Philip M Short

• MBChB MD
• University of Dundee

Background Inhaled corticosteroid (ICS) titration in asthma is primarily based on symptoms and pulmonary function. ICSs may not be increased on this basis despite residual airway inflammation. Objective To compare the dose-response relationships of ICSs on measures of pulmonary function, symptoms, and inflammation in patients with persistent ast...

Purpose: We evaluated whether Gly16Arg beta2-receptor genotype relates to impulse oscillometry (IOS) in a real-life clinic setting. Methods: Patients with persistent asthma taking inhaled corticosteroid ± long-acting beta-agonist (ICS ± LABA) were evaluated. We compared genotype groups comprising either no Arg copies (i.e. GlyGly) versus one or tw...

Impulse oscillometry (IOS) is a novel method of assessing airway resistance. IOS is rarely used in assessing airway resistance after bronchoprovocation in adult asthma. To ascertain the degree of change in IOS measurements seen in patients with asthma undergoing bronchial challenge testing. Patients 18 to 65 years old with mild to moderate asthma,...

Left ventricular hypertrophy (LVH) is a significant cardiac risk factor, associated with increased mortality. The impact of LVH on mortality in chronic obstructive pulmonary disease (COPD) is unknown. We evaluated the impact of LVH on mortality in COPD patients by measurement of left ventricular dimensions by echocardiography. Retrospective cohort...

SESSION TITLE: COPD Exacerbation Risk SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, October 29, 2014 at 02:45 PM - 04:15 PM PURPOSE: Prior data suggested that among Anthonisen criteria only an increase in sputum purulence was a predictor of clinical failure among mild to moderate COPD outpatients who did not receive antibiotic...

The murine asthma model shows that switching off airway beta-2 receptors with an inverse agonist may confer anti-inflammatory effects as well as corticosteroid-sparing activity. We assessed for any corticosteroid-sparing effects of propranolol, an inverse agonist, added to low dose inhaled corticosteroid (ICS) versus higher dose ICS. A randomized,...

Evidence suggests that platelets play a significant role in inflammation in addition to their role in thrombosis. Systemic inflammation is linked to poor short and long term outcomes in COPD. Increased platelet activation has been reported in acute exacerbations of COPD (AECOPD). We investigated whether thrombocytosis is independently associated wi...

Macrolides are frequently used antibacterials in the treatment of community acquired pneumonia (CAP). Observational data have suggested that macrolide use in CAP is associated with lower mortality and morbidity. Studies in other chronic respiratory conditionshave demonstrated that macrolide antibiotics have anti-inflammatory effects, which extend b...

Introduction Acute exacerbations of COPD (AECOPD) frequently cause hospitalisation and death in COPD patients. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) issued recent guidelines for the treatment of COPD including that of exacerbations. GOLD guidance included the use of corticosteroids, bronchodilators, controlled oxygen the...

Introduction and Objectives Prognostic assessment of COPD exacerbations is currently limited by models that only take into account short term prognostic factors. We developed a multidimensional tool for COPD exacerbations, predicting both short and long term outcome. Methods A prospective multicentre, UK observational cohort of patients hospitalise...

Introduction and Objectives Chronic propranolol does not improve airway hyper-responsiveness (AHR) in persistent asthmatics taking medium dose inhaled corticosteroid (ICS), 440µg/day1. We wished to assess for any putative corticosteroid-sparing effect of propranolol added to low dose ICS versus higher dose ICS, on histamine AHR. Methods We conducte...

Introduction and Objectives It is increasingly recognised that small airway dysfunction is associated with suboptimal asthma control. We have previously reported that β2-adrenoreceptor polymorphism at position 16 (i.e. Arg/Gly) is not related to FEV1 or airway hyper-responsiveness in persistent asthmatics.1 However effects of β2-adrenoreceptor poly...

Introduction and Objectives Long-acting muscarinic antagonists (LAMA) and long-acting beta-agonists (LABA) are first-line treatments for COPD. The addition of inhaled corticosteroids (ICS) is recommended for patients with frequent exacerbations who are not adequately controlled with long-acting bronchodilators. These medications have been largely e...

Introduction and Objectives Left ventricular hypertrophy (LVH) is a significant risk factor of cardiovascular disease and is associated with increased mortality. Previous studies have shown an increased prevalence of LVH in normoxaemic COPD patients. The impact of LVH on mortality in COPD is yet to be established. We evaluated the impact of LVH on...

Background The arginine-16-glycine (Arg16Gly) beta-2 adrenoceptor (ADR) polymorphism is associated with worse outcomes in patients exposed to regular beta-agonists. We therefore wished to know if Arg16Gly conferred a similar effect in response to beta-antagonists in asthma. Methods and observations We have performed a retrospective composite analys...

Background Large randomised controlled trials such as TORCH (towards a revolution in chronic obstructive pulmonary disease (COPD) health) report an increased risk of pneumonia associated with use of inhaled corticosteroids (ICS) in COPD but no corresponding increase in pneumonia-related mortality. However, these trials exclude patients who are elde...

