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com

Poster sessions

Methods  A prospective observational cohort study of patients asked their patients about birth-weight, being born preterm, preg-
admitted with an acute exacerbation of COPD (AECOPD) was per- nancy and postnatal complications, and time in a neonatal unit;
formed. Patients were >40 years of age, with spirometry confirmed whether patients’ knew this information, and also whether mem-
COPD, admitted to one of 12 UK centres between 2009–2012. bers believed their patients had airflow limitation due to prematu-
Hazard ratios for mortality and cardiovascular events at 1 year rity or low birth-weight.
follow up, based upon the presence of either sinus tachycardia or Results  There was good geographical spread of the 123 replies
new onset AF at the initial hospital admission were calculated (61% consultants, 21% doctors in training, 15% nursing profession,
through Cox proportional hazard regression analysis following cor- 2% GPs and 1% SAS doctors). 93% worked in the secondary care
rection for influential covariates. Logistic regression was performed sector (55% in teaching hospitals), and only 13 dealt predominantly
to calculate odds ratios (OR) identifying predictor variables of both with children (12 in hospital, 1 community).
sinus tachycardia and AF. Results are summarised in the Table. Only a small minority
Results  1343 patients were included in our study. New onset AF (mainly hospital paediatricians) ask “most respiratory patients”
was recorded in 155 patients (12%) of patients. Mean (IQR) age was about early life factors. In those who do ask, there is a wide varia-
72(63–79). Mean (95%CI) FEV1% predicted and MRC dyspnoea tion in patient knowledge, this being greatest for children, in whom
score were 46 (34–67) and 4 (3–5) respectively. Hazard Ratios parental recall or use of the “red book” assisted. Although 47%
(95%CI) for new onset AF and tachycardia are displayed in table 1. thought some of their patients were born preterm or had a low
Factors predicting new onset AF included; history of IHD (OR birth-weight, 46% were unaware and 7% thought there were none.
4.8; 95%CI 2.95–7.80), increasing age (OR 1.03; 95% CI 1.01–1.07) Discussion  Given evidence suggesting early life factors do impact
and worsening MRC dyspnoea score (OR 1.74; 95%CI 1.31–2.29). on respiratory health, the survey suggests little current consider-
Prior beta blocker use was not significant (OR 0.68; 95%CI ation is given to these in adult medicine. Limited retrospective recall
0.35–1.28). may preclude accurate assessment. To develop a greater understand-
For sinus tachycardia >120bpm, there were significant relation- ing of the potential impact of early life influences on chronic respira-
ships for MRC dyspnoea score (OR 1.73; 95%CI 1.43–2.09), respira- tory disease requires a new approach, for example accessing early
tory acidosis (OR 1.80; 95%CI 1.20–2.70) and aminophylline medical records, recall by a living parent of the patient or via a pre-
treatment (OR 1.53; 95%CI1.06–2.20). Prior beta blocker use was term registry. In tandem, training needs to address the gaps in his-
protective (OR 0.68; 95% CI 0.47–0.97). tory taking.
Conclusions  The presence of tachycardia and new onset AF in
patients admitted with AECOPD are associated with a deleterious
effect on short and long term mortality. For sinus tachycardia risk Abstract P217 Table 1
was greatest around the time of exacerbation, however new onset
AF also heralds more significant 1 year mortality and risk of cardiac “Do you ever ask patients you review about….”
events. Perinatal or pregnancy
complications or time in
Birth-weight? Born Preterm? Neonatal unit?
Abstract P216 Table 1  Hazard Ratios for Mortality and Cardiovascular Most patients with 14% 20% 20%
Events respiratory disease
Occasionally 27% 37% 38%
Cardiovascular events (acute Selected patients 4% 8% 4%
In hospital 1 year coronary syndrome, cardiac – asthma, COPD,
Predictor mortality mortality failure, serious arrhythmia) restrictive lung disease or
combination
HR>100 (sinus) 1.43 (0.83-2.46) 1.31 (1.02-1.67) 1.06 (0.81-1.39)
Do not ask 55% 35% 38%
HR>110 (sinus) 1.87 (1.12-3.11) 1.33 (1.04-1.71) 1.14 (0.88-1.49)
HR>120 (sinus) 2.25 (1.33-3.83) 1.37 (1.04-1.81) 1.23 (0.89-1.70)
New onset atrial 2.14 (1.26-3.62) 1.60 (1.20-2.12) 1.44 (1.07-1.96)
fibrillation P218 PREVALENCE OF BRONCHIECTASIS IN COPD PATIENTS IN
A GENERAL RESPIRATORY CLINIC
doi:10.1136/thoraxjnl-2012-202678.279

