Publications
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Karsanji U, Lawson CA, Bottle A, et al., 2022, DESCRIBING LONG-TERM OUTCOMES AND THE ASSOCIATION WITH BOTH RECEIVING A DIAGNOSIS AND TIME TO DIAGNOSIS IN ADULTS PRESENTING WITH BREATHLESSNESS: A UK RETROSPECTIVE STUDY USING ELECTRONIC HEALTHCARE RECORDS, Winter Meeting of the British-Thoracic-Society (BTS), Publisher: BMJ PUBLISHING GROUP, Pages: A179-A180, ISSN: 0040-6376
Stone P, Hickman K, Holmes S, et al., 2022, Comparison of COPD primary care in England, Scotland, Wales, and Northern Ireland, npj Primary Care Respiratory Medicine, Vol: 32, ISSN: 2055-1010
Currently the National Asthma and COPD audit programme (NACAP) only undertakes audit of COPD primary care in Wales due to its near complete data coverage. We aimed to determine if the quality of COPD primary care in the other UK nations is comparable with Wales. We found that English, Scottish, and Northern Irish practices were significantly worse than Welsh practices at recording coded lung function parameters used in COPD diagnosis (ORs: 0.51 [0.43–0.59], 0.29 [0.23–0.36], 0.42 [0.31–0.58], respectively) and referring appropriate patients for pulmonary rehabilitation (ORs: 0.10 [0.09–0.11], 0.12 [0.11–0.14], 0.22 [0.19–0.25], respectively). Completing national audits of primary care in Wales only may have led to improvements in care, or at least improvements in the recording of care in Wales that are not occurring elsewhere in the UK. This highlights the potential importance of audit in improving care quality and accurate recording of that care.
Karsanji U, Evans RA, Quint JK, et al., 2022, Mortality associated with metabolic syndrome in people with COPD managed in primary care, ERJ OPEN RESEARCH, Vol: 8
Leavy OC, Kawano-Dourado L, Stewart ID, et al., 2022, Rheumatoid arthritis and idiopathic pulmonary fibrosis: a bidirectional Mendelian randomisation study
<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>A usual interstitial pneumonia (UIP) pattern of lung injury is a key feature of idiopathic pulmonary fibrosis (IPF) and is also observed in up to 40% of individuals with rheumatoid arthritis (RA) related Interstitial Lung Disease (RA-ILD). The RA-UIP phenotype could result from either a causal relationship of RA on UIP or vice versa, or from a simple co-occurrence of RA and IPF due to shared demographic, genetic or environmental risk factors.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We used two-sample bidirectional Mendelian Randomisation (MR) to investigate the causal effects of RA on UIP and of UIP on RA, using variants from genome-wide association studies of RA (separately for seropositive and seronegative RA) and of IPF as genetic instruments. We conducted inverse-variance-weighted fixed-effect MR as a primary analysis and undertook sensitivity analyses to assess potential violations of the key MR assumption of no (horizontal) pleiotropy.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Seropositive RA showed a significant protective effect on IPF (Odds Ratio, OR = 0.93; 95% Confidence Interval, CI: 0.87-0.99; <jats:italic>P</jats:italic>=0.032), while the MR in the other direction showed a strongly significant causal effect of IPF on seropositive RA (OR = 1.06, 95% CI: 1.04-1.08, <jats:italic>P</jats:italic>=1.22×10<jats:sup>−11</jats:sup>).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Our findings support the hypothesis that RA-UIP may be due to a cause-effect relationship between IPF and RA, rather than due to a coincidental occurrence of IPF in patients with RA. The causal effect of IPF on seropositive RA sugg
Daines L, Zheng B, Elneima O, et al., 2022, Characteristics and risk factors for persistent breathlessness after hospitalisation for COVID-19, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Karsanji U, Lawson CA, Quint JK, et al., 2022, Using UK primary care electronic health records to understand diagnostic pathways for chronic breathlessness, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Kelly JD, Curteis T, Rawal A, et al., 2022, Post-acute sequelae of SARS-CoV-2 among previously hospitalised individuals with COVID-19: a systematic literature review and meta-analysis, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Quint JK, Arnetorp S, Kocks JWH, et al., 2022, Short-acting β2-agonist exposure and severe asthma exacerbations: SABINA findings from Europe and North America, The Journal of Allergy and Clinical Immunology: In Practice, Vol: 10, Pages: 2297-2309.10, ISSN: 2213-2198
