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Buttery SC, Banya W, Bilancia R, et al., 2023, Lung volume reduction surgery versus endobronchial valves: a randomised controlled trial., Eur Respir J, Vol: 61
BACKGROUND: Lung volume reduction surgery (LVRS) and bronchoscopic lung volume reduction (BLVR) with endobronchial valves can improve outcomes in appropriately selected patients with emphysema. However, no direct comparison data exist to inform clinical decision making in people who appear suitable for both procedures. Our aim was to investigate whether LVRS produces superior health outcomes when compared with BLVR at 12 months. METHODS: This multicentre, single-blind, parallel-group trial randomised patients from five UK hospitals, who were suitable for a targeted lung volume reduction procedure, to either LVRS or BLVR and compared outcomes at 1 year using the i-BODE score. This composite disease severity measure includes body mass index, airflow obstruction, dyspnoea and exercise capacity (incremental shuttle walk test). The researchers responsible for collecting outcomes were masked to treatment allocation. All outcomes were assessed in the intention-to-treat population. RESULTS: 88 participants (48% female, mean±sd age 64.6±7.7 years, forced expiratory volume in 1 s percent predicted 31.0±7.9%) were recruited at five specialist centres across the UK and randomised to either LVRS (n=41) or BLVR (n=47). At 12 months follow-up, the complete i-BODE was available in 49 participants (21 LVRS/28 BLVR). Neither improvement in the i-BODE score (LVRS -1.10±1.44 versus BLVR -0.82±1.61; p=0.54) nor in its individual components differed between groups. Both treatments produced similar improvements in gas trapping (residual volume percent predicted: LVRS -36.1% (95% CI -54.6- -10%) versus BLVR -30.1% (95% CI -53.7- -9%); p=0.81). There was one death in each treatment arm. CONCLUSION: Our findings do not support the hypothesis that LVRS is a substantially superior treatment to BLVR in individuals who are suitable for both treatments.
Hopkinson NS, 2023, Secondary prevention must include treating tobacco dependence., BMJ: British Medical Journal, Vol: 380, Pages: 1-1, ISSN: 0959-535X
Jeyin N, Desai SR, Padley SPG, et al., 2023, Dual-energy computed tomographic pulmonary angiography accurately estimates lobar perfusion before lung volume reduction for severe emphysema, Journal of Thoracic Imaging, Vol: 38, Pages: 104-112, ISSN: 0883-5993
PURPOSE: To assess if dual-energy computed tomographic pulmonary angiography (DECTPA) derived lobar iodine quantification can provide an accurate estimate of lobar perfusion in patients with severe emphysema, and offer an adjunct to single-photon emission CT perfusion scintigraphy (SPECT-PS) in assessing suitability for lung volume reduction (LVR). MATERIALS AND METHODS: Patients with severe emphysema (forced expiratory volume in 1 s <49% predicted) undergoing evaluation for LVR between May 2018 and April 2020 imaged with both SPECT-PS and DECTPA were included in this retrospective study. DECTPA perfused blood volume maps were automatically segmented and lobar iodine mass was estimated and compared with lobar technetium (Tc99m) distribution acquired with SPECT-PS. Pearson correlation and Bland-Altman analysis were used for intermodality comparison between DECTPA and SPECT-PS. Univariate and adjusted multivariate linear regression were modelled to ascertain the effect sizes of possible confounders of disease severity, sex, age, and body mass index on the relationship between lobar iodine and Tc99m values. Effective radiation dose and adverse reactions were recorded. RESULTS: In all, 123 patients (64.5±8.8 y, 71 men; mean predicted forced expiratory volume in 1 s 32.1 ±12.7%,) were eligible for inclusion. There was a linear relationship between lobar perfusion values acquired using DECTPA and SPECT-PS with statistical significance (P<0.001). Lobar relative perfusion values acquired using DECTPA and SPECT-PS had a consistent relationship both by linear regression and Bland-Altman analysis (mean bias, -0.01, mean r2 0.64; P<0.0001). Individual lobar comparisons demonstrated moderate correlation (r=0.79, 0.78, 0.84, 0.78, 0.8 for the right upper, middle, lower, left upper, and lower lobes, respectively, P<0.0001). The relationship between lobar iodine and Tc99m values was not significantly altered after controlling for conf
