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Journal articlePowell AA, Ireland G, Leeson R, et al., 2023,
National and regional prevalence of SARS-CoV-2 antibodies in primary and secondary school children in England: the School Infection Survey, a national open cohort study, November 2021SARS-CoV-2 antibody prevalence in school children
, JOURNAL OF INFECTION, Vol: 86, Pages: 361-368, ISSN: 0163-4453 -
Journal articleStewart I, Molyneaux PL, Fabbri L, et al., 2023,
Residual lung abnormalities following COVID-19 hospitalization: interim analysis of the UKILD Post-COVID study
, American Journal of Respiratory and Critical Care Medicine, Vol: 207, Pages: 693-703, ISSN: 1073-449XRationale: Shared symptoms and genetic architecture between coronavirus disease (COVID-19) and lung fibrosis suggest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to progressive lung damage.Objectives: The UK Interstitial Lung Disease Consortium (UKILD) post–COVID-19 study interim analysis was planned to estimate the prevalence of residual lung abnormalities in people hospitalized with COVID-19 on the basis of risk strata.Methods: The PHOSP–COVID-19 (Post-Hospitalization COVID-19) study was used to capture routine and research follow-up within 240 days from discharge. Thoracic computed tomography linked by PHOSP–COVID-19 identifiers was scored for the percentage of residual lung abnormalities (ground-glass opacities and reticulations). Risk factors in linked computed tomography were estimated with Bayesian binomial regression, and risk strata were generated. Numbers within strata were used to estimate posthospitalization prevalence using Bayesian binomial distributions. Sensitivity analysis was restricted to participants with protocol-driven research follow-up.Measurements and Main Results: The interim cohort comprised 3,700 people. Of 209 subjects with linked computed tomography (median, 119 d; interquartile range, 83–155), 166 people (79.4%) had more than 10% involvement of residual lung abnormalities. Risk factors included abnormal chest X-ray (risk ratio [RR], 1.21; 95% credible interval [CrI], 1.05–1.40), percent predicted DlCO less than 80% (RR, 1.25; 95% CrI, 1.00–1.56), and severe admission requiring ventilation support (RR, 1.27; 95% CrI, 1.07–1.55). In the remaining 3,491 people, moderate to very high risk of residual lung abnormalities was classified at 7.8%, and posthospitalization prevalence was estimated at 8.5% (95% CrI, 7.6–9.5), rising to 11.7% (95% CrI, 10.3–13.1) in the sensitivity analysis.Conclusions: Residual lung abnormalities were estimated in up to 11% of
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Journal articleCook S, Schmedt N, Broughton J, et al., 2023,
Characterising the burden of chronic kidney disease among people with type 2 diabetes in England: a cohort study using the Clinical Practice Research Datalink
, BMJ Open, Vol: 13, Pages: 1-13, ISSN: 2044-6055Objectives To describe prevalence of chronic kidney disease (CKD), demographic and clinical characteristics, treatment patterns and rates of cardiovascular and renal complications for patients with type 2 diabetes (T2D) treated in routine clinical care.Design Repeat cross-sectional study (6 monthly cross-sections) and cohort study from 1 January 2017 to 31 December 2019.Setting Primary care data from English practices contributing to the UK Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics mortality data.Participants Patients with T2D aged >18 years, at least one year of registration data.Primary and secondary outcomes Primary outcome was prevalence of CKD defined as chronic kidney disease epidemiology collaboration (CKD-EPI) estimated glomerular filtration rate <60 mL/min/1.73 m2, and/or urinary albumin creatinine ratio ≥3 mg/mmol in the past 24 months. Secondary outcomes were prescriptions of medications of interest and clinical and demographic characteristics in the past 3 months.In the cohort study rates of renal and cardiovascular complications, all-cause mortality and hospitalisations over the study period were compared among those with and without CKD.Results There were 574 190 eligible patients with T2D as of 1 January 2017 and 664 296 as of 31 December 2019. Estimated prevalence of CKD across the study period was stable at approximately 30%. Medication use was stable over time in people with CKD and T2D, with low use of steroidal mineralocorticoid receptor antagonists (approximately 4.5% across all time points) and a low use but steady increase in use of sodium-glucose co-transporter-2 inhibitors (from 2.6% to 6.2%). Rates of all complications were higher in those with CKD at the start of the study period, with increasing rates, with increased severity of CKD, heart failure and albuminuria.Conclusions The burden of CKD in patients with T2D is high and asso
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Journal articleMorgan A, Maslova E, Kallis C, et al., 2023,
Short-acting β<sub>2</sub>-agonists and exacerbations in children with asthma in England: SABINA Junior
, ERJ OPEN RESEARCH, Vol: 9- Author Web Link
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Journal articleCalvo RA, Peters D, Moradbakhti L, et al., 2023,
