43 results found
Coker RK, Armstrong A, Church AC, et al., 2022, BTS Clinical Statement on air travel for passengers with respiratory disease, Thorax, Vol: 77, Pages: 329-350, ISSN: 0040-6376
Vekaria G, Alhaffar A, Abdi A, et al., 2021, REMOTE FRAILTY ASSESSMENT AND PREVALENCE OF FRAILTY IN OLDER OUTPATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS, Publisher: BMJ PUBLISHING GROUP, Pages: A70-A71, ISSN: 0040-6376
Woods DR, Coker RK, Ind P, et al., 2021, PULMONARY HYPERTENSION AND OUTCOMES IN A SINGLE-CENTRE IPF COHORT, Publisher: BMJ PUBLISHING GROUP, Pages: A161-A162, ISSN: 0040-6376
Wilson AM, Clark AB, Cahn T, et al., 2020, Effect of co-trimoxazole (Trimethoprim-Sulfamethoxazole) vs placebo on death, lung transplant, or hospital admission in patients with moderate and severe idiopathic pulmonary fibrosis the EME-TIPAC randomized clinical trial, JAMA: Journal of the American Medical Association, Vol: 324, Pages: 2282-2291, ISSN: 0098-7484
Importance Idiopathic pulmonary fibrosis (IPF) has a poor prognosis and limited treatment options. Patients with IPF have altered lung microbiota, with bacterial burden within the lungs associated with mortality; previous studies have suggested benefit with co-trimoxazole (trimethoprim-sulfamethoxazole).Objective To determine the efficacy of co-trimoxazole in patients with moderate and severe IPF.Design, Setting, and Participants Double-blind, placebo-controlled, parallel randomized trial of 342 patients with IPF, breathlessness (Medical Research Council dyspnea scale score >1), and impaired lung function (forced vital capacity ≤75% predicted) conducted in 39 UK specialist interstitial lung disease centers between April 2015 (first patient visit) and April 2019 (last patient follow-up).Interventions Study participants were randomized to receive 960 mg of oral co-trimoxazole twice daily (n = 170) or matched placebo (n = 172) for between 12 and 42 months. All patients received 5 mg of folic acid orally once daily.Main Outcomes and Measures The primary outcome was time to death (all causes), lung transplant, or first nonelective hospital admission. There were 15 secondary outcomes, including the individual components of the primary end point respiratory-related events, lung function (forced vital capacity and gas transfer), and patient-reported outcomes (Medical Research Council dyspnea scale, 5-level EuroQol 5-dimension questionnaire, cough severity, Leicester Cough Questionnaire, and King’s Brief Interstitial Lung Disease questionnaire scores).Results Among 342 individuals who were randomized (mean age, 71.3 years; 46 [13%] women), 283 (83%) completed the trial. The median (interquartile range) duration of follow-up was 1.02 (0.35-1.73) years. Events per person-year of follow-up among participants randomized to the co-trimoxazole and placebo groups were 0.45 (84/186) and 0.38 (80/209), respectively, with a hazard ratio of
Drake TM, Docherty AB, Harrison EM, et al., 2020, Outcome of hospitalization for COVID-19 in patients with interstitial lung disease: an international multicenter study., American Journal of Respiratory and Critical Care Medicine, Vol: 202, Pages: 1656-1665, ISSN: 1073-449X
RATIONALE: The impact of COVID-19 on patients with Interstitial Lung Disease (ILD) has not been established. OBJECTIVES: To assess outcomes in patients with ILD hospitalized for COVID-19 versus those without ILD in a contemporaneous age, sex and comorbidity matched population. METHODS: An international multicenter audit of patients with a prior diagnosis of ILD admitted to hospital with COVID-19 between 1 March and 1 May 2020 was undertaken and compared with patients, without ILD obtained from the ISARIC 4C cohort, admitted with COVID-19 over the same period. The primary outcome was survival. Secondary analysis distinguished IPF from non-IPF ILD and used lung function to determine the greatest risks of death. MEASUREMENTS AND MAIN RESULTS: Data from 349 patients with ILD across Europe were included, of whom 161 were admitted to hospital with laboratory or clinical evidence of COVID-19 and eligible for propensity-score matching. Overall mortality was 49% (79/161) in patients with ILD with COVID-19. After matching ILD patients with COVID-19 had higher mortality (HR 1.60, Confidence Intervals 1.17-2.18 p=0.003) compared with age, sex and co-morbidity matched controls without ILD. Patients with a Forced Vital Capacity (FVC) of <80% had an increased risk of death versus patients with FVC ≥80% (HR 1.72, 1.05-2.83). Furthermore, obese patients with ILD had an elevated risk of death (HR 2.27, 1.39-3.71). CONCLUSIONS: Patients with ILD are at increased risk of death from COVID-19, particularly those with poor lung function and obesity. Stringent precautions should be taken to avoid COVID-19 in patients with ILD. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Kumar K, Mak V, Groom K, et al., 2020, Respiratory specialists working in different ways: development of a GP hotline and respiratory support service during the COVID-19 pandemic, Future Healthcare Journal, Vol: 7, Pages: e88-e92, ISSN: 2055-3323
Integration of primary and secondary care for the management of respiratory disease is a long-held ambition. Here, we describe how respiratory specialists at a large NHS trust, working with primary care clinicians in the area, set up a GP hotline and respiratory support service in response to the COVID-19 pandemic, with the aim of enhancing delivery of care to patients in this unprecedented time. Working across traditional organisational boundaries in this way confers benefits to patients and clinicians, illustrating the value of new, integrated models of care.
