Publications
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Wedzicha J, Calverley P, Rabe K, 2016, Roflumilast: a review of its use in the treatment of COPD, International Journal of Chronic Obstructive Pulmonary Disease, Vol: 11, Pages: 81-90, ISSN: 1176-9106
Crisafulli E, Torres A, Huerta A, et al., 2016, Predicting In-Hospital Treatment Failure (≤7 days) in Patients with COPD Exacerbation Using Antibiotics and Systemic Steroids, COPD-JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE, Vol: 13, Pages: 82-92, ISSN: 1541-2555
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- Citations: 18
Singh R, Wang Z, Brown JR, et al., 2016, The Influence Of Stable State Eosinophil Count And Acute Exacerbations On The Airway Microbiome In COPD, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
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- Citations: 1
Donaldson GC, Kowlessar B, Sapsford R, et al., 2016, Influenza Vaccination In COPD Patients - No Detectable Changes In Lung Function, Systemic Or Airway Inflammatory Markers, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Mackay AJ, Patel ARC, Singh R, et al., 2016, Reduction Of Airway Inflammation With Roflumilast Initiated At Onset Of Acute Exacerbation Of COPD: Results From The Randomised, Double-Blind, Placebo-Controlled, Parallel-Group Trial, Treatment With Roflumilast At Exacerbation (treat), International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Mackay AJ, Patel ARC, Singh R, et al., 2016, Roflumilast Initiated At Onset Of Acute Exacerbation Of COPD Enhances Lung Function Recovery: Results From The Randomised, Double-Blind, Placebo-Controlled, Parallel-Group Trial, Treatment With Roflumilast At Exacerbation (treat), International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Allinson JP, Hardy R, Donaldson GC, et al., 2016, The Utility Of Chronic Respiratory Symptoms During Middle-Age In Identifying Smokers Who Developed COPD By Their Early Sixties Within A Nationally Representative Birth Cohort Study, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Donaldson GC, Belchamber KBR, Singh R, et al., 2016, Dissociation Between Airway And Systemic Inflammatory Changes At Exacerbation In COPD, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Finney LJ, Belchamber KBR, Edwards MR, et al., 2016, Rhinovirus Impairs Phagocytosis Of Bacteria By Monocyte Derived Macrophages In Chronic Obstructive Pulmonary Disease, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Wedzicha JA, Mezzi K, Fogel R, et al., 2016, Correlation Between Symptoms Pattern And Future Exacerbations: a Post-Hoc Analysis From The Spark Study, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Mackay AJ, Patel ARC, Singh R, et al., 2016, Increased Systemic Inflammation, As Measured By Absolute Levels And Change In Il-6, At Exacerbation Onset Predicts Clinical Non-Recovery At 35 Days, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Allinson JP, Hardy R, Donaldson GC, et al., 2015, The presence of chronic mucus hypersecretion across Adult life in relation to COPD development, American Journal of Respiratory and Critical Care Medicine, Vol: 193, Pages: 662-672, ISSN: 1073-449X
RATIONALE: Chronic Mucus Hypersecretion(CMH) is common amongst smokers and is associated with Chronic Obstructive Pulmonary Disease(COPD) development and progression. Understanding how the relationships between smoking, CMH and COPD develop during adult life could facilitate earlier disease detection and intervention. METHODS: We analysed data on CMH, smoking and lung function prospectively collected by the MRC National Survey of Health and Development, a nationally representative British cohort followed since birth in 1946. We analysed the longitudinal relationships between smoking and CMH, how symptoms during life related to airflow limitation at 60-64 years and how CMH duration between ages 43 to 60-64 years related to concurrent FEV1 decline. RESULTS: From 5362 individuals enrolled at birth, 4427 contributed data between ages 20 and 64 years (52%male;63%ever-smoker). Amongst smokers CMH prevalence escalated between ages 36 and 43 from 7.6±2.0% to 13.0±2.6%. At these ages symptoms were associated with a higher risk of subsequent airflow limitation (OR(95%CI):3.70(1.62-8.45);4.11(1.85-9.13) respectively). Across adult life, CMH followed a dynamic remitting-relapsing course. Symptom prevalence following smoking cessation returned to levels seen amongst never-smokers. The longer CMH was present across 3 occasions (ages 43, 53 and 60-64), the greater the concurrent FEV1 decline, corresponding to an additional decrement of 3.6±2.5ml/year per occasion that CMH was present(p=0.005). CONCLUSIONS: CMH amongst middle-aged smokers represents an early developmental phase of COPD. Smoking-related CMH usually resolves following smoking cessation but the longer its duration the greater the FEV1 lost, suggesting the course of CMH across adult life may reflect the underlying course of airway disease activity.