P217 CURRENT PRACTISE IN CONSIDERING EARLY LIFE

1
SE Brill, S Sikka, CE Miller, A Ghali, S Hare, 1R Vancheeswaran. 1Department of
1 1 2 2

FACTORS IN RESPIRATORY DISEASE: A BRITISH THORACIC Thoracic Medicine, Barnet Hospital, London, United Kingdom; 2Department of Radiology,
SOCIETY SURVEY Barnet Hospital, London, United Kingdom

doi:10.1136/thoraxjnl-2012-202678.278 Introduction  There is increasing recognition that radiological

bronchiectasis is present in many patients with COPD. However,
1
CE Bolton, A Bush, JR Hurst, S Kotecha, LP McGarvey, J Stocks, M Walshaw.
2 3 4 5 6 7

1
University of Nottingham, Nottingham, UK; 2Imperial College London, London, UK; estimated prevalence varies from 4% (Agusti, Respir Res; 2010) to
3
University College London, London, UK; 4Cardiff University, Cardiff, UK; 5The Queen’s 50% (Patel, AJRCCM; 2004), with the prevalence in the UK general
University of Belfast, Belfast, UK; 6UCL Institute of Child Health, London, UK; 7Liverpool secondary care population unknown. We assessed this in patients
Heart and Chest Hospital, Liverpool, UK from the respiratory clinic at our general hospital.
Methods  COPD patients underwent chest CT as part of their clini-
Background  Despite an 8% UK preterm birth rate and the improved cal assessment. Patients were included if COPD was diagnosed based
survival of very preterm infants into adulthood, we hypothesised on spirometry and clinical assessment and excluded if there was
that the longer term impact of early life factors on respiratory health clinical bronchiectasis. Scoring was by a simplified system based on
and disease is not routinely considered by respiratory specialists. We Smith (Thorax, 1996) and returned a score of 0 (no bronchiectasis),
surveyed BTS members to determine their practise. 1 (0–50% of bronchi involved), or 2 (50–100% of bronchi involved)
Methods  Using a survey link, an email was sent twice, 4 weeks for each lobe, with a total score of 12 including the lingula; emphy-
apart, to clinically active BTS members, enquiring whether they sema, interstitial lung disease (ILD), or other pathology was noted.

Thorax 2012;67(Suppl 2):A1–A204 A159

 Downloaded from http://thorax.bmj.com/ on October 29, 2016 - Published by group.bmj.com

