and outcome measures that should be collected within a programme. Current evidence surrounding outcome measures in cardiac and pulmonary rehabilitation were presented by experts at a stakeholder consensus event and all stakeholders (n = 18) were asked to (1) rank in order of importance a list of categories, (2) prioritise outcome measures and (3) prioritise baseline patient evaluation measures that should be assessed in a combined COPD and CHF rehabilitation programme. The tasks were completed anonymously and related to clinical rehabilitation programmes and associated research. Health-related quality of life, exercise capacity and symptom evaluation were voted as the most important categories to assess for clinical purposes (median rank: 1, 2 and 3 accordingly) and research purposes (median rank; 1, 3 and 4.5 accordingly) within combined exercise rehabilitation. All stakeholders agreed that profiling symptoms at baseline were ‘moderately’, ‘very’ or ‘extremely’ important to assess for clinical and research purposes in combined rehabilitation. Profiling of frailty was ranked of the same importance for clinical purposes in combined rehabilitation. Stakeholders identified a suite of multidisciplinary measures that may be important to assess in a combined COPD and CHF exercise rehabilitation programme.
Gulea C, Zakeri R, Quint JK, 2019, Impact of chronic obstructive pulmonary disease on readmission after hospitalization for acute heart failure: A nationally representative US cohort study, International Journal of Cardiology, Vol: 290, Pages: 113-118, ISSN: 0167-5273
BackgroundPatients hospitalized for heart failure (HF) are at high risk of readmission. Chronic obstructive pulmonary disease (COPD) is one of the most prevalent comorbidities in this population. However, few data and only small studies describe the impact of COPD on the risk of readmission.Methods and resultsHospitalizations for HF were identified in the 2012 National Readmissions Database. We compared clinical characteristics and the risk of all-cause, cardiovascular (CV) and respiratory-related readmission for patients with and without COPD. We included 225,160 patients hospitalized for HF among whom 54,953 had comorbid COPD. Patients with COPD were younger (median age 76 years COPD versus 77 years without COPD; p < 0.001), had a higher burden of comorbidity and were more frequently male (53% versus 49%, p < 0.001). Thirty-day all-cause readmission risk was two-fold greater in patients with COPD compared to those without COPD (adjusted HR 2.02, 95%CI 1.97–2.08). Most readmissions were attributed to a CV cause, though fewer patients with COPD had a CV admission (49% versus 51% without COPD). COPD was independently associated with significantly more frequent unplanned respiratory-related readmission (adjusted HR 2.90, 95%CI 2.68–3.15) as well as CV readmission risk (adjusted HR 1.92, 95%CI 1.85–1.99).ConclusionsIn patients hospitalized for HF, most readmissions are due to a CV cause. However, patients with comorbid COPD are at a significantly elevated risk of respiratory in addition to CV-related readmission. These data stress the importance of a multidisciplinary management approach, including optimization of non-CV conditions, in order to reduce readmissions post index HF hospitalization.
Roche N, Anzueto A, Anticevich SB, et al., 2019, The importance of real-life research in respiratory medicine: manifesto of the Respiratory Effectiveness Group, European Respiratory Journal, Vol: 54, Pages: 1-6, ISSN: 0903-1936
Chatzidiakou L, Krause A, Popoola OAM, et al., 2019, Characterising low-cost sensors in highly portable platforms to quantify personal exposure in diverse environments, Atmospheric Measurement Techniques, Vol: 12, Pages: 4643-4657, ISSN: 1867-1381
The inaccurate quantification of personal exposure to air pollution introduces error and bias in health estimations, severely limiting causal inference in epidemiological research worldwide. Rapid advancements in affordable, miniaturised air pollution sensor technologies offer the potential to address this limitation by capturing the high variability of personal exposure during daily life in large-scale studies with unprecedented spatial and temporal resolution. However, concerns remain regarding the suitability of novel sensing technologies for scientific and policy purposes. In this paper we characterise the performance of a portable personal air quality monitor (PAM) that integrates multiple miniaturised sensors for nitrogen oxides (NOx), carbon monoxide (CO), ozone (O3) and particulate matter (PM) measurements along with temperature, relative humidity, acceleration, noise and GPS sensors. Overall, the air pollution sensors showed high reproducibility (mean R¯¯¯2=0.93, min–max: 0.80–1.00) and excellent agreement with standard instrumentation (mean R¯¯¯2=0.82, min–max: 0.54–0.99) in outdoor, indoor and commuting microenvironments across seasons and different geographical settings. An important outcome of this study is that the error of the PAM is significantly smaller than the error introduced when estimating personal exposure based on sparsely distributed outdoor fixed monitoring stations. Hence, novel sensing technologies such as the ones demonstrated here can revolutionise health studies by providing highly resolved reliable exposure metrics at a large scale to investigate the underlying mechanisms of the effects of air pollution on health.
