David M G Halpin

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• MA DPhil MBBS FRCP FERS
• Professor at University of Exeter

Smoking cessation is more effective when supported by medicines. Data on the availability, cost and affordability of these treatments in low-income and middle-income countries (LMIC) are limited. Cross-sectional data for smoking cessation medications were collected from pharmacies, healthcare facilities and central medicine stores in 60 LMIC (2022–...

To optimize patient outcomes, healthcare decisions should be based on the most up-to-date high-quality evidence. Randomized controlled trials (RCTs) are vital for demonstrating the efficacy of interventions; however, information on how an intervention compares to already available treatments and/or fits into treatment algorithms is sometimes limite...

Chronic obstructive pulmonary disease (COPD) is a heterogenous lung condition characterized by progressive airflow obstruction. Despite advancements in diagnosis and treatment, the disease burden remains high; although clinical trials have shown improvements in outcomes such as exacerbations, quality of life, and lung function, improvement may not...

The Global initiative for chronic Obstructive Lung Disease (GOLD) report states that the diagnosis of chronic obstructive pulmonary disease (COPD) should be considered in individuals with chronic respiratory symptoms and / or exposure to risk factors. Forced spirometry demonstrating airflow obstruction after bronchodilation is required to confirm t...

Background Allergic rhinitis (AR) is a highly prevalent disease. We aimed to assess the symptoms that physicians who see patients with AR perceive as the most bothersome in their patients. Methods We performed a cross-sectional study based on an online questionnaire sent to all members of the Allergic Rhinitis and its Impact on Asthma (ARIA) initi...

Introduction Low- and middle-income countries (LMICs) carry the highest burden of tobacco-related diseases. Smoking cessation is more successful when supported by pharmacotherapy, which should be accessible globally. This study provided data on the availability, cost and affordability of smoking cessation medications in LMICs. Methods This was a c...

Background COPD has high mortality, compounded by comorbid cardiovascular disease. We investigated two electrocardiogram (ECG) markers, Cardiac Infarction Injury Score (CIIS) and P pulmonale, as prognostic tools for adverse cardiopulmonary events in COPD. Methods Post hoc analysis of the IMPACT trial. Outcomes included odds (odds ratio [95% confid...

The WHO recently published a Tobacco Knowledge Summary (TKS) synthesizing current evidence on tobacco and COPD, aiming to raise awareness among a broad audience of health care professionals. Furthermore, it can be used as an advocacy tool in the fight for tobacco control and prevention of tobacco-related disease. This article builds on the evidence...

Objective People with advanced chronic obstructive pulmonary disease (COPD) have substantial palliative care needs, but uncertainty exists around appropriate identification of patients for palliative care referral. We conducted a Delphi study of international experts to identify consensus referral criteria for specialist outpatient palliative care...

Background Prior exacerbation history is used to guide initial maintenance therapy in chronic obstructive pulmonary disease (COPD); however, the recommendations were derived from patients already diagnosed and treated. Method We assessed the rates of moderate ( i.e. treated with antibiotics and/or systemic corticosteroids) and severe ( i.e. hospit...

Introduction: Chronic obstructive pulmonary disease (COPD) is the third most common cause of death worldwide and 24% of the patients die within 5 years of diagnosis. Areas covered: The epidemiology of mortality and the interventions that reduce it are reviewed. The increasing global deaths reflect increases in population sizes, increasing life e...

Contemporary data on the availability, cost and affordability of essential medicines for chronic respiratory diseases (CRDs) across low-income and middle-income countries (LMICs) are missing, despite most people with CRDs living in LMICs. Cross-sectional data for seven CRD medicines in pharmacies, healthcare facilities and central medicine stores w...

Contemporary data on the availability, cost and affordability of essential medicines for chronic respiratory diseases (CRDs) across low-income and middle-income countries (LMICs) are missing, despite most people with CRDs living in LMICs. Cross-sectional data for seven CRD medicines in pharmacies, healthcare facilities and central medicine stores w...

Contemporary data on the availability, cost and affordability of essential medicines for chronic respiratory diseases (CRDs) across low-income and middle-income countries (LMICs) are missing, despite most people with CRDs living in LMICs. Cross-sectional data for seven CRD medicines in pharmacies, healthcare facilities and central medicine stores w...

