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Buttery S, Philip KEJ, Williams P, et al., 2021, Patient symptoms and experience following COVID-19: results from a UK wide survey, Publisher: Cold Spring Harbor Laboratory
Objectives To investigate the experience of people who continue to be unwell after acute COVID-19, often referred to as ‘long COVID’, both in terms of their symptoms and their interactions with healthcare.Design We conducted a mixed-methods analysis (quantitative and qualitative) of responses to a survey accessed through a UK online post-COVID support and information hub between April 2020 and December 2020 about people’s experiences after having acute COVID-19.Participants Of 3290 respondents, 78% were female, median age range 45-54 years, 92.1% reported white ethnicity; 12.7% had been hospitalised. 494 respondents (16.5%) completed the survey between 4 and 8 weeks of the onset of their symptoms, 641 (21.4%) between 8 and 12 weeks and 1865 (62.1%) more than 12 weeks after.Results The ongoing symptoms most frequently reported were; breathing problems (92.1%), fatigue (83.3%), muscle weakness or joint stiffness (50.6%), sleep disturbances (46.2%), problems with mental abilities (45.9%) changes in mood, including anxiety and depression (43.1%) and cough (42.3%). Symptoms did not appear to be related to the severity of the acute illness or to the presence of pre-existing medical conditions. Analysis of free text responses revealed three main themes (1) Experience of living with COVID-19 – physical and psychological symptoms that fluctuate unpredictably; (2) Interactions with healthcare; (3) Implications for the future – their own condition, society and the healthcare system and the need for researchConclusion People living with persistent problems after the acute phase of COVID-19 report multiple and varying symptoms that are not necessarily associated with initial disease severity or the presence of pre-existing health conditions. Many have substantial unmet needs and experience barriers to accessing healthcare. Consideration of patient perspective and experiences will assist in the planning of services to address this.Ethical approval Et
Quint JK, Bottle A, 2021, The Role of Individual and Neighborhood Factors on Racial Disparity in Respiratory Outcomes Won't You Be My Neighbor?, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 203, Pages: 939-940, ISSN: 1073-449X
Whittaker HR, Gulea C, Koteci A, et al., 2021, Post-acute COVID-19 sequelae in cases managed in the community or hospital in the UK: a population based study
<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>To compare post-COVID-19 sequelae between hospitalised and non-hospitalised individuals</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Population-based cohort study</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>1,383 general practices in England contributing to Clinical Practice Research Database Aurum</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>46,687 COVID-19 cases diagnosed between 1<jats:sup>st</jats:sup> August to 17<jats:sup>th</jats:sup> October 2020 (45.4% male; mean age 40), either hospitalised within two weeks of diagnosis or non-hospitalised, and followed-up for a maximum of three months.</jats:p></jats:sec><jats:sec><jats:title>Main outcome measures</jats:title><jats:p>Event rates of new symptoms, diseases, prescriptions and healthcare utilisation in hospitalised and non-hospitalised individuals, with between-group comparison using Cox regression. Outcomes compared at 6 and 12 months prior to index date, equating to first UK wave and pre-pandemic. Non-hospitalised group outcomes stratified by age and sex.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>45,272 of 46,687 people were non-hospitalised; 1,415 hospitalised. Hospitalised patients had higher rates of 13/26 symptoms and 11/19 diseases post-COVID-19 than the community group, received more prescriptions and utilised more healthcare. The largest differences were noted for rates per 100,000 person-weeks [95%CI] of <jats:italic>breathlessness:</jats:italic> 536 [432 to 663] v. 85 [77 to 93]; <jats:italic>joint pain:</jats:italic> 295 [221 to 392] v. 168 [158 to 179]
Kadirvelu B, Burcea G, Quint JK, et al., 2021, Covid-19 does not look like what you are looking for: Clustering symptoms by nation and multi-morbidities reveal substantial differences to the classical symptom triad
<jats:title>ABSTRACT</jats:title><jats:p>COVID-19 is by convention characterised by a triad of symptoms: cough, fever and loss of taste/smell. The aim of this study was to examine clustering of COVID-19 symptoms based on underlying chronic disease and geographical location. Using a large global symptom survey of 78,299 responders in 190 different countries, we examined symptom profiles in relation to geolocation (grouped by country) and underlying chronic disease (single, co- or multi-morbidities) associated with a positive COVID-19 test result using statistical and machine learning methods to group populations by underlying disease, countries, and symptoms. Taking the responses of 7980 responders with a COVID-19 positive test in the top 5 contributing countries, we find that the most frequently reported symptoms differ across the globe: For example, fatigue 4108(51.5%), headache 3640(45.6%) and loss of smell and taste 3563(44.6%) are the most reported symptoms globally. However, symptom patterns differ by continent; India reported a significantly lower proportion of headache (22.8% vs 45.6%, p<0.05) and itchy eyes (7.0% vs. 15.3%, p<0.05) than other countries, as does Pakistan (33.6% vs 45.6%, p<0.05 and 8.6% vs 15.3%, p<0.05). Mexico and Brazil report significantly less of these symptoms. As with geographic location, we find people differed in their reported symptoms, if they suffered from specific underlying diseases. For example, COVID-19 positive responders with asthma or other lung disease were more likely to report shortness of breath as a symptom, compared with COVID-19 positive responders who had no underlying disease (25.3% vs. 13.7%, p<0.05, and 24.2 vs.13.7%, p<0.05). Responders with no underlying chronic diseases were more likely to report loss of smell and tastes as a symptom (46%), compared with the responders with type 1 diabetes (21.3%), Type 2 diabetes (33.5%) lung disease (29.3%), or hype
