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Journal articleWhittaker H, Van Ganse E, Dalon F, et al., 2022,
Differences in severe exacerbations rates and health care utilisation in COPD populations in the UK and France
, BMJ Open, Vol: 9, ISSN: 2044-6055IntroductionChronic obstructive pulmonary disease (COPD) is a leading cause of mortality in Europe; however, it is important to understand how clinical practice patterns differ between countries and how this might relate to disease outcomes, to identify ways of improving local disease management. We aimed to describe and compare the management of COPD patients in the UK and France between 2008 and 2017. MethodsWe used data from the Clinical Practice Research Datalink GOLD and Hospital Episode Statistics in the UK and the Echantillon Généraliste des Bénéficiaire in France to identify COPD patients each year between 2008 and 2017. We compared patient characteristics, all-cause mortality, and COPD exacerbations each year between 2008 and 2017 for patients in the UK and France separately. Health care utilisation and COPD exacerbations in 2017 were compared between France and the UK using t-tests and chi-squared tests. ResultsCOPD patients were similar in gender and comorbidities in both countries. In the UK, incidence of COPD exacerbations remained stable in the UK and France between 2007-2017. In 2017, the proportion of all-cause and COPD-related hospitalisations was greater in the UK than in France (43.9% vs. 32.8% and 8.3% vs 4.9%, respectively; p<0.001) as was the proportion of patients visiting accident and emergency (39.8% vs 16.2%, respectively; p<0.001). In addition, the mean length of stay in hospital for COPD related causes was shorted in the UK than in France (6.2 days (SD 8.4) vs 10.5 days (SD 9.1), respectively; p<0.001). DiscussionOverall, UK patients were more likely to go to accident and emergency (A&E) and be hospitalised for COPD-related causes and stay in hospital for fewer days after being admitted for COPD-related reasons compared to patients in France, illustrating a difference in health-seeking behaviours and access to healthcare.
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Journal articleThygesen JH, Tomlinson C, Hollings S, et al., 2022,
COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records
, LANCET DIGITAL HEALTH, Vol: 4, Pages: E542-E557- Author Web Link
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- Citations: 17
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Journal articleGulea C, Zakeri R, Kallis C, et al., 2022,
Impact of COPD and asthma on in-hospital mortality and management of patients with heart failure in England and Wales: an observational analysis
, BMJ Open, Vol: 12, ISSN: 2044-6055Objective: To evaluate the association between having concomitant COPD or asthma, and in-patient mortality and post-discharge management among patients hospitalised for acute HF.Setting: Data were obtained from patients enrolled in the National Heart Failure Audit.Participants: 217,329 patients hospitalised for HF in England-Wales between March 2012 and 2018.Outcomes: In-hospital mortality, referrals to cardiology follow-up and prescriptions for HF medications were compared between patients with comorbid COPD (COPD-HF) or asthma (asthma-HF) versus HF-alone using mixed-effects logistic regression. Results: Patients with COPD-HF were more likely to die during hospitalisation, and those with asthma-HF had a reduced likelihood of death, compared with patients who had HF-alone ([adjusted]ORadj, 95% CI: 1.10, 1.06-1.14 and ORadj, 95%CI: 0.85, 0.79-0.88). In patients who survived to discharge, referral to HF follow-up services differed between groups: COPD-HF patients had reduced odds of cardiology follow-up (ORadj, 95%CI 0.79, 0.77-0.81), whilst cardiology referral odds for asthma-HF were similar to HF-alone. Overall, proportions of HF medication prescriptions at discharge were low for both COPD-HF and asthma-HF groups, particularly prescriptions for beta-blockers. Conclusions: In this nationwide analysis, we showed that COPD and asthma significantly impact the clinical course in patients hospitalised for HF. COPD is associated with higher in-patient mortality and lower cardiology referral odds, whilst COPD and asthma are both associated with lower use of prognostic HF therapies on discharge. These data highlight therapeutic gaps and a need for better integration of cardiopulmonary services to improve healthcare provision for patients with HF and coexisting respiratory disease.