BackgroundExpert national/global asthma management recommendations raise the issue whether a safe threshold of short-acting β2-agonist (SABA) use without concomitant inhaled corticosteroids (ICS) exists.ObjectiveTo examine SABA and maintenance therapy associations with severe asthma exacerbations across North America and Europe.MethodsObservational analyses of 10 SABa use IN Asthma (SABINA) datasets involving 1,033,564 patients (≥12 years) from Canada, France, the Netherlands, Poland, Spain, United Kingdom (UK), and United States (US). Negative binomial models (incidence rate-ratio [95% confidence interval]) adjusted for prespecified-covariates]) evaluated associations between SABA and exacerbations.ResultsAcross severities, 40.2% of patients were prescribed/possessed ≥3 SABA canisters/year. Per GINA-2018 definitions, step 3‒5-treated patients prescribed/possessing ≥3 vs. 1‒2 SABA experienced more severe exacerbations (between 1.08 [1.04‒1.13], US-Medicare; 2.11 [1.96‒2.27], Poland). This association was not observed in all step 1‒2-treated patients (the Netherlands 1.25 [0.91‒1.71]; US-commercial 0.92 [0.91‒0.93]; US-Medicare 0.74 [0.71‒0.76]). We hypothesize that this inverse association between SABA and severe exacerbations in the US datasets was attributable to the large patient population possessing <3 SABA and no maintenance therapy and receiving oral corticosteroid bursts without face-to-face healthcare provider encounters. In US SABA monotherapy-treated patients, ≥3 SABA was associated with more emergency/outpatient visits and hospitalizations (1.31 [1.29‒1.34]). Most GINA 2‒5-treated study patients (60.6%) did not have maintenance therapy for up to 50% of the time; however, the association of ≥3 SABA and severe exacerbations persisted (1.32 [1.18‒1.49]) after excluding these patients and the independent effect was further confirmed when UK SABA data was analyzed as a continuous variable in patients with up to 100% annual coverage for
Griffiths M, O'Kane CM, Quint JK, 2022, Airwaves., Thorax, Vol: 77
Dashtban A, Mizani MA, Denaxas S, et al., 2022, A retrospective cohort study predicting and validating impact of the COVID-19 pandemic in individuals with chronic kidney disease, KIDNEY INTERNATIONAL, Vol: 102, Pages: 652-660, ISSN: 0085-2538
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- Citations: 7
Humbert M, Kovacs G, Hoeper MM, et al., 2022, 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension Developed by the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Endorsed by the International Society for Heart and Lung Transplantation (ISHLT) and the European Reference Network on rare respiratory diseases (ERN-LUNG), European Heart Journal, Pages: 1-114, ISSN: 0195-668X
Buttery S, Philip K, Alghamdi S, et al., 2022, Reporting of data on participant ethnicity and socioeconomic status in high-impact medical journals: A targeted literature review, BMJ Open, Vol: 12, ISSN: 2044-6055
Objectives: To assess the frequency of reporting of ethnicity (or ‘race’) and socioeconomic status (SES) indicators in high-impact journals.Design: Targeted literature reviewData sources: The 10 highest ranked general medical journals using Google scholar h5 index.Eligibility criteria: Inclusion criteria were, human research, reporting participant level data. Exclusion criteria were non-research article, animal/other non-human participant/subject; or no participant characteristics reported.Data extraction and synthesis: Working backwards from 19/04/2021 in each journal, two independent reviewers selected the 10 most recent articles meeting inclusion/exclusion criteria, to create a sample of 100 articles.Data on the frequency of reporting of ethnicity (or ‘race’) and SES indicators were extracted and presented using descriptive statistics.Results: Of one hundred research articles included, 35 reported ethnicity and 13 SES. By contrast, 99 reported age, and 97 reported sex or gender. Among the articles