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Loewenthal L, Busby J, McDowell R, Brown T, Burhan H, Chaudhuri R, Dennison P, Dodd JW, Doe S, Faruqi S, Gore R, Idris E, Jackson DJ, Patel M, Pantin T, Pavord I, Pfeffer PE, Price DB, Rupani H, Siddiqui S, Heaney LG, Menzies-Gow A. Impact of sex on severe asthma: a cross-sectional retrospective analysis of UK primary and specialist care. Thorax 2024; 79:403-411. [PMID: 38124220 DOI: 10.1136/thorax-2023-220512] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/25/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION After puberty, females are more likely to develop asthma and in a more severe form than males. The associations between asthma and sex are complex with multiple intrinsic and external factors. AIM To evaluate the sex differences in the characteristics and treatment of patients with severe asthma (SA) in a real-world setting. METHODS Demographic, clinical and treatment characteristics for patients with SA in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD) were retrospectively analysed by sex using univariable and multivariable logistic regression analyses adjusted for year, age and hospital/practice. RESULTS 3679 (60.9% female) patients from UKSAR and 18 369 patients (67.9% female) from OPCRD with SA were included. Females were more likely to be symptomatic with increased Asthma Control Questionnaire-6 (UKSAR adjusted OR (aOR) 1.14, 95% CI 1.09 to 1.18) and Royal College of Physicians-3 Question scores (OPCRD aOR 1.29, 95% CI 1.13 to 1.47). However, they had a higher forced expiratory volume in 1 second per cent (FEV1%) predicted (UKSAR 68.7% vs 64.8%, p<0.001) with no significant difference in peak expiratory flow. Type 2 biomarkers IgE (UKSAR 129 IU/mL vs 208 IU/mL, p<0.001) and FeNO (UKSAR 36ppb vs 46ppb, p<0.001) were lower in females with no significant difference in blood eosinophils or biological therapy. Females were less likely to be on maintenance oral corticosteroids (UKSAR aOR 0.86, 95% CI 0.75 to 0.99) but more likely to be obese (UKSAR aOR 1.67, 95% CI 145 to 1.93; OPCRD SA aOR 1.46, 95% CI 1.34 to 1.58). CONCLUSIONS Females had increased symptoms and were more likely to be obese despite higher FEV1% predicted and lower type 2 biomarkers with consistent and clinically important differences across both datasets.
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Affiliation(s)
- Lola Loewenthal
- National Lung and Heart Institute, Imperial College London, London, UK
- Department of Asthma and Allergy, Department of Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
| | - John Busby
- Centre for Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
| | - Ronald McDowell
- Queen's University Belfast, Belfast, UK
- Ulster University, Coleraine, UK
| | - Thomas Brown
- Respiratory Medicine, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Hassan Burhan
- Respiratory Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rekha Chaudhuri
- Respiratory Medicine, Gartnavel General Hospital, Glasgow, UK
- University of Glasgow, Glasgow, UK
| | - Paddy Dennison
- Southampton NIHR Respiratory Biomedical Research Unit, Southampton University Hospitals NHS Trust, Southampton, UK
| | - James William Dodd
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Westbury on Trym, UK
| | - Simon Doe
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Shoaib Faruqi
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - David Joshua Jackson
- Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Mitesh Patel
- University Hospitals Plymouth, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Thomas Pantin
- Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ian Pavord
- NIHR Respiratory BRC, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | | | - David B Price
- Observational and Pragmatic Research Institute Pte Ltd, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Hitasha Rupani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton, Southampton, UK
| | - Salman Siddiqui
- National Lung and Heart Institute, Imperial College London, London, UK
| | - Liam G Heaney
- Centre of Infection and Immunity, Queen's University Belfast, Belfast, UK
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Kumar K, Dave K, Loewenthal L, Ward E, Addy C. British Thoracic Society survey of the career intentions of respiratory medicine specialty trainees in the UK. BMJ Open Respir Res 2022; 9:9/1/e001219. [PMID: 35584849 PMCID: PMC9109097 DOI: 10.1136/bmjresp-2022-001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/26/2022] [Accepted: 04/11/2022] [Indexed: 11/04/2022] Open
Abstract
There were respiratory consultant post vacancies in 82% of surveyed UK hospitals in 2021. Understanding respiratory trainees' career intentions is vital to plan and train a future respiratory workforce. In 2020, the British Thoracic Society surveyed trainee members (n=144) to assess career plans and perceived barriers and facilitators when applying for consultant posts. Most trainees (79, 55.6%) report intending to pursue UK-based posts with general internal medicine responsibilities. Consultant applications are influenced by location, hospital type, previous local experience and availability of subspecialty posts. Insufficient guidance is available regarding consultant applications.
