Richard Douglas Turner

Richard Douglas Turner
Imperial College Healthcare NHS Trust · Division of Respiratory Medicine

MA, MBChB, MRCP, DTM+H, PhD

About

68
Publications
5,811
Reads
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402
Citations
Citations since 2016
41 Research Items
375 Citations
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2016201720182019202020212022020406080100
2016201720182019202020212022020406080100
2016201720182019202020212022020406080100
Additional affiliations
July 2016 - April 2019
King's College Hospital NHS Foundation Trust
Position
  • Consultant
June 2012 - August 2015
Homerton University Hospital NHS Foundation Trust
Position
  • Researcher
August 2008 - June 2012
Sheffield Teaching Hospitals NHS Foundation Trust
Position
  • Respiratory Registrar

Publications

Publications (68)
Article
Full-text available
Cough is a predominant feature of respiratory infection and, in tuberculosis, is of prime importance for transmitting infection. Tuberculosis is transmitted by the air, yet the process by which bacilli are aerosolized has received little attention. Features of cough may account for differences in transmission rates from source cases of pulmonary di...
Article
Full-text available
Chronic cough is common in the community and can cause significant morbidity. It is not clear how closely treatment guidelines are used in general practice, or how often specialist referral is indicated. We aimed to assess the management of chronic cough in primary care before referral to a cough clinic, and to assess the outcome of managing chroni...
Article
Full-text available
Setting: Although cough in tuberculosis (TB) is presumed to be important for transmission, there is little objective supporting evidence. Objective: To describe 24-h cough frequency in a group with TB, and investigate associations with household rates of infection. Design: Patients with a new diagnosis of pulmonary TB underwent 24-h cough freq...
Article
Cough is a prominent symptom of pulmonary tuberculosis (TB), one of the oldest and most prevalent infectious diseases. Coughing probably has a pivotal role in transmission of the causative organism Mycobacterium tuberculosis. Despite this, little research to date has addressed this subject. Current knowledge of the mechanisms of cough in TB and how...
Article
Full-text available
Objectives The primary objective of MATIS is to determine the efficacy of ruxolitinib (RUX) or fostamatinib (FOS) compared to standard of care (SOC) with respect to reducing the proportion of hospitalised patients progressing from mild or moderate to severe COVID-19 pneumonia. Secondary objectives, at 14 and 28 days, are to: Determine the efficacy...
Article
Introduction: Severe COVID-19 pneumonia is characterised by respiratory and multi-organ failure in the context of marked systemic inflammation. This hyperinflammatory syndrome is reflected by the elevation of several inflammatory molecules, such as C-reactive protein (CRP), ferritin, IL-6, troponin, and D-dimer. In a subset of patients, early inter...
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...
Preprint
Full-text available
The primary objective of MATIS is to determine the efficacy of ruxolitinib (RUX) or fostamatinib (FOS) compared to standard of care (SOC) with respect to reducing the proportion of hospitalised patients progressing from mild or moderate to severe COVID-19 pneumonia. Secondary objectives, at 14 and 28 days, are to: · Determine the efficacy of RUX or...
Article
Cough and pain appear at first glance to be two common, yet very distinct, symptoms. However, further consideration and a review of the current literature rapidly reveals analogies and deeper similarities between the two. At a basic level, both symptoms represent physiologic responses that are protective and adaptive, but in chronic pathologic stat...
Chapter
Chronic cough is a common reason for medical consultation, and effective assessment is essential for management. A routine clinical assessment should include history, examination, a chest radiograph and spirometry as a minimum. Further investigations should be guided by the presenting features, comorbidities, and previous investigation results and...
Article
Cough reflex hypersensitivity (CRH) and impaired cough suppression are features of chronic refractory cough (CRC). Little is known about cough suppression and CRH in cough associated with chronic obstructive pulmonary disease (COPD). This study investigated the ability of participants with COPD to suppress cough during a cough challenge test in com...
Conference Paper
ntroduction Acute cough is a common symptom of respiratory tract infection (RTI) though there is currently no validated acute cough severity assessment tool. A preliminary Acute Cough Scale (ACS) was developed following focus groups and interviews with healthcare professionals and patients. We investigated the internal consistency, responsiveness a...
Article
The widespread use of cough counting tools has, to date, been limited by a reliance on human input to determine cough frequency. However, over the last two decades advances in digital technology and audio capture have reduced this dependence. As a result, cough frequency is increasingly recognised as a measurable parameter of respiratory disease. C...
Article
Full-text available
