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Shrikrishna D, Taylor CJ, Stonham C, Gale CP. Exacerbating the burden of cardiovascular disease: how can we address cardiopulmonary risk in individuals with chronic obstructive pulmonary disease? Eur Heart J 2024; 45:247-249. [PMID: 37832033 PMCID: PMC10821359 DOI: 10.1093/eurheartj/ehad669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Affiliation(s)
- Dinesh Shrikrishna
- Department of Respiratory Medicine, Musgrove Park Hospital, Somerset NHS Foundation Trust, Parkfield Drive, Taunton TA1 5DA, UK
| | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carol Stonham
- Primary Care Respiratory Society (PCRS), London, UK
- NHS Gloucestershire Integrated Care Board, Gloucester, UK
| | - Chris P Gale
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
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Hartley T, Lane ND, Steer J, Elliott MW, Sovani MP, Curtis HJ, Fuller ER, Murphy PB, Shrikrishna D, Lewis KE, Ward NR, Turnbull CD, Hart N, Bourke SC. The Noninvasive Ventilation Outcomes (NIVO) score: prediction of in-hospital mortality in exacerbations of COPD requiring assisted ventilation. Eur Respir J 2021; 58:13993003.04042-2020. [PMID: 33479109 PMCID: PMC8358235 DOI: 10.1183/13993003.04042-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/29/2020] [Indexed: 11/05/2022]
Abstract
Introduction Acute exacerbations of COPD (AECOPD) complicated by acute (acidaemic) hypercapnic respiratory failure (AHRF) requiring ventilation are common. When applied appropriately, ventilation substantially reduces mortality. Despite this, there is evidence of poor practice and prognostic pessimism. A clinical prediction tool could improve decision making regarding ventilation, but none is routinely used. Methods Consecutive patients admitted with AECOPD and AHRF treated with assisted ventilation (principally noninvasive ventilation) were identified in two hospitals serving differing populations. Known and potential prognostic indices were identified a priori. A prediction tool for in-hospital death was derived using multivariable regression analysis. Prospective, external validation was performed in a temporally separate, geographically diverse 10-centre study. The trial methodology adhered to TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) recommendations. Results Derivation cohort: n=489, in-hospital mortality 25.4%; validation cohort: n=733, in-hospital mortality 20.1%. Using six simple categorised variables (extended Medical Research Council Dyspnoea score 1–4/5a/5b, time from admission to acidaemia >12 h, pH <7.25, presence of atrial fibrillation, Glasgow coma scale ≤14 and chest radiograph consolidation), a simple scoring system with strong prediction of in-hospital mortality is achieved. The resultant Noninvasive Ventilation Outcomes (NIVO) score had area under the receiver operating curve of 0.79 and offers good calibration and discrimination across stratified risk groups in its validation cohort. Discussion The NIVO score outperformed pre-specified comparator scores. It is validated in a generalisable cohort and works despite the heterogeneity inherent to both this patient group and this intervention. Potential applications include informing discussions with patients and their families, aiding treatment escalation decisions, challenging pessimism and comparing risk-adjusted outcomes across centres. The NIVO score was created to predict in-hospital mortality in exacerbations of COPD requiring assisted ventilation. Prospective validation under real-world conditions in 10 UK hospitals shows it easily outperforms existing alternative scores.https://bit.ly/3oKMZdI
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Affiliation(s)
- Tom Hartley
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Respiratory Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Nicholas D Lane
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Respiratory Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - John Steer
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Respiratory Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Mark W Elliott
- Respiratory Medicine, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Milind P Sovani
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Helen Jane Curtis
- Respiratory and Critical Care Medicine, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Elizabeth R Fuller
- Department of Respiratory Medicine, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Patrick B Murphy
- Lane Fox Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Dinesh Shrikrishna
- Respiratory Medicine, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK
| | - Keir E Lewis
- Respiratory Medicine, Hywel Dda University Health Board, Llanelli, UK.,School of Medicine, University of Swansea, Swansea, UK
| | - Neil R Ward
- Respiratory Medicine, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Chris D Turnbull
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas Hart
- Lane Fox Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Stephen C Bourke
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Respiratory Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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Pavitt MJ, Tanner RJ, Lewis A, Buttery S, Mehta B, Jefford H, Curtis KJ, Banya WAS, Husain S, Satkunam K, Shrikrishna D, Man W, Polkey MI, Hopkinson NS. Oral nitrate supplementation to enhance pulmonary rehabilitation in COPD: ON-EPIC a multicentre, double-blind, placebo-controlled, randomised parallel group study. Thorax 2020; 75:547-555. [PMID: 32376732 DOI: 10.1136/thoraxjnl-2019-214278] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/23/2020] [Accepted: 04/15/2020] [Indexed: 12/25/2022]
Abstract
RATIONALE Dietary nitrate supplementation has been proposed as a strategy to improve exercise performance, both in healthy individuals and in people with COPD. We aimed to assess whether it could enhance the effect of pulmonary rehabilitation (PR) in COPD. METHODS This double-blind, placebo-controlled, parallel group, randomised controlled study performed at four UK centres, enrolled adults with Global Initiative for Chronic Obstructive Lung Disease grade II-IV COPD and Medical Research Council dyspnoea score 3-5 or functional limitation to undertake a twice weekly 8-week PR programme. They were randomly assigned (1:1) to either 140 mL of nitrate-rich beetroot juice (BRJ) (12.9 mmol nitrate), or placebo nitrate-deplete BRJ, consumed 3 hours prior to undertaking each PR session. Allocation used computer-generated block randomisation. MEASUREMENTS The primary outcome was change in incremental shuttle walk test (ISWT) distance. Secondary outcomes included quality of life, physical activity level, endothelial function via flow-mediated dilatation, fat-free mass index and blood pressure parameters. RESULTS 165 participants were recruited, 78 randomised to nitrate-rich BRJ and 87 randomised to placebo. Exercise capacity increased more with active treatment (n=57) than placebo (n=65); median (IQR) change in ISWT distance +60 m (10, 85) vs +30 m (0, 70), estimated treatment effect 30 m (95% CI 10 to 40); p=0.027. Active treatment also impacted on systolic blood pressure: treatment group -5.0 mm Hg (-5.0, -3.0) versus control +6.0 mm Hg (-1.0, 15.5), estimated treatment effect -7 mm Hg (95% CI 7 to -20) (p<0.0005). No significant serious adverse events or side effects were reported. CONCLUSIONS Dietary nitrate supplementation appears to be a well-tolerated and effective strategy to augment the benefits of PR in COPD. TRIAL REGISTRATION NUMBER ISRCTN27860457.
