Publications
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Tsipouri V, Visca D, Mori L, et al., 2017, Ambulatory oxygen in fibrotic lung disease (AMBOX): study protocol for a randomised controlled trial, TRIALS, Vol: 18, ISSN: 1745-6215
Visca D, Tsipouri V, Mori L, et al., 2017, Ambulatory oxygen in fibrotic lung disease (AmbOx): study protocol for a randomised controlled trial, TRIALS, Vol: 18, ISSN: 1745-6215
Background:Fibrotic interstitial lung diseases (ILDs) are chronic and often progressive conditions resulting in substantial morbidity and mortality. Shortness of breath, a symptom often linked to oxygen desaturation on exertion, is tightly linked to worsening quality of life in these patients. Although ambulatory oxygen is used empirically in their treatment, there are no ILD-specific guidelines on its use. To our knowledge, no studies are available on the effects of ambulatory oxygen on day-to-day life in patients with ILD.Methods/design:Ambulatory oxygen in fibrotic lung disease (AmbOx) is a multicentre, randomised controlled crossover trial (RCT) funded by the Research for Patient Benefit Programme of the National Institute for Health Research. The trial will compare ambulatory oxygen used during daily activities with no ambulatory oxygen in patients with fibrotic lung disease whose oxygen saturation (SaO2) is ≥94% at rest, but drops to ≤88% on a 6-min Walk Test. The randomised controlled trial (RCT) will evaluate the effects on health status (measured by the King’s Brief ILD Questionnaire: K-BILD) of ambulatory oxygen used at home, at an optimal flow rate determined by titration at screening visit, and administered for a 2-week period, compared to 2 weeks off oxygen. Key secondary outcomes will include breathlessness on activity scores, as measured by the University of California San Diego Shortness of Breath Questionnaire, global patient assessment of change scores, as well as quality of life scores (St George’s Respiratory Questionnaire), anxiety and depression scores (Hospital Anxiety and Depression Scale), activity markers measured by SenseWear Armbands, pulse oximetry measurements, patient-reported daily activities, patient- and oxygen company-reported oxygen cylinder use. The study also includes a qualitative component and will explore in interviews patients’ experiences of the use of a portable oxygen supply and trial participation
Pavitt MJ, Swanton LL, Hind M, et al., 2017, Choking on a foreign body: a physiological study of the effectiveness of abdominal thrust manoeuvres to increase thoracic pressure, THORAX, Vol: 72, Pages: 576-578, ISSN: 0040-6376
The Heimlich manoeuvre is a well-known intervention for the management of choking due to foreign body airway occlusion, but the evidence base for guidance on this topic is limited and guidelines differ. We measured pressures during abdominal thrusts in healthy volunteers. The angle at which thrusts were performed (upthrust vs circumferential) did not affect intrathoracic pressure. Self-administered abdominal thrusts produced similar pressures to those performed by another person. Chair thrusts, where the subject pushed their upper abdomen against a chair back, produced higher pressures than other manoeuvres. Both approaches should be included in basic life support teaching.
Demeyer H, Louvaris Z, Frei A, et al., 2017, Physical activity is increased by a 12 week semi-automated telecoaching program in patients with COPD, a multicenter randomized controlled trial, Thorax, Vol: 72, Pages: 415-423, ISSN: 1468-3296
RationaleReduced physical activity (PA) in patients with COPD is associated with a poor prognosis. Increasing PA is a key therapeutic target, but thus far few strategies have been found effective in this patient group. ObjectivesTo investigate the effectiveness of a 12 week semi-automated telecoaching intervention on PA in COPD patients in a multicenter European RCT. Methods343 patients from 6 centers, including a wide disease spectrum, were randomly allocated to either a usual care group (UCG) or a telecoaching intervention group (IG) between June and December 2014. This 12 weeks intervention included an exercise booklet and a step counter providing feedback both directly and via a dedicated smartphone application. The latter provided an individualized daily activity goal (steps) revised weekly and text messages as well as allowing occasional telephone contacts with investigators. Physical activity was measured using accelerometry during 1 week preceding randomization and during week 12. Secondary outcomes included exercise capacity and health status. Analyses were based on intention-to-treat.Main resultsBoth groups were comparable at baseline in terms of factors influencing PA. At 12 weeks, the intervention yielded a between group difference of mean, 95% [ll-ul] +1469, 95% [971 – 1965] steps.day-1 and +10.4, 95% [6.1 - 14.7] min.day-1 moderate physical activity; favoring the IG (all p≤0.001). The change in six minute walk distance was significantly different (13.4, 95% [3.40 - 23.5]m, p<0.01), favoring the IG. In IG patients an improvement could be observed in the functional state domain of the CCQ (p=0.03), when compared to UCG. Other health status outcomes did not differ.ConclusionsThe amount and intensity of PA can be significantly increased in COPD patients using a 12 week semi-automated telecoaching intervention including a stepcounter and an application installed on a smartphone.
