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O'Sullivan O, Behan FP, Coppack RJ, Stocks J, Kluzek S, Valdes AM, Bennett AN. Osteoarthritis in the UK Armed Forces: a review of its impact, treatment and future research. BMJ Mil Health 2023:e002390. [PMID: 37491135 DOI: 10.1136/military-2023-002390] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/31/2023] [Indexed: 07/27/2023]
Abstract
Within the UK Armed Forces, musculoskeletal injuries account for over half of all medical downgrades and discharges. Data from other Armed Forces show that osteoarthritis (OA), more common in military personnel, is likely to contribute to this, both in its primary form and following injury (post-traumatic OA, PTOA), which typically presents in the third or fourth decade. OA is not a progressive 'wear and tear' disease, as previously thought, but a heterogenous condition with multiple aetiologies and modulators, including joint damage, abnormal morphology, altered biomechanics, genetics, low-grade inflammation and dysregulated metabolism. Currently, clinical diagnosis, based on symptomatic or radiological criteria, is followed by supportive measures, including education, exercise, analgesia, potentially surgical intervention, with a particular focus on exercise rehabilitation within the UK military. Developments in OA have led to a new paradigm of organ failure, with an emphasis on early diagnosis and risk stratification, prevention strategies (primary, secondary and tertiary) and improved aetiological classification using genotypes and phenotypes to guide management, with the introduction of biological markers (biomarkers) potentially having a role in all these areas. In the UK Armed Forces, there are multiple research studies focused on OA risk factors, epidemiology, biomarkers and effectiveness of different interventions. This review aims to highlight OA, especially PTOA, as an important diagnosis to consider in serving personnel, outline current and future management options, and detail current research trends within the Defence Medical Services.
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Affiliation(s)
- Oliver O'Sullivan
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, LE12 5QW, UK
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
| | - F P Behan
- Department of Bioengineering, Imperial College London, London, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, LE12 5QW, UK
- Centre for Sport, Exercise and Osteoarthritis Research, Versus Arthritis, Nottingham, UK
| | - J Stocks
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
| | - S Kluzek
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
- Centre for Sport, Exercise and Osteoarthritis Research, Versus Arthritis, Nottingham, UK
| | - A M Valdes
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, LE12 5QW, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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Aurora P, Duncan JA, Lum S, Davies G, Wade A, Stocks J, Viviani L, Raywood E, Pao C, Ruiz G, Bush A. Early Pseudomonas aeruginosa predicts poorer pulmonary function in preschool children with cystic fibrosis. J Cyst Fibros 2022; 21:988-995. [DOI: 10.1016/j.jcf.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/08/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022]
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Davies G, Stanojevic S, Raywood E, Duncan JA, Stocks J, Lum S, Bush A, Viviani L, Wade A, Calder A, Owens CM, Goubau C, Carr SB, Bossley CJ, Pao C, Aurora P. An observational study of the lung clearance index throughout childhood in cystic fibrosis: early years matter. Eur Respir J 2020; 56:13993003.00006-2020. [PMID: 32444409 PMCID: PMC7527650 DOI: 10.1183/13993003.00006-2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 08/02/2019] [Accepted: 04/23/2020] [Indexed: 01/15/2023]
Abstract
The London Cystic Fibrosis Collaboration (LCFC) has prospectively followed a clinically diagnosed cohort of infants with cystic fibrosis (CF) born in South East England since 1999 [1–4]. Over the past 20 years, the LCFC has obtained comprehensive measures of lung function and structure, including measures of ventilation inhomogeneity (lung clearance index (LCI)) and high-resolution computed tomography (HRCT) scans. By pre-school age, 73% of this cohort had LCI above the limits of normal, compared with 7% with abnormal forced expiratory volume in 0.5 seconds (FEV0.5) [1]. Children with elevated LCI during pre-school years also had worse lung function at early school age [2]. The aim of this study was to investigate how LCI changes across childhood to better understand to what extent LCI results at pre-school age are an indicator of lung disease severity in adolescence. Lung clearance index (LCI) in the early years was associated with LCI during adolescence in children with cystic fibrosis. Pre-school LCI may help to identify children in whom treatment could be intensified.https://bit.ly/2yKyMbM
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Affiliation(s)
- Gwyneth Davies
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK .,Dept of Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Joint first authors
| | - Sanja Stanojevic
- Translational Medicine, SickKids Research Institute, Toronto, ON, Canada.,Joint first authors
| | - Emma Raywood
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
| | - Julie A Duncan
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
| | - Janet Stocks
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
| | - Sooky Lum
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
| | - Andrew Bush
- Dept of Paediatric Respiratory Medicine, Imperial College and Royal Brompton and Harefield Hospital NHS Foundation Trust, London, UK
| | - Laura Viviani
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
| | - Angie Wade
- Clinical Epidemiology, Nutrition and Biostatistics Section, UCL GOS ICH, London, UK
| | - Alistair Calder
- Dept of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Catherine M Owens
- Dept of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Christophe Goubau
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK
| | - Siobhán B Carr
- Dept of Paediatric Respiratory Medicine, Imperial College and Royal Brompton and Harefield Hospital NHS Foundation Trust, London, UK
| | - Cara J Bossley
- Dept of Paediatric Respiratory Medicine, Kings College Hospital, London, UK
| | - Caroline Pao
- Dept of Paediatric Respiratory Medicine, Royal London Hospital, London, UK
| | - Paul Aurora
- Infection, Immunity and Inflammation Research and Teaching Dept, UCL Great Ormond Street Institute of Child Health (UCL GOS ICH), London, UK.,Dept of Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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4
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Davies G, Thia LP, Stocks J, Bush A, Hoo AF, Wade A, Nguyen TTD, Brody AS, Calder A, Klein NJ, Carr SB, Wallis C, Suri R, Pao CS, Ruiz G, Balfour-Lynn IM. Minimal change in structural, functional and inflammatory markers of lung disease in newborn screened infants with cystic fibrosis at one year. J Cyst Fibros 2020; 19:896-901. [PMID: 32044244 DOI: 10.1016/j.jcf.2020.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND With the widespread introduction of newborn screening for cystic fibrosis (CF), there has been considerable emphasis on the need to develop objective markers of lung health that can be used during infancy. We hypothesised that in a newborn screened (NBS) UK cohort, evidence of airway inflammation and infection at one year would be associated with adverse structural and functional outcomes at the same age. METHODS Infants underwent lung function testing, chest CT scan and bronchoscopy with bronchoalveolar lavage (BAL) at 1 year of age when clinically well. Microbiology cultures were also available from routine cough swabs. RESULTS 65 infants had lung function, CT and BAL. Mean (SD) lung clearance index and forced expiratory volume in 0.5 s z-scores were 0.9(1.2) and -0.6(1.1) respectively; median Brody II CF-CT air trapping score on chest CT =0 (interquartile range 0-1, maximum possible score 27). Infants isolating any significant pathogen by 1 yr of age had higher LCI z-score (mean difference 0.9; 95%CI:0.4-1.4; p = 0.001) and a trend towards higher air trapping scores on CT (p = 0.06). BAL neutrophil elastase was detectable in 23% (10/43) infants in whom BAL supernatant was available. This did not relate to air trapping score on CT. CONCLUSIONS In this UK NBS cohort at one year of age, lung and airway damage is much milder and associations between inflammation, abnormal physiology and structural changes were at best weak, contrary to our hypothesis and previously published reports. Continued follow-up will clarify longer term implications of these very mild structural, functional and inflammatory changes.
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Affiliation(s)
- Gwyneth Davies
- Respiratory, Critical Care and Anaesthesia section, UCL Great Ormond Street Institute of Child Health (GOS ICH), London, United Kingdom; Department of Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
| | - Lena P Thia
- Respiratory, Critical Care and Anaesthesia section, UCL Great Ormond Street Institute of Child Health (GOS ICH), London, United Kingdom; Department of Paediatric Respiratory Medicine, Cardiff University and Children's Hospital for Wales, Cardiff, United Kingdom
| | - Janet Stocks
- Respiratory, Critical Care and Anaesthesia section, UCL Great Ormond Street Institute of Child Health (GOS ICH), London, United Kingdom
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Imperial College & Royal Brompton & Harefield Hospital NHS Foundation Trust, London, United Kingdom
| | - Ah-Fong Hoo
- Respiratory, Critical Care and Anaesthesia section, UCL Great Ormond Street Institute of Child Health (GOS ICH), London, United Kingdom; Department of Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Angie Wade
- Clinical Epidemiology, Nutrition and Biostatistics Section, UCL GOS ICH, London, United Kingdom
| | - The Thanh Diem Nguyen
- Respiratory, Critical Care and Anaesthesia section, UCL Great Ormond Street Institute of Child Health (GOS ICH), London, United Kingdom; Department of Respiratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Alan S Brody
- University of Cincinnati College of Medicine and Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Alistair Calder
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Nigel J Klein
- Infection, Inflammation and Rheumatology Section, UCL GOS ICH, London, United Kingdom
| | - Siobhán B Carr
- Department of Paediatric Respiratory Medicine, Imperial College & Royal Brompton & Harefield Hospital NHS Foundation Trust, London, United Kingdom
| | - Colin Wallis
- Respiratory, Critical Care and Anaesthesia section, UCL Great Ormond Street Institute of Child Health (GOS ICH), London, United Kingdom; Department of Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Ranjan Suri
- Respiratory, Critical Care and Anaesthesia section, UCL Great Ormond Street Institute of Child Health (GOS ICH), London, United Kingdom; Department of Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Caroline S Pao
- Department of Paediatric Respiratory Medicine, Royal London Hospital, London, United Kingdom
| | - Gary Ruiz
- Department of Paediatric Respiratory Medicine, Kings College Hospital, London, United Kingdom
| | - Ian M Balfour-Lynn
- Department of Paediatric Respiratory Medicine, Imperial College & Royal Brompton & Harefield Hospital NHS Foundation Trust, London, United Kingdom
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Akin-Akinyosoye K, Sarmanova A, Fernandes GS, Frowd N, Swaithes L, Stocks J, Valdes A, McWilliams DF, Zhang W, Doherty M, Ferguson E, Walsh DA. Baseline self-report 'central mechanisms' trait predicts persistent knee pain in the Knee Pain in the Community (KPIC) cohort. Osteoarthritis Cartilage 2020; 28:173-181. [PMID: 31830591 DOI: 10.1016/j.joca.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 04/05/2019] [Revised: 10/13/2019] [Accepted: 11/18/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We investigated whether baseline scores for a self-report trait linked to central mechanisms predict 1 year pain outcomes in the Knee Pain in the Community cohort. METHOD 1471 participants reported knee pain at baseline and responded to a 1-year follow-up questionnaire, of whom 204 underwent pressure pain detection thresholds (PPTs) and radiographic assessment at baseline. Logistic and linear regression models estimated the relative risks (RRs) and associations (β) between self-report traits, PPTs and pain outcomes. Discriminative performance for each predictor was compared using receiver-operator characteristics (ROC) curves. RESULTS Baseline Central Mechanisms trait scores predicted pain persistence (Relative Risk, RR = 2.10, P = 0.001) and persistent pain severity (β = 0.47, P < 0.001), even after adjustment for age, sex, BMI, radiographic scores and symptom duration. Baseline joint-line PPTs also associated with pain persistence (RR range = 0.65 to 0.68, P < 0.02), but only in univariate models. Lower baseline medial joint-line PPT was associated with persistent pain severity (β = -0.29, P = 0.013) in a fully adjusted model. The Central Mechanisms trait model showed good discrimination of pain persistence cases from resolved pain cases (Area Under the Curve, AUC = 0.70). The discrimination power of other predictors (PPTs (AUC range = 0.51 to 0.59), radiographic OA (AUC = 0.62), age, sex and BMI (AUC range = 0.51 to 0.64), improved significantly (P < 0.05) when the central mechanisms trait was included in each logistic regression model (AUC range = 0.69 to 0.74). CONCLUSION A simple summary self-report Central Mechanisms trait score may indicate a contribution of central mechanisms to poor knee pain prognosis.
