Publications
297 results found
Brighton LJ, Tunnard I, Farquhar M, et al., 2019, Recommendations for services for people living with chronic breathlessness in advanced disease: Results of a transparent expert consultation, Chronic Respiratory Disease, Vol: 16, ISSN: 1479-9723
Chronic breathlessness is highly distressing for people with advanced disease and their informal carers, yet health services for this group remain highly heterogeneous. We aimed to generate evidence-based stakeholder-endorsed recommendations for practice, policy and research concerning services for people with advanced disease and chronic breathlessness. We used transparent expert consultation, comprising modified nominal group technique during a stakeholder workshop, and an online consensus survey. Stakeholders, representing multiple specialities and professions, and patient/carers were invited to participate. Thirty-seven participants attended the stakeholder workshop and generated 34 separate recommendations, rated by 74 online survey respondents. Seven recommendations had strong agreement and high levels of consensus. Stakeholders agreed services should be person-centred and flexible, should cut across multiple disciplines and providers and should prioritize breathlessness management in its own right. They advocated for wide geographical coverage and access to expert care, supported through skills-sharing among professionals. They also recommended recognition of informal carers and their role by clinicians and policymakers. Overall, stakeholders' recommendations reflect the need for improved access to person-centred, multi-professional care and support for carers to provide or access breathlessness management interventions. Future research should test the optimal models of care and educational strategies to meet these recommendations.
Nolan CM, Maddocks M, Maher T, et al., 2019, Single-Versus Multi-Component Physical Performance Measures and Mortality in Idiopathic Pulmonary Fibrosis, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Barker RE, Jones SE, Banya W, et al., 2019, A Video Intervention to Increase Pulmonary Rehabilitation Uptake for Patients Hospitalized with Acute Exacerbations of COPD (virtue): A Randomized Controlled Trial, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
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- Citations: 3
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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- Citations: 2
Nolan CM, Maddocks M, Maher TM, et al., 2018, Gait speed and prognosis in patients with idiopathic pulmonary fibrosis: a prospective cohort study, European Respiratory Journal, Vol: 53, Pages: 1-10, ISSN: 0903-1936
The four metre gait speed (4 MGS), a simple physical performance measure and surrogate marker of frailty, consistently predicts adverse prognosis in older adults. We hypothesised that 4 MGS could predict all-cause mortality and non-elective hospitalisation in patients with idiopathic pulmonary fibrosis (IPF).4 MGS and lung function were measured at baseline in 130 outpatients newly diagnosed with IPF. Survival status and non-elective hospital admissions were recorded over one year. We assessed the predictive value of 4 MGS (as a continuous variable and as a binary variable: slow versus preserved 4 MGS) by calculating hazard ratios (HR) using Cox proportional regression, adjusting for potential confounding variables. Receiver Operating Characteristic curves assessed discrimination between the multivariable regression models and established prognostic indices.Continuous 4 MGS and slow 4 MGS were independent predictors of all-cause mortality (4 MGS: HR 0.03 (0.01-0.31), p=0.004; slow 4 MGS: 2.63 (1.01-6.87), p=0.049) and hospitalisation (4 MGS: HR 0.02 (0.01-0.14), p<0.001; slow 4 MGS: 2.76 (1.16-6.58), p=0.02). Multivariable models incorporating 4 MGS or slow 4 MGS had better discrimination for predicting mortality than either the Gender Age Physiology index or Composite Physiologic Index.In patients with IPF, 4 MGS is an independent predictor of all-cause mortality and non-elective hospitalisation.
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, 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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- Citations: 1
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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- Citations: 3
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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- Citations: 1
Nolan CM, Delogu V, Maddocks M, et al., 2018, Validity, responsiveness and minimum clinically important difference of the incremental shuttle walk in idiopathic pulmonary fibrosis: a prospective study, International Conference of the American-Thoracic-Society (ATS), Publisher: BMJ PUBLISHING GROUP, Pages: 680-682, ISSN: 0040-6376
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- Citations: 20
Jones SE, Barker RE, Nolan CM, et al., 2018, Pulmonary rehabilitation in patients with an acute exacerbation of chronic obstructive pulmonary disease., Journal of Thoracic Disease, Vol: 10, Pages: S1390-S1399, ISSN: 2072-1439
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are one of the most common causes of emergency hospital admission and place great burden upon healthcare systems. Furthermore, AECOPD represent an important life event for patients, and are associated with significant reductions in physical activity, skeletal muscle function, exercise tolerance and health-related quality of life. Pulmonary rehabilitation, an intervention comprising supervised exercise-training and education, may counteract these negative consequences and target modifiable risk factors for hospital readmission. A recent Cochrane systematic review included 20 randomized controlled trials comparing pulmonary rehabilitation after exacerbation of COPD versus conventional care. Overall, the evidence supports moderate to large effects on health-related quality of life and exercise capacity. However, there is substantial heterogeneity across studies, and more recent studies have been more equivocal, including around hospital readmissions, particularly when rehabilitation is started in the inpatient setting. In this narrative review, we examine the rationale for pulmonary rehabilitation following AECOPD with a particular focus on skeletal muscle function, review the current evidence for pulmonary rehabilitation in the AECOPD setting, and identify areas that require future research, including the structure and nature of the intervention, improving uptake and adherence, and the role of alternative rehabilitation strategies for patients with AECOPD.
