Publications
515 results found
Newby PR, Crossley D, Crisford H, et al., 2019, A specific proteinase 3 activity footprint in α1-antitrypsin deficiency, ERJ Open Research, Vol: 5, ISSN: 2312-0541
α1-Antitrypsin (α1-AT) deficiency is a risk factor for emphysema due to tissue damage by serine proteases. Neutrophil elastase (NE) has long been considered the enzyme responsible. However, proteinase 3 (PR3) also produces the pathological features of chronic obstructive pulmonary disease (COPD), is present in the same granules in the neutrophil and is inhibited after NE. We developed a specific footprint assay for PR3 activity and assessed its relationship to an NE footprint in α1-AT deficiency. An ELISA was developed for the specific PR3 fibrinogen cleavage site Aα-Val541. Levels were measured in plasma from 239 PiZZ patients, 94 PiSZ patients, 53 nondeficient healthy smokers and 78 individuals with usual COPD. Subjects underwent extensive demographic characterisation including full lung function and lung computed tomography scanning. Aα-Val541 was greater than the NE footprint in all cohorts, consistent with differential activity. Values were highest in the PiZZ α1-AT-deficient patients and correlated with the NE marker Aα-Val360, but were ∼17 times higher than for the NE footprint, consistent with a greater potential contribution to lung damage. Aα-Val541 was related cross-sectionally to the severity of lung disease (forced expiratory volume in 1 s % pred: rs= -0.284; p<0.001) and was sensitive to augmentation therapy, falling from 287.2 to 48.6 nM (p<0.001). An in vivo plasma footprint of PR3 activity is present in greater quantities than an NE footprint in patients with α1-AT deficiency, is sensitive to augmentation therapy and represents a likely biomarker for dose-ranging studies.
Hopkinson NS, Hart N, Jenkins G, et al., 2019, Climate change and lung health: presidential failure, professional responsibility, Thorax, Vol: 74, Pages: 627-628, ISSN: 1468-3296
Philip K, Lewis A, Hopkinson NS, 2019, Music and dance in chronic lung disease, Breathe, Vol: 15, Pages: 116-120, ISSN: 1810-6838
Arts in Health interventions show potential to improve the quality of life of people with chronic lung disease. Listening to music, making music, and dance have accepted and established roles in the lives of people without chronic disease. However, their potential utility in chronic disease management is infrequently considered by medical professionals. The aim of this review is to examine the use of music and dance in the treatment and self-management of chronic lung disease. Although the evidence base is currently limited, existing research suggests a range of biopsychosocial benefits. As personalised medicine and social prescribing become more prominent, further research is required to establish the role of arts interventions in chronic lung disease.
Laverty AA, Filippidis FT, Taylor-Robinson D, et al., 2019, Smoking uptake in UK children: Analysis of the UK Millennium Cohort Study., Thorax, Vol: 74, Pages: 607-610, ISSN: 0040-6376
We used data from 11 577 children in the UK Millennium Cohort Study, collected at approximately 14 years of age (early teens), to assess characteristics associated with smoking, and generated regional estimates of numbers of smokers. 13.8% of UK early teens studied had ever smoked; 1.9% were current smokers. This corresponds to 2 28 136 and 39 653 (13-14 year olds) in the UK, respectively. Ever smoking risk increased if caregivers (26.0% vs 10.9%) or friends smoked (35.1% vs 4.0%), with a dose-response effect for friends' smoking. Caregiver and peer-group smoking remain important drivers of child smoking uptake and thus important targets for intervention.
Hopkinson NS, 2019, Keep out of reach of children-the case for increasing the legal age for tobacco purchase to 21, BMJ, Vol: 364, ISSN: 0959-8138
Increasing the legal age for tobacco purchase should be combined with other measures to reduce smoking rates in young people.
