1
|
Chan KPF, Ting-Fung M, Sridhar S, Lui MMS, Ho JCM, Lam DCL, Ip MSM, Ho PL. Changes in the incidence, clinical features and outcomes of tuberculosis during COVID-19 pandemic. J Infect Public Health 2024; 17:102511. [PMID: 39068731 DOI: 10.1016/j.jiph.2024.102511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND COVID-19 pandemic has disrupted tuberculosis (TB) services in many countries, but the impacts on sites of involvement, drug susceptibility, smear positivity and clinical outcomes, and clinical outcomes of co-infection with influenza and COVID-19 remain unclear. METHODS Descriptive epidemiological study using episode-based and patient unique data of tuberculosis from Hospital Authority's territory-wide electronic medical record database, comparing baseline (January 2015-December 2019) and COVID-19 period (January 2020-December 2022), followed by univariate and multivariate analyses. Effects of co-infection with influenza and COVID-19 were investigated. RESULTS The study included 10,473 episodes of laboratory-confirmed TB, with 6818 in baseline period and 3655 during COVID-19 period. During COVID-19 period, TB patients had a lower proportion of smear positivity (49.2 % vs 54.7 %, P < 0.001), and fewer cases of extrapulmonary TB (7.0 % vs 8.0 %, P = 0.078) and multidrug resistant TB (1.0 % vs 1.6 %, P = 0.020). Mortality was higher in TB patients with COVID-19 coinfection (OR 1.7, P = 0.003) and influenza coinfection (OR 2.6, P = 0.004). During COVID-19 period, there were higher rates of treatment delay (20.5 % vs 15.5 %, P < 0.001) and episodic death (15.1 % vs 13.3 %, P = 0.006). Factors associated with higher mortality included age ≥ 70 years (OR 7.24), treatment delay (OR 2.16), extrapulmonary TB (OR 2.13). smear positivity (OR 1.71) and Charlson comorbidity index score ≥ 3 (OR 1.37). Higher mortality was observed with co-infection by influenza (OR 1.18) and COVID-19 (OR 1.7). CONCLUSIONS The epidemiology and outcomes of TB were changed during COVID-19 period. Mortality was higher during COVID-19 period and with co-infection by influenza and COVID-19.
Collapse
Affiliation(s)
- King-Pui Florence Chan
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Ma Ting-Fung
- Department of Statistics, University of South Carolina, USA
| | - Siddharth Sridhar
- Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region
| | - Macy Mei-Sze Lui
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - James Chung-Man Ho
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - David Chi-Leung Lam
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Mary Sau-Man Ip
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region
| | - Pak-Leung Ho
- Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong Special Administrative Region; Carol Yu Centre for Infection, University of Hong Kong, Hong Kong Special Administrative Region.
| |
Collapse
|
2
|
Marco MH, Ahmedov S, Castro KG. The global impact of COVID-19 on tuberculosis: A thematic scoping review, 2020-2023. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003043. [PMID: 38959278 PMCID: PMC11221697 DOI: 10.1371/journal.pgph.0003043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/25/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND This thematic scoping review of publications sought to understand the global impact of COVID-19 on tuberculosis (TB), interpret the scope of resonating themes, and offer policy recommendations to stimulate TB recovery and future pandemic preparedness. DATA SOURCES Publications were captured from three search engines, PubMed, EBSCO, and Google Scholar, and applicable websites written in English from January 1, 2020, to April 30, 2023. STUDY SELECTION Our scoping review was limited to publications detailing the impact of COVID-19 on TB. Original research, reviews, letters, and editorials describing the deleterious and harmful--yet sometimes positive--impact of COVID-19 (sole exposure) on TB (sole outcome) were included. The objective was to methodically categorize the impacts into themes through a comprehensive review of selected studies to provide significant health policy guidance. DATA EXTRACTION Two authors independently screened citations and full texts, while the third arbitrated when consensus was not met. All three performed data extraction. DATA SYNTHESIS/RESULTS Of 1,755 screened publications, 176 (10%) covering 39 countries over 41 months met the inclusion criteria. By independently using a data extraction instrument, the three authors identified ten principal themes from each publication. These themes were later finalized through a consensus decision. The themes encompassed TB's care cascade, patient-centered care, psychosocial issues, and health services: 1) case-finding and notification (n = 45; 26%); 2) diagnosis and laboratory systems (n = 19; 10.7%) 3) prevention, treatment, and care (n = 22; 12.2%); 4) telemedicine/telehealth (n = 12; 6.8%); 5) social determinants of health (n = 14; 8%); 6) airborne infection prevention and control (n = 8; 4.6%); 7) health system strengthening (n = 22; 13%); 8) mental health (n = 13; 7.4%); 9) stigma (n = 11; 6.3%); and 10) health education (n = 10; 5.7%). LIMITATIONS Heterogeneity of publications within themes. CONCLUSIONS We identified ten globally generalizable themes of COVID-19's impact on TB. The impact and lessons learned from the themed analysis propelled us to draft public health policy recommendations to direct evidence-informed guidance that strengthens comprehensive global responses, recovery for TB, and future airborne pandemic preparedness.