Nolan CM, Maddocks M, Canavan JL, et al., 2018, Increasing Physical Activity in Daily Life in Chronic Obstructive Pulmonary Disease: To Solve the Puzzle, Every Piece Counts Reply, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 197, Pages: 1089-1090, ISSN: 1073-449X
Patel S, Kon S, Nolan C, et al., 2018, The Epworth sleepiness scale: minimum clinically important difference in obstructive sleep apnea, American Journal of Respiratory and Critical Care Medicine, Vol: 197, Pages: 961-961, ISSN: 1073-449X
Nolan CM, Maddocks M, Canavan JL, et al., 2018, Are All Steps Created Equal? Revisiting Pedometer Use during Pulmonary Rehabilitation for Individuals Living with Chronic Obstructive Pulmonary Disease Reply, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 197, Pages: 406-+, ISSN: 1073-449X
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- Citations: 1
Wilson KC, Krishnan JA, Sliwinski P, et al., 2018, Pulmonary rehabilitation for patients with COPD during and after an exacerbation-related hospitalisation: back to the future?, European Respiratory Journal, Vol: 51, ISSN: 0903-1936
Guideline recommendation against the initiation of pulmonary rehabilitation during hospitalisation was justified.
Wilson KC, Krishnan JA, Sliwinski P, et al., 2018, Pulmonary rehabilitation for patients with COPD during and after an exacerbation-related hospitalisation: back to the future?, European Respiratory Journal, Vol: 51, ISSN: 0903-1936
Healthcare professionals should educate COPD patients and recommend rehabilitation in the peri-exacerbation period.
Jones SE, Nolan CM, Patel S, et al., 2018, The Minimum Important Difference in Pedometer Step Count in Patients with Chronic Obstructive Pulmonary Disease, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Kwan H, Maddocks M, Nolan CM, et al., 2018, Cachexia and Response to Pulmonary Rehabilitation: A Propensity Matched Analysis, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Patel S, Nolan CM, Jones SE, et al., 2018, Responsiveness and Minimum Important Difference of Quadriceps Maximum Voluntary Contraction in Chronic Obstructive Pulmonary Disease, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Patel S, Nolan CM, Jones SE, et al., 2018, Responsiveness of the Short Physical Performance Battery to Pulmonary Rehabilitation in Patients with Chronic Respiratory Disease and Frailty, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Nolan CM, Maddocks M, Maher TM, et al., 2018, Improvement in Gait Speed with Pulmonary Rehabilitation Is Associated with Increased Survival in Idiopathic Pulmonary Fibrosis, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Barker R, Nolan CM, Jones SE, et al., 2018, Response of a Simple Functional Capacity Test to Home-Based Exercise Training in Chronic Obstructive Pulmonary Disease, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Barker R, Kon S, Jones SE, et al., 2018, Gait Speed and Mortality Following Hospitalization for Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Prospective Cohort Study, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Abdullah R, Kent-Bramer J, Renzoni EA, et al., 2018, Severity of Sleep Disordered Breathing in Patients with Idiopathic Pulmonary Fibrosis and Chronic Hypersensitivity Pneumonitis, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Jones SE, Nolan CM, Patel S, et al., 2018, Five-Repetition Sit-to-Stand Test in Idiopathic Pulmonary Fibrosis, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Nolan CM, Maddocks M, Maher TM, et al., 2018, Physical Frailty in Idiopathic Pulmonary Fibrosis, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
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- Citations: 1
Kwan H, Maddocks M, Nolan CM, et al., 2018, Cachexia, Precachexia and Mortality in Chronic Obstructive Pulmonary Disease (COPD), International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Nolan CM, Maddocks M, Maher TM, et al., 2017, Phenotypic characteristics associated with slow gait speed in idiopathic pulmonary fibrosis, Respirology, Vol: 23, Pages: 498-506, ISSN: 1323-7799