Poster sessions

The scans were scored independently by two radiologists blinded to Methods  Gender, demographics and symptoms were examined for
disease severity and the average score used for analysis. patients referred by a GP to a community spirometry service with
Results  100 COPD patients were included. Patient characteristics “suspected COPD or “definite COPD” over a 4 year period. These
are summarised in Table 1. were compared with the final diagnosis after spirometry and spe-
Bronchiectasis was present in 74% of patients (score ≥2/12) and cialist review.
there was significant inter-observer correlation in the scoring Results  445 GP referrals for “suspected” or “definite COPD” (221
(r=0.60, p<0.0001). Scores were highest in the lower lobes and low- Males, 224 females) were reviewed. When the GP suggested a diag-
est in the middle lobes (1.56 vs 0.96, p<0.000). Patients with wide- nosis of “definite COPD” (n=180), this was confirmed in 87.5% of
spread bronchiectasis (score ≥6/12, n=27) had a trend towards men (77/88) and 73.9% (68/92) of women (p=0.022). There was a
reduced bronchodilator reversibility (4% vs 9%, p=0.08) than those trend for women to present more frequently with allergies
with limited bronchiectasis. Other spirometric criteria were similar (p=0.055) and men with progressive breathlessness as their main
(FEV1%predicted 61 vs 53 [p=0.11], residual volume% predicted 145 symptom (p=0.051). Similarly for those with suspected COPD
vs130, p=0.28, TLCO%predicted 55 vs 52, p=0.54) and rates of (n=265) 60.9% (81/133) of men and 43.2% (57/132) of women had
P. seudomonas aeruginosa colonisation (7.4% vs 5.5%, p=0.73). this diagnosis confirmed (p=0.004). Women were more likely to
Emphysema was present in 88% and ILD in 11%. report allergies (p=0.002), although a large percentage (81%)
Conclusions  In this study, we found a higher prevalence of bron- reported symptoms starting in later decades. Females who did not
chiectasis than previously reported which may reflect the heteroge- receive a diagnosis of COPD (n=75) had a lower prevalence of
neity of COPD patients in a general respiratory clinic. Radiological smoking (ex/current smokers (79%, 59/75, p=0.042) compared to
features of bronchial wall thickening and mild bronchiectasis were women who received a diagnosis of COPD (91%, 52/57). Women
commonly seen and when widespread this may result in reduced who did not have COPD confirmed were likely to have a non-­
bronchodilator reversibility; however, the presence of radiological respiratory cause for their symptoms (45%, 34/75), normal spirom-
bronchiectasis was not related to disease severity. Further work is etry (33%, 25/75), restrictive spirometry (13%, 10/75) and asthma
needed to delineate the clinical consequences of this and the impli- (8%, 6/75).
cations for appropriate bronchodilator therapy. Men who did not have COPD (52/133) were likely to have nor-
mal spirometry (69%, 36/52), restrictive spirometry (15%, 8/52), a
non-respiratory cause (8%, 4/52) or asthma (6%, 3/52). In this
Abstract P218 Table 1
group 86% of men smoked (45/52) compared to 95% (77/81) of
those with confirmed COPD.
Conclusions  In GP referrals with “suspected” and “definite”
COPD, there were significant differences in final diagnosis between
men and women after spirometry. Women were more likely to have
a GP diagnosis of COPD which was amended after spirometry. High
levels of smoking were evident in both groups perhaps influencing
GPs towards this, as opposed to other possible diagnoses, particu-
larly in women.
1. Mosca L et al. Circulation 2005; 111:499–510.

Care of advanced lung disease: NIV and

beyond

P220 EVOLVING SET-UP PRACTISES AT A RESPIRATORY WARD-

BASED NON-INVASIVE VENTILATION (NIV) UNIT
doi:10.1136/thoraxjnl-2012-202678.281
1
S Agarwal, B Beauchamp, B Chakraborty, 1K Morley, 1A Oakes, 1S Ejiofor,
1 2

1
E Gallagher, 1R Mukherjee. 1Birmingham Heartlands Hospital, Birmingham, UK; 2School
of Mathematics, Univ. of Birmingham, Birmingham, UK

Introduction NIV for acute hypercapnic respiratory failure

(AHRF) in COPD, obesity related morbidity, chest wall and neuro-
muscular conditions has become widespread in the UK over the past
decade. In terms of acute NIV set up, the BTS/Royal College of
Physicians/Intensive Care Society 2008 guidance recommends
starting with an inspiratory positive airway pressure (IPAP) of 10
cm H2O and expiratory positive airway pressure(EPAP) of 4–5
cmH2O, with small increments in IPAP aiming for apressure target
P219 GENDER DIFFERENCES IN GP SUGGESTED DIAGNOSIS FOR
of 20 cm H2O or until therapeutic response is achieved. We felt it
COPD IN PRIMARY CARE
necessary to analyse trends in maximum pressures achieved in the
doi:10.1136/thoraxjnl-2012-202678.280 evolution of a respiratory ward-based NIV Unit (established2004).
1
NJ Roberts, 2IS Patel, 2MR Partridge. 1Glasgow Caledonian University, Glasgow, Methods  Comparison of the in-house NIV registry data01/08/2004
Scotland; 2Imperial College London, London, United Kingdom –31/01/2006(Period 1) with 01/01/2011–30/06/2012 (Period 2) at an
11-bedded ward-based NIV unit within a1000-bedded hospital
Background  Mosca et al has shown that clinicians fail to recognise Trust in central England, looking at maximum IPAP and maximum
cardiovascular risk in women (1). We have explored whether the EPAP achieved. There were 281 episodes of AHRF treated in Period
same applies to COPD. 1 and 240 in Period 2 with similar distribution of gender.

A160 Thorax 2012;67(Suppl 2):A1–A204

 Downloaded from http://thorax.bmj.com/ on October 29, 2016 - Published by group.bmj.com

P218 Prevalence of bronchiectasis in COPD

patients in a general respiratory clinic
SE Brill, S Sikka, CE Miller, A Ghali, S Hare and R Vancheeswaran

Thorax 2012 67: A159-A160

doi: 10.1136/thoraxjnl-2012-202678.279

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