James Hull

James Hull
Royal Brompton and Harefield NHS Foundation Trust · Heart and lung divisions

PhD FRCP FACSM

About

297
Publications
35,173
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4,478
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Introduction
Pulmonary dysfunction in athletes, cough, laryngeal dysfunction, unexplained dyspnoea, asthma.

Publications

Publications (297)
Article
Exercise-induced laryngeal obstruction (EILO) is a key differential diagnosis for respiratory symptoms in athletes and is particularly prevalent in aquatic athletes. A definitive diagnosis of EILO is dependent on laryngoscopy, performed continuously, while an athlete engages in the sport that precipitates their symptoms. This report provides the fi...
Article
Full-text available
The larynx is one of the most highly innervated organs in humans and serves a number of vitally important, complex and highly-evolved biological functions. On a day-to-day basis, the larynx functions autonomously, addressing several roles including airway protection, swallowing and phonation. In some situations the larynx appears to adopt a functio...
Article
Background: Exercise-induced bronchoconstriction (EIB) describes acute airway narrowing that occurs as a result of exercise. EIB occurs in a substantial proportion of patients with asthma, but may also occur in individuals without known asthma. Methods: To provide clinicians with practical guidance, a multidisciplinary panel of stakeholders was...
Article
Full-text available
Respiratory problems are common in athletes of all abilities and can significantly impact upon their health and performance. In this article, we provide an overview of respiratory physiology in athletes. We also discuss the assessment and management of common clinical respiratory conditions as they pertain to athletes, including airways disease, re...
Article
Acute illnesses affecting the respiratory tract are common and form a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. Acute respiratory illness (ARill) can broadly be classified as non-infective ARill and acute respiratory infections (ARinf). The aim of this consensus is to provide the SEM clinician with an overvi...
Article
Full-text available
Allergy and respiratory disorders are common in young athletic individuals. In the context of elite sport, it is essential to secure an accurate diagnosis in order to optimise health and performance. It is also important, however, to consider the potential impact or consequences of these disorders, in recreationally active individuals engaging in s...
Article
Acute respiratory infections (ARinf) are common in athletes, but their effects on exercise and sports performance remain unclear. This systematic review aimed to determine the acute (short-term) and longer-term effects of ARinf, including SARS-CoV-2 infection, on exercise and sports performance outcomes in athletes. Data sources searched included P...
Article
Acute respiratory illness (ARill) is common and threatens the health of athletes. ARill in athletes forms a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to non-infective ARill in athletes. The Internationa...
Article
Full-text available
Background Respiratory tract infection (RTI) is a leading cause of training and in-competition time-loss in athlete health. The immune factors associated with RTI susceptibility remain unclear. In this study, we prospectively characterise host immune factors in elite athletes exhibiting RTI susceptibility. Methods Peripheral blood lymphocyte flow...
Article
Full-text available
Background The coronavirus disease-19 (COVID-19) pandemic led to the prohibition of group-based exercise and the cancellation of sporting events. Evaluation of respiratory aerosol emissions is necessary to quantify exercise-related transmission risk and inform mitigation strategies. Methods Aerosol mass emission rates are calculated from concurren...
Article
Full-text available
This British Thoracic Society (BTS) Clinical Statement addresses the diagnosis, evaluation and management of respiratory problems in athletic individuals. The overall recommendations issued in this document are built on a synthesis of the best available published evidence, where available and appropriate, but are largely based on expert opinion, wi...
Article
Exercise-induced laryngeal obstruction (EILO) is caused by paradoxical inspiratory adduction of laryngeal structures during exercise. EILO is an important cause of upper airway dysfunction in young individuals and athletes, can impair exercise performance and mimic lower airway dysfunction, such as asthma and/or exercise-induced bronchoconstriction...
