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Gonsard A, Mekov E, Barron S, Castellana G, Khurtsidze E, Vontetsianos A, Pennati F, Sivapalan P, Latimer LE, Marillier M, Hui CY, Kaltsakas G, Kolekar S, Vagheggini G, Vicente C, Drummond D, Poberezhets V, Bayat S, Franssen FM, Vogiatzis I, Gille T. ERS International Congress 2023: highlights from the Respiratory Clinical Care and Physiology Assembly. ERJ Open Res 2024; 10:00178-2024. [PMID: 38770003 PMCID: PMC11103686 DOI: 10.1183/23120541.00178-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 05/22/2024] Open
Abstract
It is a challenge to keep abreast of all the clinical and scientific advances in the field of respiratory medicine. This article contains an overview of laboratory-based science, clinical trials and qualitative research that were presented during the 2023 European Respiratory Society International Congress within the sessions from the five groups of Assembly 1 (Respiratory Clinical Care and Physiology). Selected presentations are summarised from a wide range of topics: clinical problems, rehabilitation and chronic care, general practice and primary care, electronic/mobile health (e-health/m-health), clinical respiratory physiology, exercise and functional imaging.
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Affiliation(s)
- Apolline Gonsard
- Department of Paediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP and Université Paris Cité, Paris, France
- These authors have contributed equally to this work and share first authorship
| | - Evgeni Mekov
- Department of Pulmonary Diseases, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
- These authors have contributed equally to this work and share first authorship
| | - Sarah Barron
- Tallaght University Hospital, Dublin, Ireland
- These authors have contributed equally to this work and share first authorship
| | - Giorgio Castellana
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
- These authors have contributed equally to this work and share first authorship
| | - Elene Khurtsidze
- Alte University, Tbilisi, Georgia
- Clinical Department, Geo Hospitals, Tbilisi, Georgia
- These authors have contributed equally to this work and share first authorship
| | - Angelos Vontetsianos
- 1st Respiratory Medicine Department, “Sotiria” Hospital for Diseases of the Chest, National and Kapodistrian University of Athens Medical School, Athens, Greece
- These authors have contributed equally to this work and share first authorship
| | - Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
- These authors have contributed equally to this work and share first authorship
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Department of Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- University of Copenhagen, Faculty of Health Sciences, Department of Clinical Medicine, Copenhagen, Denmark
- These authors have contributed equally to this work and share first authorship
| | - Lorna E. Latimer
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Institute for Lung Health, National Institute for Health Research Leicester Biomedical Research Centre – Respiratory, Glenfield Hospital, Leicester, UK
- These authors have contributed equally to this work and share first authorship
| | - Mathieu Marillier
- Université Grenoble Alpes, Inserm, Laboratoire HP2, Grenoble, France
- Laboratory of Clinical Exercise Physiology, Queen's University, Kingston, ON, Canada
- These authors have contributed equally to this work and share first authorship
| | - Chi-Yan Hui
- The University of Edinburgh, Allergy and Respiratory Research Group, Usher Institute, Edinburgh, UK
- These authors have contributed equally to this work and share first authorship
| | - Georgios Kaltsakas
- 1st Respiratory Medicine Department, “Sotiria” Hospital for Diseases of the Chest, National and Kapodistrian University of Athens Medical School, Athens, Greece
- Lane Fox Respiratory Service, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- Centre of Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Shailesh Kolekar
- University of Copenhagen, Faculty of Health Sciences, Department of Clinical Medicine, Copenhagen, Denmark
- Zealand University Hospital Roskilde, Department of Internal Medicine, Roskilde, Denmark
| | - Guido Vagheggini
- Azienda USL Toscana Nord Ovest, Department of Medical Specialties, Chronic Respiratory Failure Care Pathway, Volterra, Italy
- Fondazione Volterra Ricerche Onlus, Volterra, Italy
| | | | - David Drummond
- Department of Paediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP and Université Paris Cité, Paris, France
- Inserm UMR 1138, HeKA team, Centre de Recherche des Cordeliers, Paris, France
| | - Vitalii Poberezhets
- Department of Propedeutics of Internal Medicine, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Sam Bayat
- CHU Grenoble Alpes, Service de Pneumologie et de Physiologie, Grenoble, France
- Université Grenoble Alpes, Inserm UA07 STROBE, Grenoble, France
| | - Frits M.E. Franssen
- Maastricht Universitair Medisch Centrum+, Department of Respiratory Medicine, Maastricht, The Netherlands
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne, UK
| | - Thomas Gille
- Physiologie et Explorations Fonctionnelles, DMU NARVAL, Hôpitaux Universitaires de Paris Seine-Saint-Denis, AP-HP, Bobigny, France
- Inserm UMR 1272 “Hypoxia & the Lung”, UFR SMBH Léonard de Vinci, Université Sorbonne Paris Nord, Bobigny, France