Background Compared with multiple-inhaler triple therapy (MITT), single-inhaler triple therapy (SITT) with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) demonstrated improved lung function and meaningful improvements in chronic obstructive pulmonary disease (COPD) Assessment Test score. This real-world study compared the effectiveness of...

Background Errors using inhaled delivery systems for COPD are common and it is assumed that these lead to worse clinical outcomes. Previous systematic reviews have included patients with both asthma and COPD and much of the evidence related to asthma. More studies in COPD have now been published. Through systematic review, the relationship between...

This document is the eighth in a series of Tobacco Knowledge Summaries. This document is prepared with the objective to summarize the association between tobacco use and COPD, as well as describe the effectiveness of interventions to reduce tobacco use and tobacco-related complications. This is also intended as an advocacy tool to widely include he...

Introduction COPD exacerbations lead to increased mortality and disease progression. Maintenance inhaled therapies can reduce exacerbation risk amongst COPD patients, but non-adherence reportedly ranges from 20–60% in this population. The ongoing cluster randomised trial (MAGNIFY) is investigating the use of digital adherence support as a solution...

Background Triple therapy is recommended for patients with chronic obstructive pulmonary disease (COPD) who remain symptomatic despite dual therapy. The optimal timing of triple therapy following an exacerbation of COPD is unknown. The outcomes of prompt (≤ 30 days) vs. delayed (31–180 days) initiation of single-inhaler triple therapy with fluticas...

Background The phase 3 QUEST ( NCT02414854 ) and TRAVERSE ( NCT02134028 ) studies demonstrated the efficacy of dupilumab 200/300 mg versus placebo every 2 weeks for 52 weeks (QUEST) and dupilumab 300 mg up to an additional 96 weeks (TRAVERSE) in patients ≥12 years with uncontrolled, moderate-to-severe asthma. Overall, safety was consistent with the...

Real world data comprise information on health care that is derived from multiple sources outside typical clinical research settings. This review focuses on what real world evidence tells us about problems with the diagnosis of chronic obstructive pulmonary disease (COPD), problems with the initial and follow-up pharmacological and non-pharmacologi...

It can be challenging for health care professionals (HCPs) to prescribe inhaled therapy for patients with chronic obstructive pulmonary disease (COPD) due to the multiple individual and combinations of inhaled medications available in numerous delivery systems. Guidance on selection of an inhaled delivery system has received limited attention compa...

Background: This study compared management of high-risk COPD patients in the UK to national and international management recommendations and quality standards, including the COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST). The primary comparison was in 2019, but trends from 2000 to 2019...

Asthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of “one‐airway‐one‐disease,” coined over 20 years ago, is a simplistic approach of the links between upper‐ and lower‐airway allergic diseases. With new data, it is time to reassess the concept. This article re...

Exposure to air pollution is a major contributor to the pathogenesis of chronic obstructive pulmonary disease (COPD) worldwide. Indeed, most recent estimates suggest that 50% of the total attributable risk of COPD may be related to air pollution. In response, the GOLD Scientific Committee performed a comprehensive review on this topic, qualitativel...

Executive summary of the Global Strategy for Prevention, Diagnosis and Management of COPD 2023: the latest evidence-based strategy document from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) https://bit.ly/3KCaTGe

Background: In IMPACT, single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) significantly reduced severe exacerbation rates and all-cause mortality (ACM) risk versus UMEC/VI among patients with chronic obstructive pulmonary disease (COPD). This post hoc analysis aimed to define the risk of ACM during and following a moderate/sev...

Introduction and Objectives Recruitment rates to clinical trials in primary care are often lower than anticipated, even in successful trials. Researchers can be too optimistic about the number of eligible patients, and the GPs’ time and ability to recruit patients. The MAGNIFY cluster randomised trial is investigating the effect of a technologicall...

Introduction and Objectives Maintenance inhaled therapies can stabilise COPD symptoms and reduce the risk of exacerbations, but inhaler adherence is often poor. Patients experiencing frequent exacerbations represent a specific high-risk population in need of further intervention. Little data exist regarding inhaled medication adherence amongst exac...

