Imperial College London

ProfessorNickHopkinson

Faculty of MedicineNational Heart & Lung Institute

Professor of Respiratory Medicine
 
 
 
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Contact

 

n.hopkinson

 
 
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Location

 

Muscle LabSouth BlockRoyal Brompton Campus

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Summary

 

Publications

Publication Type
Year
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439 results found

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, ISSN: 2044-6055

Journal article

Demeyer H, Mohan D, Burtin C, Vaes A, Heasley M, Bowler R, Casaburi R, Cooper CB, Corriol-Rohou S, Frei A, Hamilton A, Hopkinson NS, Karlsson N, Man WD-C, Moy ML, Pitta F, Polkey MI, Puhan M, Rennard SI, Rochester CL, Rossiter HB, Sciurba F, Singh S, Tal-Singer R, Vogiatzis I, Watz H, Lummel RV, Wyatt J, Merrill DD, Spruit MA, Garcia-Aymerich J, Troosters T, COPD Biomarker Qualification Consortium CBQC Task Force on Physical Activityet al., 2021, Objectively Measured Physical Activity in Patients with COPD: Recommendations from an International Task Force on Physical Activity., Chronic Obstr Pulm Dis, ISSN: 2372-952X

Journal article

Alsulayyim A, Alasmari AM, Alghamdi SM, Polkey M, Hopkinson Net 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, 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.

Journal article

Samaranayake CB, Warren C, Siewers K, Craig S, Price L, Kempny A, Dimopoulos K, Gatzoulis M, Hopkinson NS, Wort SJ, Hull JH, McCabe Cet al., 2021, Impact of cyanosis on ventilatory responses during stair climb exercise in Eisenmenger's syndrome and idiopathic pulmonary arterial hypertension., Int J Cardiol

Studies assessing exercise ventilatory responses during real-life exercise in pulmonary arterial hypertension (PAH) which include patients with cyanotic congenital heart disease are scarce. We assessed the ventilatory response to stairclimbing in patients with idiopathic PAH (IPAH) and congenital heart disease-associated PAH with Eisenmenger (EIS) physiology compared to healthy controls. Fifteen adults with IPAH, six EIS and 15 age and body mass index (BMI) matched controls were prospectively recruited. Participants completed spirometry and a self-paced stair-climb (48 steps) with portable cardiopulmonary exercise testing (CPET) equipment in-situ. Borg dyspnoea scores were measured at rest and on stair-climb cessation. Both IPAH and EIS groups had amplified ventilatory responses compared to Controls. The rate of increase in minute ventilation (VE) was exaggerated in EIS driven by an early increase in tidal volume (Tv) and more gradual increase in respiratory rate (RR). Peak Tv, RR, Tv: forced vital capacity (FVC) ratio, VE/VCO2 slope and stairclimb duration were significantly higher in EIS and IPAH compared to controls despite similar baseline spirometry and change in oxygen uptake on exercise. A decline in end-tidal carbon dioxide (CO2) and arterial oxygen saturations in early exercise distinguished EIS and IPAH patients. Significant correlations were observed between peak exercise Borg score and stair-climb time (r = 0.73, p = 0.002), peak end-tidal CO2 (r = -0.73, p = 0.001), peak VE (r = 0.53, p = 0.008), peak RR (r = 0.42, p = 0.011) and VE/VCO2 slope (r = 0.54, p = 0.001). Patients with IPAH and EIS have exaggerated ventilatory responses to stair-climbing compared to the controls with more severe levels of dyspnoea perception in Eisenmenger syndrome for equivalent oxygen uptake and work.

Journal article

Hopkinson NS, Stokes-Lampard H, Dixon J, Rae M, Bauld L, Woolnough S, Goddard A, de Gruchy J, Griffiths C, Walker I, Bennett Jet 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

Journal article

Barker RE, Kon SS, Clarke SF, Wenneberg J, Nolan CM, Patel S, Walsh JA, Polgar O, Maddocks M, Farquhar M, Hopkinson NS, Bell D, Wedzicha JA, Man WD-Cet 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.

