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Devereux G, Cotton S, Nath M, McMeekin N, Campbell K, Chaudhuri R, Choudhury G, De Soyza A, Fielding S, Gompertz S, Haughney J, Lee AJ, MacLennan G, Morice A, Norrie J, Price D, Short P, Vestbo J, Walker P, Wedzicha J, Wilson A, Wu O, Lipworth BJ. Bisoprolol in Patients With Chronic Obstructive Pulmonary Disease at High Risk of Exacerbation: The BICS Randomized Clinical Trial. JAMA 2024:2819083. [PMID: 38762800 DOI: 10.1001/jama.2024.8771] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
Importance Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Observational studies report that β-blocker use may be associated with reduced risk of COPD exacerbations. However, a recent trial reported that metoprolol did not reduce COPD exacerbations and increased COPD exacerbations requiring hospital admission. Objective To test whether bisoprolol decreased COPD exacerbations in people with COPD at high risk of exacerbations. Design, Setting, and Participants The Bisoprolol in COPD Study (BICS) was a double-blind placebo-controlled randomized clinical trial conducted in 76 UK sites (45 primary care clinics and 31 secondary clinics). Patients with COPD who had at least moderate airflow obstruction on spirometry (ratio of forced expiratory volume in the first second of expiration [FEV1] to forced vital capacity <0.7; FEV1 <80% predicted) and at least 2 COPD exacerbations treated with oral corticosteroids, antibiotics, or both in the prior 12 months were enrolled from October 17, 2018, to May 31, 2022. Follow-up concluded on April 18, 2023. Interventions Patients were randomly assigned to bisoprolol (n = 261) or placebo (n = 258). Bisoprolol was started at 1.25 mg orally daily and was titrated as tolerated during 4 sessions to a maximum dose of 5 mg/d, using a standardized protocol. Main Outcomes and Measures The primary clinical outcome was the number of patient-reported COPD exacerbations treated with oral corticosteroids, antibiotics, or both during the 1-year treatment period. Safety outcomes included serious adverse events and adverse reactions. Results Although the trial planned to enroll 1574 patients, recruitment was suspended from March 16, 2020, to July 31, 2021, due to the COVID-19 pandemic. Two patients in each group were excluded postrandomization. Among the 515 patients (mean [SD] age, 68 [7.9] years; 274 men [53%]; mean FEV1, 50.1%), primary outcome data were available for 514 patients (99.8%) and 371 (72.0%) continued taking the study drug. The primary outcome of patient-reported COPD exacerbations treated with oral corticosteroids, antibiotics, or both was 526 in the bisoprolol group, with a mean exacerbation rate of 2.03/y, vs 513 exacerbations in the placebo group, with a mean exacerbation rate of 2.01/y. The adjusted incidence rate ratio was 0.97 (95% CI, 0.84-1.13; P = .72). Serious adverse events occurred in 37 of 255 patients in the bisoprolol group (14.5%) vs 36 of 251 in the placebo group (14.3%; relative risk, 1.01; 95% CI, 0.62-1.66; P = .96). Conclusions and Relevance Among people with COPD at high risk of exacerbation, treatment with bisoprolol did not reduce the number of self-reported COPD exacerbations requiring treatment with oral corticosteroids, antibiotics, or both. Trial Registration isrctn.org Identifier: ISRCTN10497306.
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Affiliation(s)
- Graham Devereux
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, United Kingdom
- Liverpool University Hospitals Foundation NHS Trust, University Hospital Aintree, Liverpool, United Kingdom
| | - Seonaidh Cotton
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, United Kingdom
| | - Mintu Nath
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Nicola McMeekin
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Karen Campbell
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, United Kingdom
| | - Rekha Chaudhuri
- School of Infection & Immunity, University of Glasgow, Glasgow, United Kingdom
| | | | - Anthony De Soyza
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Shona Fielding
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Simon Gompertz
- Department of Respiratory Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - John Haughney
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
| | - Amanda J Lee
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, United Kingdom
| | - Alyn Morice
- Cardiovascular and Respiratory Studies, Castle Hill Hospital, Hull, United Kingdom
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh BioQuarter, Edinburgh, United Kingdom
| | - David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
| | - Philip Short
- Respiratory Medicine, Ninewells Hospital, Dundee, United Kingdom
| | - Jorgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
| | - Paul Walker
- Liverpool University Hospitals Foundation NHS Trust, University Hospital Aintree, Liverpool, United Kingdom
| | - Jadwiga Wedzicha
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Andrew Wilson
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Olivia Wu
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Brian J Lipworth
- Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
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Parker SM, Smith JA, Birring SS, Chamberlain-Mitchell S, Gruffydd-Jones K, Haines J, Hennessey S, McGarvey LP, Marsden P, Martin MJ, Morice A, O'Hara J, Thomas M. British Thoracic Society Clinical Statement on chronic cough in adults. Thorax 2023; 78:s3-s19. [PMID: 38088193 DOI: 10.1136/thorax-2023-220592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Sean M Parker
- Department of Respiratory Medicine, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Jaclyn Ann Smith
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Surinder S Birring
- Department of Respiratory Medicine, Kings College Hospital, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | - Jemma Haines
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | | | - Paul Marsden
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- North West Lung Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | | | - Alyn Morice
- Castle Hill Hospital, Cottingham, UK
- University of Hull, Hull, UK
| | - James O'Hara
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Mike Thomas
- Academic Unit of Primary Care and Population Science, University of Southampton, Southampton, UK
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McGarvey L, Morice A, Dupont L. Speaking the language of cough for our patients. Respir Med Res 2023; 84:101036. [PMID: 37625377 DOI: 10.1016/j.resmer.2023.101036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Lorcan McGarvey
- Wellcome-Wolfson Institute for Experimental Medicine,School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
| | - Alyn Morice
- Centre for Clinical Sciences, Hull York Medical School, University of Hull, Hull, UK
| | - Lieven Dupont
- Dept of Respiratory Diseases, University Hospital Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
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Zheng Z, Huang J, Xiang Z, Wu T, Lan X, Xie S, Lin Z, Tang K, Morice A, Li S, Song WJ, Chen R. Efficacy and safety of pharmacotherapy for refractory or unexplained chronic cough: a systematic review and network meta-analysis. EClinicalMedicine 2023; 62:102100. [PMID: 37538538 PMCID: PMC10393600 DOI: 10.1016/j.eclinm.2023.102100] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 08/05/2023] Open
Abstract
Background Refractory chronic cough (RCC) has a significant impact on patient's health-related quality of life and represents a challenge in clinical management. However, the optimal treatment for RCC remains controversial. This study aimed to investigate and compare the efficacy and safety of the current pharmacological therapeutic options for RCC. Methods A systematic review was performed by searching PubMed, Web of Science, Embase, and Ovid databases from January 1, 2008 to March 1, 2023. All randomised control trials (RCTs) reporting outcomes of efficacy or/and safety were included in the Bayesian network meta-analysis. Here, we compared the effects on Leicester Cough Questionnaire (LCQ), Visual Analogue Scale (VAS), and objective cough frequency of patients with RCC. Besides, we also compared the incidence of adverse events (AEs) for analysis of safety. PROSPERO registration: CRD42022345940. Findings 19 eligible RCTs included 3326 patients and 7 medication categories: P2X3 antagonist, GABA modulator, Transient Receptor Potential (TRP) modulator, NK-1 agonist, opioid analgesic, macrolide, and sodium cromoglicate. Compared with placebo, mean difference (MD) of LCQ and 24 h cough frequency for P2X3 antagonist relief were 1.637 (95% CI: 0.887-2.387) and -11.042 (P = 0.035). Compared with placebo, effect sizes (MD for LCQ and cough severity VAS) for GABA modulator were 1.347 (P = 0.003) and -7.843 (P = 0.003). In the network meta-analysis, gefapixant is the most effective treatment for patients with RCC (The Surface Under the Cumulative Ranking Curves (SUCRA) is 0.711 in LCQ, 0.983 in 24 h cough frequency, and 0.786 in cough severity VAS). Lesogaberan had better efficacy than placebo (SUCRA: 0.632 vs. 0.472) in 24 h cough frequency. Eliapixant and lesogaberan had better efficacy than placebo in cough severity VAS. However, TRP modulator had worse efficacy than placebo. In the meta-analysis of AEs, the present study found P2X3 antagonist had a significant correlation to AEs (RR: 1.129, 95% CI: 1.012-1.259), especially taste-related AEs (RR: 6.216, P < 0.05). Interpretation In this network meta-analysis, P2X3 antagonist showing advantages in terms of efficacy is currently the most promising medication for treatment of RCC. GABA modulator also showed potential efficacy for RCC but with AEs of the central system. Nevertheless, the role of TRP modulator needed to be revisited. Further research is needed to determine the potential beneficiary population for optimizing the pharmacological management of chronic cough. Funding National Natural Science Foundation of China (81870079), Guangdong Science and Technology Project (2021A050520012), Incubation Program of National Science Foundation for Distinguished Young Scholars (GMU2020-207).
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Affiliation(s)
- Ziwen Zheng
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Junfeng Huang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ziyuan Xiang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Tong Wu
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaoqing Lan
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shuojia Xie
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zikai Lin
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Kailun Tang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Clinical Medical College of Henan University, Zhengzhou, Henan, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Alyn Morice
- Centre for Clinical Sciences, Hull York Medical School, University of Hull, Hull, UK
| | - Shiyue Li
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ruchong Chen
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, National Centre for Respiratory Medicine, Guangzhou, Guangdong, China
- Department of Allergy and Clinical Immunology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Crooks MG, Crowther L, Cummings H, Cohen J, Huang C, Pitel L, Pearson M, Morice A, Turgoose J, Faruqi S, Watt M, Morris T, Xu Y. Improving asthma care through implementation of the SENTINEL programme: findings from the pilot site. ERJ Open Res 2023; 9:00685-2022. [PMID: 37228273 PMCID: PMC10204732 DOI: 10.1183/23120541.00685-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/12/2023] [Indexed: 05/27/2023] Open
Abstract
Aim Short-acting β2-agonist (SABA) overuse adversely impacts asthma-related outcomes and the environment. The SABA rEductioN Through ImplemeNting Hull asthma guidELines (SENTINEL) programme aims to reduce SABA overuse through supported implementation of an adult asthma guideline, which advocates for a SABA-free maintenance and reliever therapy (MART)-preferred treatment where appropriate, across six primary care networks (PCNs) in the UK. We present findings on patient/disease characteristics, asthma prescribing patterns and exacerbation rates from the pilot PCN. Methods Patients (aged ≥18 years, prescribed at least one inhaled therapy) and their prescribed asthma treatments were characterised using National Health Service data. Asthma treatments and exacerbations were analysed for three periods: 24‒12 months pre-, 12 months pre- and 12 months post-SENTINEL implementation (November 2020‒January 2021). Results Of the 2571 registered asthma patients, 33.6% (n=864) underwent an asthma review, of whom 44.7% (n=386) were transitioned to MART. Fewer patients were prescribed three or more SABA canisters per year post-implementation in the overall asthma population (45.4% and 46.2% during 24‒12 months and 12 months pre-implementation, respectively, and 23.9% 12 months post-implementation), and in the two subgroups: 1) those who had an asthma review (74.5% and 83.6% during 24‒12 months and 12 months pre-implementation, respectively, and 26.5% post-implementation); and 2) those transitioned to MART following a review (76.4% and 86.5% during 24‒12 months and 12 months pre-implementation, respectively, and 16.3% post-implementation). A higher proportion of patients were exacerbation-free post-implementation in the overall asthma population and in the two subgroups. At least 71.5% of patients transitioned to MART were still prescribed MART 12 months post-implementation, of whom ≥86.7% were SABA-free. Conclusion SENTINEL implementation led to reduced SABA prescribing, increased inhaled corticosteroid uptake and fewer asthma exacerbations. MART was considered appropriate for ∼50% of reviewed patients, with improved prescribing patterns sustained post-implementation.