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Drover H, Gardiner L, Singh SJ, Evans RA, Daynes E, Orme MW. Protected characteristics reported in pulmonary rehabilitation: a scoping review. Eur Respir Rev 2024; 33:230236. [PMID: 39009405 DOI: 10.1183/16000617.0236-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/19/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND An individual's characteristics are reported to influence access, completion and outcomes of pulmonary rehabilitation and may contribute to health inequalities. Many countries have policies to promote equity among individuals' characteristics, including the UK Equality Act 2010 which lists nine protected characteristics (age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation). OBJECTIVES To describe the extent to which UK Equality Act 2010 protected characteristics have been collected and reported in UK studies and audits of pulmonary rehabilitation. METHODS A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines was conducted using five databases. UK studies and audits collecting data on pulmonary rehabilitation from 1 October 2010 (date of Equality Act 2010 inception) were eligible. The protected characteristics collected and how they were reported were extracted. RESULTS Out of 45 included studies and audits (41 studies and four audits), 98% (k=44) reported age. Sex was reported in 40% (k=18), and 20% (k=9) reported gender with only male and female categories. Half (50%, k=2) of audits reported gender with male, female and transgender categories. Race was reported through ethnicity in 2% (k=1) of studies and 75% (k=3) of audits. No studies or audits explicitly reported disability, but all reported measures indicating disease severity (e.g. forced expiratory volume in 1 s % predicted: 67%, k=30). No studies or audits reported marriage and civil partnership, pregnancy and maternity, religion or belief or sexual orientation. CONCLUSIONS Protected characteristics are not commonly reported or are inconsistently reported in UK pulmonary rehabilitation studies and audits. Without reporting these characteristics, health inequalities in pulmonary rehabilitation will remain unclear.
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Affiliation(s)
- Holly Drover
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lucy Gardiner
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rachael A Evans
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Enya Daynes
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
- Both authors contributed equally
| | - Mark W Orme
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- Centre for Exercise and Rehabilitation Science, National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre - Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
- Both authors contributed equally
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Man W, Chaplin E, Daynes E, Drummond A, Evans RA, Greening NJ, Nolan C, Pavitt MJ, Roberts NJ, Vogiatzis I, Singh SJ. British Thoracic Society Clinical Statement on pulmonary rehabilitation. Thorax 2023; 78:s2-s15. [PMID: 37770084 DOI: 10.1136/thorax-2023-220439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Affiliation(s)
- William Man
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Emma Chaplin
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Enya Daynes
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Alistair Drummond
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - Rachael A Evans
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Neil J Greening
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
| | - Claire Nolan
- Royal Brompton & Harefield Hospitals, Guy's and St.Thomas' NHS Foundation Trust, London, UK
- Department of Health Sciences, College of Health Medicine and Life Sciences, Brunel University London, London, UK
| | - Matthew J Pavitt
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Nicola J Roberts
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumberland University Newcastle, Newcastle Upon Tyne, UK
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, NIHR Biomedical Research Centre - Respiratory, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, Leicester, UK
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Cheng SWM, McKeough ZJ, McNamara RJ, Alison JA. Pulmonary Rehabilitation Using Minimal Equipment for People With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Phys Ther 2023; 103:pzad013. [PMID: 37140475 PMCID: PMC10158642 DOI: 10.1093/ptj/pzad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/10/2022] [Accepted: 12/28/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Pulmonary rehabilitation programs that use minimal equipment for exercise training, rather than gymnasium equipment, would enable delivery of pulmonary rehabilitation to a greater number of people with chronic obstructive pulmonary disease (COPD). The effectiveness of minimal equipment programs in people with COPD is unclear. This systematic review and meta-analysis aimed to determine the effects of pulmonary rehabilitation using minimal equipment for aerobic and/or resistance training in people with COPD. METHODS Literature databases were searched up to September 2022 for randomized controlled trials (RCTs) comparing the effect of minimal equipment programs with usual care or with exercise