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Affiliation(s)
- Kartik Kumar
- National Heart and Lung Institute, Imperial College London, London, UK .,Host Defence Unit, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kavita Dave
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lola Loewenthal
- National Heart and Lung Institute, Imperial College London, London, UK.,Asthma and Allergy, Department of Respiratory Medicine, Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Emily Ward
- Department of Respiratory Medicine, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Charlotte Addy
- All Wales Adult Cystic Fibrosis Centre, University Hospital Llandough, Cardiff and Vale University Health Board, Cardiff, UK
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Loewenthal L, Menzies-Gow A. FeNO in Asthma. Semin Respir Crit Care Med 2022; 43:635-645. [DOI: 10.1055/s-0042-1743290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractAsthma is a common disease affecting 350 million people worldwide, which is characterized by airways inflammation and hyperreactivity. Historically diagnosis and treatment have been mainly based on symptoms, which have the potential to result in misdiagnosis and inappropriate treatment. Nitric oxide (NO) is exhaled in human breath and is a marker of airways inflammation. Levels of NO are increased in the exhaled breath of patients with type 2 asthma and fractional exhaled nitric oxide (FeNO) provides an objective biomarker of airway inflammation. FeNO testing is an accessible, noninvasive, and easy-to-use test. Cut-off values have been established by the American Thoracic Society (ATS), the Global Initiative for Asthma (GINA), and the National Institute for Health and Care Excellence (NICE) but vary between guidance. FeNO levels have been shown to be predictive of blood and sputum eosinophil levels but should not be used in isolation and current guidance emphasizes the importance of incorporating clinical symptoms and testing when utilizing FeNO results. The inclusion of FeNO testing can increase diagnostic accuracy of asthma, while high levels in asthmatic patients can help predict response to inhaled corticosteroids (ICS) and suppression of levels with ICS to monitor adherence. FeNO levels are also a predictor of asthma risk with increased exacerbation rates and accelerated decline in lung function associated with high levels as well as having an emerging role in predicting response to some biologic therapies in severe asthma. FeNO testing is cost-effective and has been shown, when combined with clinical assessment, to improve asthma management.
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Affiliation(s)
- Lola Loewenthal
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Andrew Menzies-Gow
- Department of Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, United Kingdom
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Stanton AE, Edey A, Evison M, Forrest I, Hippolyte S, Kastelik J, Latham J, Loewenthal L, Nagarajan T, Roberts M, Smallwood N, Park JES. British Thoracic Society Training Standards for Thoracic Ultrasound (TUS). BMJ Open Respir Res 2021; 7:7/1/e000552. [PMID: 32430401 PMCID: PMC7245450 DOI: 10.1136/bmjresp-2019-000552] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction The British Thoracic Society (BTS) responded to a call from the pleural community to establish this new Training Standard to detail the capabilities in practice for thoracic ultrasound (TUS), which will build on the previous curricula and extend the remit to include training for the emergency provision of TUS. Methods BTS convened a working group to produce a set of Training Standards. Results This document provides a comprehensive Training Standard for TUS facilitating timely and improved management of patients with respiratory presentations, particularly (but not exclusively) pleural pathologies. Discussion The Training Standards document will be widely disseminated.