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Affiliation(s)
- Michael G. Crooks
- Hull York Medical School, Daisy Building, Castle Hill Hospital, Cottingham, UK
| | - Lucia Crowther
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull, UK
| | - Helena Cummings
- Hull York Medical School, Daisy Building, Castle Hill Hospital, Cottingham, UK
| | - Judith Cohen
- Hull Health Trials Unit, Hull York Medical School, University of Hull, Hull, UK
| | - Chao Huang
- Hull Health Trials Unit, Hull York Medical School, University of Hull, Hull, UK
| | - Lukas Pitel
- Hull Health Trials Unit, Hull York Medical School, University of Hull, Hull, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Allam Medical Building, University of Hull, Hull, UK
| | - Alyn Morice
- Hull York Medical School, Daisy Building, Castle Hill Hospital, Cottingham, UK
| | - John Turgoose
- Hull Health Trials Unit, Hull York Medical School, University of Hull, Hull, UK
| | - Shoaib Faruqi
- The Hull University Teaching Hospitals NHS Trust, Hull, UK
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Brindle K, Morice A, Carter N, Sykes D, Zhang M, Hilton A. The "vicious circle" of chronic cough: the patient experience - qualitative synthesis. ERJ Open Res 2023; 9:00094-2023. [PMID: 37228274 PMCID: PMC10204820 DOI: 10.1183/23120541.00094-2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 02/16/2022] [Accepted: 03/23/2023] [Indexed: 05/27/2023] Open
Abstract
Aim The aim of this study was to systematically search and synthesise findings from peer-reviewed qualitative studies describing the experiences of those living with chronic cough. Methods A systematic search was conducted to identify all studies that used qualitative methodology to report on the experiences of adults living with chronic cough. A thematic synthesis of the first-hand narratives was undertaken. Key themes in relation to personal perspectives and experiences of living with chronic cough were identified and grouped into analytical themes. Results Six studies met the inclusion criteria. The thematic synthesis generated three analytical themes: 1) "It's just a cough"; 2) "Constant cough and constant worry"; and 3) "No light at the end of the tunnel", highlighting the biopsychosocial nature of chronic cough. The synthesis highlights chronic cough as a heterogeneous experience that may appear idiosyncratic, completely consuming the lives of those living with it. Conclusion This is to our knowledge the first qualitative synthesis reporting on the perceptions and experiences of adults living with chronic cough. Our review draws attention to the paucity of literature that utilises qualitative methodology to explore the experience of living with chronic cough. We highlight the missing voice of people living with chronic cough in the contemporary literature. There is now a requirement for research exploring the narratives of those living with chronic cough, to gain an understanding of the condition beyond simple quantification.
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Affiliation(s)
- Kayleigh Brindle
- Hull University Teaching Hospitals NHS Trust, Respiratory Research Group, Hull, UK
- Hull York Medical School, Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
| | - Alyn Morice
- Hull University Teaching Hospitals NHS Trust, Respiratory Research Group, Hull, UK
- Hull York Medical School, Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
| | - Natalie Carter
- Hull University Teaching Hospitals NHS Trust, Respiratory Research Group, Hull, UK
| | - Dominic Sykes
- Hull York Medical School, Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
| | - Mengru Zhang
- Hull York Medical School, Centre for Clinical Science, Respiratory Medicine, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Andrea Hilton
- University of Hull, Faculty of Health Sciences, Hull, UK
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McGarvey L, Smith JA, Morice A, Birring SS, Chung KF, Dicpinigaitis PV, Niimi A, Benninger MS, Sher M, Matsunaga Y, Miyazaki S, Machida M, Ishihara H, Mahmood A, Gomez JC. A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Phase 2b Trial of P2X3 Receptor Antagonist Sivopixant for Refractory or Unexplained Chronic Cough. Lung 2023; 201:25-35. [PMID: 36512069 PMCID: PMC9745691 DOI: 10.1007/s00408-022-00592-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION To determine the optimal dose of sivopixant, a highly selective P2X3 receptor antagonist, for refractory or unexplained chronic cough (RCC/UCC). METHODS In this phase 2b, randomized, double-blind, placebo-controlled, parallel-group, multicenter trial, patients received sivopixant 50, 150, or 300 mg or placebo once daily for 4 weeks. The primary endpoint was a change from baseline in 24-h cough frequency (coughs/h) with sivopixant vs placebo. RESULTS Overall, 390/406 randomized patients completed the study. Placebo-adjusted changes in hourly cough count over 24 h were 13.17% (P = 0.3532), - 1.77% (P = 0.8935), and - 12.47% (P = 0.3241) and in cough severity (visual analog scale) were 1.75 mm (P = 0.5854), - 1.21 mm (P = 0.7056), and - 6.55 mm (P = 0.0433) with sivopixant 50, 150, and 300 mg, respectively. Placebo-adjusted changes from baseline in Leicester Cough Questionnaire total scores were - 0.37 (P = 0.4207), - 0.07 (P = 0.8806), and 0.69 (P = 0.1473) with sivopixant 50, 150, and 300 mg, respectively. Additionally, 61.3%, 78.3%, 86.8%, and 71.4% of patients receiving sivopixant 50, 150, and 300 mg and placebo, respectively, reported any improvements in Patient Global Impression of Change. The incidence of treatment-emergent adverse events (TEAEs) was 25.7%, 32.0%, 49.0%, and 20.6% in sivopixant 50, 150, and 300 mg and placebo groups, respectively; all TEAEs in the sivopixant group were mild-to-moderate. CONCLUSION Sivopixant did not demonstrate a statistically significant difference vs placebo in change from baseline in 24-h cough frequency. The dose of 300 mg has potential for RCC/UCC, showing the greatest improvements in cough frequency and patient-reported outcomes and dose-related mild to moderate reversible taste disturbance, although further trials are needed. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier NCT04110054; registered September 26, 2019.
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Affiliation(s)
| | - Jaclyn A Smith
- University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
| | - Alyn Morice
- University of Hull, Castle Hill Hospital, Hull, UK
| | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Kian Fan Chung
- National Heart & Lung Institute, Imperial College London & Royal Brompton and Harefield Hospitals, London, UK
| | - Peter V Dicpinigaitis
- Albert Einstein College of Medicine, Montefiore Medical Center, Division of Critical Care Medicine, Bronx, NY, USA
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University, Nagoya, Japan
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Jahanfar F, Sadofsky L, Morice A, D’Amico M. Nebivolol as a Potent TRPM8 Channel Blocker: A Drug-Screening Approach through Automated Patch Clamping and Ligand-Based Virtual Screening. Membranes (Basel) 2022; 12:954. [PMID: 36295712 PMCID: PMC9609861 DOI: 10.3390/membranes12100954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
Transient Receptor Potential Melastatin 8 (TRPM8) from the melastatin TRP channel subfamily is a non-selective Ca2+-permeable ion channel with multimodal gating which can be activated by low temperatures and cooling compounds, such as menthol and icilin. Different conditions such as neuropathic pain, cancer, overactive bladder syndrome, migraine, and chronic cough have been linked to the TRPM8 mode of action. Despite the several potent natural and synthetic inhibitors of TRPM8 that have been identified, none of them have been approved for clinical use. The aim of this study was to discover novel blocking TRPM8 agents using automated patch clamp electrophysiology combined with a ligand-based virtual screening based on the SwissSimilarity platform. Among the compounds we have tested, nebivolol and carvedilol exhibited the greatest inhibitory effect, with an IC50 of 0.97 ± 0.15 µM and 9.1 ± 0.6 µM, respectively. This study therefore provides possible candidates for future drug repurposing and suggests promising lead compounds for further optimization as inhibitors of the TRPM8 ion channel.
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Affiliation(s)
- Farhad Jahanfar
- Di.V.A.L. Toscana S.r.l., Via Madonna del Piano 6, 50019 Sesto Fiorentino, Italy
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Laura Sadofsky
- Centre for Atherothrombosis and Metabolic Disease, Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - Alyn Morice
- Respiratory Research Group, Hull York Medical School, Castle Hill Hospital, Cottingham HU16 5JQ, UK
| | - Massimo D’Amico
- Di.V.A.L. Toscana S.r.l., Via Madonna del Piano 6, 50019 Sesto Fiorentino, Italy
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Friedrich C, Francke K, Gashaw I, Scheerans C, Klein S, Fels L, Smith JA, Hummel T, Morice A. Safety, Pharmacodynamics, and Pharmacokinetics of P2X3 Receptor Antagonist Eliapixant (BAY 1817080) in Healthy Subjects: Double-Blind Randomized Study. Clin Pharmacokinet 2022; 61:1143-1156. [PMID: 35624408 PMCID: PMC9349145 DOI: 10.1007/s40262-022-01126-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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] [Accepted: 03/30/2022] [Indexed: 12/12/2022]
Abstract
Background and Objective There is no licensed treatment for refractory chronic cough; off-label therapies have limited efficacy and can produce adverse effects. Excessive adenosine triphosphate signaling via P2X3 receptors is implicated in refractory chronic cough, and selective P2X3 receptor antagonists such as eliapixant (BAY 1817080) are under investigation. The objective of the study was to investigate the safety and tolerability of ascending repeated oral doses of eliapixant in healthy volunteers. Methods We conducted a repeated-dose, double-blind, randomized, placebo-controlled study in 47 healthy male individuals. Subjects received repeated twice-daily ascending oral doses of eliapixant (10, 50, 200, and 750 mg) or placebo for 2 weeks. The primary outcome was frequency and severity of adverse events. Other outcomes included pharmacokinetics and evaluation of taste disturbances, which have occurred with the less selective P2X3 receptor antagonist gefapixant. Results Peak plasma concentrations of eliapixant were reached 3–4 h after administration of the first and subsequent doses. With multiple dosing, steady-state plasma concentrations were reached after ~ 6 days, and plasma concentrations predicted to achieve ≥ 80% P2X3 receptor occupancy (the level required for efficacy) were reached at 200 and 750 mg. Increases in plasma concentrations with increasing doses were less than dose proportional. After multiple dosing, mean plasma concentrations of eliapixant showed low peak–trough fluctuations and were similar for 200- and 750-mg doses. Eliapixant was well tolerated with a low incidence of taste-related adverse events. Conclusions Eliapixant (200 and 750 mg) produced plasma concentrations that cover the predicted therapeutic threshold over 24 h, with good safety and tolerability. These results enabled eliapixant to progress to clinical trials in patients with refractory chronic cough. Clinical Trial Registration Clinicaltrials.gov: NCT03310645 (initial registration: 16 October, 2017). Supplementary Information The online version contains supplementary material available at 10.1007/s40262-022-01126-1. There are few effective treatments for patients with a long-term (chronic) cough. It is thought that chronic cough is caused by nerves becoming oversensitive, wrongly causing a cough when there is no need. We tested a new drug called eliapixant in 47 healthy men. Eliapixant reduces the excessive nerve signaling responsible for chronic cough. We looked for side effects of eliapixant and measured how it behaves in the body. In particular we looked for side effects relating to the sense of taste because gefapixant, a similar drug to eliapixant, can affect taste. Participants took one of four eliapixant doses or a placebo twice daily for 2 weeks. The highest levels of eliapixant in the blood were seen 3–4 h after taking the drug, and stable concentrations were seen after about 6 days. At the two highest doses, eliapixant reached concentrations in the body that should be high enough to work in patients with chronic cough. Side effects were generally similar between eliapixant and placebo. Taste-related side effects were mild and went away without needing treatment. The positive results of this study meant that eliapixant could be tested in patients with chronic cough.