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Affiliation(s)
- K Akin-Akinyosoye
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - A Sarmanova
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - G S Fernandes
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK; Centre for Sports, Exercise, and Osteoarthritis Versus Arthritis, UK.
| | - N Frowd
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - L Swaithes
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - J Stocks
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - A Valdes
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - D F McWilliams
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - W Zhang
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - M Doherty
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - E Ferguson
- Pain Centre Versus Arthritis, UK; School of Psychology, University of Nottingham, UK.
| | - D A Walsh
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
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6
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Persson MSM, Stocks J, Walsh DA, Doherty M, Zhang W. The relative efficacy of topical non-steroidal anti-inflammatory drugs and capsaicin in osteoarthritis: a network meta-analysis of randomised controlled trials. Osteoarthritis Cartilage 2018; 26:1575-1582. [PMID: 30172837 PMCID: PMC6267943 DOI: 10.1016/j.joca.2018.08.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/23/2018] [Accepted: 08/16/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the efficacy of topical non-steroidal anti-inflammatory drugs (NSAIDs) with topical capsaicin for pain relief in osteoarthritis (OA). DESIGN A systematic literature search was conducted for randomised controlled trials (RCTs) examining any topical NSAID or capsaicin in OA. Pain relief at or nearest to 4 weeks was pooled using a random-effects network meta-analysis (NMA) in a Frequentist and Bayesian setting. Analysis was conducted for all trials and for trials using drugs listed as licensed for OA in the British National Formulary (BNF). RESULTS The trial network comprised 28 RCTs (7372 participants), of which 17 RCTs (3174 participants) were included in the as licensed analyses. No RCTs directly compared topical NSAIDs with capsaicin. Placebo was the only common comparator for topical NSAIDs and capsaicin. Frequentist and Bayesian effect size (ES) estimates were in agreement. Topical NSAIDs were statistically superior to placebo overall (ES 0.30, 95% confidence interval [CI] 0.19 to 0.41) and as licensed (ES 0.32, 95% CI 0.24 to 0.39). However, capsaicin was only statistically superior to placebo when used at licensed doses (ES 0.41, 95% CI 0.17 to 0.64). No significant differences were observed in pain relief between topical NSAIDs and capsaicin (overall: ES 0.04, 95% CI -0.26 to 0.33; as licensed: ES-0.09, 95% CI -0.34 to 0.16). CONCLUSIONS Current evidence indicates that topical NSAIDs and capsaicin in licensed doses may be equally effective for pain relief in OA. Whether the equivalence varies between individuals remains unknown.
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Affiliation(s)
- M S M Persson
- Academic Rheumatology, Division of Rheumatology, Orthopaedics, and Dermatology, University of Nottingham, UK; Arthritis Research UK Pain Centre, UK.
| | - J Stocks
- Academic Rheumatology, Division of Rheumatology, Orthopaedics, and Dermatology, University of Nottingham, UK; Arthritis Research UK Pain Centre, UK.
| | - D A Walsh
- Academic Rheumatology, Division of Rheumatology, Orthopaedics, and Dermatology, University of Nottingham, UK; Arthritis Research UK Pain Centre, UK.
| | - M Doherty
- Academic Rheumatology, Division of Rheumatology, Orthopaedics, and Dermatology, University of Nottingham, UK; Arthritis Research UK Pain Centre, UK.
| | - W Zhang
- Academic Rheumatology, Division of Rheumatology, Orthopaedics, and Dermatology, University of Nottingham, UK; Arthritis Research UK Pain Centre, UK.
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MacGregor IR, Dawes J, Pepper DS, Prowse CV, Stocks J. Metabolism of Sodium Pentosan Polysulphate in Man Measured by a New Competitive Binding Assay for Sulphated Polysaccharides – Comparison with Effects Upon Anticoagulant Activity, Lipolysis and Platelet α-Granule Proteins. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661326] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThree human volunteers were injected with a range of doses of pentosan polysulphate, SP54, i.v. or s.c. A competitive binding assay (CBA) for sulphated polysaccharides was used to detect circulating SP54 after doses as low as 1 mg i.v. and a linear relationship was observed between the peak plasma concentration of SP54 measured by CBA and the administered dose. A comparison was made between the clearance of SP54 measured by CBA and its anticoagulant and lipolytic activities. SP54 was detectable by CBA after doses which caused no alteration in activated partial thromboplastin time (APTT) or anti-factor Xa activity but after which a small increase of lipase activity was measurable. After SP54 at 10 mg i.v. or 100 mg s.c. anti-factor Xa activity was 4-6 times greater than would be expected from the in vitro activity of the concentrations of SP54 measured by CBA. Like heparin and other heparin analogues, SP54 caused an increase in plasma concentrations of platelet factor 4 (PF4) without a concomitant rise in p-thromboglobulin (β-TG).It is concluded that the newly developed CBA will provide a more sensitive means than conventional bioassays for the determination of plasma concentrations of SP54.
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Affiliation(s)
- I R MacGregor
- The Scottish National Blood Transfusion Service Headquarters Unit Laboratory, Edinburgh, UK
| | - J Dawes
- The MRC/SNBTS Blood Components Assay Group, Edinburgh, UK
| | - D S Pepper
- The Scottish National Blood Transfusion Service Headquarters Unit Laboratory, Edinburgh, UK
| | - C V Prowse
- The S-E Scotland Blood Transfusion Service, Royal Infirmary, Edinburgh, UK
| | - J Stocks
- The Lipid Laboratory, St. Bartholomew’s Hospital, London, UK
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8
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Davies G, Stocks J, Thia LP, Hoo AF, Bush A, Aurora P, Brennan L, Lee S, Lum S, Cottam P, Miles J, Chudleigh J, Kirkby J, Balfour-Lynn IM, Carr SB, Wallis C, Wyatt H, Wade A. Pulmonary function deficits in newborn screened infants with cystic fibrosis managed with standard UK care are mild and transient. Eur Respir J 2017; 50:50/5/1700326. [PMID: 29122914 DOI: 10.1183/13993003.00326-2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 08/03/2017] [Indexed: 12/17/2022]
Abstract
With the advent of novel designer molecules for cystic fibrosis (CF) treatment, there is huge need for early-life clinical trial outcomes, such as infant lung function (ILF). We investigated the degree and tracking of ILF abnormality during the first 2 years of life in CF newborn screened infants.Forced expiratory volume in 0.5 s (FEV0.5), lung clearance index (LCI) and plethysmographic functional residual capacity were measured at ∼3 months, 1 year and 2 years in 62 infants with CF and 34 controls.By 2 years there was no significant difference in FEV0.5 z-score between CF and controls, whereas mean LCI z-score was 0.81 (95% CI 0.45-1.17) higher in CF. However, there was no significant association between LCI z-score at 2 years with either 3-month or 1-year results. Despite minimal average group changes in any ILF outcome during the second year of life, marked within-subject changes occurred. No child had abnormal LCI or FEV0.5 on all test occasions, precluding the ability to identify "high-risk" infants in early life.In conclusion, changes in lung function are mild and transient during the first 2 years of life in newborn screened infants with CF when managed according to a standardised UK treatment protocol. Their potential role in tracking disease to later childhood will be ascertained by ongoing follow-up.
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Affiliation(s)
- Gwyneth Davies
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK .,Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Janet Stocks
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lena P Thia
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ah-Fong Hoo
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK.,Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andrew Bush
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Paul Aurora
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK.,Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lucy Brennan
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Simon Lee
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Sooky Lum
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Philippa Cottam
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Joanne Miles
- Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jane Chudleigh
- Dept of Child Health, King's College London, London, UK.,Dept of Child Health, City, University of London, London, UK
| | - Jane Kirkby
- Respiratory, Anaesthesia and Critical Care Section, Infection, Immunity, Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, UK.,Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ian M Balfour-Lynn
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Siobhán B Carr
- Dept of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK.,Dept of Paediatric Respiratory Medicine, Royal London Hospital, London, UK
| | - Colin Wallis
- Respiratory Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Hilary Wyatt
- Dept of Child Health, King's College London, London, UK
| | - Angie Wade
- Clinical Epidemiology, Nutrition and Biostatistics, Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
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Fernandes GS, Sarmanova A, Warner S, Harvey H, Akin-Akinyosoye K, Richardson H, Frowd N, Marshall L, Stocks J, Hall M, Valdes AM, Walsh D, Zhang W, Doherty M. Knee pain and related health in the community study (KPIC): a cohort study protocol. BMC Musculoskelet Disord 2017; 18:404. [PMID: 28934932 PMCID: PMC5609004 DOI: 10.1186/s12891-017-1761-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/13/2017] [Indexed: 04/10/2023] Open
Affiliation(s)
- G S Fernandes
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - A Sarmanova
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom
| | - S Warner
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom
| | - H Harvey
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom
| | - K Akin-Akinyosoye
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - H Richardson
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom
| | - N Frowd
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - L Marshall
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - J Stocks
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - M Hall
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - A M Valdes
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - D Walsh
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - W Zhang
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom. .,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom. .,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom.
