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1. Once Daily Versus Overnight and Symptom Versus Physiological Monitoring to Detect Exacerbations of Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial

Author

Al Rajeh, Ahmed M, Aldabayan, Yousef Saad, Aldhahir, Abdulelah, Pickett, Elisha, Quaderi, Shumonta, Alqahtani, Jaber S, Mandal, Swapna, Lipman, Marc CI, and Hurst, John R

Subjects
Information technology, T58.5-58.64, Public aspects of medicine, RA1-1270
Abstract

BackgroundEarlier detection of chronic obstructive pulmonary disease (COPD) exacerbations may facilitate more rapid treatment with reduced risk of hospitalization. Changes in pulse oximetry may permit early detection of exacerbations. We hypothesized that overnight pulse oximetry would be superior to once-daily monitoring for the early detection of exacerbations. ObjectiveThis study aims to evaluate whether measuring changes in heart rate and oxygen saturation overnight is superior to once-daily monitoring of both parameters and to assess symptom changes in facilitating earlier detection of COPD exacerbations. MethodsA total of 83 patients with COPD were randomized to once-daily or overnight pulse oximetry. Both groups completed the COPD assessment test questionnaire daily. The baseline mean and SD for each pulse oximetry variable were calculated from 14 days of stable monitoring. Changes in exacerbation were expressed as Z scores from this baseline. ResultsThe mean age of the patients was 70.6 (SD 8.1) years, 52% (43/83) were female, and the mean FEV1 was 53.0% (SD 18.5%) predicted. Of the 83 patients, 27 experienced an exacerbation. Symptoms were significantly elevated above baseline from 5 days before to 12 days after treatment initiation. Day-to-day variation in pulse oximetry during the stable state was significantly less in the overnight group than in the once-daily group. There were greater relative changes at exacerbation in heart rate than oxygen saturation. An overnight composite score of change in heart rate and oxygen saturation changed significantly from 7 days before initiation of treatment for exacerbation and had a positive predictive value for exacerbation of 91.2%. However, this was not statistically better than examining changes in symptoms alone. ConclusionsOvernight pulse oximetry permits earlier detection of COPD exacerbations compared with once-daily monitoring. Monitoring physiological variables was not superior to monitoring symptoms, and the latter would be a simpler approach, except where there is a need for objective verification of exacerbations. Trial RegistrationClinicalTrials.gov NCT03003702; https://clinicaltrials.gov/ct2/show/NCT03003702

Published
2020
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3. Airway measurement by refinement of synthetic images improves mortality prediction in idiopathic pulmonary fibrosis

Author

Pakzad, Ashkan, Xu, Mou-Cheng, Cheung, Wing Keung, Vermant, Marie, Goos, Tinne, De Sadeleer, Laurens J, Verleden, Stijn E, Wuyts, Wim A, Hurst, John R, and Jacob, Joseph

Subjects
Electrical Engineering and Systems Science - Image and Video Processing, Computer Science - Computer Vision and Pattern Recognition, Physics - Medical Physics
Abstract

Several chronic lung diseases, like idiopathic pulmonary fibrosis (IPF) are characterised by abnormal dilatation of the airways. Quantification of airway features on computed tomography (CT) can help characterise disease progression. Physics based airway measurement algorithms have been developed, but have met with limited success in part due to the sheer diversity of airway morphology seen in clinical practice. Supervised learning methods are also not feasible due to the high cost of obtaining precise airway annotations. We propose synthesising airways by style transfer using perceptual losses to train our model, Airway Transfer Network (ATN). We compare our ATN model with a state-of-the-art GAN-based network (simGAN) using a) qualitative assessment; b) assessment of the ability of ATN and simGAN based CT airway metrics to predict mortality in a population of 113 patients with IPF. ATN was shown to be quicker and easier to train than simGAN. ATN-based airway measurements were also found to be consistently stronger predictors of mortality than simGAN-derived airway metrics on IPF CTs. Airway synthesis by a transformation network that refines synthetic data using perceptual losses is a realistic alternative to GAN-based methods for clinical CT analyses of idiopathic pulmonary fibrosis. Our source code can be found at https://github.com/ashkanpakzad/ATN that is compatible with the existing open-source airway analysis framework, AirQuant., Comment: 11 Pages, 4 figures. Source code available: https://github.com/ashkanpakzad/ATN. Initial submission version, to be published in MICCAI Workshop on Deep Generative Models 2022

Published
2022

4. Evaluation of automated airway morphological quantification for assessing fibrosing lung disease

Author

Pakzad, Ashkan, Cheung, Wing Keung, Quan, Kin, Mogulkoc, Nesrin, Van Moorsel, Coline H. M., Bartholmai, Brian J., Van Es, Hendrik W., Ezircan, Alper, Van Beek, Frouke, Veltkamp, Marcel, Karwoski, Ronald, Peikert, Tobias, Clay, Ryan D., Foley, Finbar, Braun, Cassandra, Savas, Recep, Sudre, Carole, Doel, Tom, Alexander, Daniel C., Wijeratne, Peter, Hawkes, David, Hu, Yipeng, Hurst, John R, and Jacob, Joseph

Subjects
Physics - Medical Physics, Computer Science - Computer Vision and Pattern Recognition
Abstract

Abnormal airway dilatation, termed traction bronchiectasis, is a typical feature of idiopathic pulmonary fibrosis (IPF). Volumetric computed tomography (CT) imaging captures the loss of normal airway tapering in IPF. We postulated that automated quantification of airway abnormalities could provide estimates of IPF disease extent and severity. We propose AirQuant, an automated computational pipeline that systematically parcellates the airway tree into its lobes and generational branches from a deep learning based airway segmentation, deriving airway structural measures from chest CT. Importantly, AirQuant prevents the occurrence of spurious airway branches by thick wave propagation and removes loops in the airway-tree by graph search, overcoming limitations of existing airway skeletonisation algorithms. Tapering between airway segments (intertapering) and airway tortuosity computed by AirQuant were compared between 14 healthy participants and 14 IPF patients. Airway intertapering was significantly reduced in IPF patients, and airway tortuosity was significantly increased when compared to healthy controls. Differences were most marked in the lower lobes, conforming to the typical distribution of IPF-related damage. AirQuant is an open-source pipeline that avoids limitations of existing airway quantification algorithms and has clinical interpretability. Automated airway measurements may have potential as novel imaging biomarkers of IPF severity and disease extent., Comment: 14 pages, 8 Figures, for associated source code, see https://github.com/ashkanpakzad/AirQuant

Published
2021

6. The challenges of deploying artificial intelligence models in a rapidly evolving pandemic

Author

Hu, Yipeng, Jacob, Joseph, Parker, Geoffrey JM, Hawkes, David J, Hurst, John R, and Stoyanov, Danail

Subjects
Computer Science - Computers and Society, Computer Science - Machine Learning
Abstract

The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2, emerged into a world being rapidly transformed by artificial intelligence (AI) based on big data, computational power and neural networks. The gaze of these networks has in recent years turned increasingly towards applications in healthcare. It was perhaps inevitable that COVID-19, a global disease propagating health and economic devastation, should capture the attention and resources of the world's computer scientists in academia and industry. The potential for AI to support the response to the pandemic has been proposed across a wide range of clinical and societal challenges, including disease forecasting, surveillance and antiviral drug discovery. This is likely to continue as the impact of the pandemic unfolds on the world's people, industries and economy but a surprising observation on the current pandemic has been the limited impact AI has had to date in the management of COVID-19. This correspondence focuses on exploring potential reasons behind the lack of successful adoption of AI models developed for COVID-19 diagnosis and prognosis, in front-line healthcare services. We highlight the moving clinical needs that models have had to address at different stages of the epidemic, and explain the importance of translating models to reflect local healthcare environments. We argue that both basic and applied research are essential to accelerate the potential of AI models, and this is particularly so during a rapidly evolving pandemic. This perspective on the response to COVID-19, may provide a glimpse into how the global scientific community should react to combat future disease outbreaks more effectively., Comment: Accepted in Nature Machine Intelligence

Published
2020
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11. Reproducibility of an airway tapering measurement in CT with application to bronchiectasis

Author

Quan, Kin, Tanno, Ryutaro, Shipley, Rebecca J., Brown, Jeremy S., Jacob, Joseph, Hurst, John R., and Hawkes, David J.

