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Tsakok MT, Watson RA, Saujani SJ, Kong M, Xie C, Peschl H, Wing L, MacLeod FK, Shine B, Talbot NP, Benamore RE, Eyre DW, Gleeson F. Reduction in Chest CT Severity and Improved Hospital Outcomes in SARS-CoV-2 Omicron Compared with Delta Variant Infection. Radiology 2022; 306:261-269. [PMID: 35727150 PMCID: PMC9272784 DOI: 10.1148/radiol.220533] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [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] [Indexed: 01/19/2023]
Abstract
Background The SARS-Cov-2 Omicron variant demonstrates rapid spread but reduced disease severity. Studies evaluating lung imaging findings of Omicron infection versus non-Omicron infection remain lacking. Purpose To compare the Omicron variant with the SARS-CoV-2 Delta variant according to their chest CT radiologic pattern, biochemical parameters, clinical severity, and hospital outcomes after adjusting for vaccination status. Materials and Methods This retrospective study included hospitalized adult patients with reverse transcriptase-polymerase chain reaction test results positive for SARS-CoV-2, with CT pulmonary angiography performed within 7 days of admission between December 1, 2021, and January 14, 2022. Multiple readers performed blinded radiologic analyses that included RSNA CT classification, chest CT severity score (CTSS) (range, 0 [least severe] to 25 [most severe]), and CT imaging features, including bronchial wall thickening. Results A total of 106 patients (Delta group, n = 66; Omicron group, n = 40) were evaluated (overall mean age, 58 years ± 18 [SD]; 58 men). In the Omicron group, 37% of CT pulmonary angiograms (15 of 40 patients) were categorized as normal compared with 15% (10 of 66 patients) of angiograms in the Delta group (P = .016). A generalized linear model was used to control for confounding variables, including vaccination status, and Omicron infection was associated with a CTSS that was 7.2 points lower than that associated with Delta infection (β = -7.2; 95% CI: -9.9, -4.5; P < .001). Bronchial wall thickening was more common with Omicron infection than with Delta infection (odds ratio [OR], 2.4; 95% CI: 1.01, 5.92; P = .04). A booster shot was associated with a protective effect for chest infection (median CTSS, 5; IQR, 0-11) when compared with unvaccinated individuals (median CTSS, 11; IQR, 7.5-14.0) (P = .03). The Delta variant was associated with a higher OR of severe disease (OR, 4.6; 95% CI: 1.2, 26; P = .01) and admission to a critical care unit (OR, 7.0; 95% CI: 1.5, 66; P = .004) when compared with the Omicron variant. Conclusion The SARS-CoV-2 Omicron variant was associated with fewer and less severe changes on chest CT images compared with the Delta variant. Patients with Omicron infection had greater frequency of bronchial wall thickening but less severe disease and improved hospital outcomes when compared with patients with Delta infection. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Maria T. Tsakok
- From the Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom (M.T.T., R.A.W., S.J.S., M.K., C.X., H.P., L.W., F.K.M., B.S., N.P.T., R.E.B., D.W.E., F.G.); and Weatherall Institute of Molecular Medicine (R.A.W.), Department of Oncology (R.A.W.), Department of Physiology, Anatomy and Genetics (N.P.T.), and Big Data Institute, Nuffield Department of Population Health (D.W.E.), University of Oxford, Oxford, United Kingdom
| | - Robert A. Watson
- From the Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom (M.T.T., R.A.W., S.J.S., M.K., C.X., H.P., L.W., F.K.M., B.S., N.P.T., R.E.B., D.W.E., F.G.); and Weatherall Institute of Molecular Medicine (R.A.W.), Department of Oncology (R.A.W.), Department of Physiology, Anatomy and Genetics (N.P.T.), and Big Data Institute, Nuffield Department of Population Health (D.W.E.), University of Oxford, Oxford, United Kingdom
| | - Shyamal J. Saujani
- From the Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom (M.T.T., R.A.W., S.J.S., M.K., C.X., H.P., L.W., F.K.M., B.S., N.P.T., R.E.B., D.W.E., F.G.); and Weatherall Institute of Molecular Medicine (R.A.W.), Department of Oncology (R.A.W.), Department of Physiology, Anatomy and Genetics (N.P.T.), and Big Data Institute, Nuffield Department of Population Health (D.W.E.), University of Oxford, Oxford, United Kingdom
| | - Mark Kong
- From the Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom (M.T.T., R.A.W., S.J.S., M.K., C.X., H.P., L.W., F.K.M., B.S., N.P.T., R.E.B., D.W.E., F.G.); and Weatherall Institute of Molecular Medicine (R.A.W.), Department of Oncology (R.A.W.), Department of Physiology, Anatomy and Genetics (N.P.T.), and Big Data Institute, Nuffield Department of Population Health (D.W.E.), University of Oxford, Oxford, United Kingdom
