Publications
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Pengo M, Sichang X, Ratneswaran C, et al., 2016, RANDOMISED SHAM-CONTROLLED TRIAL OF TRANSCUTANEOUS ELECTRICAL STIMULATION IN OBSTRUCTIVE SLEEP APNOEA, THORAX, Vol: 71, Pages: A3-A3, ISSN: 0040-6376
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Reed KI, Pengo MF, Xiao S, et al., 2016, FEASIBILITY AND PATIENT TOLERABILITY OF TRANSCUTANEOUS ELECTRICAL STIMULATION IN OBSTRUCTIVE SLEEP APNOEA, THORAX, Vol: 71, Pages: A16-A17, ISSN: 0040-6376
Garfield BE, Shao D, Parfitt L, et al., 2016, LOW SKELETAL MUSCLE STRENGTH AND PHYSICAL ACTIVITY ARE ASSOCIATED WITH POOR OUTCOMES IN PULMONARY ARTERIAL HYPERTENSION, THORAX, Vol: 71, Pages: A64-A64, ISSN: 0040-6376
Murphy PB, Arbane G, Bourke S, et al., 2016, HOT-HMV UK TRIAL SECONDARY OUTCOME ANALYSIS: EARLY READMISSION IS REDUCED BY THE ADDITION OF HOME MECHANICAL VENTILATION TO HOME OXYGEN THERAPY IN COPD PATIENTS WITH CHRONIC RESPIRATORY FAILURE FOLLOWING A LIFE-THREATENING EXACERBATION, THORAX, Vol: 71, Pages: A68-A69, ISSN: 0040-6376
He B-T, Lu G, Xiao S-C, et al., 2016, Coexistence of OSA may compensate for sleep related reduction in neural respiratory drive in patients with COPD, Thorax, Vol: 72, Pages: 256-262, ISSN: 1468-3296
Background The mechanisms underlying sleep-related hypoventilation in patients with coexisting COPD and obstructive sleep apnoea (OSA), an overlap syndrome, are incompletely understood. We compared neural respiratory drive expressed as diaphragm electromyogram (EMGdi) and ventilation during stage 2 sleep in patients with COPD alone and patients with overlap syndrome.Methods EMGdi and airflow were recorded during full polysomnography in 14 healthy subjects, 14 patients with OSA and 39 consecutive patients with COPD. The ratio of tidal volume to EMGdi was measured to indirectly assess upper airway resistance.Results Thirty-five patients with COPD, 12 healthy subjects and 14 patients with OSA completed the study. Of 35 patients with COPD, 19 had COPD alone (FEV1 38.5%±16.3%) whereas 16 had an overlap syndrome (FEV1 47.5±16.2%, AHI 20.5±14.1 events/hour). Ventilation (VE) was lower during stage 2 sleep than wakefulness in both patients with COPD alone (8.6±2.0 to 6.5±1.5 L/min, p<0.001) and those with overlap syndrome (8.3±2.0 to 6.1±1.8 L/min). Neural respiratory drive from wakefulness to sleep decreased significantly for patients with COPD alone (29.5±13.3% to 23.0±8.9% of maximal, p<0.01) but it changed little in those with overlap syndrome. The ratio of tidal volume to EMGdi was unchanged from wakefulness to sleep in patients with COPD alone and healthy subjects but was significantly reduced in patients with OSA or overlap syndrome (p<0.05).Conclusions Stage 2 sleep-related hypoventilation in COPD alone is due to reduction of neural respiratory drive, but in overlap syndrome it is due to increased upper airway resistance.
Polkey MI, Griffiths MJ, Kemp PR, 2016, Muscle regeneration after critical illness: are satellite cells the answer?, American Journal of Respiratory and Critical Care Medicine, Vol: 194, Pages: 780-782, ISSN: 1535-4970
Mohan D, Lewis A, Patel MS, et al., 2016, Using laser capture microdissection to study fiber specific signalling in locomotor muscle in COPD: A pilot study, Muscle & Nerve, Vol: 55, Pages: 902-912, ISSN: 1097-4598
INTRODUCTION: Quadriceps dysfunction is important in chronic obstructive pulmonary disease (COPD), with an associated increased proportion of type II fibers. Investigation of protein synthesis and degradation has yielded conflicting results, possibly due to study of whole biopsy samples, whereas signalling may be fiber-specific. Our objective was to develop a method for fiber-specific gene expression analysis. METHODS: 12 COPD and 6 healthy subjects underwent quadriceps biopsy. Cryosections were immunostained for type II fibers, which were separated using laser capture microdissection (LCM). Whole muscle and different fiber populations were subject to quantitative polymerase chain reaction (qPCR). RESULTS: Muscle-RING-finger-protein-1(MURF-1) and Atrogin-1 were lower in type II fibers of COPD versus healthy subjects (P=0.02 and P=0.03, respectively), but differences were not apparent in whole muscle or type I fibers. DISCUSSION: We describe a novel method for studying fiber-specific gene expression in optimum-cutting-temperature (OCT) compound-embedded muscle specimens. LCM offers a more sensitive way to identify molecular changes in COPD muscle. This article is protected by copyright. All rights reserved.