Mansfield KE, Mathur R, Tazare J, et al., 2021, Indirect acute effects of the COVID-19 pandemic on physical and mental health in the UK: a population-based study, The Lancet Digital Health, Vol: 3, Pages: e217-e230, ISSN: 2589-7500
BACKGROUND: There are concerns that the response to the COVID-19 pandemic in the UK might have worsened physical and mental health, and reduced use of health services. However, the scale of the problem is unquantified, impeding development of effective mitigations. We aimed to ascertain what has happened to general practice contacts for acute physical and mental health outcomes during the pandemic. METHODS: Using de-identified electronic health records from the Clinical Research Practice Datalink (CPRD) Aurum (covering 13% of the UK population), between 2017 and 2020, we calculated weekly primary care contacts for selected acute physical and mental health conditions: anxiety, depression, self-harm (fatal and non-fatal), severe mental illness, eating disorder, obsessive-compulsive disorder, acute alcohol-related events, asthma exacerbation, chronic obstructive pulmonary disease exacerbation, acute cardiovascular events (cerebrovascular accident, heart failure, myocardial infarction, transient ischaemic attacks, unstable angina, and venous thromboembolism), and diabetic emergency. Primary care contacts included remote and face-to-face consultations, diagnoses from hospital discharge letters, and secondary care referrals, and conditions were identified through primary care records for diagnoses, symptoms, and prescribing. Our overall study population included individuals aged 11 years or older who had at least 1 year of registration with practices contributing to CPRD Aurum in the specified period, but denominator populations varied depending on the condition being analysed. We used an interrupted time-series analysis to formally quantify changes in conditions after the introduction of population-wide restrictions (defined as March 29, 2020) compared with the period before their introduction (defined as Jan 1, 2017 to March 7, 2020), with data excluded for an adjustment-to-restrictions period (March 8-28). FINDINGS: The overall population included 9 863 903 individuals
Bachtiger P, Adamson A, Chow J-J, et al., 2021, The Impact of the COVID-19 Pandemic on the Uptake of Influenza Vaccine: UK-Wide Observational Study, Publisher: JMIR PUBLICATIONS, INC
Galani J, Mulder H, Rockhold F, et al., 2021, Association of chronic obstructive pulmonary disease with morbidity and mortality in patients with peripheral artery disease: insights from the EUCLID trial, International Journal of COPD, Vol: 16, Pages: 841-851, ISSN: 1176-9106
Background: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of developing lower extremity peripheral artery disease (PAD) and suffering PAD-related morbidity and mortality. However, the effect and burden of COPD on patients with PAD is less well defined. This post hoc analysis from EUCLID aimed to analyze the risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in patients with PAD and concomitant COPD compared with those without COPD, and to describe the adverse events specific to patients with COPD.Methods: EUCLID randomized 13,885 patients with symptomatic PAD to monotherapy with either ticagrelor or clopidogrel for the prevention of MACE. In this analysis, MACE, MALE, mortality, and adverse events were compared between groups with and without COPD using unadjusted and adjusted Cox proportional hazards model.Results: Of the 13,883 patients with COPD status available at baseline, 11% (n=1538) had COPD. Patients with COPD had a higher risk of MACE (6.02 vs 4.29 events/100 patient-years; p< 0.001) due to a significantly higher risk of myocardial infarction (MI) (3.55 vs 1.85 events/100 patient-years; p< 0.001) when compared with patients without COPD. These risks persisted after adjustment (MACE: adjusted hazard ratio (aHR) 1.30, 95% confidence interval [CI] 1.11– 1.52; p< 0.001; MI: aHR 1.45, 95% CI 1.18– 1.77; p< 0.001). However, patients with COPD did not have an increased risk of MALE or major bleeding. Patients with COPD were more frequently hospitalized for dyspnea and pneumonia (2.66 vs 0.9 events/100 patient-years; aHR 2.77, 95% CI 2.12– 3.63; p< 0.001) and more frequently discontinued study drug prematurely (19.36 vs 12.54 events/100 patient-years; p< 0.001; aHR 1.34, 95% CI 1.22– 1.47; p< 0.001).Conclusion: In patients with comorbid PAD and COPD, the risks of MACE, respiratory-related adverse events, and premature study drug discontinuation were
wing K, williamson E, carpenter J, et al., 2021, Real world effects of COPD medications: a cohort study with validation against results from randomised controlled trials, European Respiratory Journal, Vol: 57, Pages: 1-13, ISSN: 0903-1936