Patel S, Jones SE, Walsh JA, et al., 2023, The Six-minute Step Test as an Exercise Outcome in Chronic Obstructive Pulmonary Disease., Ann Am Thorac Soc, Vol: 20, Pages: 476-479
Williams PJ, Philip KEJ, Gill NK, et al., 2023, Immediate, remote smoking cessation intervention in participants undergoing a targeted lung health check: quit smoking lung health intervention trial, a randomized controlled trial, Chest, Vol: 163, Pages: 455-463, ISSN: 0012-3692
BACKGROUND: Lung cancer screening programs provide an opportunity to support people who smoke to quit, but the most appropriate model for delivery remains to be determined. Immediate face-to-face smoking cessation support for people undergoing screening can increase quit rates, but it is not known whether remote delivery of immediate smoking cessation counselling and pharmacotherapy in this context also is effective. RESEARCH QUESTION: Does an immediate telephone smoking cessation intervention increase quit rates compared with usual care among a population enrolled in a targeted lung health check (TLHC)? STUDY DESIGN AND METHODS: In a single-masked randomized controlled trial, people 55 to 75 years of age who smoke and attended a TLHC were allocated by day of attendance to receive either immediate telephone smoking cessation intervention (TSI) support (starting immediately and lasting for 6 weeks) with appropriate pharmacotherapy or usual care (UC; very brief advice to quit and signposting to smoking cessation services). The primary outcome was self-reported 7-day point prevalence smoking abstinence at 3 months. Differences between groups were assessed using logistic regression. RESULTS: Three hundred fifteen people taking part in the screening program who reported current smoking with a mean ± SD age of 63 ± 5.4 years, 48% of whom were women, were randomized to TSI (n = 152) or UC (n = 163). The two groups were well matched at baseline. Self-reported quit rates were higher in the intervention arm, 21.1% vs 8.9% (OR, 2.83; 95% CI, 1.44-5.61; P = .002). Controlling for participant demographics, neither baseline smoking characteristics nor the discovery of abnormalities on low-dose CT imaging modified the effect of the intervention. INTERPRETATION: Immediate provision of an intensive telephone-based smoking cessation intervention, delivered within a targeted lung screening context, is associated with incr
Williams P, Cheeseman H, Arnott D, et al., 2023, Use of tobacco and e-cigarettes among youth in Great Britain in 2022: analysis of a cross sectional survey, Tobacco Induced Diseases, Vol: 21, ISSN: 1617-9625
Introduction:Although e-cigarettes can be an effective form of nicotine substitution for adults attempting to quit smoking, their use among children and young people is a concern. Accurate data about this are needed to inform debates over policy and regulation in the UK and elsewhere.Methods:Using data from an online survey of 2613 youth aged 11–18 years, conducted by the market research company YouGov in March 2022, we present prevalence estimates of e-cigarette and tobacco use. We use logistic regression models to assess differences in e-cigarette use, tobacco use and use of disposable e-cigarettes across a range of covariates including age, sex, tobacco smoking status, social class, and country.Results:Among the 18.0% of those surveyed who reported ever having smoked a cigarette, 83.9% were not regular (at least once per week) smokers and 16.1% were (15.1% and 2.9% of the total sample, respectively). Among the 19.2% of those surveyed who had ever used an e-cigarette, 79.2% were not regular users, while 20.8% were (15.2% and 4.0% of the total sample, respectively). Regular e-cigarette use was more common than regular tobacco smoking (4.0% vs 2.9%). E-cigarette use was more common among those who also smoked tobacco, with 9.0% of never e-cigarette users ever smoking tobacco, compared with 89.4% of regular e-cigarette users. Both smoking and e-cigarette use were associated with increasing age and use by others within the home, but not with social class. Use of disposable e-cigarettes was reported by 53.8% of those who have ever used an e-cigarette, and more common among females than males.Conclusions:Regular e-cigarette use is now more common than smoking in children and youth, though the majority of this is among those who have also smoked tobacco. Measures to reduce the appeal of both e-cigarettes and tobacco to children and young people are warranted.