Assessing the feasibility of a text-based conversational agent for asthma support: protocol for a mixed methods observational study
, JMIR Research Protocols, Vol: 12, Pages: 9-9, ISSN: 1929-0748BACKGROUND: Despite efforts, the UK death rate from asthma is the highest in Europe, and 65% of people with asthma in the United Kingdom do not receive the professional care they are entitled to. Experts have recommended the use of digital innovations to help address the issues of poor outcomes and lack of care access. An automated SMS text messaging-based conversational agent (ie, chatbot) created to provide access to asthma support in a familiar format via a mobile phone has the potential to help people with asthma across demographics and at scale. Such a chatbot could help improve the accuracy of self-assessed risk, improve asthma self-management, increase access to professional care, and ultimately reduce asthma attacks and emergencies. OBJECTIVE: The aims of this study are to determine the feasibility and usability of a text-based conversational agent that processes a patient's text responses and short sample voice recordings to calculate an estimate of their risk for an asthma exacerbation and then offers follow-up information for lowering risk and improving asthma control; assess the levels of engagement for different groups of users, particularly those who do not access professional services and those with poor asthma control; and assess the extent to which users of the chatbot perceive it as helpful for improving their understanding and self-management of their condition. METHODS: We will recruit 300 adults through four channels for broad reach: Facebook, YouGov, Asthma + Lung UK social media, and the website Healthily (a health self-management app). Participants will be screened, and those who meet inclusion criteria (adults diagnosed with asthma and who use WhatsApp) will be provided with a link to access the conversational agent through WhatsApp on their mobile phones. Participants will be sent scheduled and randomly timed messages to invite them to engage in dialogue about their asthma risk during the period of study. After a data collection period (28
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Journal articleDolby T, Nafilyan V, Morgan A, et al., 2023,
Relationship between asthma and severe COVID-19: a national cohort study
, Thorax, Vol: 78, Pages: 120-127, ISSN: 0040-6376Background: We aimed to determine whether children and adults with poorly controlled or more severe asthma have greater risk of hospitalisation and/or death from COVID-19. Methods: We used individual-level data from the Office for National Statistics Public Health Data Asset, based on the 2011 census in England, and the General Practice Extraction Service (GPES) data for pandemic planning and research linked to death registration records and Hospital Episode Statistics admission data. Adults were followed from 1 January 2020 until 30 September 2021 for hospitalisation or death from COVID-19. For children, only hospitalisation was included. Results: Our cohort comprised 35,202,533 adults and 2,996,503 children aged 12–17 years. After controlling for socio-demographic factors, pre-existing health conditions and vaccine status, the risk of death involving COVID-19 for adults with asthma prescribed low dose ICS was not significantly different from those without asthma. Adults with asthma prescribed medium and high dosage ICS had an elevated risk of COVID-19 death; hazard ratios (HRs) 1.18 [1.14–1.23] and 1.36 [1.28–1.44] respectively. A similar pattern was observed for COVID-19 hospitalisation; fully adjusted HRs 1.53 [1.50–1.56] and 1.52 [1.46–1.56] for adults with asthma prescribed medium and high dosage ICS respectively. Risk of hospitalisation was greater for children with asthma prescribed one (2.58 [1.82–3.66]) or two or more (3.80 [2.41–5.95]) courses of OCS in the year prior to the pandemic.Discussion: People with mild and/or well-controlled asthma are neither at significantly increased risk of hospitalisation with nor more likely to die from COVID-19 than adults without asthma. What is already known on this topic?It is not clear if children or adults with asthma are at greater risk of hospitalisation and/or death from COVID-19 compared with the general population.What this study addsAdults and children with poorly contr
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Journal articleZhang X, Quint JK, Whittaker H, 2023,
Inequalities in respiratory health based on sex and gender
, ERS Monograph, Vol: 2023, Pages: 40-50, ISSN: 2312-508XThere is a growing body of literature showing that sex and gender affect the incidence, susceptibility, presentation, diagnosis and severity of lung diseases. However, despite the availability of data on differences in health outcomes, current medical practice does not take sex and gender sufficiently into account in relation to disease management. In this chapter, we explore the importance of considering sex and gender relative to outcomes in chronic respiratory diseases to promote disease prevention and better management for respiratory patients.
