457 results found
Philip K, Bu F, Polkey M, et al., 2022, Relationship of smoking with current and future social isolation and loneliness: 12-year follow-up of older adults in England, The Lancet Regional Health Europe, Vol: 14, ISSN: 2666-7762
BackgroundSmoking is often colloquially considered “social”. However, the actual relationship of smoking with current and future social isolation and loneliness is unclear. We therefore examined these relationships over a 12-year follow-up.MethodsIn this cohort study, we used a nationally representative sample of community dwelling adults aged 50 years and over from the English Longitudinal Study of Ageing (N=8780) (45% male, mean(SD) age 67(10) years. We examined associations of self-reported smoking status at baseline assessment, with social isolation (low social contact, social disengagement, domestic isolation), and loneliness (3-item UCLA loneliness scale), measured at baseline, and follow-up at 4, 8 and 12 years, using ordinary least squares regression models.FindingsAt baseline, smokers were more likely to be lonely (coef.=0·111, 95% CI 0·025 – 0·196) and socially isolated than non-smokers, having less frequent social interactions with family and friends (coef.= 0·297, 95%CI 0·148 – 0·446), less frequent engagement with community and cultural activities (coef.= 0·534, 95%CI 0·421 – 0·654), and being more likely to live alone (Odds Ratio =1·400, 95%CI 1·209 – 1·618). Smoking at baseline was associated with larger reductions in social contact (coef.=0·205, 95%CI 0·053 – 0·356, to 0·297, 95%CI 0·140 – 0·455), increases in social disengagement (coef.=0·168, 95%CI 0·066 – 0·270, to coef.=0·197, 95%CI 0·087 – 0·307), and increases in loneliness (coef.=0·105, 95%CI 0·003 – 0·207), at 4-year follow-up) over time. No association was found between smoking and changes in cohabitation status. Findings were independent of all identified confounders, including age, sex, social class and the presence of physical and mental
Williams P, Buttery S, Mweseli R, et al., 2022, Immediate smoking cessation support vs usual care in smokers attending a targeted lung health check; the QuLIT trial, BMJ Open Respiratory Research, ISSN: 2052-4439
Objectives: Lung cancer screening programmes offer an opportunity to address tobacco dependence in current smokers. The effectiveness of different approaches to smoking cessation in this context has not yet been established. We investigated if immediate smoking cessation support, including pharmacotherapy, offered as part of a lung cancer screening programme, increases quit rates compared to usual care (Very Brief Advice to quit and signposting to smoking cessation services).Materials and Methods: We conducted a single-blind randomised controlled trial of current smokers aged 55-75 years attending a Targeted Lung Health Check (TLHC). On randomly allocated days smokers received either (1) immediate support from a trained smoking cessation counsellor with appropriate pharmacotherapy or (2) usual care. The primary outcome was self-reported quit rate at three months. We performed thematic analysis of participant interview responses.Results: Of 412 people attending between January and March 2020, 115(27.9%) were current smokers; 46% female, mean(SD) 62.4(5.3) years. Follow up data were available for 84 smokers. At 3 months quit rates in the intervention group were higher 14/48(29.2%) versus 4/36(11%) (2 3.98, p=0.04). Participant interviews revealed four smoking-cessation related themes; 1) Stress and anxiety, 2) Impact of the COVID-19 pandemic, 3) Computerised tomography scans influencing desire to quit, 4) Individual beliefs about stopping smoking. Conclusion: The provision of immediate smoking cessation support is associated with a substantial increase in quit rates at three months. Further research is needed to investigate longer term outcomes and to refine future service delivery.