Subjects
Computer Science - Computer Vision and Pattern Recognition, Physics - Medical Physics
Abstract

Purpose: This paper proposes a pipeline to acquire a scalar tapering measurement from the carina to the most distal point of an individual airway visible on CT. We show the applicability of using tapering measurements on clinically acquired data by quantifying the reproducibility of the tapering measure. Methods: We generate a spline from the centreline of an airway to measure the area and arclength at contiguous intervals. The tapering measurement is the gradient of the linear regression between area in log space and arclength. The reproducibility of the measure was assessed by analysing different radiation doses, voxel sizes and reconstruction kernel on single timepoint and longitudinal CT scans and by evaluating the effct of airway bifurcations. Results: Using 74 airways from 10 CT scans, we show a statistical difference, p = 3.4 $\times$ 10$^{-4}$ in tapering between healthy airways (n = 35) and those affected by bronchiectasis (n = 39). The difference between the mean of the two populations was 0.011mm$^{-1}$ and the difference between the medians of the two populations was 0.006mm$^{-1}$. The tapering measurement retained a 95\% confidence interval of $\pm$0.005mm$^{-1}$ in a simulated 25 mAs scan and retained a 95% confidence of $\pm$0.005mm$^{-1}$ on simulated CTs up to 1.5 times the original voxel size. Conclusion: We have established an estimate of the precision of the tapering measurement and estimated the effect on precision of simulated voxel size and CT scan dose. We recommend that the scanner calibration be undertaken with the phantoms as described, on the specific CT scanner, radiation dose and reconstruction algorithm that is to be used in any quantitative studies. Our code is available at https://github.com/quan14/AirwayTaperingInCT, Comment: 55 pages, 18 figures, The manuscript was originally published in Journal of Medical Imaging

Published
2019
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12. Tapering Analysis of Airways with Bronchiectasis

Author

Quan, Kin, Shipley, Rebecca J., Tanno, Ryutaro, McPhillips, Graeme, Vavourakis, Vasileios, Edwards, David, Jacob, Joseph, Hurst, John R., and Hawkes, David J.

Subjects
Electrical Engineering and Systems Science - Image and Video Processing, Computer Science - Computer Vision and Pattern Recognition, Physics - Medical Physics, Quantitative Biology - Quantitative Methods
Abstract

Bronchiectasis is the permanent dilation of airways. Patients with the disease can suffer recurrent exacerbations, reducing their quality of life. The gold standard to diagnose and monitor bronchiectasis is accomplished by inspection of chest computed tomography (CT) scans. A clinician examines the broncho-arterial ratio to determine if an airway is brochiectatic. The visual analysis assumes the blood vessel diameter remains constant, although this assumption is disputed in the literature. We propose a simple measurement of tapering along the airways to diagnose and monitor bronchiectasis. To this end, we constructed a pipeline to measure the cross-sectional area along the airways at contiguous intervals, starting from the carina to the most distal point observable. Using a phantom with calibrated 3D printed structures, the precision and accuracy of our algorithm extends to the sub voxel level. The tapering measurement is robust to bifurcations along the airway and was applied to chest CT images acquired in clinical practice. The result is a statistical difference in tapering rate between airways with bronchiectasis and controls. Our code is available at https://github.com/quan14/AirwayTaperingInCT., Comment: 12 pages, 7 figures. Previously submitted for SPIE Medical Imaging, 2018, Houston, Texas, United States

Published
2019
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13. Determinants of recovery from post-COVID-19 dyspnoea: analysis of UK prospective cohorts of hospitalised COVID-19 patients and community-based controls