Article
Full-text available
Objective Chronic cough (CC) is a debilitating respiratory symptom, now increasingly recognised as a discrete disease entity. This study evaluated the burden of CC in a primary care setting. Design Cross-sectional, retrospective cohort study. Setting Discover dataset from North West London, which links coded data from primary and secondary care....
Article
Full-text available
Large airway collapse (LAC) describes the phenomenon of excessive, abnormal, inward movement of the large airways (i.e. trachea and/or main bronchi and/or bronchus intermedius) occurring during the expiratory phase of the respiratory cycle. It is an increasingly well-recognised problem and a prevalent comorbidity in other chronic respiratory condit...
Article
Objective To determine the days until return to sport (RTS) after acute respiratory illness (ARill), frequency of time loss after ARill resulting in >1 day lost from training/competition, and symptom duration (days) of ARill in athletes. Design Systematic review and meta-analysis. Data sources PubMed, EBSCOhost, Web of Science, January 1990–July...
Conference Paper
Introduction Asthma remains diagnostically challenging, with up to one-third of patients labelled as asthmatic without supportive evidence of obstructive or reversible spirometry. The COVID-19 pandemic had a profound impact on the capacity to perform in-hospital lung function testing, leaving numerous patients with airways disease incompletely diag...
Conference Paper
Full-text available
Background The coronavirus disease-19 (COVID-19) pandemic has profoundly impacted sports and exercise, disrupting a plethora of events worldwide. Aerosol transmission is increasingly recognised as an important route for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with systematic evaluation of particulate matter release during exer...
Conference Paper
Full-text available
Introduction The Patient Global Impression of Severity (PGI-S) scale is a simple validated, single-item, self-reported categorical scale. The PGI-S is used to assess the severity of different clinical conditions, including as an outcome measure in clinical trials and in economic modelling. The aim of this study was to investigate the relationship o...
Conference Paper
Rationale Respiratory tract infection (RTI) is a major issue in athlete health and is the leading cause of training and competition time-loss. The host-defence immunomodulatory factors associated with heightened RTI susceptibility remains unclear. Objective This prospective study aimed to characterise host immune factors in international athletes...
Conference Paper
Full-text available
Background Exertional dyspnoea is a pervasive clinical feature for many patients following COVID-19 infection, with a high prevalence of breathing pattern disorder (BPD) reported. In this study we aimed to characterise exercise ventilatory patterns in patients with exertional dyspnoea following COVID-19 infection, using a non-linear statistical app...
Article
Objective To report the prevalence of lower airway dysfunction in athletes and highlight risk factors and susceptible groups. Design Systematic review and meta-analysis. Data sources PubMed, EBSCOhost and Web of Science (1 January 1990 to 31 July 2020). Eligibility criteria Original full-text studies, including male or female athletes/physically...
Article
Objective: Some groups of elite athletes have an apparent increased susceptibility to respiratory tract infection (RTI) with implications for their health and athletic performance. In this study, we aim to systemically evaluate vaccine response patterns as a potentially efficacious intervention strategy in elite athletes preparing for Olympic comp...
Article
Studies assessing exercise ventilatory responses during real-life exercise in pulmonary arterial hypertension (PAH) which include patients with cyanotic congenital heart disease are scarce. We assessed the ventilatory response to stairclimbing in patients with idiopathic PAH (IPAH) and congenital heart disease-associated PAH with Eisenmenger (EIS)...
Article
Full-text available
Objectives: To report COVID-19 illness pattern, symptom duration, and time-loss in UK elite athletes Methods: Observational, clinical and database review of athletes with symptomatic COVID-19 illness managed within the UK Sports Institutes. Athletes were classified as confirmed (positive SARS-CoV-2 PCR or antibody tests) or probable (consistent cl...
Article
1. Introduction This infographic outlines considerations for athletes and their teams around vaccination against the SARS-CoV-2 (Covid-19) virus. There are currently three vaccines approved for use in the United Kingdom (UK); Pfizer/BioNTech, Moderna and Oxford/AstraZenica. It is important for athletes and their physicians to be aware of the poten...