Philip K, Buttery S, Williams P, et al., 2021, Impact of COVID-19 on people with asthma: A mixed methods analysis from a UK wide survey, BMJ Open Respiratory Research, ISSN: 2052-4439
Hopkinson N, 2021, Vectura and Philip Morris – the leopard hasn’t changed its spots., Thorax, ISSN: 0040-6376
The uniquely lethal nature of the tobacco industry’s products, the industry’s environmental impact and its incompatibility with human rights make the takeover of Vectura, a pharmaceutical company focused on inhaler technology, by tobacco giant Philip Morris International (PMI), extremely unwelcome. The idea that a company which, based on its market share and the global death toll, kills more than a million people every year4 should be allowed to expand into the delivery of healthcare has been widely condemned, including by the British Thoracic Society, the European Respiratory Society and the US COPD Foundation, as well as the American Lung Association and American Thoracic Society who referred to the move as “reprehensible”.
Pavitt M, Lewis A, Buttery S, et al., 2021, Dietary nitrate supplementation to enhance exercise capacity in hypoxic COPD: EDEN-OX a double-blind, placebo-controlled, randomised crossover study, Thorax, ISSN: 0040-6376
Rationale: Dietary nitrate supplementation improves skeletal muscle oxygen utilisation and vascular endothelial function. We hypothesised that these effects might be sufficient to improve exercise performance in patients with COPD and hypoxia severe enough to require supplemental oxygen.Methods: We conducted a single-centre, double-blind, placebo-controlled, cross-over study, enrolling adults with COPD who were established users of long-term oxygen therapy. Participants performed an endurance shuttle walk test, using their prescribed oxygen, 3 hours after consuming either 140 mL of nitrate-rich beetroot juice (BRJ) (12.9 mmol nitrate) or placebo (nitrate-depleted BRJ). Treatment order was allocated (1:1) by computer-generated block randomisation.Measurements: The primary outcome was endurance shuttle walk test time. The secondary outcomes included area under the curve to isotime for fingertip oxygen saturation and heart rate parameters during the test, blood pressure, and endothelial function assessed using flow-mediated dilatation. Plasma nitrate and nitrite levels as well as FENO were also measured.Main results: 20 participants were recruited and all completed the study. Nitrate-rich BRJ supplementation prolonged exercise endurance time in all participants as compared with placebo: median (IQR) 194.6 (147.5–411.7) s vs 159.1 (121.9–298.5) s, estimated treatment effect 62 (33–106) s (p<0.0001). Supplementation also improved endothelial function: NR-BRJ group +4.1% (−1.1% to 14.8%) vs placebo BRJ group −5.0% (−10.6% to –0.6%) (p=0.0003).Conclusion: Acute dietary nitrate supplementation increases exercise endurance in patients with COPD who require supplemental oxygen.
Burtin C, Mohan D, Troosters T, et al., 2021, Objectively Measured Physical Activity as a COPD Clinical Trial Outcome, CHEST, Vol: 160, Pages: 2080-2100, ISSN: 0012-3692
Holt H, Talaei M, Greenig M, et al., 2021, Risk factors for developing COVID-19: a population-based longitudinal study (COVIDENCE UK), THORAX, ISSN: 0040-6376
Lewis A, Philip KEJ, Lound A, et al., 2021, The physiology of singing and implications for 'Singing for Lung Health' as a therapy for individuals with chronic obstructive pulmonary disease, BMJ OPEN RESPIRATORY RESEARCH, Vol: 8, ISSN: 2052-4439
Capstick TGD, Hopkinson NS, 2021, Adapting Inhaled Medication Practice in COPD and Asthma to Avoid Funding the Tobacco Industry [Corrigendum], International Journal of Chronic Obstructive Pulmonary Disease, Vol: Volume 16, Pages: 3239-3241
Demeyer H, Mohan D, Burtin C, et al., 2021, Objectively measured physical activity in patients with COPD: recommendations from an international task force on physical activity., COPD: Journal of Chronic Obstructive Pulmonary Disease, Vol: 8, Pages: 528-550, ISSN: 1541-2555
Physical activity (PA) is of key importance for health among healthy persons and individuals with chronic obstructive pulmonary disease (COPD). PA has multiple dimensions that can be assessed and quantified objectively using activity monitors. Moreover, as shown in the published literature, variable methodologies have been used to date to quantify PA among individuals with COPD, precluding clear comparisons of outcomes across studies. The present paper aims to provide a summary of the available literature for the rationale behind using objectively measured PA and proposes a standardized methodology for assessment, including standard operating procedures for future research. The present paper, therefore, describes the concept of PA, reports on the importance of PA, summarizes the dimensions of PA, provides a standard operating procedure on how to monitor PA using objective assessments, and describes the psychometric properties of objectively measured PA. The present international task force recommends implementation of the standard operating procedure for PA data collection and reporting in the future. This should further clarify the relationship between PA and clinical outcomes, test the impact of treatment interventions on PA in individuals with COPD, and successfully propose a PA endpoint for regulatory qualification in the future.