equipment-based programs for exercise capacity, health-related quality of life (HRQoL), and strength. RESULTS Nineteen RCTs were included in the review and 14 RCTs were included in the meta-analyses, which reported low to moderate certainty of evidence. Compared with usual care, minimal equipment programs increased 6-minute walk distance (6MWD) by 85 m (95% CI = 37 to 132 m). No difference in 6MWD was observed between minimal equipment and exercise equipment-based programs (14 m, 95% CI = -27 to 56 m). Minimal equipment programs were more effective than usual care for improving HRQoL (standardized mean difference = 0.99, 95% CI = 0.31 to 1.67) and were not different from exercise equipment-based programs for improving upper limb strength (6 N, 95% CI = -2 to 13 N) or lower limb strength (20 N, 95% CI = -30 to 71 N). CONCLUSION In people with COPD, pulmonary rehabilitation programs using minimal equipment elicit clinically significant improvements in 6MWD and HRQoL and are comparable with exercise equipment-based programs for improving 6MWD and strength. IMPACT Pulmonary rehabilitation programs using minimal equipment may be a suitable alternative in settings where access to gymnasium equipment is limited. Delivery of pulmonary rehabilitation programs using minimal equipment may improve access to pulmonary rehabilitation worldwide, particularly in rural and remote areas and in developing countries.
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Affiliation(s)
- Sonia Wing Mei Cheng
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Zoe J McKeough
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Renae J McNamara
- Department of Physiotherapy, Prince of Wales Hospital, South Eastern Sydney Local Health District, Sydney, Australia
- Woolcock Emphysema Centre, Woolcock Institute of Medical Research, Sydney, Australia
| | - Jennifer A Alison
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Allied Health Professorial Unit, Sydney Local Health District, Sydney, Australia
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Patel S, Jones SE, Walsh JA, Barker RE, Polgar O, Maddocks M, Hopkinson NS, Nolan CM, Man WDC. The Six-minute Step Test as an Exercise Outcome in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2023; 20:476-479. [PMID: 36240127 PMCID: PMC9993159 DOI: 10.1513/annalsats.202206-516rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Suhani Patel
- Guy’s and St. Thomas’ NHS Foundation TrustLondon, United Kingdom
- Imperial College LondonLondon, United Kingdom
| | - Sarah E. Jones
- Guy’s and St. Thomas’ NHS Foundation TrustLondon, United Kingdom
| | - Jessica A. Walsh
- Guy’s and St. Thomas’ NHS Foundation TrustLondon, United Kingdom
| | - Ruth E. Barker
- Guy’s and St. Thomas’ NHS Foundation TrustLondon, United Kingdom
- Wessex Academic Health Science NetworkHampshire, United Kingdom
| | - Oliver Polgar
- Guy’s and St. Thomas’ NHS Foundation TrustLondon, United Kingdom
| | | | | | - Claire M. Nolan
- Guy’s and St. Thomas’ NHS Foundation TrustLondon, United Kingdom
- Brunel University LondonLondon, United Kingdom
| | - William D.-C. Man
- Guy’s and St. Thomas’ NHS Foundation TrustLondon, United Kingdom
- Imperial College LondonLondon, United Kingdom
- King’s College LondonLondon, United Kingdom
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Pan Y, Yang H, Quan L, Wang S, Xu Y, Chen Y. Effects of full-body exercise-based pulmonary rehabilitation in patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e064212. [PMID: 36564122 PMCID: PMC9791421 DOI: 10.1136/bmjopen-2022-064212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease characterised by progressive and irreversible fibrosis of the lung parenchyma, resulting in reduced lung function. Since conventional medicines can be associated with low effective rates and adverse events, pulmonary rehabilitation may be a promising non-pharmacological therapy for IPF. Thus, we aimed to evaluate the effects of full-body exercise-based pulmonary rehabilitation on patients with IPF by conducting a systematic review and meta-analysis of randomised controlled trials (RCTs). METHODS AND ANALYSIS This systematic review and meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO). From inception to 31 August 2022, electronic databases in English and Chinese were searched, including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials among the English databases. China National Knowledge Infrastructure, Chinese Biomedical Literature, VIP Chinese Science and Technology Periodical, and Wan Fang Data were among the Chinese databases. Two independent reviewers then screened the potential RCT studies, which were analysed according to the Cochrane Handbook criteria. The efficacy and safety of full-body exercise pulmonary rehabilitation for IPF were evaluated based on outcomes, including exercise capacity measured by 6 min walking distance and quality of life measured by St. George's Respiratory Questionnaire. Lung function was measured based on the forced vital capacity, total lung capacity, diffusing capacity of the lungs for carbon monoxide and dyspnoea assessed by the modified Medical Research Council scale. ETHICS AND DISSEMINATION Ethical approval was not required for this systematic review and meta-analysis. Results will be published in a peer-reviewed journal and presented at conferences. PROSPERO REGISTRATION NUMBER CRD42021284293.