Journal article

Burtin C, Mohan D, Troosters T, Watz H, Hopkinson NS, Garcia-Aymerich J, Moy ML, Vogiatzis I, Rossiter HB, Singh S, Merrill DD, Hamilton A, Rennard SI, Fageras M, Petruzzelli S, Tal-Singer R, Tomaszewski E, Corriol-Rohou S, Rochester CL, Sciurba FC, Casaburi R, Man WD-C, Van Lummel RC, Cooper CB, Demeyer H, Spruit MA, Vaes A, CBQC Task Force on Physical Activityet al., 2021, Objectively Measured Physical Activity as a COPD Clinical Trial Outcome., Chest

BACKGROUND: Reduced physical activity is common in COPD and is associated with poor outcomes. Physical activity is therefore a worthy target for intervention in clinical trials; however, trials evaluating physical activity have used heterogeneous methods. RESEARCH QUESTION: What is the available evidence on the efficacy and/or effectiveness of various interventions to enhance objectively measured physical activity in patients with COPD, taking into account the minimal preferred methodologic quality of physical activity assessment? STUDY DESIGN AND METHODS: In this narrative review, the COPD Biomarker Qualification Consortium (CBQC) task force searched three scientific databases for articles that reported the effect of an intervention on objectively measured physical activity in COPD. Based on scientific literature and expert consensus, only studies with ≥ 7 measurement days and ≥ 4 valid days of ≥ 8 h of monitoring were included in the primary analysis. RESULTS: Thirty-seven of 110 (34%) identified studies fulfilled the criteria, investigating the efficacy and/or effectiveness of physical activity behavior change programs (n = 7), mobile or electronic-health interventions (n = 9), rehabilitative exercise (n = 9), bronchodilation (n = 6), lung volume reduction procedures (n = 3), and other interventions (n = 3). Results are generally variable, reflecting the large differences in study characteristics and outcomes. Few studies show an increase beyond the proposed minimal important change of 600 to 1100 daily steps, indicating that enhancing physical activity levels is a challenge. INTERPRETATION: Only one-third of clinical trials measuring objective physical activity in people with COPD fulfilled the preset criteria regarding physical activity assessment. Studies showed variable effects on physical activity even when investigating similar interventions.

Journal article

Vass L, Fisk M, Cheriyan J, Mohan D, Forman J, Oseni A, Devaraj A, Mäki-Petäjä KM, McEniery CM, Fuld J, Hopkinson NS, Lomas DA, Cockcroft JR, Tal-Singer R, Polkey MI, Wilkinson IBet al., 2021, Quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography to assess pulmonary inflammation in COPD., ERJ Open Res, Vol: 7, ISSN: 2312-0541

Rationale: COPD and smoking are characterised by pulmonary inflammation. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging may improve knowledge of pulmonary inflammation in COPD patients and aid early development of novel therapies as an imaging biomarker. Objectives: To evaluate pulmonary inflammation, assessed by FDG uptake, in whole and regional lung in "usual" (smoking-related) COPD patients, alpha-1 antitrypsin deficiency (α1ATD) COPD patients, smokers without COPD and never-smokers using FDG PET/CT. Secondly, to explore cross-sectional associations between FDG PET/CT and systemic inflammatory markers in COPD patients and repeatability of the technique in COPD patients. Methods: Data from two imaging studies were evaluated. Pulmonary FDG uptake (normalised Ki; nKi) was measured by Patlak graphical analysis in four subject groups: 84 COPD patients, 11 α1ATD-COPD patients, 12 smokers and 10 never-smokers. Within the COPD group, associations between nKi and systemic markers of inflammation were assessed. Repeatability was evaluated in 32 COPD patients comparing nKi values at baseline and at 4-month follow-up. Results: COPD patients, α1ATD-COPD patients and smokers had increased whole lung FDG uptake (nKi) compared with never-smokers (0.0037±0.001, 0.0040±0.001, 0.0040±0.001 versus 0.0028±0.001 mL·cm-3·min-1, respectively, p<0.05 for all). Similar results were observed in upper and middle lung regions. In COPD participants, plasma fibrinogen was associated with whole lung nKi (β=0.30, p=0.02) in multivariate analysis adjusted for current smoking, forced expiratory volume in 1 s % predicted, systemic neutrophils and C-reactive protein levels. Mean percentage difference in nKi between the baseline and follow-up was 3.2%, and the within subject coefficient of variability was 7.7%. Conclusions: FDG PET/CT has potential as a noninvasive tool to enabl

Journal article

Hopkinson N, Rossi N, El-Sayed Moustafa JS, Laverty A, Quint J, Freidin MB, Visconti A, Murray B, Modat M, Ourselin S, Small K, Davies R, Wolf J, Spector TD, Steves CJ, Falchi Met 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.