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Affiliation(s)
- Christian Friedrich
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany.
| | - Klaus Francke
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany
| | - Isabella Gashaw
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany.,Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Christian Scheerans
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany
| | - Stefan Klein
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany
| | - Lueder Fels
- Bayer AG Research & Development, Pharmaceuticals Clinical Pharmacology, 1 Building M004, 13353, Berlin, Germany
| | - Jaclyn A Smith
- University of Manchester, Manchester University NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - Thomas Hummel
- Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Alyn Morice
- Centre for Clinical Sciences, Hull York Medical School, University of Hull, Hull, UK
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Cotton S, Devereux G, Abbas H, Briggs A, Campbell K, Chaudhuri R, Choudhury G, Dawson D, De Soyza A, Fielding S, Gompertz S, Haughney J, Lang CC, Lee AJ, MacLennan G, MacNee W, McCormack K, McMeekin N, Mills NL, Morice A, Norrie J, Petrie MC, Price D, Short P, Vestbo J, Walker P, Wedzicha J, Wilson A, Lipworth BJ. Use of the oral beta blocker bisoprolol to reduce the rate of exacerbation in people with chronic obstructive pulmonary disease (COPD): a randomised controlled trial (BICS). Trials 2022; 23:307. [PMID: 35422024 PMCID: PMC9009490 DOI: 10.1186/s13063-022-06226-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/31/2022] [Accepted: 03/26/2022] [Indexed: 12/13/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is associated with significant morbidity, mortality and healthcare costs. Beta blockers are well-established drugs widely used to treat cardiovascular conditions. Observational studies consistently report that beta blocker use in people with COPD is associated with a reduced risk of COPD exacerbations. The bisoprolol in COPD study (BICS) investigates whether adding bisoprolol to routine COPD treatment has clinical and cost-effective benefits. A sub-study will risk stratify participants for heart failure to investigate whether any beneficial effect of bisoprolol is restricted to those with unrecognised heart disease. Methods BICS is a pragmatic randomised parallel group double-blind placebo-controlled trial conducted in UK primary and secondary care sites. The major inclusion criteria are an established predominant respiratory diagnosis of COPD (post-bronchodilator FEV1 < 80% predicted, FEV1/FVC < 0.7), a self-reported history of ≥ 2 exacerbations requiring treatment with antibiotics and/or oral corticosteroids in a 12-month period since March 2019, age ≥ 40 years and a smoking history ≥ 10 pack years. A computerised randomisation system will allocate 1574 participants with equal probability to intervention or control groups, stratified by centre and recruitment in primary/secondary care. The intervention is bisoprolol (1.25 mg tablets) or identical placebo. The dose of bisoprolol/placebo is titrated up to a maximum of 4 tablets a day (5 mg bisoprolol) over 4–7 weeks depending on tolerance to up-dosing of bisoprolol/placebo—these titration assessments are completed by telephone or video call. Participants complete the remainder of the 52-week treatment period on the final titrated dose (1, 2, 3, 4 tablets) and during that time are followed up at 26 and 52 weeks by telephone or video call. The primary outcome is the total number of participant reported COPD exacerbations requiring oral corticosteroids and/or antibiotics during the 52-week treatment period. A sub-study will risk stratify participants for heart failure by echocardiography and measurement of blood biomarkers. Discussion The demonstration that bisoprolol reduces the incidence of exacerbations would be relevant not only to patients and clinicians but also to healthcare providers, in the UK and globally. Trial registration Current controlled trials ISRCTN10497306. Registered on 16 August 2018 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06226-8.
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Affiliation(s)
- Seonaidh Cotton
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Graham Devereux
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, AB25 2ZD, UK. .,Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.
| | - Hassan Abbas
- Division of Applied Medicine, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Andrew Briggs
- Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Karen Campbell
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Rekha Chaudhuri
- Gartnavel General Hospital, University of Glasgow, Glasgow, G12 0YN, UK
| | | | - Dana Dawson
- Division of Applied Medicine, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Anthony De Soyza
- University of Newcastle, Medical School, Newcastle Upon Tyne, NE2 4HH, UK
| | - Shona Fielding
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Simon Gompertz
- Queen Elizabeth Hospital Birmingham, Birmingham, B15 2WB, UK
| | - John Haughney
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Chim C Lang
- Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
| | - Amanda J Lee
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - William MacNee
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Kirsty McCormack
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Nicola McMeekin
- Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Alyn Morice
- Cardiovascular and Respiratory Studies, Castle Hill Hospital, Hull, HU16 5JQ, UK
| | - John Norrie
- NINE Edinburgh BioQuarter, University of Edinburgh, 9 Little France Road, Edinburgh, EH16 4UX, UK
| | - Mark C Petrie
- Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TD, UK
| | - David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | | | - Jorgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, M23 9LT, UK
| | - Paul Walker
- Liverpool University Hospitals Foundation NHS Trust, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK
| | - Jadwiga Wedzicha
- National Heart and Lung Institute, Imperial College, London, SW3 6LY, UK
| | - Andrew Wilson
- Department of Medicine, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Brian J Lipworth
- Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK
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Zhang M, Brindle K, Robinson M, Ingram D, Cavany T, Morice A. Chronic cough in cystic fibrosis - the effect of modulator therapy on objective 24-hour cough monitoring. ERJ Open Res 2022; 8:00031-2022. [PMID: 35509439 PMCID: PMC9062297 DOI: 10.1183/23120541.00031-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/06/2022] [Indexed: 11/28/2022] Open
Abstract
Cystic fibrosis (CF) is an autosomal recessive condition, deletion of phenylalanine at position 508 (F508del) being the most frequent mutation in CF patients. Kaftrio, also called Trikafta in the USA, (Vertex Pharmaceuticals Inc., Germany) is a licensed modulator therapy for CF patients with at least one F508del mutation [1]. Several clinical trials have demonstrated its efficacy [2]. However, the primary outcome measured in these studies was the change in per cent predicted of forced expiratory volume in 1 s (FEV1), which was in the order of 10%, and thus may have a relatively low sensitivity in predicting efficacy, particularly in more severely affected patients [3]. This is a prospective observation of the effect of Kaftrio initiation in CF. An early and dramatic improvement in the objective measure of 24-h cough monitoring was observed, providing noninvasive, objective evidence of efficacy and compliance in CF.https://bit.ly/3LpnABB
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Blaiss M, Dicpinigaitis P, Birring S, McGarvey L, Morice A, Pavord I, Satia I, Smith J, La Rosa C, Li Q, Nguyen AM, Schelfhout J, Tzontcheva A, Muccino D. Comparisons Of Baseline Characteristics And Treatment Efficacy In Individuals With Refractory Or Unexplained Chronic Cough Enrolled In Phase 3 Trials Of Gefapixant. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.101] [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: 10/19/2022]
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13
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Morice A, Dicpinigaitis P, McGarvey L, Birring SS. Chronic cough: new insights and future prospects. Eur Respir Rev 2021; 30:30/162/210127. [PMID: 34853095 PMCID: PMC9488126 DOI: 10.1183/16000617.0127-2021] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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] [Received: 05/27/2021] [Accepted: 08/20/2021] [Indexed: 11/25/2022] Open
Abstract
Chronic cough is defined in adults as a cough that lasts for ≥8 weeks. When it proves intractable to standard-of-care treatment, it can be referred to as refractory chronic cough (RCC). Chronic cough is now understood to be a condition of neural dysregulation. Chronic cough and RCC result in a serious, often unrecognized, disease burden, which forms the focus of the current review. The estimated global prevalence of chronic cough is 2–18%. Patients with chronic cough and RCC report many physical and psychological effects, which impair their quality of life. Chronic cough also has a significant economic burden for the patient and healthcare systems. RCC diagnosis and treatment are often delayed for many years as potential treatable triggers must be excluded first and a stepwise empirical therapeutic regimen is recommended. Evidence supporting most currently recommended treatments is limited. Many treatments do not address the underlying pathology, are used off-label, have limited efficacy and produce significant side-effects. There is therefore a significant unmet need for alternative therapies for RCC that target the underlying disease mechanisms. Early clinical data suggest that antagonists of the purinergic P2X3 receptor, an important mediator of RCC, are promising, though more evidence is needed. Chronic cough exerts a considerable burden on patients and healthcare systems. In addition to effective targeted therapies, further data are needed to understand the pathophysiology, epidemiology and disease burden.https://bit.ly/3Be9JZI
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Affiliation(s)
- Alyn Morice
- Centre for Clinical Sciences, Hull York Medical School, University of Hull, Hull, UK
| | - Peter Dicpinigaitis
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Lorcan McGarvey
- Centre for Experimental Medicine, Dentistry, and Biomedical Sciences, Queen's University, Belfast, UK
| | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College Hospital, London, UK
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Morice A, Smith JA, McGarvey L, Birring SS, Parker SM, Turner A, Hummel T, Gashaw I, Fels L, Klein S, Francke K, Friedrich C. Eliapixant (BAY 1817080), a P2X3 receptor antagonist, in refractory chronic cough: a randomised, placebo-controlled, crossover phase 2a study. Eur Respir J 2021; 58:2004240. [PMID: 33986030 PMCID: PMC8607926 DOI: 10.1183/13993003.04240-2020] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/05/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND ATP acting via P2X3 receptors is an important mediator of refractory chronic cough (RCC). This phase 2a double-blinded crossover study assessed the safety, tolerability and efficacy of eliapixant (BAY 1817080), a selective P2X3 receptor antagonist, in adults with RCC attending specialist centres. METHODS In period A, patients received placebo for 2 weeks then eliapixant 10 mg for 1 week. In period B, patients received eliapixant 50, 200 and 750 mg twice daily for 1 week per dose level. Patients were randomised 1:1 to period A-B (n=20) or B-A (n=20). The primary efficacy end-point was change in cough frequency assessed over 24 h. The primary safety end-point was frequency and severity of adverse events (AEs). RESULTS 37 patients completed randomised therapy. Mean cough frequency fell by 17.4% versus baseline with placebo. Eliapixant reduced cough frequency at doses ≥50 mg (reduction versus placebo at 750 mg: 25% (90% CI 11.5-36.5%); p=0.002). Doses ≥50 mg also significantly reduced cough severity. AEs, mostly mild or moderate, were reported in 65% of patients with placebo and 41-49% receiving eliapixant. Cumulative rates of taste-related AEs were 3% with placebo and 5-21% with eliapixant; all were mild. CONCLUSIONS Selective P2X3 antagonism with eliapixant significantly reduced cough frequency and severity, confirming this as a viable therapeutic pathway for RCC. Taste-related side-effects were lower at therapeutic doses than with the less selective P2X3 antagonist gefapixant. Selective P2X3 antagonism appears to be a novel therapeutic approach for RCC.