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Affiliation(s)
- Yi Pan
- Chengdu Second People's Hospital, Chengdu, China
| | - Han Yang
- Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, Sichuan, China
| | - Luo Quan
- Chengdu Second People's Hospital, Chengdu, Sichuan Province, China
| | - Shurong Wang
- Chengdu Second People's Hospital, Chengdu, Sichuan Province, China
| | - Youli Xu
- Chengdu Second People's Hospital, Chengdu, Sichuan Province, China
| | - Yu Chen
- Chengdu Second People's Hospital, Chengdu, Sichuan, China
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Alexiou C, Chambers F, Megaritis D, Wakenshaw L, Echevarria C, Vogiatzis I. Greater exercise tolerance in COPD during acute intermittent compared to continuous shuttle walking protocols: A proof-of-concept study. Chron Respir Dis 2022; 19:14799731221142023. [PMID: 36548147 PMCID: PMC9793067 DOI: 10.1177/14799731221142023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives: Ground-based walking is a simple training modality which would suit pulmonary rehabilitation (PR) settings with limited access to specialist equipment. Patients with COPD are, however, unable to walk uninterruptedly at a relatively fast walking pace to optimise training benefits. We compared an intermittent (IntSW) to a continuous (CSW) shuttle walking protocol.Methods: In 14 COPD patients (mean ± SD. FEV1: 45 ± 21% predicted) we measured walking distance, cardiac output (CO), arterial oxygen saturation (SpO2), and symptoms during (a) an IntSW protocol, consisting of 1-min walking alternating with 1-min rest, and (b) a CSW protocol, both sustained at 85% of predicted VO2 peak to the limit of tolerance (Tlim).Results: Median (IQR) distance was greater (p = 0.001) during the IntSW protocol (735 (375-1107) m) than the CSW protocol (190 (117-360) m). At iso-distance (distance at Tlim during CSW) the IntSW compared to the CSW protocol was associated with lower CO (8.6 ± 2.6 vs 10.3 ± 3.7 L/min; p = 0.013), greater SpO2 (92 ± 6% versus 90 ± 7%; p = 0.002), and lower symptoms of dyspnoea (2.8 ± 1.3 vs 4.9 ± 1.4; p = 0.001) and leg discomfort (2.3 ± 1.7 vs 4.2 ± 2.2; p = 0.001). At Tlim symptoms of dyspnoea and leg discomfort did not differ between the IntSW (4.4 ± 1.9 and 3.6 ± 2.1, respectively) and the CSW protocol.Conclusions: The IntSW protocol may provide important clinical benefits during exercise training in the PR settings because it allows greater work outputs compared to the CSW.
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Affiliation(s)
- Charikleia Alexiou
- Faculty of Health and Life
Sciences, Department of Sport, Exercise and Rehabilitation, Northumbria University
Newcastle, Newcastle upon Tyne, UK,Charikleia Alexiou, Faculty of Health and
Life Sciences, Northumbria University Newcastle, Department of Sport, Exercise
and Rehabilitation, Northumberland Building, Newcastle upon Tyne NE1 8ST, UK.