Real-world data provide the potential for generating evidence on drug treatment effects in groups excluded from trials, but rigorous, validated methodology for doing so is lacking. We investigated whether non-interventional methods applied to real-world data could reproduce results from the landmark TORCH COPD trial.We performed a historical cohort study (2000–2017) of COPD drug treatment effects in the UK Clinical Practice Research Datalink (CPRD). Two control groups were selected from CPRD by applying TORCH inclusion/exclusion criteria and 1:1 matching to TORCH participants: control group 1- people with COPD not prescribed fluticasone propionate-salmeterol (FP-SAL), control group 2- people with COPD prescribed salmeterol (SAL). FP-SAL exposed groups were then selected from CPRD by propensity-score matching to each control group. Outcomes studied were COPD exacerbations, death from any cause and pneumonia.2652 FP-SAL exposed people were propensity-score matched to 2652 FP-SAL unexposed people while 991 FP-SAL exposed people were propensity-score matched to 991 SAL exposed people. Exacerbation rate ratio was comparable to TORCH for FP-SAL versus SAL (0.85, 95% CI 0.74–0.97 versus 0.88, 0.81–0.95) but not for FP-SAL versus no FP-SAL (1.30, 1.19–1.42 versus 0.75, 0.69–0.81). Active comparator results were also consistent with TORCH for mortality (hazard ratio 0.93, 0.65–1.32 versus 0.93, 0.77–1.13) and pneumonia (risk ratio 1.39, 1.04–1.87 versus 1.47, 1.25–1.73).We obtained very similar results to the TORCH trial for active comparator analyses, but were unable to reproduce placebo-controlled results. Application of these validated methods for active comparator analyses to groups excluded from RCTs provides a practical way for contributing to the evidence base and supporting COPD treatment decisions.
Quint J, Montonen J, Esposito D, et al., 2021, Effectiveness and Safety of COPD Maintenance Therapy with a LAMA/LABA versus LABA/ICS in a US Claims Database, Advances in Therapy, ISSN: 0741-238X
Walker JL, Grint DJ, Strongman H, et al., 2021, UK prevalence of underlying conditions which increase the risk of severe COVID-19 disease: a point prevalence study using electronic health records, BMC Public Health, Vol: 21, Pages: 1-14, ISSN: 1471-2458
BackgroundCharacterising the size and distribution of the population at risk of severe COVID-19 is vital for effective policy and planning. Older age, and underlying health conditions, are associated with higher risk of death from COVID-19. This study aimed to describe the population at risk of severe COVID-19 due to underlying health conditions across the United Kingdom.MethodsWe used anonymised electronic health records from the Clinical Practice Research Datalink GOLD to estimate the point prevalence on 5 March 2019 of the at-risk population following national guidance. Prevalence for any risk condition and for each individual condition is given overall and stratified by age and region with binomial exact confidence intervals. We repeated the analysis on 5 March 2014 for full regional representation and to describe prevalence of underlying health conditions in pregnancy. We additionally described the population of cancer survivors, and assessed the value of linked secondary care records for ascertaining COVID-19 at-risk status.ResultsOn 5 March 2019, 24.4% of the UK population were at risk due to a record of at least one underlying health condition, including 8.3% of school-aged children, 19.6% of working-aged adults, and 66.2% of individuals aged 70 years or more. 7.1% of the population had multimorbidity. The size of the at-risk population was stable over time comparing 2014 to 2019, despite increases in chronic liver disease and diabetes and decreases in chronic kidney disease and current asthma. Separately, 1.6% of the population had a new diagnosis of cancer in the past 5 y.ConclusionsThe population at risk of severe COVID-19 (defined as either aged ≥70 years, or younger with an underlying health condition) comprises 18.5 million individuals in the UK, including a considerable proportion of school-aged and working-aged individuals. Our national estimates broadly support the use of Global Burden of Disease modelled estimates in other countrie
Requena G, Dedman D, Quint JK, et al., 2021, The utilization and safety of umeclidinium and umeclidinium/vilanterol in UK primary care: a retrospective cohort study, The International Journal of Chronic Obstructive Pulmonary Disease, Vol: 16, Pages: 629-642, ISSN: 1176-9106
Background: Umeclidinium bromide (UMEC) and umeclidinium/vilanterol (UMEC/VI) received European approval for maintenance treatment of patients with chronic obstructive pulmonary disease (COPD) in 2014. This study examined prescribing patterns, possible off-label prescribing, potential safety-related outcomes and adherence of these medications in routine clinical practice post-approval.Methods: This retrospective, multi-database, longitudinal observational study of new users of UMEC, UMEC/VI, or other long-acting bronchodilators (LABD) analyzed data from UK electronic health record databases (primary care cohort), linked to hospital data (linked cohort). Off-label prescribing, safety outcomes (cardiovascular, respiratory, and mortality), treatment patterns, and medication adherence were assessed.Results: In the primary care cohort (new users of UMEC n=3875; UMEC/VI n=2224; other LABD n=32,809), two-thirds of UMEC users were prescribed concomitant inhaled corticosteroids/long-acting β2-agonists. Possible off-label prescribing, defined as use in patients without COPD, was similar for UMEC (7.0%) and UMEC/VI (8.8%), but higher for new users of other LABD (18.0%). There were 547 UMEC users and 512 UMEC/VI users in the linked cohort. In both cohorts, incidence rates (IRs) of cardiovascular outcomes were similar for UMEC and UMEC/VI users (myocardial infarction IR per 1000 person-years [95% CIs]: UMEC 6.9 [4.4, 10.2]; UMEC/VI 6.8 [3.5, 11.9]). IRs of pneumonia and acute COPD exacerbations (AECOPD) were slightly higher among UMEC users compared with UMEC/VI users (AECOPD IR per 1000 person-years [95% CIs]: UMEC 979 [931, 1030]; UMEC/VI 746 [687, 811]). Adherence (medication possession ratio ≥ 80%) was 64% for UMEC and UMEC/VI.Conclusion: Most new users of UMEC were receiving multiple-inhaler triple therapy. Off-label prescribing was uncommon for new users of UMEC and UMEC/VI. Incidence of cardiovascular and respiratory outcomes was as expected for these drug classes