| | - M Doherty
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
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Cooper BG, Stocks J, Hall GL, Culver B, Steenbruggen I, Carter KW, Thompson BR, Graham BL, Miller MR, Ruppel G, Henderson J, Vaz Fragoso CA, Stanojevic S. The Global Lung Function Initiative (GLI) Network: bringing the world's respiratory reference values together. Breathe (Sheff) 2017; 13:e56-e64. [PMID: 28955406 PMCID: PMC5607614 DOI: 10.1183/20734735.012717] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Global Lung Function Initiative (GLI) Network has become the largest resource for reference values for routine lung function testing ever assembled. This article addresses how the GLI Network came about, why it is important, and its current challenges and future directions. It is an extension of an article published in Breathe in 2013 [1], and summarises recent developments and the future of the GLI Network. Learn about the GLI Network, the largest resource reference for routine lung function testinghttp://ow.ly/ZZor30epWgi
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Affiliation(s)
- Brendan G Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Janet Stocks
- Respiratory, Critical Care and Anaesthesia section, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Graham L Hall
- Telethon Kids Institute, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Bruce Culver
- Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Bruce Robert Thompson
- Allergy Immunology and Respiratory Medicine, The Alfred Hospital and Monash University, Melbourne, Australia
| | - Brian L Graham
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Martin R Miller
- Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
| | - Gregg Ruppel
- Pulmonary, Critical Care and Sleep Medicine, Saint Louis University School of Medicine, Saint Louis, MO USA
| | - John Henderson
- School of Social and Community Medicine, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Carlos A Vaz Fragoso
- Dept of Internal Medicine, Veterans Affairs Clinical Epidemiology Research Center, West Haven, CT, USA
| | - Sanja Stanojevic
- Respiratory Medicine, Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
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11
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12
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Lelijveld N, Kerac M, Seal A, Chimwezi E, Wells JC, Heyderman RS, Nyirenda MJ, Stocks J, Kirkby J. Long-term effects of severe acute malnutrition on lung function in Malawian children: a cohort study. Eur Respir J 2017; 49:49/4/1601301. [PMID: 28381429 PMCID: PMC5540677 DOI: 10.1183/13993003.01301-2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 07/01/2016] [Accepted: 12/03/2016] [Indexed: 12/31/2022]
Abstract
Early nutritional insults may increase risk of adult lung disease. We aimed to quantify the impact of severe acute malnutrition (SAM) on spirometric outcomes 7 years post-treatment and explore predictors of impaired lung function. Spirometry and pulse oximetry were assessed in 237 Malawian children (median age: 9.3 years) who had been treated for SAM and compared with sibling and age/sex-matched community controls. Spirometry results were expressed as z-scores based on Global Lung Function Initiative reference data for the African–American population. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were low in all groups (mean FEV1 z-score: −0.47 for cases, −0.48 for siblings, −0.34 for community controls; mean FVC z-score: −0.32, −0.38, and −0.15 respectively). There were no differences in spirometric or oximetry outcomes between SAM survivors and controls. Leg length was shorter in SAM survivors but inter-group sitting heights were similar. HIV positive status or female sex was associated with poorer FEV1, by 0.55 and 0.31 z-scores, respectively. SAM in early childhood was not associated with subsequent reduced lung function compared to local controls. Preservation of sitting height and compromised leg length suggest “thrifty” or “lung-sparing” growth. Female sex and HIV positive status were identified as potentially high-risk groups. Despite stunting, survivors of acute malnutrition do not have worse lung function than controlshttp://ow.ly/2nvH308LroU
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Affiliation(s)
- Natasha Lelijveld
- Institute for Global Health, University College London, London, UK .,Malawi-Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.,Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Marko Kerac
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.,Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Leonard Cheshire Disability and Inclusive Development Centre, Dept of Epidemiology and Child Health, University College London, London, UK
| | - Andrew Seal
- Institute for Global Health, University College London, London, UK
| | - Emmanuel Chimwezi
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, UCL Great Ormond Street, Institute of Child Health, University College London, London, UK
| | - Robert S Heyderman
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.,Division of Infection and Immunity, University College London, London, UK
| | - Moffat J Nyirenda
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.,Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Stocks
- Respiratory, Critical Care and Anaesthesia section in III, UCL Great Ormond Street, Institute of Child Health, University College London, London, UK
| | - Jane Kirkby
- Respiratory, Critical Care and Anaesthesia section in III, UCL Great Ormond Street, Institute of Child Health, University College London, London, UK
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13
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Affiliation(s)
- Janet Stocks
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), UCL Institute of Child Health, London, UK
| | - Sooky Lum
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), UCL Institute of Child Health, London, UK
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14
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Lum S, Stocks J. Inclusion of children with airway disease for the development of spirometry reference data. Eur Respir J 2016; 47:1292-3. [PMID: 27037321 DOI: 10.1183/13993003.02028-2015] [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: 12/03/2015] [Accepted: 12/16/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Sooky Lum
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), UCL, Institute of Child Health, London, UK
| | - Janet Stocks
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), UCL, Institute of Child Health, London, UK
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15
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Lum S, Bountziouka V, Quanjer P, Sonnappa S, Wade A, Beardsmore C, Chhabra SK, Chudasama RK, Cook DG, Harding S, Kuehni CE, Prasad KVV, Whincup PH, Lee S, Stocks J. Challenges in Collating Spirometry Reference Data for South-Asian Children: An Observational Study. PLoS One 2016; 11:e0154336. [PMID: 27119342 PMCID: PMC4847904 DOI: 10.1371/journal.pone.0154336] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 12/23/2015] [Accepted: 04/11/2016] [Indexed: 01/28/2023] Open
Abstract
Availability of sophisticated statistical modelling for developing robust reference equations has improved interpretation of lung function results. In 2012, the Global Lung function Initiative(GLI) published the first global all-age, multi-ethnic reference equations for spirometry but these lacked equations for those originating from the Indian subcontinent (South-Asians). The aims of this study were to assess the extent to which existing GLI-ethnic adjustments might fit South-Asian paediatric spirometry data, assess any similarities and discrepancies between South-Asian datasets and explore the feasibility of deriving a suitable South-Asian GLI-adjustment.
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Affiliation(s)
- Sooky Lum
- Respiratory, Critical Care & Anaesthesia section (Portex Unit), UCL, Institute of Child Health, London, United Kingdom
- * E-mail:
| | - Vassiliki Bountziouka
- Respiratory, Critical Care & Anaesthesia section (Portex Unit), UCL, Institute of Child Health, London, United Kingdom
| | - Philip Quanjer
- Department of Pulmonary Diseases and Department of Paediatrics-Pulmonary Diseases, Erasmus Medical Centre, Erasmus University, Rotterdam, Netherlands
| | - Samatha Sonnappa
- Respiratory, Critical Care & Anaesthesia section (Portex Unit), UCL, Institute of Child Health, London, United Kingdom
- Department of Paediatric Pulmonology, Rainbow Children’s Hospital, Bangalore, India
| | - Angela Wade
- Clinical Epidemiology, Nutrition and Biostatistics section, UCL, Institute of Child Health, London, United Kingdom
| | - Caroline Beardsmore
- Institute for Lung Health, NIHR Leicester Respiratory Biomedical Research Unit, and Department of Infection, Immunity & Inflammation, University of Leicester, Leicester, United Kingdom
| | - Sunil K. Chhabra
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | | | - Derek G. Cook
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Seeromanie Harding
- Diabetes & Nutritional Sciences Division, Kings College London, London, United Kingdom
| | - Claudia E. Kuehni
- Institute of Social and Preventative Medicine, University of Bern, Switzerland
| | - K. V. V. Prasad
- Department of Physiology, Vemana Yoga Research Institute, Hyderabad, India
| | - Peter H. Whincup
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Simon Lee
- Respiratory, Critical Care & Anaesthesia section (Portex Unit), UCL, Institute of Child Health, London, United Kingdom
| | - Janet Stocks
- Respiratory, Critical Care & Anaesthesia section (Portex Unit), UCL, Institute of Child Health, London, United Kingdom
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16
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Kirkby J, Bountziouka V, Lum S, Wade A, Stocks J. Natural variability of lung function in young healthy school children. Eur Respir J 2016; 48:411-9. [PMID: 27076582 DOI: 10.1183/13993003.01795-2015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/25/2016] [Indexed: 12/31/2022]
Abstract
Knowledge about long-term variability of lung function in healthy children is essential when monitoring and treating those with respiratory disease over time. The aim of this study was to define the natural variability in spirometry in young children after an interval of 12 months.The Size and Lung function In Children study was a prospective study designed to assess spirometry and body size, shape and composition in a multi-ethnic population of London school children. 14 schools with a wide range of socioeconomic circumstances were recruited. Spirometric and anthropometric assessments and parental questionnaires pertaining to respiratory symptoms, previous medical history, pubertal status and socioeconomic circumstances were completed at baseline and ∼1 year later.Technically acceptable spirometry data on two occasions ∼1 year apart (range 9-16 months) were available in 758 children (39% boys, mean±sd age 8.1±1.6 years), 593 of whom were classified as "healthy". Mean±sd within-subject between-test variability was 0.05±0.6 z-scores, with 95% of all the children achieving a between-test variability within ±1.2 z-scores (equating to ∼13% predicted).Natural variations of up to 1.2 z-scores occur in healthy children over ∼1 year. These must be considered when interpreting results from annual reviews in those with lung disease who are otherwise stable, if unnecessary further investigations or changes in treatment are to be avoided.