Background Cough is predictive of exacerbations of chronic obstructive pulmonary disease (COPD). Little is known about cough reflex sensitivity during exacerbation of COPD and whether it is associated with exacerbation frequency. This pilot study aimed to investigate cough reflex sensitivity during and following recovery from exacerbation of COPD,...
Conference Paper
Introduction Cough leads to increased intra-abdominal pressure, thus chronic cough may increase the risk of stress urinary incontinence. We investigated the prevalence, duration and frequency of urinary incontinence in female patients with chronic cough. Methods Consecutive female patients with chronic cough were recruited from a tertiary speciali...
Conference Paper
Introduction Increased cough is common in chronic obstructive pulmonary disease exacerbations (ECOPDs). We hypothesised that cough reflex sensitivity (CRS) is increased during ECOPD, and that CRS is associated with future ECOPD risk. Methods Patients hospitalised with ECOPD underwent inhaled capsaicin challenges to determine threshold concentrat...
Conference Paper
Introduction Inflammation-mediated sensory sensitisation may increase breathlessness intensity relative to neural respiratory drive (NRD) during ECOPD. We hypothesised that breathlessness intensity is higher relative to NRD during ECOPD than at recovery. Methods Patients hospitalised with ECOPD underwent the incremental shuttle walk test (ISWT)...
Article
The accurate and consistent assessment of cough is essential not only for optimum standards of clinical care but also to drive forward advances in our understanding of cough. A range of tools for the subjective and objective measurement of cough exists, and their ongoing development has coincided with growth in clinical and preclinical research in...
Article
Full-text available
Functional brain imaging in individuals with chronic cough demonstrates reduced activation in cortical regions associated with voluntary cough suppression. Little is known about the ability of patients with chronic cough to suppress cough. This study aimed to compare the ability to voluntarily suppress cough during inhaled capsaicin challenge in pa...
Conference Paper
Introduction Functional MR brain imaging data suggest a reduction in voluntary cough suppression may be an important mechanism underlying chronic refractory cough (CRC). Cough is a common symptom of COPD. The ability to suppress cough voluntarily in COPD is not known; a better understanding may yield an insight into the mechanisms of cough in COPD....
Conference Paper
Introduction Increased breathlessness is a cardinal symptom of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Breathlessness intensity is closely related to neural respiratory drive (NRD). However, it has been proposed that airway inflammation, leading to sensitisation of pulmonary C-fibres, may increase breathlessness inten...
Conference Paper
Introduction Acute cough is a common symptom of upper respiratory tract infections (URTI); a condition with a high health economic impact. There is currently no validated acute cough symptom severity assessment tool. A preliminary Acute Cough Scale (ACS) was developed following focus groups and semi-structured interviews with patients and healthcar...
Conference Paper
Introduction Increased cough is a defining feature of exacerbations of chronic obstructive pulmonary disease (COPD). In order to investigate the role of airway afferent sensitisation, we investigated cough reflex sensitivity (CRS), and objective cough frequency, during and 6 weeks after COPD exacerbations. Methods Patients hospitalised with COPD...
Conference Paper
Introduction Breathlessness intensity is closely related to neural respiratory drive (NRD) but inter-individual variation in this relationship is unknown. We aimed to investigate the inter-individual variability of breathlessness-NRD relationships in COPD. Methods 10 stable COPD patients (median(IQR) age 64(59-72), 7 male, FEV1 46(39-77)% predic...
Conference Paper
Introduction A recent fMRI study has shown that patients with chronic refractory cough (CRC) have reduced activity in regions of their brains associated with voluntary cough suppression. There is a wide overlap between patients with CRC and healthy individuals in cough challenge tests, hence their limited clinical application. Cough challenge tests...
Conference Paper
Introduction Urge to cough is a conscious perception of the need to cough. We investigated urge-to-cough, triggers and somatic sensations associated with cough in patients with COPD and compared it to patients with chronic refractory cough (CRC). Methods We undertook a prospective case-control study of COPD patients with chronic cough (>8 weeks) a...
Conference Paper
Introduction A recent functional MRI study has shown that patients with chronic refractory cough (CRC) have reduced activity in the areas of the brain associated with cough suppression. Cough challenge tests focus only on provoking cough and have limited clinical application due to the wide overlap between healthy subjects and patients with cough....
Article
Full-text available
The transmission of tuberculosis is complex. Necessary factors include a source case with respiratory disease that has developed sufficiently for Mycobacterium tuberculosis to be present in the airways. Viable bacilli must then be released as an aerosol via the respiratory tract of the source case. This is presumed to occur predominantly by coughin...
Conference Paper