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Affiliation(s)
- Matthew J Pavitt
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Rebecca Jayne Tanner
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Adam Lewis
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Sara Buttery
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Bhavin Mehta
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Helen Jefford
- Greenwich Adult Community Health Service, Oxleas NHS Foundation Trust, Dartford, Kent, UK
| | - Katrina J Curtis
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Winston A S Banya
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
| | - Syed Husain
- Respiratory Medicine, Maidstone and Tunbridge Wells NHS Trust, Maidstone, Kent, UK
| | - Karnan Satkunam
- Greenwich Adult Community Health Service, Oxleas NHS Foundation Trust, Dartford, Kent, UK
| | - Dinesh Shrikrishna
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK
| | - William Man
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Royal Brompton Campus, Imperial College London, London, UK
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Kon SSC, Jolley CJ, Shrikrishna D, Montgomery HE, Skipworth JRA, Puthucheary Z, Moxham J, Polkey MI, Man WDC, Hopkinson NS. ACE and response to pulmonary rehabilitation in COPD: two observational studies. BMJ Open Respir Res 2017; 4:e000165. [PMID: 28321311 PMCID: PMC5353252 DOI: 10.1136/bmjresp-2016-000165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/13/2016] [Accepted: 01/13/2017] [Indexed: 01/17/2023] Open
Abstract
Introduction Skeletal muscle impairment is an important feature of chronic obstructive pulmonary disease (COPD). Renin–angiotensin system activity influences muscle phenotype, so we wished to investigate whether it affects the response to pulmonary rehabilitation. Methods Two studies are described; in the first, the response of 168 COPD patients (mean forced expiratory volume in one second 51.9% predicted) to pulmonary rehabilitation was compared between different ACE insertion/deletion polymorphism genotypes. In a second, independent COPD cohort (n=373), baseline characteristics and response to pulmonary rehabilitation were compared between COPD patients who were or were not taking ACE inhibitors or angiotensin receptor antagonists (ARB). Results In study 1, the incremental shuttle walk distance improved to a similar extent in all three genotypes; DD/ID/II (n=48/91/29) 69(67)m, 61 (76)m and 78 (78)m, respectively, (p>0.05). In study 2, fat free mass index was higher in those on ACE-I/ARB (n=130) than those who were not (n=243), 17.8 (16.0, 19.8) kg m−2 vs 16.5 (14.9, 18.4) kg/m2 (p<0.001). However change in fat free mass, walking distance or quality of life in response to pulmonary rehabilitation did not differ between groups. Conclusions While these data support a positive association of ACE-I/ARB treatment and body composition in COPD, neither treatment to reduce ACE activity nor ACE (I/D) genotype influence response to pulmonary rehabilitation.
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Affiliation(s)
- Samantha S C Kon
- NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK
| | - Caroline J Jolley
- Department of Respiratory Medicine , King's College Hospital , London , UK
| | - Dinesh Shrikrishna
- NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK
| | - Hugh E Montgomery
- Institute for Human Health and Performance University College , London , UK
| | | | - Zudin Puthucheary
- Department of Respiratory Medicine , King's College Hospital , London , UK
| | - John Moxham
- NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK
| | - William D-C Man
- NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK
| | - Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK
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5
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Mesquita R, Spina G, Pitta F, Donaire-Gonzalez D, Deering BM, Patel MS, Mitchell KE, Alison J, van Gestel AJ, Zogg S, Gagnon P, Abascal-Bolado B, Vagaggini B, Garcia-Aymerich J, Jenkins SC, Romme EA, Kon SS, Albert PS, Waschki B, Shrikrishna D, Singh SJ, Hopkinson NS, Miedinger D, Benzo RP, Maltais F, Paggiaro P, McKeough ZJ, Polkey MI, Hill K, Man WDC, Clarenbach CF, Hernandes NA, Savi D, Wootton S, Furlanetto KC, Cindy Ng LW, Vaes AW, Jenkins C, Eastwood PR, Jarreta D, Kirsten A, Brooks D, Hillman DR, Sant'Anna T, Meijer K, Dürr S, Rutten EP, Kohler M, Probst VS, Tal-Singer R, Gil EG, den Brinker AC, Leuppi JD, Calverley PM, Smeenk FW, Costello RW, Gramm M, Goldstein R, Groenen MT, Magnussen H, Wouters EF, ZuWallack RL, Amft O, Watz H, Spruit MA. Physical activity patterns and clusters in 1001 patients with COPD. Chron Respir Dis 2017; 14:256-269. [PMID: 28774199 PMCID: PMC5720232 DOI: 10.1177/1479972316687207] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We described physical activity measures and hourly patterns in patients with chronic obstructive pulmonary disease (COPD) after stratification for generic and COPD-specific characteristics and, based on multiple physical activity measures, we identified clusters of patients. In total, 1001 patients with COPD (65% men; age, 67 years; forced expiratory volume in the first second [FEV1], 49% predicted) were studied cross-sectionally. Demographics, anthropometrics, lung function and clinical data were assessed. Daily physical activity measures and hourly patterns were analysed based on data from a multisensor armband. Principal component analysis (PCA) and cluster analysis were applied to physical activity measures to identify clusters. Age, body mass index (BMI), dyspnoea grade and ADO index (including age, dyspnoea and airflow obstruction) were associated with physical activity measures and hourly patterns. Five clusters were identified based on three PCA components, which accounted for 60% of variance of the data. Importantly, couch potatoes (i.e. the most inactive cluster) were characterised by higher BMI, lower FEV1, worse dyspnoea and higher ADO index compared to other clusters (p < 0.05 for all). Daily physical activity measures and hourly patterns are heterogeneous in COPD. Clusters of patients were identified solely based on physical activity data. These findings may be useful to develop interventions aiming to promote physical activity in COPD.