Journal article

Philip K, Lewis A, Buttery S, McCabe C, Fancourt D, Orton C, Polkey M, Hopkinson Net 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).

Journal article

Hopkinson N, 2021, Acknowledging breathlessness post-covid., BMJ, Vol: 373, Pages: 1-1, ISSN: 1759-2151

Journal article

Lee AHY, Snowden CP, Hopkinson N, Pattinson KTSet 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.

Journal article

Philip KEJ, Cartwright LL, Westlake D, Nyakoojo G, Kimuli I, Kirenga B, Brakema EA, Orme MW, Fancourt D, Hopkinson NS, Jones R, Katagira Wet al., 2021, Music and Dance in respiratory disease management in Uganda: A qualitative study of patient and healthcare professional perspectives

<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

Journal article

Buttery S, Philip KEJ, Williams P, Fallas A, West B, Cumella A, Cheung C, Walker S, Quint J, Polkey M, Hopkinson Net 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

Working paper

Hurst JR, Cumella A, Niklewicz CN, Philip KEJ, Singh V, Hopkinson NSet 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

Journal article

Sadaka AS, Faisal A, Khalil YM, Mourad SM, Zidan MH, Polkey MI, Hopkinson NSet 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

Journal article

Hopkinson NS, Jenkins G, Hart N, 2021, COVID-19 and what comes after?, THORAX, Vol: 76, Pages: 324-325, ISSN: 0040-6376

Journal article

Buttery SC, Zysman M, Vikjord SAA, Hopkinson NS, Jenkins C, Vanfleteren LEGWet al., 2021, Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity, RESPIROLOGY, Vol: 26, Pages: 419-441, ISSN: 1323-7799

Journal article

Koreny M, Demeyer H, Benet M, Arbillaga-Etxarri A, Balcells E, Barberan-Garcia A, Gimeno-Santos E, Hopkinson NS, De Jong C, Karlsson N, Louvaris Z, Polkey MI, Puhan MA, Rabinovich RA, Rodríguez-Roisin R, Vall-Casas P, Vogiatzis I, Troosters T, Garcia-Aymerich J, Urban Training Study Group and PROactive Consortium members, Urban Training Study Group, Arbillaga-Etxarri A, Benet M, Delgado A, Garcia-Aymerich J, Gimeno-Santos E, Torrent-Pallicer J, Vilaró J, Barberan-Garcia A, Balcells E, Chiaradía DAR, Marín A, Ortega P, Celorrio N, Teagudo MM, Montellà N, Muñoz L, Toran P, Simonet P, Jané C, Martín-Cantera C, Borrell E, Vall-Casas P, PROactive Consortium members, Ivanoff N, Karlsson N, Corriol-Rohou S, Jarrod I, Erzen D, Brindicci C, Higenbottam T, Scuri M, McBride P, Kamel N, Tabberer M, Troosters T, Dobbels F, Garcia-Aymerich J, de Boer P, Kulich K, Glendenning A, Rudell K, Wilson FJ, Polkey MI, Hopkinson NS, Vogiatzis I, Nikai E, van der Molen T, De Jong C, Rabinovich RA, MacNee B, Puhan MA, Frei Aet al., 2021, Patterns of physical activity progression in patients with COPD, Archivos de Bronconeumologia, Vol: 57, Pages: 214-223, ISSN: 0300-2896