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Affiliation(s)
- Andrew E Stanton
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, England, UK
| | - Anthony Edey
- Department of Imaging, North Bristol NHS Trust, Bristol, UK
| | - Matthew Evison
- North West Lung Centre, University Hospital South Manchester, Manchester, UK.,Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - Ian Forrest
- Respiratory Medicine, Royal Victoria Infirmary, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sabrine Hippolyte
- Respiratory Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Jack Kastelik
- Respiratory Medicine, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Jennifer Latham
- Respiratory Medicine, Raigmore Hospital, Inverness, Highland, UK
| | - Lola Loewenthal
- Respiratory Medicine, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Thapas Nagarajan
- Respiratory Medicine, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Mark Roberts
- Respiratory Medicine, Sherwood Forest Hospitals NHS Foundation Trust, Sutton-In-Ashfield, Nottinghamshire, UK
| | | | - John E S Park
- Respiratory Medicine, Royal Berkshire Hospital, Reading, Reading, UK
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Smith SJ, Busby J, Heaney LG, Pfeffer PE, Jackson DJ, Yang F, Fowler SJ, Menzies-Gow A, Idris E, Brown T, Gore R, Faruqi S, Dennison P, Dodd JW, Doe S, Mansur AH, Priyadarshi R, Holmes J, Hearn A, Al-Aqqad H, Loewenthal L, Cooper A, Fox L, Selvan M, Crooks MG, Thompson A, Higbee D, Fawdon M, Nathwani V, Holmes L, Chaudhuri R. The impact of the first COVID-19 surge on severe asthma patients in the UK. Which is worse: the virus or the lockdown? ERJ Open Res 2021; 7:00768-2020. [PMID: 33564672 PMCID: PMC7681958 DOI: 10.1183/23120541.00768-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/15/2022] Open
Abstract
Asthma therapy, including monoclonal antibodies, was not associated with #COVID19 infection or hospitalisation in a UK severe asthma population. Shielding led to a reported worsening of mental health in nearly half of patients contacted (47%). https://bit.ly/3jImUsG.
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Affiliation(s)
- Steven J. Smith
- Gartnavel General Hospital and University of Glasgow, Glasgow, UK
| | | | | | - Paul E. Pfeffer
- St Bartholomew's Hospital, Bart's Health NHS Trust, London & Queen Mary University of London, London, UK
| | - David J. Jackson
- Guy's and St Thomas' Hospitals, London, UK
- Guy's and St Thomas’ NHS Trust, London & King's College London, London, UK
| | - Freda Yang
- Gartnavel General Hospital and University of Glasgow, Glasgow, UK
| | - Stephen J. Fowler
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | | | | | | | | | | | - James W. Dodd
- Academic Respiratory Unit, University of Bristol and North Bristol Lung Centre, Southmead Hospital, Bristol, UK
| | - Simon Doe
- Royal Victoria Infirmary, Newcastle, UK
| | - Adel H. Mansur
- Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - Radhika Priyadarshi
- St Bartholomew's Hospital, Bart's Health NHS Trust, London & Queen Mary University of London, London, UK
| | | | - Andrew Hearn
- Guy's and St Thomas' Hospitals, London, UK
- Guy's and St Thomas’ NHS Trust, London & King's College London, London, UK
| | - Hamsa Al-Aqqad
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | | | - Lauren Fox
- Queen Alexandra Hospital, Portsmouth, UK
| | | | | | | | - Daniel Higbee
- Academic Respiratory Unit, University of Bristol and North Bristol Lung Centre, Southmead Hospital, Bristol, UK
| | | | - Vishal Nathwani
- Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - LeanneJo Holmes
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Rekha Chaudhuri
- Gartnavel General Hospital and University of Glasgow, Glasgow, UK
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Stringfellow TD, Rohrer RM, Loewenthal L, Gorrard-Smith C, Sheriff IHN, Armit K, Lees PD, Spurgeon PC. Defining the structure of undergraduate medical leadership and management teaching and assessment in the UK. Med Teach 2015; 37:747-754. [PMID: 25301039 DOI: 10.3109/0142159x.2014.971723] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Medical leadership and management (MLM) skills are essential in preventing failings of healthcare; it is unknown how these attitudes can be developed during undergraduate medical education. This paper aims to quantify interest in MLM and recommends preferred methods of teaching and assessment at UK medical schools. Two questionnaires were developed, one sent to all UK medical school faculties, to assess executed and planned curriculum changes, and the other sent to medical students nationally to assess their preferences for teaching and assessment. Forty-eight percent of UK medical schools and 260 individual student responses were recorded. Student responses represented 60% of UK medical schools. 65% of schools valued or highly valued the importance of teaching MLM topics, compared with 93.2% of students. Students' favoured teaching methods were seminars or lectures (89.4%) and audit and quality improvement (QI) projects (77.8%). Medical schools preferred portfolio entries (55%) and presentations (35%) as assessment methods, whilst simulation exercises (76%) and audit reports (61%) were preferred by students. Preferred methods encompass experiential learning or simulation and a greater emphasis should be placed on encouraging student audit and QI projects. The curriculum changes necessary could be achieved via further integration into future editions of Tomorrow's Doctors.