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Affiliation(s)
- Rafael Mesquita
- 1 Department of Research & Education, CIRO, Horn, The Netherlands.,2 Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Gabriele Spina
- 3 Department of Signal Processing Systems, Technische Universiteit Eindhoven, Eindhoven, The Netherlands.,4 Smart Professional Spaces Group, Philips Research, Eindhoven, The Netherlands
| | - Fabio Pitta
- 5 Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - David Donaire-Gonzalez
- 6 Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,7 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Brenda M Deering
- 8 Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Mehul S Patel
- 9 NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Katy E Mitchell
- 10 NIHR EM CLAHRC - Centre for Exercise and Rehabilitation Science, University Hospitals, Leicester, UK
| | - Jennifer Alison
- 11 Clinical and Rehabilitation Sciences, The University of Sydney, Sydney, NSW, Australia.,12 Physiotherapy Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Arnoldus Jr van Gestel
- 13 Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland.,Deceased 3 June 2016
| | - Stefanie Zogg
- 14 Medical University Clinic, Cantonal Hospital Baselland, Liestal and Medical Faculty, University of Basel, Basel, Switzerland
| | - Philippe Gagnon
- 15 Centre de recherche, Institut Universitaire de cardiologie et de pneumologie de Québec, 2725 Chemin Ste-Foy Québec, Université Laval, Québec, Canada
| | - Beatriz Abascal-Bolado
- 16 Division of Pulmonary, Hospital U. Marqués de Valdecilla, IFIMAV, Santander, Spain.,17 Mindful Breathing Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Barbara Vagaggini
- 18 Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Judith Garcia-Aymerich
- 6 Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,7 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,19 Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Sue C Jenkins
- 20 School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Elisabeth Apm Romme
- 21 Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Samantha Sc Kon
- 9 NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Paul S Albert
- 22 School of Ageing and Chronic Disease, University Hospital Aintree, Liverpool, UK
| | - Benjamin Waschki
- 23 Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North, Member of the German Centre for Lung Research, Grosshansdorf, Germany
| | - Dinesh Shrikrishna
- 9 NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK.,24 Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Somerset, UK
| | - Sally J Singh
- 10 NIHR EM CLAHRC - Centre for Exercise and Rehabilitation Science, University Hospitals, Leicester, UK
| | - Nicholas S Hopkinson
- 9 NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - David Miedinger
- 14 Medical University Clinic, Cantonal Hospital Baselland, Liestal and Medical Faculty, University of Basel, Basel, Switzerland
| | - Roberto P Benzo
- 17 Mindful Breathing Laboratory, Mayo Clinic, Rochester, MN, USA
| | - François Maltais
- 15 Centre de recherche, Institut Universitaire de cardiologie et de pneumologie de Québec, 2725 Chemin Ste-Foy Québec, Université Laval, Québec, Canada
| | - Pierluigi Paggiaro
- 18 Cardio-Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Zoe J McKeough
- 11 Clinical and Rehabilitation Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Michael I Polkey
- 9 NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Kylie Hill
- 20 School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - William D-C Man
- 9 NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | | | - Nidia A Hernandes
- 5 Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Daniela Savi
- 25 Department of Pediatrics and Pediatric Neurology, Cystic Fibrosis Center, Sapienza University of Rome, Rome, Italy
| | - Sally Wootton
- 11 Clinical and Rehabilitation Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Karina C Furlanetto
- 5 Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Li W Cindy Ng
- 20 School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Anouk W Vaes
- 1 Department of Research & Education, CIRO, Horn, The Netherlands.,26 Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Christine Jenkins
- 27 Woolcock Institute of Medical Research, The University of Sydney, Camperdown, NSW, Australia
| | - Peter R Eastwood
- 28 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Anne Kirsten
- 23 Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North, Member of the German Centre for Lung Research, Grosshansdorf, Germany
| | - Dina Brooks
- 30 Respiratory Medicine, West Park Healthcare Centre and Faculty of Medicine, University of Toronto, Toronto, Canada
| | - David R Hillman
- 28 Department of Pulmonary Physiology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Thaís Sant'Anna
- 5 Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil
| | - Kenneth Meijer
- 31 Department of Human Movement Science, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Selina Dürr
- 14 Medical University Clinic, Cantonal Hospital Baselland, Liestal and Medical Faculty, University of Basel, Basel, Switzerland
| | - Erica Pa Rutten
- 1 Department of Research & Education, CIRO, Horn, The Netherlands
| | - Malcolm Kohler
- 13 Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | - Vanessa S Probst
- 5 Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina (UEL), Londrina, Brazil.,32 Center for Research in Health Sciences, University North of Paraná (UNOPAR), Londrina, Brazil
| | | | | | | | - Jörg D Leuppi
- 14 Medical University Clinic, Cantonal Hospital Baselland, Liestal and Medical Faculty, University of Basel, Basel, Switzerland
| | - Peter Ma Calverley
- 22 School of Ageing and Chronic Disease, University Hospital Aintree, Liverpool, UK
| | - Frank Wjm Smeenk
- 21 Department of Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Richard W Costello
- 8 Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Marco Gramm
- 23 Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North, Member of the German Centre for Lung Research, Grosshansdorf, Germany
| | - Roger Goldstein
- 30 Respiratory Medicine, West Park Healthcare Centre and Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Helgo Magnussen
- 23 Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North, Member of the German Centre for Lung Research, Grosshansdorf, Germany
| | - Emiel Fm Wouters
- 1 Department of Research & Education, CIRO, Horn, The Netherlands.,2 Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Richard L ZuWallack
- 34 Department of Pulmonary and Critical Care, Saint Francis Hospital and Medical Center, Hartford, CT, USA
| | - Oliver Amft
- 3 Department of Signal Processing Systems, Technische Universiteit Eindhoven, Eindhoven, The Netherlands.,35 ACTLab group, Chair of Sensor Technology, University Passau, Passau, Germany
| | - Henrik Watz
- 23 Pulmonary Research Institute at LungClinic Grosshansdorf, Airway Research Center North, Member of the German Centre for Lung Research, Grosshansdorf, Germany
| | - Martijn A Spruit
- 1 Department of Research & Education, CIRO, Horn, The Netherlands.,2 Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands.,36 REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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Burden T, Davis C, Johnstone E, Spence J, Shrikrishna D. P77 Experience of a joint palliative and respiratory clinic on niv treatment initiation in motor neurone disease. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Shrikrishna D, Williams S, Restrick L, Hopkinson NS. Influenza vaccination for NHS staff: attitudes and uptake. BMJ Open Respir Res 2015; 2:e000079. [PMID: 26019875 PMCID: PMC4442178 DOI: 10.1136/bmjresp-2015-000079] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/18/2015] [Accepted: 03/20/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Annual vaccination against influenza (flu) is recommended for all UK National Health Service (NHS) staff to help reduce the risk of contracting the virus and transmitting it to patients. However, despite flu campaigns and vaccination promotion, uptake remains low. The aim of this study was to investigate staff attitudes to flu vaccination to see how this may influence their decision to be vaccinated. METHODS An online survey was sent to staff members across 6 NHS trusts, asking if staff had been vaccinated in the preceding flu season (2013-2014); the survey included questions about beliefs and attitudes to the vaccination, scored on a 5-point Likert scale. RESULTS 3059 NHS staff members responded to the survey (86% in the 26-59 age group, 77% female and 84% hospital based). 68% of respondents reported being vaccinated in the preceding year. Using a stepwise regression model, the survey response retained as a positive predictor of having been vaccinated was 'people working in healthcare should have the flu vaccination every year' (p<0.001), and the responses retained as negative predictors were 'the flu vaccination will make me unwell' (p<0.001) and 'the flu vaccination was too much trouble for me' (p<0.001). Analysis by staff group showed a significant difference in the response to 'the flu vaccination will make me unwell' between groups (p=0.01), with doctors having a greater tendency to disagree with this statement than other staff members. CONCLUSIONS These results suggest that addressing NHS staff beliefs around the need for vaccination, while ensuring that practical barriers to having the vaccination are removed, may help to increase uptake. An emphasis on alleviating the concerns of particular staff groups regarding adverse effects of the vaccine may also be of benefit in improving uptake, to protect patients as well as staff.