INTRODUCTION: Although mean physical activity in COPD patients declines by 400-500steps/day annually, it is unknown whether the natural progression is the same for all patients. We aimed to identify distinct physical activity progression patterns using a hypothesis-free approach and to assess their determinants. METHODS: We pooled data from two cohorts (usual care arm of Urban Training [NCT01897298] and PROactive initial validation [NCT01388218] studies) measuring physical activity at baseline and 12 months (Dynaport MoveMonitor). We identified clusters (patterns) of physical activity progression (based on levels and changes of steps/day) using k-means, and compared baseline sociodemographic, interpersonal, environmental, clinical and psychological characteristics across patterns. RESULTS: In 291 COPD patients (mean±SD 68±8 years, 81% male, FEV1 59±19%pred) we identified three distinct physical activity progression patterns: Inactive (n=173 [59%], baseline: 4621±1757 steps/day, 12-month change (Δ): -487±1201 steps/day), ActiveImprovers (n=49 [17%], baseline: 7727±3275 steps/day, Δ:+3378±2203 steps/day) and ActiveDecliners (n=69 [24%], baseline: 11 267±3009 steps/day, Δ: -2217±2085 steps/day). After adjustment in a mixed multinomial logistic regression model using Active Decliners as reference pattern, a lower 6-min walking distance (RRR [95% CI] 0.94 [0.90-0.98] per 10m, P=.001) and a higher mMRC dyspnea score (1.71 [1.12-2.60] per 1 point, P=.012) were independently related with being Inactive. No baseline variable was independently associated with being an Active Improver. CONCLUSIONS: The natural progression in physical activity over time in COPD patients is heterogeneous. While Inactive patients relate to worse scores for clinical COPD characteristics, Active Improvers and Decliners cannot be predicted at baseline.

Journal article

Garner J, Biddiscombe MF, Meah S, Lewis A, Buttery SC, Hopkinson NS, Kemp SV, Usmani OS, Shah PL, Verbanck Set al., 2021, Endobronchial valve lung volume reduction and small airways function., American Journal of Respiratory and Critical Care Medicine, Vol: 203, Pages: 1576-1579, ISSN: 1073-449X

Journal article

Garcia-Aymerich J, Puhan MA, Corriol-Rohou S, de Jong C, Demeyer H, Dobbels F, Erzen D, Frei A, Gimeno-Santos E, Hopkinson NS, Ivanoff N, Karlsson N, Louvaris Z, Polkey MI, Rabinovich RA, Scuri M, Tabberer M, Vogiatzis I, Troosters T, PROactive consortiumet al., 2021, Validity and responsiveness of the Daily- and Clinical visit-PROactive Physical Activity in COPD (D-PPAC and C-PPAC) instruments, Thorax, Vol: 76, Pages: 228-238, ISSN: 0040-6376

BACKGROUND: The Daily-PROactive and Clinical visit-PROactive Physical Activity (D-PPAC and C-PPAC) instruments in chronic obstructive pulmonary disease (COPD) combines questionnaire with activity monitor data to measure patients' experience of physical activity. Their amount, difficulty and total scores range from 0 (worst) to 100 (best) but require further psychometric evaluation. OBJECTIVE: To test reliability, validity and responsiveness, and to define minimal important difference (MID), of the D-PPAC and C-PPAC instruments, in a large population of patients with stable COPD from diverse severities, settings and countries. METHODS: We used data from seven randomised controlled trials to evaluate D-PPAC and C-PPAC internal consistency and construct validity by sex, age groups, COPD severity, country and language as well as responsiveness to interventions, ability to detect change and MID. RESULTS: We included 1324 patients (mean (SD) age 66 (8) years, forced expiratory volume in 1 s 55 (17)% predicted). Scores covered almost the full range from 0 to 100, showed strong internal consistency after stratification and correlated as a priori hypothesised with dyspnoea, health-related quality of life and exercise capacity. Difficulty scores improved after pharmacological treatment and pulmonary rehabilitation, while amount scores improved after behavioural physical activity interventions. All scores were responsive to changes in self-reported physical activity experience (both worsening and improvement) and to the occurrence of COPD exacerbations during follow-up. The MID was estimated to 6 for amount and difficulty scores and 4 for total score. CONCLUSIONS: The D-PPAC and C-PPAC instruments are reliable and valid across diverse COPD populations and responsive to pharmacological and non-pharmacological interventions and changes in clinically relevant variables.

