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Autumn 2020 Newsletter – Out Now

 

For the Autumn 2020 newsletter, please click here

 

 

 

 

Can COVID-19 cause lung fibrosis?

The interstitial lung diseases (ILDs) are a group of over 200 different diseases that may result in lung inflammation or (in the worst case) pulmonary fibrosis (PF). There are many different aetiologies for ILD/PF and in some cases,  we do not know the cause, so called ‘idiopathic’. One of the questions that we at Breathing Matters want to answer is can COVID-19 give you pulmonary fibrosis? There are a few clues that this might be the case. Other coronaviruses such as Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS) have been reported to cause PF in a small percentage of patients, but of course the numbers of patients affected by SARS-CoV-2, the virus that causes COVID-19, will be much greater so, even if only a small percentage are affected, the numbers may still be very large. The diagnosis of ILD/PF is suggested by a clinical finding of breathlessness and abnormal lung function. The diagnosis is then confirmed with a CT scan of the chest.

Initial studies from China, Italy and the UK have remarkably similar findings. Of patients with COVID-19 discharged from a hospital in China, nearly half had abnormal lung function (Mo X, et al. European Respiratory Journal 55: 2001217, 2020).  Data from Leeds of patients with COVID-19 discharged from hospital showed that the majority (75% of those admitted to intensive care, and 65% of those admitted to the regular wards) still suffered from fatigue at 6 to 8 weeks post discharge. The number suffering from continual breathlessness was also high (70% of those admitted to intensive care, and 45% of those admitted to the ward).  (Halpin S et al. Journal Medical Virology, First published: 30 July 2020, DOI: (10.1002/jmv.26368).  An Italian study from Rome found that at 60 days around 55% of patients were suffering from fatigue and 40% from breathlessness.  It is unclear what is the cause of these high levels of breathlessness, but a study from Austria is following their patients up in more detail at 6, 12 and 24 weeks after discharge. So far, they have found that at 6 weeks 47% of patients are short of breath and this falls to 39% at 12 weeks. In addition, 33% have abnormal lung function suggestive of lung fibrosis, but this falls to 22% at 12 weeks. Of course, to diagnose lung fibrosis requires at CT scan of the chest and they found that CT scans suggested an interstitial lung disease (ILD) or lung fibrosis in 88% falling to 56% at 12 weeks. However, it is also important to know how much of the lung is affected, and many of the studies do not clarify this, but just comment on whether ILD is present or not. The result is that it is hard to know whether these patients had minimal or significant ILD changes on the CT scan. Clearly, Breathing Matters will be looking out for the 24 week data.

Our own experience is that of around 800 patients seen at UCLH with COVID-19, around 8% have persistent or slowly resolving CT changes at 5 months suggestive of interstitial lung involvement. Our main priority at the moment is to analyse our data from the ‘first wave’ to see how common the development of ILD/ PF is in these patients, how much of the lung is affected and what the critical contributory factors are. It may be that this virus and the enormous numbers of patients that have been infected will shed some light on the pathogenesis of other ILD/PF diseases.

We will let you know as soon as we have reviewed all these patients and their scans.

 

Clean Air Day Campaign

We are honoured to have worked with Health Awareness on the 2020 Respiratory Health Clean Air Day Campaign.

A printed publication is enclosed within every copy of the Guardian newspaper published on 8th October 2020 and the content is available online at www.healthawareness.co.uk/respiratory.

The campaign features exclusive content from key thought leaders and industry voices about respiratory conditions and external risk factors such as air pollution and COVID-19.

All You Want for Christmas is a Santa Dash

The Virtual Santa Dash is a 5K fun run to be done with friends and family/pets or competitively on your own. Take this 5K challenge anytime in November or December 2020. Do it in your running gear alone or dressed as Christmas elves with the family! Earn the offical Santa Dash Medal and goodie bag. Simply register for the event and you will be given access to the Virtual Marathon Series runners portal where you can submit your evidence before or on your run day.

The Virtual Santa Dash has a special challenge attached and requires you to dress up in Christmas fancy dress to complete it. The Virtual Marathon Series are also offering two prizes:

  1. The first one is for the fastest time in Christmas fancy dress, become the Christmas world record holder.
  2. Secondly, to the person who raises the most money for their chosen charity by Christmas Day.

They will donate £250 to the charities chosen by the 2 winners who will receive a goodies pack from their partner Run Through in the post.

All you need to do now is register – here’s how:

  1. Register here – you will receive a confirmation email to log in to the Secure Charity Portal where you can pay your registration fee [£25 covers the cost of the place and medal only and does not go to the charity].
  2. Breathing Matters will get notification that you have signed up for your challenge and will contact you – or you can contact us directly at breathingmatters@ucl.ac.uk
  3. Set up a Breathing Matters personal fundraising page.  It is up to you how much you want to raise for Breathing Matters; there is no minimum sponsorship limit.
  4. Sort out your Santa outfit and start training!!!

New COVID-19 Clinical Trials Funded

Professor Joanna Porter was delighted to be awarded over £2M from LifeArc to run two clinical trials in COVID-19.