| | - Cheng Xie
- From the Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom (M.T.T., R.A.W., S.J.S., M.K., C.X., H.P., L.W., F.K.M., B.S., N.P.T., R.E.B., D.W.E., F.G.); and Weatherall Institute of Molecular Medicine (R.A.W.), Department of Oncology (R.A.W.), Department of Physiology, Anatomy and Genetics (N.P.T.), and Big Data Institute, Nuffield Department of Population Health (D.W.E.), University of Oxford, Oxford, United Kingdom
| | - Heiko Peschl
- From the Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom (M.T.T., R.A.W., S.J.S., M.K., C.X., H.P., L.W., F.K.M., B.S., N.P.T., R.E.B., D.W.E., F.G.); and Weatherall Institute of Molecular Medicine (R.A.W.), Department of Oncology (R.A.W.), Department of Physiology, Anatomy and Genetics (N.P.T.), and Big Data Institute, Nuffield Department of Population Health (D.W.E.), University of Oxford, Oxford, United Kingdom
| | - Louise Wing
- From the Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom (M.T.T., R.A.W., S.J.S., M.K., C.X., H.P., L.W., F.K.M., B.S., N.P.T., R.E.B., D.W.E., F.G.); and Weatherall Institute of Molecular Medicine (R.A.W.), Department of Oncology (R.A.W.), Department of Physiology, Anatomy and Genetics (N.P.T.), and Big Data Institute, Nuffield Department of Population Health (D.W.E.), University of Oxford, Oxford, United Kingdom
| | - Fiona K. MacLeod
- From the Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom (M.T.T., R.A.W., S.J.S., M.K., C.X., H.P., L.W., F.K.M., B.S., N.P.T., R.E.B., D.W.E., F.G.); and Weatherall Institute of Molecular Medicine (R.A.W.), Department of Oncology (R.A.W.), Department of Physiology, Anatomy and Genetics (N.P.T.), and Big Data Institute, Nuffield Department of Population Health (D.W.E.), University of Oxford, Oxford, United Kingdom
| | - Brian Shine
- From the Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom (M.T.T., R.A.W., S.J.S., M.K., C.X., H.P., L.W., F.K.M., B.S., N.P.T., R.E.B., D.W.E., F.G.); and Weatherall Institute of Molecular Medicine (R.A.W.), Department of Oncology (R.A.W.), Department of Physiology, Anatomy and Genetics (N.P.T.), and Big Data Institute, Nuffield Department of Population Health (D.W.E.), University of Oxford, Oxford, United Kingdom
| | - Nicholas P. Talbot
- From the Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom (M.T.T., R.A.W., S.J.S., M.K., C.X., H.P., L.W., F.K.M., B.S., N.P.T., R.E.B., D.W.E., F.G.); and Weatherall Institute of Molecular Medicine (R.A.W.), Department of Oncology (R.A.W.), Department of Physiology, Anatomy and Genetics (N.P.T.), and Big Data Institute, Nuffield Department of Population Health (D.W.E.), University of Oxford, Oxford, United Kingdom
| | - Rachel E. Benamore
- From the Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom (M.T.T., R.A.W., S.J.S., M.K., C.X., H.P., L.W., F.K.M., B.S., N.P.T., R.E.B., D.W.E., F.G.); and Weatherall Institute of Molecular Medicine (R.A.W.), Department of Oncology (R.A.W.), Department of Physiology, Anatomy and Genetics (N.P.T.), and Big Data Institute, Nuffield Department of Population Health (D.W.E.), University of Oxford, Oxford, United Kingdom
| | - David W. Eyre
- From the Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom (M.T.T., R.A.W., S.J.S., M.K., C.X., H.P., L.W., F.K.M., B.S., N.P.T., R.E.B., D.W.E., F.G.); and Weatherall Institute of Molecular Medicine (R.A.W.), Department of Oncology (R.A.W.), Department of Physiology, Anatomy and Genetics (N.P.T.), and Big Data Institute, Nuffield Department of Population Health (D.W.E.), University of Oxford, Oxford, United Kingdom
| | - Fergus Gleeson
- From the Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, United Kingdom (M.T.T., R.A.W., S.J.S., M.K., C.X., H.P., L.W., F.K.M., B.S., N.P.T., R.E.B., D.W.E., F.G.); and Weatherall Institute of Molecular Medicine (R.A.W.), Department of Oncology (R.A.W.), Department of Physiology, Anatomy and Genetics (N.P.T.), and Big Data Institute, Nuffield Department of Population Health (D.W.E.), University of Oxford, Oxford, United Kingdom