Journal article

Patel S, Palmer MD, Nolan CM, Barker RE, Walsh JA, Wynne SC, Jones SE, Shannon H, Hopkinson NS, Kon SSC, Gao W, Maddocks M, Man WD-Cet al., 2021, Supervised pulmonary rehabilitation using minimal or specialist exercise equipment in COPD: a propensity-matched analysis, Thorax, Vol: 76, Pages: 264-271, ISSN: 0040-6376

BACKGROUND: Many trials supporting the benefits of pulmonary rehabilitation (PR) have used specialist exercise equipment, such as treadmills and cycle ergometers. However, access to specialist equipment may not be feasible in some settings. There is growing interest in delivering PR programmes with minimal, low-cost equipment, but uncertainty remains regarding their efficacy compared with programmes using specialist equipment. METHODS: Using propensity score matching, 318 consecutive patients with COPD undergoing supervised PR using minimal equipment (PR-min) were compared 1:1 with a control group of 318 patients with COPD who underwent supervised PR using specialist equipment (PR-gym). A non-inferiority analysis was performed for the primary outcome (incremental shuttle walk (ISW)) and secondary outcomes (Chronic Respiratory Disease Questionnaire (CRQ)-domain and total scores). RESULTS: Similar improvements in ISW and CRQ-domains were observed in PR-min and PR-gym groups (mean difference ISW: 3 m (95% CI -16 to 9); CRQ-total: 0.9 (95% CI -2.7 to 4.5)). The 95% CI between group differences for ISW and CRQ-total did not cross the predefined non-inferiority margins. However, completion rates were lower in PR-min compared with PR-gym (64% vs 73%; p=0.014). CONCLUSIONS: In patients with COPD, PR delivered using minimal equipment produces clinically significant benefits in exercise capacity and health-related quality of life that are non-inferior to rehabilitation delivered using specialist equipment. This study provides support for the provision of PR using minimal exercise equipment, particularly in areas where access to specialist exercise equipment is limited.

Journal article

Philip KEJ, Lewis A, Buttery SC, McCabe C, Fancourt D, Orton C, Polkey MI, Hopkinson NSet al., 2021, Aerosol transmission of SARS-CoV-2: inhalation as well as exhalation matters for COVID-19, American Journal of Respiratory and Critical Care Medicine, Vol: 203, Pages: 1041-1042, ISSN: 1073-449X

Journal article

Hopkinson NS, 2021, Lung volume reduction for emphysema comes of age., BMJ, Vol: 372, Pages: 1-2, ISSN: 1759-2151

Journal article

Laverty A, Millett C, Hopkinson N, Filippidis Fet al., 2020, Introduction of standardised packaging and availability of illicit cigarettes: a difference-in-difference analysis of European Union survey data 2015-2018., Thorax, Vol: 76, Pages: 89-91, ISSN: 0040-6376

Standardised packaging of tobacco products is intended to reduce the appeal of smoking, but the tobacco industry claims this increases illicit trade. We examined the percentage of people reporting being offered illicit cigarettes before and after full implementation of standardised packaging in the UK, Ireland and France and compared this to other European Union countries. Reported ever illicit cigarette exposure fell from 19.8% to 18.1% between 2015 and 2018 in the three countries fully implementing the policy, and from 19.6% to 17.0% in control countries (p for difference=0.320). Standardised packaging does not appear to increase the availability of illicit cigarettes.

Journal article

Kjærgaard J, Nissen TN, Isaeva E, Quynh NN, Reventlow S, Lund S, Sooronbaev T, Le An P, Østergaard MS, Stout J, Poulsen A, FRESH AIR collaboratorset al., 2020, No time for change? Impact of contextual factors on the effect of training primary care healthcare workers in Kyrgyzstan and Vietnam on how to manage asthma in children - A FRESH AIR implementation study., BMC Health Services Research, Vol: 20, Pages: 1-9, ISSN: 1472-6963