BACKGROUND Access to affordable inhaled medicines for chronic respiratory diseases (CRDs) is severely limited in low- and middle-income countries (LMICs), causing avoidable morbidity and mortality. The International Union Against Tuberculosis and Lung Disease convened a stakeholder meeting on this topic in February 2022. METHODS Focused group disc...

Background Smoking is the major risk factor for chronic obstructive pulmonary disease (COPD). In IMPACT, single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) triple therapy significantly reduced moderate/severe exacerbation rates and improved lung function and health status versus FF/VI or UMEC/VI in COPD patients. This post hoc...

Background Asthma and chronic obstructive pulmonary disease (COPD) cause a considerable burden of morbidity and mortality in low-income and middle-income countries (LMICs). Access to safe, effective, quality-assured, and affordable essential medicines is variable. We aimed to review the existing literature relating to the availability, cost, and af...

Purpose: The 24-week INTREPID trial demonstrated the clinical benefits of once-daily single-inhaler triple therapy (SITT) with fluticasone furoate, umeclidinium, and vilanterol (FF/UMEC/VI) versus non-ELLIPTA multiple-inhaler triple therapy (MITT) in patients with symptomatic chronic obstructive pulmonary disease (COPD). This analysis assessed the...

Background The association between chronic obstructive pulmonary disease exacerbations and increased cardiovascular event risk has not been adequately studied in a heterogenous population with both low and high cardiovascular risk. Methods and Results This post hoc analysis of the IMPACT (Informing the Pathway of COPD Treatment) trial (N=10 355 sy...

Purpose: Triple therapy comprising a long-acting muscarinic antagonist, long-acting β2-agonist and inhaled corticosteroid is recommended for patients with chronic obstructive pulmonary disease (COPD) who continue to experience frequent exacerbations or symptoms whilst receiving dual therapy. Adherence and persistence to multiple-inhaler triple the...

Background and objective Dupilumab blocks the shared receptor component for interleukin (IL)-4/IL-13, key and central drivers of type 2 inflammation in multiple diseases. In phase 3 QUEST (NCT02414854), add-on dupilumab 200 and 300 mg every 2 weeks reduced severe exacerbations, improved pre-bronchodilator forced expiratory volume in 1 s (FEV1), and...

Background and objective: Chronic mucus hypersecretion (CMH) is a clinical phenotype of COPD. This exploratory post hoc analysis assessed relationship between CMH status and treatment response in IMPACT. Methods: Patients were randomized to once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) 100/62.5/25 μg, FF/VI 100/25 μg or UME...

Introduction: Few randomised controlled trials (RCTs) have directly compared long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) dual maintenance therapies for patients with chronic obstructive pulmonary disease (COPD). This systematic literature review and network meta-analysis (NMA) compared the efficacy of umeclidinium/vilanter...

Introduction: Randomized controlled trials (RCTs) comparing triple therapies (inhaled corticosteroid [ICS], long-acting β2-agonist [LABA], and long-acting muscarinic antagonist [LAMA]) for the treatment of chronic obstructive pulmonary disease (COPD) are limited. This network meta-analysis (NMA) investigated the comparative efficacy of single-inha...

Over the last 20 years, it has become possible to use a precision medicine approach to the management of chronic obstructive pulmonary disease (COPD). Clinical and physiological features as well as a blood biomarker can be used to target treatments to patients most likely to benefit and avoid treatment in patients less likely to benefit. Future adv...

Objectives: In the IMPACT trial (NCT02164513), triple therapy with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) showed clinical benefit compared with dual therapy with either FF/VI or UMEC/VI in the treatment of chronic obstructive pulmonary disease (COPD). We used data from IMPACT to determine whether this translated into differences...

Nicola A Hanania,1 Jorge F Maspero,2 David MG Halpin,3 David J Jackson,4,5 Reynold A Panettieri,6 Mario Castro,7 Christian Domingo,8 Nadia Daizadeh,9 Rebecca Gall,10 Juby A Jacob-Nara,11 Benjamin Ortiz,10 Michel Djandji,9 Paul J Rowe,11 Yamo Deniz10 1Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA; 2Fun...