Mohan D, Polkey M, Forman J, et al., 2016, LATE-BREAKING ABSTRACT: Cardiovascular and skeletal muscle manifestations in COPD: The ERICA study, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Pengo M, Xiao S, Ratneswaran C, et al., 2016, LATE-BREAKING ABSTRACT: Randomised, sham-controlled, double-blind cross-over trial of transcutaneous electrical stimulation of the pharyngeal dilator muscles in obstructive sleep apnoea, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Fisk M, Mohan D, Cheriyan J, et al., 2016, A functional imaging study to evaluate aortic inflammation in OSA subjects, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Murphy P, Arbane G, Bourke S, et al., 2016, LATE-BREAKING ABSTRACT: Improving admission free survival with home mechanical ventilation (HMV) and home oxygen therapy (HOT) following life threatening COPD exacerbations: HoT-HMV UK Trial NCT00990132, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Labey A, Canavan JL, Nolan CM, et al., 2016, Longitudinal change in ultrasound measurement of rectus femoris cross-sectional area in COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Hopkinson N, Kemp S, Toma T, et al., 2016, Survival benefit from successful bronchoscopic lung volume reduction with endobronchial valves - A 10 year follow up study, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Kon S, Jones S, Schofield S, et al., 2016, Short physical performance battery as a predictor of adverse outcomes following hospitalisation for an acute exacerbation of COPD, ERS International Congress 2016, Publisher: European Respiratory Society, ISSN: 0903-1936
Background: Hospitalisation for acute exacerbations of COPD (AECOPD) is associated with increased mortality, and high risk of readmission. The Short Physical Performance Battery (SPPB), a composite index of 3 lower extremity physical performance measures (score 0-12), is a consistent predictor of adverse outcomes in the geriatric population.Hypothesis: SPPB measured at discharge predicts risk of readmission and death at 1 year in patients hospitalised with AECOPD.Methods: SPPB was measured in 213 patients hospitalised with an AECOPD. Hospitalisations and vital status were recorded at 1 year.Results: Baseline characteristics:mean age 72, FEV1 40%pred, 52% male. Mean(SD) SPPB was 6.3(3.1). 52.1% patients were readmitted and 16.4% died during 1 year of follow-up. Patients with low SPPB scores(0-3) at hospital discharge had significantly increased rates of all-cause readmission and mortality compared with those with the highest scores(10-12):(29.7% vs. 10.8%;p=0.004 and 37.1% vs. 5.7%;p<0.001). Low SPPB scores were associated with greater odds of all cause readmission and mortality at 1 year;crude OR(95% CI) 6.14(2.42-15.55) and 7.68(1.62-36.5) respectively). Each one point increase in SPPB score resulted in lower odds of readmission and mortality at 1 year (OR 0.81(0.74-0.90) and 0.81(0.71-0.93) respectively). Gait speed (a component of SPPB) as a single item was equivalent or better than the SPPB in predicting readmission (c-statistic 0.672vs.0.671) and death (0.698vs.0.666) at 1 year.Conclusion: The SPPB predicts readmission and mortality at 1 year in patients hospitalised with AECOPD, but has no additional prognostic value over its component, gait speed.