Hopkinson N, Polkey M, Alghamdi S, et al., 2023, Oscillatory positive expiratory pressure therapy in COPD (O-COPD): a randomised controlled trial, Thorax, Vol: 78, Pages: 136-143, ISSN: 0040-6376
Background: Oscillatory Positive Expiratory Pressure (OPEP) devices are intended to facilitate sputum clearance and reduce cough, but there is limited evidence for their effectiveness in COPD, or to guide patient selection. We aimed to assess the impact of OPEP therapy on quality of life and objective measures of cough and sleep disturbance in COPD patients with regular sputum production.Methods: We enrolled stable COPD patients, who reported sputum production every day or most days, into an assessor-blind, parallel group, randomised controlled trial comparing three months of using an Acapella device against usual care (including use of the active cycle of breathing technique (ACBT)). The primary outcome was cough-related quality of life measured using the Leicester Cough Questionnaire (LCQ). Secondary outcomes included fatigue (FACIT score) and generic quality of life(EQ-5D). In a sub study(n=45), objective monitoring of cough and disturbance/movement during sleep were also available.Results: 122 participants (61/61 OPEP/control) were recruited, 40% female, 17% smokers, FEV1 38(25-56)% predicted, and age 62±10 years. 103 completed the study (55/48 OPEP/control). Use of OPEP was associated with an improvement in LCQ compared to controls; MD [95% CI] +1.03[0.71 to 2.10]; (p=0.03), FACIT score +4.68[1.34 to 8.02];(p<0.001) and EQ-5D +4.00[0.49 to 19.75];(p=0.04). There was also an improvement in cough frequency -60[-43 to -95] coughs/24 hours (P<0.001), but no statistically significant effect on sleep disturbance was identified.Conclusions: Regular use of an Acapella device improves symptoms and quality of life in people with COPD who produce sputum daily or most days.
Vrinten C, Parnham JC, Filippidis FT, et al., 2022, Risk factors for adolescent smoking uptake: an analysis of prospective data from the Millennium Cohort Study, Publisher: ELSEVIER SCIENCE INC
Vrinten C, Parnham JC, Filippidis FT, et al., 2022, Risk factors for adolescent smoking uptake: an analysis of prospective data from the Millennium Cohort Study., The Lancet, Vol: 400, Pages: S57-S57, ISSN: 0140-6736
BACKGROUND: Preventing smoking uptake among adolescents is essential to achieve a smoke-free generation. The aim of this study was to assess risk factors for smoking in late adolescence and smoking uptake between early and late adolescence, using data from the Millennium Cohort Study. We also present estimates of numbers of smokers and smoking uptake. METHODS: Adolescents aged 14-17 years were included in the analysis. In separate logistic regression models, we assessed associations between age, sex, ethnicity, household income, country of residence, current smoking of a caregiver, current smoking of peers and use of social media, and regular smoking (defined as smoking at least one cigarette per week) at the age of 17 years and smoking uptake between the ages of 14 and 17 years (defined as being a never-smoker at the age of 14 years and a regular smoker at the age of 17 years). We also estimated numbers of regular smoking and smoking uptake using the Office for National Statistics 2018-19 population estimates. FINDINGS: Data from 8944 adolescents aged 14-17 years with smoking data available were included, 948 (10·6%) of which were regular tobacco smokers at the age of 17 years. 488 (51·5%) of these 948 started smoking between the ages of 14 years and 17 years. Smoking uptake was more common among adolescents reporting caregiver smoking (162 [13·6%] of 1188 vs 324 [5·0%] of 6538 with non-smoking caregivers; p<0·0001); peers smoking (223 [12·6%] of 1764 vs 229 [4·3%] of 5350 without smoking peers; p<0·0001), and those reporting higher (at least 5 h/weekday) social media use (115 [9·8%] of 1176 vs 120 [4·1%] of 2947 with lower [less than 1 h/weekday] social media use; p=0·0059), among 7786 adolescents who did not smoke at age 14. We estimated that 164 313 (95% CI 146 815-181 811) adolescents were regular smokers by the age of 17 years, of whom 101 715 (85 994-117 435) took up the habit
Hopkinson N, 2022, The health and social care crisis makes tobacco control an imperative, BMJ: British Medical Journal, Vol: 379, Pages: 1-2, ISSN: 0959-535X
