Publications by authors named "Adam T Hill"

Background And Objective: This study explored the relationship between total bacterial density, airway microbiota composition and clinical parameters in bronchiectasis. We determined changes with time during clinical stability and following antibiotic treatment of a pulmonary exacerbation.

Methods: We conducted a multicentre longitudinal cohort study of UK participants with CT confirmed bronchiectasis.

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  • International guidelines emphasize the importance of airway clearance management in treating bronchiectasis, yet its actual usage across Europe remains unclear.
  • A study involving 16,723 patients from 28 countries showed that 52% reported using regular airway clearance, with significant variation in techniques and usage between countries.
  • Patients using airway clearance tended to have more severe disease and symptoms, and access to specialized respiratory physiotherapy was notably low, especially in Eastern Europe.
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  • - The study utilized a 4-point sputum colour chart to assess airway inflammation in bronchiectasis patients, analyzing data from 13,484 individuals across 31 countries in the EMBARC registry.
  • - Findings revealed that more purulent sputum correlates with worse lung function, a higher severity of the disease, increased frequency of exacerbations, and greater risk of hospitalizations and mortality.
  • - The research concluded that sputum colour serves as an effective, straightforward indicator for predicting clinical outcomes and disease severity in bronchiectasis patients.
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Background: Asthma is commonly reported in patients with a diagnosis of bronchiectasis.

Objective: The aim of this study was to evaluate whether patients with bronchiectasis and asthma (BE+A) had a different clinical phenotype and different outcomes compared with patients with bronchiectasis without concomitant asthma.

Methods: A prospective observational pan-European registry (European Multicentre Bronchiectasis Audit and Research Collaboration) enrolled patients across 28 countries.

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Background: Higher-valency pneumococcal vaccines are anticipated. We aimed to describe serotype distribution and risk factors for vaccine-serotype community-acquired pneumonia (CAP) in the two years pre-SARS-CoV-2 pandemic.

Methods: We conducted a prospective cohort study of adults hospitalised with CAP at three UK sites between 2018 and 2020.

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  • * An international panel of experts created a core outcome set (COS) after a systematic review identified 21 potential outcomes, which were ranked by 562 participants, including parents, patients, and healthcare professionals from diverse backgrounds.
  • * The final COS includes ten outcomes, emphasizing five key areas: quality of life, symptom management, exacerbation frequency, unscheduled healthcare visits, and hospitalizations, aiming to standardize research and enhance clinical care in this field.
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Introduction: Bronchiectasis is a long-term lung condition, with dilated bronchi, chronic inflammation, chronic infection and acute exacerbations. Recurrent exacerbations are associated with poorer clinical outcomes such as increased severity of lung disease, further exacerbations, hospitalisations, reduced quality of life and increased risk of death. Despite an increasing prevalence of bronchiectasis, there is a critical lack of high-quality studies into the disease and no treatments specifically approved for its treatment.

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Background: Bronchiectasis is a heterogeneous, neglected disease with few multicentre studies exploring the causes, severity, microbiology, and treatment of the disease across Europe. This aim of this study was to describe the clinical characteristics of bronchiectasis and compare between different European countries.

Methods: EMBARC is an international clinical research network for bronchiectasis.

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The global burden of bronchiectasis in children and adolescents is being recognised increasingly. However, marked inequity exists between, and within, settings and countries for resources and standards of care afforded to children and adolescents with bronchiectasis compared with those with other chronic lung diseases. The European Respiratory Society (ERS) clinical practice guideline for the management of bronchiectasis in children and adolescents was published recently.

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Purpose: Asthma is a common comorbidity in patients with bronchiectasis and has been shown to increase the risk of bronchiectasis exacerbations. This paper explores the impact of comorbid asthma on patients receiving intravenous antibiotic treatment for bronchiectasis exacerbations.

Methods: This was a post hoc analysis of the Meropenem randomised controlled trial of 90 patients that had intravenous antibiotic treatment for bronchiectasis exacerbations.

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There is a lack of outcome measures with robust clinimetric properties in bronchiectasis. To determine the clinimetric properties (reliability over 1 year during clinical stability and responsiveness over the course of antibiotics for pulmonary exacerbation) of objective and patient-reported outcome measures. This multicenter cohort study included adults with bronchiectasis from seven hospitals in the United Kingdom.

