Respiratory Medicine

Permanent URI for this collection

https://hdl.handle.net/20.500.14709/77

Browse

First-line medical thoracoscopy for pleural infection: the SPIRIT randomised controlled feasibility trial
(BMJ Publishing Group, 2025-12-10) Bansal, Krishnan Ragab; Arnold, David; Tucker, Emma; Morley, Anna; Ahmed, Liju; Ip, Hugh; Sivakumar, Parthipan; Steer, Henry; Evison, Matthew; Rahman, Najib; Munavvar, Mohammed; Blyth, Kevin; Pepperell, Justin; Maskell, Nick; Bhatnagar, Rahul; Steer, Henry; Medical and Dental
Background: Pleural infection remains a significant clinical challenge, requiring hospitalisation, intravenous antibiotics and early chest drain insertion. Medical thoracoscopy (MT), a minimally invasive procedure used electively in the UK for malignant effusions, has demonstrated good outcomes when applied to acute pleural infection in retrospective case series. However, it has not been evaluated as a first-line intervention in the UK in a randomised controlled trial (RCT). Objectives: The Studying Pleuroscopy in Routine Pleural Infection Treatment (SPIRIT) trial assessed the feasibility of conducting a full-scale RCT comparing MT with chest drain insertion for acute pleural infection within UK National Health Service (NHS) hospitals. Methods: SPIRIT was an open-label, randomised feasibility trial conducted across seven NHS centres between 2017 and 2019. Adults with suspected pleural infection were prescreened; eligible patients were randomised to either chest drain insertion (control) or MT (performed the same or following day) with 90-day follow-up. The primary outcome was feasibility, assessed through a composite of prescreen, screen and allocation failure rates. Secondary outcomes included inpatient-stay duration, mortality, radiological and microbiological outcomes, second-line interventions, patient-reported outcomes and adverse events. Results: Of 193 patients prescreened, 181 (93.8%) were excluded due to at least one criterion. Key factors included lack of MT deliverability (49.2%), a not truly infected effusion (45.1%) and contraindications to drainage or study involvement (44.0%). Consequently, the primary feasibility endpoint was not met. All 12 eligible patients were randomised with no attrition. MT lasted 15 min longer than drain insertion, but chest drains remained in situ over 3 days longer (p=0.17) with a longer hospital stay (p=0.57). Radiological improvement, microbiological yield and symptom scores were similar. Adverse events occurred in one control and three MT patients. Conclusion: A full-scale RCT is not likely to be feasible in an NHS setting on the proposed protocol. Targeted recruitment from centres equipped for emergency MT may enhance feasibility. Trial registration number: ISRCTN98460319.
Exploring gender and ethnic disparities in sarcoidosis: insights from the British Thoracic Society UK Interstitial Lung Disease Registry
(BMJ Publishing Group, 2025-11-18) Baczek, Karol; Sia, Cheng Leng; Amanda, Gina; Achaiah, Andrew; Sese, Lucile; Chaudhuri, Nazia; Achaiah, Andrew; Medical and Dental
Introduction Sex and ethnicity influence sarcoidosis internationally, but UK data are limited. We analysed the British Thoracic Society Interstitial Lung Disease Registry to assess whether gender or ethnic differences affect presentation and management of pulmonary sarcoidosis in the UK. Methods A retrospective study included adults with confirmed pulmonary sarcoidosis recorded between January 2013 and December 2024. Demographics, symptoms, comorbidities, investigations, radiology, treatment and Index of Multiple Deprivation were extracted. Group comparisons used χ², t-tests or Mann-Whitney U tests; multivariable logistic regression identified factors associated with immunosuppressive initiation. Results Among 1071 patients, 55.5% were male; median age 54 years (SD 13). Ethnicity was documented in 918 (85.7%): 55.4% white, 14.2% non-white (black, South Asian, mixed). Gender: Women presented older than men (56 vs 52 years; p=0.002) and reported more fatigue, higher erythrocyte sedimentation rate and prior tuberculosis. Men had more lymphopenia, elevated ACE and arrhythmia. Lung function and CT patterns were similar, but methotrexate use was higher in men (4.9% vs 2.3%; p=0.017). Non-white patients presented younger (52 vs 54 years; p<0.001) with greater symptom burden (breathlessness 46% vs 33%; cough 44% vs 27%) and more comorbidities (hypertension, diabetes, tuberculosis). Physiology was comparable, but CT nodularity (54% vs 36%) and abnormal liver tests (16% vs 9%) were more frequent, and mycophenolate was prescribed more often (3.7% vs 0.3%; p=0.036). In multivariable analysis, male sex (OR 2.34), non-white ethnicity (OR 3.20), breathlessness (OR 2.05) and lower forced vital capacity (OR 0.97 per % predicted) were independently associated with immunosuppressive treatment (all p≤0.031). Conclusions In this UK cohort, treatment decisions were more influenced by sex and ethnicity than by lung function or imaging. Male and non-white patients received immunosuppression more frequently, suggesting possible biological, socioeconomic or practice-related differences.