Hopkinson N, 2021, A children’s charter for lung health., Thorax, ISSN: 0040-6376
Every child and young person has the right to breathe clean air, with healthy lungs. Pre-conception, in utero and early life conditions affect children’s lungs, their lung growth and their long-term health. Government, societal and individual action to address this is needed, including the provision and distribution of the necessary resources, both to protect children now and to prevent future ill health, disability and premature death. Government, charities, professional bodies, and other organisations must consider impacts on child health in all their policies and ensure children, their families and carers have appropriate protection and support. To address this, the Asthma UK and British Lung Foundation Partnership Children’s Charter for Lung Health, endorsed by The British Paediatric Respiratory Society and the British Thoracic Society as well as the Association of Chartered Physiotherapists in Respiratory Care, and the Association of Respiratory Nurse Specialists sets out 10 principles in three groups to guide policy development and action.
Hopkinson N, 2021, Adapting inhaled medication practice in COPD and asthma to avoid funding the tobacco industry, International Journal of COPD, Vol: 2021, Pages: 2917-2923, ISSN: 1176-9106
The takeover of Vectura, a healthcare company specialising in inhaled medication, by Philip Morris International raises serious ethical concerns. The European Respiratory Society, notes that “health professionals will avoid prescribing drugs from any company that enriches the tobacco industry due to the ethical implications”. People with chronic obstructive pulmonary disease (COPD) and asthma will also be reluctant to use medications which profit a company that is estimated to kill at least one million people every year.We discuss the practicalities involved in switching people with lung disease to inhaled medications that are not tobacco industry linked. Potential alternative inhaled medications are set out, which are likely to be equally effective for most patients. A consideration of beneficence, non-maleficence, autonomy, and distributive justice demonstrates strong ethical reasons to support switching away from the prescription of tobacco industry linked products.
Hurst JR, Cumella A, Niklewicz CN, et al., 2021, Acceptability of hygiene, face covering and social distancing interventions to prevent exacerbations in people living with airways diseases, THORAX, ISSN: 0040-6376
Buttery S, Philip K, Quint J, et al., 2021, Patient symptoms and experience following COVID-19: results from a UK wide survey, BMJ Open Respiratory Research, ISSN: 2052-4439
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 of responses to a survey accessed through a UK online post-COVID support and information hub between April and December 2020 about people’s experiences after having acute COVID-19.Participants: 3290 respondents, 78% female 92.1% white ethnicity and median age range 45-54 years; 12.7% had been hospitalised. 494(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%) >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 that were unsatisfactory; (3) Implications for the future – their own condition, society and the healthcare system, and the need for researchConclusion: Consideration of patient perspective and experiences will assist in the planning of services to address problems persisting in people who remain symptomatic after the acute phase of COVID-19.
