Nicholas S Hopkinson

• MA PhD FRCP
• Professor of Respiratory Medicine at Imperial College London

Introduction: Abnormal breathing patterns unexplained by pathophysiology are typically referred to using terms including chronic breathlessness syndrome or complex breathlessness. Often patients with these conditions are referred to physiotherapy for an assessment of this breathlessness, where some are diagnosed with breathing pattern disorder (BrP...

Background: Pulmonary rehabilitation(PR) is a highly effective intervention for people with chronic respiratory disease, however it is not known how best to sustain its benefits. Clinical trials are needed to establish if participation in Singing for Lung Health(SLH) groups following PR will improve health-related quality-of-life, healthcare utilis...

Dietary nitrate supplementation, which improves skeletal muscle oxygen utilisation, vascular endothelial function and exercise capacity in people with chronic obstructive pulmonary disease, may benefit other lung conditions. In a double-blind, placebo-controlled, crossover study, in 19 adults with Group 3 pulmonary hypertension who desaturated duri...

Introduction. Integrating smoking cessation support into lung cancer screening can improve abstinence rates. However, healthcare decision makers need evidence of cost effectiveness to understand the cost/benefit of adopting this approach. Methods. To evaluate the cost-effectiveness of different smoking cessation interventions, and service delivery,...

Background The Six-minute walk test (6MWT) is extensively used to assess functional capacity in patients with COPD. The current gold standard for administering and recording the test is a combination of assessor and video recording (1). The use of digital wearable devices has the potential to make recording the distance more accurate, easier and sa...

Background Breathlessness is a common and distressing symptom impacting quality of life and limiting activities of daily living. Social isolation and loneliness are associated with increased morbidity and mortality, and there is an increasing appreciation that these are global health priorities. Qualitative research suggests breathlessness could le...

Background Breathlessness can be a complex and debilitating symptom in people with long COVID, and the evidence base for interventions is limited. A previous randomised controlled trial found that participation in a six-week online breathing and wellbeing programme (ENO Breathe) that uses singing techniques, was associated with improvements in heal...

Introduction Breathing pattern disorders are characterised by breathing (or specifically breathing patterns) that deviate from allostasis (respiratory or metabolic requirements) when conscious or unconscious processes override autonomic control. This systematic review appraised the evidence of measurement properties (reliability, validity, and resp...

Objectives To explore participant experience and perceived impacts of an online dance-based long COVID support programme. Design Mixed-methods study using thematic analysis of semi-structured interviews and structured observations, and ordinal scale questionnaire responses. Setting Online, community-based, with participants in Scotland and Englan...

Introduction There is majority support in parliament and across the United Kingdom to implement a “smoke-free generation” policy which would mean people born on or after January 1, 2009, could never legally be sold tobacco. To explore the potential impact this policy could have, we estimated the number of young adults (18–25 years) currently taking...

Introduction Spirometry is a point-of-care lung function test that helps support the diagnosis and monitoring of chronic lung disease. The quality and interpretation accuracy of spirometry is variable in primary care. This study aims to evaluate whether artificial intelligence (AI) decision support software improves the performance of primary care...

Background There is majority support in parliament and across the United Kingdom (UK) to implement a ‘smokefree generation’ policy which would increase the legal age of sale of tobacco from 18 by one year each year from 2027 onwards, such that people born on or after 1 January 2009 could never legally be sold tobacco. To explore the potential impac...

Background Social media may influence children and young people’s health behaviour, including cigarette and e-cigarette use. Methods We analysed data from participants aged 10–25 years in the UK Household Longitudinal Study 2015–2021. The amount of social media use reported on a normal weekday was related to current cigarette smoking and e-cigaret...

Background Singing for lung health (SLH) is an arts-based breathing control and movement intervention for people with long-term respiratory conditions, intended to improve symptoms and quality of life. Online, remotely delivered programmes might improve accessibility; however, no previous studies have assessed the effectiveness of this approach. M...

Objective People with mustard gas lung disease experience cough, sputum, breathlessness and exercise limitation. We hypothesised that pulmonary rehabilitation (PR) would be beneficial in this condition. Design An assessor-blind, two-armed, parallel-design randomised controlled clinical trial. Setting Secondary care clinics in Iran. Participants...