A patient-centred approach to malignant pleural effusion
(Taylor and Francis, 2025-11-01) Shorthose, Matthew; Crook, Rebecca; Bhatnagar, Rahul; Shorthose, Matthew; Medical and Dental
Background: Malignant pleural effusion (MPE) occurs in up to 20% of malignancies, most commonly from a breast or pulmonary primary. It confers a poor prognosis, with a median survival of less than a year, and the mainstay in treatment has previously been achieving pleurodesis. Aims and methods: This review provides an overview of the most up to date literature for the treatment of MPE using a PubMed search, with a focus on patient-centred care. Results: There is increased focus on outpatient management and control of symptoms for patients with MPE, allowing more in-depth conversations to be had over what individual patient goals are. The development of new approaches such as indwelling pleural catheters (IPC) and local anaesthetic thoracoscopy (LAT) also increase the options available. When manging the complexities of MPE, such as non-expansile lung and septated effusions, various approaches can be taken to treat them including fibrinolytics and IPC. Discussion: The treatment of MPE has changed in the last 15 years to focus on outpatient management and symptom control. Careful discussions must be undertaken on a patient-by-patient basis. Keywords: Malignant pleural effusion; indwelling pleural catheter; intercostal drain; non-expansile lung; patient focus; pleurodesis; septated effusion.
Gender differences in clinical features, comorbidities and prognostic outcomes in idiopathic pulmonary fibrosis—a retrospective cohort analysis from the British Thoracic Society Interstitial Lung Disease Registry
(BMJ Publishing Group, 2025-10-28) Sia, Cheng Leng; Amanda, Gina; Baczek, Karol; Achaiah, Andrew; Sese, Lucile; Chaudhuri, Nazia; Achaiah, Andrew; Medical and Dental
Background Idiopathic pulmonary fibrosis (IPF), an unknown aetiology type of interstitial lung disease (ILD), carries the poorest prognosis and is more common in males and the elderly. Gender differences in baseline presentation, lung function and comorbidities may have an impact on prognostic outcomes. Objective The aim of this study was to explore gender differences in clinical features, comorbidities and outcomes in IPF in a UK cohort. Method This was a retrospective cohort study analysing data from the British Thoracic Society UK IPF ILD Registry from January 2013 to February 2024. We compared baseline characteristics between males and females, and a survival analysis in both genders was performed using the Cox proportional hazards model. Results We identified 6666 IPF patients with a mean age at diagnosis of 74.1±8.1. Our cohort was predominantly male (5197, 78%), with a higher proportion of current and ex-smokers compared with females (69.9% vs 59.9%, p<0.001) and higher rates of comorbidities such as ischaemic heart disease (IHD) and diabetes (19.7% vs 14.6% and 19.9% vs 11.2%, respectively, p<0.001). Baseline forced vital capacity (FVC) % predicted was 77.76±17.4 in males and 81.83±19.7 in females (p=0.001), while diffusing capacity for carbon monoxide (DLCO) was similar between the two groups. In multivariate analysis, after adjusting for age, IHD and lower baseline FVC, DLCO was a poor survival predictor in males. Hiatus hernia is a protective factor. Conversely, disease duration of <12 months, gastro-oesophageal reflux disease, not requiring oxygen at baseline and higher baseline DLCO predicted better survival in females. Conclusion Gender differences in baseline characteristics and prognostic factors were observed in IPF. A gender-based approach in managing IPF is warranted, and further studies are needed to clarify these differences and their impact on IPF management.