White P, Gilworth G, Lewin S, et al., 2019, Improving uptake and completion of pulmonary rehabilitation in COPD with lay health workers: feasibility of a clinical trial, International Journal of Chronic Obstructive Pulmonary Disease, Vol: 14, Pages: 631-643, ISSN: 1176-9106
Purpose: This study was designed to evaluate the feasibility of a cluster randomized controlled trial to test the efficacy of lay health workers (LHWs) in improving the uptake and completion of pulmonary rehabilitation (PR) in the treatment of COPD. Materials and methods: LHWs, trained in confidentiality, role boundaries, and behavior change techniques, supported patients newly referred for PR. Interactions between LHWs and participants were recorded with smartphones. Outcomes were recruitment and retention rates of LHWs, questionnaire and interview-evaluated acceptability and analysis of intervention fidelity. Results: Forty (36%) of 110 PR-experienced COPD patients applied to become LHWs. Twenty (18%) were selected for training. Twelve (11%) supported patients. Sixty-six COPD patients referred for PR received the intervention (5.5 participants per LHW). Ten LHWs were retained to the end of the study. Seventy-three percent of supported patients were satisfied or very satisfied with the intervention. LHWs delivered the intervention with appropriate style and variable fidelity. LHWs would welcome more intensive training. Based on this proof of concept, a cluster randomized controlled trial of an LHW intervention to improve uptake and completion of PR is feasible. Conclusion: PR-experienced COPD patients can be recruited, trained, and retained as LHWs to support participation in PR, and can deliver the intervention. Participant COPD patients found the intervention acceptable. A cluster randomized controlled clinical trial is feasible.
Brakema EA, van Gemert FA, van der Kleij RMJJ, et al., 2019, COPD's early origins in low-and-middle income countries: what are the implications of a false start?, npj Primary Care Respiratory Medicine, Vol: 29, ISSN: 2055-1010
Wilkinson A, Hillman T, Hopkinson NS, et al., 2019, Our patients and our planet-holistic considerations for inhaler choice, Lancet Respiratory Medicine, Vol: 7, Pages: e11-e11, ISSN: 2213-2600
Hopkinson NS, 2019, The prominence of e-cigarettes is a symptom of decades of failure to tackle smoking properly, BMJ, Vol: 364, ISSN: 0959-8138
Moghadam MRS, Ghanei M, Kenn K, et al., 2019, Pulmonary rehabilitation in patients with mustard gas lung disease: a study protocol for a randomized controlled trial, Trials, Vol: 20, ISSN: 1745-6215
BackgroundMore than 60,000 people have health problems due to chemical weapons exposure during the Iran–Iraq war. Respiratory consequences of mustard gas exposure are common and disabling; medical interventions have limited effect. Patients complain of cough, sputum, breathlessness and exercise limitation. We hypothesized that patients with this condition would benefit from pulmonary rehabilitation.MethodsWe outline the protocol for an assessor-blind, two-armed, parallel-design randomized controlled clinical trial (IRCT2016051127848N1). Sixty patients with respiratory disease due to documented sulfur mustard gas exposure will be randomized to either take part in a 6-week pulmonary rehabilitation programme or receive usual care. Inclusion criteria include forced expiratory volume in 1 second < 80% predicted and Medical Research Council dyspnoea score ≥ 3. The primary endpoint will be the change in cycle endurance time at 70% baseline exercise capacity at 6 weeks. Lung function, physical activity, the strength and endurance of the quadriceps muscle, and quality of life will also be compared. Outcomes will be assessed at 6 weeks and 12 months. Health care utilization will also be assessed.DiscussionIf the study confirms that rehabilitation is effective for patients with mustard gas lung disease this should prompt provision of the intervention to this patient group.