van Dael J, Neves AL, Painter A, et al., 2021, Patient perspectives on the use of digital health services at a multi-site hospital in North-West London: a quantitative content analysis (Preprint), Journal of Medical Internet Research, ISSN: 1438-8871
Background:Following a large increase in the adoption of digital health amidst the COVID-19 crisis, there is increasing policy interest in the longer-term implementation of digital health services. Yet, there is still much unknown about the inherent quality of remote digital care, and research on patient perspectives remains comparatively small. Widespread usage amidst COVID-19 presents an important opportunity to better understand patients’ first-hand experiences with using these technologies.Objective:This study examined patients’ perspectives on main benefits and concerns with using digital health services in a large multi-site teaching hospital in North-West London during the COVID-19 crisis.Methods:Qualitative data was obtained from a larger questionnaire conducted during the COVID-19 pandemic on Care Information Exchange, which represents the largest patient-facing electronic health records in the English National Health Service. All responses were analysed using the framework analysis method. Quantitative content analysis was performed by mapping frequencies of reported themes across the respondent population.Results:Of all 6,766 respondents, 25.1% reported to have no concerns with digital health services, compared to 3.0% reporting no benefits. Reported benefits included: ease of access (37.1%), feeling empowered and informed (23.2%), improved timeliness of access and treatment (18.6%), healthcare capacity (11.5%), and care continuity amidst COVID-19 (7.4%). In contrast, reported concerns included issues around data security and privacy (17.5%), clinical uncertainty (17.0%), impact on patient-doctor relationship (11.9%), inequity in access and use (11.8%), misunderstanding health information (6.3%), and digital maturity (3.8%).Conclusions:Patients report many benefits with digital health services beyond immediate COVID-19 support, including improved access, timeliness, and enhanced healthcare capacity. Yet, some concerns remain, including some le
Whittaker H, Bloom C, Morgan A, et al., 2021, Accelerated FEV1 decline and risk of cardiovascular disease and mortality in a primary care population of COPD patients, European Respiratory Journal, Vol: 57, ISSN: 0903-1936
Accelerated lung function decline has been associated with increased risk of cardiovascular disease (CVD) in a general population, but little is known about this association in chronic obstructive pulmonary disease (COPD). We investigated the association between accelerated lung function decline and CVD outcomes and mortality in a primary care COPD population.COPD patients without a history of CVD were identified in the Clinical Practice Research Datalink (CPRD-GOLD) primary care dataset (n=36 282). Accelerated FEV1 decline was defined using the fastest quartile of the COPD population's decline. Cox regression assessed the association between baseline accelerated FEV1 decline and a composite CVD outcome over follow-up (myocardial infarction, ischaemic stroke, heart failure, atrial fibrillation, coronary artery disease, and CVD mortality). The model was adjusted for age, gender, smoking status, BMI, history of asthma, hypertension, diabetes, statin use, mMRC dyspnoea, exacerbation frequency, and baseline FEV1 percent predicted.6110 (16.8%) COPD patients had a CVD event during follow-up; median length of follow-up was 3.6 years [IQR 1.7–6.1]). Median rate of FEV1 decline was –19.4 mL·year−1 (IQR, –40.5 to 1.9); 9095 (25%) patients had accelerated FEV1 decline (>–40.5 mL·year−1), 27 287 (75%) did not (≤ –40.5 mL·year−1). Risk of CVD and mortality was similar between patients with and without accelerated FEV1 decline (HRadj 0.98 [95%CI, 0.90–1.06]). Corresponding risk estimates were 0.99 (95%CI 0.83–1.20) for heart failure, 0.89 (95%CI 0.70–1.12) for myocardial infarction, 1.01 (95%CI 0.82–1.23) for stroke, 0.97 (95%CI 0.81–1.15) for atrial fibrillation, 1.02 (95%CI 0.87–1.19) for coronary artery disease, and 0.94 (95%CI 0.71–1.25) for CVD mortality. Rather, risk of CVD was associated with mMRC score ≥2 and ≥2 exacerbations in the year prior.CVD out
Bottle A, Quint J, 2021, COPD: still an unpredictable journey, EUROPEAN RESPIRATORY JOURNAL, Vol: 57, ISSN: 0903-1936
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Gulea C, Zakeri R, Alderman V, et al., 2021, Beta-blocker therapy in patients with COPD: a systematic literature review and meta-analysis with multiple treatment comparison, Respiratory Research, Vol: 22, Pages: 1-14, ISSN: 1465-9921