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Affiliation(s)
- Alyn Morice
- Respiratory Research Group, Hull York Medical School, University of Hull, Hull, UK
| | - Jaclyn A Smith
- Manchester University NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK
| | - Lorcan McGarvey
- Wellcome Wolfson Institute of Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College Hospital, London, UK
| | - Sean M Parker
- North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Alice Turner
- Institute of Applied Health Research and Population Sciences, University of Birmingham, Birmingham, UK
| | - Thomas Hummel
- Smell and Taste Clinic, Dept of Otorhinolaryngology, TU Dresden, Dresden, Germany
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Ludbrook VJ, Hanrott KE, Kreindler JL, Marks-Konczalik JE, Bird NP, Hewens DA, Beerahee M, Behm DJ, Morice A, McGarvey L, Parker SM, Birring SS, Smith J. Adaptive study design to assess effect of TRPV4 inhibition in patients with chronic cough. ERJ Open Res 2021; 7:00269-2021. [PMID: 34350286 PMCID: PMC8326712 DOI: 10.1183/23120541.00269-2021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 04/19/2021] [Accepted: 06/04/2021] [Indexed: 01/29/2023] Open
Abstract
Objective Airway sensory nerves involved in the cough reflex are activated by adenosine triphosphate (ATP) agonism of P2X purinoceptor 3 (P2X3) receptors. Transient receptor potential vanilloid 4 (TRPV4) channel activation causes ATP release from airway cells, and it is hypothesised that a TRPV4-ATP-P2X3 axis contributes to chronic cough. An adaptive study was run to determine if TRPV4 inhibition, using the selective TRPV4 channel blocker GSK2798745, was effective in reducing cough. Methods A two-period randomised, double blinded, placebo-controlled crossover study was designed with interim analyses for futility and sample size adjustment. Refractory chronic cough patients received either GSK2798745 or placebo once daily for 7 days with a washout between treatments. Pharmacokinetic samples were collected for analysis of GSK2798745 at end of study. The primary end-point was total cough counts assessed objectively during day-time hours (10 h) following 7 days of dosing. Results Interim analysis was performed after 12 participants completed both treatment periods. This showed a 32% increase in cough counts on Day 7 for GSK2798745 compared to placebo; the pre-defined negative criteria for the study were met and the study was stopped. At this point 17 participants had been enrolled (mean 61 years; 88% female), and 15 had completed the study. Final study results for posterior median cough counts showed a 34% (90% credible interval: -3%, +85%) numerical increase for GSK2798745 compared to placebo. Conclusion There was no evidence of an anti-tussive effect of GSK2798745. The study design allowed the decision on lack of efficacy to be made with minimal participant exposure to the investigational drug.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Surinder S Birring
- Centre for Human & Applied Physiological Sciences, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Jaclyn Smith
- Division of Infection Immunity and Respiratory Medicine, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK
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Morice A, Jablon E, Delevaque C, Khonsari R, Picard A, Kadlub N. Virtual versus traditional classroom on facial traumatology learning: Evaluation of medical student's knowledge acquisition and satisfaction. Journal of Stomatology, Oral and Maxillofacial Surgery 2020; 121:642-645. [DOI: 10.1016/j.jormas.2020.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 03/02/2020] [Indexed: 11/25/2022]
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Morice A, Cornette R, Giudice A, Collet C, Paternoster G, Arnaud É, Galliani E, Picard A, Legeai-Mallet L, Khonsari RH. Early mandibular morphological differences in patients with FGFR2 and FGFR3-related syndromic craniosynostoses: A 3D comparative study. Bone 2020; 141:115600. [PMID: 32822871 DOI: 10.1016/j.bone.2020.115600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/10/2020] [Accepted: 08/14/2020] [Indexed: 01/04/2023]
Abstract
Syndromic craniosynostoses are defined by the premature fusion of one or more cranial and facial sutures, leading to skull vault deformation, and midfacial retrusion. More recently, mandibular shape modifications have been described in FGFR-related craniosynostoses, which represent almost 75% of the syndromic craniosynostoses. Here, further characterisation of the mandibular phenotype in FGFR-related craniosynostoses is provided in order to confirm mandibular shape modifications, as this could contribute to a better understanding of the involvement of the FGFR pathway in craniofacial development. The aim of our study was to analyse early mandibular morphology in a cohort of patients with FGFR2- (Crouzon and Apert) and FGFR3- (Muenke and Crouzonodermoskeletal) related syndromic craniosynostoses. We used a comparative geometric morphometric approach based on 3D imaging. Thirty-one anatomical landmarks and eleven curves with sliding semi-landmarks were defined to model the shape of the mandible. In total, 40 patients (12 with Crouzon, 12 with Apert, 12 with Muenke and 4 with Crouzonodermoskeletal syndromes) and 40 age and sex-matched controls were included (mean age: 13.7 months ±11.9). Mandibular shape differed significantly between controls and each patient group based on geometric morphometrics. Mandibular shape in FGFR2-craniosynostoses was characterized by open gonial angle, short ramus height, and high and prominent symphysis. Short ramus height appeared more pronounced in Apert than in Crouzon syndrome. Additionally, narrow inter-condylar and inter-gonial distances were observed in Crouzon syndrome. Mandibular shape in FGFR3-craniosynostoses was characterized by high and prominent symphysis and narrow inter-gonial distance. In addition, narrow condylar processes affected patients with Crouzonodermoskeletal syndrome. Statistical analysis of variance showed significant clustering of Apert and Crouzon, Crouzon and Muenke, and Apert and Muenke patients (p < 0.05). Our results confirm distinct mandibular shapes at early ages in FGFR2- (Crouzon and Apert syndromes) and FGFR3-related syndromic craniosynostoses (Muenke and Crouzonodermoskeletal syndromes) and reinforce the hypothesis of genotype-phenotype correspondence concerning mandibular morphology.
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Affiliation(s)
- A Morice
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares MAFACE Fentes et Malformations Faciales, Université de Paris, Paris, France; Laboratoire 'Bases Moléculaires et Physiopathologiques des Ostéochondrodysplasies', INSERM UMR 1163, Institut Imagine, Paris, France.