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Turnbull CD, Porter BML, Evans SB, Smith O, Lardner R, Hallifax R, Bettinson HV, Talbot NP, Bafadhel M, Rahman NM, Petousi N. Improved COVID-19 outcomes in a large non-invasive respiratory support cohort despite emergence of the alpha variant. BMJ Open Respir Res 2021; 8:8/1/e001044. [PMID: 34848495 PMCID: PMC8634283 DOI: 10.1136/bmjresp-2021-001044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/12/2021] [Accepted: 11/02/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Respiratory high-dependency units (rHDUs) are used to manage respiratory failure in COVID-19 outside of the intensive care unit (ICU). The alpha variant of COVID-19 has been linked to increased rates of mortality and admission to ICU; however, its impact on a rHDU population is not known. We aimed to compare rHDU outcomes between the two main UK waves of COVID-19 infection and evaluate the impact of the alpha variant on second wave outcomes. Methods We conducted a single-centre, retrospective analysis of all patients with a diagnosis of COVID-19 admitted to the rHDU of our teaching hospital for respiratory support during the first and second main UK waves. Results In total, 348 patients were admitted to rHDU. In the second wave, mortality (26.7% s vs 50.7% first wave, χ2=14.7, df=1, p=0.0001) and intubation rates in those eligible (24.3% s vs 58.8% first wave, χ2=17.3, df=2, p=0.0002) were improved compared with the first wave. In the second wave, the alpha variant had no effect on mortality (OR 1.18, 95% CI 0.60 to 2.32, p=0.64). Continuous positive airway pressure (CPAP) (89.5%) and awake proning (85.6%) were used in most patients in the second wave. Discussion Our single-centre experience shows that rHDU mortality and intubation rates have improved over time in spite of the emergence of the alpha variant. Our data support the use of CPAP and awake proning, although improvements in outcome are likely to be multifactorial.
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Affiliation(s)
- 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.,Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Benedict M L Porter
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah B Evans
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Oliver Smith
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Therapies Clinical Service Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rachel Lardner
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Therapies Clinical Service Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robert Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Henry V Bettinson
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nicholas P Talbot
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Mona Bafadhel
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Nayia Petousi
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Oxford NIHR Biomedical Research Centre, Oxford, UK
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3
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Cassar MP, Lewandowski AJ, Mahmod M, Xie C, Tunnicliffe EM, Petousi N, Talbot NP, Holdsworth D, Neubauer S, Raman B. Longitudinal trajectory of cardiac magnetic resonance and cardiopulmonary exercise testing findings in moderate to severe COVID-19 and association with symptoms. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac magnetic resonance (CMR) and cardiopulmonary exercise testing (CPET) have provided important insights into the prevalence of early cardiopulmonary abnormalities in COVID-19 patients. It is currently unknown whether such abnormalities persist over time and relate to ongoing symptoms.
Purpose
To describe the longitudinal trajectory of cardiopulmonary abnormalities on CMR and CPET in moderate to severe COVID-19 patients and assess their relationship with ongoing symptoms.
Methods
Fifty-eight previously hospitalised COVID-19 patients and 30 age, sex, body mass index, comorbidity-matched controls underwent CMR, CPET and a symptom-based questionnaire at 2–3 months (2–3m). Repeat assessments (including gas transfer) were performed in 46 patients at 6 months (6m).
Results
During admission, 1/3rd of patients needed ventilation or intensive care (Table 1) and three (5%) had a raised troponin.
On CMR, patients had preserved left (LV) and right ventricular (RV) volumes and function at 2–3m from infection. By 6m, LV function did not change but RV end diastolic volume decreased (mean difference −4.3 mls/m2, p=0.005) and RV function increased (mean difference +3.2%, p<0.001, Fig. 1A).
Patients had higher native T1 (a marker of fibroinflammation) at 2–3m compared to controls (Table 1, Fig. 1B), which normalised by 6m. Extracellular volume was normal and improved by 6m. Native T2, a marker of myocardial oedema, did not differ between patients and controls on serial CMR. At 2–3m, late gadolinium enhancement (LGE) was higher in patients (p=0.023) but became comparable to controls by 6m (p=0.62). Six (12%) patients had LGE in a myocarditis pattern and one (2%) had myocardial infarction. None had active myocarditis using the Modified Lake Louise Criteria.
Lung imaging (T2-weighted) revealed parenchymal abnormalities in 2/3rds of patients at 2–3 and 6 months. The extent of abnormalities improved on serial imaging (Table 1). Gas transfer (DLco) was worse in those with lung abnormalities (77% vs 91% of predicted, p=0.009).