Kumar K, Groom K, Owles H, et al., 2020, Linking advice line queries to education during the COVID-19 pandemic: learning together, PCRS Respiratory Conference
Thickett D, Voorham J, Ryan R, et al., 2020, Historical database cohort study addressing the clinical patterns prior to idiopathic pulmonary fibrosis (IPF) diagnosis in UK primary care, BMJ Open, Vol: 10, Pages: 1-10, ISSN: 2044-6055
Objective To explore the clinical pathways, including signs and symptoms, and symptom progression patterns preceding idiopathic pulmonary fibrosis (IPF) diagnosis.Design and setting A historical cohort study was conducted using primary care patient records from the Optimum Patient Care Research Database.Participants Patients included were at least 30 years, had IPF diagnosis, identified via clinical-coding and free-text records and had a consultation with a chest specialist prior to IPF diagnosis.Outcome measures The signs and symptoms in the year prior to IPF diagnosis from clinical codes and free-text in primary care electronic records included: cough, dyspnoea, dry cough, weight loss, fatigue/malaise, loss of appetite, crackles and clubbed fingers. The time course of presentations of clinical features and investigations in the years prior to IPF diagnosis were mapped.Results Within 462 patients identified, the majority (77.9%) had a respiratory consultation within 365 days prior to the chest specialist visit preceding the IPF diagnosis recorded in their primary care records. The most common symptoms recorded in the 1 year prior to IPF diagnosis were dyspnoea (48.7%) and cough (40.9%); other signs and symptoms were rarely recorded (<5%). The majority of patients with cough (58.0%) and dyspnoea (55.0%) in the 1 year before IPF diagnosis had multiple recordings of the respective symptoms. Both cough and dyspnoea were recorded in 23.4% of patients in the year prior to diagnosis. Consultation rates for cough, dyspnoea and both, but not other signs or symptoms, began to increase 4 to 5 years prior diagnosis, with the sharpest increase in the last year. Cough and dyspnoea were often preceded by a reduction in measured weight over 5 years leading to IPF diagnosis.Conclusion Prolonged cough and/or progressive dyspnoea, especially if accompanied with weight loss, should signal for a referral to specialist assessment at the earliest opportunity.
Sethi R, Gawecki F, Mohamed M, et al., 2019, THE VETERANS SPECIFIC ACTIVITY QUESTIONNAIRE AS A PATIENT REPORTED OUTCOME MEASURE IN PULMONARY VASCULITIS AND INTERSTITIAL LUNG DISEASE, Winter Meeting of the British-Thoracic-Society, Publisher: BMJ PUBLISHING GROUP, Pages: A89-A89, ISSN: 0040-6376
Thillai M, Chang W, Chaudhuri N, et al., 2019, Sarcoidosis in the UK: Insights from British Thoracic Society registry data, BMJ Open Respiratory Research, Vol: 6, ISSN: 2052-4439
Introduction The British Thoracic Society Sarcoidosis Registry allows physicians to record clinical data after gaining written consent from patients. The registry’s aim is to phenotype sarcoidosis in the UK.Methods Between February 2013 and July 2017, demographic details for 308 patients (with complete clinical data for 205 patients) presenting to 24 UK hospitals were recorded. This data was analysed to detail methods of presentation, diagnosis and management.Results Fatigue was a significant complaint, affecting 30% of all patients. The most prevalent CT findings were nodules (in 77% of cases) with traction bronchiectasis (11%), distortion (9%) and ground glass (5%) less prominent. Of 205 patients with complete clinical data, only 64% had a diagnostic tissue biopsy. 35% of all patients underwent endobronchial ultrasound-guided transbronchial needle aspirate (EBUS-TBNA) with 15% having a transbronchial biopsy. Use of EBUS-TBNA showed an overall increase over time, from 28% of all patients in 2013 to 43% in 2016. The most common steroid sparing treatment was methotrexate, but 42% of patients were not initiated on any pharmacological treatment at the time of inclusion.Discussion Fatigue was common and has shown association with poor quality of life. We therefore suggest using a fatigue questionnaire as part of all new patient assessments. It may be that EBUS-TBNA should be reserved for cases of stage I or II disease where there is a reported higher yield than using transbronchial biopsy alone. Bronchoalveolar lavage was not widely used in our data, but it is generally a safe and useful adjunct and should be used more widely.