Boutou AK, Franks R, Mohan D, et al., 2017, Exercise-induced changes in QT interval are smaller in COPD patients and have no impact on mortality, European Respiratory Journal, Vol: 49, ISSN: 0903-1936
Curtis K, Hopkinson NS, 2017, Exercise training in interstitial lung disease: lumping or splitting?, Thorax, Vol: 72, Pages: 589-590, ISSN: 0040-6376
Kon SSC, Jolley CJ, Shrikrishna D, et al., 2017, ACE and response to pulmonary rehabilitation in COPD: two observational studies, BMJ Open Respiratory Research, Vol: 4, ISSN: 2052-4439
IntroductionSkeletal muscle impairment is an important feature of chronic obstructive pulmonary disease (COPD). Renin-angiotensin system activity influences muscle phenotype, so we wished to investigate whether it affects the response to pulmonary rehabilitation.MethodsTwo studies are described; in the first, the response of 168 COPD patients (mean FEV1 51.9%predicted) to pulmonary rehabilitation was compared between different ACE Insertion/Deletion polymorphism genotypes. In a second, independent COPD cohort (n=373), baseline characteristics and response to pulmonary rehabilitation were compared between COPD patients who were or were not taking angiotensin converting enzyme inhibitors (ACE-I) or angiotensin receptor antagonists (ARB).ResultsIn study 1, the incremental shuttle walk distance improved to a similar extent in all three genotypes; DD/ID/II (n=48/91/29) 69(67)m, 61(76)m, 78(78)m respectively (p>0.05). In the second study, fat free mass index was higher in those on ACE-I/ARB (n=130) than those who were not (n=243) 17.8(16.0, 19.8)kgm-2 vs 16.5(14.9,18.4) kgm-2 (p<0.001). However change in fat free mass, walking distance or quality of life in response to pulmonary rehabilitation did not differ between groups.ConclusionWhile these data support a positive association of ACE-I/ARB treatment and body composition in COPD, neither treatment to reduce ACE activity nor ACE(I/D) genotype influence response to pulmonary rehabilitation.
Demeyer H, Duenas-Espin I, De Jong C, et al., 2017, Can health status questionnaires be used as a measure of physical activity in COPD patients? (vol 47, pg 1565, 2016), EUROPEAN RESPIRATORY JOURNAL, Vol: 49, ISSN: 0903-1936
Hopkinson NS, Baxter N, 2017, Breathing SPACE – a practical approach to the breathless patient., npj Primary Care Respiratory Medicine, Vol: 27, ISSN: 2055-1010
Breathlessness is a common symptom which may have multiple causes in any one individual and causes which may change over time. Breathlessness campaigns encourage people to see their GP if they are unduly breathless. Members of the London Respiratory Network collaborated to develop a tool which would encourage a holistic approach to breathlessness, which was applicable both at the time of diagnosis and during ongoing management. This has led to the development of the aide memoire “Breathing SPACE” which encompasses 5 key themes – Smoking, Pulmonary disease, Anxiety/psychosocial factors, Cardiac disease and Exercise/fitness. A particular concern was to ensure that high value interventions (smoking cessation and exercise interventions) are prioritised across the life-course and throughout the course of disease management. The approach is relevant both to well people and in those with an underling diagnosis or diagnoses. The inclusion of anxiety draws attention to the importance of mental health issues. Parity of esteem requires the physical health problems of people with mental illness to be addressed.The SPACE mnemonic also addresses the problem of underdiagnosis of heart disease in people with lung disease and vice versa, as well as the systematic undertreatment of these conditions where they do co-occur.