BACKGROUND AND OBJECTIVE: Usual gait speed over 4 m (4MGS) is an established functional performance measure in older adults that consistently predicts adverse health outcomes, but few data exist in idiopathic pulmonary fibrosis (IPF). We assessed the reliability of 4MGS, its relationship with established outcome measures and its responsiveness to pulmonary rehabilitation. METHODS: In four prospective IPF cohorts, 4MGS inter-observer (n = 46) and test-retest (n = 46) reliability, concurrent validity (n = 65 and n = 62) and responsiveness (n = 60) were determined. The phenotypic characteristics of all patients stratified according to slow 4MGS (<0.8 m/s) were compared, including lung function parameters, HRCT of the chest, 6-min walking distance (6MWD), Medical Respiratory Council (MRC) dyspnoea score, King's Brief Interstitial Lung Disease (KBILD) questionnaire and Gender, Age and lung Physiology (GAP) prognostic index. RESULTS: Intra-class correlation coefficients for inter-observer and test-retest reliability were 0.996 and 0.983, respectively. There was a strong association between 4MGS and 6MWD (r = 0.76; P < 0.0001) and moderate correlations with MRC (r = -0.56), KBILD (r = 0.44) and GAP index (r = -0.41); all P < 0.005. 4MGS improved significantly with pulmonary rehabilitation (mean (95% CI) change: 0.16 (0.12-0.20) m/s), effect size 0.65. Patients with slow 4MGS had significantly worse exercise performance (6MWD: -167 (-220 to -133) m), dyspnoea, health status and prognosis index than those with preserved 4MGS, despite similar lung function and HRCT parameters. CONCLUSION: 4MGS is a simple, reliable, valid and responsive tool that may detect a patient phenotype with worse exercise performance, dyspnoea, health status and prognosis index in stable IPF.
Maddocks M, Lovell N, Booth S, et al., 2017, Palliative care and management of troublesome symptoms for people with chronic obstructive pulmonary disease., Lancet, Vol: 390, Pages: 988-1002, ISSN: 0140-6736
People with advanced chronic obstructive pulmonary disease (COPD) have distressing physical and psychological symptoms, often have limited understanding of their disease, and infrequently discuss end-of-life issues in routine clinical care. These are strong indicators for expert multidisciplinary palliative care, which incorporates assessment and management of symptoms and concerns, patient and caregiver education, and sensitive communication to elicit preferences for care towards the end of life. The unpredictable course of COPD and the difficulty of predicting survival are barriers to timely referral and receipt of palliative care. Early integration of palliative care with respiratory, primary care, and rehabilitation services, with referral on the basis of the complexity of symptoms and concerns, rather than prognosis, can improve patient and caregiver outcomes. Models of integrated working in COPD could include: services triggered by troublesome symptoms such as refractory breathlessness; short-term palliative care; and, in settings with limited access to palliative care, consultation only in specific circumstances or for the most complex patients.
Mesquita R, Spina G, Pitta F, et al., 2017, Physical activity patterns and clusters in 1001 patients with COPD, Chronic Respiratory Disease, Vol: 14, Pages: 256-269, ISSN: 1479-9723
We described physical activity measures and hourly patterns in patients with chronic obstructive pulmonary disease (COPD) after stratification for generic and COPD-specific characteristics and, based on multiple physical activity measures, we identified clusters of patients. In total, 1001 patients with COPD (65% men; age, 67 years; forced expiratory volume in the first second [FEV1], 49% predicted) were studied cross-sectionally. Demographics, anthropometrics, lung function and clinical data were assessed. Daily physical activity measures and hourly patterns were analysed based on data from a multisensor armband. Principal component analysis (PCA) and cluster analysis were applied to physical activity measures to identify clusters. Age, body mass index (BMI), dyspnoea grade and ADO index (including age, dyspnoea and airflow obstruction) were associated with physical activity measures and hourly patterns. Five clusters were identified based on three PCA components, which accounted for 60% of variance of the data. Importantly, couch potatoes (i.e. the most inactive cluster) were characterised by higher BMI, lower FEV1, worse dyspnoea and higher ADO index compared to other clusters (p < 0.05 for all). Daily physical activity measures and hourly patterns are heterogeneous in COPD. Clusters of patients were identified solely based on physical activity data. These findings may be useful to develop interventions aiming to promote physical activity in COPD.
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