Author

Abel, K., Adamali, H., Adeloye, D., Adeyemi, O., Adrego, R., Aguilar Jimenez, L.A., Ahmad, S., Ahmad Haider, N., Ahmed, R., Ahwireng, N., Ainsworth, M., Al-Sheklly, B., Alamoudi, A., Ali, M., Aljaroof, M., All, A.M., Allan, L., Allen, R.J., Allerton, L., Allsop, L., Almeida, P., Altmann, D., Alvarez Corral, M., Amoils, S., Anderson, D., Antoniades, C., Arbane, G., Arias, A., Armour, C., Armstrong, L., Armstrong, N., Arnold, D., Arnold, H., Ashish, A., Ashworth, A., Ashworth, M., Aslani, S., Assefa-Kebede, H., Atkin, C., Atkin, P., Aul, R., Aung, H., Austin, L., Avram, C., Ayoub, A., Babores, M., Baggott, R., Bagshaw, J., Baguley, D., Bailey, L., Baillie, J.K., Bain, S., Bakali, M., Bakau, M., Baldry, E., Baldwin, D., Baldwin, M., Ballard, C., Banerjee, A., Bang, B., Barker, R.E., Barman, L., Barratt, S., Barrett, F., Basire, D., Basu, N., Bates, M., Bates, A., Batterham, R., Baxendale, H., Bayes, H., Beadsworth, M., Beckett, P., Beggs, M., Begum, M., Beirne, P., Bell, D., Bell, R., Bennett, K., Beranova, E., Bermperi, A., Berridge, A., Berry, C., Betts, S., Bevan, E., Bhui, K., Bingham, M., Birchall, K., Bishop, L., Bisnauthsing, K., Blaikely, J., Bloss, A., Bolger, A., Bolton, C.E., Bonnington, J., Botkai, A., Bourne, C., Bourne, M., Bramham, K., Brear, L., Breen, G., Breeze, J., Briggs, A., Bright, E., Brightling, C.E., Brill, S., Brindle, K., Broad, L., Broadley, A., Brookes, C., Broome, M., Brown, A., Brown, J., Brown, J.S., Brown, M., Brown, V., Brugha, T., Brunskill, N., Buch, M., Buckley, P., Bularga, A., Bullmore, E., Burden, L., Burdett, T., Burn, D., Burns, G., Burns, A., Busby, J., Butcher, R., Butt, A., Byrne, S., Cairns, P., Calder, P.C., Calvelo, E., Carborn, H., Card, B., Carr, C., Carr, L., Carson, G., Carter, P., Casey, A., Cassar, M., Cavanagh, J., Chablani, M., Chalder, T., Chalmers, J.D., Chambers, R.C., Chan, F., Channon, K.M., Chapman, K., Charalambou, A., Chaudhuri, N., Checkley, A., Chen, J., Cheng, Y., Chetham, L., Childs, C., Chilvers, E.R., Chinoy, H., Chiribiri, A., Chong-James, K., Choudhury, G., Choudhury, N., Chowienczyk, P., Christie, C., Chrystal, M., Clark, D., Clark, C., Clarke, J., Clohisey, S., Coakley, G., Coburn, Z., Coetzee, S., Cole, J., Coleman, C., Conneh, F., Connell, D., Connolly, B., Connor, L., Cook, A., Cooper, B., Cooper, J., Cooper, S., Copeland, D., Cosier, T., Coulding, M., Coupland, C., Cox, E., Craig, T., Crisp, P., Cristiano, D., Crooks, M.G., Cross, A., Cruz, I., Cullinan, P., Cuthbertson, D., Daines, L., Dalton, M., Daly, P., Daniels, A., Dark, P., Dasgin, J., David, A., David, C., Davies, E., Davies, F., Davies, G., Davies, G.A., Davies, K., Davies, M.J., Dawson, J., Daynes, E., De Soyza, A., Deakin, B., Deans, A., Deas, C., Deery, J., Defres, S., Dell, A., Dempsey, K., Denneny, E., Dennis, J., Dewar, A., Dharmagunawardena, R., Diar-Bakerly, N., Dickens, C., Dipper, A., Diver, S., Diwanji, S.N., Dixon, M., Djukanovic, R., Dobson, H., Dobson, S.L., Docherty, A.B., Donaldson, A., Dong, T., Dormand, N., Dougherty, A., Dowling, R., Drain, S., Draxlbauer, K., Drury, K., drury, H.J.C., Dulawan, P., Dunleavy, A., Dunn, S., Dupont, C., Earley, J., Easom, N., Echevarria, C., Edwards, S., Edwardson, C., El-Taweel, H., Elliott, A., Elliott, K., Ellis, Y., Elmer, A., Elneima, O., Evans, D., Evans, H., Evans, J., Evans, R., Evans, R.A., Evans, R.I., Evans, T., Evenden, C., Evison, L., Fabbri, L., Fairbairn, S., Fairman, A., Fallon, K., Faluyi, D., Favager, C., Fayzan, T., Featherstone, J., Felton, T., Finch, J., Finney, S., Finnigan, J., Finnigan, L., Fisher, H., Fletcher, S., Flockton, R., Flynn, M., Foot, H., Foote, D., Ford, A., Forton, D., Fraile, E., Francis, C., Francis, R., Francis, S., Frankel, A., Fraser, E., Free, R., French, N., Fu, X., Fuld, J., Furniss, J., Garner, L., Gautam, N., Geddes, J.R., George, J., George, P., Gibbons, M., Gill, M., Gilmour, L., Gleeson, F., Glossop, J., Glover, S., Goodman, N., Goodwin, C., Gooptu, B., Gordon, H., Gorsuch, T., Greatorex, M., Greenhaff, P.L., Greenhalf, W., Greenhalgh, A., Greening, N.J., Greenwood, J., Gregory, H., Gregory, R., Grieve, D., Griffin, D., Griffiths, L., Guerdette, A.-M., Guio, B. Guillen, Gummadi, M., Gupta, A., Gurram, S., Guthrie, E., Guy, Z., Henson, H.H., Hadley, K., Haggar, A., Hainey, K., Hairsine, B., Haldar, P., Hall, I., Hall, L., Halling-Brown, M., Hamil, R., Hancock, A., Hancock, K., Hanley, N.A., Haq, S., Hardwick, H.E., Hardy, E., Hardy, T., Hargadon, B., Harrington, K., Harris, E., Harris, V.C., Harrison, E.M., Harrison, P., Hart, N., Harvey, A., Harvey, M., Harvie, M., Haslam, L., Havinden-Williams, M., Hawkes, J., Hawkings, N., Haworth, J., Hayday, A., Haynes, M., Hazeldine, J., Hazelton, T., Heaney, L.G., Heeley, C., Heeney, J.L., Heightman, M., Heller, S., Henderson, M., Hesselden, L., Hewitt, M., Highett, V., Hillman, T., Hiwot, T., Ho, L.P., Hoare, A., Hoare, M., Hockridge, J., Hogarth, P., Holbourn, A., Holden, S., Holdsworth, L., Holgate, D., Holland, M., Holloway, L., Holmes, K., Holmes, M., Holroyd-Hind, B., Holt, L., Hormis, A., Horsley, A., Hosseini, A., Hotopf, M., Houchen-Wolloff, L., Howard, K., Howard, L.S., Howell, A., Hufton, E., Hughes, A.D., Hughes, J., Hughes, R., Humphries, A., Huneke, N., Hurditch, E., Hurst, J., Husain, M., Hussell, T., Hutchinson, J., Ibrahim, W., Ilyas, F., Ingham, J., Ingram, L., Ionita, D., Isaacs, K., Ismail, K., Jackson, T., Jacob, J., James, W.Y., Jang, W., Jarman, C., Jarrold, I., Jarvis, H., Jastrub, R., Jayaraman, B., Jenkins, R.G., Jezzard, P., Jiwa, K., Johnson, C., Johnson, S., Johnston, D., Jolley, C.J., Jones, D., Jones, G., Jones, H., Jones, I., Jones, L., Jones, M.G., Jones, S., Jose, S., Kabir, T., Kaltsakas, G., Kamwa, V., Kanellakis, N., s. Kaprowska, Kausar, Z., Keenan, N., Kelly, S., Kemp, G., Kerr, S., Kerslake, H., Key, A.L., Khan, F., Khunti, K., Kilroy, S., King, B., King, C., Kingham, L., Kirk, J., Kitterick, P., Klenerman, P., Knibbs, L., Knight, S., Knighton, A., Kon, O., Kon, S., Kon, S.S., Koprowska, S., Korszun, A., Koychev, I., Kurasz, C., Kurupati, P., Laing, C., Lamlum, H., Landers, G., Langenberg, C., Lasserson, D., Lavelle-Langham, L., Lawrie, A., Lawson, C., Layton, A., Lea, A., Leavy, O.C., Lee, D., Lee, J.