Rachael A Evans

Rachael A Evans
University of Leicester, Glenfield Hospital · Respiratory Sciences and Health Sciences

FRCP (UK), PhD
Long COVID, Diagnostic Breathlessness Pathways, Pulmonary Rehabilitation, Exercise, Physical Activity

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156
Publications
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Publications

Publications (156)
Article
Patients with Chronic Heart Failure (CHF) develop similar symptoms of exertional breathlessness and fatigue as patients with COPD. Although pulmonary (exercise based) rehabilitation (PR) is an integral part of the management of COPD, the potential for exercise rehabilitation (ER) to assist patients with CHF may not be as readily appreciated. We inv...
Article
We aimed to describe the minimum important difference (MID) of the incremental shuttle walk test (ISWT) in patients with COPD using both distribution and anchor-based methods. Two cohorts were used (n=613) with eligibility criteria of a clinical diagnosis of COPD, an FEV 1 /FVC <70% and an ISWT (after familiarisation) before and after a 7-week cour...
Article
Full-text available
Background: the impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. Methods:...
Preprint
Full-text available
Background There are currently no effective pharmacological or non-pharmacological interventions for Long-COVID. To identify potential therapeutic targets, we focussed on previously described four recovery clusters five months after hospital discharge, their underlying inflammatory profiles and relationship with clinical outcomes at one year. Metho...
Article
Full-text available
Introduction Chronic breathlessness is a common and debilitating symptom, associated with high healthcare use and reduced quality of life. Challenges and delays in diagnosis for people with chronic breathlessness frequently occur, leading to delayed access to therapies. The overarching hypothesis is a symptom-based approach to diagnosis in primary...
Preprint
Full-text available
Background Most studies of immunity to SARS-CoV-2 focus on circulating antibody, giving limited insights into mucosal defences that prevent viral replication and onward transmission. We studied nasal and plasma antibody responses one year after hospitalisation for COVID-19, including a period when SARS-CoV-2 vaccination was introduced. Methods Plas...
Article
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Objective The prevalence of Metabolic Syndrome (MetS) has been reported to be higher in selected populations of people with COPD. The impact of MetS on mortality in COPD is unknown. We used routinely collected healthcare data to estimate the prevalence of MetS in people with COPD managed in primary care and determine its impact on 5-year mortality....
Article
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Background The number of individuals recovering from severe COVID-19 is increasing rapidly. However, little is known about physical behaviours that make up the 24-h cycle within these individuals. This study aimed to describe physical behaviours following hospital admission for COVID-19 at eight months post-discharge including associations with acu...
Article
One in four adults in the UK have two or more medical conditions. One in three adults admitted to hospital in the UK have five or more conditions. People with multimorbidity have poorer functional status, quality of life and health outcomes, and are higher users of ambulatory and inpatient care than those without multimorbidity. The entire healthca...
Article
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It is a challenge to keep abreast of all the clinical and scientific advances in the field of respiratory medicine. This article contains an overview of laboratory-based science, randomised controlled trials and qualitative research that were presented during the 2021 European Respiratory Society International Congress within the sessions from the...
Article
Full-text available
Background No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the...
Article
Full-text available
Background No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the...
Article
Full-text available
Given the large numbers of people infected and high rates of ongoing morbidity, research is clearly required to address the needs of adult survivors of COVID-19 living with ongoing symptoms (long COVID). To help direct resource and research efforts, we completed a research prioritisation process incorporating views from adults with ongoing symptoms...
Preprint
Introduction Shared characteristics between COVID-19 and pulmonary fibrosis, including symptoms, genetic architecture, and circulating biomarkers, suggests interstitial lung disease (ILD) development may be associated with SARS-CoV-2 infection. Methods The UKILD Post-COVID study planned interim analysis was designed to stratify risk groups and est...
Article
Full-text available
There is now a rich body of knowledge on acute COVID-19, but much less is known about the risk factors, clinical presentation, duration and management of persistent or new symptoms following recovery from initial infection, often termed long COVID1. Post-infection follow-up data show that a significant proportion of hospitalized and non-hospitalize...
Article
Full-text available
Background The longitudinal trajectories of cardiopulmonary abnormalities and symptoms following infection with coronavirus disease (COVID-19) are unclear. We sought to describe their natural history in previously hospitalised patients, compare this with controls, and assess the relationship between symptoms and cardiopulmonary impairment at 6 mont...
Article
Full-text available
Background: The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. Methods...
Article
Full-text available
Background: The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. Methods:...
Article
Full-text available
Background The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. Methods...
Preprint
Full-text available
Background The longitudinal trajectories of cardiopulmonary abnormalities and symptoms following infection with coronavirus disease (COVID-19) are unclear. We sought to describe their natural history in previously hospitalised patients, compare this with controls, and assess the relationship between symptoms and cardiopulmonary impairment at 6 mont...