| | - R Cornette
- Institut de Systématique, Evolution, Biodiversité (ISYEB), Muséum National d'Histoire Naturelle, Sorbonne Université, Ecole Pratique des Hautes Etudes, Université des Antilles, CNRS, CP 50, 57 rue Cuvier, 75005 Paris, France
| | - A Giudice
- Università Degli Studi di Catanzaro 'Magna Graecia', Catanzaro, Italy
| | - C Collet
- BIOSCAR, INSERM U1132, Université de Paris, Hôpital Lariboisière, 75010 Paris, France; Service de Biochimie et Biologie Moléculaire, CHU-Paris-GH Saint Louis Lariboisière Widal, Paris, France
| | - G Paternoster
- Service de Neurochirurgie, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST Craniosténoses et Malformations Craniofaciales, Université de Paris, Paris, France
| | - É Arnaud
- Service de Neurochirurgie, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST Craniosténoses et Malformations Craniofaciales, Université de Paris, Paris, France
| | - E Galliani
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares MAFACE Fentes et Malformations Faciales, Université de Paris, Paris, France
| | - A Picard
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares MAFACE Fentes et Malformations Faciales, Université de Paris, Paris, France
| | - L Legeai-Mallet
- Laboratoire 'Bases Moléculaires et Physiopathologiques des Ostéochondrodysplasies', INSERM UMR 1163, Institut Imagine, Paris, France
| | - R H Khonsari
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares MAFACE Fentes et Malformations Faciales, Université de Paris, Paris, France; Laboratoire 'Bases Moléculaires et Physiopathologiques des Ostéochondrodysplasies', INSERM UMR 1163, Institut Imagine, Paris, France; Service de Neurochirurgie, Hôpital Universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence Maladies Rares CRANIOST Craniosténoses et Malformations Craniofaciales, Université de Paris, Paris, France
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Bernstein J, Morice A, Fonseca E, Zeiger R, Oppenheimer J, McGarvey L, Meltzer E, Dicpinigaitis P, Li V. P501 COUGH TRIGGERS BY GENDER: A POPULATION SURVEY OF US AND UK ADULTS WITH CHRONIC COUGH. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.159] [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: 11/30/2022]
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Devereux G, Cotton S, Fielding S, McMeekin N, Barnes PJ, Briggs A, Burns G, Chaudhuri R, Chrystyn H, Davies L, Soyza AD, Gompertz S, Haughney J, Innes K, Kaniewska J, Lee A, Morice A, Norrie J, Sullivan A, Wilson A, Price D. Low-dose oral theophylline combined with inhaled corticosteroids for people with chronic obstructive pulmonary disease and high risk of exacerbations: a RCT. Health Technol Assess 2020; 23:1-146. [PMID: 31343402 DOI: 10.3310/hta23370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite widespread use of therapies such as inhaled corticosteroids (ICSs), people with chronic obstructive pulmonary disease (COPD) continue to suffer, have reduced life expectancy and utilise considerable NHS resources. Laboratory investigations have demonstrated that at low plasma concentrations (1-5 mg/l) theophylline markedly enhances the anti-inflammatory effects of corticosteroids in COPD. OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of adding low-dose theophylline to a drug regimen containing ICSs in people with COPD at high risk of exacerbation. DESIGN A multicentre, pragmatic, double-blind, randomised, placebo-controlled clinical trial. SETTING The trial was conducted in 121 UK primary and secondary care sites. PARTICIPANTS People with COPD [i.e. who have a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) of < 0.7] currently on a drug regimen including ICSs with a history of two or more exacerbations treated with antibiotics and/or oral corticosteroids (OCSs) in the previous year. INTERVENTIONS Participants were randomised (1 : 1) to receive either low-dose theophylline or placebo for 1 year. The dose of theophylline (200 mg once or twice a day) was determined by ideal body weight and smoking status. PRIMARY OUTCOME The number of participant-reported exacerbations in the 1-year treatment period that were treated with antibiotics and/or OCSs. RESULTS A total of 1578 people were randomised (60% from primary care): 791 to theophylline and 787 to placebo. There were 11 post-randomisation exclusions. Trial medication was prescribed to 1567 participants: 788 in the theophylline arm and 779 in the placebo arm. Participants in the trial arms were well balanced in terms of characteristics. The mean age was 68.4 [standard deviation (SD) 8.4] years, 54% were male, 32% smoked and mean FEV1 was 51.7% (SD 20.0%) predicted. Primary outcome data were available for 98% of participants: 772 in the theophylline arm and 764 in the placebo arm. There were 1489 person-years of follow-up data. The mean number of exacerbations was 2.24 (SD 1.99) for participants allocated to theophylline and 2.23 (SD 1.97) for participants allocated to placebo [adjusted incidence rate ratio (IRR) 0.99, 95% confidence interval (CI) 0.91 to 1.08]. Low-dose theophylline had no significant effects on lung function (i.e. FEV1), incidence of pneumonia, mortality, breathlessness or measures of quality of life or disease impact. Hospital admissions due to COPD exacerbation were less frequent with low-dose theophylline (adjusted IRR 0.72, 95% CI 0.55 to 0.94). However, 39 of the 51 excess hospital admissions in the placebo group were accounted for by 10 participants having three or more exacerbations. There were no differences in the reporting of theophylline side effects between the theophylline and placebo arms. LIMITATIONS A higher than expected percentage of participants (26%) ceased trial medication; this was balanced between the theophylline and placebo arms and mitigated by over-recruitment (n = 154 additional participants were recruited) and the high rate of follow-up. The limitation of not using documented exacerbations is addressed by evidence that patient recall is highly reliable and the results of a small within-trial validation study. CONCLUSION For people with COPD at high risk of exacerbation, the addition of low-dose oral theophylline to a drug regimen that includes ICSs confers no overall clinical or health economic benefit. This result was evident from the intention-to-treat and per-protocol analyses. FUTURE WORK To promote consideration of the findings of this trial in national and international COPD guidelines. TRIAL REGISTRATION Current Controlled Trials ISRCTN27066620. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 37. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Graham Devereux
- Respiratory Medicine, Aberdeen Royal Infirmary, University of Aberdeen, Aberdeen, UK
| | - Seonaidh Cotton
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Shona Fielding
- Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Nicola McMeekin
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andy Briggs
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Graham Burns
- Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Rekha Chaudhuri
- Gartnavel General Hospital, University of Glasgow, Glasgow, UK
| | | | - Lisa Davies
- Aintree Chest Centre, University Hospital Aintree, Liverpool, UK
| | | | | | - John Haughney
- Gartnavel General Hospital, University of Glasgow, Glasgow, UK
| | - Karen Innes
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Joanna Kaniewska
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Amanda Lee
- Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Alyn Morice
- Cardiovascular and Respiratory Studies, Castle Hill Hospital, Cottingham, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | | | - Andrew Wilson
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - David Price
- Respiratory Medicine, Aberdeen Royal Infirmary, University of Aberdeen, Aberdeen, UK.,Academic Primary Care, University of Aberdeen, Aberdeen, UK
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Smith JA, Kitt MM, Morice AH, Birring SS, McGarvey LP, Sher MR, Li YP, Wu WC, Xu ZJ, Muccino DR, Ford AP, Smith J, McGarvey L, Birring S, Hull J, Carr WW, Goldsobel AB, Gross GN, Holcomb JR, Hussain I, Sher M, Spangenthal S, Storms W, Morice A, Elkayam D, Steven GC, Krainson J, Fakih FA, Matz J, Brooks GD, Casale T, Berman GD, Condemi JJ, Greos LS, Gogate SU, Sher ER, Friesen JH, Schenkel EJ, Bernstein DI, Corren J, Sundar K, Gotfried MH, Montanaro A, Lumry WR, Amar NJ, Kaplan MS, Prenner BM, Murphy TR, Good JS, Parker S, Harrison T, Pavord I, Brightling C, Djukanovic R, McQuaid D, Denenberg M, Ettinger NA, Iyer V. Gefapixant, a P2X3 receptor antagonist, for the treatment of refractory or unexplained chronic cough: a randomised, double-blind, controlled, parallel-group, phase 2b trial. The Lancet Respiratory Medicine 2020; 8:775-785. [DOI: 10.1016/s2213-2600(19)30471-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 01/02/2023]
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21
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Muccino D, Morice A, Birring A, Mcgarvey L, Dicpinigaitis P, Pavord I, La Rosa C, Urdaneta E, Assaid C, Smith J. BASELINE CHARACTERISTICS FROM A PHASE 3, RANDOMIZED CONTROLLED TRIAL (COUGH-2) OF GEFAPIXANT, A P2X3 RECEPTOR ANTAGONIST, IN REFRACTORY OR UNEXPLAINED CHRONIC COUGH. Chest 2020. [DOI: 10.1016/j.chest.2020.05.005] [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: 10/24/2022] Open
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22
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Sher M, Birring S, Morice A, McGarvey L, Smith J, Wu WC, Schelfhout J, Muccino D. Evaluation of co-morbid conditions among refractory or unexplained chronic cough patients in two phase 2 randomized controlled trials. J Allergy Clin Immunol 2020. [DOI: 10.1016/j.jaci.2019.12.228] [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: 10/24/2022]
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23
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Holden SE, Morice A, Birring SS, Jenkins-Jones S, Langerman H, Weaver J, Currie CJ. Cough presentation in primary care and the identification of chronic cough: a need for diagnostic clarity? Curr Med Res Opin 2020; 36:139-150. [PMID: 31558053 DOI: 10.1080/03007995.2019.1673716] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To investigate patterns of presentation of cough in primary care and develop an algorithm to identify probable and possible chronic cough (CC).Methods: This retrospective observational study used routine English primary care data and linked hospital data. Patients with ≥1 cough event in the study period (March 2014-February 2015) were selected. Index date was that of the earliest cough event in this period. Adults (aged ≥18 years) were classified as having probable CC if they had an explicit CC diagnosis; as having possible CC if they had ≥3 cough events recorded over 8-26 weeks; or, otherwise, as having acute cough. Underlying conditions associated with CC were identified.Results: 198,151 people were identified. 56.5% were female; median age was 47.0 years. The prevalence of cough in the study year was 17.6%. Of the 150,213 identified adults, 1600 (1.1%), 10,913 (7.3%) and 137,718 (91.7%) were classified as having probable CC, possible CC or acute cough, respectively. Compared with probable CC and acute cough, a higher percentage of possible CC cases had a record on or prior to index date indicative of chronic obstructive pulmonary disease (30.6% versus 10.1% and 9.7%), gastro-esophageal reflux disease (32.6% versus 24.9% and 21.1%) or asthma (45.9% versus 27.6% and 27.9%). Prevalences of probable and possible CC were 0.18% and 1.2%, respectively.Conclusions: The prevalence of CC was lower than reported in previous studies. People with possible CC had higher rates of underlying conditions associated with CC. These observations may suggest poor recognition and/or under-recording of CC in primary care.
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Affiliation(s)
| | - Alyn Morice
- Hull York Medical School, University of Hull, Hull, UK
| | - Surinder S Birring
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | | | | | - Craig J Currie
- Pharmatelligence, Cardiff, UK
- The Institute of Population Medicine, Cardiff University, Cardiff, UK
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24
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Barlow G, Morice A. Successful treatment of resistant Burkholderia multivorans infection in a patient with cystic fibrosis using ceftazidime/avibactam plus aztreonam. J Antimicrob Chemother 2019; 73:2270-2271. [PMID: 29912407 DOI: 10.1093/jac/dky136] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Gavin Barlow
- The Centre for Immunology and Infection, Hull York Medical School, University of York, Heslington, York, UK.,Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | - Alyn Morice
- Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Hull, UK.,Cardiorespiratory Studies, Hull York Medical School, University of Hull, Castle Hill Hospital, Hull, UK
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Mehta A, Birring S, McGarvey L, Smith J, Morice A, Sher M, Schelfhout J, Muccino D. BENEFITS OBSERVED WITH PATIENT-REPORTED OUTCOMES IN A PHASE 2B CLINICAL TRIAL OF GEFAPIXANT, A P2X3 RECEPTOR ANTAGONIST IN CHRONIC COUGH. Chest 2019. [DOI: 10.1016/j.chest.2019.08.1548] [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: 11/16/2022] Open
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26
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Mehta A, Morice A, Birring S, McGarvey L, Sher M, Muccino D, Smith J. CONSISTENCY OF IMPROVEMENT WITH GEFAPIXANT, A P2X3 RECEPTOR ANTAGONIST, IN CHRONIC COUGH PATIENTS DURING WAKING HOURS AND OVER 24 HOURS. Chest 2019. [DOI: 10.1016/j.chest.2019.08.1389] [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: 10/25/2022] Open
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Mcgarvey L, Morice A, Way N, Li V, Weaver J, Doshi I, Urdaneta E, Boggs R. Prevalence of chronic cough, patient characteristics and health outcomes among UK adults. Epidemiology 2019. [DOI: 10.1183/13993003.congress-2019.pa3327] [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: 11/05/2022]
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28
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Giudice A, Belhous K, Barone S, Soupre V, Morice A, Vazquez MP, Boddeart N, Abadie V, Picard A. The use of three-dimensional reconstructions of CT scans to evaluate anomalies of hyoid bone in Pierre Robin sequence: A retrospective study. J Stomatol Oral Maxillofac Surg 2019; 121:357-362. [PMID: 31499229 DOI: 10.1016/j.jormas.2019.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/30/2019] [Indexed: 10/26/2022]
Abstract
AIM The aim of the study was to investigate hyoid bone anomalies in patients with Pierre Robin sequence (PRS) compared to the control group, using computed tomography (CT) examination and three-dimensional reconstruction of the hyoid bone and mandible. METHODS A retrospective study was performed of patients between birth and 12 months old with isolated PRS (i-PRS) and syndromic PRS (ni-PRS), who had undergone CT examination, and whose results were compared to the control group of the same age. DICOM data was processed to highlight bone tissue. The mandible and hyoid bones were the main targets of the three-dimensional reconstruction. The study outcomes were the analysis of hyoid bone ossification, volume, and position (distance between hyoid and mandibular symphysis). Univariate and multivariate statistical analyses were performed with α=0.05 as level of significance. RESULTS The study sample included 29 i-PRS and 21 ni-PRS patients, while 43 infants in the control group. Hyoid ossification was present in 26/50 (52%) PRS patients (14 i-PRS; 12 ni-PRS) but in 31/43 controls (72%). Statistical analysis showed that absence of hyoid ossification was significantly associated with the diagnosis of PRS (P<0.05). Only ni-PRS patients showed a significant reduction of the distance between hyoid and mandible compared to the control group (P<0.001). Hyoid volume was significantly lower only in the ni-PRS group than in controls (P<0.001). CONCLUSION I-PRS and ni-PRS patients differ both etiologically and clinically. Ni-PRS patients confirmed their worst clinical condition than i-PRS with severe anomalies of hyoid development, helping for their ontogeny classification.