Thoracic Ultrasound for guiding pleurodesis in malignant pleural effusion: a randomised trial
(European Respiratory Society, 2021-11-25) Hassan, Maged; Psallidas, Ioannis; Yousuf, Ahmed; Duncan, Tracy; Leyakathali Khan, Shahul; Blyth, Kevin; Evison, Matthew; Corcoran, John; Barnes, Simon; Reddy, Raja; Bonta, Peter; Bhatnagar, Rahul; Kagithala, Gayathri; Dobson, Melissa; Knight, Ruth; Dutton, Susan; Hedley, Emma; Piotrowska, Hamia; Brown, Louise; Mercer, Rachel; Asciak, Rachelle; Bedawi, Eihab; Hallifax, Rob; Slade, Mark; Benamore, Rachel; Edey, Anthony; Miller, Robert; Maskell, Nick; Rahman, Najib; Slade, Mark; Medical and Dental
Introduction: Pleurodesis is a treatment for symptomatic recurrent malignant pleural effusion (MPE) that requires hospital admission. This trial investigated if the use of thoracic ultrasound (TUS) in pleurodesis guidance could shorten length of hospital stay (LOS) in MPE patients undergoing pleurodesis. Methods: Patients were randomized to TUS-guided care or standard care in 1:1 ratio. In intervention arm, daily TUS examination of pleural sliding in nine regions was conducted to derive an ‘adherence score’ (min: 9, sliding present; max: 27, complete absence of sliding), and chest tube was removed if score was >20. In standard care arm tube removal was based on daily output volume. Primary outcome was LOS and secondary outcomes were pleurodesis failure at 3 months, time to tube removal and cost-effectiveness of TUS. Results: 313 patients were recruited; 159 randomised to TUS and 154 to standard care. The median [IQR] LOS was significantly shorter in the TUS arm (2 [2-4] days) compared to standard care (3 [2-5] days, difference 1 day, p<0.001). TUS was non-inferior to standard care in terms of pleurodesis failure at 3 months which occurred in 34.6% of patients (37/107) in the TUS arm vs 32.2% of patients (37/115) in the standard care arm (risk dif. 3.2%; 95% CI -6.1% to 12.6%, non-inferiority margin 15%). Mean (SD) time to chest tube removal in the TUS arm was 2.4 (2.5) days vs. 3.1 (2.0) days in the standard arm (mean dif. -0.72 days, p=0.006). TUS was found to be highly cost-effective. Conclusion: TUS-guided care for pleurodesis in patients with MPE results in shorter hospital stay without reducing pleurodesis success. The data support standard use of TUS in MPE patients undergoing pleurodesis.
The prognostic value of cardiopulmonary exercise testing in interstitial lung disease: a systematic review
(European Respiratory Society, 2020-07) Barratt, Shaney; Davis, Richard; Sharp, Charles; Pauling, John; Sharp, Charles; Medical and Dental
The heterogeneity of interstitial lung disease (ILD) results in prognostic uncertainty concerning end-of-life discussions and optimal timing for transplantation. Effective prognostic markers and prediction models are needed. Cardiopulmonary exercise testing (CPET) provides a comprehensive assessment of the physiological changes in the respiratory, cardiovascular and musculoskeletal systems in a controlled laboratory environment. It has shown promise as a prognostic factor for other chronic respiratory conditions. We sought to evaluate the prognostic value of CPET in predicting outcomes in longitudinal studies of ILD. MEDLINE, Embase and the Cochrane Database of Systematic Reviews were used to identify studies reporting the prognostic value of CPET in predicting outcomes in longitudinal studies of ILD. Study quality was assessed using the Quality in Prognosis Study risk of bias tool. Thirteen studies were included that reported the prognostic value of CPET in ILD. All studies reported at least one CPET parameter predicting clinical outcomes in ILD, with survival being the principal outcome assessed. Maximum oxygen consumption, reduced ventilatory efficiency and exercise-induced hypoxaemia were all reported to have prognostic value in ILD. Issues with study design (primarily due to inherent problems of retrospective studies, patient selection and presentation of numerous CPET parameters), insufficient adjustment for important confounders and inadequate statistical analyses limit the strength of the conclusions that can be drawn at this stage. There is insufficient evidence to confirm the value of CPET in facilitating "real-world" clinical decisions in ILD. Additional prospective studies are required to validate the putative prognostic associations reported in previous studies in carefully phenotyped patient populations. Copyright ©ERS 2020.