Article
Full-text available
Objective: Multi-morbidity contributes to mortality and hospitalisation in COPD, but it is uncertain how this interacts with disease severity in risk prediction. We compared contributions of multi-morbidity and disease severity factors in modelling future health risk using UK primary care healthcare data. Methods: Health records from 103,955 pat...
Article
Full-text available
During the COVID-19 pandemic, semi-structured interviews were undertaken with 20 adults awaiting a diagnosis for their chronic breathlessness. Three key themes were identified using thematic analysis: (1) de-prioritisation of diagnosis, (2) following UK ‘lockdown’ guidance for the general population but patients fearful they were more at risk, and...
Article
Full-text available
Background Asthma and COPD continue to cause considerable diagnostic and treatment stratification challenges. Volatile Organic Compounds (VOCs) have been proposed as feasible diagnostic and monitoring biomarkers in airways diseases. Aims To conduct a systematic review evaluating (i) the diagnostic accuracy of VOCs in diagnosing airways diseases, (...
Preprint
Full-text available
Background The impact of COVID-19 on physical and mental health, and employment following hospitalisation is poorly understood. Methods PHOSP-COVID is a multi-centre, UK, observational study of adults discharged from hospital with a clinical diagnosis of COVID-19 involving an assessment between two- and seven-months later including detailed symptom...
Conference Paper
Aim To describe experiences during the COVID-19 pandemic of people living with chronic breathlessness without a diagnosis. Methods As part of a wider mixed methods study (Breathlessness - DiagnosE Early in Primary care: Breathe-DEEP), semi-structured interviews were undertaken with people referred for investigation of chronic breathlessness across...
Preprint
Full-text available
Objectives Fatigue is a pervasive clinical symptom for many infected with respiratory viruses such as influenza or coronaviruses. Prior evidence from influenza and coronavirus epidemics suggest that fatigue symptomology may continue beyond the acute phase, lasting for several months to several years post-discharge. This systematic review aimed to e...
Article
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Introduction: The impact of the SARS-CoV-2 pandemic, and lockdown measures, on acute exacerbations of COPD (AECOPD) is unknown. We aimed to evaluate the change in AECOPD treatment frequency during the first six weeks of lockdown in the UK compared with 2019 and assess changes in self-reported behaviour and well-being. Methods: In this observation...
Preprint
Full-text available
Introduction: The impact of the SARS-CoV-2 pandemic, and lockdown measures, on acute exacerbations of COPD (AECOPD) is unknown. We aimed to evaluate the change in AECOPD treatment frequency during the first six weeks of lockdown in the UK compared with 2019 and assess changes in self-reported behaviour and well-being. Methods: In this observational...
Article
Background Eccentric cycling (ECC) may be an attractive exercise modality in COPD due to both low cardiorespiratory demand and perception of effort compared to conventional concentric cycling (CON) at matched mechanical loads. However, it is unknown whether ECC can be performed by individuals with COPD at an intensity able to cause sufficient metab...
Chapter
Cardiovascular co-morbidity is common in patients with COPD. Although the services of cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) are organised according to specialty, this is a slight misnomer as the main benefits of both services occur via the systemic features of the conditions. There is therefore a need to consider how service...
Article
Background Currently the acceptability and efficacy of pulmonary rehabilitation (PR) for adults with severe asthma is unknown. Objective We investigated the feasibility of performing a randomised controlled trial of asthma-tailored PR (AT-PR) versus usual care (UC). Methods Adults with severe asthma were recruited and randomised 2:1 to AT-PR:UC....
Article
Background We investigated the effect of aerobic training and exercise prescription on peak oxygen uptake (V̇O2peak) in COPD. Methods A systematic review was performed using MEDLINE, EMBASE, CINAHL and Cochrane databases for all studies measuring V̇O2peak before and after supervised lower limb aerobic training in COPD (PROSPERO CRD42018099300). A...
Conference Paper
Introduction and objectives Although advanced COPD is associated with poor survival, individual trajectories are difficult to predict and clinician ability to recognise those in the last year of life is unknown. Factors which are prognostic for mortality have been identified across the spectrum of COPD severity. Whether they retain prognostication...
Conference Paper
Introduction Self-reported gastro-oesophageal reflux disease (GORD) and associated laryngopharyngeal reflux (LPR) are common co-morbidities in patients with COPD and associated with an increased risk of exacerbations.1 2 However, history of GORD or LPR are not routinely collected in these patients. Furthermore, silent reflux may predispose patients...
Conference Paper
Introduction Current WHO physical activity guidelines recommend adults accumulate ≥150 minutes per week of moderate intensity activity in bouts of ≥10 minutes. We aimed to compare daily physical activity levels and intensity of physical activity between adults with severe asthma and healthy controls. Methods Adults with severe asthma, defined by s...
Conference Paper
Background Eccentric cycling (ECC) may be an attractive exercise modality in COPD due to lower cardiorespiratory demand and perception of effort compared to conventional concentric cycling (CON) at equivalent mechanical workloads. However, it is unknown whether ECC can be performed by individuals with COPD at an intensity able to induce metabolic a...