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Affiliation(s)
- Jane Kirkby
- Respiratory, Critical Care and Anaesthesia section in Portex Unit, University College London, Institute of Child Health, London, UK Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Vassiliki Bountziouka
- Respiratory, Critical Care and Anaesthesia section in Portex Unit, University College London, Institute of Child Health, London, UK
| | - Sooky Lum
- Respiratory, Critical Care and Anaesthesia section in Portex Unit, University College London, Institute of Child Health, London, UK
| | - Angie Wade
- Population, Policy and Practice Programme, University College London, Institute of Child Health, London, UK
| | - Janet Stocks
- Respiratory, Critical Care and Anaesthesia section in Portex Unit, University College London, Institute of Child Health, London, UK
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Lum S, Bountziouka V, Wade A, Hoo AF, Kirkby J, Moreno-Galdo A, de Mir I, Sardon-Prado O, Corcuera-Elosegui P, Mattes J, Borrego LM, Davies G, Stocks J. New reference ranges for interpreting forced expiratory manoeuvres in infants and implications for clinical interpretation: a multicentre collaboration. Thorax 2015; 71:276-83. [DOI: 10.1136/thoraxjnl-2015-207278] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/29/2015] [Indexed: 12/20/2022]
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18
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Lum S, Bountziouka V, Sonnappa S, Wade A, Cole TJ, Harding S, Wells JCK, Griffiths C, Treleaven P, Bonner R, Kirkby J, Lee S, Raywood E, Legg S, Sears D, Cottam P, Feyeraband C, Stocks J. Lung function in children in relation to ethnicity, physique and socioeconomic factors. Eur Respir J 2015; 46:1662-71. [PMID: 26493801 DOI: 10.1183/13993003.00415-2015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 07/14/2015] [Indexed: 11/05/2022]
Abstract
Can ethnic differences in spirometry be attributed to differences in physique and socioeconomic factors?Assessments were undertaken in 2171 London primary schoolchildren on two occasions 1 year apart, whenever possible, as part of the Size and Lung function In Children (SLIC) study. Measurements included spirometry, detailed anthropometry, three-dimensional photonic scanning for regional body shape, body composition, information on ethnic ancestry, birth and respiratory history, socioeconomic circumstances, and tobacco smoke exposure.Technically acceptable spirometry was obtained from 1901 children (mean (range) age 8.3 (5.2-11.8) years, 46% boys, 35% White, 29% Black-African origin, 24% South-Asian, 12% Other/mixed) on 2767 test occasions. After adjusting for sex, age and height, forced expiratory volume in 1 s was 1.32, 0.89 and 0.51 z-score units lower in Black-African origin, South-Asian and Other/mixed ethnicity children, respectively, when compared with White children, with similar decrements for forced vital capacity (p<0.001 for all). Although further adjustment for sitting height and chest width reduced differences attributable to ethnicity by up to 16%, significant differences persisted after adjusting for all potential determinants, including socioeconomic circumstances.Ethnic differences in spirometric lung function persist despite adjusting for a wide range of potential determinants, including body physique and socioeconomic circumstances, emphasising the need to use ethnic-specific equations when interpreting results.
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Affiliation(s)
- Sooky Lum
- Respiratory, Critical Care & Anaesthesia Section in IIIP Programme, UCL Institute of Child Health, London, UK
| | - Vassiliki Bountziouka
- Respiratory, Critical Care & Anaesthesia Section in IIIP Programme, UCL Institute of Child Health, London, UK
| | - Samatha Sonnappa
- Respiratory, Critical Care & Anaesthesia Section in IIIP Programme, UCL Institute of Child Health, London, UK UCL Institute of Global Health, London, UK
| | - Angie Wade
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
| | - Tim J Cole
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
| | - Seeromanie Harding
- MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jonathan C K Wells
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
| | - Chris Griffiths
- Asthma UK Centre for Applied Research, Blizard Institute - Queen Mary University of London, London, UK
| | | | - Rachel Bonner
- Respiratory, Critical Care & Anaesthesia Section in IIIP Programme, UCL Institute of Child Health, London, UK
| | - Jane Kirkby
- Respiratory, Critical Care & Anaesthesia Section in IIIP Programme, UCL Institute of Child Health, London, UK Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Simon Lee
- Respiratory, Critical Care & Anaesthesia Section in IIIP Programme, UCL Institute of Child Health, London, UK
| | - Emma Raywood
- Respiratory, Critical Care & Anaesthesia Section in IIIP Programme, UCL Institute of Child Health, London, UK
| | - Sarah Legg
- Respiratory, Critical Care & Anaesthesia Section in IIIP Programme, UCL Institute of Child Health, London, UK
| | - Dave Sears
- Respiratory, Critical Care & Anaesthesia Section in IIIP Programme, UCL Institute of Child Health, London, UK
| | - Philippa Cottam
- Respiratory, Critical Care & Anaesthesia Section in IIIP Programme, UCL Institute of Child Health, London, UK
| | | | - Janet Stocks
- Respiratory, Critical Care & Anaesthesia Section in IIIP Programme, UCL Institute of Child Health, London, UK
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Robinson PD, Stocks J, Marchal F, Nielsen KG, Thompson BR, Tomalak W, Kirkby J. Poor standardisation of plethysmographic specific airways resistance measurement despite widespread use. Eur Respir J 2015; 46:1811-4. [DOI: 10.1183/13993003.00377-2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 06/19/2015] [Indexed: 11/05/2022]
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Affiliation(s)
- Philip H Quanjer
- Dept of Pulmonary Diseases and Dept of Paediatrics, Division of Respiratory Medicine, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Brendan Cooper
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - Gregg L Ruppel
- Pulmonary, Critical Care and Sleep Medicine, St Louis University School of Medicine, St Louis, MO, USA
| | - Maureen P Swanney
- Respiratory Medicine, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Janet Stocks
- Respiratory, Critical Care and Anaesthesia section, UCL Institute of Child Health, London, UK
| | - Bruce H Culver
- Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Bruce R Thompson
- Allergy Immunology and Respiratory Medicine, The Alfred Hospital and Monash University, Melbourne, Australia
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21
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Devakumar D, Ayres JG, Bartington S, Stocks J, Chaube SS, Saville NM, Manandhar DS, Costello A, Osrin D. Cross-sectional study of asthma and rhinitis symptoms in the context of exposure to air pollution in Nepal. ERJ Open Res 2015; 1. [PMID: 26689255 PMCID: PMC4681090 DOI: 10.1183/23120541.00004-2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Asthma is common in children worldwide, although its prevalence varies substantially by location. The prevalence of wheeze over a 12-month period ranged from 2.1% to 32.2% in the older age group (13–14 years) and 4.1% to 32.1% in the younger age group (6–7 years) [1]. There is a positive association between current symptoms of asthma in younger and older children with gross national income [2], and it is generally slightly less common in girls than boys in the younger group [1–3]. Exposure to air pollution is associated with asthma exacerbations. Odds ratios for wheeze in the past year and the use of solely an open fire for cooking were 2.17 (95% CI 1.64–2.87) for children aged 6–7 years and 1.35 (95% CI 1.11–1.64) for children aged 13–14 years [4]. Nepalese children are exposed to high levels of indoor air pollution from the burning of biomass fuels [5]. This study aimed to estimate their prevalence of asthma, and to investigate the association of air pollution and risk of wheeze and rhinitis symptoms using personal exposure estimates of air pollution. Amongst children in rural Nepal, an association of dry cough with air pollution was seen only in boyshttp://ow.ly/MOa5u
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Affiliation(s)
| | - Jonathan G Ayres
- Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham UK
| | | | - Janet Stocks
- Institute of Child Health, UCL and Great Ormond St Hospital for Children NHS Trust Foundation, London, UK
| | | | | | | | | | - David Osrin
- Institute for Global Health, UCL, London, UK
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22
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Hankinson JL, Eschenbacher B, Townsend M, Stocks J, Quanjer PH. Use of forced vital capacity and forced expiratory volume in 1 second quality criteria for determining a valid test. Eur Respir J 2015; 45:1283-92. [PMID: 25537554 PMCID: PMC4416111 DOI: 10.1183/09031936.00116814] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 10/23/2014] [Indexed: 11/21/2022]
Abstract
The 2005 American Thoracic Society (ATS)/European Respiratory Society (ERS) spirometry guidelines define valid tests as having three acceptable blows and a repeatable forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). The aim of this study was to determine how reviewer and computer-determined ATS/ERS quality could affect population reference values for FVC and FEV1. Spirometry results from 7777 normal subjects aged 8-80 years (NHANES (National Health and Nutrition Examination Survey) III) were assigned quality grades A to F for FVC and FEV1 by a computer and one reviewer (reviewer 1). Results from a subgroup of 1466 Caucasian adults (aged 19-80 years ) were reviewed by two additional reviewers. Mean deviations from NHANES III predicted for FVC and FEV1 were examined by quality grade (A to F). Reviewer 1 rejected (D and F grade) 5.2% of the 7777 test sessions and the computer rejected ∼16%, primarily due to end-of-test (EOT) failures. Within the subgroup, the computer rejected 11.5% of the results and the three reviewers rejected 3.7-5.9%. Average FEV1 and FVC were minimally influenced by grades A to C allocated by reviewer 1. Quality assessment of individual blows including EOT assessments should primarily be used as an aid to good quality during testing rather than for subsequently disregarding data. Reconsideration of EOT criteria and its application, and improved grading standards and training in over-reading are required. Present EOT criteria results in the exclusion of too many subjects while having minimal impact on predicted values.
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Affiliation(s)
| | | | | | - Janet Stocks
- Respiratory, Critical Care and Anaesthesia Section (Portex Unit), UCL Institute of Child Health, London, UK
| | - Philip H Quanjer
- Dept of Pulmonary Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands Dept of Paediatrics, Division of Respiratory Medicine, Erasmus University Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
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Wells JCK, Stocks J, Bonner R, Raywood E, Legg S, Lee S, Treleaven P, Lum S. Acceptability, Precision and Accuracy of 3D Photonic Scanning for Measurement of Body Shape in a Multi-Ethnic Sample of Children Aged 5-11 Years: The SLIC Study. PLoS One 2015; 10:e0124193. [PMID: 25919034 PMCID: PMC4412635 DOI: 10.1371/journal.pone.0124193] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/29/2015] [Indexed: 11/18/2022] Open
Abstract
Background Information on body size and shape is used to interpret many aspects of physiology, including nutritional status, cardio-metabolic risk and lung function. Such data have traditionally been obtained through manual anthropometry, which becomes time-consuming when many measurements are required. 3D photonic scanning (3D-PS) of body surface topography represents an alternative digital technique, previously applied successfully in large studies of adults. The acceptability, precision and accuracy of 3D-PS in young children have not been assessed. Methods We attempted to obtain data on girth, width and depth of the chest and waist, and girth of the knee and calf, manually and by 3D-PS in a multi-ethnic sample of 1484 children aged 5–11 years. The rate of 3D-PS success, and reasons for failure, were documented. Precision and accuracy of 3D-PS were assessed relative to manual measurements using the methods of Bland and Altman. Results Manual measurements were successful in all cases. Although 97.4% of children agreed to undergo 3D-PS, successful scans were only obtained in 70.7% of these. Unsuccessful scans were primarily due to body movement, or inability of the software to extract shape outputs. The odds of scan failure, and the underlying reason, differed by age, size and ethnicity. 3D-PS measurements tended to be greater than those obtained manually (p<0.05), however ranking consistency was high (r2>0.90 for most outcomes). Conclusions 3D-PS is acceptable in children aged ≥5 years, though with current hardware/software, and body movement artefacts, approximately one third of scans may be unsuccessful. The technique had poorer technical success than manual measurements, and had poorer precision when the measurements were viable. Compared to manual measurements, 3D-PS showed modest average biases but acceptable limits of agreement for large surveys, and little evidence that bias varied substantially with size. Most of the issues we identified could be addressed through further technological development.