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Affiliation(s)
- Dinesh Shrikrishna
- Department of Respiratory Medicine , Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust , London , UK
| | - Siân Williams
- London Respiratory Network, Strategic Clinical Networks , NHS England (London Region) , London , UK
| | - Louise Restrick
- Department of Respiratory Medicine , Whittington Hospital NHS Trust , London , UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust & Imperial College London , London , UK
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8
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Shrikrishna D, Tanner RJ, Lee JY, Natanek A, Lewis A, Murphy PB, Hart N, Moxham J, Montgomery HE, Kemp PR, Polkey MI, Hopkinson NS. A randomized controlled trial of angiotensin-converting enzyme inhibition for skeletal muscle dysfunction in COPD. Chest 2014; 146:932-940. [PMID: 24556825 PMCID: PMC4188149 DOI: 10.1378/chest.13-2483] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Skeletal muscle impairment is a recognized complication of COPD, predicting mortality in severe disease. Increasing evidence implicates the renin-angiotensin system in control of muscle phenotype. We hypothesized that angiotensin-converting enzyme (ACE) inhibition would improve quadriceps function and exercise performance in COPD. METHODS This double-blind, randomized placebo-controlled trial investigated the effect of the ACE inhibitor, fosinopril, on quadriceps function in patients with COPD with quadriceps weakness. Primary outcomes were change in quadriceps endurance and atrophy signaling at 3 months. Quadriceps maximum voluntary contraction (QMVC), mid-thigh CT scan of the cross-sectional area (MTCSA), and incremental shuttle walk distance (ISWD) were secondary outcomes. RESULTS Eighty patients were enrolled (mean [SD], 65 [8] years, FEV1 43% [21%] predicted, 53% men). Sixty-seven patients (31 fosinopril, 36 placebo) completed the trial. The treatment group demonstrated a significant reduction in systolic BP (Δ-10.5 mm Hg; 95% CI, -19.9 to -1.1; P = .03) and serum ACE activity (Δ-20.4 IU/L; 95% CI, -31.0 to -9.8; P < .001) compared with placebo. No significant between-group differences were observed in the primary end points of quadriceps endurance half-time (Δ0.5 s; 95% CI, -13.3-14.3; P = .94) or atrogin-1 messenger RNA expression (Δ-0.03 arbitrary units; 95% CI, -0.32-0.26; P = .84). QMVC improved in both groups (fosinopril: Δ1.1 kg; 95% CI, 0.03-2.2; P = .045 vs placebo: Δ3.6 kg; 95% CI, 2.1-5.0; P < .0001) with a greater increase in the placebo arm (between-group, P = .009). No change was shown in the MTCSA (P = .09) or ISWD (P = .51). CONCLUSIONS This randomized controlled trial found that ACE inhibition, using fosinopril for 3 months, did not improve quadriceps function or exercise performance in patients with COPD with quadriceps weakness. TRIAL REGISTRY Current Controlled Trials; No.: ISRCTN05581879; URL: www.controlled-trials.com.
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Affiliation(s)
- Dinesh Shrikrishna
- National Heart & Lung Institute (NHLI), NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, University College London, London, England; Molecular Medicine Section, National Heart & Lung Institute (NHLI), Imperial College London, University College London, London, England
| | - Rebecca J Tanner
- National Heart & Lung Institute (NHLI), NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, University College London, London, England
| | - Jen Y Lee
- Molecular Medicine Section, National Heart & Lung Institute (NHLI), Imperial College London, University College London, London, England
| | - Amanda Natanek
- National Heart & Lung Institute (NHLI), NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, University College London, London, England; Molecular Medicine Section, National Heart & Lung Institute (NHLI), Imperial College London, University College London, London, England
| | - Amy Lewis
- Molecular Medicine Section, National Heart & Lung Institute (NHLI), Imperial College London, University College London, London, England
| | - Patrick B Murphy
- Guy's and St. Thomas' NHS Foundation Trust and NIHR Comprehensive Biomedical Research Centre and Department of Asthma, Allergy &, University College London, London, England
| | - Nicholas Hart
- Guy's and St. Thomas' NHS Foundation Trust and NIHR Comprehensive Biomedical Research Centre and Department of Asthma, Allergy &, University College London, London, England
| | - John Moxham
- Respiratory Science, Division of Asthma, Allergy and Lung Biology, King's College London, University College London, London, England
| | - Hugh E Montgomery
- Institute for Human Health and Performance, University College London, London, England
| | - Paul R Kemp
- Molecular Medicine Section, National Heart & Lung Institute (NHLI), Imperial College London, University College London, London, England
| | - Michael I Polkey
- National Heart & Lung Institute (NHLI), NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, University College London, London, England
| | - Nicholas S Hopkinson
- National Heart & Lung Institute (NHLI), NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, University College London, London, England.
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Maddocks M, Shrikrishna D, Vitoriano S, Natanek SA, Tanner RJ, Hart N, Kemp PR, Moxham J, Polkey MI, Hopkinson NS. Skeletal muscle adiposity is associated with physical activity, exercise capacity and fibre shift in COPD. Eur Respir J 2014; 44:1188-98. [PMID: 24993908 PMCID: PMC4216454 DOI: 10.1183/09031936.00066414] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Quadriceps muscle phenotype varies widely between patients with chronic obstructive pulmonary disease (COPD) and cannot be determined without muscle biopsy. We hypothesised that measures of skeletal muscle adiposity could provide noninvasive biomarkers of muscle quality in this population. In 101 patients and 10 age-matched healthy controls, mid-thigh cross-sectional area, percentage intramuscular fat and skeletal muscle attenuation were calculated using computed tomography images and standard tissue attenuation ranges: fat -190- -30 HU; skeletal muscle -29-150 HU. Mean±sd percentage intramuscular fat was higher in the patient group (6.7±3.5% versus 4.3±1.2%, p = 0.03). Both percentage intramuscular fat and skeletal muscle attenuation were associated with physical activity level, exercise capacity and type I fibre proportion, independent of age, mid-thigh cross-sectional area and quadriceps strength. Combined with transfer factor of the lung for carbon monoxide, these variables could identify >80% of patients with fibre type shift with >65% specificity (area under the curve 0.83, 95% CI 0.72-0.95). Skeletal muscle adiposity assessed by computed tomography reflects multiple aspects of COPD related muscle dysfunction and may help to identify patients for trials of interventions targeted at specific muscle phenotypes.