BACKGROUND: Training is a common and cost-effective way of trying to improve quality of care in low- and middle-income countries but studies of contextual factors for the successful translation of increased knowledge into clinical change are lacking, especially in primary care. The purpose of this study was to assess the impact of contextual factors on the effect of training rural healthcare workers in Kyrgyzstan and Vietnam on their knowledge and clinical performance in managing pediatric patients with respiratory symptoms. METHODS: Primary care health workers in Kyrgyzstan and Vietnam underwent a one-day training session on asthma in children under five. The effect of training was measured on knowledge and clinical performance using a validated questionnaire, and by direct clinical observations. RESULTS: Eighty-one healthcare workers participated in the training. Their knowledge increased by 1.1 Cohen's d (CI: 0.7 to 1.4) in Kyrgyzstan where baseline performance was lower and 1.5 Cohen's d (CI: 0.5 to 2.5) in Vietnam. Consultations were performed by different types of health care workers in Kyrgyzstan and there was a 79.1% (CI 73.9 to 84.3%) increase in consultations where at least one core symptom of respiratory illness was asked. Only medical doctors participated in Vietnam, where the increase was 25.0% (CI 15.1 to 34.9%). Clinical examination improved significantly after training in Kyrgyzstan. In Vietnam, the number of actions performed generally declined. The most pronounced difference in contextual factors was consultation time, which was median 15 min in Kyrgyzstan and 2 min in Vietnam. DISCUSSION AND CONCLUSION: The effects on knowledge of training primary care health workers in lower middle-income countries in diagnosis and management of asthma in children under five only translated into changes in clinical performance where consultation time allowed for changes to clinical practice, emphasizing the importance of considering contextual facto

Journal article

Philip KEJ, Lewis A, Buttery S, McCabe C, Manivannan B, Fancourt D, Orton C, Polkey M, Hopkinson Net al., 2020, The physiological demands of Singing for Lung Health compared to treadmill walking (pre print), Publisher: arXiv

Participating in singing is considered to have a range of social and psychological benefits. However, the physiological demands of singing, whether it can be considered exercise, and its intensity as a physical activity are not well understood. We therefore compared cardiorespiratory parameters while completing components of Singing for Lung Health (SLH) sessions, with treadmill walking at differing speeds (2, 4, and 6km/hr). Eight healthy adults were included, none of whom reported regular participation in formal singing activities. Singing induced physiological responses that were consistent with moderate intensity activity (METS: median 4.12, IQR 2.72 - 4.78), with oxygen consumption, heart rate, and volume per breath above those seen walking at 4km/hr. Minute ventilation was higher during singing (median 22.42L/min, IQR 16.83 - 30.54) than at rest (11L/min, 9 - 13), lower than 6km/hr walking (30.35L/min, 26.94 - 41.11), but not statistically different from 2km/hr (18.77L/min, 16.89 - 21.35) or 4km/hr (23.27L/min, 20.09 - 26.37) walking. Our findings suggest the metabolic demands of singing may contribute to the health and wellbeing benefits attributed to 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.

Working paper

Philip K, Lonergan B, Cumella A, Farrington-Douglas J, Laffan M, Hopkinson NSet al., 2020, COVID-19 related concerns of people with long-term respiratory conditions: a qualitative study, BMC Pulmonary Medicine, Vol: 319, Pages: 1-10, ISSN: 1471-2466

BACKGROUNDThe COVID-19 pandemic is having profound psychological impacts on populations globally, with increasing levels of stress, anxiety, and depression being reported, especially in people with pre-existing medical conditions who appear to be particularly vulnerable. There are limited data on the specific concerns people have about COVID-19 and what these are based on. METHODSThe aim of this study was to identify and explore the concerns of people with long-term respiratory conditions in the UK regarding the impact of the COVID-19 pandemic and how these concerns were affecting them. We conducted a thematic analysis of free text responses to the question “What are your main concerns about getting coronavirus?”, which was included in the British Lung Foundation/Asthma UK (BLF-AUK) partnership COVID-19 survey, conducted between the 1st and 8th of April 2020. This was during the 3rd week of the UK’s initial ‘social distancing measures’ which included advice to stay at home and only go outside for specific limited reasons.RESULTS7,039 responses were analysed, with respondents from a wide range of age groups (under 17 to over 80), gender, and all UK nations. Respondents reported having asthma (85%), COPD (9%), bronchiectasis (4%), interstitial lung disease (2%), or ‘other’ lung diseases (e.g. lung cancer) (1%). Four main themes were identified: 1) vulnerability to COVID-19; 2) anticipated experience of contracting COVID-19; 3) pervasive uncertainty; and 4) inadequate national response.CONCLUSIONSThe COVID-19 pandemic is having profound psychological impacts. The concerns we identified largely reflect contextual factors, as well as their subjective experience of the current situation. Hence, key approaches to reducing these concerns require changes to the reality of their situation, and are likely to include i) helping people optimise their health, limit risk of infection, and access necessities; ii) minimising the negative exp