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Affiliation(s)
- Jonathan C. K. Wells
- Childhood Nutrition Research Centre, UCL Institute of Child Health, London, United Kingdom
- * E-mail:
| | - Janet Stocks
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), UCL Institute of Child Health, London, United Kingdom
| | - Rachel Bonner
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), UCL Institute of Child Health, London, United Kingdom
| | - Emma Raywood
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), UCL Institute of Child Health, London, United Kingdom
| | - Sarah Legg
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), UCL Institute of Child Health, London, United Kingdom
| | - Simon Lee
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), UCL Institute of Child Health, London, United Kingdom
| | - Philip Treleaven
- UCL Department of Computer Science, Malet Place, London, United Kingdom
| | - Sooky Lum
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), UCL Institute of Child Health, London, United Kingdom
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Stanojevic S, Bilton D, McDonald A, Stocks J, Aurora P, Prasad A, Cole TJ, Davies G. Global Lung Function Initiative equations improve interpretation of FEV1 decline among patients with cystic fibrosis. Eur Respir J 2015; 46:262-4. [DOI: 10.1183/09031936.00187314] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/30/2015] [Indexed: 02/02/2023]
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Sonnappa S, Lum S, Kirkby J, Bonner R, Wade A, Subramanya V, Lakshman PT, Rajan B, Nooyi SC, Stocks J. Disparities in pulmonary function in healthy children across the Indian urban-rural continuum. Am J Respir Crit Care Med 2015; 191:79-86. [PMID: 25412016 DOI: 10.1164/rccm.201406-1049oc] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Marked socioeconomic health-care disparities are recognized in India, but lung health inequalities between urban and rural children have not been studied. OBJECTIVES We investigated whether differences exist in spirometric pulmonary function in healthy children across the Indian urban-rural continuum and compared results with those from Indian children living in the UK. METHODS Indian children aged 5 to 12 years were recruited from Indian urban, semiurban, and rural schools, and as part of the Size and Lung Function in Children study, London. Anthropometric and spirometric assessments were undertaken. MEASUREMENTS AND MAIN RESULTS Acceptable spirometric data were obtained from 728 (58% boys) children in India and 311 (50% boys) UK-Indian children. As an entire group, the India-resident children had significantly lower z FEV1 and z FVC than UK-Indian children (P < 0.0005), when expressed using Global Lung Function Initiative-2012 equations. However, when India-resident children were categorized according to residence, there were no differences in z FEV1 and z FVC between Indian-urban and UK-Indian children. There were, however, significant reductions of ∼ 0.5 z scores and 0.9 z scores in both FEV1 and FVC (with no difference in FEV1/FVC) in Indian-semiurban and Indian-rural children, respectively, when compared with Indian-urban children (P < 0.0005). z Body mass index, socioeconomic circumstances, tobacco, and biomass exposure were individually significantly associated with z FEV1 and z FVC (P < 0.0005). CONCLUSIONS The presence of an urban-rural continuum of lung function within a specific ethnic group emphasizes the impact of environmental factors on lung growth in emerging nations such as India, which must be taken into account when developing ethnic-specific reference values or designing studies to optimize lung health.
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Affiliation(s)
- Samatha Sonnappa
- 1 Respiratory, Critical Care, and Anaesthesia Section (Portex Unit) and
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Quanjer PH, Kubota M, Kobayashi H, Omori H, Tatsumi K, Kanazawa M, Stanojevic S, Stocks J, Cole TJ. Secular Changes in Relative Leg Length Confound Height-Based Spirometric Reference Values. Chest 2015; 147:792-797. [DOI: 10.1378/chest.14-1365] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Devakumar D, Stocks J, Ayres JG, Kirkby J, Yadav SK, Saville NM, Devereux G, Wells JCK, Manandhar DS, Costello A, Osrin D. Effects of antenatal multiple micronutrient supplementation on lung function in mid-childhood: follow-up of a double-blind randomised controlled trial in Nepal. Eur Respir J 2015; 45:1566-75. [PMID: 25700386 DOI: 10.1183/09031936.00188914] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 12/12/2014] [Indexed: 12/20/2022]
Abstract
A randomised trial of prenatal multiple micronutrient supplementation in Nepalese women increased birthweight and weight at 2 years of age in offspring, compared to those born to mothers who only received iron and folic acid supplements. Further follow-up of this cohort provided an opportunity to investigate the effect of antenatal multiple micronutrients on subsequent lung function by measuring spirometry at 7-9 years of age in C: hildren born during the trial. 841 children (80% of the cohort) were seen at mean±sd 8.5±0.4 years. Technically successful spirometry results were obtained in 793 (94.3%) children, 50% of whom had been randomised to micronutrient supplementation. Background characteristics, including anthropometry, were similar in the two allocation groups. Lung function was also similar, mean (95% CI) difference in z-scores (supplementation minus control) was -0.08 (-0.19-0.04), -0.05 (-0.17-0.06) and -0.04 (-0.15-0.07) for forced expiratory volume in 1 s (FEV1), forced vital capacity and FEV1/FVC, respectively. Compared with healthy white children, FEV1 and FVC in the "healthy" Nepalese children were ∼1 (∼13%) z-score lower, with no difference in FEV1/FVC. We conclude that, compared with routine iron and folic acid, multiple micronutrient supplementation during pregnancy has no effect on spirometric lung function in Nepalese children at 8.5 years of age.
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Affiliation(s)
- Delan Devakumar
- Institute for Global Health, University College London, London, UK.
| | - Janet Stocks
- Respiratory, Critical Care and Anaesthesia Section (Portex Unit), Institute of Child Health, University College London, London, UK
| | - Jon G Ayres
- Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
| | - Jane Kirkby
- Respiratory, Critical Care and Anaesthesia Section (Portex Unit), Institute of Child Health, University College London, London, UK. Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Naomi M Saville
- Institute for Global Health, University College London, London, UK
| | - Graham Devereux
- Child Health Dept, University of Aberdeen, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, Institute of Child Health, University College London, London, UK
| | | | - Anthony Costello
- Institute for Global Health, University College London, London, UK
| | - David Osrin
- Institute for Global Health, University College London, London, UK
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Lum S, Bountziouka V, Sonnappa S, Cole TJ, Bonner R, Stocks J. How "healthy" should children be when selecting reference samples for spirometry? Eur Respir J 2015; 45:1576-81. [PMID: 25700391 DOI: 10.1183/09031936.00223814] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/23/2014] [Indexed: 11/05/2022]
Abstract
How "healthy" do children need to be when selecting reference samples for spirometry? Anthropometry and spirometry were measured in an unselected, multi-ethnic population of school children aged 5-11 years in London, UK, with follow-up assessments 12 months later. Parents provided information on children's birth data and health status. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were adjusted for sex, age, height and ethnicity using the 2012 Global Lungs Initiative equations, and the effects of potential exclusion criteria on the z-score distributions were examined. After exclusions for current and chronic lung disease, acceptable data were available for 1901 children on 2767 occasions. Healthy children were defined as those without prior asthma or hospitalisation for respiratory problems, who were born at full-term with a birthweight ≥2.5 kg and who were asymptomatic at testing. Mean±sd z-scores for FEV1 and FVC approximated 0±1, indicating the 2012 Global Lungs Initiative equations were appropriate for this healthy population. However, if children born preterm or with low birthweight, children with prior asthma or children mildly symptomatic at testing were included in the reference, overall results were similar to those for healthy children, while increasing the sample size by 25%. With the exception of clear-cut factors, such as current and chronic respiratory disease, paediatric reference samples for spirometry can be relatively inclusive and hence more generalisable to the target population.
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Affiliation(s)
- Sooky Lum
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), University College London, Institute of Child Health, London, UK.
| | - Vassiliki Bountziouka
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), University College London, Institute of Child Health, London, UK
| | - Samatha Sonnappa
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), University College London, Institute of Child Health, London, UK. Institute of Global Health, University College London, Institute of Child Health, London, UK
| | - Tim J Cole
- Population, Policy and Practice Programme, University College London, Institute of Child Health, London, UK
| | - Rachel Bonner
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), University College London, Institute of Child Health, London, UK
| | - Janet Stocks
- Respiratory, Critical Care and Anaesthesia section (Portex Unit), University College London, Institute of Child Health, London, UK
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Bonner R, Bountziouka V, Stocks J, Harding S, Wade A, Griffiths C, Sears D, Fothergill H, Slevin H, Lum S. Birth data accessibility via primary care health records to classify health status in a multi-ethnic population of children: an observational study. NPJ Prim Care Respir Med 2015; 25:14112. [PMID: 25612149 PMCID: PMC4353844 DOI: 10.1038/npjpcrm.2014.112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 08/12/2014] [Revised: 11/02/2014] [Accepted: 11/11/2014] [Indexed: 01/25/2023] Open
Abstract
Background: Access to reliable birth data (birthweight (BW) and gestational age (GA)) is essential for the identification of individuals who are at subsequent health risk. Aims: This study aimed to explore the feasibility of retrospectively collecting birth data for schoolchildren from parental questionnaires (PQ) and general practitioners (GPs) in primary care clinics, in inner city neighbourhoods with high density of ethnic minority and disadvantaged populations. Methods: Attempts were made to obtain birth data from parents and GPs for 2,171 London primary schoolchildren (34% White, 29% Black African origin, 25% South Asians, 12% Other) as part of a larger study of respiratory health. Results: Information on BW and/or GA were obtained from parents for 2,052 (95%) children. Almost all parents (2,045) gave consent to access their children’s health records held by GPs. On the basis of parental information, GPs of 1,785 children were successfully contacted, and GPs of 1,202 children responded. Birth data were retrieved for only 482 children (22% of 2,052). Missing birth data from GPs were associated with non-white ethnicity, non-UK born, English not the dominant language at home or socioeconomic disadvantage. Paired data were available in 376 children for BW and in 407 children for GA. No significant difference in BW or GA was observed between PQ and GP data, with <5% difference between sources regardless of normal or low birth weight, or term or preterm status. Conclusions: Parental recall of birth data for primary schoolchildren yields high quality and rapid return of data, and it should be considered as a viable alternative in which there is limited access to birth records. It provides the potential to include children with an increased risk of health problems within epidemiological studies.
