M. Shepherd

University of Glasgow, Glasgow, Scotland, United Kingdom

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Publications (4)15.01 Total impact

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    ABSTRACT: Published information on the effectiveness of bronchial thermoplasty (BT) for severe asthma in 'real life' patients is limited. We compared safety and efficacy outcomes 12 months post procedure in 10 clinic patients and 15 patients recruited to clinical trials of BT at the same centre. Baseline asthma severity was greater in the clinic group. Adverse events were similar. Clinical improvements occurred in 50% of the clinic patients compared with 73% of the research patients. © The Author(s), 2015.
    No preview · Article · Aug 2015 · Therapeutic Advances in Respiratory Disease
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    ABSTRACT: Introduction and Objectives Bronchial thermoplasty involves the delivery of radio frequency energy to the airways during flexible bronchoscopy, and possibly exerts its effect by reduction of airway smooth muscle mass (1). Clinical trials of bronchial thermoplasty have shown benefits in the treatment of patients with moderate or severe asthma. We describe our experience of introducing bronchial thermoplasty into a severe asthma clinical service. Methods Funding was obtained from the Greater Glasgow and Clyde NHS Health Board to evaluate bronchial thermoplasty in the treatment of ten patients with moderate to severe asthma. Patients were assessed at the Difficult Asthma Clinic and selected for the procedure using criteria similar to those employed in clinical trials of bronchial thermoplasty. Patients on all forms of asthma medication were eligible for treatment including omalizumab and oral prednisolone. Procedures were performed by 2 physicians or by 1 physician and a nurse, using conscious sedation with alfentanyl and midazolam. One patient required deeper sedation [remifentanyl and propofol] due to a complicated medical history. Bronchial thermoplasty was administered in three sessions, treating the right lower lobe, the left lower lobe and both upper lobes respectively. Follow up is at 3 monthly intervals for both safety and efficacy outcomes. Results Between 2nd June 2011 and 30th April 2012, ten patients underwent bronchial thermoplasty in Glasgow [7 males, 3 females] (Table 1). Six patients were at Step 5 and four at Step 4 of the British Guideline on the Management of Asthma scale. 4/10 were taking oral prednisolone daily and 2/10 were receiving omalizumab treatment [for 4th year and 3rd year respectively]. Treatment sessions were largely uneventful and adverse effects were similar to those reported in clinical trials. To date, there has been a reduction in some asthma medications: two patients receiving omalizumab have successfully discontinued treatment; those taking oral steroids are being weaned off prednisolone. Conclusion Bronchial thermoplasty can be safely delivered in a clinical setting to patients with severe asthma. References
    Preview · Article · Nov 2012 · Thorax
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    ABSTRACT: Dendritic cells (DCs) are crucial for the processing of antigens, T lymphocyte priming and the development of asthma and allergy. Smokers with asthma display altered therapeutic behaviour and a reduction in endobronchial DC CD83 expression compared with non-smokers with asthma. No information is available on the impact of smoking on peripheral blood DC profiles. Determine peripheral blood DC profiles in subjects with and without asthma with differing smoking histories. Forty-three asthmatics (17 smokers, nine ex-smokers and 17 never-smokers) and 16 healthy volunteers (nine smokers and seven never-smokers) were recruited. Spirometry, exhaled nitric oxide and venesection was performed. DC elution was by flow cytometry via the expression of DC surface markers [plasmacytoid (pDC) (BDCA-2, CD303), type 1 conventional (cDC) (BDCA-1, CD1c), and type 2 cDC (BDCA-3, CD141)]. Subjects with asthma displayed increases in all DC subtypes compared with normal never-smokers: [type 1 cDCs - asthma [median% (IQR)]: 0.59% (0.41, 0.74), normal never-smokers: 0.35% (0.26, 0.43), P=0.013]; type 2 cDCs - asthma: 0.04% (0.02, 0.06), normal never-smokers: 0.02% (0.01, 0.03), P=0.008 and pDCs - asthma: 0.32% (0.27, 0.46), normal never-smokers: 0.22% (0.17, 0.31), P=0.043, and increased pDC and type 1 cDCs compared with normal smokers. Smoking did not affect DC proportions in asthma. Cigarette smoking reduced pDC proportions in normal subjects [normal never-smokers: 0.22% (0.17, 0.31); normal smokers: 0.09% (0.08, 0.15), P=0.003]. This study shows for the first time that subjects with asthma display a large increase in peripheral blood DC proportions. Cigarette smoking in asthma did not affect the peripheral blood DC profile but did suppress pDC proportions in non-asthmatic subjects. Asthma is associated with a significant increase in circulating DCs, reflecting increased endobronchial levels and the importance of DCs to the development and maintenance of asthma. (Clinical trials.gov identifier: NCT00411320)
    No preview · Article · Feb 2011 · Clinical & Experimental Allergy

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