Introduction The efficacy of some anti-tussives is greater in patients with higher cough frequency (CF). We investigated the sensitivity and specificity of symptom scales for identifying raised 24-hour CF (CF24). Method Subjects attending a cough clinic underwent 24-hr ambulatory cough monitoring with Leicester Cough Monitor (normal CF24 <5 c/h)....
Article
Introduction and objectives The afferent receptor TRPV1 is implicated in the cough reflex. Several single nucleotide polymorphisms (SNPs) in TRPV1 appear to be associated with symptoms of cough in the general population.¹ We investigated whether such SNPs are associated with the objective measures of cough reflex sensitivity and 24-hour cough frequ...
Conference Paper
Introduction and objective Cough is prominent in pulmonary tuberculosis (TB) and transmits infection, yet no tool has been validated for assessing cough symptoms. We evaluated the Leicester Cough Questionnaire (LCQ) for measuring cough-related quality of life (QOL) in TB. Method The face validity of the LCQ was evaluated by structured interviews wi...
Conference Paper
Introduction and objective Cough is predominant in pulmonary tuberculosis and transmits infection, yet it is unclear how rapidly it responds to treatment. We explored changes in objectively-measured cough frequency during TB therapy with respect to other markers of disease. Method Before or on commencing anti-tuberculous treatment, consecutive pati...
Article
Background: Coughing is important in the transmission of tuberculosis (TB). It is not known if characteristics of cough in TB are distinct and whether they are clinically useful. Aims: To compare temporal patterns of coughing in TB to those in COPD and refractory chronic cough. Methods: Patients with stable COPD, refractory chronic cough and newly-...
Article
Extract The recent European Respiratory Society (ERS) Task Force Report on chronic cough [1] should be commended for drawing attention to a neglected area of respiratory medicine and discussing controversies surrounding the approach to this common clinical problem. Cough hypersensitivity syndrome is proposed as a new shorthand to refer to patient-r...
Conference Paper
Introduction. Patterns of cough in tuberculosis influence transmission of disease yet have been little studied. We report the prevalence, duration, severity and frequency of coughing in tuberculosis. Method. The first part was a retrospective review of the medical records of all individuals diagnosed with pulmonary tuberculosis (PTB) at our hospita...
Article
Background Interferon-gamma release assays (IGRAs) are being used to confirm significant exposure to tuberculosis (TB) after a positive tuberculin skin test (TST). We explored the variability of a positive test in a large UK TB clinic amongst contacts of active disease. Methods The records of all individuals notified with active TB and of their scr...
Article
Background Cough causes morbidity and transmits disease yet has been under-researched. The best method for recognising and counting coughs remains unclear. We tested the accuracy of the human ear and measured the influence of visual data on cough counting. We also evaluated PulmoTrack®, a potentially fully-automated cough monitor. Methods Consiste...
Article
Michelsen and colleagues1 usefully add to the evidence for the protective effect of BCG against active TB. However, we are puzzled by the conclusion that BCG also prevents Mycobacterium tuberculosis (Mtb) infection. Others have similarly used interferon gamma release assay (IGRA) responses as a surrogate for Mtb infection with similar conclusions.2...
Article
BCG protects against primary tuberculosis, but evidence for protection against infection with Mycobacterium tuberculosis remains controversial. Roy and colleagues merely showed that previous BCG vaccination is associated with a reduced frequency of positive interferon γ release assay (IGRA) results in children recently exposed to M tuberculosis .1...
Conference Paper
Introduction. Coughing hinders EBUS and aerosolises secretions. Predictors of cough in bronchoscopy and methods of quantifying it are poorly described. Method. Successive patients wore an audio recorder and microphone immediately before, during and after EBUS. Each recording was analysed by one of three authors; half were re-analysed by the main a...
Conference Paper
Full-text available
Introduction Cough is the unique respiratory symptom. Although associated with a range of conditions it has been little studied in acute respiratory disease. We describe cough frequency and cough-related quality of life in this group. Method Participants had a diagnosis of acute exacerbation of asthma (asthma), chronic obstructive pulmonary disease...
Article
Full-text available
Nitrofurantoin has well-described associations with a range of adverse pulmonary effects. We report the case of a 72-year old woman with relapsing pneumonitis secondary to the intermittent use of nitrofurantoin, a pattern of disease not well-represented in the literature. The case is also noteworthy as the diagnosis was initially overlooked due to...
Article
Full-text available
On entering medical school we were taught that the most fundamental skill for a medical student to learn was how to elicit an accurate history from a patient, requiring communication skills, an inquisitive mind and, above all, patience. Once the scene was set by the history, the examination would proceed to add depth, colour and clarity to the pati...

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