Collapse
Affiliation(s)
- Michael H. Marco
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
- Global Health Technical Assistance and Mission Support, Vienna, Virginia, United States of America
| | - Sevim Ahmedov
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
| | - Kenneth G. Castro
- TB Division, Office of Infectious Diseases, Bureau for Global Health, United States Agency for International Development, Washington, District of Columbia, United States of America
- Rollins School of Public Health, School of Medicine, Emory/Georgia TB Research Advancement Center, Atlanta, Georgia, United States of America
| |
Collapse
|
3
|
Ge R, Zhu G, Tian M, Hou Z, Pan W, Feng H, Liu K, Xiao Q, Chen Z. Analysis on time delay of tuberculosis among adolescents and young adults in Eastern China. Front Public Health 2024; 12:1376404. [PMID: 38651131 PMCID: PMC11033351 DOI: 10.3389/fpubh.2024.1376404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/26/2024] [Indexed: 04/25/2024] Open
Abstract
Background Tuberculosis (TB) is recognized as a significant global public health concern. Still, there remains a dearth of comprehensive evaluation regarding the specific indicators and their influencing factors of delay for adolescents and young adults. Methods All notified pulmonary TB (PTB) patients in Jiaxing City were collected between 2005 and 2022 from China's TB Information Management System. Logistic regression models were conducted to ascertain the factors that influenced patient and health system delays for PTB cases, respectively. Furthermore, the impact of the COVID-19 pandemic on local delays has been explored. Results From January 1, 2005 to December 31, 2022, a total of 5,282 PTB cases were notified in Jiaxing City, including 1,678 adolescents and 3,604 young adults. For patient delay, female (AOR: 1.18, 95%CI: 1.05-1.32), PTB complicated with extra-pulmonary TB (AOR: 1.70, 95% CI: 1.28-2.26), passive case finding (AOR: 1.46, 95% CI: 1.07-1.98) and retreatment (AOR: 1.52, 95% CI: 1.11-2.09) showed a higher risk of delay. For health system delay, minorities (AOR: 0.69, 95% CI: 0.53-0.90) and non-students (AOR: 0.83, 95% CI: 0.71-0.98) experienced a lower delay. Referral (AOR: 1.46, 95% CI: 1.29-1.65) had a higher health system delay compared with clinical consultation. Furthermore, county hospitals (AOR: 1.47, 95% CI: 1.32-1.65) and etiological positive results (AOR: 1.46, 95% CI: 1.30-1.63) were associated with comparatively high odds of patient delay. Contrarily, county hospitals (AOR: 0.88, 95% CI: 0.78-1.00) and etiological positive results (AOR: 0.67, 95% CI: 0.59-0.74) experienced a lower health system delay. Besides, the median of patient delay, health system delay, and total delay during the COVID-19 pandemic were significantly lower than that before. Conclusion In general, there has been a noteworthy decline in the notification rate of PTB among adolescents and young adults in Jiaxing City while the declining trend was not obvious in patient delay, health system delay, and total delay, respectively. It also found factors such as gender, case-finding method, and the hospital level might influence the times of seeking health care and diagnosis in health agencies. These findings will provide valuable insights for refining preventive and treatment strategies for TB among adolescents and young adults.