Prospective validation of the RAPID clinical risk prediction score in adult patients with pleural infection: the PILOT study
(European Respiratory Society, 2020-11-26) Corcoran, John; Psallidas, Ioannis; Gerry, Stephen; Piccolo, Francesco; Koegelenberg, Coenraad; Saba, Tarek; Daneshvar, Cyrus; Fairburn, Ian; Heinink, Richard; West, Alex; Stanton, Andrew; Holme, Jayne; Kastelik, Jack; Steer, Henry; Steer, Henry; Medical and Dental
Background: Over 30% of adult patients with pleural infection either die and/or require surgery. There is no robust means of predicting at baseline presentation which patients will suffer a poor clinical outcome. A validated risk prediction score would allow early identification of high-risk patients, potentially directing more aggressive treatment thereafter. Objectives: To prospectively assess a previously described risk score (the RAPID (Renal (urea), Age, fluid Purulence, Infection source, Dietary (albumin)) score) in adults with pleural infection. Methods: Prospective observational cohort study that recruited patients undergoing treatment for pleural infection. RAPID score and risk category were calculated at baseline presentation. The primary outcome was mortality at 3 months; secondary outcomes were mortality at 12 months, length of hospital stay, need for thoracic surgery, failure of medical treatment and lung function at 3 months. Results: Mortality data were available in 542 out of 546 patients recruited (99.3%). Overall mortality was 10% at 3 months (54 out of 542) and 19% at 12 months (102 out of 542). The RAPID risk category predicted mortality at 3 months. Low-risk mortality (RAPID score 0-2): five out of 222 (2.3%, 95% CI 0.9 to 5.7%); medium-risk mortality (RAPID score 3-4): 21 out of 228 (9.2%, 95% CI 6.0 to 13.7%); and high-risk mortality (RAPID score 5-7): 27 out of 92 (29.3%, 95% CI 21.0 to 39.2%). C-statistics for the scores at 3 months and 12 months were 0.78 (95% CI 0.71-0.83) and 0.77 (95% CI 0.72-0.82), respectively. Conclusions: The RAPID score stratifies adults with pleural infection according to increasing risk of mortality and should inform future research directed at improving outcomes in this patient population.
Ensuring access to staff with advanced respiratory skills during Covid-19
(EMAP, 2021-08) Kerslake, Emilie; Hams, Steve; Kerslake, Emilie; Hams, Steve; Nursing and Midwifery Registered
As our trust prepared to care for up to 500 patients with Covid-19, we created a team of nurses and other health professionals with advanced respiratory skills to provide support across our hospitals. The respiratory response team of 200 staff was highly visible, wearing bright yellow lanyards, so those working outside their usual area of expertise knew who to approach for help. We also created an online learning package for staff to boost their knowledge of caring for patients needing respiratory care. Our project and materials have since been shared widely across other NHS trusts and beyond.
P175 Clinico-radiological recovery following severe COVID-19 pneumonia
(BMJ Publishing Group, 2022-09-12) Creamer, Andrew; Alaee, Seema; Iftikhar, Hina; Steer, Henry; Creamer, Andrew; Alaee, Seema; Iftikhar, Hina; Steer, Henry; Medical and Dental
No abstract available
53 An audit investigating the role of nasal high flow oxygen therapy in oncology patients – is it delaying appropriate palliation?