Samaranayake CB, Warren C, Siewers K, et al., 2021, Impact of cyanosis on ventilatory responses during stair climb exercise in Eisenmenger syndrome and idiopathic pulmonary arterial hypertension, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 341, Pages: 84-87, ISSN: 0167-5273
Polhemus A, Ortiz LD, Brittain G, et al., 2021, Walking on common ground: a cross-disciplinary scoping review on the clinical utility of digital mobility outcomes, NPJ DIGITAL MEDICINE, Vol: 4, ISSN: 2398-6352
Laverty AA, Filippidis FT, Been JV, et al., 2021, Smoke-free vehicles – impact of legislation on child smoke exposure across three countries, European Respiratory Journal, Vol: 58, Pages: 1-3, ISSN: 0903-1936
Philip K, Hopkinson N, 2021, Music and Dance in respiratory disease management in Uganda: A qualitative study of patient and healthcare professional perspectives, BMJ Open, Vol: 11, Pages: 1-9, ISSN: 2044-6055
Introduction:Music and dance are increasingly used as adjunctive arts-in-health interventions in high-income settings, with a growing body of research suggesting biopsychosocial benefits. Such low-cost, low-resource interventions may have application in low-resource settings such as Uganda. However, research on perceptions of patients and healthcare professionals regarding such approaches is lacking. MethodsWe delivered sample sessions of music and dance for chronic respiratory disease (CRD) to patients and healthcare professionals. Seven participants took part in one singing and dance sample session. One patient completed only the dance session. We then conducted an exploratory qualitative study, using thematic analysis of semi-structured interviews with the healthcare professionals and patients regarding i) the role of music and dance in Ugandan life and ii) the perceived acceptability and feasibility of using music and dance in CRD management in Uganda.ResultsWe interviewed 19 participants, made up of eleven patients with long-term respiratory conditions and eight healthcare professionals, who were selected by purposeful convenience sampling. Four key themes were identified from interview analysis: Music and dance: 1) were central components of daily life; 2) had an established role supporting health and wellbeing; 3) had strong therapeutic potential in respiratory disease management. A fourth theme was: 4) the importance of modulating demographic considerations of culture, religion and age. ConclusionMusic and dance are central to life in Uganda, with established roles supporting health and wellbeing. These roles could be built on in the development of music and dance interventions as adjuncts to established components of CRD disease management like pulmonary rehabilitation. Through consideration of key contextual factors, and co-development and adaptation of interventions, such approaches are likely to be well received.
Alsulayyim A, Alasmari AM, Alghamdi SM, et al., 2021, Impact of dietary nitrate supplementation on exercise capacity and cardiovascular parameters in chronic respiratory disease: a systematic review and meta-analysis, BMJ Open Respiratory Research, Vol: 8, Pages: 1-12, ISSN: 2052-4439
Background: Dietary nitrate supplementation, usually in the form of beetroot juice, may improve exercise performance and endothelial function. We undertook a systematic review and meta-analysis to establish whether this approach has beneficial effects in people with respiratory disease.Methods: A systematic search of records up to March 2021 was performed on PubMed, CINAHL, Medline (Ovid), Cochrane and Embase to retrieve clinical trials that evaluated the efficacy of dietary nitrate supplementation on cardiovascular parameters and exercise capacity in chronic respiratory conditions. Two authors independently screened titles, abstracts, full texts of potential studies and performed the data extraction. Results: After full-text review of 67 papers, eleven (two randomised controlled trials and nine cross-over trials) involving 282 participants met the inclusion criteria. Three were single dose, seven short term and one, the largest (n=122), done in the context of pulmonary rehabilitation. Pooled analysis showed that dietary nitrate supplementation reduced systolic BP, diastolic BP and mean arterial pressure (MD (95% CI), -3.39 mmHg (-6.79 to 0.01); p=0.05, -2.20 mmHg (-4.36 to -0.03); p=0.05 and -4.40 mmHg (-7.49 to -1.30); p=0.005 respectively. It was associated with increased walk distance in the context of pulmonary rehabilitation (SMD (95% CI), 0.47 (0.11 to 0.83), p=0.01), but no effect was identified in short term studies (0.08 (-0.32 to 0.49). Conclusion: Dietary nitrate supplementation may have a beneficial effect on blood pressure and augment the effect of pulmonary rehabilitation on exercise capacity. Short term studies do not suggest a consistent benefit on exercise capacity.