Hopkinson NS, Dacre J, Regan L, et al., 2017, The need for a new Tobacco Control Plan: an issue of justice, British Medical Journal, Vol: 356, ISSN: 1468-5833
Hopkinson NS, Hart N, Jenkins G, et al., 2017, Climate change and lung health: the challenge for a new president, Thorax, Vol: 72, Pages: 295-296, ISSN: 0040-6376
Spina G, Spruit MA, Alison J, et al., 2017, Analysis of nocturnal actigraphic sleep measures in patients with COPD and their association with daytime physical activity., Thorax, Vol: 72, Pages: 694-701, ISSN: 0040-6376
BACKGROUND: Sleep disturbances are common in patients with chronic obstructive pulmonary disease (COPD) with a considerable negative impact on their quality of life. However, factors associated with measures of sleep in daily life have not been investigated before nor has the association between sleep and the ability to engage in physical activity on a day-to-day basis been studied. AIMS: To provide insight into the relationship between actigraphic sleep measures and disease severity, exertional dyspnoea, gender and parts of the week; and to investigate the association between sleep measures and next day physical activity. METHODS: Data were analysed from 932 patients with COPD (66% male, 66.4±8.3 years, FEV1% predicted=50.8±20.5). Participants had sleep and physical activity continuously monitored using a multisensor activity monitor for a median of 6 days. Linear mixed effects models were applied to investigate the factors associated with sleep impairment and the association between nocturnal sleep and patients' subsequent daytime physical activity. RESULTS: Actigraphic estimates of sleep impairment were greater in patients with worse airflow limitation and worse exertional dyspnoea. Patients with better sleep measures (ie, non-fragmented sleep, sleeping bouts ≥225 min, sleep efficiency ≥91% and time spent awake after sleep onset <57 min) spent significantly more time in light (p<0.01) and moderate-to-vigorous physical activity (p<0.01). CONCLUSIONS: There is a relationship between measures of sleep in patients with COPD and the amount of activity they undertake during the waking day. Identifying groups with specific sleep characteristics may be useful information when designing physical activity-enhancing interventions.
Hopkinson NS, Slebos D-J, Zoumot Z, et al., 2017, Endobronchial Valves For Emphysema: An Individual Patient Level Reanalysis Of Randomised Controlled Trials, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Hopkinson NS, 2017, Lung volume reduction in advanced emphysema, Tanaffos, Vol: 16, Pages: S9-S11, ISSN: 1735-0344
Hopkinson NS, Polkey, Shah P, et al., 2016, Endobronchial valves for patients with heterogeneous emphysema and without interlobar collateral ventilation – open label treatment following the BeLieVeR-HIFi study, Thorax, Vol: 72, Pages: 277-279, ISSN: 1468-3296
Outcomes in early trials of bronchoscopic lung volume reduction using endobronchial valves for the treatment of patients with advanced emphysema were inconsistent. However improvements in patient selection with focus on excluding those with interlobar collateral ventilation and homogeneous emphysema resulted in significant benefits in the BeLieVeR-HIFi study compared to sham treated controls. In this manuscript we present data from the control patients in the BeLieVeR-HIFi study who went on to have open label endobronchial valve treatment after completion of the clinical trial (n=12), combined with data from those in the treatment arm who did not have collateral ventilation (n=19). Three months after treatment the forced expiratory volume in the 1st second increased by 27.3(36.4)%, residual volume reduced by 0.49(0.76)L, the 6 minute walk distance increased by 32.6(68.7) m, and the St George Respiratory Questionnaire for COPD score improved by 8.2(20.2) points. These data extend the evidence for endobronchial valve placement in appropriately selected patients with COPD.
Hopkinson NS, Russell A, 2016, Singing for Lung Health – a systematic review of the literature and consensus statement., npj Primary Care Respiratory Medicine, Vol: 26, ISSN: 2055-1010
Abstract:There is growing interest in Singing for Lung Health (SLH), an approach where patients with respiratory disease take part in singing groups, intended to improve their condition. A consensus group was convened in early 2016 to address issues including; the specific features that make SLH distinct from other forms of participation in singing; the existing evidence base via a systematic review; gaps in the evidence base including the need to define value-based outcome measures for sustainable commissioning of SLH; defining the measures needed to evaluate individuals' responses to SLH and the quality of singing programmes; core training, expertise and competencies required by singing group leaders to deliver high quality programmes.A systematic review to establish the extent of the evidence base for Singing for Lung Health was undertaken. Electronic databases including Pubmed, OVID Medline and Embase, Web of Science, Cochrane central register of controlled trials and PEDro were used. Six studies were included in the final review. Quantitative data suggest singing has the potential to improve health related quality of life, particularly related to physical health, and levels of anxiety without causing significant side effects. There is a significant risk of bias in many of the existing studies with small numbers of subjects overall. Little comparison can be made between studies due to their heterogeneity in design. Qualitative data indicate that singing is an enjoyable experience for patients who consistently report that it helps them to cope with their condition better.Larger and longer term trials are needed.