Background: Despite the importance of gait as a determinant of falls, disability and mortality in older people, understanding of gait impairment in COPD is limited. This study aimed to identify differences in gait characteristics during supervised walking tests between people with COPD and healthy controls. Methods: We searched 11 electronic datab...

Background Regular clinical reviews of people with COPD provide an opportunity to optimise management and are recommended in national and international guidelines. However, there are limited data about the relationship between having an annual review and other aspects of care quality, which might influence decision-making by healthcare professional...

Background Pulmonary rehabilitation (PR) is a programme of exercise and education and the most effective treatment for the symptoms and disability associated with chronic obstructive pulmonary disease. However, the benefits of PR are limited by poor uptake and completion. This trial will determine whether using trained volunteer lay health workers,...

Lung health, the development of lung disease, and how well a person with lung disease is able to live, all depend on a wide range of societal factors. These systemic factors that adversely affect people and cause injustice, can be thought of as "structural violence". To make the causal processes relating to COPD more apparent, and the responsibilit...

Introduction Lung volume reduction surgery (LVRS) and endobronchial valve (EBV) placement can produce substantial benefits in appropriately selected people with emphysema. The UK Lung Volume Reduction (UKLVR) registry is a national multicentre observational study set up to support quality standards and assess outcomes from LVR procedures at special...

Introduction The clinical validity of real-world walking cadence in people with chronic obstructive pulmonary disease (COPD) is unsettled. Objective: to assess the levels, variability and association with clinically relevant COPD characteristics and outcomes of real-world walking cadence. Methods We assessed walking cadence (steps per minute durin...

This study aimed to validate a wearable device’s walking speed estimation pipeline, considering complexity, speed, and walking bout duration. The goal was to provide recommendations on the use of wearable devices for real-world mobility analysis. Participants with Parkinson’s Disease, Multiple Sclerosis, Proximal Femoral Fracture, Chronic Obstructi...

Background Short term studies suggest that dietary nitrate supplementation may improve cardiovascular risk profile, lowering blood pressure (BP) and enhancing endothelial function. It is not clear if these beneficial effects are sustained and whether they apply in people with COPD, who have a worse cardiovascular profile than those without COPD. Ni...

Background The introduction of community infection control measures during the COVID-19 pandemic was associated with a reduction in acute exacerbations of lung disease. We aimed to understand the acceptability of continued use of infection control measures among people with chronic lung disease and to understand the barriers and facilitators of use...

Background Reduced mobility is a central feature of COPD. Assessment of mobility outcomes that can be measured digitally (digital mobility outcomes (DMOs)) in daily life such as gait speed and steps per day is increasingly possible using devices such as pedometers and accelerometers, but the predictive value of these measures remains unclear in rel...

Introduction The American Thoracic Society and European Respiratory Society (ATS/ERS) updated their spirometry technical standards in 2019 with the intention of increasing the accuracy, precision and quality of spirometry. We assessed the technical quality of primary care spirometry according to ATS/ERS 2019 standards and evaluated inter-expert agr...

Rationale Dietary nitrate supplementation improves skeletal muscle oxygen utilisation and vascular endothelial function in people with COPD. We hypothesised that these effects might also improve exercise performance in patients with pulmonary hypertension and hypoxia. Methods We conducted a single-centre, double-blind, placebo-controlled, cross-ov...

Background Immediate smoking cessation interventions delivered alongside targeted lung health checks (TLHCs) to screen for lung cancer increase self-reported abstinence at 3 months. The impact on longer term, objectively confirmed quit rates remains to be established. Methods We followed up participants from two clinical trials in people aged 55–7...

Objectives Clearing secretions from the airway can be difficult for people with chronic obstructive pulmonary disease (COPD). Mucus clearance devices (MCDs) are an option in disease management to help with this, but healthcare provider awareness and knowledge about them as well as current clinical practice in Saudi Arabia are not known. Design A c...

Lung health, the development of lung disease, and how well a person with lung disease is able to live, all depend on a wide range of societal factors. Considering COPD as a manifestation of structural violence, something that continues to be done to people, despite it being largely preventable, makes the causal processes more apparent and the respo...