Hopkinson NS, Stokes-Lampard H, Dixon J, et al., 2021, Open letter to the prime minister and secretary of state on the second anniversary of England's announcement that it would be smoke-free by 2030., BMJ, Vol: 374, Pages: 1-2, ISSN: 1759-2151
Barker RE, Kon SS, Clarke SF, et al., 2021, COPD discharge bundle and pulmonary rehabilitation referral and uptake following hospitalisation for acute exacerbation of COPD, Thorax, Vol: 76, Pages: 829-831, ISSN: 0040-6376
Pulmonary rehabilitation (PR) following hospitalisations for acute exacerbation of COPD (AECOPD) is associated with improved exercise capacity and quality of life, and reduced readmissions. However, referral for, and uptake of, post-hospitalisation PR are low. In this prospective cohort study of 291 consecutive hospitalisations for AECOPD, COPD discharge bundles delivered by PR practitioners compared with non-PR practitioners were associated with increased PR referral (60% vs 12%, p<0.001; adjusted OR: 14.46, 95% CI: 5.28 to 39.57) and uptake (40% vs 32%, p=0.001; adjusted OR: 8.60, 95% CI: 2.51 to 29.50). Closer integration between hospital and PR services may increase post-hospitalisation PR referral and uptake.
Vass L, Fisk M, Cheriyan J, et al., 2021, Quantitative F-18-fluorodeoxyglucose positron emission tomography/computed tomography to assess pulmonary inflammation in COPD, ERJ OPEN RESEARCH, Vol: 7
Hopkinson N, Rossi N, El-Sayed Moustafa JS, et al., 2021, Current smoking and COVID-19 risk: results from a population symptom app in over 2.4 million people, Thorax, Vol: 76, Pages: 714-722, ISSN: 0040-6376
Background: The association between current tobacco smoking, the risk of developing symptomatic COVID-19 and the severity of illness is an important information gap.Methods: UK users of the Zoe COVID Symptom Study App provided baseline data including demographics, anthropometrics, smoking status and medical conditions, and were asked to log their condition daily. Participants who reported that they did not feel physically normal were then asked by the app to complete a series of questions, including 14 potential COVID-19 symptoms and about hospital attendance. The main study outcome was the development of “classic” symptoms of COVID-19 during the pandemic defined as fever, new persistent cough and breathlessness and their association with current smoking. The number of concurrent COVID-19 symptoms was used as a proxy for severity and the pattern of association between symptoms was also compared between smokers and non-smokers. Results: Between 24th March 2020 to 23rd April 2020, data were available on 2,401,982 participants, mean(SD) age 43.6(15.1) years, 63.3% female, overall smoking prevalence 11.0%. 834,437 (35%) participants reported being unwell and entered one or more symptoms. Current smokers were more likely to report symptoms suggesting a diagnosis of COVID-19; classic symptoms adjusted OR[95%CI] 1.14[1.10 to 1.18]; >5 symptoms 1.29[1.26 to 1.31]; >10 symptoms 1.50[1.42 to 1.58]. The pattern of association between reported symptoms did not vary between smokers and non-smokers.Interpretation: These data are consistent with people who smoke being at an increased risk of developing symptomatic COVID-19.
