Mike Thomas

• PhD
• Professor at University of Southampton

Objective: Oral corticosteroids (OCS) are used to treat uncontrolled asthma, either as short rescue courses of treatment for severe disease exacerbations, or as long-term maintenance therapy in addition to other controller medications. Although the adverse events (AEs) associated with OCS are well understood by healthcare professionals (HCPs), the...

Background Clinical decision support systems (CDSSs) can promote adherence to clinical guidelines and improve patient outcomes. Exploring implementation determinants during the development of CDSSs enables intervention optimisation to promote acceptability, perceived appropriateness and fidelity during subsequent implementation. This study sought t...

Despite great advancements in the treatment of chronic airway diseases, improvements in morbidity and mortality have stalled in recent years. Asthma and chronic obstructive pulmonary disease are complex and heterogeneous diseases that require tailored management based on individual patient characteristics and needs. The Treatable Traits (TTs) appro...

The treatable traits approach represents a strategy for patient management. It is based on the identification of characteristics susceptible to treatments or predictive of treatment response in each individual patient. With the objective of accelerating progress in research and clinical practice relating to such a treatable traits approach, the Por...

Backgrounds: New interventions need to fit with existing ways of working in primary care. The Person-Based Approach (PBA) is a way to tailor interventions to context and stakeholder engagement can be a more or lesser part of this approach. Using co-participatory stakeholder engagement, as part of the PBA, provides a novel way to involve clinicians...

Background Digital interventions offer a potentially cost-effective means to support patient self-management in primary care, but evidence for the feasibility, acceptability and cost-effectiveness of digital interventions remains mixed. This programme focused on the potential for self-management digital interventions to improve outcomes in two comm...

Background Inhaled corticosteroids (ICS) are frequently prescribed outside guidelines to patients with chronic obstructive pulmonary disease (COPD) with mild/moderate airflow limitation and low exacerbation risk. This primary care trial explored the feasibility of identifying patients with mild/moderate COPD taking ICS, and the acceptability of ICS...

Objectives: To describe a transparent approach to planning a digital intervention for adolescents to self-manage their asthma using breathing retraining (BRT), based on an existing, effective adult intervention (BREATHE). Methods: A theory-, evidence and Person-Based Approach was used to maximise the effectiveness and persuasiveness of the inter...

Rationale: Moderate-to-severe asthma is associated with impaired asthma control and quality of life (QoL) despite access to specialist care and modern pharmacotherapy. Breathing exercises (BrEX) improve QoL in incompletely controlled mild asthma, but impact in moderate-to-severe asthma is unknown. Objective: To investigate the effectiveness of b...

Background Inhaled corticosteroids (ICS) are frequently prescribedoutsideguidelines to COPD patients with mild or moderate airflow limitation and low exacerbation risk, despite little evidence of benefit and risk of adverse effects. This trial explored thefeasibilityof ICS withdrawalfrompatients with mild/moderate COPD in primary care. Methods Open...

Asthma outcomes remain suboptimal, despite effective pharmacotherapy. Psychological dysfunction (such as anxiety) is common, and associated with poorer outcomes. We evaluated a digital mindfulness programme as an intervention to improve asthma-related quality of life for primary care patients, in a prospectively registered randomized-controlled fea...

Objectives Chronic rhinosinusitis (CRS) symptoms are experienced by an estimated 11% of UK adults, and symptoms have major impacts on quality of life. Data from UK and elsewhere suggest high economic burden of CRS, but detailed cost information and economic analyses regarding surgical pathway are lacking. This paper estimates healthcare costs for p...

Current methods to assess asthma and guide inhaled corticosteroid (ICS) dose titration mainly centre on patient-reported symptoms and lung function assessments. However, these methods correlate only weakly with airway inflammation making them unreliable predictors of future exacerbations and ICS requirement. Fractional Exhaled Nitric Oxide (FeNO) i...