Mikolaizak AS, Rochester L, Maetzler W, et al., 2022, Connecting real-world digital mobility assessment to clinical outcomes for regulatory and clinical endorsement-the Mobilise-D study protocol, PLoS One, Vol: 17, ISSN: 1932-6203
BACKGROUND: The development of optimal strategies to treat impaired mobility related to ageing and chronic disease requires better ways to detect and measure it. Digital health technology, including body worn sensors, has the potential to directly and accurately capture real-world mobility. Mobilise-D consists of 34 partners from 13 countries who are working together to jointly develop and implement a digital mobility assessment solution to demonstrate that real-world digital mobility outcomes have the potential to provide a better, safer, and quicker way to assess, monitor, and predict the efficacy of new interventions on impaired mobility. The overarching objective of the study is to establish the clinical validity of digital outcomes in patient populations impacted by mobility challenges, and to support engagement with regulatory and health technology agencies towards acceptance of digital mobility assessment in regulatory and health technology assessment decisions. METHODS/DESIGN: The Mobilise-D clinical validation study is a longitudinal observational cohort study that will recruit 2400 participants from four clinical cohorts. The populations of the Innovative Medicine Initiative-Joint Undertaking represent neurodegenerative conditions (Parkinson's Disease), respiratory disease (Chronic Obstructive Pulmonary Disease), neuro-inflammatory disorder (Multiple Sclerosis), fall-related injuries, osteoporosis, sarcopenia, and frailty (Proximal Femoral Fracture). In total, 17 clinical sites in ten countries will recruit participants who will be evaluated every six months over a period of two years. A wide range of core and cohort specific outcome measures will be collected, spanning patient-reported, observer-reported, and clinician-reported outcomes as well as performance-based outcomes (physical measures and cognitive/mental measures). Daily-living mobility and physical capacity will be assessed directly using a wearable device. These four clinical cohorts were chose
Vrinten C, Parnham J, Hopkinson N, et al., 2022, Risk factors for adolescent smoking uptake – analysis of prospective data from the UK Millennium Cohort Study, Tobacco Induced Diseases, Vol: 20, Pages: 1-6, ISSN: 1617-9625
Introduction:Most people who smoke initiate smoking in adolescence. Risk factors for smoking are changing over time as demographics shift, and technologies such as social media create new avenues for the tobacco industry to recruit smokers. We assessed risk factors associated with smoking uptake and regular smoking among a representative cohort of UK adolescents.Methods:Data come from 8944 children followed prospectively as part of the UK Millennium Cohort Study. Smoking uptake was assessed as adolescents who had never smoked tobacco at the age of 14 years, but reported smoking ≥1 cigarette per week by the age of 17 years (regular smoking). We used logistic regression to assess associations between smoking uptake and selected sociodemographic factors including household income, caregiver smoking, peer smoking, and social media use. Weighted percentages and Office for National Statistics Data were used to estimate numbers of regular smokers and new smokers in the UK.Results:Among the whole sample, 10.6% of adolescents were regular smokers at the age of 17 years. Of these, 52% initiated smoking between the ages of 14 and 17 years. Uptake was more common if caregivers smoked (13.6% vs 5.0%, p<0.001) or friends smoked (12.6% vs 4.3%, p<0.001), and among those reporting >5 hours/ day of social media use (9.8% vs 4.1%, p=0.006). Applying these percentages to population data, an estimated 160000 adolescents in the UK were regular smokers by the age of 17 years, of whom more than 100000 initiated smoking between the ages of 14 and 17 years.Conclusions:This analysis of smoking uptake and regular smoking highlight that smoking behavior remains highly transmissible within families and peer groups, reinforcing inequalities. Social media are highlighted as a potential vector.