| | - Francesca Chambers
- Pulmonary Rehabilitation Services, Newcastle upon Tyne Hospitals NHS
Foundation Trust, Newcastle upon Tyne, UK
| | - Dimitrios Megaritis
- Faculty of Health and Life
Sciences, Department of Sport, Exercise and Rehabilitation, Northumbria University
Newcastle, Newcastle upon Tyne, UK
| | - Lynsey Wakenshaw
- Pulmonary Rehabilitation Services, Newcastle upon Tyne Hospitals NHS
Foundation Trust, Newcastle upon Tyne, UK
| | - Carlos Echevarria
- Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS
Foundation Trust, Newcastle upon Tyne, UK
| | - Ioannis Vogiatzis
- Faculty of Health and Life
Sciences, Department of Sport, Exercise and Rehabilitation, Northumbria University
Newcastle, Newcastle upon Tyne, UK
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Gloeckl R, Zwick R, Fürlinger U, Jarosch I, Schneeberger T, Leitl D, Koczulla A, Vonbank K, Alexiou C, Vogiatzis I, Spruit M. Prescribing and adjusting exercise training in chronic respiratory diseases – Expert-based practical recommendations. Pulmonology 2022:S2531-0437(22)00215-X. [DOI: 10.1016/j.pulmoe.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/26/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022] Open
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Osadnik CR. Challenging the Evidence for Pulmonary Rehabilitation in Pulmonary Fibrosis. Chest 2022; 161:599-600. [DOI: 10.1016/j.chest.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022] Open
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Bickton FM, Mankhokwe T, Nightingale R, Fombe C, Mitengo M, Mwahimba L, Lipita W, Wilde L, Pina I, Yusuf ZK, Ahmed Z, Kamponda M, Limbani F, Shannon H, Chisati E, Barton A, Free RC, Steiner M, Matheson JA, Manise A, Singh SJ, Rylance J, Orme M. Protocol for a single-centre mixed-method pre-post single-arm feasibility trial of a culturally appropriate 6-week pulmonary rehabilitation programme among adults with functionally limiting chronic respiratory diseases in Malawi. BMJ Open 2022; 12:e057538. [PMID: 35105655 PMCID: PMC8804676 DOI: 10.1136/bmjopen-2021-057538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/13/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Malawi has a substantial burden of chronic respiratory diseases (CRDs) which cause significant morbidity and loss of economic productivity, affecting patients, families and health systems. Pulmonary rehabilitation (PR) is a highly recommended non-pharmacological intervention in the clinical management of people with CRDs. However, Malawi lacks published evidence on the implementation of PR for people with CRDs. This trial will test the feasibility and acceptability of implementing a culturally appropriate hospital-based PR programme among adults with functionally limiting CRDs at Queen Elizabeth Central Hospital in Blantyre, Malawi. METHODS AND ANALYSIS This is a single-centre mixed-methods pre-post single-arm feasibility trial. Ten patients aged ≥18 years, with a spirometry confirmed diagnosis of a CRD and breathlessness of ≥2 on the modified Medical Research Council dyspnoea scale, will be consecutively recruited. Their baseline lung function, exercise tolerance and health status will be assessed; including spirometry, Incremental Shuttle Walk Test and Chronic Obstructive Pulmonary Disease Assessment Test, respectively. Pretrial semistructured in-depth interviews will explore their experiences of living with CRD and potential enablers and barriers to their PR uptake. Along with international PR guidelines, these data will inform culturally appropriate delivery of PR. We initially propose a 6-week, twice-weekly, supervised centre-based PR programme, with an additional weekly home-based non-supervised session. Using combination of researcher observation, interaction with the participants, field notes and informal interviews with the participants, we will assess the feasibility of running the programme in the following areas: participants' recruitment, retention, engagement and protocol adherence. Following programme completion (after 6 weeks), repeat assessments of lung function, exercise tolerance and health status will be conducted. Quantitative changes in clinical outcomes will be described in relation to published minimal clinically important differences. Post-trial semistructured interviews will capture participants' perceived impact of the PR programme on their quality of life, enablers, and barriers to fully engaging with the programme, and allow iteration of its design. ETHICS AND DISSEMINATION Ethical approval for this trial was obtained from University of Malawi College of Medicine Research and Ethics Committee (COMREC), Blantyre, Malawi (protocol number: P.07/19/2752) and University of Leicester Research Ethics Committee, Leicester, UK (ethics reference: 31574). The results of the trial will be disseminated through oral presentations at local and international scientific conferences or seminars and publication in a peer-reviewed journal. We will also engage the participants who complete the PR trial and the Science Communication Department at Malawi-Liverpool-Wellcome Trust Clinical Research Programme to organise community outreach activities within Blantyre to educate communities about CRDs and PR. We will also broadcast our trial results through national radio station programmes such as the weekly "Thanzi la Onse" (Health of All) programme by Times Radio Malawi. We will formally present our trial results to Blantyre District Health Office and Malawi Ministry of Health. TRIAL REGISTRATION NUMBER ISRCTN13836793.