(BMJ Publishing Group, 2021-03-16) Green, Seema; Pereira, Adriana; Green, Seema; Pereira, Adriana; Medical and Dental
Introduction High-flow nasal oxygen (HFNO) is increasingly used as part of ward-based treatment, especially for oncology patients with respiratory failure that is either directly due to the underlying malignancy or secondary to anti-cancer drugs or radiotherapy-induced pneumonitis. Patient selection is paramount to its success, as unsuitable selection can result in delays in appropriate palliation, leading to unrealistic expectations for relatives. Methods We performed a retrospective audit of 40 patients across both Gloucester Royal and Cheltenham General Hospitals, who received HFNO on the respiratory wards over July-December 2019. Results The average age for patients receiving HFNO was 74 years with mortality rates being the highest at 80% in the 80–89 years age group. Interestingly, 81% of patients with HFNO as their ceiling of treatment died and only 10% of patients deemed for full escalation of treatment died. The majority of referrals were from medical specialities, closely followed by oncology. The oncology patients did show the highest mortality rates. The majority of patients referred for NHFO were those deemed not to be appropriate for escalation to ITU. Conclusion Our experience demonstrates that the mortality of oncology patients on HFNO is high. Although starting HFNO in these patient groups might be appropriate if we can demonstrate evidence of reversible pathology, care needs to be taken in managing the expectations of patients and their families, and where relevant, appropriate palliative input sought.
16 - What do we do with chest X-rays which are abnormal but not suspicious for lung cancer? Still a role for direct recall CT
(Elsevier, 2021-05-28) Perry-Thomas, Robyn; Steer, Henry; Noble, Jonathan; Amer, Rehman; Steer, Henry; Medical and Dental
No abstract available
Association between Tunneled Pleural Catheter Use and Infection in Patients Immunosuppressed from Antineoplastic Therapy. A Multicenter Study
(American Thoracic Society, 2021-04) Wilshire, Candice; Chang, Shu-Ching; Gilbert, Christopher; Akulian, Jason; AlSarraj, Mohammed; Asciak, Rachelle; Bevill, Benjamin; Davidson, Kevin; Delgado, Ashley; Grosu, Horiana; Steer, Henry; Steer, Henry; Medical and Dental
Rationale: Patients with malignant or paramalignant pleural effusions (MPEs or PMPEs) may have tunneled pleural catheter (TPC) management withheld because of infection concerns from immunosuppression associated with antineoplastic therapy. Objectives: To determine the rate of infections related to TPC use and to determine the relationship to antineoplastic therapy, immune system competency, and overall survival (OS). Methods: We performed an international, multiinstitutional study of patients with MPEs or PMPEs undergoing TPC management from 2008 to 2016. Patients were stratified by whether or not they underwent antineoplastic therapy and/or whether or not they were immunocompromised. Cumulative incidence functions and multivariable competing risk regression analyses were performed to identify independent predictors of TPC-related infection. Kaplan-Meier method and multivariable Cox proportional hazards modeling were performed to examine for independent effects on OS. Results: A total of 1,408 TPCs were placed in 1,318 patients. Patients had a high frequency of overlap between antineoplastic therapy and an immunocompromised state (75-83%). No difference in the overall (6-7%), deep pleural (3-5%), or superficial (3-4%) TPC-related infection rates between subsets of patients stratified by antineoplastic therapy or immune status was observed. The median time to infection was 41 (interquartile range, 19-87) days after TPC insertion. Multivariable competing risk analyses demonstrated that longer TPC duration was associated with a higher risk of TPC-related infection (subdistribution hazard ratio, 1.03; 95% confidence interval [CI], 1.00-1.06; P = 0.028). Cox proportional hazards analysis showed antineoplastic therapy was associated with better OS (hazard ratio, 0.84; 95% CI, 0.73-0.97; P = 0.015). Conclusions: The risk of TPC-related infection does not appear to be increased by antineoplastic therapy use or an immunocompromised state. The overall rates of infection are low and comparable with those of immunocompetent patients with no relevant antineoplastic therapy. These results support TPC palliation for MPE or PMPEs regardless of plans for antineoplastic therapy.