Jones S, Canavan J, Nolan C, et al., 2016, Longitudinal validity of the five-repetition sit-to-stand in COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Fisk M, Mohan D, Coello C, et al., 2016, A functional imaging study to investigate the relationship between pulmonary inflammation and systemic inflammation in COPD patients, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Loeckx M, Louvaris Z, Tanner R, et al., 2016, Contact time between patients with COPD and coach during an activity telecoaching intervention: Impact on the intervention effect, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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- Citations: 2
Maddocks M, Kon S, Canavan J, et al., 2016, Physical frailty and pulmonary rehabilitation in COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Canavan JL, Maddocks M, Kon S, et al., 2016, Normalised quadriceps muscle strength cut-points and mortality in COPD, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Luo Y, Qiu Z, Steier J, et al., 2016, Inspiratory capacity manoeuvres may underestimate dynamic hyperinflation in patients with COPD; the explanation for apparent non-inflators, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Aymerich JG, Puhan M, de Jongh C, et al., 2016, Responsiveness of PROactive instruments to measure physical activity in COPD patients, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Nolan CM, Maddocks M, Canavan JL, et al., 2016, Do pedometers maintain the benefits of pulmonary rehabilitation in COPD patients?, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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He B, Lu G, Xiao S, et al., 2016, Neural respiratory drive in patients with COPD alone and those with overlap syndrome, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Garner J, Kemp SV, Toma TP, et al., 2016, Survival after endobronchial valve placement for emphysema: a 10-Year follow-up study, American Journal of Respiratory and Critical Care Medicine, Vol: 194, Pages: 519-521, ISSN: 1535-4970
Polkey MI, Lyall RA, Yang K, et al., 2016, Respiratory muscle strength as predictive biomarker for survival in amyotrophic lateral sclerosis, American Journal of Respiratory and Critical Care Medicine, Vol: 195, Pages: 86-95, ISSN: 1535-4970
Rationale: Biomarkers for survival in amyotrophic lateral sclerosis (ALS) would facilitate the development of novel drugs. Although respiratory muscle weakness is a known predictor of poor prognosis, a comprehensive comparison of different tests is lacking.Objectives: To compare the predictive power of invasive and noninvasive respiratory muscle strength assessments for survival or ventilator-free survival, up to 3 years.Methods: From a previously published report respiratory muscle strength measurements were available for 78 patients with ALS. Time to death and/or ventilation were ascertained. Receiver operating characteristic analysis was used to determine the cutoff point of each parameter.Measurements and Main Results: Each respiratory muscle strength assessment individually achieved statistical significance for prediction of survival or ventilator-free survival. In multivariate analysis sniff trans-diaphragmatic and esophageal pressure, twitch trans-diaphragmatic pressure (Tw Pdi), age, and maximal static expiratory mouth pressure were significant predictors of ventilation-free survival and Tw Pdi and maximal static expiratory mouth pressure for absolute survival. Although all measures had good specificity, there were differing sensitivities. All cutoff points for the VC were greater than 80% of normal, except for prediction of 3-month outcomes. Sequential data showed a linear decline for direct measures of respiratory muscle strength, whereas VC showed little to no decline until 12 months before death/ventilation.Conclusions: The most powerful biomarker for mortality stratification was Tw Pdi, but the predictive power of sniff nasal inspiratory pressure was also excellent. A VC within normal range suggested a good prognosis at 3 months but was of little other value.
Pengo MF, Xiao S, Ratneswaran C, et al., 2016, Randomised sham-controlled trial of transcutaneous electrical stimulation in obstructive sleep apnoea, Thorax, Vol: 71, Pages: 923-931, ISSN: 1468-3296
Introduction Obstructive sleep apnoea (OSA) is characterised by a loss of neuromuscular tone of the upper airway dilator muscles while asleep. This study investigated the effectiveness of transcutaneous electrical stimulation in patients with OSA.Patients and methods This was a randomised, sham-controlled crossover trial using transcutaneous electrical stimulation of the upper airway dilator muscles in patients with confirmed OSA. Patients were randomly assigned to one night of sham stimulation and one night of active treatment. The primary outcome was the 4% oxygen desaturation index, responders were defined as patients with a reduction >25% in the oxygen desaturation index when compared with sham stimulation and/or with an index <5/hour in the active treatment night.Results In 36 patients (age mean 50.8 (SD 11.2) years, male/female 30/6, body mass index median 29.6 (IQR 26.9–34.9) kg/m2, Epworth Sleepiness Scale 10.5 (4.6) points, oxygen desaturation index median 25.7 (16.0–49.1)/hour, apnoea-hypopnoea index median 28.1 (19.0–57.0)/hour) the primary outcome measure improved when comparing sham stimulation (median 26.9 (17.5–39.5)/hour) with active treatment (median 19.5 (11.6–40.0)/hour; p=0.026), a modest reduction of the mean by 4.1 (95% CI −0.6 to 8.9)/hour. Secondary outcome parameters of patients' perception indicated that stimulation was well tolerated. Responders (47.2%) were predominantly from the mild-to-moderate OSA category. In this subgroup, the oxygen desaturation index was reduced by 10.0 (95% CI 3.9 to 16.0)/hour (p<0.001) and the apnoea-hypopnoea index was reduced by 9.1 (95% CI 2.0 to 16.2)/hour (p=0.004).Conclusion Transcutaneous electrical stimulation of the pharyngeal dilators during a single night in patients with OSA improves upper airway obstruction and is well tolerated.