Pavitt M, Lewis A, Buttery S, et al., 2022, Dietary nitrate supplementation to enhance exercise capacity in hypoxic COPD: EDEN-OX a double-blind, placebo-controlled, randomised crossover study, Thorax, Vol: 77, Pages: 968-975, 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.
Philip KEJ, Bu F, Polkey M, et al., 2022, Relationship of smoking with current and future social isolation and loneliness: 12-year follow-up of 8,780 older adults in England, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Parris W, Philip K, Kaur-Gill N, et al., 2022, Effect of an immediate, remote smoking cessation intervention vs usual care among participants enrolled in lung health check: QuLIT2 study., Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Philip K, Owles H, McVey S, et al., 2022, Impact of an online breathing and wellbeing programme (ENO Breathe) in people with persistent symptoms following COVID-19: a randomised controlled trial, The Lancet Respiratory Medicine, Vol: 60, ISSN: 2213-2600
Aims: ENO Breathe is an online breathing and wellbeing programme for people with Long COVID focusing on breathing re-training using singing techniques.Aim: to assess whether ENO Breathe improves health related quality-of-life (HRQoL) in people with persistent breathlessness following COVID-19.Method:A parallel-group, single-blind, RCT, comparing ENO Breathe(6 weeks) with usual care in adults, with persisting breathlessness +/− anxiety, following assessment at an NHS Long COVID clinic.Primary outcome: change in HRQoL using the RAND SF-36 Mental(MHC) and Physical(PHC) Health Composite Scores.Secondary outcomes: CAT, VAS for breathlessness (rest, walking, stairs, and running), Dysp-12, GAD-7. Participant experience was assessed using focus groups and free-text responses.Results: 150 participants (mean(SD) 49(12)years, 81% female, 320(127) days symptomatic; ENO Breathe(n=74), Control(n=76). ENO Breathe was associated with improvement in MHC of 2.42 points (95%CI 0.03 to 4.80, p=0.045), but not PHC 0.6 (-1.33 to 2.52, p=0.541). VAS breathlessness (running) favoured ENO Breathe -10.48(-17.23 to -3.73, p=0.003). Three participant experience themes were identified 1) improvements in symptoms; 2) feeling that the programme was complementary to standard care; 3) the particular suitability of singing and music to address their needs.Conclusion: An online breathing and wellbeing programme can improve the mental component of HRQoL and elements of breathlessness in people with persisting symptoms after COVID-19. Mind-body and music-based approaches, including practical, enjoyable symptom-management techniques may have a role supporting recovery.