Despite high mortality and morbidity, COPD remains under-diagnosed. Case-finding strategies are possible, but patients’ perspectives are unexplored. Using qualitative methods, we explored the patient perspective of a case-finding intervention among at-risk patients in primary care. Semi-structured telephone interviews were transcribed and thematic...

COPD remains largely undiagnosed or is diagnosed late in the course of disease. We report findings of a specialist outreach programme to identify undiagnosed COPD in primary care. An electronic case-finding algorithm identified 1602 at-risk patients from 12 practices who were invited to attend the clinic. Three hundred and eighty-three (23.9%) resp...

This study aimed to explore user engagement with ‘My Breathing Matters’, a digital self-management intervention for asthma, and identify factors that may influence engagement. In a mixed methods design, adults with asthma allocated to the intervention arm of a feasibility trial ( n = 44) participated in semi-structured interviews ( n = 18) and a sa...

Asthma and chronic obstructive pulmonary disease (COPD) are two prevalent chronic airways diseases. Both are complex and heterogeneous. Traditionally, clinical guidelines have advocated a stepwise approach to pharmacotherapy of asthma and COPD, but there is increasing realization that both require a more personalized and precise management approach...

Introduction: Despite effective pharmacotherapy, patient-reported asthma outcomes such as quality of life remain suboptimal. Digital mindfulness interventions may be helpful for people with asthma by targeting psychological dysfunction such as illness perceptions, anxiety and depression.Methods: In a mixed-methods process evaluation, we examined ho...

• Telephone interviews were conducted with 19 MACRO trial participants from 5 ENT sites across the UK. • Trial participants experienced mixed levels of communication during the COVID period and some felt uninformed about the trial status and their clinical situation. • Participants were most concerned about getting COVID through interactions with o...

Objective: Asthma outcomes remain suboptimal, despite effective pharmacotherapy. Psychological dysfunction (such as anxiety) is common, and associated with poorer outcomes. We evaluated a digital mindfulness programme as an intervention to improve asthma-related quality of life for primary care patients, in a prospectively registered randomized-con...

Asthma differs from many other chronic conditions in that most key management decisions are made in non-specialist settings, such as general practitioner surgeries and accident and emergency departments. Diagnosis in primary care relies on recognition of a characteristic pattern of symptoms and the occurrence of asthma attacks, sometimes supplement...

Background Randomised controlled trials (RCTs) are considered the ‘gold standard’ of medical evidence; however, recruitment can be challenging. The MACRO trial is a NIHR-funded RCT for chronic rhinosinusitis (CRS) addressing the challenge of comparing surgery, antibiotics and placebo. The embedded MACRO conversation study (MCS) used qualitative res...

Background Asthma exacerbations are major contributors to asthma morbidity and mortality. They are usually managed with bronchodilators and oral corticosteroids (OCS), but clinical trial evidence suggests antibiotics could be beneficial. We aimed to assess whether treatment of asthma exacerbations with antibiotics in addition to OCS improved outcom...

Digital behaviour change interventions can provide effective and cost-effective treatments for a range of health conditions. However, after rigorous evaluation, there still remain challenges to disseminating and implementing evidence-based interventions that can hinder their effectiveness ‘in the real world’. We conducted a large-scale randomised c...

Objectives Psychological dysfunction (such as anxiety) is common in people with difficult asthma and is associated with poor outcomes. Asthma guidelines increasingly emphasise the need to recognise and address co-morbidities, and it is plausible that appropriately targeted psychological interventions may be clinically and cost-effective. We hypothe...

Management of intermittent allergic rhinitis (IAR) is suboptimal in the UK. An Australian community pharmacy-based intervention has been shown to help patients better self-manage their IAR. We conducted a pilot cluster RCT in 12 Scottish community pharmacies to assess transferability of the Australian intervention. Trained staff in intervention pha...

Asthma imposes a substantial burden on individuals and societies. Patients with asthma need high-quality primary care management; however, evidence suggests the quality of this care can be highly variable. Here we identify and report factors contributing to high-quality management. Twelve primary care global asthma experts, representing nine countr...