Article
Full-text available
Large airway collapse (LAC) is a frequently encountered clinical problem, caused by tracheobronchomalacia +/- excessive dynamic airway collapse, yet there are currently no universally accepted diagnostic criteria. We systematically reviewed studies reporting a diagnostic approach to LAC in healthy adults and patients, to compare diagnostic modaliti...
Article
Full-text available
PurposeThe aim of this study was to evaluate the respiratory function and symptom perception in professional cyclists completing a Grand Tour (GT).Methods Nine male cyclists completed La Vuelta or Tour de France (2018/19). At study entry, airway inflammation was measured via fractional exhaled nitric oxide (FeNO). Respiratory symptoms and pulmonary...
Article
Cough is one of the most common presenting symptoms of COVID-19, along with fever and loss of taste and smell. Cough can persist for weeks or months after SARS-CoV-2 infection, often accompanied by chronic fatigue, cognitive impairment, dyspnoea, or pain—a collection of long-term effects referred to as the post-COVID syndrome or long COVID. We hypo...
Article
Full-text available
Background Exercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathlessness and wheeze yet is frequently misdiagnosed as asthma. Insight regarding the demographic characteristics, laryngeal abnormalities and impact of EILO is currently limited, with data only available from individual centre reports. The aim of this work...
Article
In people recovering from COVID-19, there is concern regarding potential long-term pulmonary sequelae and associated impairment of functional capacity. Data published thus far indicate that spirometric indices appear to be generally well preserved, but that a defect in diffusing capacity (DLco) is a prevalent abnormality identified on follow-up lun...
Article
Full-text available
Background There are no data relating symptoms of an acute respiratory illness (ARI) in general, and COVID-19 specifically, to return to play (RTP). Objective To determine if ARI symptoms are associated with more prolonged RTP, and if days to RTP and symptoms (number, type, duration and severity) differ in athletes with COVID-19 versus athletes wi...
Chapter
Upper airway diseases involving the nose or throat areas are frequently observed in patients with chronic cough. However, the causal relationships with cough are controversial. Despite their frequent overlaps, evidence is largely lacking on how to assess and treat upper airway conditions in patients with chronic cough. This chapter summarizes clini...
Conference Paper
Intro A recent ERS statement on standardisation of cardiopulmonary exercise testing (CPET) in chronic lung diseases (Radtke et al 2019) discussed the criteria for determining maximal effort. A CPET with a respiratory exchange ratio (RER) >1.05 is considered maximal using these criteria; V’O2 <85% predicted, V’E >85% predicted, and HR <90% predicted...
Article
Full-text available
Objectives: The purpose of this qualitative study was to utilize the Capability, Opportunity, Motivation - Behavior model (COM-B) to: (1) evaluate athlete knowledge and understanding of current asthma-related anti-doping regulations, (2) explore the impact of environmental and societal influences on athletes with asthma, and (3) examine athlete pe...
Article
Full-text available
Laryngeal trauma is a life‐threatening injury in contact sports. Due to its potentially devastating consequences, the prevention, diagnosis, and management of neck trauma both pitch side and at the hospital are essential for athletes.
Chapter
Pre-test assessment describes the next step after deciding to do a cardiopulmonary exercise test (CPET). The indication for the test must be defined, with clear end points. A CPET is a very safe test. There are well-defined conditions which increase the risk. The most serious side effects are related to heart problems, most commonly seen in subject...
Chapter
This chapter describes how the amount of air going in and out of the lungs increases on exercise. The predicted value for minute ventilation (VE) is calculated for each subject from their own forced expiratory volume in one second (FEV1), rather than taken from published tables. Normally, ventilation does not limit exercise and VE does not reach 80...
Chapter
This chapter outlines the approach to producing a cardiopulmonary exercise test (CPET) report. A CPET is rarely diagnostic and should be looked at in the context of the clinical background and what key question is being asked. Cardiovascular, ventilatory, and gas exchange responses are looked at in turn, then reviewed in a systematic and iterative...