Collapse
Affiliation(s)
- Rui Ge
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Guoying Zhu
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Min Tian
- Nanhu Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Zhigang Hou
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Weizhe Pan
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Hao Feng
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| | - Kui Liu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Qinfeng Xiao
- The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Zhongwen Chen
- Jiaxing Center for Disease Control and Prevention, Jiaxing, Zhejiang, China
| |
Collapse
|
4
|
Huang S, Kang X, Zeng Z, Zhang Q, Huang Z, Luo K, Yao Q, Chen B, Qing C. Neutrophil lncRNA ZNF100-6:2 is a potential diagnostic marker for active pulmonary tuberculosis. Eur J Med Res 2024; 29:162. [PMID: 38475909 DOI: 10.1186/s40001-024-01755-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Active pulmonary tuberculosis (PTB) poses challenges in rapid diagnosis within complex clinical conditions. Given the close association between neutrophils and tuberculosis, we explored differentially expressed long non-coding RNAs (lncRNAs) in neutrophils as potential molecular markers for diagnosing active PTB. We employed a gene microarray to screen for lncRNA alterations in neutrophil samples from three patients with active PTB and three healthy controls. The results revealed differential expression of 1457 lncRNAs between the two groups, with 916 lncRNAs upregulated and 541 lncRNAs down-regulated in tuberculosis patients. Subsequent validation tests demonstrated down-regulation of lncRNA ZNF100-6:2 in patients with active PTB, which was restored following anti-tuberculosis treatment. Our findings further indicated a high diagnostic potential for lncRNA ZNF100-6:2, as evidenced by an area under the receiver operating characteristic (ROC) curve of 0.9796 (95% confidence interval: 0.9479 to 1.000; P < 0.0001). This study proposes lncRNA ZNF100-6:2 as a promising and novel diagnostic biomarker for active PTB.
Collapse
Affiliation(s)
- Shuying Huang
- Department of Reproductive Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China
| | - Xiuhua Kang
- Infection Control Department of the First Affiliated Hospital of Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China
- Major Public Health Medical Center of Jiangxi Province, 17 Yongwai Zhengjie, Nanchang, 330000, China
| | - Zhenguo Zeng
- Department of Intensive Care Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China
- Key Laboratory of Critical Care Medicine, Jiangxi Provincial Health Commission, 17 Yongwai Zhengjie, Nanchang, 330000, China
| | - Qilong Zhang
- Department of Neurology, Chest Hospital of Jiangxi Province, Nanchang, 330006, China
| | - Zikun Huang
- Nanchang Key Laboratory of Diagnosis of Infectious Diseases, Nanchang, China
- Department of Clinical Laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China
| | - Kaihang Luo
- Department of Intensive Care Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China
| | - Qinqin Yao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China
| | - Bing Chen
- Department of Infection, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China
| | - Cheng Qing
- Department of Intensive Care Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, 17 Yongwai Zhengjie, Nanchang, 330000, China.
- Key Laboratory of Critical Care Medicine, Jiangxi Provincial Health Commission, 17 Yongwai Zhengjie, Nanchang, 330000, China.
- Nanchang Key Laboratory of Diagnosis of Infectious Diseases, Nanchang, China.
| |
Collapse
|
5
|
Liu W, Guo J, Jiang Q, Zhou G, Dong Y, Xu B, Liu Z, Zhang Z, Liu J. Quality Control Circle Practices to Improve Mask-Wearing Compliance by Patients Diagnosed with Tuberculosis During External Examinations. Patient Prefer Adherence 2024; 18:227-237. [PMID: 38274356 PMCID: PMC10810000 DOI: 10.2147/ppa.s445632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
Objective The purpose of this study is to examine the effect of quality control circle (QCC) activities on increasing the mask-wearing compliance of hospitalized patients diagnosed with tuberculosis (TB) during external examinations. Methods To assess the mask-wearing compliance of patients diagnosed with TB admitted to a ward in our hospital in 2019, who visited other departments, we conducted activities in accordance with the ten steps of the QCC. We outlined the causes of non-compliance and developed and implemented improvement plans. We compared the results obtained before and after the implementation of the QCC to assess the enhancement in patient compliance concerning wearing masks during external examinations, particularly among individuals diagnosed with pulmonary tuberculosis. Results The compliance rate for mask-wearing during external examinations rose from an initial 32.61% (45/138) prior to the intervention to 83.71% (149/178) following the intervention. The difference between the two groups was statistically significant (χ2 = 85.635, P < 0.001). The following countermeasures and implementation measures were formulated: (1) Increasing public health education and awareness; (2) Strengthening the training of nursing staff to enhance their knowledge; (3) Providing free surgical masks; (4) Establishing an effective monitoring system with the department of auxiliary examinations. Conclusion QCC interventions were significantly effective in enhancing adherence to mask-wearing protocols during external examinations of hospitalized patients with tuberculosis. Such improvements contribute substantially to the mitigation of tuberculosis transmission within clinical and healthcare environments.