Background Completion of pulmonary rehabilitation is recognised in chronic obstructive pulmonary disease (COPD) guidelines as a key opportunity to consider systematically whether a respiratory review to assess potential suitability for a lung volume reduction (LVR) procedure might be appropriate. We describe the development of a simple decision-sup...

Background Gait characteristics are important risk factors for falls, hospitalisations, and mortality in older adults, but the impact of COPD on gait performance remains unclear. We aimed to identify differences in gait characteristics between adults with COPD and healthy age-matched controls during (1) laboratory tests that included complex moveme...

Background: Patterning of cigarette and e-cigarette use among young people remains poorly characterized. We aimed to describe these patterns in the UK Millennium Cohort Study at age 14 and 17 years. Methods: Data on cigarette and e-cigarette use come from 9731 adolescents. Latent class analysis assigned participants to membership of classes of p...

Introduction It is illegal in the UK to sell tobacco or nicotine e-cigarettes to people under the age of 18 years, as is displaying tobacco cigarettes at the point of sale. This paper examined changes in exposure to display of these products in shops and sources of these products among children and adolescent users over time Methods Data from repr...

Background Spirometry services to diagnose and monitor lung disease in primary care were identified as a priority in the NHS Long Term Plan, and are restarting post-COVID-19 pandemic in England; however, evidence regarding best practice is limited. Aim To explore perspectives on spirometry provision in primary care, and the potential for artificia...

Introduction: Lung cancer screening presents an important teachable moment to promote smoking cessation, but the most effective strategy to deliver support in this context remains to be established. Methods: We undertook a systematic review and meta-analysis of smoking cessation interventions delivered during lung health screening, published pri...

Background Social media may influence children and young peoples health behaviour, including smoking and e-cigarette use. Methods We analysed data from participants aged 10-25 in the UK Household Longitudinal Study 2015-2022. The amount of social media use reported on a normal weekday, was related to current tobacco smoking and e-cigarette use. Gen...

Introduction It is illegal in the UK to sell tobacco or nicotine e-cigarettes to people under the age of 18 years, as is displaying tobacco cigarettes at the point of sale. This paper examined changes in exposure to display of these products in shops and sources of these products among adolescent users over time. Methods: Data from representative r...

Introduction Lung cancer screening presents an important teachable moment to promote smoking cessation, but the most effective strategy to deliver support in this context remains to be established. Methods We undertook a systematic review and meta-analysis of smoking cessation interventions delivered during lung health screening, published prior to...

Background Lung volume reduction surgery (LVRS) and bronchoscopic lung volume reduction (BLVR) with endobronchial valves (EBVs) can improve outcomes in appropriately selected patients with emphysema. However, no direct comparison data exist to inform clinical decision-making in people who appear suitable for both procedures. Our aim was to investig...

Introduction: Although e-cigarettes can be an effective form of nicotine substitution for adults attempting to quit smoking, their use among children and young people is a concern. Accurate data about this are needed to inform debates over policy and regulation in the UK and elsewhere. Methods: Using data from an online survey of 2613 youth aged...

Background Singing for Lung Health (SLH) is an arts-based non-pharmacological intervention for people with long-term respiratory conditions that aims to improve symptoms and quality of life (QOL). Current research suggests face-to-face SLH can improve aspects of QOL and physical performance. There is interest in online, remotely delivered SLH, howe...

Background Preventing smoking uptake among adolescents is essential to achieve a smoke-free generation. The aim of this study was to assess risk factors for smoking in late adolescence and smoking uptake between early and late adolescence, using data from the Millennium Cohort Study. We also present estimates of numbers of smokers and smoking uptak...

Background The development of optimal strategies to treat impaired mobility related to ageing and chronic disease requires better ways to detect and measure it. Digital health technology, including body worn sensors, has the potential to directly and accurately capture real-world mobility. Mobilise-D consists of 34 partners from 13 countries who ar...

Background The development of optimal strategies to treat impaired mobility related to ageing and chronic disease requires better ways to detect and measure it. Digital health technology, including body worn sensors, has the potential to directly and accurately capture real-world mobility. Mobilise-D consists of 34 partners from 13 countries who ar...