Sapey E, Bafadhel M, Bolton C, et al., 2019, Building toolkits for COPD exacerbations: lessons from the past and present, Thorax, Vol: 74, ISSN: 1468-3296
In the nineteenth century it was recognised that acute attacks of chronic bronchitis were harmful. One hundred and forty years later, it is clearer than ever that exacerbations of Chronic Obstructive Pulmonary Disease (ECOPD) are important events. They are associated with significant mortality, morbidity, a reduced quality of life and an increasing reliance on social care. ECOPD are common and are increasing in prevalence. Exacerbations beget exacerbations, with up to a quarter of in-patient episodes ending with readmission to hospital within 30 days. The healthcare costs are immense. Yet despite this, the tools available to diagnose and treat ECOPD are essentially unchanged, with the last new intervention (non-invasive ventilation) introduced over twenty-five years ago. An ECOPD is “an acute worsening of respiratory symptoms that results in additional therapy”. This symptom and healthcare utility-based definition does not describe pathology and is unable to differentiate from other causes of an acute deterioration in breathlessness with or without a cough and sputum. There is limited understanding of the host immune response during an acute event and no reliable and readily available means to identify aetiology or direct treatment at the point of care. Corticosteroids, short acting bronchodilators with or without antibiotics have been the mainstay of treatment for over thirty years. This is in stark contrast to many other acute presentations of chronic illness, where specific biomarkers and mechanistic understanding has revolutionised care pathways. So why has progress been so slow in ECOPD? This review examines the history of diagnosing and treating ECOPD. It suggests that to move forward, there needs to be an acceptance that not all exacerbations are alike (just as not all COPD is alike) and that clinical presentation alone cannot identify aetiology or stratify treatment.LAY SUMMARY: Patients with Chronic Obstructive Pulmonary Diseas
Tran TN, King E, Sarkar R, et al., 2019, Oral corticosteroid prescription patterns in asthma care in the UK and Germany, Congress of the European-Academy-of-Allergy-and-Clinical-Immunology (EAACI), Publisher: WILEY, Pages: 37-37, ISSN: 0105-4538
Wolf A, Dedman D, Williams R, et al., 2019, Feasibility of using electronic health records to identify patients with chronic obstructive pulmonary disease to enroll into pragmatic trials, Publisher: WILEY, Pages: 200-201, ISSN: 1053-8569
Wing K, Williamson E, Carpenter J, et al., 2019, Real world effects of medications for chronic obstructive pulmonary disease: a UK population-based non-interventional cohort study with validation against randomized trial results, Publisher: WILEY, Pages: 429-429, ISSN: 1053-8569
Gayle A, dickinson S, poole C, et al., 2019, Incidence of type II diabetes in chronic obstructive pulmonary disease: A nested case-control study, npj Primary Care Respiratory Medicine, Vol: 29, ISSN: 2055-1010
We investigated the incidence of type II diabetes mellitus (T2DM) among people with COPD and whether exposure to inhaled corticosteroid (ICS) and exacerbation status was associated with T2DM. This descriptive cohort study used primary care data from the Clinical Practice Research Datalink (CPRD). The patient cohort included people with a diagnosis of COPD and previous smoking history registered at a CPRD practice between January 2010 and December 2016. We determined incidence rates by age, gender and deprivation. Using a nested case–control design—where cases and controls are drawn from the cohort population—we matched 1:5 with patients by age, gender and GP practice and estimated odds of T2DM using logistic regression (adjusting for smoking status, deprivation, BMI, hypertension, coronary heart disease and heart failure). We identified 220,971 COPD patients; mean age at COPD diagnosis was 66 years (SD 12) and 54% were male. The incidence rate of T2DM in COPD patients was 1.26 per 100 patient years (95% CI: 1.24–1.28) and was higher among men (1.32 vs 1.18 among women). The adjusted odds ratio for T2DM was 1.47 (95% CI: 1.36–1.60) among frequent exacerbators (≥2 treated exacerbations per year) compared to infrequent exacerbators and the odds ratio for patients receiving high-dose ICS (>800 mcg budesonide equivalent dose) was 1.73 (95% CI 1.65–1.82) compared to patients receiving no ICS therapy. Incidence of T2DM among COPD patients is high and exposure to ICS and frequent exacerbations are associated with a higher risk of T2DM among patients with COPD.