-H., Lee, E., Leitch, K., Lenagh, R., Lewis, D., Lewis, J., Lewis, K.E., Lewis, V., Lewis-Burke, N., Li, X., Light, T., Lightstone, L., Lilaonitkul, W., Lim, L., Linford, S., Lingford-Hughes, A., Lipman, M., Liyanage, K., Lloyd, A., Logan, S., Lomas, D., Lone, N.I., Loosley, R., Lord, J.M., Lota, H., Lovegrove, W., Lucey, A., Lukaschuk, E., Lye, A., Lynch, C., MacDonald, S., MacGowan, G., Macharia, I., Mackie, J., Macliver, L., Madathil, S., Madzamba, G., Magee, N., Magtoto, M.M., Mairs, N., Majeed, N., Major, E., Malein, F., Malim, M., Mallison, G., D-C. Man, W., Mandal, S., Mangion, K., Manisty, C., Manley, R., March, K., Marciniak, S., Marino, P., Mariveles, M., Marks, M., Marouzet, E., Marsh, S., Marshall, B., Marshall, M., Martin, J., Martineau, A., Martinez, L.M., Maskell, N., Matila, D., Matimba-Mupaya, W., Matthews, L., Mbuyisa, A., McAdoo, S., McAllister-Williams, H., McArdle, A., McArdle, P., McAulay, D., McCann, G.P., McCormick, J., McCormick, W., McCourt, P., McGarvey, L., McGee, C., Mcgee, K., McGinness, J., McGlynn, K., McGovern, A., McGuinness, H., McInnes, I.B., McIntosh, J., McIvor, E., McIvor, K., McLeavey, L., McMahon, A., McMahon, M.J., McMorrow, L., Mcnally, T., McNarry, M., McNeill, J., McQueen, A., McShane, H., Mears, C., Megson, C., Megson, S., Mehta, P., Meiring, J., Melling, L., Mencias, M., Menzies, D., Merida Morillas, M., Michael, A., Miller, C., Milligan, L., Mills, C., Mills, G., Mills, N.L., Milner, L., Misra, S., Mitchell, J., Mohamed, A., Mohamed, N., Mohammed, S., Molyneaux, P.L., Monteiro, W., Moriera, S., Morley, A., Morrison, L., Morriss, R., Morrow, A., Moss, A.J., Moss, P., Motohashi, K., Msimanga, N., Mukaetova-Ladinska, E., Munawar, U., Murira, J., Nanda, U., Nassa, H., Nasseri, M., Neal, A., Needham, R., Neill, P., Neubauer, S., Newby, D.E., Newell, H., Newman, T., Newman, J., Newton-Cox, A., Nicholson, T., Nicoll, D., Nikolaidis, A., Nolan, C.M., Noonan, M.J., Norman, C., Novotny, P., Nunag, J., Nwafor, L., Nwanguma, U., Nyaboko, J., O'Brien, C., O'Donnell, K., O'Regan, D., O'Brien, L., Odell, N., Ogg, G., Olaosebikan, O., Oliver, C., Omar, Z., Openshaw, P.J.M., Orriss-Dib, L., Osborne, L., Osbourne, R., Ostermann, M., Overton, C., Owen, J., Oxton, J., Pack, J., Pacpaco, E., Paddick, S., Painter, S., Pakzad, A., Palmer, S., Papineni, P., Paques, K., Paradowski, K., Pareek, M., Parekh, D., Parfrey, H., Pariante, C., Parker, S., Parkes, M., Parmar, J., Patale, S., Patel, B., Patel, M., Patel, S., Pattenadk, D., Pavlides, M., Payne, S., Pearce, L., Pearl, J.E., Peckham, D., Pendlebury, J., Peng, Y., Pennington, C., Peralta, I., Perkins, E., Peterkin, Z., Peto, T., Petousi, N., Petrie, J., Pfeffer, P., Phipps, J., Pimm, J., Hanley, K. Piper, Pius, R., Plant, H., Plein, S., Plekhanova, T., Plowright, M., Poinasamy, K., Polgar, O., Poll, L., Porter, J.C., Porter, J., Portukhay, S., Powell, N., Prabhu, A., Pratt, J., Price, A., Price, C., Price, D., Price, L., Prickett, A., Propescu, J., Prosper, S., Pugmire, S., Quaid, S., Quigley, J., Quint, J., Qureshi, H., Qureshi, I.N., Radhakrishnan, K., Rahman, N.M., Ralser, M., Raman, B., Ramos, A., Ramos, H., Rangeley, J., Rangelov, B., Ratcliffe, L., Ravencroft, P., Reddington, A., Reddy, R., Reddy, A., Redfearn, H., Redwood, D., Reed, A., Rees, M., Rees, T., Regan, K., Reynolds, W., Ribeiro, C., Richards, A., Richardson, E., Richardson, M., Rivera-Ortega, P., Roberts, K., Robertson, E., Robinson, E., Robinson, L., Roche, L., Roddis, C., Rodger, J., Ross, A., Ross, G., Rossdale, J., Rostron, A., Rowe, A., Rowland, A., Rowland, J., Rowland, M.J., Rowland-Jones, S.L., Roy, K., Roy, M., Rudan, I., Russell, R., Russell, E., Saalmink, G., Sabit, R., Sage, E.K., Samakomva, T., Samani, N., Sampson, C., Samuel, K., Samuel, R., Sanderson, A., Sapey, E., Saralaya, D., Sargant, J., Sarginson, C., Sass, T., Sattar, N., Saunders, K., Saunders, R.M., Saunders, P., Saunders, L.C., Savill, H., Saxon, W., Sayer, A., Schronce, J., Schwaeble, W., Scott, J.T., Scott, K., Selby, N., Semple, M.G., Sereno, M., Sewell, T.A., Shah, A., Shah, K., Shah, P., Shankar-Hari, M., Sharma, M., Sharpe, C., Sharpe, M., Shashaa, S., Shaw, A., Shaw, K., Shaw, V., Sheikh, A., Shelton, S., Shenton, L., Shevket, K., Shikotra, A., Short, J., Siddique, S., Siddiqui, S., Sidebottom, J., Sigfrid, L., Simons, G., Simpson, J., Simpson, N., Singapuri, A., Singh, C., Singh, S., Singh, S.J., Sissons, D., Skeemer, J., Slack, K., Smith, A., Smith, D., Smith, S., Smith, J., Smith, L., Soares, M., Solano, T.S., Solly, R., Solstice, A.R., Soulsby, T., Southern, D., Sowter, D., Spears, M., Spencer, L.G., Speranza, F., Stadon, L., Stanel, S., Steele, N., Steiner, M., Stensel, D., Stephens, G., Stephenson, L., Stern, M., Stewart, I., Stimpson, R., Stockdale, S., Stockley, J., Stoker, W., Stone, R., Storrar, W., Storrie, A., Storton, K., Stringer, E., Strong-Sheldrake, S., Stroud, N., Subbe, C., Sudlow, C.L., Suleiman, Z., Summers, C., Summersgill, C., Sutherland, D., Sykes, D.L., Sykes, R., Talbot, N., Tan, A.L., Tarusan, L., Tavoukjian, V., Taylor, A., Taylor, C., Taylor, J., Te, A., Tedd, H., Tee, C.J., Teixeira, J., Tench, H., Terry, S., Thackray-Nocera, S., Thaivalappil, F., Thamu, B., Thickett, D., Thomas, C., Thomas, D.C., Thomas, S., Thomas, A.K., Thomas-Woods, T., Thompson, T., Thompson, A.A.R., Thornton, T., Thorpe, M., Thwaites, R.S., Tilley, J., Tinker, N., Tiongson, G.F., Tobin, M., Tomlinson, J., Tong, C., Toshner, M., Touyz, R., Tripp, K.A., Tunnicliffe, E., Turnbull, A., Turner, E., Turner, S., Turner, V., Turner, K., Turney, S., Turtle, L., Turton, H., Ugoji, J., Ugwuoke, R., Upthegrove, R., Valabhji, J., Ventura, M., Vere, J., Vickers, C., Vinson, B., Wade, E., Wade, P., Wain, L.V., Wainwright, T., Wajero, L.O., Walder, S., Walker, S., Wall, E., Wallis, T., Walmsley, S., Walsh, J.A., Walsh, S., Warburton, L., Ward, T.J.C., Warwick, K., Wassall, H., Waterson, S., Watson, E., Watson, L., Watson, J., McCall, J. Weir, Welch, C., Welch, H., Welsh, B., Wessely, S., West, S., Weston, H., Wheeler, H., White, S., Whitehead, V., Whitney, J., Whittaker, S., Whittam, B., Whitworth, V., Wight, A., Wild, J., Wilkins, M., Wilkinson, D., Williams, B., Williams, N., Williams, J., Williams-Howard, S.A., Willicombe, M., Willis, G., Willoughby, J., Wilson, A., Wilson, D., Wilson, I., Window, N., Witham, M., Wolf-Roberts, R., Wood, C., Woodhead, F., Woods, J., Wootton, D.G., Wormleighton, J., Worsley, J., Wraith, D., Brown, C. Wrey, Wright, C., Wright, L., Wright, S., Wyles, J., Wynter, I., Xu, M., Yasmin, N., Yasmin, S., Yates, T., Yip, K.P., Young, B., Young, S., Young, A., Yousuf, A.J., Zawia, A., Zeidan, L., Zhao, B., Zheng, B., Zongo, O., Zheng, Bang, Vivaldi, Giulia, Daines, Luke, Leavy, Olivia C., Richardson, Matthew, Elneima, Omer, McAuley, Hamish J.C., Shikotra, Aarti, Singapuri, Amisha, Sereno, Marco, Saunders, Ruth M., Harris, Victoria C., Houchen-Wolloff, Linzy, Greening, Neil J., Pfeffer, Paul E., Hurst, John R., Brown, Jeremy S., Shankar-Hari, Manu, Echevarria, Carlos, De Soyza, Anthony, Harrison, Ewen M., Docherty, Annemarie B., Lone, Nazir, Quint, Jennifer K., Chalmers, James D., Ho, Ling-Pei, Horsley, Alex, Marks, Michael, Poinasamy, Krishna, Raman, Betty, Heaney, Liam G., Wain, Louise V., Evans, Rachael A., Brightling, Christopher E., Martineau, Adrian, and Sheikh, Aziz