Philip K, Lewis A, Buttery S, et al., 2021, Physiological demands of Singing for Lung Health compared to treadmill walking, BMJ Open Respiratory Research, Vol: 8, Pages: 1-7, ISSN: 2052-4439
Introduction Participating in singing is considered to have a range of social and psychological benefits. However, the physiological demands of singing and its intensity as a physical activity are not well understood.Methods We compared cardiorespiratory parameters while completing components of Singing for Lung Health sessions, with treadmill walking at differing speeds (2, 4 and 6 km/hour).Results Eight healthy adults were included, none of whom reported regular participation in formal singing activities. Singing induced acute physiological responses that were consistent with moderate intensity activity (metabolic equivalents: median 4.12, IQR 2.72–4.78), with oxygen consumption, heart rate and volume per breath above those seen walking at 4 km/hour. Minute ventilation was higher during singing (median 22.42 L/min, IQR 16.83–30.54) than at rest (11 L/min, 9–13), lower than 6 km/hour walking (30.35 L/min, 26.94–41.11), but not statistically different from 2 km/hour (18.77 L/min, 16.89–21.35) or 4 km/hour (23.27 L/min, 20.09–26.37) walking.Conclusions Our findings suggest the acute metabolic demands of singing are comparable with walking at a moderately brisk pace, hence, physical effects may contribute to the health and well-being benefits attributed to singing participation. However, if physical training benefits result remains uncertain. Further research including different singing styles, singers and physical performance impacts when used as a training modality is encouraged.Trial registration number ClinicalTrials.gov registry (NCT04121351).
Hopkinson N, 2021, Acknowledging breathlessness post-covid., BMJ, Vol: 373, Pages: 1-1, ISSN: 1759-2151
Lee AHY, Snowden CP, Hopkinson N, et al., 2021, Pre-operative optimisation for chronic obstructive pulmonary disease, Anaesthesia, Vol: 76, Pages: 681-694, ISSN: 0003-2409
Chronic obstructive pulmonary disease is a condition commonly present in older people undergoing surgery and confers an increased risk of postoperative complications and mortality. Although predominantly a respiratory disease, it frequently has extra‐pulmonary manifestations and typically occurs in the context of other long‐term conditions. Patients experience a range of symptoms that affect their quality of life, functional ability and clinical outcomes. In this review, we discuss the evidence for techniques to optimise the care of people with chronic obstructive pulmonary disease in the peri‐operative period, and address potential new interventions to improve outcomes. The article centres on pulmonary rehabilitation, widely available for the treatment of stable chronic obstructive pulmonary disease, but less often used in a peri‐operative setting. Current evidence is largely at high risk of bias, however. Before surgery it is important to ensure that what have been called the ‘five fundamentals’ of chronic obstructive pulmonary disease treatment are achieved: smoking cessation; pulmonary rehabilitation; vaccination; self‐management; and identification and optimisation of co‐morbidities. Pharmacological treatment should also be optimised, and some patients may benefit from lung volume reduction surgery. Psychological and behavioural factors are important, but are currently poorly understood in the peri‐operative period. Considerations of the risk and benefits of delaying surgery to ensure the recommended measures are delivered depends on patient characteristics and the nature and urgency of the planned intervention.
Philip KEJ, Cartwright LL, Westlake D, et al., 2021, Music and Dance in respiratory disease management in Uganda: A qualitative study of patient and healthcare professional perspectives, Publisher: Cold Spring Harbor Laboratory
<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>Music and dance are increasingly used as adjunctive arts-in-health interventions in high-income settings, with a growing body of research suggesting biopsychosocial benefits. Such low-cost, low-resource interventions may have application in low-resource settings such as Uganda. However, research on perceptions of patients and healthcare professionals regarding such approaches is lacking.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We delivered taster music and dance for chronic respiratory disease (CRD) sessions to patients and healthcare professionals. We then conducted an exploratory qualitative study, using thematic analysis of semi-structured interviews with the healthcare professionals and patients regarding i) the role of music and dance in Ugandan life and ii) the perceived acceptability and feasibility of using music and dance in CRD management in Uganda.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Eleven patients with long-term respiratory conditions and eight healthcare professionals were interviewed after selection by purposeful convenience sampling. Four key themes were identified from (interview) analysis: Music and dance: 1) were central components of daily life; 2) had an established role supporting health and wellbeing; 3) had strong therapeutic potential in respiratory disease management; 4) the importance of modulating demographic considerations of culture and religion, and age.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Music and dance are central to life in Uganda, with established roles supporting health and wellbeing. These roles could be built on in the development of music and dance interventions as adjuncts to established components of