Malignant pleural effusions: the patient experience
(BMJ Publishing Group, 2021-03-11) Jones, Rachel; Steer, Henry; Preston, Nancy; Perkins, Paul; Jones, Rachel; Steer, Henry; Perkins, Paul; Medical and Dental
No abstract available
Safety and immunogenicity of concomitant administration of COVID-19 vaccines (ChAdOx1 or BNT162b2) with seasonal influenza vaccines in adults in the UK (ComFluCOV): a multicentre, randomised, controlled, phase 4 trial
(Elsevier, 2021-11-11) Lazarus, Rajeka; Baos, Sarah; Cappel-Porter, Heike; Carson-Stevens, Andrew; Clout, Madeleine; Culliford, Lucy; Emmett, Stevan; Garstang, Jonathan; Gbadamoshi, Lukuman; Hallis, Bassam; Harris, Rosie; Hutton, David; Jacobsen, Nick; Joyce, Katherine; Kaminski, Rachel; Libri, Vincenzo; Middleditch, Alex; McCullagh, Liz; Moran, Ed; Phillipson, Adrian; Price, Elizabeth; Ryan, John; Thirard, Russell; Todd, Rachel; Snape, Matthew; Tucker, David; Williams, Rachel; Nguyen-Van-Tam, Jonathan; Finn, Adam; Rogers, Chris; Kaminski, Rachel; Medical and Dental
Background: Concomitant administration of COVID-19 and influenza vaccines could reduce burden on health-care systems. We aimed to assess the safety of concomitant administration of ChAdOx1 or BNT162b2 plus an age-appropriate influenza vaccine. Methods: In this multicentre, randomised, controlled, phase 4 trial, adults in receipt of a single dose of ChAdOx1 or BNT162b2 were enrolled at 12 UK sites and randomly assigned (1:1) to receive concomitant administration of either an age-appropriate influenza vaccine or placebo alongside their second dose of COVID-19 vaccine. 3 weeks later the group who received placebo received the influenza vaccine, and vice versa. Participants were followed up for 6 weeks. The influenza vaccines were three seasonal, inactivated vaccines (trivalent, MF59C adjuvanted or a cellular or recombinant quadrivalent vaccine). Participants and investigators were masked to the allocation. The primary endpoint was one or more participant-reported solicited systemic reactions in the 7 days after first trial vaccination(s), with a difference of less than 25% considered non-inferior. Analyses were done on an intention-to-treat basis. Local and unsolicited systemic reactions and humoral responses were also assessed. The trial is registered with ISRCTN, ISRCTN14391248. Findings: Between April 1 and June 26, 2021, 679 participants were recruited to one of six cohorts, as follows: 129 ChAdOx1 plus cellular quadrivalent influenza vaccine, 139 BNT162b2 plus cellular quadrivalent influenza vaccine, 146 ChAdOx1 plus MF59C adjuvanted, trivalent influenza vaccine, 79 BNT162b2 plus MF59C adjuvanted, trivalent influenza vaccine, 128 ChAdOx1 plus recombinant quadrivalent influenza vaccine, and 58 BNT162b2 plus recombinant quadrivalent influenza vaccine. 340 participants were assigned to concomitant administration of influenza and a second dose of COVID-19 vaccine at day 0 followed by placebo at day 21, and 339 participants were randomly assigned to concomitant administration of placebo and a second dose of COVID-19 vaccine at day 0 followed by influenza vaccine at day 21. Non-inferiority was indicated in four cohorts, as follows: ChAdOx1 plus cellular quadrivalent influenza vaccine (risk difference for influenza vaccine minus placebos -1·29%, 95% CI -14·7 to 12·1), BNT162b2 plus cellular quadrivalent influenza vaccine (6·17%, -6·27 to 18·6), BNT162b2 plus MF59C adjuvanted, trivalent influenza vaccine (-12·9%, -34·2 to 8·37), and ChAdOx1 plus recombinant quadrivalent influenza vaccine (2·53%, -13·3 to 18·3). In the other two cohorts, the upper limit of the 95% CI exceeded the 0·25 non-inferiority margin (ChAdOx1 plus MF59C adjuvanted, trivalent influenza vaccine 10·3%, -5·44 to 26·0; BNT162b2 plus recombinant quadrivalent influenza vaccine 6·75%, -11·8 to 25·3). Most systemic reactions to vaccination were mild or moderate. Rates of local and unsolicited systemic reactions were similar between the randomly assigned groups. One serious adverse event, hospitalisation with severe headache, was considered related to the trial intervention. Immune responses were not adversely affected. Interpretation: Concomitant vaccination with ChAdOx1 or BNT162b2 plus an age-appropriate influenza vaccine raises no safety concerns and preserves antibody responses to both vaccines. Concomitant vaccination with both COVID-19 and influenza vaccines over the next immunisation season should reduce the burden on health-care services for vaccine delivery, allowing for timely vaccine administration and protection from COVID-19 and influenza for those in need.