Thickett D, Voorham J, Ryan R, et al., 2018, Frequency of cough versus dyspnoea as the first recorded symptom of idiopathic pulmonary fibrosis, 28th International Congress of the European-Respiratory-Society (ERS), Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Farah Z, Beasley VE, Berry M, et al., 2018, Two cases of culture proven Mycobacterium tuberculosis presenting with a broad-complex tachycardia and non-caseating granulomas., Respiratory Medicine Case Reports, Vol: 12, Pages: 41-43, ISSN: 2213-0071
Tuberculosis is a leading cause of death worldwide. It affects pulmonary and extra-pulmonary sites with a multitude of differing presentations. In this report, we describe two cases in which TB causes myopericarditis and presents with a broad-complex tachycardia that did not respond typically to standard anti-arrhythmic therapy; a very rare presentation with limited description in the literature. Both patients required extensive investigation culminating in identifying lymph nodes amenable to biopsy under endobronchial ultrasound guidance. It was not until both patients received anti-tuberculous chemotherapy alongside anti-arrhythmic management that any improvement to their condition was witnessed. Therefore, we recommend that the clinician should have a high index of suspicion for TB in any patient presenting with a broad-complex tachycardia that is not responding to standard first line management, especially if the patient is from a high risk background. We recommend an active diagnostic pursuit, and lymph node biopsy under endobronchial ultrasound guidance.
Coker RK, Ind PW, 2016, New therapies in IPF: The Hammersmith Hospital experience, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Spiteri M, Chang W, Chaudhuri N, et al., 2016, First Insights from the BTS Idiopathic Pulmonary Fibrosis (IPF) registry, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Coker RK, Chang W, Chaudhuri N, et al., 2016, Sarcoidosis in the UK: Insights from the BTS interstitial lung disease registry, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Adams G, Brown A, Burnside A, et al., 2015, An undiagnosed stupor in the acute medical unit: a case of malignant catatonia, QJM-AN INTERNATIONAL JOURNAL OF MEDICINE, Vol: 108, Pages: 335-336, ISSN: 1460-2725
Shrikrishna D, Howard L, Coker RK, 2013, Authors' response to: How should we best determine the need for in-flight oxygen in patients with pulmonary arterial hypertension, THORAX, Vol: 68, Pages: 680-681, ISSN: 0040-6376
Josephs LK, Coker RK, Thomas M, 2013, Managing patients with stable respiratory disease planning air travel: a primary care summary of the British Thoracic Society recommendations, PRIMARY CARE RESPIRATORY JOURNAL, Vol: 22, Pages: 234-238, ISSN: 1471-4418
Ahmedzai S, Balfour-Lynn IM, Bewick T, et al., 2011, Managing passengers with stable respiratory disease planning air travel: British Thoracic Society recommendations, THORAX, Vol: 66, Pages: 1-30, ISSN: 0040-6376
Shrikrishna D, Coker RK, 2011, Managing passengers with stable respiratory disease planning air travel: British Thoracic Society recommendations, THORAX, Vol: 66, Pages: 831-833, ISSN: 0040-6376
Coker RK, Wang C, Sepahzad A, et al., 2010, CHARACTERISING SARCOIDOSIS USING A WEB-BASED REGISTRY: A PILOT STUDY, British-Thoracic-Society-Winter-Meeting 2010, Publisher: B M J PUBLISHING GROUP, Pages: A26-A27, ISSN: 0040-6376
Coker RK, 2009, Management strategies for pulmonary sarcoidosis., Ther Clin Risk Manag, Vol: 5, Pages: 575-584, ISSN: 1176-6336
SARCOIDOSIS IS A SYSTEMIC INFLAMMATORY CONDITION WITH AN UNEXPLAINED PREDILECTION FOR THE LUNG: over 90% of patients have radiographic or physiological abnormalities. Respiratory physicians therefore often manage patients, but any organ may be involved, with noncaseating granulomas the characteristic feature. Sarcoidosis is the commonest interstitial lung disease (ILD), differing from most other ILDs in that many patients remain asymptomatic or improve spontaneously. Careful baseline assessment of disease distribution and severity is thus central to initial management. Subsequently, the unpredictable clinical course necessitates regular monitoring. Sarcoidosis occurs worldwide, with a high prevalence in Afro-Caribbeans and those of Swedish or Danish origin. African Americans also tend to have severe disease. Oral corticosteroids have been used since the 1950s, with evidence of short to medium response; more recent studies have examined the role of inhaled steroids. Long-term benefits of steroids remain uncertain. International guidelines published in 1999 represent a consensus view endorsed by North American and European respiratory societies. Updated British guidelines on interstitial lung disease, including sarcoidosis, were published in 2008. This review describes current management strategies for pulmonary disease, including oral and inhaled steroids, commonly used alternative immunosuppressant agents, and lung transplantation. Tumor necrosis factor alpha inhibitors are briefly discussed.