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Affiliation(s)
| | | | | | | | | | | | - Peter D Lees
- e Faculty of Medical Leadership and Management , UK
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May-Miller H, Hayter J, Loewenthal L, Hall L, Hilbert R, Quinn M, Pearson N, Patel A, Law R. Improving the quality of discharge summaries: implementing updated Academy of Medical Royal Colleges standards at a district general hospital. BMJ Qual Improv Rep 2015; 4:bmjquality_uu207268.w2918. [PMID: 26734325 PMCID: PMC4645815 DOI: 10.1136/bmjquality.u207268.w2918] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 04/19/2015] [Indexed: 11/04/2022]
Abstract
Quality of documentation is harder to quantify and incentivise, but it has a significant impact on patient care. Good discharge summaries facilitate continuity between secondary and primary care. The junior doctors' forum led this project to improve the quality of electronic discharge summaries (eDS). Baseline measurement revealed significant room for improvement. We measured the quality of 10 summaries per month (across all inpatient specialties), against 23 indicators from the revised Academy of Medical Royal Colleges (AoMRC) standards (2013) that were prioritised by GPs as a "minimum dataset". Junior doctors felt that the Trust's dual eDS systems were responsible for great variation in quality. This was confirmed by the results of a comparison audit of the systems in April 2014: one system greatly outperformed the other (57% mean compliance with iSoft clinical management (iCM) based system vs. 77% with InfoPath-based system). We recommended that the Trust move to a single eDS system, decommissioning the iCM-based system, and this proposal was approved by several Trust committees. We worked with information services, junior doctors, general practitioners and hospital physicians to develop and implement a generic template to further improve compliance with AoMRC standards. In August 2014, the iCM-based system was withdrawn, the new template went live, and training was delivered, coinciding with the changeover of junior doctors to minimise disruption. Median compliance increased from 66.7% to 77.8%. Quality of discharge summaries had improved across the specialties. There was a reduction in the number of complaints and positive qualitative feedback from general practitioners and junior doctors. Completion of discharge summaries within 24 hours was not affected by this change. There is still more to be done to improve quality; average compliance with the full AoMRC standards (39 indicators) is 59.5%. With the approval of the Trust executive committee further plan, do, study, act (PDSA) cycles are underway, working to improve the remaining specialty-specific templates.
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Affiliation(s)
| | | | | | - Louis Hall
- Epsom and St Helier University Hospitals NHS Trust
| | | | | | | | - Alisha Patel
- Epsom and St Helier University Hospitals NHS Trust
| | - Rebekah Law
- Epsom and St Helier University Hospitals NHS Trust
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Loewenthal L. Study links iodine deficiency in pregnancy with poor cognitive outcomes in children. BMJ 2013; 346:f3365. [PMID: 23704130 DOI: 10.1136/bmj.f3365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Loewenthal L, Thompson M, Elkin SL. Primary adenocarcinoma of the lung with a synchronous carcinoid tumour of the small intestine. JRSM Short Rep 2013; 4:18. [PMID: 23560217 PMCID: PMC3616297 DOI: 10.1177/2042533313476416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Lola Loewenthal
- Department of Chest & Allergy, Imperial College Healthcare NHS Trust, St Mary's Hospital , Praed Street, London W1 1NY, UK
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Lowinger P, Day R, Crandall RG, Loewenthal L. How effective is the psychiatric unit in the general hospital? Dis Nerv Syst 1968; 29:Suppl:41-4. [PMID: 5673623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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