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Affiliation(s)
- Rachel Bonner
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK
| | - Vassiliki Bountziouka
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK
| | - Janet Stocks
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK
| | - Seeromanie Harding
- MRC/CSO, Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow, UK
| | - Angela Wade
- Clinical Epidemiology, Nutrition and Biostatistics Section, UCL, Institute of Child Health, London, UK
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - David Sears
- 1] Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK [2] Lung Function Unit, Royal Brompton Hospital, London, UK
| | - Helen Fothergill
- 1] Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK [2] Torbay Hospital, South Devon NHS Trust, Torquay, Devon, UK
| | - Hannah Slevin
- 1] Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK [2] Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sooky Lum
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK
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Shannon H, Stocks J, Gregson RK, Hines S, Peters MJ, Main E. Differences in delivery of respiratory treatments by on-call physiotherapists in mechanically ventilated children: a randomised crossover trial. Physiotherapy 2015; 101:357-63. [PMID: 25749494 DOI: 10.1016/j.physio.2014.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 12/27/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate differences, if any, in the delivery of respiratory treatments to mechanically ventilated children between non-respiratory on-call physiotherapists and specialist respiratory physiotherapists. SETTING Paediatric, tertiary care hospital in the United Kingdom. PARTICIPANTS 93 children (aged between 3 days and 16 years), and 22 physiotherapists (10 specialist respiratory physiotherapists) were recruited to the study. INTERVENTIONS Recruited children received two physiotherapy treatments during a single day, one delivered by a non-respiratory physiotherapist, the other by a specialist respiratory physiotherapist in a randomised order. Selection, delivery and effects of techniques were recorded for each treatment. OUTCOME MEASURES Primary outcomes were selection and application of treatment components. Secondary outcomes included respiratory effects (in terms of changes in flow, volume and pressure) of selected treatment components. RESULTS Both non-respiratory on-call physiotherapists and specialist respiratory physiotherapists used combinations of saline instillation, manual lung inflations, chest wall vibrations and endotracheal suction during treatments. However specialist respiratory physiotherapists used combinations of chest wall vibrations with suction, and recruitment manoeuvres, significantly more frequently than non-respiratory on-call physiotherapists (92% vs 52%, and 87% vs 46% of treatments respectively, P<0.001). Chest wall vibrations delivered by non-respiratory on-call physiotherapists were 15% less effective at increasing peak expiratory flow. CONCLUSION Clinically important differences between non-respiratory and specialist respiratory physiotherapists' treatment outcomes may be related to differences in the selection and application of techniques. This suggests an important training need for non-respiratory on-call physiotherapists, particularly in the effective delivery of physiotherapy techniques. TRIAL REGISTRATION Clinicaltrials.gov NCT01999426.
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Affiliation(s)
- Harriet Shannon
- Physiotherapy Section in Infection, Immunity, Inflammation and Physiological Medicine, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
| | - Janet Stocks
- Respiratory, Critical Care and Anaesthesia Section in Infection, Immunity, Inflammation and Physiological Medicine, University College London Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom
| | - Rachael K Gregson
- Respiratory, Critical Care and Anaesthesia Section in Infection, Immunity, Inflammation and Physiological Medicine, University College London Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom; Physiotherapy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom
| | - Sarah Hines
- Physiotherapy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom
| | - Mark J Peters
- Respiratory, Critical Care and Anaesthesia Section in Infection, Immunity, Inflammation and Physiological Medicine, University College London Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom; Intensive Care Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom
| | - Eleanor Main
- Physiotherapy Section in Infection, Immunity, Inflammation and Physiological Medicine, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Lum S, Bountziouka V, Harding S, Wade A, Lee S, Stocks J. Assessing pubertal status in multi-ethnic primary schoolchildren. Acta Paediatr 2015; 104:e45-8. [PMID: 25366342 PMCID: PMC4463762 DOI: 10.1111/apa.12850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/15/2014] [Accepted: 10/30/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Sooky Lum
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit) UCL Institute of Child Health London UK
| | - Vassiliki Bountziouka
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit) UCL Institute of Child Health London UK
| | - Seeromanie Harding
- Medical Research Council/Chief Scientist Office, Social and Public Health Sciences Unit University of Glasgow Glasgow UK
| | - Angie Wade
- Clinical Epidemiology, Nutrition and Biostatistics Section UCL Institute of Child Health London UK
| | - Simon Lee
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit) UCL Institute of Child Health London UK
| | - Janet Stocks
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit) UCL Institute of Child Health London UK
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Lum S, Stocks J, Kozlowska W, Aurora P. P101 Effects Of Using A Mask Vs. Mouthpiece On The Multiple Breath Inert Gas Washout Technique. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.242] [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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Davies G, Aurora P, McDonald A, Prasad A, Bilton D, Stocks J, Stanojevic S. S66 The Gli Spirometry Reference Equations Influence The Apparent Rate Of Decline In Fev1 Among Children And Adolescents With Cystic Fibrosis. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.72] [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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Raywood E, Duncan J, Legg S, Aurora P, Stocks J. P100 The Feasibility Of Using Commercial Multiple Breath Nitrogen Washout Devices In School-aged Children. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.241] [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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Stanojevic S, Stocks J. Markers of early lung disease: the search continues…. Pediatr Pulmonol 2014; 49:1253-4. [PMID: 24500969 DOI: 10.1002/ppul.22998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 01/06/2014] [Accepted: 01/08/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Sanja Stanojevic
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
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DeBaun MR, Rodeghier M, Cohen R, Kirkham FJ, Rosen CL, Roberts I, Cooper B, Stocks J, Wilkey O, Inusa B, Warner JO, Strunk RC. Factors predicting future ACS episodes in children with sickle cell anemia. Am J Hematol 2014; 89:E212-7. [PMID: 25088663 DOI: 10.1002/ajh.23819] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 07/31/2014] [Indexed: 01/07/2023]
Abstract
While a doctor-diagnosis of asthma is associated with an increased risk of pain and acute chest syndrome (ACS) in children with sickle cell anemia (SCA), little is known about the relationship between specific asthma characteristics and clinical factors and future morbidity in children with SCA. We evaluated the relationship between (i) asthma risk factors at the time of a clinical visit (respiratory symptoms, maternal history of asthma, allergy skin tests, spirometry results) and (ii) the known risk factor of ACS early in life, on prospective pain and ACS episodes in a cohort of 159 children with SCA followed from birth to a median of 14.7 years. An ACS episode prior to 4 years of age, (incidence rate ratio [IRR] = 2.84; P < 0.001], female gender (IRR = 1.80; P = 0.009), and wheezing causing shortness of breath (IRR = 1.68; P = 0.042) were associated with future ACS rates. We subsequently added spirometry results (obstruction defined as FEV1 /FVC less than the lower limits of normal; and bronchodilator response, FEV1 ≥ 12%) and prick skin test responses to the model. Only ≥ 2 positive skin tests had a significant effect (IRR 1.87; P = 0.01). Thus, early in life ACS events, wheezing causing shortness of breath, and ≥ 2 positive skin tests predict future ACS events.
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Affiliation(s)
- Michael R. DeBaun
- Department of Pediatrics; Vanderbilt University School of Medicine; Nashville Tennessee
| | | | - Robyn Cohen
- Department of Pediatrics; Boston Medical Center/Boston University School of Medicine; Boston Massachusetts
| | - Fenella J. Kirkham
- Department of Paediatrics; Imperial College and the Biomedical Centre of Imperial College Healthcare NHS Trust; London United Kingdom
| | - Carol L. Rosen
- Department of Pediatrics; Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospitals, University Hospitals Case Medical Center; Cleveland Ohio
| | - Irene Roberts
- Department of Paediatrics; Imperial College and the Biomedical Centre of Imperial College Healthcare NHS Trust; London United Kingdom
| | - Ben Cooper
- Brown School of Social Work, Washington University; St. Louis Missouri
| | - Janet Stocks
- University College London Institute of Child Health; London United Kingdom
| | - Olu Wilkey
- Department of Paediatrics; North Middlesex Hospital NHS Trust; London United Kingdom
| | - Baba Inusa
- Department of Paediatrics; Evelina Children's Hospital, Guy's and St. Thomas' National Health Service Foundation Trust; London United Kingdom
| | - John O. Warner
- Department of Paediatrics; Imperial College and the Biomedical Centre of Imperial College Healthcare NHS Trust; London United Kingdom
| | - Robert C. Strunk
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics; Washington University School of Medicine; St. Louis Missouri
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Bensefa-Colas L, Stocks J, Namee RM, Faye S, Agius R, Momas I, Telle-Lamberton M. Impact de la diminution de l’exposition professionnelle sur les dermatites allergiques de contact : comparaison de l’effet des mesures de prévention en Grande Bretagne et en France. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2014.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Hoo AF, Gupta A, Lum S, Costeloe KL, Huertas-Ceballos A, Marlow N, Stocks J. Impact of ethnicity and extreme prematurity on infant pulmonary function. Pediatr Pulmonol 2014; 49:679-87. [PMID: 24123888 PMCID: PMC4285893 DOI: 10.1002/ppul.22882] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 02/22/2013] [Accepted: 07/06/2013] [Indexed: 11/11/2022]
Abstract
The impact of birth before 27 completed weeks of gestation on infant pulmonary function (PF) was explored in a multi-ethnic population in comparison to more mature preterm controls (PTC) and healthy fullterm infants. Plethysmographic lung volume (FRCpleth ) and forced expired volume (FEV0.5 ) were obtained at ∼12 months post-term age in 52 extremely preterm (EP) infants (median [range] gestational age [GA]: 26 [23-27] weeks; 40% White mothers; 79% with BPD), 41 PTC (GA:35 [30-36] weeks; 37% White mothers) and 95 fullterm infants (GA:40 [37-42] weeks; 86% White mothers). Using reference equations based on identical equipment and techniques, results were expressed as z-scores to adjust for age, sex and body size. FEV0.5 was significantly lower in EP infants when compared with PTC (mean difference [95% CI]: -1.02[-1.60; -0.44] z-scores, P < 0.001), as was forced vital capacity (FVC) but there were no significant differences in FRCpleth or FEV0.5 /FVC ratio. FEV0.5 , FVC, and FEV0.5 /FVC were significantly lower in both preterm groups when compared with fullterm controls. On multivariable analyses of the combined preterm dataset: FEV0.5 at ∼1 year was 0.11 [0.05; 0.17] z-scores higher/week GA, and 1.28 (0.49; 2.08) z-scores lower in EP infants with prior BPD. Among non-white preterm infants, FEV0.5 was 0.70 (0.17; 1.24) z-scores lower, with similar reductions in FVC, such that there were no ethnic differences in FEV0.5 /FVC. Similar ethnic differences were observed among fullterm infants. These results confirm the negative impact of preterm birth on subsequent lung development, especially following a diagnosis of BPD, and emphasize the importance of taking ethnic background into account when interpreting results during infancy as in older subjects.