Celli B, Tetzlaff K, Criner G, et al., 2016, The 6-minute walk test as a COPD stratification tool: insights from the COPD biomarker qualification consortium, American Journal of Respiratory and Critical Care Medicine, Vol: 194, Pages: 1483-1493, ISSN: 1535-4970
BACKGROUND: The 6-minute walk test distance (6MWD) predicts mortality in COPD. Whether variability in study type (observational versus interventional), region performed limits use of the test as a stratification tool or outcome measure for therapeutic trials is unclear. METHODS: Original data from 14,497 COPD patients from 6 observational (n = 9641) and 5 interventional (n=4856) studies larger than 100 patients and longer than 6 months in duration were included. The geographical, anthropometrics, FEV1, dyspnea, co-morbidities and health status scores were measured. Associations between 6MWD with mortality, hospitalizations and exacerbations adjusted by study type, age and gender were evaluated. Thresholds for outcome prediction were calculated using receiver-operating curves. The change in 6MWD after inhaled bronchodilator treatment and surgical lung volume reduction (LVRS) were analyzed to evaluate the responsiveness of the test as an outcome measure. RESULTS: The 6MWD was significantly lower in non-survivors, those hospitalized or who exacerbated compared with those without events at 6, 12 and > 12 months. At these time points, the 6MWD ROC-AUC to predict mortality was 0.71, 0.70 and 0.68 and for hospitalizations was 0.61, 0.60 and 0.59. After treatment, the 6MWD was not different between placebo or bronchodilators but increased after LVRS compared with medical therapy. Variation across study types (observational or therapeutic) or regions did not confound the ability of 6MWD to predict outcome. CONCLUSIONS: The 6MWD may help stratify COPD patients for clinical trials and interventions aimed at modifying exacerbations, hospitalizations or death.
Maddocks M, Kon SS, Canavan JL, et al., 2016, Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study, Thorax, Vol: 71, Pages: 988-995, ISSN: 1468-3296
BACKGROUND: Frailty is an important clinical syndrome that is consistently associated with adverse outcomes in older people. The relevance of frailty to chronic respiratory disease and its management is unknown. OBJECTIVES: To determine the prevalence of frailty among patients with stable COPD and examine whether frailty affects completion and outcomes of pulmonary rehabilitation. METHODS: 816 outpatients with COPD (mean (SD) age 70 (10) years, FEV1% predicted 48.9 (21.0)) were recruited between November 2011 and January 2015. Frailty was assessed using the Fried criteria (weight loss, exhaustion, low physical activity, slowness and weakness) before and after pulmonary rehabilitation. Predictors of programme non-completion were identified using multivariate logistic regression, and outcomes were compared using analysis of covariance, adjusting for age and sex. RESULTS: 209/816 patients (25.6%, 95% CI 22.7 to 28.7) were frail. Prevalence of frailty increased with age, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Medical Research Council (MRC) score and age-adjusted comorbidity burden (all p≤0.01). Patients who were frail had double the odds of programme non-completion (adjusted OR 2.20, 95% CI 1.39 to 3.46, p=0.001), often due to exacerbation and/or hospital admission. However, rehabilitation outcomes favoured frail completers, with consistently better responses in MRC score, exercise performance, physical activity level and health status (all p<0.001). After rehabilitation, 71/115 (61.3%) previously frail patients no longer met case criteria for frailty. CONCLUSIONS: Frailty affects one in four patients with COPD referred for pulmonary rehabilitation and is an independent predictor of programme non-completion. However, patients who are frail respond favourably to rehabilitation and their frailty can be reversed in the short term.
Dueñas-Espín I, Demeyer H, Gimeno-Santos E, et al., 2016, Depression symptoms reduce physical activity in COPD patients: a prospective multicenter study, International Journal of Chronic Obstructive Pulmonary Disease, Vol: 11, Pages: 1287-1295, ISSN: 1176-9106
Background: The role of anxiety and depression in the physical activity (PA) of patients with COPD is controversial. We prospectively assessed the effect of symptoms of anxiety and depression on PA in COPD patients.Methods: We evaluated anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), PA (Dynaport® accelerometer), and other relevant characteristics in 220 COPD patients from five European countries at baseline and at 6 and 12 months of follow-up. HADS score was categorized as: no symptoms (score 0–7), suggested (8–10), and probable (>11) anxiety or depression. We estimated the association between anxiety and depression at t (baseline and 6 months) and PA at t+1 (6 and 12 months) using regression models with a repeated measures approach.Results: Patients had a mean (standard deviation) age of 67 (8) years, forced expiratory volume in 1 second 57 (20)% predicted. At baseline, the prevalence of probable anxiety and depression was 10% and 5%, respectively. In multivariable models adjusted by confounders and previous PA, patients performed 81 fewer steps/day (95% confidence interval, -149 to -12, P=0.02) per extra point in HADS-depression score. HADS-anxiety symptoms were not associated with PA.Conclusion: In COPD patients, symptoms of depression are prospectively associated with a measurable reduction in PA 6 months later.
Pearse SS, Cowie MR, Sharma R, et al., 2016, Validity of an algorithm in implantable devices for the diagnosis of sleep-disordered breathing in heart failure, Heart Failure 2016 Conference, Publisher: Wiley, Pages: 72-73, ISSN: 1879-0844
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