Published
2023
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14. Identification of key opportunities for optimising the management of high-risk COPD patients in the UK using the CONQUEST quality standards: an observational longitudinal study

Author

Halpin, David M.G., Dickens, Andrew P., Skinner, Derek, Murray, Ruth, Singh, Mukesh, Hickman, Katherine, Carter, Victoria, Couper, Amy, Evans, Alexander, Pullen, Rachel, Menon, Shruti, Morris, Tamsin, Muellerova, Hana, Bafadhel, Mona, Chalmers, James, Devereux, Graham, Gibson, Martin, Hurst, John R., Jones, Rupert, Kostikas, Konstantinos, Quint, Jennifer, Singh, Dave, van Melle, Marije, Wilkinson, Tom, and Price, David

Published
2023
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15. Disease Progression Modeling in Chronic Obstructive Pulmonary Disease

Author

Young, Alexandra L, Bragman, Felix JS, Rangelov, Bojidar, Han, MeiLan K, Galbán, Craig J, Lynch, David A, Hawkes, David J, Alexander, Daniel C, Hurst, John R, Crapo, James D, Silverman, Edwin K, Make, Barry J, Regan, Elizabeth A, Beaty, Terri, Begum, Ferdouse, Castaldi, Peter J, Cho, Michael, DeMeo, Dawn L, Boueiz, Adel R, Foreman, Marilyn G, Halper-Stromberg, Eitan, Hayden, Lystra P, Hersh, Craig P, Hetmanski, Jacqueline, Hobbs, Brian D, Hokanson, John E, Laird, Nan, Lange, Christoph, Lutz, Sharon M, McDonald, Merry-Lynn, Parker, Margaret M, Qiao, Dandi, Wan, Emily S, Won, Sungho, Sakornsakolpat, Phuwanat, Prokopenko, Dmitry, Al Qaisi, Mustafa, Coxson, Harvey O, Gray, Teresa, Hoffman, Eric A, Humphries, Stephen, Jacobson, Francine L, Judy, Philip F, Kazerooni, Ella A, Kluiber, Alex, Newell, John D, Ross, James C, Estepar, Raul San Jose, Schroeder, Joyce, Sieren, Jered, Stinson, Douglas, Stoel, Berend C, Tschirren, Juerg, Van Beek, Edwin, van Ginneken, Bram, van Rikxoort, Eva, Washko, George, Wilson, Carla G, Jensen, Robert, Everett, Douglas, Crooks, Jim, Moore, Camille, Strand, Matt, Hughes, John, Kinney, Gregory, Pratte, Katherine, Young, Kendra A, Bhatt, Surya, Bon, Jessica, Martinez, Carlos, Murray, Susan, Soler, Xavier, Bowler, Russell P, Kechris, Katerina, Banaei-Kashani, Farnoush, Curtis, Jeffrey L, Martinez, Carlos H, Pernicano, Perry G, Hanania, Nicola, Alapat, Philip, Atik, Mustafa, Bandi, Venkata, Boriek, Aladin, Guntupalli, Kalpatha, Guy, Elizabeth, Nachiappan, Arun, Parulekar, Amit, Barr, R Graham, Austin, John, D’Souza, Belinda, Pearson, Gregory DN, Rozenshtein, Anna, Thomashow, Byron, MacIntyre, Neil, McAdams, H Page, Washington, Lacey, McEvoy, Charlene, and Tashjian, Joseph

Subjects
Biomedical Imaging, Lung, Clinical Research, Chronic Obstructive Pulmonary Disease, Aetiology, 4.2 Evaluation of markers and technologies, Detection, screening and diagnosis, 4.1 Discovery and preclinical testing of markers and technologies, 2.1 Biological and endogenous factors, Respiratory, Aged, Disease Progression, Female, Humans, Male, Middle Aged, Models, Theoretical, Pulmonary Disease, Chronic Obstructive, Tomography, X-Ray Computed, clustering, CT imaging, emphysema, bronchitis, chronic obstructive pulmonary disease, COPDGene Investigators, Medical and Health Sciences, Respiratory System
Abstract

Rationale: The decades-long progression of chronic obstructive pulmonary disease (COPD) renders identifying different trajectories of disease progression challenging.Objectives: To identify subtypes of patients with COPD with distinct longitudinal progression patterns using a novel machine-learning tool called "Subtype and Stage Inference" (SuStaIn) and to evaluate the utility of SuStaIn for patient stratification in COPD.Methods: We applied SuStaIn to cross-sectional computed tomography imaging markers in 3,698 Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1-4 patients and 3,479 controls from the COPDGene (COPD Genetic Epidemiology) study to identify subtypes of patients with COPD. We confirmed the identified subtypes and progression patterns using ECLIPSE (Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints) data. We assessed the utility of SuStaIn for patient stratification by comparing SuStaIn subtypes and stages at baseline with longitudinal follow-up data.Measurements and Main Results: We identified two trajectories of disease progression in COPD: a "Tissue→Airway" subtype (n = 2,354, 70.4%), in which small airway dysfunction and emphysema precede large airway wall abnormalities, and an "Airway→Tissue" subtype (n = 988, 29.6%), in which large airway wall abnormalities precede emphysema and small airway dysfunction. Subtypes were reproducible in ECLIPSE. Baseline stage in both subtypes correlated with future FEV1/FVC decline (r = -0.16 [P

Published
2020

16. Predictors of specialist care referrals (SCR) following emergency department review or hospital admission in adults with previous acute COVID-19: a prospective UK cohort study.

Author

Saigal, Anita, Xiao, Songyuan, Siddique, Owais, Naran, Prasheena, Bintalib, Heba M, Niklewicz, Camila Nagoda, Seligmann, George, Naidu, Sindhu Bhaarrati, Shah, Amar J, Ogbonnaya, Chibueze, Hurst, John R, Lipman, Marc Ci, and Mandal, Swapna

Subjects
MENTAL health services, POST-acute COVID-19 syndrome, MEDICAL sciences, PUBLIC health, SYMPTOM burden
Abstract