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Affiliation(s)
- A Giudice
- Department of Oral and Maxillofacial Surgery, Magna Graecia University of Catanzaro, Viale Europa, Catanzaro, 88100, Italy; Department of Maxillofacial and Plastic Surgery, Necker-Enfants Malades Hospital, 75015 Paris, France.
| | - K Belhous
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, 75015 Paris, France
| | - S Barone
- Department of Dentistry, Magna Graecia University, 88100 Catanzaro, Italy
| | - V Soupre
- Department of Maxillofacial and Plastic Surgery, Necker-Enfants Malades Hospital, 75015 Paris, France
| | - A Morice
- Department of Maxillofacial and Plastic Surgery, Necker-Enfants Malades Hospital, 75015 Paris, France
| | - M-P Vazquez
- Department of Maxillofacial and Plastic Surgery, Necker-Enfants Malades Hospital, 75015 Paris, France
| | - N Boddeart
- Department of Pediatric Radiology, Necker-Enfants Malades Hospital, 75015 Paris, France
| | - V Abadie
- Department of Pediatrics, Necker-Enfants Malades Hospital, 75015 Paris, France
| | - A Picard
- Department of Maxillofacial and Plastic Surgery, Necker-Enfants Malades Hospital, 75015 Paris, France
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29
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Morice A, Galliani E, Amiel J, Rachwalski M, Neiva C, Thauvin-Robinet C, Vazquez MP, Picard A, Kadlub N. Diagnostic criteria in Pai syndrome: results of a case series and a literature review. Int J Oral Maxillofac Surg 2019; 48:283-290. [DOI: 10.1016/j.ijom.2018.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/01/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
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30
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Devereux G, Cotton S, Fielding S, McMeekin N, Barnes PJ, Briggs A, Burns G, Chaudhuri R, Chrystyn H, Davies L, De Soyza A, Gompertz S, Haughney J, Innes K, Kaniewska J, Lee A, Morice A, Norrie J, Sullivan A, Wilson A, Price D. Effect of Theophylline as Adjunct to Inhaled Corticosteroids on Exacerbations in Patients With COPD: A Randomized Clinical Trial. JAMA 2018; 320:1548-1559. [PMID: 30326124 PMCID: PMC6233797 DOI: 10.1001/jama.2018.14432] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Chronic obstructive pulmonary disease (COPD) is a major global health issue and theophylline is used extensively. Preclinical investigations have demonstrated that low plasma concentrations (1-5 mg/L) of theophylline enhance antiinflammatory effects of corticosteroids in COPD. OBJECTIVE To investigate the effectiveness of adding low-dose theophylline to inhaled corticosteroids in COPD. DESIGN, SETTING, AND PARTICIPANTS The TWICS (theophylline with inhaled corticosteroids) trial was a pragmatic, double-blind, placebo-controlled, randomized clinical trial that enrolled patients with COPD between February 6, 2014, and August 31, 2016. Final follow-up ended on August 31, 2017. Participants had a ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) of less than 0.7 with at least 2 exacerbations (treated with antibiotics, oral corticosteroids, or both) in the previous year and were using an inhaled corticosteroid. This study included 1578 participants in 121 UK primary and secondary care sites. INTERVENTIONS Participants were randomized to receive low-dose theophylline (200 mg once or twice per day) to provide plasma concentrations of 1 to 5 mg/L (determined by ideal body weight and smoking status) (n = 791) or placebo (n = 787). MAIN OUTCOMES AND MEASURES The number of participant-reported moderate or severe exacerbations treated with antibiotics, oral corticosteroids, or both over the 1-year treatment period. RESULTS Of the 1567 participants analyzed, mean (SD) age was 68.4 (8.4) years and 54% (843) were men. Data for evaluation of the primary outcome were available for 1536 participants (98%) (772 in the theophylline group; 764 in the placebo group). In total, there were 3430 exacerbations: 1727 in the theophylline group (mean, 2.24 [95% CI, 2.10-2.38] exacerbations per year) vs 1703 in the placebo group (mean, 2.23 [95% CI, 2.09-2.37] exacerbations per year); unadjusted mean difference, 0.01 (95% CI, -0.19 to 0.21) and adjusted incidence rate ratio, 0.99 (95% CI, 0.91-1.08). Serious adverse events in the theophylline and placebo groups included cardiac, 2.4% vs 3.4%; gastrointestinal, 2.7% vs 1.3%; and adverse reactions such as nausea (10.9% vs 7.9%) and headaches (9.0% vs 7.9%). CONCLUSIONS AND RELEVANCE Among adults with COPD at high risk of exacerbation treated with inhaled corticosteroids, the addition of low-dose theophylline, compared with placebo, did not reduce the number COPD exacerbations over a 1-year period. The findings do not support the use of low-dose theophylline as adjunctive therapy to inhaled corticosteroids for the prevention of COPD exacerbations. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN27066620.
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Affiliation(s)
- Graham Devereux
- Department of Respiratory Medicine, Aberdeen Royal Infirmary, University of Aberdeen, Aberdeen, United Kingdom
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Aintree Chest Centre, University Hospital Aintree, Liverpool, United Kingdom
| | - Seonaidh Cotton
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, United Kingdom
| | - Shona Fielding
- Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Nicola McMeekin
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Peter J. Barnes
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Andrew Briggs
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Graham Burns
- Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle, United Kingdom
| | - Rekha Chaudhuri
- Asthma/COPD Clinical Research Centre, Gartnavel General Hospital, University of Glasgow, Glasgow, United Kingdom
| | - Henry Chrystyn
- Inhalation Consultancy Ltd, Tarn House, Yeadon, Leeds, United Kingdom
| | - Lisa Davies
- Aintree Chest Centre, University Hospital Aintree, Liverpool, United Kingdom
| | - Anthony De Soyza
- Medical School, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Simon Gompertz
- Respiratory Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - John Haughney
- Department of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
| | - Karen Innes
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, United Kingdom
| | - Joanna Kaniewska
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, United Kingdom
| | - Amanda Lee
- Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Alyn Morice
- Department of Cardiovascular and Respiratory Studies, Castle Hill Hospital, Hull, United Kingdom
| | - John Norrie
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, United Kingdom
| | - Anita Sullivan
- Respiratory Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Andrew Wilson
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - David Price
- Department of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
- Observational and Pragmatic Research Institute, Paya Lebar Square, Singapore
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Hussain A, Bennett R, Haqzad Y, Qadri S, Chaudhry M, Cowen M, Loubani M, Morice A. The differential effects of systemic vasoconstrictors on human pulmonary artery tension. Eur J Cardiothorac Surg 2018; 51:880-886. [PMID: 28164217 DOI: 10.1093/ejcts/ezw410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/17/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Acute pulmonary hypertension following cardiac surgery can have a significant effect on postoperative morbidity and mortality. However, limited data are available on the efficacy and potency of clinically used systemic vasopressors on the pulmonary vasculature. The aim of this study was to use human pulmonary artery to characterize the pharmacological effects of clinically used vasopressors on the human pulmonary vasculature. METHODS Fifty-seven pulmonary artery rings of internal diameter 2-4 mm and 2 mm long, mounted in a multiwire myograph system, were used to measure changes in isometric tension. We constructed concentration response curves by cumulative addition to the myograph chambers of KCl, noradrenaline (NA), adrenaline (AD), vasopressin, endothelin-1 (ET-1) and prostaglandin F2a (PGF2a). RESULTS AD, NA, ET-1, PGF2a and KCl caused dose-dependent vasoconstriction in the pulmonary artery samples (EC50 246 nM [95% confidence interval, CI, 153-394 nM], 150 nM [95% CI 51-447 nM], 1.46 nM [95% CI 0.69-3.1 nM], 6.35 µM [95% CI 3.58-11.2 µM] and 17.24 mM [95% CI 12.43-24.07 mM], respectively), whereas vasopressin had no significant effect. The order of efficacy was KCl = PGF2a > AD > NA > ET-1 and the order of potency was ET-1 T-AD = NA > PGF2a > KCl. CONCLUSIONS This study demonstrated the efficacy and potency of clinically used vasopressors and endogenous vasopressors on human pulmonary vascular tone. PGF2a and KCl equally caused maximal amounts of constriction, whereas ET-1 had less effect and vasopressin had no effect. These effects may need to be taken into account in the clinical setting because they might result in the development of pulmonary hypertension.
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Affiliation(s)
- Azar Hussain
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | - Rob Bennett
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | - Yama Haqzad
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | - Syed Qadri
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | - Mubarak Chaudhry
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | - Michael Cowen
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | - Mahmoud Loubani
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, UK
| | - Alyn Morice
- Department of Respiratory Medicine, Castle Hill Hospital, Cottingham, UK
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Haughney J, Morice A, Blyth KG, Lee AJ, Coutts A, McKnight E, Pavord I. A retrospective cohort study in severe asthma describing commonly measured biomarkers: Eosinophil count and IgE levels. Respir Med 2017; 134:117-123. [PMID: 29413497 DOI: 10.1016/j.rmed.2017.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/23/2017] [Accepted: 12/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Identifying asthma patients suitable for biologic therapy includes the assessment of blood biomarkers (IgE and eosinophils (EOS)). How they relate to each other is unclear. METHODS This retrospective, database study used routinely collected clinical data to identify and evaluate an asthma cohort (classification code for asthma; ≥ 18 years; ≥1 prescription for asthma; ≥1 estimation of serum IgE, in 2 years prior to index date). Distribution into high and low IgE and EOS groups (IgE cut-point: > or ≤75 kU/L; EOS cut point: >or ≤400 μ/L), and characteristics by group are described. FINDINGS In patients with severe asthma (British Thoracic Society Step (BTS) ≥4; N = 884), using maximum recorded IgE/EOS, 33% had high IgE/high EOS, 28% low IgE/low EOS and approximately a fifth each had high IgE/low EOS or low IgE/high EOS. Proportions were similar when EOS values measured 2 or 4 weeks before an exacerbation were excluded. Using EOS/IgE 'same day' measurements (N = 578) only identified half of the high EOS group. Patients in high IgE groups were more likely to be younger males without comorbid COPD; those in high EOS groups were more likely to be on BTS treatment Step 5 vs 4. The low IgE/low EOS group had the lowest incidence of asthma-related hospital attendances, the highest incidence was observed in the high EOS groups. CONCLUSION Maximum available EOS measurement irrespective of exacerbations may be relevant when considering therapy. These data showed low IgE/Low EOS to be more benign and high EOS groups at increased risk of frequent, severe exacerbations.