Background: Chinese herbal medicine is widely used in combination with usual care for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in China. Chinese patent medicine Shufeng Jiedu (SFJD) capsules is widely used for respiratory infectious diseases. This review aims to evaluate effectiveness and safety of SFJD for AECOPD. Me...

Background High fractional exhaled nitric oxide (FeNO) levels are associated with greater risk of asthma exacerbations. However, it is not clear how FeNO can be used to guide safe reductions in inhaled corticosteroid (ICS) doses in asthma patients. This study assesses the ability of FeNO to guide ICS reductions. Methods Systematic searching of ele...

Traditional efficacy double-blind randomised controlled trials (DBRCTs) measure the benefit a treatment produces under near-ideal test conditions in highly selected patient populations; however, the behaviour of patients and investigators in such trials is highly controlled, highly compliant and adherent, and non-representative of routine clinical...

Introduction and aim: Uncontrolled asthma is a global health challenge with substantial impact on quality of life (QoL) and overall healthcare costs. Unrecognised and/or unmanaged comorbidities often contribute to presence of uncontrolled asthma. Abnormalities in breathing pattern are termed dysfunctional breathing and are not only common in asthm...

COPD patients prescribed inhaled corticosteroids (ICS) outside guidelines should be targeted for ICS withdrawal. Within a primary care population of 209,618 we used a combination of digital search algorithm, individual record review, and clinical review to identify COPD patients suitable for a trial of ICS withdrawal. At most, 39% of COPD patients...

In the PDF and HTML versions of this Brief Communication a couple of words are not shown in a sentence in the penultimate sentence of the first paragraph of the Results, changing the meaning. This sentence should have been “The setting of a SABA use threshold was likened to “tossing a coin” (Expert 3, primary care).”

Chronic obstructive pulmonary disease (COPD) is heterogeneous, but persistent airflow obstruction (AFO) is fundamental to diagnosis. We studied AFO consistency from initial diagnosis and explored factors associated with absent or inconsistent AFO. This was a retrospective observational study using patient-anonymised routine individual data in Care...

Asthma is a common non-communicable disease, often characterised by activity limitation, negative effects on social life and relationships, problems with finding and keeping employment, and poor quality of life. The objective of the present study was to conduct a systematic review of the literature investigating the potential factors impacting qual...

Most clinical contacts with chronic obstructive pulmonary disease (COPD) patients take place in primary care, presenting opportunity for proactive clinical management. Electronic health records could be used to risk stratify diagnosed patients in this setting, but may be limited by poor data quality or completeness. We developed a risk stratificati...

The Global Initiative for Asthma (GINA) report was primarily intended as a strategy document and not a clinical guideline. However, the 2014 update moved the report towards a "practical, clinical practice‐centred document", and has in many countries formed a basis for national guidelines. A possible limitation of the GINA report is its primary focu...

Background: Childhood asthma is a common condition. Currently there is no validated objective test which can be used to guide asthma treatment in children. This study tests the hypothesis that the addition of fractional exhaled nitric oxide (FENO) monitoring in addition to standard care reduces the number of exacerbations (or attacks) in children...

Objective: to assess the feasibility of a randomised controlled trial (RCT) and acceptability of an asthma self-management digital intervention to improve asthma-specific quality of life in comparison with usual care. Design and setting: a two arm feasibility RCT conducted across 7 general practices in Wessex, UK. Participants: primary care patie...

Background: The aim of this study was to analyse rates of antibiotic usage in chronic rhinosinusitis (CRS) in primary care in England and Wales and to identify trends in the choice of antibiotics prescribed. Methods: We used linked data from primary care EHRs, with diagnoses coded using the Read terminology (Clinical Practice Research Datalink)...

Background: Asthma affects millions of people worldwide, with many patients experiencing symptoms that affect their daily lives despite receiving long-term controller medication. Purpose: Work is a large part of most people’s lives, hence this study investigated the impact of uncontrolled asthma on work productivity in adults receiving asthma maint...