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Affiliation(s)
- Fanuel Meckson Bickton
- Lung Health Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- UCL GOS Institute of Child Health, University College London, London, UK
| | - Talumba Mankhokwe
- Physiotherapy Department, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Rebecca Nightingale
- Lung Health Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Cashon Fombe
- Physiotherapy Department, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Martha Mitengo
- Physiotherapy Department, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Langsfield Mwahimba
- Physiotherapy Department, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Wilfred Lipita
- Physiotherapy Department, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Laura Wilde
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, East Midlands, UK
| | - Ilaria Pina
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, East Midlands, UK
| | - Zainab K Yusuf
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, East Midlands, UK
| | - Zahira Ahmed
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, East Midlands, UK
| | - Martin Kamponda
- Medicine Department, Queen Elizabeth Central Hospital, Blantyre, Southern Region, Malawi
| | - Felix Limbani
- Lung Health Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Harriet Shannon
- UCL GOS Institute of Child Health, University College London, London, UK
| | - Enock Chisati
- Department of Rehabilitation Sciences, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Andy Barton
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Robert C Free
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Michael Steiner
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, East Midlands, UK
| | | | - Adrian Manise
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sally J Singh
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, East Midlands, UK
| | - Jamie Rylance
- Lung Health Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mark Orme
- Department of Respiratory Sciences, University of Leicester, Leicester, Leicestershire, UK
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre Respiratory Diseases, Leicester, East Midlands, UK
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11
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Bickton FM, Shannon H. Barriers and Enablers to Pulmonary Rehabilitation in Low- and Middle-Income Countries: A Qualitative Study of Healthcare Professionals. Int J Chron Obstruct Pulmon Dis 2022; 17:141-153. [PMID: 35046649 PMCID: PMC8763198 DOI: 10.2147/copd.s348663] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/24/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction Low- and middle-income countries bear a disproportionately high burden of global morbidity and mortality caused by chronic respiratory diseases. Pulmonary rehabilitation is recommended as a core intervention in the management of people with chronic respiratory diseases. However, the intervention remains poorly accessed/utilised globally, especially in low- and middle-income countries. Aim This qualitative study explored barriers and enablers to pulmonary rehabilitation in low- and middle-income countries from the perspective of healthcare professionals with pulmonary rehabilitation experience in these settings. Methods Online-based semi-structured in-depth interviews with healthcare professionals were undertaken to data saturation, exploring lived barriers and enablers to pulmonary rehabilitation in their low- or middle-income country. Anonymised interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Results A total of seven healthcare professionals from seven low- and middle-income countries representing Africa, Asia, and South America were interviewed. They included five physiotherapists (four females), one family physician (male), and one pulmonologist (female). Themes for barriers to pulmonary rehabilitation included limited resources, low awareness, coronavirus disease 2019, and patient access-related costs. Themes for enablers included local adaptation, motivated patients, coronavirus disease 2019 (which spanned both enablers and barriers), better awareness/recognition, provision of PR training, and resource support. Conclusion Barriers to pulmonary rehabilitation in low- and middle-income countries include limited resources, low awareness, coronavirus disease 2019, and patient access-related costs. Enablers include local adaptation, motivated patients, coronavirus disease 2019 (which spanned both enablers and barriers), better awareness/recognition, provision of PR training, and resource support. Successful implementation of these enablers will require engagement with multiple stakeholders. The findings of this study are a necessary step towards developing strategies that can overcome the existing pulmonary rehabilitation evidence-practice gap in low- and middle-income countries and alleviating the burden of chronic respiratory diseases in these countries.