Introduction: Most people who smoke initiate smoking in adolescence. Risk factors for smoking are changing over time as demographics shift, and technologies such as social media create new avenues for the tobacco industry to recruit smokers. We assessed risk factors associated with smoking uptake and regular smoking among a representative cohort o...

Purpose: To assess if dual-energy computed tomographic pulmonary angiography (DECTPA) derived lobar iodine quantification can provide an accurate estimate of lobar perfusion in patients with severe emphysema, and offer an adjunct to single-photon emission CT perfusion scintigraphy (SPECT-PS) in assessing suitability for lung volume reduction (LVR)...

Background Oscillatory positive expiratory pressure (OPEP) devices are intended to facilitate sputum clearance and reduce cough, but there is limited evidence for their effectiveness in COPD, or to guide patient selection. We aimed to assess the impact of OPEP therapy on quality of life and objective measures of cough and sleep disturbance in patie...

(275 words) Background Lung cancer screening programs provide an opportunity to support people who smoke to quit, but the most appropriate model for delivery remains to be determined. Immediate face to face smoking cessation support for people undergoing screening can increase quit rates, but it is not known whether remote delivery of immediate sm...

Objectives To assess the frequency of reporting of ethnicity (or ‘race’) and socioeconomic status (SES) indicators in high-impact journals. Design Targeted literature review. Data sources The 10 highest ranked general medical journals using Google scholar h5 index. Eligibility criteria Inclusion criteria were, human research, reporting participa...

INTRODUCTION Although e-cigarettes can be an effective form of nicotine substitution for adults attempting to quit smoking, their use among children and young people is a concern. Accurate data about this are needed to inform debates over policy and regulation in the UK and elsewhere. METHODS Using data from an online survey of 2,613 people aged 1...

Background Understanding the factors driving acute exacerbations of chronic obstructive pulmonary disease (COPD) is key to reducing their impact on human health and well-being. Methods 5997 people with COPD, mean 66 years, 64% female, completed an online survey between December 2020 and May 2021 about living with COPD, developed by the charity Ast...

Background The development of optimal strategies to treat impaired mobility related to ageing and chronic disease requires better ways to detect and measure it. Digital health technology, including body worn sensors, has the potential to directly and accurately capture real-world mobility. Mobilise-D consists of 34 partners from 13 countries who ar...

Background Most smokers take up their habit in adolescence. Risk factors for smoking are changing over time as demographics shift, and technologies such as social media create new avenues for the tobacco industry to recruit smokers. We assessed risk factors associated with smoking uptake among a representative cohort of UK adolescents. Methods Dat...

Understanding the factors driving acute exacerbations of COPD is key to reducing their impact on human health and wellbeing. 5997 patients, mean 66 years, 64% female, completed an online survey between December 2020 and May 2021 about living with COPD developed by the charity Asthma+Lung UK. The 3731(62.2%) reporting frequent(≥2/year) exacerbations...

Background Lung cancer screening programs provide an opportunity to support smokers to quit, but the most appropriate model for delivery remains to be determined. Immediate face to face smoking cessation support for people undergoing screening can increase quit rates, but it is not known whether remote delivery of immediate smoking cessation counse...

Background There are few evidence-based interventions for long COVID; however, holistic approaches supporting recovery are advocated. We assessed whether an online breathing and wellbeing programme improves health related quality-of-life (HRQoL) in people with persisting breathlessness following COVID-19. Methods We conducted a parallel-group, sin...

Background Smoking is often colloquially considered “social”. However, the actual relationship of smoking with current and future social isolation and loneliness is unclear. We therefore examined these relationships over a 12-year follow-up. Methods In this cohort study, we used a nationally representative sample of community dwelling adults aged...

Objectives: Lung cancer screening programmes offer an opportunity to address tobacco dependence in current smokers. The effectiveness of different approaches to smoking cessation in this context has not yet been established. We investigated if immediate smoking cessation support, including pharmacotherapy, offered as part of a lung cancer screenin...

Introduction The impact of acute COVID-19 on people with asthma appears complex, being moderated by multiple interacting disease-specific, demographic and environmental factors. Research regarding longer-term effects in this group is limited. We aimed to assess impacts of COVID-19 and predictors of persistent symptoms, in people with asthma. Metho...