Coker RK, Shiner R, Partridge MR, 2008, Is air travel safe for those with lung disease?, EUROPEAN RESPIRATORY JOURNAL, Vol: 32, Pages: 1423-1424, ISSN: 0903-1936
Coker RK, Shiner RJ, Partridge MR, 2007, Is air travel safe for those with lung disease?, EUROPEAN RESPIRATORY JOURNAL, Vol: 30, Pages: 1057-1063, ISSN: 0903-1936
Macedo P, Coker RK, Partridge MR, 2007, Is there a uniform approach to the management of diffuse parenchymal lung disease (DPLD) in the UK? A national benchmarking exercise., BMC Pulm Med, Vol: 7
BACKGROUND: Benchmarking is the comparison of a process to the work or results of others. We conducted a national benchmarking exercise to determine how UK pulmonologists manage common clinical scenarios in diffuse parenchymal lung disease (DPLD), and to determine current use and availability of investigative resources. We compared management decisions to existing international guidelines. METHODS: Consultant members of the British Thoracic Society were mailed a questionnaire seeking their views on the management of three common scenarios in DPLD. They were asked to choose from various management options for each case. Information was also obtained from the respondents on time served as a consultant, type of institution in which they worked and the availability of a local radiologist and histopathologist with an interest/expertise in thoracic medicine. RESULTS: 370 out of 689 consultants replied (54% response rate). There were many differences in the approach to the management of all three cases. Given a scenario of relapsing pulmonary sarcoidosis in a lady with multiple co-morbidities, half of respondents would institute treatment with a variety of immunosuppressants while a half would simply observe. 42% would refer a 57-year old lady with new onset DPLD for a surgical lung biopsy, while a similar number would not. 80% would have referred her for transplantation, but a fifth would not. 50% of consultants from district general hospitals would have opted for a surgical biopsy compared to 24% from cardiothoracic centres: this may reflect greater availability of a radiologist with special interest in thoracic imaging in cardiothoracic centres, obviating the need for tissue diagnosis. Faced with an elderly male with high resolution CT thorax (HRCT) evidence of usual interstitial pneumonia (UIP), three quarters would observe, while a quarter would start immunosuppressants. 11% would refer for a surgical biopsy. 14% of UK pulmonologists responding to the survey revealed
Coker RK, 2007, Guidelines for the use of corticosteroids in the treatment of pulmonary sarcoidosis, DRUGS, Vol: 67, Pages: 1139-1147, ISSN: 0012-6667
Coker RK, 2006, Diffuse parenchymal (interstitial) lung disease, Understanding Respiratory Medicine-a problem-orientated appproach, Editors: Partridge, London, Publisher: Manson Publishing, Pages: 77-90, ISBN: 9781840760453
Coker RK, Shovlin CL, 2006, The signs of lung disease: the respiratory examination, Understanding Respiratory Medicine-a problem-orientated approach, Editors: Partridge, London, Publisher: Manson Publishing, Pages: 18-23, ISBN: 9781840760453
Coker RK, Kiani-Alikhan S, Stewart A, et al., 2006, Changes in plasma TGF beta 1 during pelvic radiotherapy for gynaecological malignancy, Acta Oncol, Vol: 45, Pages: 753-754
Coker RK, Shiner R, Partridge MR, 2005, Update on BTS/BLF UK Flight Outcomes Study, Winter Meeting of the British-Thoracic-Society, Publisher: B M J PUBLISHING GROUP, Pages: II10-II11, ISSN: 0040-6376
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