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Affiliation(s)
- John Haughney
- Centre of Academic Primary Care, University of Aberdeen, UK; Clinical Research & Development, Greater Glasgow & Clyde Health Board, Glasgow, UK.
| | - Alyn Morice
- Respiratory Medicine, Hull York Medical School, University of Hull, UK
| | - Kevin G Blyth
- Department of Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK; Institute of Infection, Immunity and Inflammation, University of Glasgow, UK
| | - Amanda J Lee
- Medical Statistics Team, University of Aberdeen, UK
| | - Alasdair Coutts
- Research Applications and Data Management Team, University of Aberdeen, UK
| | | | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory BRC, Nuffield Department of Medicine, University of Oxford, UK
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Fowles HE, Rowland T, Wright C, Morice A. ATP and cough reflex hypersensitivity: a confusion of goals? Eur Respir J 2017; 50:50/1/1700802. [PMID: 28679617 DOI: 10.1183/13993003.00802-2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 04/25/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Helen Elizabeth Fowles
- Hull York Medical School Centre for Cardiovascular and Metabolic Research, Respiratory, Castle Hill Hospital, Cottingham, UK
| | | | - Caroline Wright
- Hull York Medical School Centre for Cardiovascular and Metabolic Research, Respiratory, Castle Hill Hospital, Cottingham, UK
| | - Alyn Morice
- Hull York Medical School Centre for Cardiovascular and Metabolic Research, Respiratory, Castle Hill Hospital, Cottingham, UK
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Hussain A, Bennett R, Tahir Z, Chaudhry M, Morice A, Mahmoud L. THE IN-VITRO EFFECT OF PROSTACYCLIN ANALOGUES ON SMALL HUMAN PULMONARY ARTERY: COMPARISON WITH PHOSPHODIESTERASE INHIBITORS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35295-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fowles HE, Rowland T, Wright C, Morice A. Tussive challenge with ATP and AMP: does it reveal cough hypersensitivity? Eur Respir J 2017; 49:49/2/1601452. [PMID: 28179439 DOI: 10.1183/13993003.01452-2016] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/02/2016] [Indexed: 12/11/2022]
Abstract
Recent studies have demonstrated that blockade of P2X3 ATP receptors can profoundly inhibit chronic cough. We have considered whether inhaled ATP produces a tussive response and whether chronic cough patients are hypersensitive to inhaled ATP compared to healthy volunteers.A standardised inhalational cough challenge was performed with ATP and AMP. We randomised 20 healthy volunteers and 20 chronic cough patients as to the order of challenges. The concentration of challenge solution causing at least five coughs (C5) was compared for ATP and AMP.The study population consisted of six male and 14 female volunteers in each group. Two out of 19 healthy volunteers coughed with AMP (one volunteer could not take part in this challenge) and none reached C5. Eight out of 20 chronic cough patients coughed with AMP and two reached C5. Of the 20 healthy volunteers, 18 coughed with ATP, with 15 reaching C5. All 19 chronic cough patients completing the ATP challenge coughed with ATP and 18 reached C5. The chronic cough patients had a greater cough response at lower concentrations of ATP.The greater potency of ATP versus AMP in the inhalational challenge suggests that tussive responses are mediated through members of the P2X purinergic receptor family. This acute effect was, however, not sufficient to explain cough hypersensitivity syndrome.
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Affiliation(s)
- Helen Elizabeth Fowles
- Hull York Medical School Centre for Cardiovascular and Metabolic Research, Respiratory, Castle Hill Hospital, Cottingham, UK
| | - Tim Rowland
- Castle Hill Hospital, Respiratory, Cottingham, UK
| | - Caroline Wright
- Hull York Medical School Centre for Cardiovascular and Metabolic Research, Respiratory, Castle Hill Hospital, Cottingham, UK
| | - Alyn Morice
- Hull York Medical School Centre for Cardiovascular and Metabolic Research, Respiratory, Castle Hill Hospital, Cottingham, UK
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Morice A, Reina N, Gracia G, Bonnevialle P, Laffosse JM, Wytrykowski K, Cavaignac E, Bonnevialle N. Proximal femoral fractures in centenarians. A retrospective analysis of 39 patients. Orthop Traumatol Surg Res 2017; 103:9-13. [PMID: 27919768 DOI: 10.1016/j.otsr.2016.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 09/13/2016] [Accepted: 09/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND A corollary of the current population ageing in France is an increase in proximal femoral fractures (PFFs), particularly among centenarians. The outcomes of PFFs in centenarians in France are unknown. We therefore conducted a retrospective study of centenarians with PFFs both to assess: (1) assess clinical outcomes according to geriatric and trauma scores, (2) and to determine whether routine surgery is warranted. HYPOTHESIS Morbidity and mortality in a single-centre cohort of centenarians with surgically treated PFFs are consistent with previous reports. MATERIAL AND METHOD We retrospectively reviewed the data of 33 women and 6 men aged 100 years or over who were treated surgically for PFFs at a single-centre between 2008 and 2014. Of the 39 patients, 15 were living at home and 24 in an institution at the time of the injury. Mean (range) values were 3.30 (0-7) for the Parker Mobility Score, 5.84 (0-12) for the Katz index, and 7.46 (2-12) for the Mini Nutritional Assessment (MNA). Mean time from injury to surgery was 1.7 days (0-12). The 26 extra-capsular fractures were managed by internal fixation and the 13 intra-capsular fractures by hip arthroplasty (n=12) or screw fixation (n=1). RESULTS After a mean follow-up of 23±14 months (6-60 months), 29 patients had died, including 3 within 48h, 10 within 3 months, and 15 within 1 year. Sequential mortality rates were 33.3% within the first 3 months, 26.9% from months 4 to 9, and 42.2% within the first year. Early dislocation occurred in 3 patients and surgical-site infection in 2 patients. Other complications were heart failure (n=1), confusional state (n=2), pneumonia (n=2), and pyelonephritis (n=2). DISCUSSION A PubMed search identified five studies of PFFs in more than 10 centenarians, of which only 2 provided detailed information on postoperative general and local morbidity related to the surgical treatment. Our hypothesis was confirmed for 3-month and 1-year mortality rates, which were at the lower ends of previously reported ranges. Local complications related directly to surgery were considerably more common in our study. PFFs in centenarians carry a high risk of death. Despite the absence of a control group, our data support surgery as the best treatment option. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- A Morice
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France.
| | - N Reina
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France
| | - G Gracia
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France
| | - P Bonnevialle
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France
| | - J-M Laffosse
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France
| | - K Wytrykowski
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France
| | - E Cavaignac
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France
| | - N Bonnevialle
- Département d'orthopédie traumatologie, hôpital Pierre-Paul-Riquet, CHU de Toulouse, place du Docteur-Baylac, 31052 Toulouse cedex, France
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Hussain A, Suleiman MS, George SJ, Loubani M, Morice A. Hypoxic Pulmonary Vasoconstriction in Humans: Tale or Myth. Open Cardiovasc Med J 2017; 11:1-13. [PMID: 28217180 PMCID: PMC5301302 DOI: 10.2174/1874192401711010001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 10/13/2016] [Revised: 12/02/2016] [Accepted: 12/09/2016] [Indexed: 12/13/2022] Open
Abstract
Hypoxic Pulmonary vasoconstriction (HPV) describes the physiological adaptive process of lungs to preserves systemic oxygenation. It has clinical implications in the development of pulmonary hypertension which impacts on outcomes of patients undergoing cardiothoracic surgery. This review examines both acute and chronic hypoxic vasoconstriction focusing on the distinct clinical implications and highlights the role of calcium and mitochondria in acute versus the role of reactive oxygen species and Rho GTPases in chronic HPV. Furthermore it identifies gaps of knowledge and need for further research in humans to clearly define this phenomenon and the underlying mechanism.
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Affiliation(s)
- A Hussain
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK
| | - M S Suleiman
- School of Clinical Sciences, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - S J George
- School of Clinical Sciences, Bristol Royal Infirmary, Marlborough Street, Bristol, BS2 8HW, UK
| | - M Loubani
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK
| | - A Morice
- Department of Respiratory Medicine, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK
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Douglas L, Fowles H, Arnell K, Thackray-Nocera S, Morice A. S31 Reproducibility of four challenge modalities for chronic cough. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.37] [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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Hussain A, Bennett R, Kotidis K, Chaudhry M, Qadri S, Cowen M, Morice A, Loubani M. P246 The in vitro effect of commonly used vasodilators on human pulmonary artery. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.389] [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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Abstract
Acute cough caused by viral respiratory tract infections is probably the most common illness to afflict mankind. Despite the widespread but ineffective prescribing of antibiotics, there is no specific therapy. Home remedies and over-the-counter medicines are the mainstay for treatment of this short-lived but debilitating condition where cough is a major troublesome symptom. Across Europe, there are large variations in the recommendations made by healthcare professionals for the treatment of acute cough. This has arisen through custom and practice based on the evidence of historical studies performed to standards well short of what would be considered legitimate today. Acute cough is particularly difficult to study in a controlled setting because of the high rate of spontaneous remission and a large placebo effect. Here we detail the validated modern methodology used to assess the efficacy of antitussives and review the drugs commonly used in Europe against these standards.