Temporal Trends in Tunneled Pleural Catheter Utilization in Patients With Malignancy: A Multicenter Review
(Elsevier, 2020-12-08) Wilshire, Candice; Chang, Shu-Ching; Gilbert, Christopher; Akulian, Jason; AlSarraj, Mohammed; Asciak, Rachelle; Bevill, Benjamin; Davidson, Kevin; Delgado, Ashley; Grosu, Horiana; Steer, Henry; Steer, Henry; Medical and Dental
No abstract available
Characterisation of patients with severe asthma in the UK Severe Asthma Registry in the biologic era
(BMJ Publishing Group, 2020-12-09) Jackson, David; Busby, John; Pfeffer, Paul; Menzies-Gow, Andrew; Brown, Thomas; Gore, Robin; Doherty, Martin; Mansur, Adel; Message, Simon; Niven, Robert; Patel, Mitesh; Heaney, Liam; Message, Simon; Medical and Dental
Background The UK Severe Asthma Registry (UKSAR) is the world’s largest national severe asthma registry collecting standardised data on referrals to UK specialist services. Novel biologic therapies have transformed the management of type 2(T2)-high severe asthma but have highlighted unmet need in patients with persisting symptoms despite suppression of T2-cytokine pathways with corticosteroids. Methods Demographic, clinical and treatments characteristics for patients meeting European Respiratory Society / American Thoracic Society severe asthma criteria were examined for 2225 patients attending 15 specialist severe asthma centres. We assessed differences in biomarker low patients (fractional exhaled nitric oxide (FeNO) <25 ppb, blood eosinophils <150/μL) compared with a biomarker high population (FeNO ≥25 ppb, blood eosinophils ≥150/µL). Results Age (mean 49.6 (14.3) y), age of asthma onset (24.2 (19.1) y) and female predominance (62.4%) were consistent with prior severe asthma cohorts. Poor symptom control (Asthma Control Questionnaire-6: 2.9 (1.4)) with high exacerbation rate (4 (IQR: 2, 7)) were common despite high-dose treatment (51.7% on maintenance oral corticosteroids (mOCS)). 68.9% were prescribed biologic therapies including mepolizumab (50.3%), benralizumab (26.1%) and omalizumab (22.6%). T2-low patients had higher body mass index (32.1 vs 30.2, p<0.001), depression/anxiety prevalence (12.3% vs 7.6%, p=0.04) and mOCS use (57.9% vs 42.1%, p<0.001). Many T2-low asthmatics had evidence of a historically elevated blood eosinophil count (0.35 (0.13, 0.60)). Conclusions The UKSAR describes the characteristics of a large cohort of asthmatics referred to UK specialist severe asthma services. It offers the prospect of providing novel insights across a range of research areas and highlights substantial unmet need with poor asthma control, impaired lung function and high exacerbation rates. T2-high phenotypes predominate with significant differences apparent from T2-low patients. However, T2-low patients frequently have prior blood eosinophilia consistent with possible excessive corticosteroid exposure.