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Journal articleKoteci A, Morgan A, Portas L, et al., 2022,
Left-sided heart failure burden and mortality in idiopathic pulmonary fibrosis: a population-based study
, BMC Pulmonary Medicine, Vol: 22, Pages: 1-11, ISSN: 1471-2466BackgroundCardiovascular disease is prevalent in idiopathic pulmonary fibrosis (IPF), yet the extent of left-sided heart failure (HF) burden, whether this has changed with time and whether HF impacts mortality risk in these patients are unknown. The aims of this study were therefore to determine the temporal trends in incidence and prevalence of left-sided HF in patients with IPF in England and compare these to published estimates in the general population and those with comparable chronic respiratory conditions such as chronic obstructive pulmonary disease (COPD), as well as determine the risk of all-cause and cause-specific mortality in patients with comorbid left-sided HF and IPF at population-level using electronic healthcare data.MethodsClinical Practice Research Datalink (CPRD) Aurum primary-care data linked to mortality and secondary-care data was used to identify IPF patients in England. Left-sided HF prevalence and incidence rates were calculated for each calendar year between 2010 and 2019, stratified by age and sex. Risk of all-cause, cardiovascular and IPF-specific mortality was calculated using multivariate Cox regression.ResultsFrom 40,577patients with an IPF code in CPRD Aurum, 25, 341 IPF patients met inclusion criteria. Left-sided HF prevalence decreased from 33.4% (95% CI 32.2–34.6) in 2010 to 20.9% (20.0–21.7) in 2019. Left-sided HF incidence rate per 100 person-years (95% CI) remained stable between 2010 and 2017 but decreased from 4.3 (3.9–4.8) in 2017 to 3.4 (3.0–3.9) in 2019. Throughout follow-up, prevalence and incidence were higher in men and with increasing age. Comorbid HF was associated with poorer survival (adjusted HR (95%CI) 1.08 (1.03–1.14) for all-cause mortality; 1.32 (1.09–1.59) for cardiovascular mortality).ConclusionLeft-sided HF burden in IPF patients in England remains high, with incidence almost 4 times higher than in COPD, a comparable lung disease with similar cardiovascular risk factors.
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Conference paperKallis C, Morgan AD, Maslova E, et al., 2022,
Sabina Jr UK: The Association Between Saba (Short-Acting Beta Agonist) Prescriptions and Frequency of Asthma Exacerbations in a Paediatric Cohort
, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X -
Journal articleWood JL, Kallis C, Coid JW, 2022,
Gang Members, Gang Affiliates, and Violent Men: Perpetration of Social Harms, Violence-Related Beliefs, Victim Types, and Locations
, JOURNAL OF INTERPERSONAL VIOLENCE, Vol: 37, Pages: NP3703-NP3727, ISSN: 0886-2605- Author Web Link
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- Citations: 1
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Journal articleWhittaker H, Rubino A, Mullerova H, et al., 2022,
Frequency and severity of exacerbations of COPD associated with future Risk of exacerbations and mortality: A UK routine health care data study
, The International Journal of Chronic Obstructive Pulmonary Disease, Vol: 17, Pages: 427-437, ISSN: 1176-9106Background: Studies have shown that chronic obstructive pulmonary disease (COPD) exacerbation events are related to future events; however, previous literature typically reports frequent vs infrequent exacerbations per patient-year and no studies have investigated increasing number of severe exacerbations in relation to COPD outcomes.Objective: To investigate the association between baseline frequency and severity of exacerbations and subsequent mortality and exacerbation risk in a COPD cohort.Methods: Clinical Practice Research Datalink (CPRD) Aurum and Hospital Episode Statistics data were used to identify patients registered at general practices in the UK, who had a diagnosis of COPD, were over the age of 40 years, were smokers or ex-smokers and had data recorded from 2004 onwards. Frequency and severity of exacerbations in the baseline year were identified as moderate exacerbations (general practice events) and severe exacerbations (hospitalised events). Patients were categorised as having: none, 1 moderate only, 2 moderate only, 3+ moderate only, 1 severe (and any moderate), 2 severe (and any moderate), and 3+ severe (and any moderate exacerbations). Poisson regression was used to investigate the association between baseline exacerbation frequency/severity and exacerbation events and mortality over follow-up.Results: Overall, 340,515 COPD patients were included. Patients had higher rates of future exacerbations with increasing frequency and severity of baseline exacerbations compared to no baseline exacerbations. Adjusted incidence rate ratios (IRR) for patients with 1, 2, and 3+ moderate exacerbations compared to 0 exacerbations were 1.70 (95% CI 1.66– 1.74), 2.31 (95% CI 2.24– 2.37), and 3.52 (95% CI 3.43– 3.62), respectively. Patients with increased frequency of baseline exacerbations were more likely to die from all-cause, COPD-related, and cardiovascular-related mortality in a graduated fashion.Conclusion: Increasing number and severity o
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Journal articleCookson W, Moffatt M, Rapeport G, et al., 2022,
A pandemic lesson for global lung diseases: exacerbations are preventable.