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Affiliation(s)
- Alyn Morice
- Head of the Centre for Cardiovascular and Metabolic Research, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
| | - Peter Kardos
- Group Practice and Centre for Allergy, Respiratory and Sleep Medicine at Red Cross Maingau Hospital, Frankfurt, Germany
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Rai Z, Fowles H, Howard J, Morice A. P243 Assessing the Effect of pH on Citric Acid Cough Challenges in Chronic Cough Patients and Healthy Volunteers. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.379] [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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Devereux G, Cotton S, Barnes P, Briggs A, Burns G, Chaudhuri R, Chrystyn H, Davies L, De Soyza A, Fielding S, Gompertz S, Haughney J, Lee AJ, McCormack K, McPherson G, Morice A, Norrie J, Sullivan A, Wilson A, Price D. Use of low-dose oral theophylline as an adjunct to inhaled corticosteroids in preventing exacerbations of chronic obstructive pulmonary disease: study protocol for a randomised controlled trial. Trials 2015; 16:267. [PMID: 26058585 PMCID: PMC4465017 DOI: 10.1186/s13063-015-0782-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 05/27/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with high morbidity, mortality, and health-care costs. An incomplete response to the anti-inflammatory effects of inhaled corticosteroids is present in COPD. Preclinical work indicates that 'low dose' theophylline improves steroid responsiveness. The Theophylline With Inhaled Corticosteroids (TWICS) trial investigates whether the addition of 'low dose' theophylline to inhaled corticosteroids has clinical and cost-effective benefits in COPD. METHOD/DESIGN TWICS is a randomised double-blind placebo-controlled trial conducted in primary and secondary care sites in the UK. The inclusion criteria are the following: an established predominant respiratory diagnosis of COPD (post-bronchodilator forced expiratory volume in first second/forced vital capacity [FEV1/FVC] of less than 0.7), age of at least 40 years, smoking history of at least 10 pack-years, current inhaled corticosteroid use, and history of at least two exacerbations requiring treatment with antibiotics or oral corticosteroids in the previous year. A computerised randomisation system will stratify 1424 participants by region and recruitment setting (primary and secondary) and then randomly assign with equal probability to intervention or control arms. Participants will receive either 'low dose' theophylline (Uniphyllin MR 200 mg tablets) or placebo for 52 weeks. Dosing is based on pharmacokinetic modelling to achieve a steady-state serum theophylline of 1-5 mg/l. A dose of theophylline MR 200 mg once daily (or placebo once daily) will be taken by participants who do not smoke or participants who smoke but have an ideal body weight (IBW) of not more than 60 kg. A dose of theophylline MR 200 mg twice daily (or placebo twice daily) will be taken by participants who smoke and have an IBW of more than 60 kg. Participants will be reviewed at recruitment and after 6 and 12 months. The primary outcome is the total number of participant-reported COPD exacerbations requiring oral corticosteroids or antibiotics during the 52-week treatment period. DISCUSSION The demonstration that 'low dose' theophylline increases the efficacy of inhaled corticosteroids in COPD by reducing the incidence of exacerbations is relevant not only to patients and clinicians but also to health-care providers, both in the UK and globally. TRIAL REGISTRATION Current Controlled Trials ISRCTN27066620 was registered on Sept. 19, 2013, and the first subject was randomly assigned on Feb. 6, 2014.
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Affiliation(s)
- Graham Devereux
- Respiratory Medicine, Chest Clinic C, Aberdeen Royal Infirmary, University of Aberdeen, Aberdeen, AB25 2ZN, UK.
| | - Seonaidh Cotton
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, AB25 2ZN, UK.
| | - Peter Barnes
- Imperial College, National Heart & Lung Institute, Dovehouse Street, London, SW3 6LY, UK.
| | - Andrew Briggs
- Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - Graham Burns
- Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle Upon Tyne, NE1 4LP, UK.
| | - Rekha Chaudhuri
- Gartnavel General Hospital, University of Glasgow, Glasgow, G12 0YN, UK.
| | - Henry Chrystyn
- Division of Pharmacy & Pharmaceutical Sciences, University of Huddersfield, Huddersfield, HD1 3DH, UK.
| | - Lisa Davies
- Aintree Chest Centre, University Hospital Aintree, Liverpool, L9 7AL, UK.
| | - Anthony De Soyza
- Medical School, University of Newcastle, Newcastle Upon Tyne, NE2 4HH, UK.
| | - Shona Fielding
- Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Simon Gompertz
- Queen Elizabeth Hospital Birmingham, Birmingham, B15 2WB, UK.
| | - John Haughney
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Amanda J Lee
- Medical Statistics Team, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Kirsty McCormack
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, AB25 2ZN, UK.
| | - Gladys McPherson
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, AB25 2ZN, UK.
| | - Alyn Morice
- Cardiovascular and Respiratory Studies, Castle Hill Hospital, Hull, HU16 5JQ, UK.
| | - John Norrie
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, AB25 2ZN, UK.
| | - Anita Sullivan
- Queen Elizabeth Hospital Birmingham, Birmingham, B15 2WB, UK.
| | - Andrew Wilson
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - David Price
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
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Walshaw M, McElvaney G, Williams R, Morice A, Carroll M, Haworth C, Herzig M, Ketchell I, Myrvold R, Meland N, Myrset A, Smerud K. 45 A first-in-patient clinical trial demonstrates that inhaled alginate oligosaccharide (OligoG) is well tolerated in cystic fibrosis (CF) patients. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60182-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Morice A, Coupry A, Lintz F, Robert H. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: clinical and knee laxity outcomes in 23 cases. Orthop Traumatol Surg Res 2013; 99:693-7. [PMID: 23988420 DOI: 10.1016/j.otsr.2013.04.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 03/30/2013] [Accepted: 04/18/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The best treatment for anterior cruciate ligament (ACL) mucoid degeneration remains open to debate. Current options are total or partial ACL resection, or a more conservative strategy, reduction plasty. The goal of this study was to retrospectively evaluate the effects of reduction plasty for ACL hypertrophy due to mucoid degeneration from clinical outcome and knee laxity points of view. MATERIALS AND METHODS Arthroscopy was carried out on 23 knees (21 patients) to perform a circular volume reduction plasty of the ACL, while preserving the greatest number of ligament fibers. Notchplasty was not performed. All the patients were seen again with an average follow-up of 32 months (range 8-70). RESULTS All the knees except three had symmetric postoperative flexion. Three patients still had pain. No patient reported having subjective feelings of instability. Among the 20 knees tested with the GNRB(TM) knee laxity measurement device, one knee had a 2.4mm difference in laxity and three had between 3 and 4mm of difference; 16 knees had no residual laxity. DISCUSSION Treatment of ACL mucoid degeneration by reduction plasty leads to complete pain relief in 80% of cases while maintaining good postoperative knee stability. LEVEL OF EVIDENCE Level IV. Retrospective study.
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Affiliation(s)
- A Morice
- North Mayenne Hospital, Orthopaedic Department, 229, boulevard Paul-Lintier, 53100 Mayenne, France
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Ariyaratnam P, Bennett R, Morice A, Griffin S, Chaudhry M, Cowen M, Cale A, Guvendik L, Loubani M. 091 * HUMAN ISOLATED PERFUSED LUNG MODELS DEMONSTRATE COMPENSATION OF PULMONARY VASOCONSTRICTION IN RESPONSE TO REOXYGENATION. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.91] [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: 11/14/2022] Open
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46
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Metcalf CJE, Lessler J, Klepac P, Morice A, Grenfell BT, Bjørnstad ON. Structured models of infectious disease: inference with discrete data. Theor Popul Biol 2012; 82:275-82. [PMID: 22178687 PMCID: PMC4086157 DOI: 10.1016/j.tpb.2011.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 11/25/2011] [Accepted: 12/03/2011] [Indexed: 11/24/2022]
Abstract
The usage of structured population models can make substantial contributions to public health, particularly for infections where clinical outcomes vary over age. There are three theoretical challenges in implementing such analyses: (i) developing an appropriate framework that models both demographic and epidemiological transitions; (ii) parameterizing the framework, where parameters may be based on data ranging from the biological course of infection, basic patterns of human demography, specific characteristics of population growth, and details of vaccination regimes implemented; (iii) evaluating public health strategies in the face of changing human demography. We illustrate the general approach by developing a model of rubella in Costa Rica. The demographic profile of this infection is a crucial aspect of its public health impact, and we use a transient perturbation analysis to explore the impact of changing human demography on immunization strategies implemented.
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Affiliation(s)
- C J E Metcalf
- Department of Zoology, Oxford University, Oxford, UK.
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Zarogoulidis P, Kosmatopoulos K, Morice A, Bouros D, Freitag L, Casalini AG, Froudarakis M, Panadero FR, Manika K, Galanis N, Leonidas S, Papagiannis A, Tsakiridis K, Spyratos D, Kontakiotis T, Anoniadis A, Li Q, Zarogoulidis K. 21 st Panhellenic Congress of Thoracic Disease 1-4 November 2012, Thessaloniki, Greece. J Thorac Dis 2012; 4. [PMCID: PMC3537377 DOI: 10.3978/j.issn.2072-1439.2012.s112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Paul Zarogoulidis
- University Pulmonary Department, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Alyn Morice
- Respiratory Medicine Department, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK
| | - Demosthenes Bouros
- University Pulmonary Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Lutz Freitag
- University Pulmonary Department-Interventional Unit, “Ruhrlandklinik”, University of Duisburg-Essen, Essen, Germany
| | - Angelo G. Casalini
- Director of the Pulmonology and Thoracic Endoscopy Division, University of Parma, Italy
| | - Marios Froudarakis
- University Pulmonary Department, University General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Francisco Rodriguez Panadero
- Medical Surgical Unit of Respiratory Diseases, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Katerina Manika
- University Pulmonary Department, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Galanis
- 1 Pulmonary Department, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | - Sakkas Leonidas
- Pathology Department, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
| | | | | | - Dionysios Spyratos
- University Pulmonary Department, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Kontakiotis
- University Pulmonary Department, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Qiang Li
- Respiratory diseases department, Changhai hospital, The Second Military Medical University, Shanghai, China
| | - Konstantinos Zarogoulidis
- University Pulmonary Department, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Lebreuilly-Sohyer I, Morice A, Acher A, Dompmartin A, Clement C, de Verneuil H, Ged C, Leroy D, Verneuil L. Porphyrie érythropoïétique congénitale traitée par allogreffe de cellules souches hématopoïétiques. Ann Dermatol Venereol 2010; 137:635-9. [DOI: 10.1016/j.annder.2010.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 04/25/2010] [Accepted: 06/22/2010] [Indexed: 11/25/2022]
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Gillissen A, Hederer B, Morice A, Celli B, Kesten S, Lystig T, Tashkin D, Decramer M, Glaab T. Therapieeffekte von Tiotropium bei COPD-Patienten unter 50 Jahren: Beobachtungen aus der UPLIFT®-Studie. Pneumologie 2010. [DOI: 10.1055/s-0030-1251365] [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: 10/19/2022]
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Abstract
The panel considered the different types of cough in terms of basic mechanisms and clinical manifestations; both experimentally and clinically cough could occur in single efforts and as 'bouts' or 'epochs'. There were different definitions of cough but, provided the definition used was clear, this did not seem to be a major concern. The methods available for determining the nature or type of clinical cough were discussed, in particular automated cough counting in the clinic and more sophisticated methods available in the laboratory. With regard to semantics, there has been great variation in the names used; this applies to nervous sensors for cough, to cough reflexes and epochs, to clinical names for cough, and to cough sounds. Some simplification and uniformity of nomenclature seemed desirable although, provided the use of a name was clear, little confusion probably existed. The panel felt that the cough nomenclature would evolve with time and would prove to be useful for investigators, clinicians and coughers.
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Affiliation(s)
- Kian Fan Chung
- Airway Disease, National Heart and Lung Institute, Imperial College, London, UK
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