Chapter
This chapter describes the normal response of the speed of the heart to exercise. The maximum heart rate (HR), or pulse rate, is related to the age of the subject. Failure to reach 80% of the predicted maximum HR is considered abnormal and is sometimes called a high heart rate reserve. Unfit subjects, and those with heart disease, have a low maximu...
Chapter
This chapter outlines how dividing the volume of oxygen uptake (VO 2 ) by the pulse rate gives an estimate of the stroke volume of the heart. The amount of oxygen taken up with each heartbeat is called the oxygen pulse (O 2 pulse). It should increase steadily on exercise to a value above 10 ml/beat and may continue to rise during the recovery phase...
Chapter
This chapter explains how a combination of tables and graphs are needed to analyse a cardiopulmonary exercise test, and how to navigate through them. The nine-panel display is the most common format, but a series of four-panel plots are sometimes used. Much of the most useful information can be presented in a single four-panel plot. The steps of th...
Chapter
This chapter outlines the health benefits of exercise. A cardiopulmonary exercise test (CPET) can reassure the subject that exercise is safe for them. Exercise can be prescribed using heart rate zones derived from the CPET. Exercise should be taken for at least 30 minutes each day, or more intense exercise for 20 minutes three times per week. A com...
Chapter
This chapter describes how the most important parameter measured during a cardiopulmonary exercise test (CPET) is the volume of oxygen taken up by the body at peak exercise. This is called the maximum oxygen uptake, or VO 2 max. Sometimes the terms ‘peak’ and ‘maximal’ are also used to describe oxygen uptake. It is measured by looking at the volume...
Chapter
This chapter describes the changes that occur when anaerobic processes start to supplement aerobic metabolism during a cardiopulmonary exercise test (CPET). Lactic acid is produced, which is buffered by bicarbonate to produce carbon dioxide and water. The anaerobic threshold (AT) should be seen when VO 2 is at least 40% of predicted maximum oxygen...
Book
A Practical Guide to the Interpretation of Cardiopulmonary Exercise Tests is a short, but comprehensive, guide for those who are involved in the supervision of exercise tests and interpretation of cardiopulmonary exercise test (CPET) data. It is a clear and concise guide which will also be of interest to those who request CPETs and who wish to unde...
Chapter
This chapter describes how acidaemia stimulates ventilation in the later stages of a cardiopulmonary exercise test (CPET). This happens after the anaerobic threshold, once the capacity of the blood to buffer lactic acid has been used up. The respiratory compensation point (RCP) can be identified from an increase in the slope when minute ventilation...
Chapter
This chapter describes the typical pattern of abnormality seen on a cardiopulmonary exercise test (CPET) in different clinical conditions. The difficulty of differentiating deconditioning from mild disease is discussed. The effects of obesity and anaemia on CPET results are described. Classical patterns are recognized for conditions affecting the l...
Chapter
This chapter describes how desaturation during a cardiopulmonary exercise test (CPET) is uncommon. A fall of more than 4% from resting values is considered abnormal. Oxygen desaturation is usually caused by lung or pulmonary vascular disease, reflecting ventilation–perfusion inequality or impaired diffusion. Occasionally, a right-to-left shunt will...
Chapter
This chapter discusses how the results of a cardiopulmonary exercise test (CPET) can be used for preoperative surgical planning. A low preoperative maximum oxygen uptake (VO 2 max) is associated with a poor outcome. The lower the VO 2 max, the worse the prognosis. Use of the anaerobic threshold is less reliable. The CPET may identify clinical probl...
Chapter
This chapter describes how cycle ergometer and treadmill tests suit different subjects. A standard cardiopulmonary exercise test (CPET) involves a ramp increase in workload, until the subject’s symptoms prevent them from exercising any further. The exercise phase of the test is preceded by resting and then unloaded cycling, and followed by the reco...