Buttery SC, Lewis A, Latimer L, et al., 2022, Comparative Effect of Lung volume reduction surgery for Emphysema and Bronchoscopic lung volume reduction with valve placement: the CELEB trial, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Philip KEJ, Owles H, McVey S, et al., 2022, An online breathing and wellbeing programme (ENO Breathe) for people with persistent symptoms following COVID-19: a parallel-group, single-blind, randomised controlled trial, The Lancet Respiratory Medicine, Vol: 10, Pages: 851-862, ISSN: 2213-2600
BACKGROUND: There are few evidence-based interventions for long COVID; however, holistic approaches supporting recovery are advocated. We assessed whether an online breathing and wellbeing programme improves health related quality-of-life (HRQoL) in people with persisting breathlessness following COVID-19. METHODS: We conducted a parallel-group, single-blind, randomised controlled trial in patients who had been referred from one of 51 UK-based collaborating long COVID clinics. Eligible participants were aged 18 years or older; were recovering from COVID-19 with ongoing breathlessness, with or without anxiety, at least 4 weeks after symptom onset; had internet access with an appropriate device; and were deemed clinically suitable for participation by one of the collaborating COVID-19 clinics. Following clinical assessment, potential participants were given a unique online portal code. Participants were randomly assigned (1:1) to either immediate participation in the English National Opera (ENO) Breathe programme or to usual care. Randomisation was done by the research team using computer-generated block randomisation lists, with block size 10. The researcher responsible for randomisation was masked to responses. Participants in the ENO Breathe group participated in a 6-week online breathing and wellbeing programme, developed for people with long COVID experiencing breathlessness, focusing on breathing retraining using singing techniques. Those in the deferred group received usual care until they exited the trial. The primary outcome, assessed in the intention-to-treat population, was change in HRQoL, assessed using the RAND 36-item short form survey instrument mental health composite (MHC) and physical health composite (PHC) scores. Secondary outcome measures were the chronic obstructive pulmonary disease assessment test score, visual analogue scales (VAS) for breathlessness, and scores on the dyspnoea-12, the generalised anxiety disorder 7-item scale, and the short
Holt H, Talaei M, Greenig M, et al., 2022, Risk factors for developing COVID-19: a population-based longitudinal study (COVIDENCE UK), Thorax, Vol: 77, Pages: 900-912, ISSN: 0040-6376
Background Risk factors for severe COVID-19 include older age, male sex, obesity, black or Asian ethnicity and underlying medical conditions. Whether these factors also influence susceptibility to developing COVID-19 is uncertain.Methods We undertook a prospective, population-based cohort study (COVIDENCE UK) from 1 May 2020 to 5 February 2021. Baseline information on potential risk factors was captured by an online questionnaire. Monthly follow-up questionnaires captured incident COVID-19. We used logistic regression models to estimate multivariable-adjusted ORs (aORs) for associations between potential risk factors and odds of COVID-19.Results We recorded 446 incident cases of COVID-19 in 15 227 participants (2.9%). Increased odds of developing COVID-19 were independently associated with Asian/Asian British versus white ethnicity (aOR 2.28, 95% CI 1.33 to 3.91), household overcrowding (aOR per additional 0.5 people/bedroom 1.26, 1.11 to 1.43), any versus no visits to/from other households in previous week (aOR 1.31, 1.06 to 1.62), number of visits to indoor public places (aOR per extra visit per week 1.05, 1.02 to 1.09), frontline occupation excluding health/social care versus no frontline occupation (aOR 1.49, 1.12 to 1.98) and raised body mass index (BMI) (aOR 1.50 (1.19 to 1.89) for BMI 25.0–30.0 kg/m2 and 1.39 (1.06 to 1.84) for BMI >30.0 kg/m2 versus BMI <25.0 kg/m2). Atopic disease was independently associated with decreased odds (aOR 0.75, 0.59 to 0.97). No independent associations were seen for age, sex, other medical conditions, diet or micronutrient supplement use.Conclusions After rigorous adjustment for factors influencing exposure to SARS-CoV-2, Asian/Asian British ethnicity and raised BMI were associated with increased odds of developing COVID-19, while atopic disease was associated with decreased odds.Trial registration number ClinicalTrials.gov Registry (NCT04330599).