Collapse
Affiliation(s)
- Wangmei Liu
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, People’s Republic of China
| | - Jing Guo
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, People’s Republic of China
| | - Qiaomin Jiang
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, People’s Republic of China
| | - Guangnao Zhou
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, People’s Republic of China
| | - Yanyu Dong
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, People’s Republic of China
| | - Biqing Xu
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, People’s Republic of China
| | - Zhongda Liu
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, People’s Republic of China
| | - Zunjing Zhang
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, People’s Republic of China
| | - Jianjun Liu
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, Zhejiang, People’s Republic of China
| |
Collapse
|
6
|
Liu Y, Sun R, Zhang H, Huang J, Chen M, Zhan Y, Xiang J, Yuan J, Zou H, Martinez L, Yang C. Trends and predictions of tuberculosis notification in mainland China during and after the COVID-19 pandemic. J Infect 2023; 87:e100-e103. [PMID: 38251471 DOI: 10.1016/j.jinf.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Yueting Liu
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China; Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Ruoyao Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Hongyin Zhang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jinrong Huang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China; Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Meiru Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China; Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Yiqiang Zhan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jianbang Xiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China
| | - Jianhui Yuan
- Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China.
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - Chongguang Yang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong Province, China; Nanshan District Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China.
| |
Collapse
|
7
|
Namgung SH, Jung J, Kim SK, Kim EO, Jo KW, Shim TS, Kim SH. Incidence of tuberculosis infection in healthcare workers in high-risk departments for tuberculosis after universal wearing of KF94 mask during COVID-19 pandemic. J Infect 2023; 87:344-345. [PMID: 36958636 PMCID: PMC10029346 DOI: 10.1016/j.jinf.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/17/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Song Hee Namgung
- Office for Infection Control, Asan Medical Center, Seoul, the Republic of Korea
| | - Jiwon Jung
- Office for Infection Control, Asan Medical Center, Seoul, the Republic of Korea; Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, the Republic of Korea
| | - Sun Kyung Kim
- Office for Infection Control, Asan Medical Center, Seoul, the Republic of Korea
| | - Eun Ok Kim
- Office for Infection Control, Asan Medical Center, Seoul, the Republic of Korea
| | - Kyung-Wook Jo
- Departments of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, the Republic of Korea
| | - Tae Sun Shim
- Departments of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, the Republic of Korea
| | - Sung-Han Kim
- Office for Infection Control, Asan Medical Center, Seoul, the Republic of Korea; Departments of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, the Republic of Korea.
| |
Collapse
|
8
|
Morrison H, Perrin F, Dedicoat M, Ahmed R, Brown J, Loughenbury M, Paul S, Souto M, Ward R, Lipman M. Impact of COVID-19 on NHS tuberculosis services: Results of a UK-wide survey. J Infect 2023; 87:59-61. [PMID: 37044162 PMCID: PMC10085874 DOI: 10.1016/j.jinf.2023.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/06/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Hazel Morrison
- Centre for Clinical Vaccinology and Tropical Medicine, Jenner Vaccine Trials, Churchill Hospital, Oxford, UK.
| | - Felicity Perrin
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK.
| | - Martin Dedicoat
- Department of Infectious Diseases, University Hospitals Birmingham, Birmingham UK & TB Unit, UKHSA, 61 Colindale Avenue, London, UK.
| | - Rizwan Ahmed
- Department of Respiratory Medicine, Royal Bolton Hospital, Farnworth, Bolton, UK.
| | - James Brown
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond Road, London, UK.
| | | | - Suman Paul
- Department of Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Royal Liverpool University Hospital, Mount Vernon Street, Liverpool, UK.
| | - Miguel Souto
- British Thoracic Society, 17 Doughty Street, London, UK.
| | - Richard Ward
- Department of Respiratory Medicine, Homerton University Hospital, Homerton Row, London, UK.
| | - Marc Lipman
- Faculty of Medical Sciences, University College London, Gower St, London, UK; Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond Road, London, UK.
| |
Collapse
|