Hopkinson N, 2019, Respiratory disease is in the long term plan, BMJ: British Medical Journal, Vol: 364, ISSN: 0959-8138
Garner J, Garner S, Hardie R, et al., 2019, Evaluation of a Low Cost, Re-Useable, Bronchoscopy Biosimulator with Ventilated Lungs: The Bronchoscopy BioSim, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Loeckx M, Rabinovich RA, Demeyer H, et al., 2018, Smartphone-based physical activity telecoaching in chronic obstructive pulmonary disease: Mixed-methods study on patient experiences and lessons for implementation, JMIR mHealth and uHealth, Vol: 6, ISSN: 2291-5222
Background: Telecoaching approaches can enhance physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD). However, their effectiveness is likely to be influenced by intervention-specific characteristics.Objective: This study aimed to assess the acceptability, actual usage, and feasibility of a complex PA telecoaching intervention from both patient and coach perspectives and link these to the effectiveness of the intervention.Methods: We conducted a mixed-methods study based on the completers of the intervention group (N=159) included in an (effective) 12-week PA telecoaching intervention. This semiautomated telecoaching intervention consisted of a step counter and a smartphone app. Data from a project-tailored questionnaire (quantitative data) were combined with data from patient interviews and a coach focus group (qualitative data) to investigate patient and coach acceptability, actual usage, and feasibility of the intervention. The degree of actual usage of the smartphone and step counter was also derived from app data. Both actual usage and perception of feasibility were linked to objectively measured change in PA.Results: The intervention was well accepted and perceived as feasible by all coaches present in the focus group as well by patients, with 89.3% (142/159) of patients indicating that they enjoyed taking part. Only a minority of patients (8.2%; 13/159) reported that they found it difficult to use the smartphone. Actual usage of the step counter was excellent, with patients wearing it for a median (25th-75th percentiles) of 6.3 (5.8-6.8) days per week, which did not change over time (P=.98). The smartphone interface was used less frequently and actual usage of all daily tasks decreased significantly over time (P<.001). Patients needing more contact time had a smaller increase in PA, with mean (SD) of +193 (SD 2375) steps per day, +907 (SD 2306) steps per day, and +1489 (SD 2310) steps per day in high, medium, and low contact
Elbehairy AF, Quint JK, Rogers J, et al., 2018, THE BRITISH LUNG FOUNDATION ONLINE BREATH TEST: IMPACT ON HEALTH-CARE BEHAVIOUR, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A246-A246, ISSN: 0040-6376
Pavitt MJ, Tanner RJ, Lewis AP, et al., 2018, ORAL DIETARY NITRATE SUPPLEMENTATION TO ENHANCE PULMONARY REHABILITATION IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: A MULTI-CENTRE, DOUBLE BLIND, PLACEBO-CONTROLLED, PARALLEL GROUP STUDY, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A3-A3, ISSN: 0040-6376
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Elbehairy AF, Quint JK, Rogers J, et al., 2018, PATTERNS OF BREATHLESSNESS IN THE UK: RESULTS FROM THE BRITISH LUNG FOUNDATION ONLINE BREATH TEST, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A247-A247, ISSN: 0040-6376
Lewis A, Cave P, Hopkinson NS, 2018, Singing for lung health: Evaluation of the british lung foundation programme, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: European Respiratory Society, ISSN: 0903-1936
Introduction: Singing for Lung Health (SLH) is a novel intervention for people with respiratory disease, including physical and vocal warm ups, rhythm and pitch games, repertoire and cool down/relaxation exercises. Groups are run by leaders who have received quality assured British Lung Foundation (BLF) training (Lewis A. et al, bmjresp 2017; 000216). Qualitative results suggest benefits to physical, mental and emotional health. Limited data also suggest objective improvements in measures of quality of life with SLH are achievable (Lewis A. et al, npjpcrm 2016;80). It is not known how effective the SLH groups supported by the BLF in the UK are.Aims and Objectives: To understand the clinical impact SLH has on people with respiratory disease.Methods: The BLF conducted a questionnaire survey of 228 singers with respiratory disease from its SLH groups in 2016-2017. Questionnaires were administered prior to participants’ first session and after 12 weeks of singing.Results: 113 (49.5%) of participants provided 12 week data. There were significant improvements in CAT score (Mean -1.4 CI: (0.25 - -2.48) (p = 0.017). Furthermore, 45% of singers reported reduced GP visits (p = 0.00002) and 18% reported reduced hospital admissions (p = 0.01). However, there were no significant improvements in general quality of life, anxiety, patient activation, breathlessness or inhaler use.Conclusion: This evaluation found that participants in SLH groups report improvement in respiratory health-related quality of life and a reduction in healthcare utilisation. SLH has potential economic and health benefits. Therefore, to confirm these findings these endpoints should be evaluated further in large scale randomised controlled trials.