Chapter
This chapter describes how the respiratory exchange ratio (RER) is calculated by dividing carbon dioxide output (VCO 2 ) by the oxygen uptake (VO 2 ). At the start of a cardiopulmonary exercise test (CPET), this ratio is less than 1.0. Once anaerobic metabolism starts to kick in, more carbon dioxide is produced from buffering of lactic acid and the...
Chapter
This chapter describes the basic competencies required to safely conduct a cardiopulmonary exercise test (CPET). These include basic life support, electrocardiogram interpretation, and understanding of the normal blood pressure (BP) response to exercise. The ability to detect when a patient is becoming unwell during a CPET is developed by supervisi...
Chapter
This chapter shows how dividing the minute ventilation (VE) by the volume of carbon dioxide exhaled, or the volume of oxygen taken up, gives the ventilatory equivalents (VeqCO 2 or VeqO 2 , respectively). VeqCO 2 show how much ventilation is needed to get a given volume of carbon dioxide out of the body. In a normal subject, the VeqCO 2 fall gradua...
Chapter
This chapter describes how a maximal cardiopulmonary exercise test (CPET) assesses the exercise capacity of an individual. It identifies whether exercise is limited by the heart or lungs, or by another factor. The test can be used to elucidate the cause of symptoms such as breathlessness. By quantifying exercise capacity, a CPET can be used as a to...
Chapter
This chapter describes how carbon dioxide is produced from metabolism and also from buffering of lactic acid. The volume of carbon dioxide exhaled (VCO 2 ) is calculated from the concentration in exhaled gas and minute ventilation. If the lungs are less efficient than normal, with a high dead space, the amount of ventilation needed to achieve any g...
Chapter
This chapter describes how additional information can be obtained during an exercise test to detect the airflow obstruction of exercise-induced asthma. The forced expiratory volume in one second (FEV1) may fall a few minutes after cessation of exercise, but this test is not particularly sensitive for detecting exercise-induced bronchoconstriction....
Article
Respiratory tract illness is a leading cause of training and in-competition time-loss in elite athletes. Asthma is known to be prevalent in athletes but the co-existence of other respiratory problems, in those deemed to be susceptible to respiratory tract illness, is unknown. The aim of this study was to apply a comprehensive prospective approach t...
Article
Full-text available
Water transport and local (airway) hydration are critical for the normal functioning of lungs and airways. Currently, there is uncertainty regarding the effects of systemic dehydration on pulmonary function. Our aims were: i) to clarify the impact of exercise- or fluid restriction-induced dehydration on pulmonary function in healthy adults; and ii)...
Article
Full-text available
Prior to the COVID-19 pandemic, laryngoscopy was the mandatory gold standard for the accurate assessment and diagnosis of inducible laryngeal obstruction. However, upper airway endoscopy is considered an aerosol-generating procedure in professional guidelines, meaning routine procedures are highly challenging and the availability of laryngoscopy is...
Article
Full-text available
Background and objective: The differential diagnosis for exercise-associated breathlessness is broad, however, when a young athletic individual presents with respiratory symptoms, they are most often prescribed inhaler therapy for presumed exercise-induced asthma (EIA). The purpose of this study was therefore to use a novel sound-based approach to...
Article
Full-text available
SARS-CoV-2 is the causative virus responsible for the COVID-19 pandemic. This pandemic has necessitated that all professional and elite sport is either suspended, postponed or cancelled altogether to minimise the risk of viral spread. As infection rates drop and quarantine restrictions are lifted, the question how athletes can safely resume competi...
Article
In the healthy, untrained young adult a case is made for a respiratory system- airways, pulmonary vasculature, lung parenchyma, respiratory muscles and neural ventilatory control system - which is near ideally designed to ensure a highly efficient, homeostatic response to exercise of varying intensities and durations. Our aim was then to consider c...