Allinson JP, Hardy R, Donaldson GC, et al., 2015, CHRONIC MUCUS HYPERSECRETION MAY REPRESENT A BIOMARKER OF AIRWAYS DISEASE ACTIVITY RATHER THAN SIMPLY A PHENOTYPE: A LONGITUDINAL STUDY OF A NATIONALLY REPRESENTATIVE BRITISH BIRTH COHORT, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A186-A186, ISSN: 0040-6376
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- Citations: 1
Dal Negro RW, Iversen M, Calverley P, et al., 2015, EFFICACY AND SAFETY OF ERDOSTEINE IN COPD: RESULTS OF A 12-MONTH PROSPECTIVE, MULTINATIONAL STUDY, Asian Pacific Society of Respirology 20th Congress, Publisher: WILEY-BLACKWELL, Pages: 42-42, ISSN: 1323-7799
Pavord ID, Lettis S, Locantore N, et al., 2015, Blood eosinophils and inhaled corticosteroid/long-acting β-2 agonist efficacy in COPD, Thorax, Vol: 71, Pages: 118-125, ISSN: 1468-3296
Objective We performed a review of studies offluticasone propionate (FP)/salmeterol (SAL) (combinationinhaled corticosteroid (ICS)/long-acting β2-agonist(LABA)) in patients with COPD, which measured baseline(pretreatment) blood eosinophil levels, to test whetherblood eosinophil levels ≥2% were associated with agreater reduction in exacerbation rates with ICS therapy.Methods Three studies of ≥1-year duration met theinclusion criteria. Moderate and severe exacerbation rateswere analysed according to baseline blood eosinophillevels (<2% vs ≥2%). At baseline, 57–75% of patientshad ≥2% blood eosinophils. Changes in FEV1 and StGeorge’s Respiratory Questionnaire (SGRQ) scores werecompared by eosinophil level.Results For patients with ≥2% eosinophils, FP/SALwas associated with significant reductions inexacerbation rates versus tiotropium (INSPIRE: n=719,rate ratio (RR)=0.75, 95% CI 0.60 to 0.92, p=0.006)and versus placebo (TRISTAN: n=1049, RR=0.63, 95%CI 0.50 to 0.79, p<0.001). No significant difference wasseen in the <2% eosinophil subgroup in either study(INSPIRE: n=550, RR=1.18, 95% CI 0.92 to 1.51,p=0.186; TRISTAN: n=354, RR=0.99, 95% CI 0.67 to1.47, p=0.957, respectively). In SCO30002 (n=373), nosignificant effects were observed (FP or FP/SAL vsplacebo). No relationship was observed in any studybetween eosinophil subgroup and treatment effect onFEV1 and SGRQ.Discussion Baseline blood eosinophil levels mayrepresent an informative marker for exacerbationreduction with ICS/LABA in patients with COPD and ahistory of moderate/severe exacerbations.
Seemungal TAR, Wedzicha JA, 2015, Update in Chronic Obstructive Pulmonary Disease 2014, American Journal of Respiratory and Critical Care Medicine, Vol: 192, Pages: 1036-1044, ISSN: 1073-449X
Wedzicha JA, 2015, Mechanisms of COPD exacerbations, Annals of the American Thoracic Society, Vol: 12, Pages: S157-S159, ISSN: 2329-6933
Chronic obstructive pulmonary disease (COPD) exacerbations areimportant events that contribute to worsening health status,disease progression, and mortality. They are mainly triggered byrespiratory viruses (especially rhinovirus, the cause of the commoncold), but airway bacteria are also involved in their pathogenesis.Exacerbations are associated with both airway and systemicinflammation and, this is mainly neutrophilic in origin. Somepatients are especially prone to develop exacerbations, and these havebeen identified as a high-risk group with increased airwayinflammation and greater disease progression. Management ofacute exacerbations involves therapy with oral corticosteroids and/orantibiotics, and new therapies are needed. A number of interventionsmay prevent exacerbations, including vaccination, long-actingbronchodilators, antiinflammatory agents, and long-term antibiotictherapy. Understanding of the pathophysiological mechanisms ofCOPD exacerbations is important to develop novel therapies.