Buttery S, Philip K, Alghamdi S, et al., 2022, Reporting of data on participant ethnicity and socioeconomic status in high-impact medical journals: A targeted literature review, BMJ Open, Vol: 12, ISSN: 2044-6055
Objectives: To assess the frequency of reporting of ethnicity (or ‘race’) and socioeconomic status (SES) indicators in high-impact journals.Design: Targeted literature reviewData sources: The 10 highest ranked general medical journals using Google scholar h5 index.Eligibility criteria: Inclusion criteria were, human research, reporting participant level data. Exclusion criteria were non-research article, animal/other non-human participant/subject; or no participant characteristics reported.Data extraction and synthesis: Working backwards from 19/04/2021 in each journal, two independent reviewers selected the 10 most recent articles meeting inclusion/exclusion criteria, to create a sample of 100 articles.Data on the frequency of reporting of ethnicity (or ‘race’) and SES indicators were extracted and presented using descriptive statistics.Results: Of one hundred research articles included, 35 reported ethnicity and 13 SES. By contrast, 99 reported age, and 97 reported sex or gender. Among the articles not reporting ethnicity only 3 (5%) highlighted this as a limitation, and only 6 (7%) where SES data were missing. Median number of articles reporting ethnicity per journal was 2.5/10 (range 0 to 9). Only 2 journals explicitly requested reporting of ethnicity (or race), and 1 requested SES. Conclusions: The majority of research published in high-impact medical journals does not include data on the ethnicity and socioeconomic status of participants, and this omission is rarely acknowledged as a limitation. This situation persists despite the well-established importance of this issue and ICMJE recommendations to include relevant demographic variables to ensure representative samples. Standardized explicit minimum standards are required.Strengths and Limitations of this study - This study included recent studies from a range of the highest impact general medical journals.- Different inclusion/exclusion criteria for articles could be justifiably use
Williams PJ, Cheeseman H, Arnott D, et al., 2022, Use of tobacco and e-cigarettes among youth in Great Britain in 2022: analysis of a cross-sectional survey, Publisher: Cold Spring Harbor Laboratory
INTRODUCTION Although e-cigarettes can be an effective form of nicotine substitution for adults attempting to quit smoking, their use among children and young people is a concern. Accurate data about this are needed to inform debates over policy and regulation in the UK and elsewhere.METHODS Using data from an online survey of 2,613 people aged 11 to 18 years, conducted by the market research company YouGov in March 2022, we present prevalence estimates of e-cigarette and tobacco use.We use logistic regression models to assess differences in e-cigarette use, tobacco use and use of disposable e-cigarettes across a range of covariates including age, sex, tobacco smoking status, social class and country.RESULTS Among the 18.0% of those surveyed who reported ever having smoked a cigarette, 83.9% were not regular (at least once per week) smokers and 16.1% were (15.1% and 2.9% of the total sample respectively). Among the 19.2% of those surveyed who had ever used an e-cigarette, 79.2% were not regular users, while 20.8% were (15.2% and 4.0% respectively. Regular e-cigarette use was more common than regular tobacco smoking (4.0% vs 2.9%). E-cigarette use was more common among those who also smoked tobacco, with 9.0% of never e-cigarette users ever smoking tobacco, compared with 89.4% of regular e-cigarette users. Both smoking and e-cigarette use were associated with increasing age and use by others within the home, but not with social class. Use of disposable e-cigarettes was reported by 53.8% of those who have ever used an e-cigarette, and more common among girls than boys.DISCUSSION Regular e-cigarette use is now more common than smoking in children and youth, though the majority of this is among those who have also smoked tobacco. Measures to reduce the appeal of e-both e-cigarettes and tobacco to children and young people are warranted.