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Affiliation(s)
- Ah-Fong Hoo
- Portex Respiratory Unit, UCL Institute of Child Health, London, WC1N 1EH, UK; Paediatric Respiratory Medicine Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
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Abstract
Marked differences in lung function occur between children of different racial and ethnic backgrounds even when all known confounders including socioeconomic circumstances have been taken into account. Use of ethnic-specific equations, such as those recently published by the Global Lung Function Initiative, help to minimize such differences, thereby improving the accuracy with which lung disease can be identified and treated during childhood, as well as enabling the true impact of adverse environmental or socioeconomic exposures to be assessed, irrespective of ethnic background. In future, incorporation of ancestry and, within emerging nations undergoing secular changes in anthropometry, sitting height, into normative equations may further improve the accuracy of predicting lung function and hence assessment of disease severity within any given individual.
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Affiliation(s)
- Janet Stocks
- Respiratory, Critical Care and Anaesthesia Section (Portex Unit), UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Affiliation(s)
- Sanja Stanojevic
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tim J Cole
- Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, London, UK
| | - Janet Stocks
- Portex Respiratory Unit, UCL Institute of Child Health, London, UK
| | - Philip H Quanjer
- Department of Pulmonary Diseases and Department of Paediatrics-Pulmonary Diseases, Erasmus Medical Centre, Erasmus University, Rotterdam, The Netherlands
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Bonner R, Lum S, Stocks J, Kirkby J, Wade A, Sonnappa S. Applicability of the global lung function spirometry equations in contemporary multiethnic children. Am J Respir Crit Care Med 2014; 188:515-6. [PMID: 23947526 DOI: 10.1164/rccm.201212-2208le] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Cohen RT, Strunk RC, Field JJ, Rosen CL, Kirkham FJ, Redline S, Stocks J, Rodeghier MJ, DeBaun MR. Environmental tobacco smoke and airway obstruction in children with sickle cell anemia. Chest 2014; 144:1323-1329. [PMID: 23681054 DOI: 10.1378/chest.12-1569] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The contribution of environmental tobacco smoke (ETS) exposure to pulmonary morbidity in children with sickle cell anemia (SCA) is poorly understood. We tested the hypothesis that children with SCA and ETS exposure would have an increased prevalence of obstructive lung disease and respiratory symptoms compared with children with SCA and no ETS exposure. METHODS Parent reports of ETS and respiratory symptom frequency were obtained for 245 children with SCA as part of a multicenter prospective cohort study. One hundred ninety-six children completed pulmonary function testing. Multivariable regression models were used to evaluate the associations between ETS exposure at different time points (prenatal, infant [birth to 2 years], preschool [2 years to first grade], and current) and lung function and respiratory symptoms. RESULTS Among the 245 participants, a high prevalence of prior (44%) and current (29%) ETS exposure was reported. Of the 196 children who completed pulmonary function testing, those with parent-reported infant and current ETS exposure were more likely to have airway obstruction (defined as an FEV1/FVC ratio below the lower limit normal) compared with unexposed children (22.0% vs 3.1%, P < .001). Those with ETS exposure also had a lower forced expiratory flow, midexpiratory phase/FVC ratio (0.82 vs 0.97, P = .001) and were more likely to have evidence of bronchodilator responsiveness (23% vs 11%, P = .03). Current and prior ETS exposure and in utero smoke exposure were associated with increased frequency of respiratory symptoms. CONCLUSIONS ETS exposure is associated with evidence of lower airway obstruction and increased respiratory symptoms in SCA.
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Affiliation(s)
- Robyn T Cohen
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | - Robert C Strunk
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Joshua J Field
- Blood Research Institute, Blood Center of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Carol L Rosen
- Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH
| | | | - Susan Redline
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Janet Stocks
- Portex Respiratory Unit, UCL Institute of Child Health, London, England
| | | | - Michael R DeBaun
- Department of Pediatrics, Vanderbilt School of Medicine, Nashville, TN.
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Hopkinson N, Wallis C, Higgins B, Gaduzo S, Sherrington R, Keilty S, Stern M, Britton J, Bush A, Moxham J, Sylvester K, Griffiths V, Sutherland T, Crossingham I, Raju R, Spencer C, Safavi S, Deegan P, Seymour J, Hickman K, Hughes J, Wieboldt J, Shaheen F, Peedell C, Mackenzie N, Nicholl D, Jolley C, Crooks G, Crooks G, Dow C, Deveson P, Bintcliffe O, Gray B, Kumar S, Haney S, Docherty M, Thomas A, Chua F, Dwarakanath A, Summers G, Prowse K, Lytton S, Ong YE, Graves J, Banerjee T, English P, Leonard A, Brunet M, Chaudhry N, Ketchell RI, Cummings N, Lebus J, Sharp C, Meadows C, Harle A, Stewart T, Parry D, Templeton-Wright S, Moore-Gillon J, Stratford- Martin J, Saini S, Matusiewicz S, Merritt S, Dowson L, Satkunam K, Hodgson L, Suh ES, Durrington H, Browne E, Walters N, Steier J, Barry S, Griffiths M, Hart N, Nikolic M, Berry M, Thomas A, Miller J, McNicholl D, Marsden P, Warwick G, Barr L, Adeboyeku D, Mohd Noh MS, Griffiths P, Davies L, Quint J, Lyall R, Shribman J, Collins A, Goldman J, Bloch S, Gill A, Man W, Christopher A, Yasso R, Rajhan A, Shrikrishna D, Moore C, Absalom G, Booton R, Fowler RW, Mackinlay C, Sapey E, Lock S, Walker P, Jha A, Satia I, Bradley B, Mustfa N, Haqqee R, Thomas M, Patel A, Redington A, Pillai A, Keaney N, Fowler S, Lowe L, Brennan A, Morrison D, Murray C, Hankinson J, Dutta P, Maddocks M, Pengo M, Curtis K, Rafferty G, Hutchinson J, Whitfield R, Turner S, Breen R, Naveed SUN, Goode C, Esterbrook G, Ahmed L, Walker W, Ford D, Connett G, Davidson P, Elston W, Stanton A, Morgan D, Myerson J, Maxwell D, Harrris A, Parmar S, Houghton C, Winter R, Puthucheary Z, Thomson F, Sturney S, Harvey J, Haslam PL, Patel I, Jennings D, Range S, Mallia-Milanes B, Collett A, Tate P, Russell R, Feary J, O'Driscoll R, Eaden J, Round J, Sharkey E, Montgomery M, Vaughan S, Scheele K, Lithgow A, Partridge S, Chavasse R, Restrick L, Agrawal S, Abdallah S, Lacy-Colson A, Adams N, Mitchell S, Haja Mydin H, Ward A, Denniston S, Steel M, Ghosh D, Connellan S, Rigge L, Williams R, Grove A, Anwar S, Dobson L, Hosker H, Stableforth D, Greening N, Howell T, Casswell G, Davies S, Tunnicliffe G, Mitchelmore P, Phitidis E, Robinson L, Prowse K, Bafadhel M, Robinson G, Boland A, Lipman M, Bourke S, Kaul S, Cowie C, Forrest I, Starren E, Burke H, Furness J, Bhowmik A, Everett C, Seaton D, Holmes S, Doe S, Parker S, Graham A, Paterson I, Maqsood U, Ohri C, Iles P, Kemp S, Iftikhar A, Carlin C, Fletcher T, Emerson P, Beasley V, Ramsay M, Buttery R, Mungall S, Crooks S, Ridyard J, Ross D, Guadagno A, Holden E, Coutts I, Cullen K, O'Connor S, Barker J, Sloper K, Watson J, Smith P, Anderson P, Brown L, Nyman C, Milburn H, Clive A, Serlin M, Bolton C, Fuld J, Powell H, Dayer M, Woolhouse I, Georgiadi A, Leonard H, Dodd J, Campbell I, Ruiz G, Zurek A, Paton JY, Malin A, Wood F, Hynes G, Connell D, Spencer D, Brown S, Smith D, Cooper D, O'Kane C, Hicks A, Creagh-Brown B, Lordan J, Nickol A, Primhak R, Fleming L, Powrie D, Brown J, Zoumot Z, Elkin S, Szram J, Scaffardi A, Marshall R, Macdonald I, Lightbody D, Farmer R, Wheatley I, Radnan P, Lane I, Booth A, Tilbrook S, Capstick T, Hewitt L, McHugh M, Nelson C, Wilson P, Padmanaban V, White J, Davison J, O'Callaghan U, Hodson M, Edwards J, Campbell C, Ward S, Wooler E, Ringrose E, Bridges D, Long A, Parkes M, Clarke S, Allen B, Connelly C, Forster G, Hoadley J, Martin K, Barnham K, Khan K, Munday M, Edwards C, O'Hara D, Turner S, Pieri-Davies S, Ford K, Daniels T, Wright J, Towns R, Fern K, Butcher J, Burgin K, Winter B, Freeman D, Olive S, Gray L, Pye K, Roots D, Cox N, Davies CA, Wicker J, Hilton K, Lloyd J, MacBean V, Wood M, Kowal J, Downs J, Ryan H, Guyatt F, Nicoll D, Lyons E, Narasimhan D, Rodman A, Walmsley S, Newey A, Buxton M, Dewar M, Cooper A, Reilly J, Lloyd J, Macmillan AB, Roots D, Olley A, Voase N, Martin S, McCarvill I, Christensen A, Agate R, Heslop K, Timlett A, Hailes K, Davey C, Pawulska B, Lane A, Ioakim S, Hough A, Treharne J, Jones H, Winter-Burke A, Miller L, Connolly B, Bingham L, Fraser U, Bott J, Johnston C, Graham A, Curry D, Sumner H, Costello CA, Bartoszewicz C, Badman R, Williamson K, Taylor A, Purcell H, Barnett E, Molloy A, Crawfurd L, Collins N, Monaghan V, Mir M, Lord V, Stocks J, Edwards A, Greenhalgh T, Lenney W, McKee M, McAuley D, Majeed A, Cookson J, Baker E, Janes S, Wedzicha W, Lomas Dean D, Harrison B, Davison T, Calverley P, Wilson R, Stockley R, Ayres J, Gibson J, Simpson J, Burge S, Warner J, Lenney W, Thomson N, Davies P, Woodcock A, Woodhead M, Spiro S, Ormerod L, Bothamley G, Partridge M, Shields M, Montgomery H, Simonds A, Barnes P, Durham S, Malone S, Arabnia G, Olivier S, Gardiner K, Edwards S. Children must be protected from the tobacco industry's marketing tactics. BMJ 2013; 347:f7358. [PMID: 24324220 DOI: 10.1136/bmj.f7358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nicholas Hopkinson
- British Thoracic Society Chronic Obstructive Pulmonary Disease Specialist Advisory Group, National Heart and Lung Institute, Imperial College, London SW3 6NP, UK
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Stanojevic S, Quanjer P, Miller MR, Stocks J. The Global Lung Function Initiative: dispelling some myths of lung function test interpretation. Breathe (Sheff) 2013. [DOI: 10.1183/20734735.012113] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Brennan LC, Thia LP, Hoo A, Nguyen T, Chudleigh J, Lum S, Wade A, Wallis C, Bush A, Balfour-Lynn I, Wyatt H, Carr S, Stocks J. S7 Evolution of lung function during the first two years of life in infants with cystic fibrosis diagnosed by newborn screening. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.13] [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: 11/04/2022]