Wedzicha JA, 2015, Mechanisms of Chronic Obstructive Pulmonary Disease Exacerbations., Ann Am Thorac Soc, Vol: 12, Pages: S157-S159
Chronic obstructive pulmonary disease (COPD) exacerbations are important events that contribute to worsening health status, disease progression, and mortality. They are mainly triggered by respiratory viruses (especially rhinovirus, the cause of the common cold), but airway bacteria are also involved in their pathogenesis. Exacerbations are associated with both airway and systemic inflammation and, this is mainly neutrophilic in origin. Some patients are especially prone to develop exacerbations, and these have been identified as a high-risk group with increased airway inflammation and greater disease progression. Management of acute exacerbations involves therapy with oral corticosteroids and/or antibiotics, and new therapies are needed. A number of interventions may prevent exacerbations, including vaccination, long-acting bronchodilators, antiinflammatory agents, and long-term antibiotic therapy. Understanding of the pathophysiological mechanisms of COPD exacerbations is important to develop novel therapies.
Rothnie KJ, Smeeth L, Herrett E, et al., 2015, GRACE scores in COPD patients with acute coronary syndromes: performance and impact on secondary prevention, European Respiratory Society International Congress 2015, Publisher: European Respiratory Society, ISSN: 0903-1936
Background: Treatment after acute coronary syndrome (ACS) is influenced by the GRACE score which predicts the risk of death at 6 months. We investigated how well the GRACE score performed in COPD patients and how it was used to guide treatment compared to non-COPD patients.Methods: Patients with an admission for ACS between 2003-2013 were identified in the UK MINAP database. COPD patients had a record of obstructive airway disease, smoking history and were aged >35. GRACE scores were calculated using a previously validated method1 and converted to predicted risk of death. Discrimination (c-statistic) and calibration (Hosmer-Lemeshow Chi2) measures were calculated for COPD and non-COPD patients. We then used logistic regression adjusted for GRACE score to compare management for COPD and non-COPD patients with the same GRACE score.Results: 483798 patients with ACS were included. 58940 (12.2%) had COPD. Discrimination and calibration of GRACE scores were poorer for COPD patients (Table 1). Compared to non-COPD patients with the same GRACE score, COPD patients were under-treated and under-investigated (Table 2).
Wedzicha JA, Mezzi K, Fogel R, et al., 2015, Baseline symptom scores and future risk of severe exacerbation: The SPARK study, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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- Citations: 2
Benson VS, Mullerova H, Vestbo J, et al., 2015, Associations between gastro-oesophageal reflux, its management and exacerbations of chronic obstructive pulmonary disease, RESPIRATORY MEDICINE, Vol: 109, Pages: 1147-1154, ISSN: 0954-6111
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- Citations: 36
Siddiqui SH, Guasconi A, Vestbo J, et al., 2015, Blood Eosinophils: A Biomarker of Response to Extrafine Beclomethasone/Formoterol in Chronic Obstructive Pulmonary Disease, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 192, Pages: 523-525, ISSN: 1073-449X
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- Citations: 287
Brill S, Law M, El-Emir E, et al., 2015, Effects of different antibiotic classes on airwaybacteria in stable COPD using culture and molecularQ1 techniques: a randomised controlled trial, Thorax, Vol: 70, Pages: 930-938, ISSN: 1468-3296