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Affiliation(s)
- Fanuel Meckson Bickton
- UCL Great Ormond Street Institute of Child Health, London, UK
- Lung Health Research Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Harriet Shannon
- UCL Great Ormond Street Institute of Child Health, London, UK
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12
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Nolan CM, Walsh JA, Patel S, Barker RE, Polgar O, Maddocks M, Gao W, Wilson R, Fiorentino F, Man W. Minimal versus specialist equipment in the delivery of pulmonary rehabilitation: protocol for a non-inferiority randomised controlled trial. BMJ Open 2021; 11:e047524. [PMID: 34663653 PMCID: PMC8524266 DOI: 10.1136/bmjopen-2020-047524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Pulmonary rehabilitation (PR), an exercise and education programme for people with chronic lung disease, aims to improve exercise capacity, breathlessness and quality of life. Most evidence to support PR is from trials that use specialist exercise equipment, for example, treadmills (PR-gym). However, a significant proportion of programmes do not have access to specialist equipment with training completed with minimal exercise equipment (PR-min). There is a paucity of robust literature examining the efficacy of supervised, centre-based PR-min. We aim to determine whether an 8-week supervised, centre-based PR-min programme is non-inferior to a standard 8-week supervised, centre-based PR-gym programme in terms of exercise capacity and health outcomes for patients with chronic lung disease. METHODS AND ANALYSIS Parallel, two-group, assessor-blinded and statistician-blinded, non-inferiority randomised trial. 436 participants will be randomised using minimisation at the individual level with a 1:1 allocation to PR-min (intervention) or PR-gym (control). Assessment will take place pre-PR (visit 1), post-PR (visit 2) and 12 months following visit 1 (visit 3). Exercise capacity (incremental shuttle walk test), dyspnoea (Chronic Respiratory Questionnaire (CRQ)-Dyspnoea), health-related quality of life (CRQ), frailty (Short Physical Performance Battery), muscle strength (isometric quadriceps maximum voluntary contraction), patient satisfaction (Global Rating of Change Questionnaire), health economic as well as safety and trial process data will be measured. The primary outcome is change in exercise capacity between visit 1 and visit 2. Two sample t-tests on an intention to treat basis will be used to estimate the difference in mean primary and secondary outcomes between patients randomised to PR-gym and PR-min. ETHICS AND DISSEMINATION London-Camden and Kings Cross Research Ethics Committee and Health Research Authority have approved the study (18/LO/0315). Results will be submitted for publication in peer-reviewed journals, presented at international conferences, disseminated through social media, patient and public routes and directly shared with stakeholders. TRIAL REGISTRATION NUMBER ISRCTN16196765.
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Affiliation(s)
- Claire M Nolan
- Harefield Respiratory Research Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Jessica A Walsh
- Harefield Respiratory Research Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Suhani Patel
- Harefield Respiratory Research Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Ruth E Barker
- Harefield Respiratory Research Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Oliver Polgar
- Harefield Respiratory Research Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute, Division of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute, Division of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Rebecca Wilson
- Cicely Saunders Institute, Division of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Francesca Fiorentino
- Imperial Clinical Trials Unit, Imperial College London, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - William Man
- Harefield Respiratory Research Group, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Harefield Pulmonary Rehabilitation Unit, Royal Brompton and Harefield Clinical Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
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13
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da Silva MMC, Arcuri JF, Di Lorenzo VAP. Individualized, low-cost and accessible pulmonary rehabilitation program based on functional clinical tests for individuals with COPD-a study protocol of a randomized controlled trial. Trials 2021; 22:367. [PMID: 34039406 PMCID: PMC8152053 DOI: 10.1186/s13063-021-05267-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) present pulmonary and extrapulmonary impairments. The strategies used to mitigate these impairments are pulmonary rehabilitation programs (PRP). However, there is limited access to PRP in specialized centers and the study of low-cost home rehabilitation programs had non-individualized prescription, which might have led to insignificant positive effects. So, it is important to develop new low-cost protocols that involve individualized prescription, as well as physiotherapist supervision. This study describes an accessible, low-cost, and individualized pulmonary rehabilitation protocol and compare its results when performed with or without a weekly physiotherapist-supervised session on patients with COPD. METHODS This is a descriptive protocol of a clinical trial, randomized, single-blinded, and type of framework is superiority conducted at the Spirometry and Respiratory Physical Therapy Laboratory of the Federal University of São Carlos (UFSCar). The trial is registered in the Brazilian Clinical Trials Registry (ReBec) URL: http://www.ensaiosclinicos.gov.br/rg/RBR-533hht/ with Register Number UTN code U1111-1220-8245. The sample size is 50 patients and is calculated using the results of a pilot study. DISCUSSION-POTENTIAL IMPACT AND SIGNIFICANCE OF THE STUDY It is expected that the low-cost and new supervised rehabilitation program complemented with home exercises will present positive results, especially on exercise capacity, which will make available a more accessible and effective PRP for patients with COPD. TRIAL REGISTRATION ClinicalTrials.gov U1111-1220-8245 . Registered on September 20, 2018.