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Journal articleRaslan AS, Quint J, Cook S, 2023,
All-cause, cardiovascular and respiratory mortality in people with Type 2 Diabetes and Chronic Obstructive Pulmonary Disease (COPD) in England: a cohort study using the Clinical Practice Research Datalink (CPRD)
, The International Journal of Chronic Obstructive Pulmonary Disease, Vol: 18, Pages: 1207-1218, ISSN: 1176-9106Background: Type 2 diabetes (T2D) and chronic obstructive pulmonary disease (COPD) are common non-communicable diseases. Both have an inflammatory nature and similar risk factors, and there is overlap and interaction between them. To date, there is a lack of research on outcomes in people that have both conditions. The aim of this study was to investigate whether the presence of COPD in people with T2D was associated with an increased risk of all-cause, respiratory-cause and cardiovascular-cause mortality.Methods: A three-year cohort study (2017– 19) was done using the Clinical Practice Research Datalink Aurum database. The study population was 121,563 people with T2D aged ≥ 40. The exposure was COPD status at baseline. Incident rates for all-cause, respiratory-cause and cardiovascular-cause mortality were calculated. Poisson models for each outcome were fitted to estimate rate ratios for COPD status adjusted for age, sex, Index of Multiple Deprivation, smoking status, body mass index, prior asthma and cardiovascular disease.Results: COPD was present in 12.1% people with T2D. People with COPD had a higher all-cause mortality rate (448.7 persons per 1000 person years) compared with people without COPD (296.6 persons per 1000 person years). People with COPD also had substantially higher respiratory mortality incidence rates and moderately raised cardiovascular mortality rates. Fully adjusted Poisson models showed that people with COPD had a 1.23 (95% CI 1.21, 1.24) times higher rate of all-cause mortality as compared with those without COPD and a 3.03 (95% CI 2.89, 3.18) times higher rate of respiratory-cause mortality. There was no evidence of an association with cardiovascular mortality after adjusting for existing cardiovascular disease.Conclusion: Co-morbid COPD in people with T2D was associated with increased mortality overall and particularly from respiratory causes. People with both COPD and T2D are a high-risk group who would benefit from particularly
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Journal articleWhittaker HR, Wing K, Douglas I, et al., 2022,
Inhaled corticosteroid withdrawal and change in lung function in primary care chronic obstructive pulmonary disease patients in England
, Annals of the American Thoracic Society, Vol: 19, Pages: 1834-1841, ISSN: 1546-3222RATIONALE: In COPD, inhaled corticosteroids (ICS) are associated with pneumonia highlighting the importance of investigating subgroups of patients who may benefit from prolonged ICS use. Despite this, the WISDOM trial found a greater decline in forced expiratory volume in 1 second (FEV1) in COPD patients who withdrew from inhaled corticosteroids (ICS) compared to patients who remained on triple therapy (TT). OBJECTIVES: We investigated the association between ICS withdrawal and rate of FEV1 decline in COPD patients using routinely collected electronic healthcare records. METHODS: Using Clinical Practice Research Datalink (CPRD) Aurum and Hospital episode statistics we included COPD patients who had been on TT for at least four months. Patients were categorised into those who withdrew from ICS and those who remained on TT during follow-up. Three cohorts were created: i) patients meeting the WISDOM trial eligibility criteria; ii) patients with COPD not restricted by the WISDOM trial eligibility criteria; and iii) patients who would have been excluded from the WISDOM trial based on their comorbidities. Mixed linear regression was used to model the association between ICS withdrawal and rate of FEV1 decline (ml/year) adjusted for baseline characteristics. RESULTS: 6,008 COPD patients met the WISDOM eligibility criteria, of which 9.0% withdrew from ICS. Mean rates of FEV1 decline -7.8 ml/year (95% CI -19.7 to +4.1) for withdrawers and -15.2 ml/year (95% CI -18.7 to -11.8) for those who remained on TT (difference p=0.264). 60,645 COPD patients were not restricted by the WISDOM eligibility criteria. Mean rate of FEV1 decline was -32.6ml/year (-33.6 to -31.5) for withdrawers and -36.4ml/year (-39.4 to -33.4) for those who remained on TT. 32,882 COPD patients were included in the last population representing those would have been excluded from the WISDOM trial due to their comorbidities. Mean rate of FEV1 decline was -29.4ml/year in withdrawers and -31.3ml/year in those who
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Journal articleStone P, Hickman K, Holmes S, et al., 2022,
Comparison of COPD primary care in England, Scotland, Wales, and Northern Ireland
, npj Primary Care Respiratory Medicine, Vol: 32, ISSN: 2055-1010Currently the National Asthma and COPD audit programme (NACAP) only undertakes audit of COPD primary care in Wales due to its near complete data coverage. We aimed to determine if the quality of COPD primary care in the other UK nations is comparable with Wales. We found that English, Scottish, and Northern Irish practices were significantly worse than Welsh practices at recording coded lung function parameters used in COPD diagnosis (ORs: 0.51 [0.43–0.59], 0.29 [0.23–0.36], 0.42 [0.31–0.58], respectively) and referring appropriate patients for pulmonary rehabilitation (ORs: 0.10 [0.09–0.11], 0.12 [0.11–0.14], 0.22 [0.19–0.25], respectively). Completing national audits of primary care in Wales only may have led to improvements in care, or at least improvements in the recording of care in Wales that are not occurring elsewhere in the UK. This highlights the potential importance of audit in improving care quality and accurate recording of that care.
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