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This British Thoracic Society Quality Standard for Clinically Significant Bronchiectasis in Adults 2022 aims to encourage good practice by setting standards of high-quality respiratory care that services should follow.

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Bronchiectasis is being diagnosed increasingly in children and adolescents. Recurrent respiratory exacerbations are common in children and adolescents with this chronic pulmonary disorder. Respiratory exacerbations are associated with an impaired quality of life, poorer long-term clinical outcomes, and substantial costs to the family and health systems.

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Lung clearance index (LCI) has good intravisit repeatability with better sensitivity in detecting lung disease on computed tomography scan compared with forced expiratory volume in 1 second (FEV) in adults with bronchiectasis. Alternative multiple-breath washout parameters have not been systematically studied in bronchiectasis. To determine the validity, repeatability, sensitivity, specificity, and feasibility of standard LCI (LCI), shortened LCI (LCI), ventilation heterogeneity arising within proximal conducting airways (SVT), and ventilation heterogeneity arising within the acinar airways (SVT) in a cross-sectional observational cohort of adults with bronchiectasis.

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Introduction: Bronchiectasis is characterised by excessive neutrophilic inflammation. Lipid mediators such as prostaglandins and leukotrienes have crucial roles in the inflammatory response. Further characterisation of these lipids and understanding the interplay of anti-inflammatory and proinflammatory lipid mediators could lead to the development of novel anti-inflammatory therapies for bronchiectasis.

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Bronchiectasis refers to both a clinical disease and a radiological appearance that has multiple causes and can be associated with a range of conditions. Disease heterogeneity and the absence of standardised definitions have hampered clinical trials of treatments for bronchiectasis and are important challenges in clinical practice. In view of the need for new therapies for non-cystic fibrosis bronchiectasis to reduce the disease burden, we established an international taskforce of experts to develop recommendations and definitions for clinically significant bronchiectasis in adults to facilitate the standardisation of terminology for clinical trials.

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The global burden of children and young people (CYP) with bronchiectasis is being recognised increasingly. They experience a poor quality of life and recurrent respiratory exacerbations requiring additional treatment, including hospitalisation. However, there are no published data on patient-driven clinical needs and/or research priorities for paediatric bronchiectasis.

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Article Synopsis
  • A study aimed to explore if the duration of intravenous antibiotics for bronchiectasis exacerbations could be shortened based on bacterial load, comparing a 14-day treatment group with a bacterial load-guided group (BLGG).
  • Of the participants, 88% in the BLGG stopped antibiotics by day 8, whereas some in the 14-day group might have done the same, but those on 14 days experienced more exacerbations overall.
  • Although there was a slight trend for improved clinical outcomes by day 21 with the 14-day regimen, the BLGG showed a significantly longer time to the next exacerbation, suggesting that shorter treatment might be adequate for most cases.
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: Amikacin liposome inhalation suspension (ALIS) contains amikacin sulfate, an aminoglycoside antibacterial drug. It has been approved in the US as a combined antibiotic treatment for refractory MAC lung disease patients. ALIS, as an inhaled antibiotic, can deliver amikacin to the infected site effectively and reduce systemic toxicity.

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Maintaining adherence to treatment for tuberculosis (TB) is essential if the disease is to be eliminated. As part of formative research to develop an intervention to improve adherence, we documented the lived experiences of adults receiving anti-TB treatment (ATT) in three UK cities and examined how personal, social, and structural circumstances interacted to impact on individuals' adherence to treatment. Using a topic guide that explored social circumstances and experiences of TB care, we conducted in-depth interviews with 18 adults (six women) who were being or had been treated for TB () and four adults (all women) who were caring for a friend, relative, or partner being treated for TB ().

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Bronchiectasis has been a largely overlooked disease area in respiratory medicine. This is reflected by a shortage of large-scale studies and lack of approved therapies, in turn leading to a variation of treatment across centres. BronchUK (Bronchiectasis Observational Cohort and Biobank UK) is a multicentre, prospective, observational cohort study working collaboratively with the European Multicentre Bronchiectasis Audit and Research Collaboration project.

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