Global Initiative for Chronic Obstructive Lung Disease guidelines support the prescription of fixed combination inhaled corticosteroids (ICS) and long-acting β-agonists in symptomatic COPD patients with frequent or severe exacerbations, with the aim of preventing them. ICS are frequently also prescribed to COPD patients with mild or moderate airflo...

Background: Chronic rhinosinusitis (CRS) is a common source of ill health; 11% of UK adults reported CRS symptoms in a worldwide population study. Guidelines are conflicting regarding whether antibiotics should be included in primary medical management, reflecting the lack of evidence in systematic reviews. Insufficient evidence to inform the role...

Background MACRO (Defining best Management for Adults with Chronic RhinOsinusitis) is an NIHR-funded programme of work designed to establish best practice for adults with chronic rhinosinusitis (CRS). The 7-year programme comprises three consecutive workstreams, designed to explore NHS care pathways through analysis of primary and secondary data so...

Background: Macrolide antibiotics have demonstrated important anti-inflammatory and immunomodulatory properties in chronic rhinosinusitis (CRS) patients. However, reports of increased risks of cardiovascular events have led to safety concerns. We investigated the risk of all-cause and cardiac death, and cardiovascular outcomes, associated with mac...

Objectives To explore patient views and perspectives of current management of chronic rhinosinusitis (CRS) in primary and secondary care. Design Semistructured qualitative telephone interviews as part of the MACRO programme (Defining best Management for Adults with Chronic RhinOsinusitis). Setting Primary care and secondary care ear, nose and thr...

Introduction A Task Force was commissioned jointly by the European Academy of Allergy and Clinical Immunology (EAACI) and the Respiratory Effectiveness Group (REG) to develop a quality assessment tool for real-life observational research to identify high-quality real-life asthma studies that could be considered within future guideline development....

Background MACRO (Defining best Management for Adults with Chronic RhinOsinusitis) is an NIHR-funded programme of work designed to establish best practice for adults with chronic rhinosinusitis (CRS). The 7-year programme comprises three consecutive workstreams, designed to explore NHS care pathways through analysis of primary and secondary data so...

Objective Explore qualitative differences between interventions (DVD and booklet (DVDB) versus face-to-face and booklet (F2FB) versus usual care) in the BREATHE (Breathing Retraining for Asthma Trial of Home Exercises) trial of breathing retraining for asthma. Design Quantitative process analysis exploring group expectancy, experience and practice...

Objectives: To explore patient views and perspectives of current management of chronic rhinosinusitis (CRS) in primary and secondary care. Design: Semi-structured qualitative telephone interviews as part of the MACRO programme (Defining best Management for Adults with Chronic RhinOsinusitis) . Setting Primary care and secondary care ENT outpatie...

p>In the PDF and HTML versions of this Brief Communication a couple of words are not shown in a sentence in the penultimate sentence of the first paragraph of the Results, changing the meaning. This sentence should have been “The setting of a SABA use threshold was likened to “tossing a coin” (Expert 3, primary care).”</p

Asthma occurs across the life course. Its optimal treatment includes the use of personalized management plans that recognize the importance of co-morbidities including so-called “dysfunctional breathing.” Such symptoms can arise as a result of induced laryngeal obstruction (ILO) or alterations in the mechanics of normal breathing called breathing p...

Background MACRO (Defining best Management for Adults with Chronic RhinOsinusitis) is an NIHR-funded programme of work designed to establish best practice for adults with chronic rhinosinusitis (CRS). The 7-year programme comprises three consecutive workstreams, designed to explore NHS care pathways through analysis of primary and secondary data so...

Background: Respiratory disease is a common cause for primary care consultations, and increasingly, patients with complex and ‘high-risk’ lung disease are managed in the community. Variation in the quality of community management of ‘high-risk’ patients may lead to sub-optimal outcomes for some. The ASSIST study (REC: 16/5C/0629) has implemented a...