not reporting ethnicity only 3 (5%) highlighted this as a limitation, and only 6 (7%) where SES data were missing. Median number of articles reporting ethnicity per journal was 2.5/10 (range 0 to 9). Only 2 journals explicitly requested reporting of ethnicity (or race), and 1 requested SES. Conclusions: The majority of research published in high-impact medical journals does not include data on the ethnicity and socioeconomic status of participants, and this omission is rarely acknowledged as a limitation. This situation persists despite the well-established importance of this issue and ICMJE recommendations to include relevant demographic variables to ensure representative samples. Standardized explicit minimum standards are required.Strengths and Limitations of this study - This study included recent studies from a range of the highest impact general medical journals.- Different inclusion/exclusion criteria for articles could be justifiably use
Whittaker H, Van Ganse E, Dalon F, et al., 2022, Differences in severe exacerbations rates and health care utilisation in COPD populations in the UK and France, BMJ Open, Vol: 9, ISSN: 2044-6055
IntroductionChronic obstructive pulmonary disease (COPD) is a leading cause of mortality in Europe; however, it is important to understand how clinical practice patterns differ between countries and how this might relate to disease outcomes, to identify ways of improving local disease management. We aimed to describe and compare the management of COPD patients in the UK and France between 2008 and 2017. MethodsWe used data from the Clinical Practice Research Datalink GOLD and Hospital Episode Statistics in the UK and the Echantillon Généraliste des Bénéficiaire in France to identify COPD patients each year between 2008 and 2017. We compared patient characteristics, all-cause mortality, and COPD exacerbations each year between 2008 and 2017 for patients in the UK and France separately. Health care utilisation and COPD exacerbations in 2017 were compared between France and the UK using t-tests and chi-squared tests. ResultsCOPD patients were similar in gender and comorbidities in both countries. In the UK, incidence of COPD exacerbations remained stable in the UK and France between 2007-2017. In 2017, the proportion of all-cause and COPD-related hospitalisations was greater in the UK than in France (43.9% vs. 32.8% and 8.3% vs 4.9%, respectively; p<0.001) as was the proportion of patients visiting accident and emergency (39.8% vs 16.2%, respectively; p<0.001). In addition, the mean length of stay in hospital for COPD related causes was shorted in the UK than in France (6.2 days (SD 8.4) vs 10.5 days (SD 9.1), respectively; p<0.001). DiscussionOverall, UK patients were more likely to go to accident and emergency (A&E) and be hospitalised for COPD-related causes and stay in hospital for fewer days after being admitted for COPD-related reasons compared to patients in France, illustrating a difference in health-seeking behaviours and access to healthcare.
Evans RA, Leavy OC, Richardson M, et al., 2022, Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study, The Lancet Respiratory Medicine, Vol: 10, Pages: 761-775, ISSN: 2213-2600
BackgroundNo effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.MethodsThe Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.Findings2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7–9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46–0·99]), obes
Shah S, Quint J, Sheikh A, 2022, Impact of COVID-19 pandemic on asthma exacerbations: retrospective cohort study of over 500,000 patients in a national English primary care database, The Lancet Regional Health Europe, Vol: 19, Pages: 1-12, ISSN: 2666-7762