, American Journal of Respiratory and Critical Care Medicine, Vol: 205, Pages: 1271-1280, ISSN: 1073-449XA dramatic global reduction in the incidence of common seasonal respiratory viral infections has resulted from measures to limit the transmission of SARS2-Cov-19 during the pandemic . This has been accompanied by falls reaching 50% internationally in the incidence of acute exacerbations of pre-existing chronic respiratory diseases that include asthma, Chronic Obstructive Pulmonary Disease (COPD) and Cystic Fibrosis (CF). At the same time, the incidence of acute bacterial pneumonia and sepsis has fallen steeply world-wide. Such findings demonstrate the profound impact of common respiratory viruses on the course of these global illnesses. Reduced transmission of common respiratory bacterial pathogens and their interactions with viruses appear also as central factors. This review summarises pandemic changes in exacerbation rates of asthma, COPD, Cystic Fibrosis (CF) and pneumonia. We draw attention to the substantial body of knowledge about respiratory virus infections in these conditions, and that it has not yet translated into clinical practice. Now the large-scale of benefits that could be gained by managing these pathogens is unmistakable, we suggest the field merits substantial academic and industrial investment. We consider how pandemic-inspired measures for prevention and treatment of common infections should become a cornerstone for managing respiratory diseases. 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/).
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Journal articleMacRae C, Whittaker H, Mukherjee M, et al., 2022,
Deriving a standardised recommended respiratory disease codelist repository for future research
, Pragmatic and Observational Research, Vol: 13, ISSN: 1179-7266Background: Electronic health record (EHR) databases provide rich, longitudinal data on interactions with healthcare providers, and can be used to advance research into respiratory conditions. However, since these data are primarily collected to support health care delivery, clinical coding can be inconsistent, resulting in inherent challenges in using these data for research purposes.Methods: We systematically searched existing international literature and UK code repositories to find respiratory disease codelists for asthma from January 2018, and chronic obstructive pulmonary disease 1 and respiratory tract infections from January 2020, based on prior searches. Medline searches using key terms provided article lists. Full-text articles, supplementary files, and reference lists were examined for codelists, and codelists repositories were searched. A reproducible methodology for codelists creation was developed with recommended lists for each disease created based on multidisciplinary expert opinion and previously published literature. Results: Medline searches returned 1,126 asthma articles, 70 COPD articles, and 90 respiratory infection articles, with 3%, 22% and 5% including codelists, respectively. Repository searching returned 12 asthma, 23 COPD, and 64 respiratory infection codelists. We have systematically compiled respiratory disease codelists and from these derived recommended lists for use by researchers to find the most up-to-date and relevant respiratory disease codelists that can be tailored to individual research questions. Conclusions: Few published papers include codelists, and where published diverse codelists were used, even when answering similar research questions. Whilst some advances have been made. greater consistency and transparency across studies using routine data to study respiratory diseases are needed.
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Journal articleWhittaker H, Gulea C, Koteci A, et al., 2021,
GP consultation rates for post-acute COVID-19 sequelae in cases managed in the community or hospital in the UK: a population-based study
, BMJ: British Medical Journal, Vol: 375, Pages: 1-13, ISSN: 0959-535XObjectiveTo describe GP consultation rates for post-COVID-19 sequelae in non-hospitalised and hospitalised COVID-19 patients, and among non-hospitalised individuals describe how GP consultation rates for post-COVID-19 sequelae change over time, as well as following COVID-19 vaccination. DesignPopulation-based cohort study.Setting1,392 general practices in England contributing to the Clinical Practice Research Datalink Aurum database.Participants456,002 COVID-19 cases diagnosed between 1st August 2020 to 14th February2021 (44.7% male; median age 61 years), either hospitalised within two weeks of diagnosis or not hospitalised and followed-up for a maximum of 9.2 months. A negative control group of individuals without COVID-19 (N=38,511) and patients with influenza before the pandemic (N=21,803) were used to contextualise findings.Main outcome measuresComparison of GP consultation rates for new symptoms, diseases, prescriptions and healthcare utilisation (HCU) in hospitalised and non-hospitalised individuals separately pre and post-COVID-19 infection using Cox regression and negative binomial regression for HCU. This was repeated for the negative control and influenza cohorts. In non-hospitalised individuals, outcomes were additionally described over time following COVID-19 diagnosis and compared pre and post-COVID-19 vaccine in individuals who were symptomatic post-COVID-19, using negative binomial regression. Results Relative to the negative control and influenza cohorts non-hospitalised patients (N=437,943) had significantly higher GP consultation rates for multiple sequelae, the most common being loss of smell/taste (HRadj 5.28 [95%CI 3.89 to 7.17]; p<0.001), venous thromboembolism (VTE) (3.35 [2.87 to 3.90]; p<0.001), lung fibrosis (2.41 [1.37 to 4.25]; p=0.002), and muscle pain (1.89 [1.6 3to 2.20]; p<0.001), as well as HCU post COVID-19 diagnosis compared with 1-year prior. In terms of absolute proportions, the most common outcomes ≥ 4-weeks post-CO
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