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Affiliation(s)
- Matthew Maddocks
- Dept of Palliative Care, Policy and Rehabilitation, King's College London, London, UK Dept of Asthma, Allergy and Lung Biology, King's College London, London, UK Both authors contributed equally
| | - Dinesh Shrikrishna
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK Both authors contributed equally
| | - Simone Vitoriano
- Dept of Palliative Care, Policy and Rehabilitation, King's College London, London, UK Dept of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Samantha A Natanek
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Rebecca J Tanner
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Nicholas Hart
- NIHR Comprehensive Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Paul R Kemp
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - John Moxham
- Dept of Palliative Care, Policy and Rehabilitation, King's College London, London, UK Dept of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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Shaikh ZF, Kelly JL, Shrikrishna D, de Villa M, Mullen MJ, Hopkinson NS, Morrell MJ, Polkey MI. Patent foramen ovale is not associated with hypoxemia in severe chronic obstructive pulmonary disease and does not impair exercise performance. Am J Respir Crit Care Med 2014; 189:540-7. [PMID: 24450410 DOI: 10.1164/rccm.201309-1618oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Patent foramen ovale (PFO) may be disadvantageous in chronic obstructive pulmonary disease (COPD). It is unknown whether right-to-left shunting through PFO increases during exercise impairing exercise performance. OBJECTIVES To determine whether (1) PFO prevalence is greater in hypoxemic versus less hypoxemic patients with COPD, (2) PFO is associated with clinically relevant impairment, and (3) right-to-left shunting increases during exercise and impairs exercise performance. METHODS Patients with COPD and age-matched control subjects underwent contrast transthoracic echocardiography and transcranial Doppler to identify PFO. Patients with COPD with no shunt and patients with large PFO underwent cardiopulmonary exercise tests with contrast transcranial Doppler, esophageal, and gastric balloon catheters. MEASUREMENTS AND MAIN RESULTS PFO prevalence was similar in 50 patients with COPD and 50 healthy control subjects (46% vs. 30%; P = 0.15). Large shunts were more common in patients with COPD (26% vs. 6%; P = 0.01). In an expanded COPD cohort, PFO prevalence was similar in 31 hypoxemic (Pao2 ≤ 7.3 kPa) and 63 less hypoxemic (Pao2 > 8.0 kPa) patients with COPD (39% vs. 52%; P = 0.27). Patients with intrapulmonary shunting had lower Pao2 than both patients with PFO and those with no right-to-left shunt (7.7 vs. 8.6 vs. 9.3 kPa, respectively; P = 0.002). Shunting significantly increased during exercise in patients with COPD with PFO. Endurance time at 60% Vo2max was 574 (178) seconds for patients with PFO and 534 (279) seconds for those without (P = ns). CONCLUSIONS Hypoxemic patients with COPD do not have a higher prevalence of PFO. Patients with COPD with PFO do not perform less well either on a 6-minute walk or submaximal exercise testing despite increased right-to-left shunting during exercise.
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Affiliation(s)
- Zarrin F Shaikh
- 1 Academic Unit of Sleep and Ventilation, National Heart and Lung Institute, and
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Mendoza L, Gogali A, Shrikrishna D, Cavada G, Kemp SV, Natanek SA, Jackson AS, Polkey MI, Wells AU, Hopkinson NS. Quadriceps strength and endurance in fibrotic idiopathic interstitial pneumonia. Respirology 2013; 19:138-43. [DOI: 10.1111/resp.12181] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 07/04/2013] [Accepted: 08/03/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Mendoza
- Hospital Clínico; Universidad de Chile; Santiago Chile
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Athena Gogali
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Dinesh Shrikrishna
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Gabriel Cavada
- Escuela de Salud Pública; Universidad de Chile; Santiago Chile
| | - Samuel V. Kemp
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Samantha A. Natanek
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Abigail S. Jackson
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Michael I. Polkey
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Athol U. Wells
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
| | - Nicholas S. Hopkinson
- National Institute for Health Research Respiratory Biomedical Research Unit; Royal Brompton and Harefield NHS Foundation Trust and Imperial College; London UK
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Hopkinson N, Wallis C, Higgins B, Gaduzo S, Sherrington R, Keilty S, Stern M, Britton J, Bush A, Moxham J, Sylvester K, Griffiths V, Sutherland T, Crossingham I, Raju R, Spencer C, Safavi S, Deegan P, Seymour J, Hickman K, Hughes J, Wieboldt J, Shaheen F, Peedell C, Mackenzie N, Nicholl D, Jolley C, Crooks G, Crooks G, Dow C, Deveson P, Bintcliffe O, Gray B, Kumar S, Haney S, Docherty M, Thomas A, Chua F, Dwarakanath A, Summers G, Prowse K, Lytton S, Ong YE, Graves J, Banerjee T, English P, Leonard A, Brunet M, Chaudhry N, Ketchell RI, Cummings N, Lebus J, Sharp C, Meadows C, Harle A, Stewart T, Parry D, Templeton-Wright S, Moore-Gillon J, Stratford- Martin J, Saini S, Matusiewicz S, Merritt S, Dowson L, Satkunam K, Hodgson L, Suh ES, Durrington H, Browne E, Walters N, Steier J, Barry S, Griffiths M, Hart N, Nikolic M, Berry M, Thomas A, Miller J, McNicholl D, Marsden P, Warwick G, Barr L, Adeboyeku D, Mohd Noh MS, Griffiths P, Davies L, Quint J, Lyall R, Shribman J, Collins A, Goldman J, Bloch S, Gill A, Man W, Christopher A, Yasso R, Rajhan A, Shrikrishna D, Moore C, Absalom G, Booton R, Fowler RW, Mackinlay C, Sapey E, Lock S, Walker P, Jha A, Satia I, Bradley B, Mustfa N, Haqqee R, Thomas M, Patel A, Redington A, Pillai A, Keaney N, Fowler S, Lowe L, Brennan A, Morrison D, Murray C, Hankinson J, Dutta P, Maddocks M, Pengo M, Curtis K, Rafferty G, Hutchinson J, Whitfield R, Turner S, Breen R, Naveed SUN, Goode C, Esterbrook G, Ahmed L, Walker W, Ford D, Connett G, Davidson P, Elston W, Stanton A, Morgan D, Myerson J, Maxwell D, Harrris A, Parmar S, Houghton C, Winter R, Puthucheary Z, Thomson F, Sturney S, Harvey J, Haslam