Despite their benefits in the treatment of cardiovascular disease, β-blockers are seldom used to treat asthmatics. We assessed the safety and tolerability of acute dosing with esmolol and propranolol in patients with asthma. Post-hoc analysis of a double blind, randomised, placebo controlled trial of β-blocker use in asthma. Mild-to-moderate asthma...

Asthmatic patients receiving inhaled corticosteroids may take frequent add-on therapy with salbutamol despite on-demand prescription. Frequent salbutamol use can be detrimental in asthma. The isomeric formulation of salbutamol and the beta-2 adrenoceptor 16 genotype may also influence this phenomenon. We performed a randomised, double-blind, placeb...

Rationale: Unblinded studies have shown improvements in airway hyperresponsiveness with chronic nadolol in steroid-naive patients with asthma. Objectives: To assess the effects of chronic nonselective β-blockade as add-on to inhaled corticosteroids (ICS) in patients with asthma. Methods: A double-blind randomized placebo-controlled crossover t...

To study the association of clarithromycin with cardiovascular events in the setting of acute exacerbations of chronic obstructive pulmonary disease and community acquired pneumonia. Analysis of two prospectively collected datasets. Chronic obstructive pulmonary disease dataset including patients admitted to one of 12 hospitals around the United Ki...

The editorial by Jenkins and Beasley1 makes a speculative recommendation that tiotropium Respimat should not be prescribed in the treatment of chronic obstructive pulmonary disease (COPD), being primarily based on meta-analysis where mortality was not the primary end point. The meta-analysis by Singh et al 2 reported that treating 124 patients per...

Impulse oscillometry (IOS) provides an alternative method of assessing pulmonary function to conventional spirometry. To compare the sensitivities of IOS and spirometry in assessing bronchoconstriction to propranolol and bronchodilation with salbutamol. A post-hoc analysis of a randomized placebo-controlled crossover study was performed. Patients w...

International guidelines advocate a standard approach to asthma management for all, despite its heterogeneity. "Personalized" treatment of inflammatory asthma phenotypes confers superior benefits. We wished to evaluate dose response to inhaled corticosteroids (ICSs) in patients with asthma with an elevated fractional exhaled nitric oxide (Feno) phe...

Introduction and Objectives Cardiac arrhythmias are regularly found in patients with COPD, with higher frequencies reported during exacerbations. We wished to examine the impact of tachycardia and new onset atrial fibrillation (AF) on long term outcome in patients hospitalised with a COPD exacerbation. Methods A prospective observational cohort st...

Background Asthmatic patients receiving inhaled corticosteroids often take frequent add-on therapy with albuterol despite on-demand prescription. We wished to evaluate trough methacholine airway hyper-responsiveness (the primary outcome) following regular treatment with racemic salbutamol and levosalbutamol compared to placebo, in steroid treated a...

Background Previous studies have suggested that use of macrolide antibiotics may increase cardiovascular risk. Objective To study the effects of clarithromycin on cardiovascular events in the setting of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and community acquired pneumonia (CAP). Design Cohort study of two prospectiv...

Aims: Alveolar nitric oxide (CA(NO)) is a potential biomarker of small airway inflammation. We investigated effects on CA(NO) of the addition of coarse and fine particle inhaled corticosteroids to standard therapy in severe asthma. Methods: Severe asthmatics taking ≥1600 µg day(-1) budesonide or equivalent performed a randomized open-label cross...

We compared titrating inhaled corticosteroid (ICS) against mannitol airway hyperresponsiveness (AHR) or a reference strategy (control) based on symptoms, reliever use, and lung function in primary care. One hundred sixty-four patients with persistent asthma were randomized in parallel group fashion following an initial ICS tapering. Subsequent ICS...

Alveolar nitric oxide (CA(NO)) has been suggested as a surrogate marker of distal airway inflammation in COPD. Coarse particle-inhaled corticosteroids (ICS) have been shown not to suppress CA(NO). We evaluated whether extra-fine particle size ICS (HFA-BDP) or systemic oral corticosteroids could suppress CA(NO) in COPD. Chronic obstructive pulmonary...

β(2)-Agonists have previously been shown to be effective inhibitors of mediator release from airway mucosal mast cells. To evaluate the effects of intranasal salmeterol and fluticasone propionate alone and in combination on the response to nasal adenosine monophosphate (AMP) challenge to assess mast cell activation. Twenty-three patients with persi...

Introduction and Objectives Alveolar nitric oxide (CANO) has been proposed as a potential biomarker of small airway inflammation in severe asthma. We wished to investigate the effects on CANO of the addition of coarse or fine particle inhaled corticosteroids to standard therapy in severe asthma. Methods Severe asthmatics taking =1600 μg/daybudeson...

Previous studies have focused upon the relationship between airway inflammation and hyperresponsiveness with different conclusions. We re-examined the relationship between airway inflammation (FE(NO)), hyperresponsiveness to methacholine (AHR), and calibre (FEV(1) % predicted) in mild-to-moderate asthmatics. We searched our database for asthmatics...