Background: Long-COVID research to date focuses on outcomes in non-hospitalised vs. hospitalised survivors. However Emergency Department attendees (post-ED) presenting with acute COVID-19 may experience less supported recovery compared to people admitted and discharged from hospital (post-hospitalised group, PH). Objective: We evaluated outcomes and predictors of specialty care referrals (SCR) in those with ongoing symptomatic Long-COVID, comparing post-ED and PH adults. Methods: This prospective observational cohort study evaluates 800 PH and 484 post-ED adults from a single hospital in London, United Kingdom. Participants had either confirmed laboratory-positive SARS-CoV-2 infection or clinically suspected acute COVID-19 and were offered post-COVID clinical follow-up at approximately six weeks after their ED attendance or inpatient discharge, to assess ongoing symptoms and support recovery. Multiple logistic regression determined associations with specialist care referrals (SCR) to respiratory, cardiology, physiotherapy (including chest physiotherapy), and mental health services. Results: Presence of at least one Long-COVID symptom was lower in adults attending ED services with acute COVID-19 compared to those hospitalised (70.1% post-ED vs. 79.5% PH adults, p < 0.001). Total number of Long-COVID symptoms was associated with increased SCR in all patients (adjusted odds ratio (aOR) = 1.26, 95%CI:1.16, 1.36, p < 0.001), with post-ED adults more likely to need a SCR overall (aOR = 1.82, 95%CI:1.19, 2.79, p = 0.006). Post-ED adults had higher SCR to both physiotherapy (aOR = 2.59, 95%CI:1.35, 4.96, p = 0.004) and mental health services (aOR = 3.84, 95%CI:2.00, 7.37, p < 0.001), with pre-existing mental illness linked to the latter (aOR = 4.08, 95%CI:1.07, 15.6, p = 0.04). Conclusions: We demonstrate greater specialist care referrals to mental health and physiotherapy services in patients attending the ED and discharged with acute COVID-19, compared to those admitted, despite lower ongoing COVID-19 symptom burden. Total number of symptoms, pre-existing co-morbidity such as smoking status, cardiac co-morbidities, and mental health illnesses may predict those requiring healthcare input. This information may enable better post-COVID support for ED attendees, a distinct group who should not be neglected when preparing for future pandemics. Trial registration: This study had HRA approval (20/HRA/4928). [ABSTRACT FROM AUTHOR]

Published
2025
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19. Illness Representations of Chronic Obstructive Pulmonary Disease (COPD) to Inform Health Education Strategies and Research Design-Learning from Rural Uganda

Author

Nagourney, Emily M., Robertson, Nicole M., Rykiel, Natalie, Siddharthan, Trishul, Alupo, Patricia, Encarnacion, Marysol, Kirenga, Bruce J., Kalyesubula, Robert, Quaderi, Shumonta A., Hurst, John R., Checkley, William, and Pollard, Suzanne L.

Abstract

More than 90% of chronic obstructive pulmonary disease (COPD)-related deaths occur in low- and middle-income countries; however, few studies have examined the illness experiences of individuals living with and providing treatment for COPD in these settings. This study characterizes illness representations for COPD in Nakaseke, Uganda from the perspectives of health care providers, village health teams and community members (CMs) with COPD. We conducted 40 in-depth, semi-structured interviews (16 health care providers, 12 village health teams and 12 CMs, aged 25-80 years). Interviews were analyzed using inductive coding, and the Illness Representations Model guided our analysis. Stakeholder groups showed concordance in identifying causal mechanisms of COPD, but showed disagreement in reasons for care seeking behaviors and treatment preferences. CMs did not use a distinct label to differentiate COPD from other respiratory illnesses, and described both the physical and social consequences of COPD. Local representations can inform development of adapted educational and self-management tools for COPD.

Published
2020
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20. Effectiveness-implementation of COPD case finding and self-management action plans in low- and middle-income countries: global excellence in COPD outcomes (GECo) study protocol

Author

Siddharthan, Trishul, Pollard, Suzanne L, Quaderi, Shumonta A, Mirelman, Andrew J, Cárdenas, Maria Kathia, Kirenga, Bruce, Rykiel, Natalie A, Miranda, J Jaime, Shrestha, Laxman, Chandyo, Ram K, Cattamanchi, Adithya, Michie, Susan, Barber, Julie, Checkley, William, and Hurst, John R

Subjects
Health Services and Systems, Health Sciences, Chronic Obstructive Pulmonary Disease, Lung, Clinical Trials and Supportive Activities, Clinical Research, Health Services, Comparative Effectiveness Research, Prevention, Respiratory, Adult, Cost-Benefit Analysis, Humans, Peak Expiratory Flow Rate, Pulmonary Disease, Chronic Obstructive, Randomized Controlled Trials as Topic, Self Care, Spirometry, Surveys and Questionnaires, COPD, COPD exacerbations, COPD case finding, COPD action plan, Non-communicable disease, Self-management, GECo Study Investigators, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Cardiovascular System & Hematology, General & Internal Medicine, Clinical sciences, Epidemiology, Health services and systems
Abstract

BackgroundChronic obstructive pulmonary disease (COPD) is the end result of a susceptible individual being exposed to sufficiently deleterious environmental stimuli. More than 90% of COPD-related deaths occur in low- and middle-income countries (LMICs). LMICs face unique challenges in managing COPD; for example, deficient primary care systems present challenges for proper diagnosis and management. Formal diagnosis of COPD requires quality-assured spirometry, which is often limited to urban health centres. Similarly, standard treatment options for COPD remain limited where few providers are trained to manage COPD. The Global Excellence in COPD Outcomes (GECo) studies aim to assess the performance of a COPD case-finding questionnaire with and without peak expiratory flow (PEF) to diagnose COPD, and inform the effectiveness and implementation of COPD self-management Action Plans in LMIC settings. The ultimate goal is to develop simple, low-cost models of care that can be implemented in LMICs. This study will be carried out in Nepal, Peru and Uganda, three distinct LMIC settings.Methods/designWe aim to assess the diagnostic accuracy of a simple questionnaire with and without PEF to case-find COPD (GECo1), and examine the effectiveness, cost-effectiveness and implementation of a community-health-worker-supported self-management Action Plan strategy for managing exacerbations of COPD (GECo2). To achieve the first aim, we will enrol a randomly selected sample of up to 10,500 adults aged ≥ 40 years across our three sites, with the goal to enrol 240 participants with moderate-to-severe COPD in to GECo2. We will apply two case-finding questionnaires (Lung Function Questionnaire and CAPTURE) with and without PEF and compare performance against spirometry. We will report ROC areas, sensitivity and specificity. Individuals who are identified as having COPD grades B-D will be invited to enrol in an effectiveness-implementation hybrid randomised trial of a multi-faceted COPD self-management Action Plan intervention delivered by CHWs. The intervention group will receive (1) COPD education, (2) facilitated-self management Action Plans for COPD exacerbations and (3) monthly visits by community health workers. The control group will receive COPD education and standard of care treatment provided by local health providers. Beginning at baseline, we will measure quality of life with the EuroQol-5D (EQ-5D) and St. George's Respiratory Questionnaire (SGRQ) every 3 months over a period of 1 year. The primary endpoint is SGRQ at 12 months. Quality-adjusted life years (QALYs) using the Short-Form 36 version 2 will also be calculated. We will additionally assess the acceptability and feasibility of implementing COPD Action Plans in each setting among providers and individuals with COPD.DiscussionThis study should provide evidence to inform the use of pragmatic models of COPD diagnosis and management in LMIC settings.Trial registrationNCT03359915 (GECo1). Registered on 2 December 2017 and NCT03365713 (GECo2). Registered on 7 December 2017. Trial acronym: Global Excellence in COPD Outcomes (GECo1; GECo2).

Published
2018

23. Investigating pulmonary and non-infectious complications in common variable immunodeficiency disorders: a UK national multi-centre study.

