An enormous amount of data are generated through routine NHS encounters. Some of this routinely collected heathcare data is de-identified and can be made available for research purposes. The Respiratory EHR group, led by Professor Jennifer Quint, has developed core expertise in the use of various sources of these types of data, including data collated by the Clinical Practice Research Datalink (CPRD) as well as NHS Digital to support research into the UK’s most common respiratory diseases, such as asthma and COPD.
The Respiratory EHR group brings together people from different backgrounds including clinical medicine, epidemiology and medical statistics, mathematics and computer science, nursing, and the core biological sciences. The result is a multidisciplinary team that has both depth and breadth and the team work on a broad spectrum of projects, spanning basic epidemiology, disease aetiology, safety and effectiveness of medications, investigation of patient pathways, risk factor analysis and prediction modelling, as well as qualitative research on patient–healthcare practitioner interactions and risk communication. Underpinning all of this work is a robust understanding of the strengths and limitations of using routinely-collected health data for research purposes, and in particular, of diagnostic coding practices in clinical settings and how these might then affect research outcomes.
Examples of recent and current projects can be found below:
Understanding who is at risk of an exacerbation event, defining frequent exacerbators and investigating how exacerbations are associated with future exacerbations and morbidity as well as understanding how respiratory infections prior to a diagnosis of COPD might be related to future COPD outcomes.
- Rothnie KJ, Müllerová H, Hurst JR, Smeeth L, Davis K, Thomas SL, et al. (2016) Validation of the Recording of Acute Exacerbations of COPD in UK Primary Care Electronic Healthcare Records. PLoS ONE 11(3): e0151357. https://doi.org/10.1371/journal.pone.0151357
- Rothnie KJ, Müllerová H, Smeeth L, Quint JK. Natural History of Chronic Obstructive Pulmonary Disease Exacerbations in a General Practice-based Population with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2018 Aug 15;198(4):464-471. doi: 10.1164/rccm.201710-2029OC. PMID: 29474094; PMCID: PMC6118021.
- Whittaker H, Nordon C, Rubino A, et al Frequency and severity of respiratory infections prior to COPD diagnosis and risk of subsequent postdiagnosis COPD exacerbations and mortality: EXACOS-UK health care data study Thorax Published Online First: 31 October 2022. doi: 10.1136/thorax-2022-219039
- Whittaker H, Rubino A, Müllerová H, Morris T, Varghese P, Xu Y, De Nigris E, Quint JK. Frequency and Severity of Exacerbations of COPD Associated with Future Risk of Exacerbations and Mortality: A UK Routine Health Care Data Study. Int J Chron Obstruct Pulmon Dis. 2022 Mar 3;17:427-437. doi: 10.2147/COPD.S346591. PMID: 35264849; PMCID: PMC8901192.
Investigating changes in mortality in people with COPD over time, including understanding what patients with COPD are dying of and specifically which subgroups of COPD patients are more likely to die of what causes than other groups of COPD patients to enable targeted interventions.
- Whittaker HR, Pimenta JM, Jarvis D, Kiddle SJ, Quint JK. Characteristics Associated with Accelerated Lung Function Decline in a Primary Care Population with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis. 2020 Nov 25;15:3079-3091. doi: 10.2147/COPD.S278981. PMID: 33268984; PMCID: PMC7701160.
- Gayle AV, Axson EL, Bloom CI, et al Changing causes of death for patients with chronic respiratory disease in England, 2005-2015 Thorax 2019;74:483-491.
- Lenoir A, Whittaker H, Gayle A, et al Mortality in non-exacerbating COPD: a longitudinal analysis of UK primary care data Thorax Published Online First: 24 November 2022. doi: 10.1136/thorax-2022-218724
Emulating randomised control trials to investigate whether similar effects can be seen in a more generalisable population of COPD, rather than the specific populations of COPD patients included in randomised control trials. Our studies have included investigating the association between inhaled corticosteroid use and risk of COPD related outcomes such as lung function decline.
- Whittaker HR, Müllerova H, Jarvis D, Barnes NC, Jones PW, Compton CH, Kiddle SJ, Quint JK. Inhaled corticosteroids, blood eosinophils, and FEV1 decline in patients with COPD in a large UK primary health care setting. Int J Chron Obstruct Pulmon Dis. 2019 May 23;14:1063-1073. doi: 10.2147/COPD.S200919. PMID: 31213788; PMCID: PMC6536812.
- Whittaker HR, Wing K, Douglas I, Kiddle SJ, Quint JK. Inhaled Corticosteroid Withdrawal and Change in Lung Function in Primary Care Patients with Chronic Obstructive Pulmonary Disease in England. Ann Am Thorac Soc. 2022 Nov;19(11):1834-1841. doi: 10.1513/AnnalsATS.202111-1238OC. PMID: 35767034.