PL, Patel I, Jennings D, Range S, Mallia-Milanes B, Collett A, Tate P, Russell R, Feary J, O'Driscoll R, Eaden J, Round J, Sharkey E, Montgomery M, Vaughan S, Scheele K, Lithgow A, Partridge S, Chavasse R, Restrick L, Agrawal S, Abdallah S, Lacy-Colson A, Adams N, Mitchell S, Haja Mydin H, Ward A, Denniston S, Steel M, Ghosh D, Connellan S, Rigge L, Williams R, Grove A, Anwar S, Dobson L, Hosker H, Stableforth D, Greening N, Howell T, Casswell G, Davies S, Tunnicliffe G, Mitchelmore P, Phitidis E, Robinson L, Prowse K, Bafadhel M, Robinson G, Boland A, Lipman M, Bourke S, Kaul S, Cowie C, Forrest I, Starren E, Burke H, Furness J, Bhowmik A, Everett C, Seaton D, Holmes S, Doe S, Parker S, Graham A, Paterson I, Maqsood U, Ohri C, Iles P, Kemp S, Iftikhar A, Carlin C, Fletcher T, Emerson P, Beasley V, Ramsay M, Buttery R, Mungall S, Crooks S, Ridyard J, Ross D, Guadagno A, Holden E, Coutts I, Cullen K, O'Connor S, Barker J, Sloper K, Watson J, Smith P, Anderson P, Brown L, Nyman C, Milburn H, Clive A, Serlin M, Bolton C, Fuld J, Powell H, Dayer M, Woolhouse I, Georgiadi A, Leonard H, Dodd J, Campbell I, Ruiz G, Zurek A, Paton JY, Malin A, Wood F, Hynes G, Connell D, Spencer D, Brown S, Smith D, Cooper D, O'Kane C, Hicks A, Creagh-Brown B, Lordan J, Nickol A, Primhak R, Fleming L, Powrie D, Brown J, Zoumot Z, Elkin S, Szram J, Scaffardi A, Marshall R, Macdonald I, Lightbody D, Farmer R, Wheatley I, Radnan P, Lane I, Booth A, Tilbrook S, Capstick T, Hewitt L, McHugh M, Nelson C, Wilson P, Padmanaban V, White J, Davison J, O'Callaghan U, Hodson M, Edwards J, Campbell C, Ward S, Wooler E, Ringrose E, Bridges D, Long A, Parkes M, Clarke S, Allen B, Connelly C, Forster G, Hoadley J, Martin K, Barnham K, Khan K, Munday M, Edwards C, O'Hara D, Turner S, Pieri-Davies S, Ford K, Daniels T, Wright J, Towns R, Fern K, Butcher J, Burgin K, Winter B, Freeman D, Olive S, Gray L, Pye K, Roots D, Cox N, Davies CA, Wicker J, Hilton K, Lloyd J, MacBean V, Wood M, Kowal J, Downs J, Ryan H, Guyatt F, Nicoll D, Lyons E, Narasimhan D, Rodman A, Walmsley S, Newey A, Buxton M, Dewar M, Cooper A, Reilly J, Lloyd J, Macmillan AB, Roots D, Olley A, Voase N, Martin S, McCarvill I, Christensen A, Agate R, Heslop K, Timlett A, Hailes K, Davey C, Pawulska B, Lane A, Ioakim S, Hough A, Treharne J, Jones H, Winter-Burke A, Miller L, Connolly B, Bingham L, Fraser U, Bott J, Johnston C, Graham A, Curry D, Sumner H, Costello CA, Bartoszewicz C, Badman R, Williamson K, Taylor A, Purcell H, Barnett E, Molloy A, Crawfurd L, Collins N, Monaghan V, Mir M, Lord V, Stocks J, Edwards A, Greenhalgh T, Lenney W, McKee M, McAuley D, Majeed A, Cookson J, Baker E, Janes S, Wedzicha W, Lomas Dean D, Harrison B, Davison T, Calverley P, Wilson R, Stockley R, Ayres J, Gibson J, Simpson J, Burge S, Warner J, Lenney W, Thomson N, Davies P, Woodcock A, Woodhead M, Spiro S, Ormerod L, Bothamley G, Partridge M, Shields M, Montgomery H, Simonds A, Barnes P, Durham S, Malone S, Arabnia G, Olivier S, Gardiner K, Edwards S. Children must be protected from the tobacco industry's marketing tactics. BMJ 2013; 347:f7358. [PMID: 24324220 DOI: 10.1136/bmj.f7358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nicholas Hopkinson
- British Thoracic Society Chronic Obstructive Pulmonary Disease Specialist Advisory Group, National Heart and Lung Institute, Imperial College, London SW3 6NP, UK
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Shrikrishna D, Howard L, Coker RK. Authors' response to: how should we best determine the need for in-flight oxygen inpatients with pulmonary arterial hypertension. Thorax 2013; 68:680-1. [PMID: 23771948 DOI: 10.1136/thoraxjnl-2013-203936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shrikrishna D, Howard L, Coker RK. Authors’ response to: How should we best determine the need for in-flight oxygen in patients with pulmonary arterial hypertension. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-203379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Chronic obstructive pulmonary disease (COPD) is characterised by high morbidity and mortality. It remains unknown which aspect of lung function carries the most prognostic information and if simple spirometry is sufficient. Survival was assessed in COPD outpatients whose data had been added prospectively to a clinical audit database from the point of first full lung function testing including spirometry, lung volumes, gas transfer and arterial blood gases. Variables univariately associated with survival were entered into a multivariate Cox proportional hazard model. 604 patients were included (mean±sd age 61.9±9.7 years; forced expiratory volume in 1 s 37±18.1% predicted; 62.9% males); 229 (37.9%) died during a median follow-up of 83 months. Median survival was 91.9 (95% CI 80.8–103) months with survival rates at 3 and 5 years 0.83 and 0.66, respectively. Carbon monoxide transfer factor % pred quartiles (best quartile (>51%): HR 0.33, 95% CI 0.172–0.639; and second quartile (51–37.3%): HR 0.52, 95% CI 0.322–0.825; versus lowest quartile (<27.9%)), age (HR 1.04, 95% CI 1.02–1.06) and arterial oxygen partial pressure (HR 0.85, 95% CI 0.77–0.94) were the only parameters independently associated with mortality. Measurement of gas transfer provides additional prognostic information compared to spirometry in patients under hospital follow-up and could be considered routinely. Transfer factor not GOLD stage is the most powerful predictor of survival in patients with COPDhttp://ow.ly/mGmjG
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Affiliation(s)
- Afroditi K Boutou
- NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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Maddocks M, Shrikrishna D, Vitoriano S, Tanner RJ, Natanek SA, Hart N, Kemp PR, Moxham J, Polkey MI, Hopkinson NS. P78 Physical Inactivity is Associated with Mid-Thigh Intramuscular Fat in Patients with COPD. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shrikrishna D, Tanner RJ, Lee JY, Natanek SA, Lewis A, Murphy PB, Hart N, Moxham J, Montgomery H, Kemp PR, Polkey MI, Hopkinson NS. S48 The Effect of Angiotensin-Converting Enzyme Inhibition on Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease: A Randomised Controlled Trial. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Puthucheary ZA, Rawal J, Mcphail M, Connolly B, Ratnayake G, Sidhu PS, Seymour J, Chan P, Hopkins P, Shrikrishna D, Hopkinson N, Polkey MI, Velloso C, Agley CC, Selby A, Limb M, Edwards L, Smith K, Rennie M, Rowlerson A, Moxham J, Harridge SDR, Hart N, Montgomery H. T3 Acute Muscle Loss in the Critically Ill: From Bedside to Bench. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jackson AS, Shrikrishna D, Kelly JL, Hart N, Moxham J, Polkey MI, Kemp P, Hopkinson NS. Vitamin D and skeletal muscle strength and endurance in COPD. Eur Respir J 2012; 41:309-16. [DOI: 10.1183/09031936.00043112] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kelly JL, Bamsey O, Smith C, Lord VM, Shrikrishna D, Jones PW, Polkey MI, Hopkinson NS. Health status assessment in routine clinical practice: the chronic obstructive pulmonary disease assessment test score in outpatients. ACTA ACUST UNITED AC 2012; 84:193-9. [PMID: 22441322 DOI: 10.1159/000336549] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 01/05/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND The chronic obstructive pulmonary disease (COPD) assessment test (CAT) is a simple, self-completion questionnaire developed to measure health status in patients with COPD, which is potentially suitable for routine clinical use. OBJECTIVES The purpose of this study was to establish the determinants of the CAT score in routine clinical practice. METHODS Patients attending the clinic completed the CAT score before being seen. Clinical data, including, where available, plethysmographic lung volumes, transfer factor and arterial blood gas analysis, were recorded on a pro forma in the clinic. RESULTS In 224 patients (36% female), mean forced expiratory volume in 1 s (FEV₁) was 40.1% (17.9) of predicted (%pred); CAT score was associated with exacerbation frequency [0-1/year 20.1 (7.6); 2-4/year 23.5 (7.8); >4/year 28.5 (7.3), p < 0.0001; 41/40/19% in each category] and with Medical Research Council (MRC) dyspnoea score (r² = 0.26, p < 0.0001) rising approximately 4 points with each grade. FEV(1) %pred had only a weak influence. Using stepwise regression, CAT score = 2.48 + 4.12 [MRC (1-5) dyspnoea score] + 0.08 (FEV(1) %pred) + 1.06 (exacerbation rate/year)] (r² = 0.36, p < 0.0001). The CAT score was higher in patients (n = 54) with daily sputum production [25.9 (7.5) vs. 22.2 (8.2); p = 0.004]. Detailed lung function (plethysmography and gas transfer) was available in 151 patients but had little influence on the CAT score. CONCLUSION The CAT score is associated with clinically important variables in patients with COPD and enables health status measurement to be performed in routine clinical practice.
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Affiliation(s)
- Julia L Kelly
- NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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Shrikrishna D, Patel M, Tanner RJ, Seymour JM, Connolly BA, Puthucheary ZA, Walsh SLF, Bloch SA, Sidhu PS, Hart N, Kemp PR, Moxham J, Polkey MI, Hopkinson NS. Quadriceps wasting and physical inactivity in patients with COPD. Eur Respir J 2012; 40:1115-22. [PMID: 22362854 DOI: 10.1183/09031936.00170111] [Citation(s) in RCA: 216] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Quadriceps weakness is an important complication of advanced chronic obstructive pulmonary disease (COPD) but few data exist concerning muscle bulk in early disease. We hypothesised that quadriceps bulk, measured by ultrasound rectus femoris cross-sectional area (USRF(CSA)), would be reduced in mild, as well as advanced, COPD compared with controls, and would correlate with physical activity. 161 patients with stable COPD and 40 healthy subjects had a measurement of USRF(CSA) and wore a multisensor armband to record physical activity. USRF(CSA) was reduced in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I patients compared with healthy subjects (p=0.0002). Stage II-IV patients had reduced USRF(CSA) (p<0.0001) compared with controls but were not significantly different from those with stage I disease. Physical activity level was reduced in stage I (p=0.002) and stage II-IV disease compared with controls. Using regression analysis, physical activity level was independently associated with USRF(CSA) in stage I (p=0.01) but not stage II-IV disease, where residual volume to total lung capacity ratio was the only independent predictor of physical activity level. Quadriceps wasting exists in patients with mild, as well as advanced, COPD, and is independently associated with physical inactivity in GOLD stage I disease. The identification of these patients may guide early lifestyle and therapeutic interventions.
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Affiliation(s)
- Dinesh Shrikrishna
- NIHR Respiratory Biomedical Research Unit of Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, Fulham Road, SW3 6NP, UK.
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Affiliation(s)
- Dinesh Shrikrishna
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust & Imperial College London, Royal Brompton Hospital, London
| | - Nicholas S Hopkinson
- NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust & Imperial College London, Royal Brompton Hospital, London
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Wieboldt J, Atallah L, Kelly JL, Shrikrishna D, Gyi KM, Lo B, Yang GZ, Bilton D, Polkey MI, Hopkinson NS. Effect of acute exacerbations on skeletal muscle strength and physical activity in cystic fibrosis. J Cyst Fibros 2012; 11:209-15. [PMID: 22226413 DOI: 10.1016/j.jcf.2011.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Skeletal muscle weakness is an important complication of chronic respiratory disease. The effect of acute exacerbations on strength in patients with cystic fibrosis is not known. METHODS Quadriceps (QMVC) and respiratory muscle strength were measured in patients at the time of acute admission, at discharge and one month later. Patients wore an activity monitor during admission and at one month. Convalescent values were compared to the stable clinic population. RESULTS Data were available for 13 acute admissions and 25 stable CF outpatients. Strength and other parameters including daily step count did not differ significantly between the stable and one month post-admission groups. At admission, QMVC was 16.7 (8.3)% lower than at convalescence, whereas inspiratory muscle strength did not change significantly. Reduction in QMVC did not correlate with activity levels or with markers of systemic inflammation. CONCLUSION Further research is needed to identify the mechanisms responsible for the reduction in QMVC.