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Affiliation(s)
- Marcela Maria Carvalho da Silva
- Postgraduate Physiotherapy Department of Federal University of São Carlos, Rodovia Washington Luiz, São Carlos, São Paulo, 13565-905, Brazil.
| | - Juliano Ferreira Arcuri
- Postgraduate Physiotherapy Department of Federal University of São Carlos, Rodovia Washington Luiz, São Carlos, São Paulo, 13565-905, Brazil
| | - Valéria Amorim Pires Di Lorenzo
- Postgraduate Physiotherapy Department of Federal University of São Carlos, Rodovia Washington Luiz, São Carlos, São Paulo, 13565-905, Brazil
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14
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Barker RE, Brighton LJ, Maddocks M, Nolan CM, Patel S, Walsh JA, Polgar O, Wenneberg J, Kon SSC, Wedzicha JA, Man WDC, Farquhar M. Integrating Home-Based Exercise Training with a Hospital at Home Service for Patients Hospitalised with Acute Exacerbations of COPD: Developing the Model Using Accelerated Experience-Based Co-Design. Int J Chron Obstruct Pulmon Dis 2021; 16:1035-1049. [PMID: 33907391 PMCID: PMC8064617 DOI: 10.2147/copd.s293048] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/01/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hospital at home (HaH) schemes allow early discharge of patients hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Traditional outpatient pulmonary rehabilitation (PR) following an AECOPD has an established evidence-base, but there are issues with low referral, uptake and completion. One commonly cited barrier to PR post-hospitalisation relates to poor accessibility. To address this, the aim of this project was to enrol service users (patients with COPD and informal carers) and healthcare professionals to co-design a model of care that integrates home-based exercise training within a HaH scheme for patients discharged from hospital following AECOPD. METHODS This accelerated experience-based co-design project included three audio-recorded stakeholder feedback events, using key "touchpoints" from previous qualitative interviews and a recent systematic review. Audio-recordings were inductively analysed using directed content analysis. An integrated model of care was then developed and finalised through two co-design groups, with the decision-making process facilitated by the tables of changes approach. RESULTS Seven patients with COPD, two informal carers and nine healthcare professionals (from an existing outpatient PR service and HaH scheme) participated in the stakeholder feedback events. Four key themes were identified: 1) individualisation, 2) progression and transition, 3) continuity between services, and 4) communication between stakeholders. Two patients with COPD, one informal carer and three healthcare professionals participated in the first joint co-design group, with five healthcare professionals attending a second co-design group. These achieved a consensus on the integrated model of care. The agreed model comprised face-to-face supervised, individually tailored home-based exercise training one to three times a week, delivered during HaH scheme visits where possible by a healthcare professional competent to provide both home-based exercise training and usual HaH care. CONCLUSION An integrated model of care has been co-designed by patients with COPD, informal carers and healthcare professionals to address low uptake and completion of PR following AECOPD. The co-designed model of care has now been integrated within a well-established HaH scheme.
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Affiliation(s)
- Ruth E Barker
- Harefield Respiratory Research Group, Harefield Hospital, Middlesex, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Lisa J Brighton
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Claire M Nolan
- Harefield Respiratory Research Group, Harefield Hospital, Middlesex, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Suhani Patel
- Harefield Respiratory Research Group, Harefield Hospital, Middlesex, UK
| | - Jessica A Walsh
- Harefield Respiratory Research Group, Harefield Hospital, Middlesex, UK
| | - Oliver Polgar
- Harefield Respiratory Research Group, Harefield Hospital, Middlesex, UK
| | | | | | | | - William D C Man
- Harefield Respiratory Research Group, Harefield Hospital, Middlesex, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
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