COPD is a heterogeneous condition. Some patients benefit from treatment with inhaled corticosteroids (ICS) but this requires a precision medicine approach, based on clinical characteristics (phenotyping) and biological information (endotyping) in order to select patients most likely to benefit. The GOLD 2019 report recommended using exacerbation hi...

Purpose There has been concern that asthma and chronic obstructive pulmonary disease [COPD] increase the risk of developing and exacerbating COVID-19. The effect of medications such as inhaled corticosteroids (ICS) and biologics on COVID-19 is unclear. This systematic literature review analyzed the published evidence on epidemiology and the burden...

Chronic obstructive pulmonary disease (COPD) is associated with a high clinical and economic burden and is the fourth leading cause of death in the United States. The management of patients with COPD aims to minimize and control symptoms, prevent exacerbations, and improve quality of life. We provide an illustrated case study of a female patient wi...

Background Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin-4/-13, key and central drivers of type 2 inflammation in multiple diseases. In phase 3 VENTURE study (NCT02528214), dupilumab vs placebo reduced oral corticosteroid (OCS) dose and improved clinical outcomes in patients with OCS-dependent se...

SETTING Household air pollution (HAP) and chronic obstructive pulmonary disease (COPD) are both major public health problems, reported to cause around 4 million and 3 million deaths every year, respectively. The great majority of these deaths, as well as the burden of disease during life is felt by people in low- and middle-income countries (LMICs)...

Dry powder inhalers (DPIs) are breath actuated, and patients using DPIs need to generate an optimal inspiratory flow during the inhalation maneuver for effective drug delivery to the lungs. However, practical and standardized recommendations for measuring peak inspiratory flow (PIF)-a potential indicator for effective DPI use in chronic obstructive...

Introduction IMPACT a démontré que la triple thérapie furoate de fluticasone/umeclidinium/vilanterol (FF/UMEC/VI) en inhalateur unique réduit significativement les taux d’exacerbation sévères (ExS) et le risque de mortalité toutes causes versus UMEC/VI chez les patients atteints de bronchopneumopathie chronique obstructive (BPCO). Une augmentation...

Patients with COPD present in different ways at different stages of the disease. The commonest symptoms are breathlessness and cough but there are often also systemic symptoms such as leg ache and fatigue. COPD symptoms lead to significant limitations in activities and affect patient’s ability to work. Quantification of the severity and impact of C...

Inhaled corticosteroids (ICS) have a class effect of increasing pneumonia risk in patients with COPD. However, pneumonia incidence varies widely across clinical trials of ICS use in COPD. This review clarifies methodological differences in defining and recording pneumonia events in these trials and discusses factors that could contribute to the var...

Rationale: Medication for treatment of COPD is available in many different delivery systems; however, national and international guidelines do not provide recommendations on how to select the optimal system for an individual patient. Objectives: To perform a systematic review of published algorithms for inhaler selection in out-patients with COP...

Background and Objectives Triple therapy with inhaled corticosteroid, long-acting muscarinic antagonist and long-acting β2-agonist (ICS/LAMA/LABA) is recommended for patients with COPD who continue to experience exacerbations on dual therapy (LAMA/LABA or ICS/LABA). Adherence to multiple-inhaler triple therapy (MITT) has previously been shown to be...

Chronic Obstructive Pulmonary Disease is the end-result of a series of dynamic and cumulative gene-environment interactions over a lifetime. The evolving understanding of COPD biology provides novel opportunities for prevention, early diagnosis, and intervention. To advance these concepts we propose therapeutic trials in two major groups of subject...

Background Data to better understand and manage the COVID-19 pandemic is urgently needed. However, there are gaps in information stored within even the best routinely-collected electronic health records (EHR) including test results, remote consultations for suspected COVID-19, shielding, physical activity, mental health, and undiagnosed or untested...

Early in the COVID pandemic there were concerns about the outcomes for patients with COPD who developed COVID-19. Although the pandemic has made the diagnosis and routine management of COPD more difficult, the risk of patients developing COVID or of having poor outcomes is less than anticipated and there have been some unexpected findings that may...