Journal article

Buttery S, Lewis A, Kemp S, Quint J, Steiner M, Hopkinson Net al., 2020, Lung volume reduction eligibility in patients with COPD completing pulmonary rehabilitation: results from the UK National Asthma and COPD Audit Programme, BMJ Open, Vol: 10, ISSN: 2044-6055

Objectives To establish what proportion of patients completing a UK pulmonary rehabilitation (PR) programme meet the 2018 National Institute for Health and Care Excellence (NICE) chronic obstructive pulmonary disease (COPD) guideline (NG115) criteria to have a respiratory review to establish whether referral to a lung volume reduction multidisciplinary team would be appropriate. This respiratory review would include evaluation of the presence of hyperinflation and the presence of emphysema on CT scan. The NICE criteria include measures of breathlessness and exercise capacity but these parameters are not completely defined.Design Observational study.Setting PR programmes across the UK in 2015 (210 centres) and 2017 (184 centres) entering data into the Royal College of Physicians’ National Asthma and COPD Audit Programme.Participants 8295 (55.7%) of 14 889 patients in programmes using incremental shuttle walk test (ISWT) or 6-minute walk test (6MWT) as an outcome measure completed PR, and 4856 (32.6%) had complete data recorded (6MWT/ISWT, baseline spirometry, Medical Research Council (MRC) dyspnoea score).Results Depending on the walking test safety threshold adopted for the ISWT (≥140 m or ≥ 80 m) and the MRC dyspnoea score threshold used (MRC score ≥3 or ≥4 at the end of PR), between 4.9% and 18.1% of PR completers met the NICE criteria for a lung volume reduction-focused respiratory review.Conclusions Lung volume reduction therapies are beneficial in appropriately selected patients with COPD, but few procedures are performed, and treatment pathways are unclear. These data help to inform the feasibility of the approach recommended by NICE and highlight the need for future systematic pathways to reduce inequalities in patients being considered for effective treatments.

Journal article

Philip K, Lewis A, Buttery S, Man W, Fancourt D, Polkey M, Hopkinson Net al., 2020, Moving singing for lung health online in response to COVID-19: experience from a randomised controlled trial, BMJ Open Respiratory Research, Vol: 7, ISSN: 2052-4439

IntroductionSinging for Lung Health (SLH) is a popular arts-in-health activity for people with long-term respiratory conditions. Participants report biopsychosocial benefits, however research on impact is limited. The ‘SHIELD trial’, a randomised controlled, single (assessor) blind, trial of 12 weeks SLH vs usual care for people with Chronic Obstructive Pulmonary Disease (COPD) (n=120) was set-up to help to address this. The first group (n=18, 9 singing and 9 controls) started face-to-face (5 sessions) before changing to online delivery (7 sessions) due to COVID-19 related physical distancing measures. As such, the experience of this group is here reported as a pilot study to inform further research in this area. MethodsWe conducted semi-structured interviews and thematic analysis regarding barriers, facilitators and key considerations for transitioning from face-to-face to online delivery. Pilot quantitative outcomes include attendance, pre and post measures of quality of life and disease impact (SF-36, CAT score), breathlessness (MRC breathlessness scale, Dyspnoea-12), depression (PHQ9), anxiety (GAD-7), balance confidence (ABC scale) and physical activity (clinical visit PROactive physical activity in COPD tool, combining subjective rating and actigraphy). ResultsAttendance was 69% overall, (90% of the face-to-face sessions, 53% online sessions). Analysis of semi-structured interviews identified three themes regarding participation in SLH delivered face-to-face and online, these where 1) perceived benefits; 2) digital barriers (online); 3) digital facilitators (online). Findings were summarised into key considerations for optimising transitioning singing groups from face-to-face to online delivery. Pilot quantitative data suggested possible improvements in depression (treatment effect -4.78 PHQ9 points, p< 0.05, MCID 5) and balance confidence (treatment effect +17.21 ABC Scale points, p=0.04, MCID 14.2).Discussion This study identifies key consider

Journal article

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