Goddard A, Burn W, Regan L, et al., 2018, Open letter to Simon Stevens to ensure that tobacco dependence treatment is provided for every smoker cared for by the NHS, as part of the long term plan, BMJ, Vol: 363, ISSN: 0959-8138
Buttery S, Kemp S, Shah P, et al., 2018, The CELEB trial: Comparative effectiveness of lung volume reduction surgery for emphysema and bronchoscopic lung volume reduction with valve placement. A protocol for a randomised controlled trial, BMJ Open, Vol: 8, ISSN: 2044-6055
Introduction: Although lung volume reduction surgery and bronchoscopic lung volume reduction with endobronchial valves have both been shown to improve lung function, exercise capacity and quality of life in appropriately selected patients with emphysema, there are no direct comparison data between the two procedures to inform clinical decision making. Methods and Analysis: We describe the protocol of the CELEB study (ISRCTN19684749), a randomised controlled trial which will compare outcomes at 1 year between the two procedures, using a composite disease severity measure, the iBODE score, which includes body mass index, lung function, breathlessness and exercise capacity.Ethics and Dissemination: Ethical approval to conduct the study has been obtained from the Fulham Research Ethics Committee, London (16/LO/0286). The outcome of this trial will provide information to guide treatment choices in this population and will be presented at national and international meetings and published in peer-reviewed journals. We will also disseminate the main results to all participants in a letter.
Hopkinson NS, 2018, Tobacco smoke and environmental injustice., BMJ, Vol: 363, ISSN: 0959-8138
Visca D, Mori L, Tsipouri V, et al., 2018, Effect of ambulatory oxygen on quality of life for patients with fibrotic lung disease (AmbOx): a prospective, open-label, mixed-method, crossover randomised controlled trial, Lancet Respiratory Medicine, Vol: 6, Pages: 759-770, ISSN: 2213-2600
BACKGROUND: In fibrotic interstitial lung diseases, exertional breathlessness is strongly linked to health-related quality of life (HRQOL). Breathlessness is often associated with oxygen desaturation, but few data about the use of ambulatory oxygen in patients with fibrotic interstitial lung disease are available. We aimed to assess the effects of ambulatory oxygen on HRQOL in patients with interstitial lung disease with isolated exertional hypoxia. METHODS: AmbOx was a prospective, open-label, mixed-method, crossover randomised controlled clinical trial done at three centres for interstitial lung disease in the UK. Eligible patients were aged 18 years or older, had fibrotic interstitial lung disease, were not hypoxic at rest but had a fall in transcutaneous arterial oxygen saturation to 88% or less on a screening visit 6-min walk test (6MWT), and had self-reported stable respiratory symptoms in the previous 2 weeks. Participants were randomly assigned (1:1) to either oxygen treatment or no oxygen treatment for 2 weeks, followed by crossover for another 2 weeks. Randomisation was by a computer-generated sequence of treatments randomly permuted in blocks of constant size (fixed size of ten). The primary outcome, which was assessed by intention to treat, was the change in total score on the King's Brief Interstitial Lung Disease questionnaire (K-BILD) after 2 weeks on oxygen compared with 2 weeks of no treatment. General linear models with treatment sequence as a fixed effect were used for analysis. Patient views were explored through semi-structured topic-guided interviews in a subgroup of participants. This study was registered with ClinicalTrials.gov, number NCT02286063, and is closed to new participants with all follow-up completed. FINDINGS: Between Sept 10, 2014, and Oct 5, 2016, 84 patients were randomly assigned, 41 randomised to ambulatory oxygen first and 43 to no oxygen. 76 participants completed the trial. Compared with no oxygen, ambulatory oxygen was ass