Edwards R, Hopkinson N, 2022, The Khan review: the UK Government must act now for a smokefree future, The Lancet, Vol: 400, Pages: 979-981, ISSN: 0140-6736
Williams P, Cumella A, Philip K, et al., 2022, Smoking and socio-economic factors linked to acute exacerbations of COPD: analysis from an Asthma + Lung UK survey, BMJ Open Respiratory Research, Vol: 9, ISSN: 2052-4439
Background: Understanding the factors driving acute exacerbations of COPD is key to reducing their impact on human health and wellbeing. Methods: 5997 patients, mean 66 years, 64% female, completed an online survey between December 2020 and May 2021 about living with COPD developed by the charity Asthma+Lung UK.Results: The 3731(62.2%) survey participants reporting frequent(>2/year) exacerbations were more likely to smoke (AOR 1.70, 95%CI 1.470-1.98), have lower annual household income (<£20,000, (AOR: 1.72, 1.36-2.17), live in a cold and damp home (AOR: 1.78, 1.50-2.11), and report previous occupational exposure to dust, fumes, and chemicals. Smokers were more likely to report attending hospital to manage their most recent AECOPD compared to ex-smokers (AOR: 1.25, 95% CI 0.99- 1.59).
Hopkinson N, 2022, Vectura and Philip Morris – the leopard hasn’t changed its spots., Thorax, Vol: 77, 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”.
Alghamdi SM, Alasmari AM, Alsulayyim AS, et al., 2022, Oscillatory Positive Expiratory Pressure (OPEP) Therapy in Chronic Obstructive Pulmonary Disease (COPD): The O-COPD Trial, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Alghamdi SM, Philip KE, Alsulayyim AS, et al., 2022, Cough Frequency in Chronic Obstructive Pulmonary Disease (COPD) with Frequent Sputum Production, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Alghamdi SM, Alasmari AM, Alsulayyim AS, et al., 2022, Impact of Oscillatory Positive Expiratory Pressure (OPEP) Therapy on Objectively Determined Cough and Sleep Disturbance in COPD: A Sub-Study from the O-COPD Trial, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Hopkinson NS, 2022, COPD, smoking, and social justice, The Lancet Respiratory Medicine, Vol: 10, Pages: 428-430, ISSN: 2213-2600
Soriano JB, Hopkinson NS, 2022, Sing out for COPD!, European Respiratory Journal, Vol: 59, Pages: 1-4, ISSN: 0903-1936
Casaburi R, Merrill DD, Harding G, et al., 2022, A Conceptual Framework for Use of Increased Endurance Time During Constant Work Rate Cycle Ergometry as a Patient-Focused Meaningful Outcome in COPD Clinical Trials., Chronic Obstr Pulm Dis, Vol: 9, Pages: 252-265, ISSN: 2372-952X
The Chronic Lung Disease Biomarker and Clinical Outcome Assessment Qualification Consortium (CBQC) evaluates the potential of biomarkers and outcome measures as drug development tools. Exercise endurance is an objective indicator of treatment benefit, closely related to daily physical function. Therefore, it is an ideal candidate for an outcome for drug development trials. Unfortunately, no exercise endurance measure is qualified by regulatory authorities for use in trials of chronic obstructive pulmonary disease (COPD) and no approved COPD therapies have claims of improving exercise endurance. Consequently, it has been challenging for developers to consider this outcome when designing clinical trials for new therapies. Endurance time during constant work rate cycle ergometry (CWRCE), performed on an electronically braked stationary cycle ergometer, provides an exercise endurance measure under standardized conditions. Baseline individualized work rate for each participant is set using an incremental test. During CWRCE the patient is encouraged to continue exercising for as long as possible. Although not required, physiological and sensory responses (e.g., pulmonary ventilation, heart rate, dyspnea ratings) are frequently collected to support interpretation of endurance time changes. Exercise tolerance limit is reached when the individual is limited by symptoms, unable to maintain pedaling cadence or unable to continue safely. At exercise cessation, exercise duration is recorded. An CWRCE endurance time increase from the pre-treatment baseline is proposed as a key efficacy endpoint in clinical trials. In COPD, improved exercise endurance has a direct relationship to the experience of physical functioning in daily life, which is a patient-centered, meaningful benefit.
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