Elbehairy A, Quint J, Rogers J, et al., 2019, Prevalence of breathlessness and associated consulting behaviour: results of an online survey, Thorax, Vol: 74, Pages: 814-817, ISSN: 1468-3296
The online British Lung Foundation Breath Test provides an opportunity to study the relationship between breathlessness, common sociobehavioural risk factors and interaction with healthcare. We analysed data from 356 799 responders: 71% were ≥50 years old and 18% were smokers. 20% reported limiting breathlessness (Medical Research Council breathlessness score ≥3), and the majority of these (85%) worried about their breathing; of these, 29% had not sought medical advice. Of those who had, 58% reported that the advice received had not helped their breathlessness. Limiting breathlessness was associated with being older, physically inactive, smoking and a higher body mass index. These data suggest a considerable unmet need associated with breathlessness as well as possibilities for intervention.
Honeyford K, Bell D, Chowdhury F, et al., 2019, Unscheduled hospital contacts after inpatient discharge: A national observational study of COPD and heart failure patients in England, PLoS ONE, Vol: 14, ISSN: 1932-6203
IntroductionReadmissions are a recognised challenge for providers of healthcare and incur financial penalties in a growing number of countries. However, the scale of unscheduled hospital contacts including attendances at emergency departments that do not result in admission is not well known. In addition, little is known about the route to readmission for patients recently discharged from an emergency hospital stay.MethodsThis is an observational study of national hospital administration data for England. In this retrospective cohort study, we tracked patients for 30 days after discharge from an emergency admission for heart failure (HF) or chronic obstructive pulmonary disorder (COPD).ResultsThe majority of patients (COPD:79%; HF:75%) had no unscheduled contact with secondary health care within 30 days of discharge. Of those who did have unscheduled contact, the most common first unscheduled contact was emergency department (ED) attendance (COPD:16%; HF:18%). A further 5% of COPD patients and 4% of HF patients were admitted for an emergency inpatient stay, but not through the ED. A small percentage of patients (COPD:<1%, HF:2%) died without any known contact with secondary care. ED conversion rates at first attendance for both COPD and HF were high: 75% and 79% respectively. A quarter of patients who were not admitted during this first ED attendance attended the ED again within the 30-day follow-up period, and around half (COPD:56%; HF:63%) of these were admitted at this point.Patients who live alone, had an index admission which included an overnight stay and were comorbid had higher odds of being admitted through the ED than via other routes.ConclusionWhile the majority of patients did not have unscheduled contact with secondary care in the 30 days after index discharge, many patients attended the ED, often multiple times, and many were admitted to hospital, not always via the ED. More frail patients were more likely to be admitted through the ED, suggesting a
Whittaker HR, Muellerova H, Jarvis D, et al., 2019, Inhaled corticosteroids, blood eosinophils, and FEV1 decline in patients with COPD in a large UK primary health care setting, International Journal of Chronic Obstructive Pulmonary Disease, Vol: 2019, Pages: 1063-1073, ISSN: 1176-9106
Background: Inhaled corticosteroid (ICS)-containing medications slow rate of decline of FEV1. Blood eosinophil (EOS) levels are associated with the degree of exacerbation reduction with ICS.Purpose: We investigated whether FEV1 decline differs between patients with and without ICS, stratified by blood EOS level.Patients and methods: The UK Clinical Practice Research Datalink (primary care records) and Hospital Episode Statistics (hospital records) were used to identify COPD patients aged 35 years or older, who were current or ex-smokers with ≥2 FEV1 measurements ≥6 months apart. Prevalent ICS use and the nearest EOS count to start of follow-up were identified. Patients were classified at baseline as higher stratum EOS (≥150 cell/μL) on ICS; higher stratum EOS not on ICS; lower stratum EOS (<150 cells/μL) on ICS; and lower stratum EOS not on ICS. In addition, an incident ICS cohort was used to investigate the rate of FEV1 change by EOS and incident ICS use. Mixed-effects linear regression was used to compare rates of FEV1 change in mL/year.Results: A total of 26,675 COPD patients met our inclusion criteria (median age 69, 46% female). The median duration of follow up was 4.2 years. The rate of FEV1 change in prevalent ICS users was slower than non-ICS users (−12.6 mL/year vs −21.1 mL/year; P =0.001). The rate of FEV1 change was not significantly different when stratified by EOS level. The rate of FEV1 change in incident ICS users increased (+4.2 mL/year) vs −21.2 mL/year loss in non-ICS users; P<0.001. In patients with high EOS, incident ICS patients showed an increase in FEV1 (+12 mL/year) compared to non-ICS users whose FEV1 decreased (−20.8 mL/year); P<0.001. No statistical difference was seen in low EOS patients. Incident ICS use is associated with an improvement in FEV1 change, however, over time this association is lost.Conclusion: Regardless of blood EOS level, prevalent ICS use is associated with slower rates of
Gayle A, Axson E, Bloom C, et al., 2019, Changing causes of death for patients with chronic respiratory disease in England, 2005-2015, Thorax, Vol: 74, Pages: 483-491, 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.
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