There is growing awareness amongst healthcare planners, providers and researchers of the need to make better use of routinely collected health data by translating it into actionable information that improves efficiency of healthcare and patient outcomes. There is also increased acceptance of the importance of real world research that recruits patie...

The National Review of Asthma Deaths (NRAD) identified high prescribing of short-acting beta2-agonists (SABAs) as a key factor in over 40% of deaths. We interviewed asthma experts from both a hospital background (n = 5) and a primary care background (n = 8), and general practitioners delivering asthma care (n = 8), to identify how SABA use is defin...

Current understanding of risk factors for asthma attacks in children is based on studies of small but well-characterised populations or pharmaco-epidemiology studies of large but poorly characterised populations. We describe an observational study of factors linked to future asthma attacks in large number of well-characterised children. From two UK...

Abstract Inhaled medications are the cornerstone of treatment and management of asthma and COPD. However, inhaler device errors are common among patients and have been linked with reduced symptom control, an increased risk of exacerbations, and increased healthcare utilisation. These observations have prompted GINA (Global INitiative for Asthma) an...

Background Asthma exacerbations affect the quality of life of patients with asthma and have a major effect on the overall costs of asthma care. An asthma self-management plan that advises the temporary quadrupling of inhaled corticosteroid dose may prevent asthma exacerbations, but this needs to be confirmed before being adopted widely. Objectives...

Background Respiratory disease is a common cause for primary care consultations, and increasingly, patients with complex and ‘high-risk’ lung disease are managed in the community. Variation in the quality of community management of ‘high-risk’ patients may lead to sub-optimal outcomes for some. The ASSIST study (REC: 16/5C/0629) has implemented a c...

Introduction and objectives Blood eosinophils are a potentially useful biomarker to guide choice of maintenance treatment in COPD. We aimed to explore rates of blood eosinophil testing, blood eosinophil counts, and their relationship to patient characteristics and disease outcomes in routine primary care. Methods We used routinely collected data f...

Aims In the United Kingdom, around 9 00 000 people have a formal diagnosis of COPD, however, it is believed that over 2 million more may be living with the disease. The ASSIST study (REC:16/5C/0629) aimed to investigate ‘case finding’ strategies in undiagnosed patients with histories and patterns of GP attendance suggestive of COPD. Methods Possib...

Introduction COPD is a leading causes of hospital admission in the UK.¹ The DOSE score (Dyspnoea, airways Obstruction, Smoking status, Exacerbation rate) can stratify the risk of subsequent hospital admission.² Resource is often focussed on patients with high symptom burden, presenting repeatedly to medical professionals. We hypothesise that early...

Introduction and objectives Blood eosinophils are a potentially useful biomarker to guide inhaled corticosteroid (ICS) treatment in COPD. We aimed to investigate whether blood eosinophil count predicts the effect of maintenance treatment with ICS versus non-ICS in routine primary care. Methods We used routinely collected data from UK primary care...

Objectives: To explore GP and ENT specialist perspectives of current treatment strategies for chronic rhinosinusitis (CRS) and care pathways through primary and secondary care. Design: Semi-structured qualitative telephone interviews as part of the MACRO programme. Setting: Primary care and secondary care ENT outpatient clinics in the UK Partic...

Introduction: Chronic Obstructive Pulmonary Disease (COPD) accounts for a significant proportion of hospital admissions in the UK and is a leading cause of death worldwide. Missed opportunities for early diagnosis and optimisation of treatment are common in primary care. We implemented a case-finding strategy in order to identify previously undiagn...

p>Background: Despite effective treatments and long-standing management guidelines, there are approximately 1400 hospital admissions for asthma weekly in the United Kingdom (UK), many of which could be avoided. In our previous research, a secondary analysis of the intervention (ARRISA) suggested an improvement in the management of at-risk asthma pa...

Computers are increasingly used to improve prescribing decisions in the management of long-term conditions however the effects on asthma prescribing remain unclear. We aimed to synthesise the evidence for the use of computerised alerts that identify excessive prescribing of short-acting beta2-agonists (SABAs) to improve asthma management for people...