β-adrenoceptor blockers are avoided in asthma due to concerns of bronchoconstriction. We investigated the safety of acute exposure to propranolol in asthmatics, sequentially challenged with histamine to mimic an asthma exacerbation and evaluated the role of intravenous hydrocortisone in potentiating salbutamol reversibility. Persistent atopic asthm...

Tiotropium has been shown to improve lung function, quality of life, and exacerbations and reduce mortality when compared with placebo in COPD. It remains unclear whether benefits are seen when tiotropium is used in conjunction with inhaled corticosteroids (ICSs) plus long-acting β-agonists (LABAs). We performed a retrospective cohort study using a...

The aim of this meta-analysis was to determine if severity assessment tools can be used to guide decisions regarding intensive care unit (ICU) admission of patients with community-acquired pneumonia. A search of PUBMED and EMBASE (1980-2009) was conducted to identify studies reporting pneumonia severity scores and prediction of ICU admission. Two r...

We therefore believe that assessing vitamin D status in a cross-sectional manner from one region may not provide a true picture of the burden of vitamin D deficiency in patients with COPD. However, we agree with the conclusion reached by Janssens et al 1 that trials of vitamin D supplementa-tion in COPD are required.

To examine the effect of β blockers in the management of chronic obstructive pulmonary disease (COPD), assessing their effect on mortality, hospital admissions, and exacerbations of COPD when added to established treatment for COPD. Retrospective cohort study using a disease specific database of COPD patients (TARDIS) linked to the Scottish morbidi...

Introduction and Objectives We wished to examine therelationships between inflammation (FENO),methacholine challenge (AHR) and airway calibre (FEV1%) in a group of mild-to-moderate asthmatics. Methods We searched our patient database forthose individuals with a known diagnosis of asthma who had a methacholine PC20≤ 8 mg/ml. Data regarding FEV1%, FE...

This study compares the in vivo relative lung bioavailability of Hydrofluoroalkane (HFA) Seretide delivered via unprimed and unwashed Aerochamber Plus (AP) or Volumatic (VM) spacers, a integrated breath-actuated vortex Synchro-Breathe (SB) device and an Evohaler pMDI (EH) device using adrenal suppression and early fall in serum potassium (K) as sur...

This study investigates the reasons for hospitalisation in patients with low-risk (CURB-65 score 0–1) community-acquired pneumonia (CAP), with a view to identifying the potential for improving outpatient management. As part of a prospective observational study of CAP, we evaluated reasons for hospitalisation in these low-risk patients. 565 patients...

Much of the focus of inflammatory surrogates and airway challenges in asthma has been directed towards success of therapy and diagnosis. Few have considered them in the context of guiding dose reduction once sufficient control has been achieved. Adenosine monophosphate (AMP) as an indirect bronchial airway challenge, together with non invasive infl...

Introduction and objectives We wished to examine if β blockers reduced mortality in addition to stepwise therapy for COPD, independent of cardiovascular disease. Methods We searched data provided by the Information Services Division of NHS Scotland, to identify patients in NHS Tayside, who required a hospital admission due to COPD. We then searched...

International guidelines recommend a severity-based approach to management in community-acquired pneumonia. CURB65, CRB65 and the Pneumonia Severity Index (PSI) are the most widely recommended severity scores. The aim of this study was to compare the performance characteristics of these scores for predicting mortality in community-acquired pneumoni...

Statins are widely used to lower cholesterol and prevent complications of cardiovascular disease. The non-lipid lowering (pleiotropic) effects of statins may also have applications to the management of infections. These include effects on endothelial function, inflammation and coagulation pathways. Several observational studies have shown a signifi...

Lowest receptor occupancy for a drug occurs at trough prior to the next dose. Previous studies have focused on the effects of triple therapy at peak dose intervals using forced expiratory maneuvers. Impulse oscillometry (IOS) and body plethysmography (PLETH) are more sensitive than spirometry to assess inhaled therapies in COPD. Nineteen patients w...

Elite swimmers have high rates of rhinoconjunctivitis and exercise-induced bronchoconstriction. Moreover, exposure to chlorine and chlorine metabolites is known to induce bronchial hyper-reactivity. To assess the early and late effects of chlorine and exercise on the unified airway of elite swimmers, and to compare the response to mannitol and fiel...

Clostridium difficile infection (CDI) remains a major healthcare problem associated with antibiotic use in hospitals. Recent years have seen a dramatic increase in the incidence of CDI in the UK and internationally. Lower respiratory tract infections (LRTIs) are the leading indication for antibiotic prescription in hospitals and are therefore a cri...

Chlorine metabolites and high training load may produce exercise-induced bronchospasm (EIB) in elite swimmers. The aim of this study was to assess the combined effects of chlorine and exercise on the unified airway of adolescent elite swimmers. The Scottish Midlands District squad were assessed during an indoor pool session at the National Swimming...