Curtis KJ, Meyrick VM, Mehta B, et al., 2016, Angiotensin-converting enzyme inhibition as an adjunct to pulmonary rehabilitation in COPD, American Journal of Respiratory and Critical Care Medicine, Vol: 194, Pages: 1349-1357, ISSN: 1535-4970
Rationale: Epidemiological studies in older individuals have found an association between use of ACE-inhibition (ACE-I) therapy and preserved locomotor muscle mass, strength and walking speed. ACE-I therapy might therefore have a role in the context of pulmonary rehabilitation. Objectives: We investigated the hypothesis that enalapril, an ACE-inhibitor, would augment the improvement in exercise capacity seen during pulmonary rehabilitation. Methods: We performed a double-blind, placebo-controlled, parallel-group randomised controlled trial. COPD patients, with at least moderate airflow obstruction and taking part in pulmonary rehabilitation, were randomised to either 10 weeks therapy with an ACE-inhibitor (10mg enalapril) or placebo. Measurements: The primary outcome measurement was the change in peak power (assessed using cycle ergometry) from baseline. Main Results: Eighty patients were enrolled, seventy-eight randomised (age 67±8years, FEV1 48±21% predicted), and sixty-five completed the trial (34 placebo, 31 ACE-inhibitor). The ACE-inhibitor treated group demonstrated a significant reduction in systolic blood pressure (Δ-16mmHg, 95% CI -22 to -11) and serum ACE activity (Δ-18IU/L, 95% CI -23 to -12) versus placebo (between group differences p<0.0001). Peak power increased significantly more in the placebo group (placebo Δ+9 Watts, 95% CI 5 to 13 vs. ACE-I Δ+1 Watt, 95% CI -2 to 4, between group difference 8 Watts, 95% CI 3 to 13, p=0.001). There was no significant between group difference in quadriceps strength or health-related quality of life. Conclusion: Use of the ACE-inhibitor enalapril alongside a programme of pulmonary rehabilitation, in patients without an established indication for ACE-inhibition, reduced the peak work rate response to exercise training in COPD patients. Clinical trial registration available at www.controlled-trials.com, ID ISRCTN79038750.
Hopkinson NS, 2016, Endobronchial valves as a treatment for emphysema. Moving out of the shadow of lung volume reduction surgery, American Journal of Respiratory and Critical Care Medicine, Vol: 194, Pages: 1039-1040, ISSN: 1535-4970
Mohan D, Lewis A, Patel MS, et al., 2016, Using laser capture microdissection to study fiber specific signalling in locomotor muscle in COPD: A pilot study, Muscle & Nerve, Vol: 55, Pages: 902-912, ISSN: 1097-4598
INTRODUCTION: Quadriceps dysfunction is important in chronic obstructive pulmonary disease (COPD), with an associated increased proportion of type II fibers. Investigation of protein synthesis and degradation has yielded conflicting results, possibly due to study of whole biopsy samples, whereas signalling may be fiber-specific. Our objective was to develop a method for fiber-specific gene expression analysis. METHODS: 12 COPD and 6 healthy subjects underwent quadriceps biopsy. Cryosections were immunostained for type II fibers, which were separated using laser capture microdissection (LCM). Whole muscle and different fiber populations were subject to quantitative polymerase chain reaction (qPCR). RESULTS: Muscle-RING-finger-protein-1(MURF-1) and Atrogin-1 were lower in type II fibers of COPD versus healthy subjects (P=0.02 and P=0.03, respectively), but differences were not apparent in whole muscle or type I fibers. DISCUSSION: We describe a novel method for studying fiber-specific gene expression in optimum-cutting-temperature (OCT) compound-embedded muscle specimens. LCM offers a more sensitive way to identify molecular changes in COPD muscle. This article is protected by copyright. All rights reserved.