Background: Beta-blockers are associated with reduced mortality in patients with cardiovascular disease but are often under prescribed in those with concomitant COPD, due to concerns regarding respiratory side-effects. We investigated the effects of beta-blockers on outcomes in patients with COPD and explored within-class differences between different agents.Methods: We searched the Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Medline for observational studies and randomized controlled trials (RCTs) investigating the effects of beta-blocker exposure versus no exposure or placebo, in patients with COPD, with and without cardiovascular indications. A meta-analysis was performed to assess the association of beta-blocker therapy with acute exacerbations of COPD (AECOPD), and a network meta-analysis was conducted to investigate the effects of individual beta-blockers on FEV1. Mortality, all-cause hospitalization, and quality of life outcomes were narratively synthesized.Results: We included 23 observational studies and 14 RCTs. In pooled observational data, beta-blocker therapy was associated with an overall reduced risk of AECOPD versus no therapy (HR 0.77, 95%CI 0.70 to 0.85). Among individual beta-blockers, only propranolol was associated with a relative reduction in FEV1 versus placebo, among 199 patients evaluated in RCTs. Narrative syntheses on mortality, all-cause hospitalization and quality of life outcomes indicated a high degree of heterogeneity in study design and patient characteristics but suggested no detrimental effects of beta-blocker therapy on these outcomes.Conclusion: The class effect of beta-blockers remains generally positive in patients with COPD. Reduced rates of AECOPD, mortality, and improved quality of life were identified in observational studies, while propranolol was the only agent associated with a deterioration of lung function in RCTs.
Bachtiger P, Adamson A, Chow J-J, et al., 2021, The impact of the Covid-19 pandemic on uptake of influenza vaccine: a UK-wide observational study., JMIR Public Health and Surveillance, Vol: 7, Pages: 1-14, ISSN: 2369-2960
BACKGROUND: In the face of the Covid-19 pandemic, the UK National Health Service (NHS) flu vaccination eligibility is extended this season to ~32.4 million (48.8%) of the population. Knowing intended uptake will inform supply and public health messaging to maximise vaccination. OBJECTIVE: The objective of this study was to measure the impact of the Covid-19 pandemic on acceptance of flu vaccination in the 2020-21 season, specifically focusing on those previously eligible who routinely decline vaccination and the newly eligible. METHODS: Intention to receive influenza vaccine in 2020-21 was asked of all registrants of the NHS's largest electronic personal health record by online questionnaire on 31st July 2020. Of those who were either newly or previously eligible but had not previously received influenza vaccination, multivariable logistic regression and network diagrams were used to examine reasons to have or decline vaccination. RESULTS: Among 6,641 respondents, 945 (14.2%) were previously eligible but not vaccinated, of whom 536 (56.7%) intended to receive flu vaccination in 2020/21, as did 466 (68.6%) of the newly eligible. Intention to receive the flu vaccine was associated with increased age, index of multiple deprivation (IMD) quintile, and considering oneself at high risk from Covid-19. Among those eligible but intending not to be vaccinated in 2020/21, 164 (30.2%) gave misinformed reasons. 47 (49.9%) of previously unvaccinated healthcare workers would decline vaccination in 2020/21. CONCLUSIONS: In this sample, Covid-19 has increased acceptance of flu vaccination in those previously eligible but unvaccinated and motivates substantial uptake in the newly eligible. This study is essential for informing resource planning and the need for effective messaging campaigns to address negative misconceptions, also necessary for Covid-19 vaccination programmes. CLINICALTRIAL: Not applicable.
Ramakrishnan S, Janssens W, Burgel PR, et al., 2021, Standardisation of clinical assessment, management and follow-up of acute hospitalised exacerbation of COPD: a Europe-wide consensus, International Journal of COPD, Vol: 16, Pages: 321-332, ISSN: 1176-9106
Background: Despite hospitalization for exacerbation being a high-risk event for morbidity and mortality, there is little consensus globally regarding the assessment and management of hospitalised exacerbations of COPD. We aimed to establish a consensus list of symptoms, physiological measures, clinical scores, patient questionnaires and investigations to be obtained at time of hospitalised COPD exacerbation and follow-up.Methods: A modified Delphi online survey with pre-defined consensus of importance, feasibility and frequency of measures at hospitalisation and follow-up of a COPD exacerbation was undertaken.Findings: A total of 25 COPD experts from 18 countries contributed to all 3 rounds of the survey. Experts agreed that a detailed history and examination were needed. Experts also agreed on which treatments are needed and how soon these should be delivered. Experts recommended that a full blood count, renal function, C-reactive protein and cardiac blood biomarkers (BNP and troponin) should be measured within 4 hours of admission and that the modified Medical Research Council dyspnoea scale (mMRC) and COPD assessment test (CAT) should be performed at time of exacerbation and follow-up. Experts encouraged COPD clinicians to strongly consider discussing palliative care, if indicated, at time of hospitalisation.Interpretation: This Europe-wide consensus document is the first attempt to standardise the assessment and care of patients hospitalised for COPD exacerbations. This should be regarded as the starting point to build knowledge and evidence on patients hospitalised for COPD exacerbations.
