Selected current projects

A multi centre randomised controlled trial of lay led, individualised self management education of adults

“We know that giving control for managing a long term condition such as asthma to patients results in the best outcomes for them. But educating patients on how best to manage their conditions can be time consuming and is often done by nurses. Our study aims to discover whether well-trained patients with asthma can train others with asthma to manage their condition equally well,” said Prof Martyn Partridge.

back to top 

A randomised controlled trial assessing the effects of an intermediate care package in preventing hospitalisation of elderly patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a term used for the conditions of chronic bronchitis and emphysema, diseases that are very common among the elderly and diseases that account for 15% of all general medical admissions to National Health Service Hospitals.

In a recent report on emergency admissions to acute hospitals in London, the King’s Fund concluded that taking better care of elderly patients with COPD could reduce pressures on acute hospitals, and suggested that identification of vulnerable patients with lung disease and “pro-active” rather than “reactive” management might reduce the chances of hospitalisation.

In this study, we are comparing a group of patients with COPD who are managed in the normal way, with another group of patients with COPD who receive all interventions known to be of some benefit to those with this condition. This includes a pulmonary rehabilitation, intensive education regarding self care, targeted advice to their general practitioners regarding how best to manage COPD, and regular contact with specialist respiratory nurses who support the patients in their own homes by a combination of home visits and telephone contact.

The value of such a comprehensive intervention is being studied, in terms of both its ability to reduce admissions to hospital and its impact on quality of life.

back to top

Study of the burden of undiagnosed sleep apnoea

Obstructive Sleep Apnoea Syndrome (OSAS) affects a minimum of 2% of middle aged women and 4% of men. The condition is associated with daytime sleepiness and reduction in quality of life and there is a documented association with hypertension, strokes and heart disease. The daytime sleepiness suffered by those with OSAS is associated with an increased risk of road traffic crashes which may be up to seven times that of the rest of the population.

Work from Canada suggests that hospital admissions and physician costs in the two years prior to the diagnosis of OSAS were significantly higher in those with OSAS than in a control group. In the year prior to diagnosis it has also been shown that prescribed medication costs were significantly higher; medication being needed for hypertension, ischaemic heart disease and congestive heart failure. Our work concerns evaluation of the burden associated with delayed diagnosis of OSAS in a West London population and new methods of screening for OSAS. 166 consecutive patients with diagnosed OSA/HS on Continuous Positive Airway Pressure therapy were asked to identify how long they could recall having symptoms at the time of diagnosis. We found that of the 119 who were drivers, 26 reported at least one or more automobile crashes in the previous five years, with seven respondents having had two, and one having had four such crashes.

Overall the results suggest a general lack of awareness amongst the general population and a probable lack of awareness of the symptoms of OSAS/HS amongst other health professionals. The delay in diagnosis is likely to have significant effects on morbidity and in recent preliminary work it has been shown that those with OSAS/HS show structural changes in brain morphology compared with healthy controls. In addition to the health and quality of life benefits to the individual to be gained by prompt diagnosis, there are also economic aspects in favour of prompt diagnosis and treatment and early benefits in terms of driving performance.

back to top 

Enhancing communication with patients with respiratory disease

Our work is concerned with enhancing the quality of the doctor/patient relationship and the use of pictorial representations to reinforce the spoken word. This includes work converting traditional patient information and Questionnaires into pictorial form more suitable for a multicultural Britain in which patients have differing linguistic abilities.

We have carried out several studies which have provided valuable information about the letters that we send to patients and how useful they are to patients. We have also surveyed their opinions about out of hours clinics. The effectiveness of telephone reminders in respiratory outpatients was also investigated improving attendance by 15% in patients who were contacted.

Current work following on from these studies includes development of an information glossary for respiratory patients, developing software to manage chronic diseases and providing alternative types of consultation such as telephone follow-ups.

back to top 

Teaching Respiratory Medicine

We have undertaken a study to find out how best we teach the accurate diagnosis of respiratory conditions by comparing the acceptability and success of three methods of teaching relevant skills, namely traditional didactic teaching, web based interactive and face to face interactive teaching.

We have also studied if skills taught in the final year of medical school are put into practice.

back to top