Understanding the relationship between cardiovascular disease and COPD
- Whittaker HR, Bloom C, Morgan A, et al. Accelerated FEV1 decline and risk of cardiovascular disease and mortality in a primary care population of COPD patients. Eur Respir J 2020; in press (https://doi.org/10.1183/13993003.00918-2020).
- Axson EL, Bottle A, Cowie MR, et al Relationship between heart failure and the risk of acute exacerbation of COPD Thorax 2021;76:807-814.
- Axson EL, Sundaram V, Bloom CI, Bottle A, Cowie MR, Quint JK. Temporal Trends in the Incidence of Heart Failure among Patients with Chronic Obstructive Pulmonary Disease and Its Association with Mortality. Ann Am Thorac Soc. 2020 Aug;17(8):939-948. doi: 10.1513/AnnalsATS.201911-820OC. PMID: 32275836.
- Gulea C, Zakeri R, Quint JK. Differences in Outcomes between Heart Failure Phenotypes in Patients with Coexistent Chronic Obstructive Pulmonary Disease: A Cohort Study. Ann Am Thorac Soc. 2022 Jun;19(6):971-980. doi: 10.1513/AnnalsATS.202107-823OC. PMID: 34905461.
Use of hospital audit data to assess the effectiveness of the Best Practice Tariff (a pay-for-performance incentive) in improving outcomes for patients hospitalised with AECOPD.
Stone PW, Adamson A, Hurst JR, et al Does pay-for-performance improve patient outcomes in acute exacerbation of COPD admissions? Thorax 2022;77:239-246.
Determining rates of new symptoms, diseases, prescriptions, and healthcare use, recorded in primary care, after acute covid-19 infection among patients admitted to hospital and those patients managed in the community.
- Whittaker H R, Gulea C, Koteci A, Kallis C, Morgan A D, Iwundu C et al. GP consultation rates for sequelae after acute covid-19 in patients managed in the community or hospital in the UK: population based study BMJ 2021; 375 :e065834 doi:10.1136/bmj-2021-065834
Understanding severity of asthma and COVID-19 outcomes
- Dolby T, Nafilyan V, Morgan A, et al Relationship between asthma and severe COVID-19: a national cohort study Thorax 2023;78:120-127.
Exploring whether specific groups of people with underlying chronic respiratory diseases have a greater risk of post-COVID-19 sequelae, particularly cardiovascular disease and VTE events, compared with others
Investigating prescribing patterns of inhalers in people with asthma and how these relate to outcomes such as exacerbations, mortality and healthcare utilisation.
- Nissen F, Quint JK, Wilkinson S, Mullerova H, Smeeth L, Douglas IJ. Validation of asthma recording in electronic health records: a systematic review. Clin Epidemiol. 2017 Dec 1;9:643-656. doi: 10.2147/CLEP.S143718. PMID: 29238227; PMCID: PMC5716672.
- Tran TN, King E, Sarkar R, Nan C, Rubino A, O'Leary C, Muzwidzwa R, Belton L, Quint JK. Oral corticosteroid prescription patterns for asthma in France, Germany, Italy and the UK. Eur Respir J. 2020 Jun 4;55(6):1902363. doi: 10.1183/13993003.02363-2019. PMID: 32165402; PMCID: PMC7270349.
- Bloom CI, Nissen F, Douglas IJ, et al Exacerbation risk and characterisation of the UK’s asthma population from infants to old age Thorax 2018;73:313-320.
Understanding asthma referrals in the UK
- Bloom CI, Walker S, Quint JK. Inadequate specialist care referrals for high-risk asthma patients in the UK: an adult population-based cohort 2006-2017. J Asthma. 2021 Jan;58(1):19-25. doi: 10.1080/02770903.2019.1672723. Epub 2019 Oct 9. PMID: 31550948.
- Nissen F, Morales DR, Mullerova H, et al Validation of asthma recording in the Clinical Practice Research Datalink (CPRD) BMJ Open 2017;7:e017474. doi: 10.1136/bmjopen-2017-017474
- Nissen F, Douglas IJ, Müllerová H, Pearce N, Bloom CI, Smeeth L, Quint JK. Clinical profile of predefined asthma phenotypes in a large cohort of UK primary care patients (Clinical Practice Research Datalink). J Asthma Allergy. 2019 Jan 8;12:7-19. doi: 10.2147/JAA.S182013. PMID: 30662273; PMCID: PMC6329349.
Predicting asthma attacks
Interstitial lung disease (ILD)
Recording of ILD in primary care databases:
We have carried out detailed investigations of how diagnoses of various ILDs, in particular idiopathic pulmonary fibrosis (IPF), are recorded in primary care datasets.
Treatment of comorbidities and potential of risk of adverse respiratory outcomes:
Koteci, A., Morgan, A.D., Portas, L. et al. Left-sided heart failure burden and mortality in idiopathic pulmonary fibrosis: a population-based study. BMC Pulm Med 22, 190 (2022). https://doi.org/10.1186/s12890-022-01973-5