Background: Several countries reported a substantial reduction in asthma exacerbations associated with COVID-19 pandemic-related restrictions. However, it is not known if these early reported declines were short-term and if these have rebounded to pre-pandemic levels following easing of lockdown restrictions. Methods: We undertook a retrospective, cohort study of all asthma patients in a national primary care database of almost 10 million patients, Optimum Patient Care Database (OPCRD), identified from January 1, 2010, to December 31, 2015, using a previously validated algorithm. We subsequently followed the identified cohort of asthma patients from January 1, 2016, to October 3, 2021, and identified every asthma exacerbation episode with a validated algorithm. To quantify any pandemic-related change in exacerbations, we created a control time-series (mean of 2016-2019) and then compared the change in exacerbation rate in 2020-2021 over quarterly periods when compared with the control period (the pre-pandemic period). We undertook overall and stratified analyses by age group, sex, and English region. Findings: We identified 100,362 asthma patients (502,669 patient-years) from across England who experienced at least one exacerbation episode (298,390 exacerbation episodes during the entire follow-up). Except for the first quarter of 2020, the exacerbation rates were substantially lower (>25%) during all quarters in 2020-2021 when compared with the rates during 2016-2019 (39.7% (95% Confidence Interval (CI): 34.6, 44.9) in quarter-2, 2020; 46.5% (95%CI: 36.7, 56.4) in quarter-3, 2020; 56.3% (95%CI: 48.7, 63.9) in quarter-4, 2020; 63.2% (95%CI: 53.9, 72.5) in quarter-1, 2021; 57.7% (95%CI: 52.9, 62.4) in quarter-2, 2021; 53.3% (95%CI: 43.8, 62.8) in quarter-3, 2021).Interpretation: There was a substantial and persistent reduction in asthma exacerbations across England over the first 18 months after the first lockdown. This is unlikely to be adequately explained by c
Plekhanova T, Rowlands A, Evans RA, et al., 2022, Device-assessed sleep and physical activity in individuals recovering from a hospital admission for COVID-19: a multicentre study, International Journal of Behavioral Nutrition and Physical Activity, Vol: 19, Pages: 1-13, ISSN: 1479-5868
BackgroundThe number of individuals recovering from severe COVID-19 is increasing rapidly. However, little is known about physical behaviours that make up the 24-h cycle within these individuals. This study aimed to describe physical behaviours following hospital admission for COVID-19 at eight months post-discharge including associations with acute illness severity and ongoing symptoms.MethodsOne thousand seventy-seven patients with COVID-19 discharged from hospital between March and November 2020 were recruited. Using a 14-day wear protocol, wrist-worn accelerometers were sent to participants after a five-month follow-up assessment. Acute illness severity was assessed by the WHO clinical progression scale, and the severity of ongoing symptoms was assessed using four previously reported data-driven clinical recovery clusters. Two existing control populations of office workers and individuals with type 2 diabetes were comparators.ResultsValid accelerometer data from 253 women and 462 men were included. Women engaged in a mean ± SD of 14.9 ± 14.7 min/day of moderate-to-vigorous physical activity (MVPA), with 12.1 ± 1.7 h/day spent inactive and 7.2 ± 1.1 h/day asleep. The values for men were 21.0 ± 22.3 and 12.6 ± 1.7 h /day and 6.9 ± 1.1 h/day, respectively. Over 60% of women and men did not have any days containing a 30-min bout of MVPA. Variability in sleep timing was approximately 2 h in men and women. More severe acute illness was associated with lower total activity and MVPA in recovery. The very severe recovery cluster was associated with fewer days/week containing continuous bouts of MVPA, longer total sleep time, and higher variability in sleep timing. Patients post-hospitalisation with COVID-19 had lower levels of physical activity, greater sleep variability, and lower sleep efficiency than a similarly aged cohort
Thygesen JH, Tomlinson C, Hollings S, et al., 2022, COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records, LANCET DIGITAL HEALTH, Vol: 4, Pages: E542-E557
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- Citations: 17
Houchen-Wolloff L, Poinasamy K, Holmes K, et al., 2022, Joint patient and clinician priority setting to identify 10 key research questions regarding the long-term sequelae of COVID-19, THORAX, Vol: 77, Pages: 717-720, ISSN: 0040-6376
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- Citations: 8