Author

Bintalib, Heba M., Grigoriadou, Sofia, Patel, Smita Y., Mutlu, Leman, Sooriyakumar, Kavitha, Vaitla, Prashantha, McDermott, Elizabeth, Drewe, Elizabeth, Steele, Cathal, Ahuja, Manisha, Garcez, Tomaz, Gompels, Mark, Grammatikos, Alexandros, Herwadkar, Archana, Ayub, Rehana, Halliday, Neil, Burns, Siobhan O., Hurst, John R., and Goddard, Sarah

Subjects
COMMON variable immunodeficiency, INTERSTITIAL lung diseases, DISEASE complications, LUNG diseases, GASTROINTESTINAL diseases, BRONCHIECTASIS
Abstract

Background: Common Variable Immunodeficiency Disorders (CVID) encompass a spectrum of immunodeficiency characterised by recurrent infections and diverse non-infectious complications (NICs). This study aimed to describe the clinical features and variation in NICs in CVID with and without interstitial lung disease (ILD) from a large UK national registry population. Methods: Retrospective, cross-sectional data from a UK multicentre database (previously known as UKPIN), categorising patients into those with CVID-ILD and those with NICs related to CVID but without pulmonary involvement (CVID-EP; EP= extra-pulmonary involvement only). Results: 129 patients were included. Chronic lung diseases, especially CVID-ILD, are prominent complications in complex CVID, occurring in 62% of the cohort. Bronchiectasis was common (64% of the cohort) and associated with greater pulmonary function impairment in patients with CVID-ILD compared to those without bronchiectasis. Lymphadenopathy and the absence of gastrointestinal diseases were significant predictors of ILD in complex CVID. Although the presence of liver disease did not differ significantly between the groups, nearly half of the CVID-ILD patients were found to have liver disease. Patients with CVID-ILD were more likely to receive immunosuppressive treatments such as rituximab and mycophenolate mofetil than the CVID-EP group, indicating greater need for treatment and risk of complications. Conclusion: This study highlights the significant burden of CVID-ILD within the CVID population with NICs only. The lungs emerged as the most frequently affected organ, with ILD and bronchiectasis both highly prevalent. These findings emphasise the necessity of a comprehensive and multidisciplinary approach in managing CVID patients, considering their susceptibility to various comorbidities and complications. [ABSTRACT FROM AUTHOR]

Published
2024
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24. Operational Modeling with Health Economics to Support Decision Making for COPD Patients

Author

Yakutcan, Usame, Demir, Eren, Hurst, John R., Taylor, Paul C., and Ridsdale, Heidi A.

Subjects
Care and treatment, Evaluation, Health aspects, Health care costs -- Evaluation, Chronic obstructive lung disease -- Care and treatment, Decision making -- Health aspects, Medical care, Cost of -- Evaluation, Lung diseases, Obstructive -- Care and treatment, Decision-making -- Health aspects
Abstract

What Is Known on This Topic * Prior studies showed the effectiveness of pulmonary rehabilitation, comparing patient outcomes, and costs. * The quantifiable impact of re-designing COPD (chronic obstructive pulmonary [...], Objective: To assess the impact of interventions for improving the management of chronic obstructive pulmonary disease (COPD), specifically increased use of pulmonary rehabilitation (PR) on patient outcomes and cost-benefit analysis. Data Sources: We used the national Hospital Episode Statistics (HES) datasets in England, local data and experts from the hospital setting, National Prices and National Tariffs, reports and the literature around the effectiveness of PR programs. Study Design: The COPD pathway was modeled using discrete event simulation (DES) to capture the patient pathway to an adequate level of detail as well as randomness in the real world. DES was further enhanced by the integration of a health economic model to calculate the net benefit and cost of treating COPD patients based on key sets of interventions. Data Collection/Extraction Methods: A total of 150 input parameters and 75 distributions were established to power the model using the HES dataset, outpatient activity data from the hospital and community services, and the literature. Principal Findings: The simulation model showed that increasing referral to PR (by 10%, 20%, or 30%) would be cost-effective (with a benefit-cost ratio of 5.81, 5.95, and 5.91, respectively) by having a positive impact on patient outcomes and operational metrics. Number of deaths, admissions, and bed days decreased (ie, by 3.56 patients, 4.90 admissions, and 137.31 bed days for a 30% increase in PR referrals) as well as quality of life increased (ie, by 5.53 QALY among 1540 patients for the 30% increase). Conclusions: No operational model, either statistical or simulation, has previously been developed to capture the COPD patient pathway within a hospital setting. To date, no model has investigated the impact of PR on COPD services, such as operations, key performance, patient outcomes, and cost-benefit analysis. The study will support policies around extending availability of PR as a major intervention. KEYWORDS COPD, cost-benefit analysis, decision support toolkit, discrete event simulation, health economics, patient flow modelling, pulmonary rehabilitation

Published
2021
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28. Long-term impact of COVID-19 hospitalisation among individuals with pre-existing airways diseases in the UK: a multicentre, longitudinal cohort study (PHOSP-COVID)

Author

Elneima, Omer, primary, Hurst, John R, additional, Echevarria, Carlos, additional, Quint, Jennifer K, additional, Walker, Samantha, additional, Siddiqui, Salman, additional, Novotny, Petr, additional, Pfeffer, Paul E, additional, Brown, Jeremy S, additional, Shankar-Hari, Manu, additional, McAuley, Hamish JC, additional, Leavy, Olivia C, additional, Shikotra, Aarti, additional, Singapuri, Amisha, additional, Sereno, Marco, additional, Richardson, Matthew, additional, Saunders, Ruth M, additional, Harris, Victoria C, additional, Houchen-Wolloff, Linzy, additional, Greening, Neil J, additional, Harrison, Ewen M, additional, Docherty, Annemarie B, additional, Lone, Nazir I, additional, Chalmers, James D, additional, Ho, Ling-Pei, additional, Horsley, Alex, additional, Marks, Michael, additional, Poinasamy, Krisnah, additional, Raman, Betty, additional, Evans, Rachael A, additional, Wain, Louise V, additional, Sheikh, Aziz, additional, Brightling, Chris E, additional, De Soyza, Anthony, additional, and Heaney, Liam G, additional

Published
2024
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30. Cardiovascular disease and risk in COPD:a state of the art review

Author

Polman, Ricardo, Hurst, John R., Uysal, Omer Faruk, Mandal, Swapna, Linz, Dominik, Simons, Sami, Polman, Ricardo, Hurst, John R., Uysal, Omer Faruk, Mandal, Swapna, Linz, Dominik, and Simons, Sami

Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) and cardiovascular diseases (CVD) commonly co-exist. Outcomes of people living with both conditions are poor in terms of symptom burden, receiving evidence-based treatment and mortality. Increased understanding of the underlying mechanisms may help to identify treatments to relieve this disease burden. This narrative review covers the overlap of COPD and CVD with a focus on clinical presentation, mechanisms, and interventions. Literature up to December 2023 are cited. Areas Covered: 1. What is COPD 2. The co-existence of COPD and cardiovascular disease 3. Mechanisms of cardiovascular disease in COPD. 4. Populations with COPD are at risk of CVD 5. Complexity in the co-diagnosis of COPD in those with cardiovascular disease. 6. Therapy for COPD and implications for cardiovascular events and risk. 7. Cardiovascular risk and exacerbations of COPD. 8. Pro-active identification and management of CV risk in COPD. Expert Opinion: The prospective identification of co-morbid COPD in CVD patients and of CVD and CV risk in people with COPD is crucial for optimizing clinical outcomes. This includes the identification of novel treatment targets and the design of clinical trials specifically designed to reduce the cardiovascular burden and mortality associated with COPD. Databases searched: Pubmed, 2006–2023.