Connell O, Whittaker H, Elbehairy A, et al., 2018, Eligibility for lung volume reduction surgery in COPD patients identified in a UK primary care setting, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Jones S, Maddocks M, Nolan C, et al., 2018, Responsiveness of a short stair climb power test to pulmonary rehabilitation in COPD, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Jones S, Nolan C, Patel S, et al., 2018, Five-repetition sit-to-stand and mortality in COPD: a prospective cohort study, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Pavitt M, Lewis AP, Buttery SC, et al., 2018, Late Breaking Abstract - Dietary nitrate supplementation increases exercise endurance time in COPD patients using ambulatory oxygen, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Price L, Kempny A, Mccabe C, et al., 2018, Sildenafil in Patients with Severe Group 3 Pulmonary Hypertension, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Pavitt M, Tanner RJ, Lewis AP, et al., 2018, Late Breaking Abstract - Dietary nitrate supplementation enhances the benefit of pulmonary rehabilitation in people with COPD, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Jones S, Nolan C, Patel S, et al., 2018, Development of a new prognosis index (BODS) in patients with COPD: a prospective cohort study, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Zafeiridou M, Hopkinson NS, Voulvoulis N, 2018, Cigarette Smoking: An assessment of tobacco's global environmental footprint across its entire supply chain, Environmental Science and Technology, Vol: 52, Pages: 8087-8094, ISSN: 0013-936X
While the health effects of cigarette smoking are well recognised and documented, the environmental impacts of tobacco are less appreciated and often overlooked. Here we evaluate tobacco's global footprint across its entire supply chain, looking at resources needs, wastes and emissions of the full cradle-to-grave life cycle of cigarettes. The cultivation of 32.4 Mt of green tobacco used for the production of 6.48 Mt of dry tobacco in the six trillion cigarettes manufactured worldwide in 2014, were shown to contribute almost 84 Mt CO2 eq emissions to climate change - approximately 0.2% of the global total, 490,000 tonnes 1,4 dichlorobenzene eq to ecosystem ecotoxicity levels, over 22 billion m3 and 21 Mt oil eq to water and fossil fuel depletion respectively. A typical cigarette was shown to have a water footprint of 3.7 litres, a climate change contribution of 14 g CO2 eq, and a fossil fuel depletion contribution of 3.5 g oil eq. Tobacco competes with essential commodities for resources and places significant pressures on the health of our planet and its most vulnerable inhabitants. Increased awareness as well as better monitoring and assessment of the environmental issues associated with tobacco should support the current efforts to reduce global tobacco use as an important element of sustainable development.
Lewis A, Cave P, Hopkinson NS, 2018, Singing for Lung Health: service evaluation of the British Lung Foundation programme., Perspectives in Public Health, Vol: 138, Pages: 215-222, ISSN: 1466-4240
AIMS: Singing for Lung Health (SLH) is a novel intervention for individuals with respiratory disease. Qualitative results suggest benefits to physical, mental and emotional health. Limited data also suggest objective improvements in measures of quality of life with SLH are achievable. It is not known how effective the SLH groups supported by the British Lung Foundation (BLF) in the UK are. The objective was to understand the clinical impact SLH has on individuals with respiratory disease. METHODS: The BLF conducted a questionnaire survey of singers with respiratory disease from new SLH groups set up in 2016-2017. Questionnaires were administered prior to participants' first session and after 12 weeks of singing. Health-related quality of life, patient activation, anxiety and breathlessness outcomes were included. Healthcare resource utilisation including general practitioner (GP) visits, hospitalisations and frequency of inhaler use were recorded. RESULTS: A total of 228 singers participated from 26 SLH groups in the UK. Participants were 70.7 (10.1) years old, 156 (68.4%) were female and 114 (47.5%) had chronic obstructive pulmonary disease (COPD). In all, 113 (49.5%) participants provided 12-week data. There were significant improvements in COPD Assessment Test (CAT) score (Mean = -1.4, CI: (-0.25 to -2.48) ( p = .017)). Furthermore, 45% of singers reported reduced GP visits ( p ≤ .001) and 18% reported reduced hospital admissions ( p = .01). However, there were no significant improvements in general quality of life, anxiety, patient activation, breathlessness or inhaler use. Baseline characteristics were not significantly different between people who completed the 12-week evaluation and those who did not. CONCLUSIONS: This service evaluation found that participants in SLH groups report improvement in respiratory health-related quality of life and a reduction in healthcare ut
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