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
Hurst JR, Cumella A, Niklewicz CN, et al., 2021, Long-Term Acceptability of Hygiene, Face Covering, and Social Distancing Interventions to Prevent Exacerbations in people living with Airways Diseases
<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>There has been a substantial reduction in admissions to hospital with exacerbations of airways diseases during the COVID-19 pandemic, likely because measures introduced to prevent the spread of SARS-CoV-2 also reduced transmission of other respiratory viruses. The acceptability to patients of continuing such interventions beyond the pandemic as a measure to prevent exacerbations is not known.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>An online survey of people living with respiratory disease was created by the Asthma UK – British Lung Foundation Partnership. People were asked what infection control measures they expected to continue themselves, and what they thought should be policy for the population more generally in the future, once the COVID-19 pandemic had subsided.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>4442 people completed the survey: 3627 with asthma, 258 with bronchiectasis and 557 with COPD. Regarding personal behaviour, 79.5% would continue increased handwashing, 68.6% social distancing indoors, 46.9% would continue to wear a face covering in indoor public places (45.7% on public transport), and 59.3% would avoid friends and family who were unwell with a respiratory infection. 45.6% wanted healthcare professionals to continue wearing a mask when seeing patients. 60.7% thought that face coverings should continue to be worn by everyone in indoor public spaces during the ‘flu season. Women and older people were, in general, more cautious.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>People living with airways diseases are supportive of infection control measures to reduce the risk of exacerbations and such measures should be considered
Sadaka AS, Faisal A, Khalil YM, et al., 2021, Reduced skeletal muscle endurance and ventilatory efficiency during exercise in adult smokers without airflow obstruction., Journal of applied physiology (Bethesda, Md. : 1985), Vol: 130, Pages: 976-986, ISSN: 1522-1601
BACKGROUND: Smokers without airflow obstruction have reduced exercise capacity, but the underlying physiological mechanisms are not fully understood. AIM: To compare quadriceps function assessed using non-volitional measures, and ventilatory requirements during exercise, between smokers without airway obstruction and never-smoker controls. STUDY DESIGN AND METHODS: Adult smokers (n=20) and never-smoker controls (n=16) aged 25-50 years with normal spirometry, underwent incremental cycle cardiopulmonary exercise testing to exhaustion with measurement of symptoms and dynamic lung volumes. Quadriceps strength and endurance were assessed non-volitionally using single and repetitive magnetic stimulation. Quadriceps bulk was assessed using ultrasound, as rectus-femoris cross-sectional area (QRF-CSA). Physical activity level was quantified using the SenseWearTM armband worn for 5 days. RESULTS: Smokers had lower peak exercise workload, peak oxygen consumption and anaerobic threshold (AT) compared to controls (170+46 vs. 256+57 W; 2.20 ±0.56 vs. 3.18 ±0.72 L/min; 1.38±0.33 vs. 2.09±0.7 L/min, respectively; p<0.01 for all). Quadriceps endurance was lower in smokers (D force-time integral 54.9±14.7% vs. 40.4±14.7%; p=0.007), but physical activity, quadriceps strength and bulk were similar between groups. Smokers displayed higher ventilation (120W: 52.6±11.8 vs. 40.7±6.0 L/min; p<0.001), decreased ventilatory efficiency (higher ⩒E/⩒CO2) and were more breathless with greater leg fatigue at iso-workloads and iso-ventilation levels compared to never-smoker controls. Smokers showed no mechanical constraints on tidal volume expansion during exercise or ventilatory limitation at peak exercise. CONCLUSION: Adult smokers without airflow obstruction have reduced skeletal muscle endurance and ventilatory efficiency compared to never-smoker controls, despite similar daily physical activity levels, which contributed to reduced p
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