Gilworth G, Tuffnell R, Hogg L, et al., 2016, Lay health workers in pulmonary rehabilitation-recruitment and training of COPD patient volunteers, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
McKee H, Cave P, McDermott M, et al., 2016, "It lifts your spirits and you come away feeling lighter" - Patient experience of British Lung Foundation singing groups, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Aymerich JG, Puhan M, de Jongh C, et al., 2016, Responsiveness of PROactive instruments to measure physical activity in COPD patients, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Loeckx M, Louvaris Z, Tanner R, et al., 2016, Contact time between patients with COPD and coach during an activity telecoaching intervention: Impact on the intervention effect, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
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Hopkinson N, Kemp S, Toma T, et al., 2016, Survival benefit from successful bronchoscopic lung volume reduction with endobronchial valves - A 10 year follow up study, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Visca D, Fleming S, Firouzi A, et al., 2016, Randomised controlled, crossover trial to evaluate the effects of ambulatory oxygen on health status in patients with fibrotic lung disease, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Pereira M, Williams S, Restrick L, et al., 2016, Healthcare worker influenza vaccination is associated with reduced rates of sickness absence, EUROPEAN RESPIRATORY JOURNAL, Vol: 48, ISSN: 0903-1936
Garner J, Kemp SV, Toma TP, et al., 2016, Survival after endobronchial valve placement for emphysema: a 10-Year follow-up study, American Journal of Respiratory and Critical Care Medicine, Vol: 194, Pages: 519-521, ISSN: 1535-4970
Hopkinson NS, Millett C, Glantz S, et al., 2016, UK government should fund stop smoking media campaigns not give tax breaks to films with smoking imagery, Addiction, Vol: 111, Pages: 2066-2067, ISSN: 1360-0443
McNelly AS, Rawal J, Shrikrishna D, et al., 2016, An Exploratory Study of Long-Term Outcome Measures in Critical Illness Survivors: Construct Validity of Physical Activity, Frailty, and Health-Related Quality of Life Measures, Critical Care Medicine, Vol: 44, Pages: e362-e369, ISSN: 1530-0293
Objective: Functional capacity is commonly impaired after critical illness. We sought to clarify the relationship between objective measures of physical activity, self-reported measures of health-related quality of life, and clinician reported global functioning capacity (frailty) in such patients, as well as the impact of prior chronic disease status on these functional outcomes.Design: Prospective outcome study of critical illness survivors.Setting: Community-based follow-up.Patients: Participants of the Musculoskeletal Ultrasound Study in Critical Care: Longitudinal Evaluation Study (NCT01106300), invasively ventilated for more than 48 hours and on the ICU greater than 7 days.Interventions: None.Measurements and Main Results: Physical activity levels (health-related quality of life [36-item short-form health survey] and daily step counts [accelerometry]) were compared to norm-based or healthy control scores, respectively. Controls for frailty (Clinical Frailty Score) were non-morbid, age- and gender-matched to survivors. Ninety-one patients were recruited on ICU admission: 41 were contacted for post-discharge assessment, and data were collected from 30 (14 female; mean age, 55.3 yr [95% CI, 48.3–62.3]; mean post-discharge, 576 d [95% CI, 539–614]). Patients’ mean daily step count (5,803; 95% CI, 4,792–6,813) was lower than that in controls (11,735; 95% CI, 10,928–12,542; p < 0.001), and lower in those with preexisting chronic disease than without (2,989 [95% CI, 776–5,201] vs 7,737 [95% CI, 4,907–10,567]; p = 0.013). Physical activity measures (accelerometry, health-related quality of life, and frailty) demonstrated good construct validity across all three tools. Step variability (from SD) was highly correlated with daily steps (r2 = 0.67; p < 0.01) demonstrating a potential boundary constraint.Conclusions: Subjective and objective measures of physical activity are all informative in ICU survivors. They are all redu
Celli B, Tetzlaff K, Criner G, et al., 2016, The 6-minute walk test as a COPD stratification tool: insights from the COPD biomarker qualification consortium, American Journal of Respiratory and Critical Care Medicine, Vol: 194, Pages: 1483-1493, ISSN: 1535-4970
BACKGROUND: The 6-minute walk test distance (6MWD) predicts mortality in COPD. Whether variability in study type (observational versus interventional), region performed limits use of the test as a stratification tool or outcome measure for therapeutic trials is unclear. METHODS: Original data from 14,497 COPD patients from 6 observational (n = 9641) and 5 interventional (n=4856) studies larger than 100 patients and longer than 6 months in duration were included. The geographical, anthropometrics, FEV1, dyspnea, co-morbidities and health status scores were measured. Associations between 6MWD with mortality, hospitalizations and exacerbations adjusted by study type, age and gender were evaluated. Thresholds for outcome prediction were calculated using receiver-operating curves. The change in 6MWD after inhaled bronchodilator treatment and surgical lung volume reduction (LVRS) were analyzed to evaluate the responsiveness of the test as an outcome measure. RESULTS: The 6MWD was significantly lower in non-survivors, those hospitalized or who exacerbated compared with those without events at 6, 12 and > 12 months. At these time points, the 6MWD ROC-AUC to predict mortality was 0.71, 0.70 and 0.68 and for hospitalizations was 0.61, 0.60 and 0.59. After treatment, the 6MWD was not different between placebo or bronchodilators but increased after LVRS compared with medical therapy. Variation across study types (observational or therapeutic) or regions did not confound the ability of 6MWD to predict outcome. CONCLUSIONS: The 6MWD may help stratify COPD patients for clinical trials and interventions aimed at modifying exacerbations, hospitalizations or death.
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