Ramakrishnan S, Janssens W, Burgel PR, et al., 2021, STANDARDISING FOLLOW UP OF SYMPTOMS, TESTS, AND OUTCOME ASSESSMENT AFTER HOSPITALISATION FOR EXACERBATION OF COPD - A DELPHI SURVEY, Winter Meeting of the British-Thoracic-Society (BTS), Publisher: BMJ PUBLISHING GROUP, Pages: A166-A166, ISSN: 0040-6376
Fuertes E, Marcon A, Potts L, et al., 2021, Health Impact assessment to predict the impact of tobacco price increases on COPD burden in Italy, England and Sweden, Scientific Reports, Vol: 11, ISSN: 2045-2322
Raising tobacco prices effectively reduces smoking, the main risk factor for chronic obstructive pulmonary disease (COPD). Using the Health Impact Assessment tool “DYNAMO-HIA”, this study quantified the reduction in COPD burden that would occur in Italy, England and Sweden over 40 years if tobacco prices were increased by 5%, 10% and 20% over current local prices, with larger increases considered in secondary analyses. A dynamic Markov-based multi-state simulation modelling approach estimated the effect of changes in smoking prevalence states and probabilities of transitioning between smoking states on future smoking prevalence, COPD burden and life expectancy in each country. Data inputs included demographics, smoking prevalences and behaviour and COPD burden from national data resources, large observational cohorts and datasets within DYNAMO-HIA. In the 20% price increase scenario, the cumulative number of COPD incident cases saved over 40 years was 479,059 and 479,302 in Italy and England (populous countries with higher smoking prevalences) and 83,694 in Sweden (smaller country with lower smoking prevalence). Gains in overall life expectancy ranged from 0.25 to 0.45 years for a 20 year-old. Increasing tobacco prices would reduce COPD burden and increase life expectancy through smoking behavior changes, with modest but important public health benefits observed in all three countries.
Magnussen H, Lucas S, Lapperre T, et al., 2021, Withdrawal of inhaled corticosteroids versus continuation of triple therapy in patients with COPD in real life: observational comparative effectiveness study, Respiratory Research, Vol: 22, ISSN: 1465-9921
BACKGROUND: Inhaled corticosteroids (ICS) are indicated for prevention of exacerbations in patients with COPD, but they are frequently overprescribed. ICS withdrawal has been recommended by international guidelines in order to prevent side effects in patients in whom ICS are not indicated. METHOD: Observational comparative effectiveness study aimed to evaluate the effect of ICS withdrawal versus continuation of triple therapy (TT) in COPD patients in primary care. Data were obtained from the Optimum Patient Care Research Database (OPCRD) in the UK. RESULTS: A total of 1046 patients who withdrew ICS were matched 1:4 by time on TT to 4184 patients who continued with TT. Up to 76.1% of the total population had 0 or 1 exacerbation the previous year. After controlling for confounders, patients who discontinued ICS did not have an increased risk of moderate or severe exacerbations (adjusted HR: 1.04, 95% confidence interval (CI) 0.94-1.15; p = 0.441). However, rates of exacerbations managed in primary care (incidence rate ratio (IRR) 1.33, 95% CI 1.10-1.60; p = 0.003) or in hospital (IRR 1.72, 95% CI 1.03-2.86; p = 0.036) were higher in the cessation group. Unsuccessful ICS withdrawal was significantly and independently associated with more frequent courses of oral corticosteroids the previous year and with a blood eosinophil count ≥ 300 cells/μL. CONCLUSIONS: In this primary care population of patients with COPD, composed mostly of infrequent exacerbators, discontinuation of ICS from TT was not associated with an increased risk of exacerbation; however, the subgroup of patients with more frequent courses of oral corticosteroids and high blood eosinophil counts should not be withdrawn from ICS. Trial registration European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (EUPAS30851).