Published
2024

31. Effectiveness of low-dose theophylline for the management of biomass-associated COPD (LODOT-BCOPD): study protocol for a randomized controlled trial

Author

Siddharthan, Trishul, Pollard, Suzanne L., Jackson, Peter, Robertson, Nicole M., Wosu, Adaeze C., Rahman, Nihaal, Padalkar, Roma, Sekitoleko, Isaac, Namazzi, Esther, Alupo, Patricia, Hurst, John R., Kalyesubula, Robert, Dowdy, David, Wise, Robert, Barnes, Peter J., Checkley, William, and Kirenga, Bruce

Published
2021
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33. Development and evaluation of a tool to optimise inhaler selection prior to hospital discharge following an exacerbation of Chronic Obstructive Pulmonary Disease

Author

Price, Evleen, primary, Ahmad, Shanaz, additional, Althobiani, Malik A, additional, Ayoob, Tareq, additional, Burgoyne, Teresa, additional, De Soyza, Anthony, additional, Dobson, Melissa, additional, Echevarria, Carlos, additional, Martin, Graham, additional, Mendes, Renata Gonçalves, additional, Preston, Anne-Marie, additional, Rahman, Najib M, additional, Sapey, Elizabeth, additional, Usmani, Omar S, additional, and Hurst, John R, additional

Published
2024
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34. Supporting self-management for patients with Interstitial Lung Diseases: Utility and acceptability of digital devices

Author

Althobiani, Malik A., primary, Shuttleworth, Rebecca, additional, Conway, John, additional, Dainton, Jonathan, additional, Duckworth, Anna, additional, Da Ponte, Ana Jorge, additional, Mandizha, Jessica, additional, Lanario, Joseph W., additional, Gibbons, Michael A., additional, Lines, Sarah, additional, Scotton, Chris J., additional, Hurst, John R., additional, Porter, Joanna C., additional, and Russell, Anne-Marie, additional

Published
2024
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35. Multimorbidity and acute infectious diseases in urban and semi-urban settings in Peru: A mixed-methods study

Author

Anza-Ramirez, Cecilia, primary, Najarro, Lizzete, additional, Bernabé-Ortiz, Antonio, additional, Diez-Canseco, Francisco, additional, Fottrell, Edward, additional, Abubakar, Ibrahim, additional, Hernández-Vásquez, Akram, additional, Carrillo-Larco, Rodrigo M., additional, Hurst, John R., additional, and Miranda, Juan Jaime, additional

Published
2024
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36. The Neutrophil-to-Lymphocyte Ratio as a Predictor of Acute Exacerbations Among Patients With COPD in Uganda

Author

Alupo, Patricia, primary, Katagira, Winceslaus, additional, Mukunya, David, additional, Okimat, Paul, additional, Tejwani, Vickram, additional, Kayongo, Alex, additional, Nalunjogi, Joanitah, additional, Robertson, Nicole M., additional, Jones, Rupert, additional, Hurst, John R., additional, Kirenga, Bruce, additional, and Siddharthan, Trishul, additional

Published
2024
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45. Cross-sectional study evaluating the impact of SARS-CoV-2 variants on Long COVID outcomes in UK hospital survivors

Author

Saigal, Anita, primary, Nagoda Niklewicz, Camila, additional, Naidu, Sindhu Bhaarrati, additional, Bintalib, Heba M, additional, Shah, Amar Jitu, additional, Seligmann, George, additional, Hunter, Alan Stewart, additional, Wey, Emmanuel, additional, Abubakar, Ibrahim, additional, Mahungu, Tabitha, additional, Miller, David, additional, Barnett, Joseph, additional, Jain, Neel Gautam, additional, Brill, Simon, additional, Goldring, James, additional, Jarvis, Hannah, additional, Smith, Colette, additional, Ogbonnaya, Chibueze, additional, Hurst, John R, additional, Lipman, Marc C I, additional, and Mandal, Swapna, additional

Published
2023
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46. Dual bronchodilators in Bronchiectasis study (DIBS): protocol for a pragmatic, multicentre, placebo-controlled, three-arm, double-blinded, randomised controlled trial studying bronchodilators in preventing exacerbations of bronchiectasis

Author

Morton, Miranda, primary, Wilson, Nina, additional, Homer, Tara Marie, additional, Simms, Laura, additional, Steel, Alison, additional, Maier, Rebecca, additional, Wason, James, additional, Ternent, Laura, additional, Abouhajar, Alaa, additional, Allen, Maria, additional, Joyce, Richard, additional, Hildreth, Victoria, additional, Lakey, Rachel, additional, Cherlin, Svetlana, additional, Walker, Adam, additional, Devereux, Graham, additional, Chalmers, James D, additional, Hill, Adam T, additional, Haworth, Charles, additional, Hurst, John R, additional, and De Soyza, Anthony, additional

Published
2023
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49. Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome: a cross-sectional observational study

Author

Walker, Sarah, primary, Goodfellow, Henry, additional, Pookarnjanamorakot, Patra, additional, Murray, Elizabeth, additional, Bindman, Julia, additional, Blandford, Ann, additional, Bradbury, Katherine, additional, Cooper, Belinda, additional, Hamilton, Fiona L, additional, Hurst, John R, additional, Hylton, Hannah, additional, Linke, Stuart, additional, Pfeffer, Paul, additional, Ricketts, William, additional, Robson, Chris, additional, Stevenson, Fiona A, additional, Sunkersing, David, additional, Wang, Jiunn, additional, Gomes, Manuel, additional, Henley, William, additional, and Collaboration, Living With Covid Recovery, additional

Published
2023
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50. Performance-based outcome measures to assess functionality in hospitalised patients with COPD exacerbations: a systematic review of the measurement properties

Author

Leonardi, Naiara Tais, Kawakami, Débora Mayumi Oliveira, Hurst, John R., Cruz, Joana, and Mendes, Renata Gonçalves

Subjects
Hospitalization, Chronic obstructive pulmonary disease, COPD, Exacerbation, Reliability, Measurement properties, Validity
Abstract

Support statement: This work was supported by Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP) (numbers process: 2015/12763-4; 2015/26501-1 (Project grant); 2021/03493-4 (NTL scholarship)). The funding source had no involvement in this analysis or in the writing of this manuscript. Funding information for this article has been deposited with the Crossref Funder Registry. Projeto financiado: Bolsa de doutoramento da FAPESP (Brasil). Introduction Hospitalised patients with exacerbations of COPD (ECOPD) may have physical and functional impairments that impact morbidity and readmission. Therefore, it is crucial to properly identify reduced functionality in these patients to support a personalised rehabilitation. The objective of this study is to summarise and compare the measurement properties of functionality performance-based outcome measures for hospitalised patients with ECOPD. Methods A systematic review based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) was performed. The PubMed, Embase, PEDro and Cochrane databases were searched using terms related to functionality, hospitalised patients with ECOPD and measurement properties. Studies were selected and extracted by two researchers. The COSMIN Risk of Bias checklist was applied to assess the methodological quality of the studies and measurement property results were compared with the criteria for good measurement properties. Quality of evidence was graded using a modified Grades of Recommendation, Assessment, Development and Evaluation approach. Results 13 studies were included with nine outcome measures, namely the 6-min pegboard ring test, the de Morton mobility index, the incremental shuttle walk test (ISWT), the 6-min walk test (6MWT), maximum inspiratory pressure (MIP), the Berg balance scale, 4-m gait speed, handgrip strength and the 6-min stepper test. Construct validity was rated as sufficient, except for the ISWT. Responsiveness, assessed only for MIP, was considered insufficient and measurement errors for the ISWT and 6MWT were insufficient, with a very low quality of evidence for all measurement properties. Conclusion Measurement properties of performance-based outcome measures to assess functionality in patients hospitalised with ECOPD are still scarce, with very low evidence supporting validity and a lack of evidence of responsiveness and reliability. Further studies are needed to address this topic and guide assertive and personalised management. info:eu-repo/semantics/publishedVersion

Published
2023

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