An investigation of the association of thromboembolic disease in patients admitted with COVID-19 in Gloucestershire Royal Hospital
(Elsevier, 2021-06-02) Alaee, Seema; Iftikhar, Hina; Kaminski, Rachel; Sharp, Charles; Bennett, Jessica; Alaee, Seema; Iftikhar, Hina; Kaminski, Rachel; Sharp, Charles; Bennett, Jessica; Medical and Dental
No abstract available
143 - A strategy for improving early recognition of inpatients with lung cancer nearing the end of life in Gloucestershire NHS Foundation Trust (GNHSFT)
(Elsevier, 2022-02-10) Green, Seema; Iftikhar, Hina; Green, Seema; Iftikhar, Hina; Medical and Dental
No abstract available
Effects of Obesity on Response to Asthma Biologic Treatment: Longitudinal Data From the United Kingdom Severe Asthma Registry
(Elsevier, 2025-08-01) Gonem, Sherif; Redmond, Charlene; Busby, John; Patel, Pujan; Jackson, David; Mansur, Adel; Pfeffer, Paul; Pantin, Thomas; Brown, Thomas; Patel, Mitesh; Idris, Efatih; Subramanian, Deepak; Burhan, Hassan; Naveed, Shamsa; Faruqi, Shoaib; Rupani, Hitasha; Vyas, Aashish; Masoli, Matthew; Chaudhuri, Rekha; Message, Simon; Doherty, Martin; Sammut, David; Heaney, Liam; Message, Simon; Medical and Dental
Background: Obesity is a common comorbidity associated with poor outcomes in severe asthma. Objective: We aimed to determine whether obesity is associated with an altered response to severe asthma biologic agents. Methods: We analyzed data from the UK Severe Asthma Registry, a large UK-wide cohort of patients attending regional severe asthma services. We analyzed the change in clinical outcomes between baseline and first annual review visit by body mass index (BMI) category (healthy range [18.50-24.99], overweight [25.00-29.99], obese [30.00-39.99], and severely obese [≥40]) and biologic treatment status. Results: The study cohort comprised 1956 patients, of whom 1477 (75.5%) commenced a biologic agent during the follow-up. Baseline Asthma Control Questionnaire-6 (ACQ-6) scores and rates of exacerbations, emergency department attendances, and hospital admissions were higher with increasing BMI category. Biologic treatment was associated with significant additional improvement in ACQ-6, compared with patients not receiving biologics, in overweight, obese, and severely obese patients. However, the ACQ-6 score after biologic treatment remained significantly different across BMI categories, with the mean score being 1.3 in the healthy weight group and 2.8 in the severely obese group (P < .001). Biologic treatment was associated with significant additional reductions in exacerbation rates in all BMI groups except for the severely obese group. Conclusions: Asthma biologic agents appear to have important clinical benefits across the spectrum of BMI. However, because patients with obesity start at a worse baseline with respect to symptoms and exacerbations, they are still more likely to remain uncontrolled after treatment.
Randomised trial of indwelling pleural catheters for refractory transudative pleural effusions
(European Respiratory Society, 2022-02-24) Walker, Steven; Bintcliffe, Oliver; Keenan, Emma; Stadon, Louise; Evison, Matthew; Haris, Mohammed; Nagarajan, Thapas; West, Alex; Ionescu, Alina; Prudon, Benjamin; Guhan, Anur; Mustafa, Rehan; Herre, Jurgen; Arnold, David; Bhatnagar, Rahul; Kahan, Brennan; Miller, Robert; Rahman, Najib; Maskell, Nick; Bintcliffe, Oliver; Medical and Dental
Objective: Refractory symptomatic transudative pleural effusions are an indication for pleural drainage. There has been supportive observational evidence for the use of indwelling pleural catheters (IPCs) for transudative effusions, but no randomised trials. We aimed to investigate the effect of IPCs on breathlessness in patients with transudative pleural effusions when compared with standard care. Methods: A multicentre randomised controlled trial, in which patients with transudative pleural effusions were randomly assigned to either an IPC (intervention) or therapeutic thoracentesis (TT; standard care). The primary outcome was mean daily breathlessness score over 12 weeks from randomisation. Results: 220 patients were screened from April 2015 to August 2019 across 13 centres, with 33 randomised to intervention (IPC) and 35 to standard care (TT). Underlying aetiology was heart failure in 46 patients, liver failure in 16 and renal failure in six. In primary outcome analysis, the mean±sd breathlessness score over the 12-week study period was 39.7±29.4 mm in the IPC group and 45.0±26.1 mm in the TT group (p=0.67). Secondary outcomes analysis demonstrated that mean±sd drainage was 17 412±17 936 mL and 2901±2416 mL in the IPC and TT groups, respectively. A greater proportion of patients had at least one adverse event in the IPC group (p=0.04). Conclusion: We found no significant difference in breathlessness over 12 weeks between IPCs or TT. TT is associated with fewer complications and IPCs reduced the number of invasive pleural procedures required. Patient preference and circumstances should be considered in selecting the intervention in this cohort.

Browse

Recent Submissions