Respiratory and Older People's Medicine Respiratory and Older People's Medicine

Overview of Placement

Within Norwich, there is a close collaboration between Respiratory Medicine (Resp Med) and Older peoples’ medicine (OPM). In particular both groups have a strong interest in idiopathic pulmonary fibrosis, Chronic Obstructive Pulmonary Disease (COPD), exercise in lung disease and pneumonia.

Andrew Wilson is currently applicant or co-applicant on grants totalling £8M including studies to evaluate therapeutic interventions in patients with pulmonary fibrosis, sarcoidosis, asthma and COPD. He is the chief investigator for 2 multi-centre clinical trials or investigational studies. These include:

  • the EME-TIPAC study – a NIHR-EME funded clinical trial of co-trimoxazole therapy in 330 patients with idiopathic pulmonary fibrosis [https://www.uea.ac.uk/eme-tipac],

  • the ARRISA-UK study – a NHR HTA funded complex intervention in primary care involving identification of 9170 patients with at-risk asthma, flagging their electronic medical records and training practice staff how to manage their care

Current trainees and PhD students are assessing the role of exhaled breath biomarkers (including volatile organic compounds) in people with acute asthma and those with sarcoidosis, evaluating the role of methylphenidate in sarcoidosis associated fatigue, evaluating the barriers to palliative care referral for people with interstitial lung disease, evaluating impulse oscillometry in people with pulmonary fibrosis and evaluating patient related outcome measures in people with interstitial lung disease.

Yoon Loke is a Convenor of the Cochrane Adverse Effects Methods Group and a clinical pharmacologist specializing in systematic reviews of drug safety. His main interests include the adverse effects of inhaled corticosteroids, as well as prognostic scoring in community-acquired pneumonia.

Helen May along with Martyn Patel are specialty clinical research network leads for Ageing Research for the Eastern Region giving us support to do multi- centre portfolio studies and support other specialties with their research. Niruban Alagaratnam is research lead for the Older peoples’ medicine (OPM) department and works on several movement disorder studies. The OPM  team have research interests that  include deprescribing, hypertension, physiology of cardiovascular ageing, syncope, stroke, movement disorders, mental health, physical and mental comorbidities. Recent OPM participation in NIHR trials have covered dementia and hip fracture, deprescribing studies in collaboration with UEA, the acceptability of continuous glucose monitoring in patients with both Diabetes and cognitive impairment; postural hypotension in older people and memory impairment and depression in stroke disease; the introduction of a toolkit to the MDC clinic to improve both the diagnosis of Lewy Body dementia and the subsequent standard of care. An academic F2 doctor is able to benefit from the research generated by these projects and to participate in aspects of these research projects. Recent post holders have not only worked on their own projects, but also contributed significantly to materials presented at the national British Geriatric Society conference whilst still finding time to recruit patients direct to NIHR multi centre studies. A broad spectrum of experience!

The group currently have three Clinical Academic Chairs, two NIHR Doctoral Fellows, one NIHR Academic Clinical Fellow, one Clinical Research Fellow, two non-clinical PhD students,  five Research Nurses and one Research Assistant.

The post holder will have access to:

  1. Clinical laboratory facilities: OPM Cardiovascular Laboratory (including Transcranial Doppler, BP monitors, Tilt table, Pulse wave velocity measures); Physiology Research Laboratory (including Spirometry, Impulse oscillometry, Airways resistance, Muscle strength and endurance, Exercise challenge tests); Clinical Respiratory Laboratory (including Body Plethysmography, and cardiopulmonary exercise testing)

  2. Clinical research trials and studies: At present there are four multicentre studies hosted by OPM and three studies hosted by respiratory. These offer the experiences only available by well-resourced large scale studies including electronic data capture, electronic case record forms and independent specialist monitors. In addition, the two departments are currently undertaking 20 single centre studies ranging from metagenomics of sarcoidosis lymph node biopsies to the qualitative and quantitative impact of introducing an Older Persons Emergency Department to the care of frail older adults presenting to acute hospital care, providing a wide choice of studies in which an academic F2 can be involved.

  3. Registers: there are currently registers in stroke, TIA, hip fracture and interstitial lung disease. These provide opportunities for data analysis.

  4. Meta-analyses, Audit and Reviewing Journal Articles: Researchers within Resp and OPM have experience undertaking meta-analyses, undertake audit regularly and frequently review articles for peer reviewed journals. This provides a resource for training in these areas.

Examples of work undertaken & outputs

Previous academic foundation doctors have been involved in a wide range of projects including assessment of lung function using novel and experimental techniques including breath condensate, impulse oscillometry, airways resistance measurements; assessment of in patients with COPD and interstitial lung disease using laboratory walking tests and accelerometery, meta-analyses and reviews in the following topics: pneumonia scoring, dysarthria, oral anti-coagulants and antiplatelets, pulmonary rehabilitation, non-lipid lowering effects of statins

  • Chan WY, Clark AB, Wilson AM, Loke YK; TIPAC investigators. The effect of co-trimoxazole on serum potassium concentration: safety evaluation of a randomized controlled trial. Br J Clin Pharmacol. 2017 Aug;83(8):1808-1814
  • Kotecha J, Shulgina L, Sexton DW, Atkins CP, Wilson AM. Plasma Vascular Endothelial Growth Factor Concentration and Alveolar Nitric Oxide as Potential Predictors of Disease Progression and Mortality in Idiopathic Pulmonary Fibrosis. J Clin Med. 2016 Sep 7;5(9). pii: E80
  • Kotecha J, Atkins CP, Wilson AM. Patient confidence and quality of life in idiopathic pulmonary fibrosis and sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2016; 33:341-348
  • Loke YK, Gibert D, Thavarajah M, Blanco P, Wilson AM. Bone Mineral Density and Fracture Risk with Long-term use of Inhaled Corticosteroids in Patients with Asthma: Systematic Review and Meta-Analysis. BMJ Open 2015 24;5(11)e008554
  • Turner RM, Kwok CS, Chen-Turner C, Maduakor CA, Singh S, Loke YK. Thiazolidinediones and associated risk of bladder cancer: a systematic review and meta-analysis. Br J Clin Pharmacol. 2014 Aug;78(2):258-73. doi: 10.1111/bcp.12306.
  • Hayton C, Clark A, Olive S, Browne P, Galey P, Knights E, Staunton L, Jones AP, Coombes E, Wilson AM Barriers to Pulmonary Rehabilitation: characteristics that predict patient attendance and adherence. Respir Med. 2013 107:401-7.
  • Airways resistance in bronchial challenge testing. Baxter MA, Coates D, Wilson AM. J Asthma. 2014 Aug 19:1-6.
  • Jennings BA, Loke YK, Skinner J, Keane M, Chu GS, Turner R, Epurescu D, Barrett A, Willis G Evaluating predictive pharmacogenetic signatures of adverse events in colorectal cancer patients treated with fluoropyrimidines.PLoS One. 2013 Oct 22;8(10):e78053. doi: 10.1371/journal.pone.0078053. eCollection 2013.