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Affiliation(s)
- Jason Wieboldt
- NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, United Kingdom
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Shrikrishna D, Tanner R, Seymour JM, Patel M, Connolly BA, Puthucheary ZA, Walsh SLF, Bloch SA, Sidhu PS, Hart N, Moxham J, Polkey MI, Hopkinson NS. S94 Ultrasound measurement of quadriceps wasting in early chronic obstructive pulmonary disease and its relationship with daily physical activity. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054b.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Boutou AK, Shrikrishna D, Tanner RJ, Smith C, Kelly JL, Coissi G, Polkey MI, Hopkinson NS. P220 Transfer factor and arterial oxygen partial pressure are predictors of survival in hospital outpatients with COPD. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Waschki B, Spruit MA, Watz H, Albert PS, Shrikrishna D, Groenen M, Smith C, Man WDC, Tal-Singer R, Edwards LD, Calverley PMA, Magnussen H, Polkey MI, Wouters EFM. Physical activity monitoring in COPD: compliance and associations with clinical characteristics in a multicenter study. Respir Med 2011; 106:522-30. [PMID: 22118987 DOI: 10.1016/j.rmed.2011.10.022] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/19/2011] [Accepted: 10/31/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about COPD patients' compliance with physical activity monitoring and how activity relates to disease characteristics in a multi-center setting. METHODS In a prospective study at three Northern European sites physical activity and clinical disease characteristics were measured in 134 COPD patients (GOLD-stage II-IV; BODE index 0-9) and 46 controls. Wearing time, steps per day, and the physical activity level (PAL) were measured by a multisensory armband over a period of 6 consecutive days (in total, 144 h). A valid measurement period was defined as ≥22 h wearing time a day on at least 5 days. RESULTS The median wearing time was 142 h:17 min (99%), 141 h:1 min (98%), and 142 h:24 min (99%), respectively in the three centres. A valid measurement period was reached in 94%, 97%, and 94% of the patients and did not differ across sites (P = 0.53). The amount of physical activity did not differ across sites (mean steps per day, 4725 ± 3212, P = 0.58; mean PAL, 1.45 ± 0.20, P = 0.48). Multivariate linear regression analyses revealed significant associations of FEV1, 6-min walk distance, quadriceps strength, fibrinogen, health status, and dyspnoea with both steps per day and PAL. Previously unrecognized correlates of activity were grade of fatigue, degree of emphysema, and exacerbation rate. CONCLUSIONS The excellent compliance with wearing a physical activity monitor irrespective of study site and consistent associations with relevant disease characteristics support the use of activity monitoring as a valid outcome in multi-center studies.
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Affiliation(s)
- Benjamin Waschki
- Pulmonary Research Institute at Hospital Grosshansdorf, Center for Pneumology and Thoracic Surgery, Woehrendamm 80, D-22927 Grosshansdorf, Germany.
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Ahmedzai S, Balfour-Lynn IM, Bewick T, Buchdahl R, Coker RK, Cummin AR, Gradwell DP, Howard L, Innes JA, Johnson AOC, Lim E, Lim WS, McKinlay KP, Partridge MR, Popplestone M, Pozniak A, Robson A, Shovlin CL, Shrikrishna D, Simonds A, Tait P, Thomas M. Managing passengers with stable respiratory disease planning air travel: British Thoracic Society recommendations. Thorax 2011; 66 Suppl 1:i1-30. [PMID: 21856702 DOI: 10.1136/thoraxjnl-2011-200295] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- S Ahmedzai
- School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK
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Abstract
This article summarises the key points from the 2011 British Thoracic Society (BTS) recommendations on managing passengers with respiratory disease planning air travel. The guidance aims to provide practical advice for respiratory specialists in secondary care and serves as a valuable reference for other healthcare professionals managing these patients. A greater awareness of the challenges posed by air travel will allow improved clinical assessment and practical advice to encourage patients to fly safely wherever possible.
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Affiliation(s)
- Dinesh Shrikrishna
- National Heart & Lung Institute, Royal Brompton Hospital and Imperial College London, UK.
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Dodd JW, Van Den Broek M, Shrikrishna D, Hopkinson NS, Jones PW. P146 Cognitive loss in stable non-hypoxaemic patients with moderate chronic obstructive pulmonary disease (COPD). Thorax 2010. [DOI: 10.1136/thx.2010.150987.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Skipworth JRA, Puthucheary Z, Raptis DA, Rawal J, Shrikrishna D, Windsor J, Cramer D, Polkey MI, Montgomery HE, Hopkinson NS. Effect of acute hypoxia on QTc interval in respiratory patients undergoing fitness to fly tests. Thorax 2010; 66:726-7. [DOI: 10.1136/thx.2010.151712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shrikrishna D, de la Rua-Domenech R, Smith NH, Colloff A, Coutts I. Human and canine pulmonary Mycobacterium bovis infection in the same household: re-emergence of an old zoonotic threat? Thorax 2009; 64:89-91. [PMID: 19103875 DOI: 10.1136/thx.2008.106302] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Bovine tuberculosis (bTB), caused by Mycobacterium bovis, remains a serious animal health problem in the UK, despite longstanding statutory surveillance and control measures. Endemic infection in the Eurasian badger population is thought to complicate bTB eradication efforts. Sporadic cases of M bovis infection have also been reported in domestic animals other than cattle. Human M bovis infection is extremely rare in the native UK population in the absence of unpasteurised milk consumption or residence abroad. Here, pulmonary TB infection in a UK born female and her pet dog is described, caused by an identical strain of M bovis. Latent TB infection was also identified in a household contact. The potential routes of infection and implications of this case are discussed.
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Affiliation(s)
- D Shrikrishna
- Department of Respiratory Medicine, Royal Cornwall Hospital, Truro, UK.
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Shrikrishna D, Green C, Wood D, Handel J. Life-threatening spontaneous intracranial hypotension responding to epidural blood patch. Br J Anaesth 2006; 97:750. [PMID: 17032670 DOI: 10.1093/bja/ael262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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