CPET revealed reduced peak oxygen consumption (pVO2) in patients at 2–3m, which normalised by 6m (80.5% to 93.3% of predicted, p=0.001) (Table 1, Fig. 1C). At 2–3m, 49% of patients had submaximal tests (respiratory exchange ratio <1.1), reducing to 25% by 6m (p=0.057). VE/VCO2 slope, a marker of lung efficiency, was abnormal in patients but improved on serial CPET (Table 1, Fig. 1D).
Cardiac symptoms (chest pain, dyspnoea, palpitations, dizziness or syncope) were present in 83% of patients at 2–3m, reducing to 52% by 6m (p<0.001). There was no significant association between CMR or CPET parameters and persistent cardiac symptoms at 6m (Fig. 1E).
Conclusions
Cardiopulmonary parameters (on CMR and CPET) improved in moderate-severe COVID-19 patients from 2–3 to 6 months post infection. Despite this, patients continued to experience cardiac symptoms which had no relationship with measured parameters.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): 1. NIHR Oxford and Oxford Health Biomedical Research Centre, Oxford British Heart Foundation (BHF) Centre of Research Excellence (RE/18/3/34214), United Kingdom Research Innovation and Wellcome Trust2. Medical Research Council and Department of Health and Social Care/National Institute for Health Research Grant (MR/V027859/1) ISRCTN number 10980107 Table 1Figure 1
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Affiliation(s)
- M P Cassar
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - A J Lewandowski
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - M Mahmod
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - C Xie
- University of Oxford, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford, United Kingdom
| | - E M Tunnicliffe
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - N Petousi
- University of Oxford, Nuffield Department of Medicine, Oxford, United Kingdom
| | - N P Talbot
- University of Oxford, Department of Physiology, Anatomy and Genetics, Oxford, United Kingdom
| | - D Holdsworth
- University of Oxford, Department of Physiology, Anatomy and Genetics, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - B Raman
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
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4
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Hallifax RJ, Porter BM, Elder PJ, Evans SB, Turnbull CD, Hynes G, Lardner R, Archer K, Bettinson HV, Nickol AH, Flight WG, Chapman SJ, Hardinge M, Hoyles RK, Saunders P, Sykes A, Wrightson JM, Moore A, Ho LP, Fraser E, Pavord ID, Talbot NP, Bafadhel M, Petousi N, Rahman NM. Successful awake proning is associated with improved clinical outcomes in patients with COVID-19: single-centre high-dependency unit experience. BMJ Open Respir Res 2020; 7:7/1/e000678. [PMID: 32928787 PMCID: PMC7490910 DOI: 10.1136/bmjresp-2020-000678] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/03/2020] [Accepted: 09/03/2020] [Indexed: 01/08/2023] Open
Abstract
The SARS-CoV-2 can lead to severe illness with COVID-19. Outcomes of patients requiring mechanical ventilation are poor. Awake proning in COVID-19 improves oxygenation, but on data clinical outcomes is limited. This single-centre retrospective study aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure (CPAP) or high-flow nasal oxygen (HFNO)) on a respiratory high-dependency unit (HDU), is associated with improved outcomes. HDU care included awake proning by respiratory physiotherapists. Of 565 patients admitted with COVID-19, 71 (12.6%) were managed on the respiratory HDU, with 48 of these (67.6%) requiring respiratory support. Patients managed with CPAP alone 22/48 (45.8%) were significantly less likely to die than patients who required transfer onto HFNO 26/48 (54.2%): CPAP mortality 36.4%; HFNO mortality 69.2%, (p=0.023); however, multivariate analysis demonstrated that increasing age and the inability to awake prone were the only independent predictors of COVID-19 mortality. The mortality of patients with COVID-19 requiring respiratory support is considerable. Data from our cohort managed on HDU show that CPAP and awake proning are possible in a selected population of COVID-19, and may be useful. Further prospective studies are required.
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Affiliation(s)
- Rob J Hallifax
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK .,Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Benedict Ml Porter
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Patrick Jd Elder
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah B Evans
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Chris D Turnbull
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Gareth Hynes
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rachel Lardner
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Therapies Clinical Service Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kirsty Archer
- Therapies Clinical Service Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Henry V Bettinson
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Annabel H Nickol
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - William G Flight
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen J Chapman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Maxine Hardinge
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rachel K Hoyles
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Peter Saunders
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Anny Sykes
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - John M Wrightson
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alastair Moore
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ling-Pei Ho
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Emily Fraser
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ian D Pavord
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Nicholas P Talbot
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Mona Bafadhel
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nayia Petousi
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Najib M Rahman
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
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