Gulea C, Zakeri R, Quint JK, 2021, Model-based comorbidity clusters in patients with heart failure: association with clinical outcomes and healthcare utilization, BMC Medicine, Vol: 19, Pages: 1-13, ISSN: 1741-7015
Background: Comorbidities affect outcomes in heart failure (HF), but are not reflected in current HF classification. The aim of this study is to characterize HF groups that account for higher-order interactions between comorbidities and to investigate the association between comorbidity groups and outcomes.Methods: Latent class analysis [LCA] was performed on 12 comorbidities from patients with HF identified from administrative claims data in the United States (OptumLabs Data Warehouse®) between 2008-2018. Associations with admission to hospital and mortality were assessed with Cox regression. Negative binomial regression was used to examine rates of healthcare use. Results: In a population of 318,384 individuals, we identified five comorbidity clusters, named according to their dominant features: low-burden, metabolic-vascular, anemic, ischemic and metabolic. Compared to the low-burden group (minimal comorbidities), patients in the metabolic-vascular group (exhibiting a pattern of diabetes, obesity and vascular disease) had the worst prognosis for admission (HR: 2.21, 95%CI 2.17-2.25) and death (HR: 1.87, 95%CI 1.74-2.01), followed by the ischemic, anemic and metabolic groups. The anemic group experienced an intermediate risk of admission (HR: 1.49, 95%CI 1.44-1.54) and death (HR: 1.46, 95%CI 1.30-1.64). Healthcare use also varied: the anemic group had the highest rate of outpatient visits, compared to the low-burden group (IRR: 2.11, 95%CI, 2.06-2.16); the metabolic-vascular and ischemic groups had the highest rate of admissions (IRR 2.11, 95%CI 2.08-2.15 and 2.11, 95%CI 2.07-2.15) and healthcare costs. Conclusions: These data demonstrate the feasibility of using LCA to classify HF based on comorbidities alone and should encourage investigation of multidimensional approaches in comorbidity management to reduce admission and mortality risk among patients with HF.
Requena G, Wolf A, Williams R, et al., 2021, Feasibility of using Clinical Practice Research Datalink data to identify patients with chronic obstructive pulmonary disease to enrol into real-world trials, Pharmacoepidemiology and Drug Safety, Vol: 30, Pages: 472-481, ISSN: 1053-8569
PurposeTo assess the feasibility of using Clinical Practice Research Datalink (CPRD) data for identifying populations of patients with chronic obstructive pulmonary disease (COPD) eligible for a hypothetical pragmatic trial.MethodsA retrospective multidatabase cohort study using CPRD primary care and linked secondary care data to describe the characteristics of populations of patients with COPD. Patients' demographic and lifestyle factors, comorbidity profile, spirometry measurements and treatment changes were evaluated, as was the distribution of follow‐up time and types of losses during follow‐up. Characteristics were evaluated using descriptive statistics.ResultsA total of 322 991 patients from 1148 primary care practices in the United Kingdom across two CPRD primary care databases, CPRD GOLD and CPRD Aurum, were potentially eligible to participate in a hypothetical trial using CPRD, starting on 31 December 2017. Patients with COPD in CPRD GOLD and CPRD Aurum were comparable in terms of age (median age 70 vs. 68 years), gender (50% vs. 52% male), disease severity (e.g., 25% vs. 24% Medical Research Council [MRC] dyspnoea score grades 3–5) and history of respiratory conditions (e.g., 43% vs. 38% asthma). High proportions of patients with COPD in CPRD GOLD and CPRD Aurum were available on 31 December 2012 for follow‐up at 1, 2, and 5 years (92%, 85% and 67%, respectively).ConclusionsPatients and data from CPRD GOLD and CPRD Aurum were comparable across key aspects relevant to COPD trials. A pragmatic trial using CPRD to recruit patients with COPD is scientifically feasible.
Stone PW, Hickman KC, Steiner MC, et al., 2021, Predictors of pulmonary rehabilitation completion in the UK, ERJ Open Research, Vol: 7, Pages: 1-10, ISSN: 2312-0541
Aim Determine characteristics of people with COPD associated with completion of pulmonary rehabilitation (PR).Methods Cross-sectional analysis of 7060 people with COPD enrolled in PR between 03/01/2017 and 31/03/2017. Data were from a UK national audit of COPD care. Factors associated with PR completion were determined using mixed-effects logistic regression with a random intercept for PR service. Factors chosen for assessment based on clinical judgement and data availability were: age, gender, country, SES, Body Mass Index (BMI), referral location, programme type, start within 90 days, smoking status, oxygen therapy, GOLD stage, MRC grade, any exercise test, and any health status questionnaire.Results 4635 (66%) people with COPD completed a PR programme. People that were 60 years or older, resident in Wales, referred within 90 days, an ex- or never smoker, received an exercise test, or received a health status questionnaire had significantly greater odds of completing PR. People that were in the most deprived quintile, underweight or very severely obese, enrolled in a rolling rather than a cohort programme, had a higher GOLD stage, and had a higher MRC grade had significantly lower odds of completing PR.Conclusion People with COPD were more likely to complete PR when best-practice guidelines were followed. People with more severe COPD symptoms and those enrolled in rolling rather than cohort programmes were less likely to complete PR. Referring people with COPD in the earlier stages of disease, ensuring programmes follow best-practice guidelines, and favouring cohort over rolling programmes could improve rates of PR completion.
Sydes MR, Barbachano Y, Bowman L, et al., 2021, Realising the full potential of data-enabled trials in the UK: a call for action, BMJ OPEN, Vol: 11, ISSN: 2044-6055
Lenoir A, Quint JK, 2021, COPD Epidemiology, Encyclopedia of Respiratory Medicine, Second Edition, Pages: 515-525, ISBN: 9780081027233
This chapter provides an overview of the epidemiology of COPD from a global perspective, in particular focusing on incidence, prevalence and mortality as well as risk factors for disease development, exacerbations and health care costs. Where appropriate, links have been made with other chapters in this book where further detail is provided.