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Lum S, Sonnappa S, Wade A, Kirkby J, Bonner R, Lee S, Bountziouka V, Legg S, Raywood E, Sears D, Cottam P, Stocks J. S11 Feasibility of conducting complex physiological measurements in london primary schools: the Size & Lung function in children (SLIC) Study: Abstract S11 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.17] [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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Thia LP, Calder A, Stocks J, Bush A, Owens CM, Wallis C, Young C, Sullivan Y, Wade A, McEwan A, Brody AS. Is chest CT useful in newborn screened infants with cystic fibrosis at 1 year of age? Thorax 2013; 69:320-7. [PMID: 24132911 PMCID: PMC3963531 DOI: 10.1136/thoraxjnl-2013-204176] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Rationale Sensitive outcome measures applicable in different centres to quantify and track early pulmonary abnormalities in infants with cystic fibrosis (CF) are needed both for clinical care and interventional trials. Chest CT has been advocated as such a measure yet there is no validated scoring system in infants. Objectives The objectives of this study were to standardise CT data collection across multiple sites; ascertain the incidence of bronchial dilatation and air trapping in newborn screened (NBS) infants with CF at 1 year; and assess the reproducibility of Brody-II, the most widely used scoring system in children with CF, during infancy. Methods A multicentre observational study of early pulmonary lung disease in NBS infants with CF at age 1 year using volume-controlled chest CT performed under general anaesthetic. Main results 65 infants with NBS-diagnosed CF had chest CT in three centres. Small insignificant variations in lung recruitment manoeuvres but significant centre differences in radiation exposures were found. Despite experienced scorers and prior training, with the exception of air trapping, inter- and intraobserver agreement on Brody-II score was poor to fair (eg, interobserver total score mean (95% CI) κ coefficient: 0.34 (0.20 to 0.49)). Only 7 (11%) infants had a total CT score ≥12 (ie, ≥5% maximum possible) by either scorer. Conclusions In NBS infants with CF, CT changes were very mild at 1 year, and assessment of air trapping was the only reproducible outcome. CT is thus of questionable value in infants of this age, unless an improved scoring system for use in mild CF disease can be developed.
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Affiliation(s)
- Lena P Thia
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, , London, UK
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Nguyen TTD, Thia LP, Hoo AF, Bush A, Aurora P, Wade A, Chudleigh J, Lum S, Stocks J. Evolution of lung function during the first year of life in newborn screened cystic fibrosis infants. Thorax 2013; 69:910-7. [PMID: 24072358 PMCID: PMC4174068 DOI: 10.1136/thoraxjnl-2013-204023] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [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] [Indexed: 11/18/2022]
Abstract
Rationale Newborn screening (NBS) for cystic fibrosis (CF) allows early intervention. Design of randomised controlled trials (RCT) is currently impeded by uncertainty regarding evolution of lung function, an important trial end point in such infants. Objective To assess changes in pulmonary function during the first year of life in CF NBS infants. Methods Observational longitudinal study. CF NBS infants and healthy controls were recruited between 2009 and 2011. Lung Clearance Index (LCI), plethysmographic lung volume (plethysmographic functional residual capacity (FRCpleth)) and forced expired volume (FEV0.5) were measured at 3 months and 1 year of age. Main results Paired measurements were obtained from 72 CF infants and 44 controls. At 3 months, CF infants had significantly worse lung function for all tests. FEV0.5 improved significantly (0.59 (95% CI 0.18 to 0.99) z-scores; p<0.01) in CF infants between 3 months and 1 year, and by 1 year, FEV0.5 was only 0.52 (0.89 to 0.15) z-scores less than in controls. LCI and FRCpleth remained stable throughout the first year of life, being on average 0.8 z-scores higher in infants with CF. Pulmonary function at 1 year was predicted by that at 3 months. Among the 45 CF infants with entirely normal LCI and FEV0.5 at 3 months, 80% remained so at 1 year, while 74% of those with early abnormalities remained abnormal at 1 year. Conclusions This is the first study reporting improvements in FEV0.5 over time in stable NBS CF infants treated with standard therapy. Milder changes in lung function occurred by 1 year than previously reported. Lung function at 3 months predicts a high-risk group, who should be considered for intensification of treatment and enrolment into RCTs.
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Affiliation(s)
- The Thanh-Diem Nguyen
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK Department of Respiratory Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Lena P Thia
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK
| | - Ah-Fong Hoo
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK Respiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Imperial College & Royal Brompton & Harefield Hospital NHS Foundation Trust, London, UK
| | - Paul Aurora
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK Respiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Angie Wade
- Centre for Paediatric Epidemiology and Biostatistics, UCL Institute of Child Health, MRC Centre for Epidemiology of Child Health, London, UK
| | - Jane Chudleigh
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK Respiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sooky Lum
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK
| | - Janet Stocks
- Portex Unit: Respiratory Physiology and Medicine, UCL Institute of Child Health, London, UK
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Abstract
Interest in the contribution of changes in lung development during early life to subsequent respiratory morbidity is increasing. Most evidence of an association between adverse intrauterine factors and structural effects on the developing lung is from animal studies. Such evidence has been augmented by epidemiological studies showing associations between insults to the developing lung during prenatal and early postnatal life and adult respiratory morbidity or reduced lung function, and by physiological studies that have elucidated mechanisms underlying these associations. The true effect of early insults on subsequent respiratory morbidity can be understood only if the many prenatal and postnatal factors that can affect lung development are taken into account. Adverse factors affecting lung development during fetal life and early childhood reduce the attainment of maximum lung function and accelerate lung function decline in adulthood, initiating or worsening morbidity in susceptible individuals. In this Review, we focus on factors that adversely affect lung development in utero and during the first 5 years after birth, thereby predisposing individuals to reduced lung function and increased respiratory morbidity throughout life. We focus particularly on asthma and COPD.
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Affiliation(s)
- Janet Stocks
- University College London, Institute of Child Health, London, UK.
| | - Alison Hislop
- University College London, Institute of Child Health, London, UK
| | - Samatha Sonnappa
- University College London, Institute of Child Health, London, UK
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50
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Goldring ST, Griffiths CJ, Martineau AR, Robinson S, Yu C, Poulton S, Kirkby JC, Stocks J, Hooper R, Shaheen SO, Warner JO, Boyle RJ. Prenatal vitamin d supplementation and child respiratory health: a randomised controlled trial. PLoS One 2013; 8:e66627. [PMID: 23826104 PMCID: PMC3691177 DOI: 10.1371/journal.pone.0066627] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 05/07/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Observational studies suggest high prenatal vitamin D intake may be associated with reduced childhood wheezing. We examined the effect of prenatal vitamin D on childhood wheezing in an interventional study. METHODS We randomised 180 pregnant women at 27 weeks gestation to either no vitamin D, 800 IU ergocalciferol daily until delivery or single oral bolus of 200,000 IU cholecalciferol, in an ethnically stratified, randomised controlled trial. Supplementation improved but did not optimise vitamin D status. Researchers blind to allocation assessed offspring at 3 years. Primary outcome was any history of wheeze assessed by validated questionnaire. Secondary outcomes included atopy, respiratory infection, impulse oscillometry and exhaled nitric oxide. Primary analyses used logistic and linear regression. RESULTS We evaluated 158 of 180 (88%) offspring at age 3 years for the primary outcome. Atopy was assessed by skin test for 95 children (53%), serum IgE for 86 (48%), exhaled nitric oxide for 62 (34%) and impulse oscillometry of acceptable quality for 51 (28%). We found no difference between supplemented and control groups in risk of wheeze [no vitamin D: 14/50 (28%); any vitamin D: 26/108 (24%) (risk ratio 0.86; 95% confidence interval 0.49, 1.50; P = 0.69)]. There was no significant difference in atopy, eczema risk, lung function or exhaled nitric oxide between supplemented groups and controls. CONCLUSION Prenatal vitamin D supplementation in late pregnancy that had a modest effect on cord blood vitamin D level, was not associated with decreased wheezing in offspring at age three years. TRIAL REGISTRATION Controlled-Trials.com ISRCTN68645785.
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Affiliation(s)
| | - Chris J. Griffiths
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Adrian R. Martineau
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Stephen Robinson
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Christina Yu
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Sheree Poulton
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Jane C. Kirkby
- Portex Respiratory Unit, University College London, Institute of Child Health, London, United Kingdom
| | - Janet Stocks
- Portex Respiratory Unit, University College London, Institute of Child Health, London, United Kingdom
| | - Richard Hooper
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Seif O. Shaheen
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - John O. Warner
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Robert J. Boyle
- Department of Paediatrics, Imperial College London, London, United Kingdom
- * E-mail:
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