Poster
Background: Eccentric cycling (ECC) may be an attractive exercise modality in COPD due to both low cardiorespiratory demand and perception of effort compared to conventional concentric cycling (CON). However, it is unknown whether ECC can be performed by individuals with COPD at an intensity able to induce metabolic adaptation. Methods: 13 individ...
Article
Full-text available
Combined exercise rehabilitation for chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) is potentially attractive. Uncertainty remains as to the baseline profiling assessments and outcome measures that should be collected within a programme. Current evidence surrounding outcome measures in cardiac and pulmonary rehabilitat...
Article
Full-text available
Introduction Adults with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) commonly suffer from exertional dyspnoea and fatigue. Exercise training is recommended in the management of both diseases, yet many of the outcome measures traditionally reported are disease specific and may not fully acknowledge the multimorbid ol...
Article
Background: The management of severe asthma poses many challenges related to treatment, adherence, and psychosocial morbidity. There is little direct data from the patient perspective to understand and negotiate the complexities of managing severe asthma. Objective: To explore the patient perceptions of living with severe asthma and the experien...
Article
Full-text available
Pulmonary rehabilitation (PR) is a complex intervention with described core components of individualized exercise training and inter‐disciplinary education in international guidelines. Compared to the overwhelming evidence of benefit for exercise training, the education component has received little attention. Educating patients about their symptom...
Article
Full-text available
Background and objective We investigated the repeatability and validity of the incremental shuttle walk test (ISWT) distance compared to peak oxygen uptake (VO2pk) during maximal incremental cycle ergometer (ICE) and treadmill (ITM) tests in adults with severe asthma. Methods Adults with severe asthma, Medical Research Council (MRC) dyspnoea ≥2, w...
Article
Full-text available
It is important for clinicians and researchers to understand the effects of treatments on their patients, both at an individual and group level. In clinical studies, treatment effects are often reported as a change in the outcome measure supported by a measure of variability; for example, the mean change with 95% confidence intervals and a probabil...
Article
Full-text available
We investigated whether the differences in exercise limitation between patients with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF) affect the repeatability or responsiveness of incremental exercise tests. Patients with COPD (Medical Research Council dyspnoea grade 2–5) and patients with CHF (New York Heart Association...
Conference Paper
Introduction and objectives Little is known on the uptake and completion of pulmonary rehabilitation (PR) in adults with COPD and either left or right heart failure (HF) (cor pulmonale [CP]). Furthermore, the responsiveness related to PR is unknown. The objectives were to explore completion rates and outcome measures in patients with COPD and co-ex...
Conference Paper
Background The recent National COPD Audit: Pulmonary Rehabilitation (PR) report¹ indicated completion of PR was associated with a survival advantage at 180 days. We investigated whether this was related to the effects of PR or to confounding due to differences in case-mix severity. Methods PR services across England and Wales provided data for all...
Chapter
Over the past two decades, a growing evidence base has emerged to support the benefits of pulmonary rehabilitation. It is now firmly established as a cornerstone of management in chronic obstructive pulmonary disease and other chronic respiratory diseases. This chapter describes the evidence base supporting the use of pulmonary rehabilitation, and...
Conference Paper
Background: Although exercise training is beneficial for patients with COPD, the magnitude of effect on V̇O2peak is unknown. Aim: To investigate the effect of conventional lower limb aerobic training (including training volume, platform and mode) on V̇O2peak in patients with COPD. Method: A systematic review was performed using MEDLINE, EMBASE, C...
Conference Paper
Rationale – Eccentric exercise, comprising muscle contractions during active lengthening, demonstrates a lower cardiopulmonary demand than traditional concentric exercise. It is therefore an attractive training modality for a disease population, particularly chronic respiratory disease where maximal exercise is often limited by ventilatory constrai...
Conference Paper
Introduction Adults with severe asthma have exercise-related symptoms and the underlying mechanism is not clearly understood. We aimed to assess 1) dynamic hyperinflation (DH) and its contribution to exercise intolerance in patients with severe asthma compared to healthy individuals; 2) the presence and magnitude of DH compared with other physiolo...
Article
Full-text available
Despite the high prevalence of osteoporosis in chronic obstructive pulmonary disease (COPD) patients, the fracture risk prediction tools are not routinely undertaken in the management of COPD. We quantified fracture risk using a validated risk prediction tool (Fracture Risk Assessment (FRAX®)) and determined potential bone-protection treatment need...
Conference Paper
Full-text available
Leicester Biomedical Research Centre, University of Leicester, Leicester, UK ²Respiratory Department, Glenfield Hospital, Leicester, UK ³Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK ⁴Centre for Exercise Rehabilitation Science, Glenfield Hospital, Leicester, UK Introduction There is limited evidence reg...
Article
Gait speed is used increasingly to predict function and future well-being among healthy elderly as well as for those with long term medical conditions. When selecting outcome measures such as walk speed, it is important to include the circumstances under which the measurement is made in order to avoid bias and ensure accurate recommendations. We co...