Adeloye D, Agarwal D, Barnes PJ, et al., 2021, Research priorities to address the global burden of chronic obstructive pulmonary disease (COPD) in the next decade, JOURNAL OF GLOBAL HEALTH, Vol: 11, ISSN: 2047-2978
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Jones R, Davis A, Stanley B, et al., 2021, Risk Predictors and Symptom Features of Long COVID Within a Broad Primary Care Patient Population Including Both Tested and Untested Patients, PRAGMATIC AND OBSERVATIONAL RESEARCH, Vol: 12, Pages: 93-104, ISSN: 1179-7266
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- Citations: 23
Bachtiger P, Adamson A, Chow J-J, et al., 2020, The Impact of the COVID-19 Pandemic on the Uptake of Influenza Vaccine: UK-Wide Observational Study (Preprint)
<sec> <title>BACKGROUND</title> <p>In the face of the COVID-19 pandemic, the UK National Health Service (NHS) extended eligibility for influenza vaccination this season to approximately 32.4 million people (48.8% of the population). Knowing the intended uptake of the vaccine will inform supply and public health messaging to maximize vaccination.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The objective of this study was to measure the impact of the COVID-19 pandemic on the acceptance of influenza vaccination in the 2020-2021 season, specifically focusing on people who were previously eligible but routinely declined vaccination and newly eligible people.</p> </sec> <sec> <title>METHODS</title> <p>Intention to receive the influenza vaccine in 2020-2021 was asked of all registrants of the largest electronic personal health record in the NHS by a web-based questionnaire on July 31, 2020. Of those who were either newly or previously eligible but had not previously received an influenza vaccination, multivariable logistic regression and network diagrams were used to examine their reasons to undergo or decline vaccination.</p> </sec> <sec> <title>RESULTS</title> <p>Among 6641 respondents, 945 (14.2%) were previously eligible but were not vaccinated; of these, 536 (56.7%) intended to receive an influenza vaccination in 2020-2021, as did 466 (68.6%) of the newly eligible respondents. Intention to receive the influenza vaccine was associated with increased age, index of multiple deprivation quintile, and considering oneself to be at high risk fr
Bachtiger P, Adamson A, Maclean W, et al., 2020, Inadequate intention to receive Covid-19 vaccination: indicators for public health messaging needed to improve uptake in UK, Publisher: MedRxiv
Data promising effective Covid-19 vaccines have accelerated the UK’s mass vaccination programme. The UK public’s attitudes to the government’s prioritisation list are unknown, and achieving critical population immunity will require the remaining majority to accept both vaccination and the delay in access of up to a year or more. This cross-sectional observational study sent an online questionnaire to registrants of the UK National Health Service’s largest personal health record. Question items covered willingness for Covid-19 vaccine uptake and attitudes to prioritisation. Among 9,122 responses, 71.5% indicated wanting a vaccine, below what previous modelling indicated as critical levels for progressing towards herd immunity. 22.7% disagreed with the prioritisation list, though 70.3% were against being able to expedite vaccination through payment. Age and female gender were, respectively, strongly positively and negatively associated with wanting a vaccine. Teachers and Black, Asian and Minority Ethnic (BAME) groups were most cited by respondents for prioritisation. This study identifies factors to inform the public health messaging critical to improving uptake.
Quint JK, Venerus A, O'Leary C, et al., 2020, Prescribing pathways to triple therapy: a retrospective observational study of adults with chronic obstructive pulmonary disease in the UK, The International Journal of Chronic Obstructive Pulmonary Disease, Vol: 2020, Pages: 3261-3271, ISSN: 1176-9106
Purpose: Treatment guidance for chronic obstructive pulmonary disease (COPD) recommends inhaled corticosteroid (ICS)+long-acting muscarinic antagonist+long-acting β2-agonist (LABA) triple therapy for patients who experience recurrent exacerbations, persistent breathlessness, or exercise limitation on dual therapy. However, information is limited on pathways to triple therapy in the UK.Patients and Methods: A retrospective cohort study was conducted using de-identified patient-level data from UK primary care electronic medical records from January 1, 2005 to May 1, 2016. Data were included from patients who had their first triple therapy regimen (index date) recorded during the study period and a minimum of 12 months’ pre-index data. Treatment pathways to triple therapy were recorded, and the proportion of patients on triple therapy before their COPD diagnosis was determined. Adherence to triple therapy was estimated using the proportion of days covered (PDC).Results: After applying eligibility criteria, 82,300 patients were included, with a mean age at COPD diagnosis of 64.7 years. The major treatment pathway (27.9%) was the first initiation of ICS+LABA prior to triple therapy. Following COPD diagnosis, the median time to triple therapy was approximately 3.5 years. The estimated mean adherence to triple therapy was 81.8% PDC. Multivariate analysis showed that the following groups were more likely to have received previous therapy prior to triple therapy: females (versus males), patients with asthma (versus those without asthma), severe COPD (versus those with non-severe COPD), or fewer exacerbations (versus those with more exacerbations).Conclusion: Treatment pathways to triple therapy in the UK are diverse, highlighting the need to better understand factors involved in clinical decision-making.
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