Daines L, Mulholland RH, Vasileiou E, et al., 2022, Deriving and validating a risk prediction model for long COVID-19: protocol for an observational cohort study using linked Scottish data, BMJ OPEN, Vol: 12, ISSN: 2044-6055
Hanlon P, Lewsey J, Quint JK, et al., 2022, Frailty in COPD: an analysis of prevalence and clinical impact using UK Biobank, BMJ OPEN RESPIRATORY RESEARCH, Vol: 9
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- Citations: 11
Gulea C, Zakeri R, Kallis C, et al., 2022, Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis, BMJ Open, Vol: 12, ISSN: 2044-6055
Objective: To evaluate the association between having concomitant COPD or asthma, and in-patient mortality and post-discharge management among patients hospitalised for acute HF.Setting: Data were obtained from patients enrolled in the National Heart Failure Audit.Participants: 217,329 patients hospitalised for HF in England-Wales between March 2012 and 2018.Outcomes: In-hospital mortality, referrals to cardiology follow-up and prescriptions for HF medications were compared between patients with comorbid COPD (COPD-HF) or asthma (asthma-HF) versus HF-alone using mixed-effects logistic regression. Results: Patients with COPD-HF were more likely to die during hospitalisation, and those with asthma-HF had a reduced likelihood of death, compared with patients who had HF-alone ([adjusted]ORadj, 95% CI: 1.10, 1.06-1.14 and ORadj, 95%CI: 0.85, 0.79-0.88). In patients who survived to discharge, referral to HF follow-up services differed between groups: COPD-HF patients had reduced odds of cardiology follow-up (ORadj, 95%CI 0.79, 0.77-0.81), whilst cardiology referral odds for asthma-HF were similar to HF-alone. Overall, proportions of HF medication prescriptions at discharge were low for both COPD-HF and asthma-HF groups, particularly prescriptions for beta-blockers. Conclusions: In this nationwide analysis, we showed that COPD and asthma significantly impact the clinical course in patients hospitalised for HF. COPD is associated with higher in-patient mortality and lower cardiology referral odds, whilst COPD and asthma are both associated with lower use of prognostic HF therapies on discharge. These data highlight therapeutic gaps and a need for better integration of cardiopulmonary services to improve healthcare provision for patients with HF and coexisting respiratory disease.
Portas L, Bauersachs R, Bowrin K, et al., 2022, Assessment of the burden of disease for patients with peripheral artery disease undergoing revascularization in England, Vascular Medicine: the international journal of research review and clinical practice, Vol: 27, Pages: 440-449, ISSN: 1358-863X
Background: Symptoms, severity, and acuteness of peripheral artery disease (PAD) are major determinants of severe limb symptoms, subsequent risk of cardiovascular events and mortality. Lower extremity revascularization (LER) is a key option to relieve symptoms and to prevent limb loss in symptomatic PAD patients. This study aimed to quantify the burden of disease among patients with PAD-LER in England. Methods: Retrospective population-based study of linked primary and secondary care electronic health records, included 13,869 adult patients (aged ≥18 years) with PAD-LER from 2003 to 2018. The incidence of first ever PAD-LER was estimated overall and by type of procedure (endovascular/surgical). Health resource utilization associated with PAD-related complications and treatment patterns were assessed. Results: A high annual incidence of lower-limb revascularization (41.2 per 1,000 person years) and a nearly double incidence of endovascular first revascularization compared with open surgery were observed. More than 70% of patients with PAD-LER had a history of hyperlipidaemia and hypertension and roughly one-third were diabetic and had a history of coronary artery disease. Cardiovascular mortality accounting for one-third (34.1 per 1,000 person years) of all-cause mortality. Over 93% of patients were hospitalized for any reason and the commonest reasons for hospitalization were cardiovascular diseases and PAD with about one third hospitalized for revascularization re-occurrence. Conclusion: There is a significant burden of PAD-LER to the individual and society with ongoing healthcare resource utilization, treatment and increasing mortality.