BackgroundLong term antibiotic therapy is used to prevent exacerbations of chronic obstructive pulmonary disease (COPD) but there is uncertainty over whether this reduces airway bacteria. The optimum antibiotic choice remains unknown. We conducted an exploratory trial in stable patients with COPD comparing three antibiotic regimens against placebo. MethodsThis was a single-centre, single-blind, randomised placebo-controlled trial (clinicaltrials.gov number NCT01398072). Patients ≥45 years with COPD, FEV1<80% predicted and chronic productive cough were randomised to receive either moxifloxacin 400mg daily for 5 days/4 weeks, doxycycline 100mg/day, azithromycin 250mg 3x/week or one placebo tablet daily for 13 weeks. The primary outcome was the change in total cultured bacterial load in sputum from baseline; secondary outcomes included bacterial load by 16S qPCR, sputum inflammation and antibiotic resistance. Results99 patients were randomised; 86 completed follow-up, were able to expectorate sputum and were analysed. After adjustment, there was a mean reduction in bacterial load of 0.42 log10 cfu/ml (95% CI -0.08, 0.91, p=0.10) with moxifloxacin, 0.11 (-0.33, 0.55, p=0.62) with doxycycline, and 0.08 (-0.38, 0.54, p=0.73) with azithromycin from placebo, respectively. There were also no significant changes in bacterial load measured by 16S qPCR or in airway inflammation. More treatment-related adverse events occurred with moxifloxacin. Of note, mean inhibitory concentrations of cultured isolates increased by at least 3 times over placebo in all treatment arms.ConclusionsTotal airway bacterial load did not decrease significantly after three months of antibiotic therapy. Large increases in antibiotic resistance were seen in all treatment groups and this has important implications for future studies.
Donaldson GC, Law M, Kowlessar B, et al., 2015, Impact of prolonged exacerbation recovery in chronic obstructive pulmonary disease, American Journal of Respiratory and Critical Care Medicine, Vol: 192, Pages: 943-950, ISSN: 1535-4970
INTRODUCTION: COPD exacerbations are important and heterogeneous events, but the consequences of prolonged exacerbation recovery are unknown. METHODS: A cohort of 384 COPD patients (FEV1 % predicted 45.8 (SD 16.6) and a median exacerbation rate of 2.13 per year (IQR 1.0-3.2)) were followed for 1039 days (IQR 660-1814) between October 1995 and January 2013. Patients recorded daily worsening of respiratory symptoms and peak expiratory flow (PEF), and when stable underwent 3-monthly spirometry, and completed the St. George's Respiratory Questionnaire (SGRQ) annually. Exacerbations were diagnosed as two consecutive days with one major symptom plus another respiratory symptom. Exacerbation duration was defined as the time from onset to the day preceding two consecutive symptom-free and recovery in PEF as return to pre-exacerbation levels. RESULTS: 351 patients had 1 or more exacerbations. Patients with a longer symptom duration (mean 14.5 days) had a worse SGRQ total score (0.2 units per 1 day; p=0.040). A longer symptomatic duration was associated with a shorter interval between exacerbation recovery and onset of the next exacerbation (Hazard Ratio=1.004; p=0.013). For 257 (7.3%) exacerbations, PEF did not recover within 99 days. These exacerbations were associated with symptoms of a viral infection (cold and sore throat). Patients with these non-recovered exacerbations showed a 10.8 ml/year (p<0.001) faster decline in FEV1. CONCLUSION: Prolonged exacerbation symptomatic duration is associated with poorer health status and a greater risk of a new event. Exacerbations where lung function does not recover are associated with symptoms of viral infections and accelerated decline in FEV1.