Kaura A, Goswami S, Benedetto U, et al., 2022, ASSOCIATION BETWEEN AGE, TROPONIN LEVEL AND MORTALITY IN PATIENTS PRESENTING TO HOSPITAL WITH ACUTE PULMONARY EMBOLISM (NIHR HEALTH INFORMATICS COLLABORATIVE TROP-PE STUDY), Annual Conference of the British-Cardiovascular-Society - 100 Years of Cardiology, Publisher: BMJ PUBLISHING GROUP, Pages: A129-A129, ISSN: 1355-6037
Wright A, Vioix H, de Silva S, et al., 2022, Cost-consequence analysis of COPD treatment according to NICE and GOLD recommendations compared with current clinical practice in the UK, BMJ OPEN, Vol: 12, ISSN: 2044-6055
Koteci A, Morgan A, Portas L, et al., 2022, Left-sided heart failure burden and mortality in idiopathic pulmonary fibrosis: a population-based study, BMC Pulmonary Medicine, Vol: 22, Pages: 1-11, ISSN: 1471-2466
BackgroundCardiovascular disease is prevalent in idiopathic pulmonary fibrosis (IPF), yet the extent of left-sided heart failure (HF) burden, whether this has changed with time and whether HF impacts mortality risk in these patients are unknown. The aims of this study were therefore to determine the temporal trends in incidence and prevalence of left-sided HF in patients with IPF in England and compare these to published estimates in the general population and those with comparable chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD), as well as determine the risk of all-cause and cause-specific mortality in patients with comorbid left-sided HF and IPF at population-level using electronic healthcare data.MethodsClinical Practice Research Datalink (CPRD) Aurum primary-care data linked to mortality and secondary-care data was used to identify IPF patients in England. Left-sided HF prevalence and incidence rates were calculated for each calendar year between 2010 and 2019, stratified by age and sex. Risk of all-cause, cardiovascular and IPF-specific mortality was calculated using multivariate Cox regression.ResultsFrom 40,577patients with an IPF code in CPRD Aurum, 25, 341 IPF patients met inclusion criteria. Left-sided HF prevalence decreased from 33.4% (95% CI 32.2–34.6) in 2010 to 20.9% (20.0–21.7) in 2019. Left-sided HF incidence rate per 100 person-years (95% CI) remained stable between 2010 and 2017 but decreased from 4.3 (3.9–4.8) in 2017 to 3.4 (3.0–3.9) in 2019. Throughout follow-up, prevalence and incidence were higher in men and with increasing age. Comorbid HF was associated with poorer survival (adjusted HR (95%CI) 1.08 (1.03–1.14) for all-cause mortality; 1.32 (1.09–1.59) for cardiovascular mortality).ConclusionLeft-sided HF burden in IPF patients in England remains high, with incidence almost 4 times higher than in COPD, a comparable lung disease with similar cardiovascular risk factors.
John C, Guyatt AL, Shrine N, et al., 2022, Genetic Associations and Architecture of Asthma-COPD Overlap, Chest, Vol: 161, Pages: 1155-1166, ISSN: 0012-3692
BACKGROUND: Some people have characteristics of both asthma and COPD (asthma-COPD overlap), and evidence suggests they experience worse outcomes than those with either condition alone. RESEARCH QUESTION: What is the genetic architecture of asthma-COPD overlap, and do the determinants of risk for asthma-COPD overlap differ from those for COPD or asthma? STUDY DESIGN AND METHODS: We conducted a genome-wide association study in 8,068 asthma-COPD overlap case subjects and 40,360 control subjects without asthma or COPD of European ancestry in UK Biobank (stage 1). We followed up promising signals (P < 5 × 10-6) that remained associated in analyses comparing (1) asthma-COPD overlap vs asthma-only control subjects, and (2) asthma-COPD overlap vs COPD-only control subjects. These variants were analyzed in 12 independent cohorts (stage 2). RESULTS: We selected 31 independent variants for further investigation in stage 2, and discovered eight novel signals (P < 5 × 10-8) for asthma-COPD overlap (meta-analysis of stage 1 and 2 studies). These signals suggest a spectrum of shared genetic influences, some predominantly influencing asthma (FAM105A, GLB1, PHB, TSLP), others predominantly influencing fixed airflow obstruction (IL17RD, C5orf56, HLA-DQB1). One intergenic signal on chromosome 5 had not been previously associated with asthma, COPD, or lung function. Subgroup analyses suggested that associations at these eight signals were not driven by smoking or age at asthma diagnosis, and in phenome-wide scans, eosinophil counts, atopy, and asthma traits were prominent. INTERPRETATION: We identified eight signals for asthma-COPD overlap, which may represent loci that predispose to type 2 inflammation, and serious long-term consequences of asthma.
Maslova K, Quint JK, Fageras M, et al., 2022, Are Patients Treated According to GINA? Treatment and Exacerbation Patterns in UK Primary Care from SABINA Heatmaps, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Whittaker H, Rothnie KJ, Quint JK, 2022, Causes of Mortality by GOLD Grade Airflow Obstruction in People with Chronic Obstructive Pulmonary Disease in England, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Kallis C, Morgan AD, Maslova E, et al., 2022, Sabina Jr UK: The Association Between Saba (Short-Acting Beta Agonist) Prescriptions and Frequency of Asthma Exacerbations in a Paediatric Cohort, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Stone P, Minelli C, Feary J, et 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.
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