Alahmari AD, Mackay AJ, Patel ARC, et al., 2015, Influence of weather and atmospheric pollution on physical activity in patients with COPD, Respiratory Research, Vol: 16, ISSN: 1465-993X
RationaleInformation concerning how climate and atmospheric pollutants affects physical activity in COPD patients is lacking and might be valuable in determining when physical activity should be encouraged.MethodsSeventy-three stable COPD patients recorded on daily diary cards worsening of respiratory symptoms, peak expiratory flow rate, hours spent outside the home and the number of steps taken per day. Pedometry data was recorded on 16,478 days, an average of 267 days per patient (range 29-658). Daily data for atmospheric PM 10 and ozone (O 3 ) were obtained for Bloomsbury Square, Central London from the Air Quality Information Archive databases. Daily weather data were obtained for London Heathrow from the British Atmospheric Data Archive.ResultsColder weather below 22.5 °C, reduced daily step count by 43.3 steps day per°C (95 % CI 2.14 to 84.4; p = 0.039) and activity was lower on rainy than dry days (p = 0.002) and on overcast compared to sunny days (p < 0.001). Daily step count was 434 steps per day lower on Sunday than Saturday (p < 0.001) and 353 steps per day lower on Saturday than Friday (p < 0.001). After allowance for these effects, higher O 3 levels decreased activity during the whole week (-8 steps/ug/m3; p = 0.005) and at weekends (-7.8 steps/ug/m3; p = 0.032). Whilst, during the week PM 10 reduced activity (p = 0.018) but not during the weekend.ConclusionsInactivity of COPD patients is greatest on cold, wet and overcast days and at the weekends. This study also provides evidence of an independent effect of atmospheric pollution at high levels.Keywords: COPD; Atmospheric pollution; Weather; Daily step-count; Physical activity; Daily monitoring
Celli BR, Decramer M, Wedzicha JA, et al., 2015, An official American Thoracic Society/European Respiratory Society statement: research questions in COPD, EUROPEAN RESPIRATORY REVIEW, Vol: 24, Pages: 159-172, ISSN: 0905-9180
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- Citations: 62
Huerta A, Donaldson G, Singh R, et al., 2015, Upper respiratory symptoms worsen over time and relate to clinical phenotype in COPD., Annals of the American Thoracic Society, Vol: 12, Pages: 997-1004, ISSN: 2329-6933
RATIONALE: How nasal symptoms in patients with COPD change over time and resolve during natural occurring exacerbation have never been described. METHODS: Patients in the London COPD cohort were asked about the presence of nasal symptoms (nasal discharge, sneezing, post-nasal drip (PND), blocked nose and anosmia) over an 8-year period (2005-2013) every three months at routine clinic visits at stable state and daily during exacerbations with the use of diary cards. Data was prospectively collected and in a subgroup of patients COPD Assessment Test (CAT) and human rhinovirus (HRV) identification by PCR was available. Patients were also defined as infrequent/frequent exacerbators (<2 or ≥2 exacerbations/year). RESULTS: On 4368 visits, 209 patients with COPD were asked about their nasal symptoms. On 2033 visits, when the patients were stable, the odds ratio (OR) for nasal discharge increased by 1.32% per year (95% CI 1.19-1.45; p<0.001); sneezing 1.16% (1.05-1.29; p=0.005); PND 1.18% (1.03-1.36; p=0.016) and anosmia 1.19% (1.03-1.37; p=0.015). At exacerbation, nasal discharge was present for 7-daysand blocked nose, sneezing and PND increased for just 3 days; anosmia did not change. Nasal discharge was more likely in frequent exacerbators; OR 1.96 (1.17-3.28; p=0.011) and when present, CAT scores were higher by 1.06 units (0.32-1.80; p=0.005) when stable and 1.30 units (0.05 to 2.57; p=0.042) at exacerbation. CONCLUSION: Upper airway symptoms increase over time in COPD patients and are related to the frequent exacerbator phenotype. These longitudinal changes may be due to increasing airway inflammation or the disease progression.
Celli BR, Decramer M, Wedzicha JA, et al., 2015, An Official American Thoracic Society/European Respiratory Society Statement: Research Questions in Chronic Obstructive Pulmonary Disease, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 191, Pages: 831-844, ISSN: 1073-449X
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- Citations: 158
Celli BR, Decramer M, Wedzicha JA, et al., 2015, An official American Thoracic Society/European Respiratory Society statement: research questions in COPD, EUROPEAN RESPIRATORY JOURNAL, Vol: 45, Pages: 879-905, ISSN: 0903-1936
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- Citations: 109
Muellerova H, Maselli DJ, Locantore N, et al., 2015, Hospitalized Exacerbations of COPD Risk Factors and Outcomes in the ECLIPSE Cohort, CHEST, Vol: 147, Pages: 999-1007, ISSN: 0012-3692
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- Citations: 221
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