The first, ATTRACT, is in collaboration with Vicore Pharma, whom we have worked with for over 10 years on developing novel approaches for pulmonary fibrosis. The drug, VP01 (Compound 21; C21) is hoped to recalibrate the renin-angiotensin- system towards repair rather than inflammation.  This should indirectly help our research into pulmonary fibrosis too.

The second study, COVASE, is a collaboration with Veni Papayannopoulos and Veronique Brilaut at The Francis Crick Institute, to investigate an approved nebulised recombinant human deoxyribonuclease I (Dornase alfa) to reduce hyperinflammation from neutrophil extracellular traps in the lungs of hospitalised participants with COVID-19.

ATTRACT is open to recruitment and COVASE will open in the next two weeks.

Here’s the LifeArc press release with more info: https://www.lifearc.org/funding/covid-19-funding/

 

Black Friday Sale – Stunning New Fundraising Events

Hot off the Press!!

Global Adventure Challenges, who we work with, have released their 2021 events and they have SIX new challenges for you – plus they have BLACK FRIDAY offers next week!

 

Below are the new challenges which are amazing and diverse – why not book up before they’re snapped up:

Global Adventure Challenges are giving supporters a whole week to save 25% on their registration fee for selected iconic adventures, including their newly launched 2021 events!

Make sure you keep an eye on their website and Facebook pages for more offers throughout Black Friday week!

Have fun, take the challenge and raise vital funds to support our research – thank you.

 

 

 

 

 

World Pneumonia Day – 12th November

Pneumonia is a major cause of death among all age groups, resulting in 1.4 million deaths in 2010 (7% of the world’s yearly total) and was the 4th leading cause of death in the world in 2016, resulting in 3 million deaths worldwide.

Pneumonia is an infection of the deep parts of the lungs called the alveoli. This is where oxygen is transferred into the blood from the air, but during pneumonia the alveoli are invaded by bacteria or viruses which then causes the alveoli to fill up with fluid and white cells in an attempt by the body to kill the bugs. Alveoli filled with fluid and cells is called consolidation and shows up on an X-ray, and is also why patients with pneumonia become breathless as there is less lung available to transfer oxygen into the blood. If the pneumonia spreads to affect the edge of the lung, then it can inflame the membrane that covers the lung called the pleura. This causes a lot of pain, especially on breathing in, and is called pleurisy.

Recent research by Professor Brown’s infection research team at UCL Respiratory has had three research papers published which describe new findings about the commonest causes of pneumonia.

Streptococcus pneumoniae interacts with humans to cause infection. They describe the mechanisms by which the human immune system recognises the presence of S. pneumoniae and then responds to cause inflammation that is necessary for controlling infection. They are basic science research which do not directly feed into clinical care, but help us better understand how diseases like pneumonia develop and could therefore be prevented.

  1. Weight CM, et al. Epithelial control of colonisation by Streptococcus pneumoniae at the human mucosal surface Nat Comms 2019 10(1):3060.
  2. Javan RR et al. Prophages and satellite prophages are widespread among Streptococcus species and may play a role in pneumococcal pathogenesis Nat Communications, in press 2019.
  3. Periselneris J et al. Relative contribution of extracellular and internalised bacteria to early macrophage pro-inflammatory responses to Streptococcus pneumoniae. mBio, in press 2019.

If you would like to support this work, please donate to: https://www.justgiving.com/campaign/breathingmatters

 

Newsletter – Autumn 2019

Lung Infection Research Update

Prof Brown’s team has had two papers on bronchiectasis published recently.

The first describes the rapid development of bronchiectasis in patients who have weakened immune systems due to haematological disease.  This includes information for around 80 patients about bronchiectasis caused by haematological disorders such as lymphoma, myeloma  or leukaemia. This is the largest number of these patients described in the medical literature, and is important as it makes other doctors aware that bronchiectasis develops very quickly in these patients and causes a lot of ill health; better awareness of the problem will make doctors much better at recognising these patients and referring them to specialist centres, such as UCLH.

The other paper on bronchiectasis uses computers and CT scans to measure the exact degree of the dilatation of the bronchi in patients with bronchiectasis.  The more dilated the bronchi the worse the bronchiectasis, but at present we can only really measure this by eye just looking at the CT scans, which is not very accurate. Using computer software to give an actual measurement for the severity of bronchial dilatation would be a significant breakthrough as it would allow us to follow what happens to a particular patient over time, and rapidly identify if things are getting worse.

Three research papers have also been published which describe new findings about how the commonest cause of pneumonia.

Streptococcus pneumoniae interacts with humans to cause infection.   They describe the mechanisms by which the human immune system recognises the presence of S. pneumoniae and then responds to cause inflammation that is necessary for controlling infection. They are basic science research which do not directly feed into clinical care, but help us better understand how diseases like pneumonia develop and could therefore be prevented.

  1. Jose R et al. De novo bronchiectasis in haematological malignancies.  ERJ Open Res5(4). doi:10.1183/23120541.00166-2019.
  2. Quan et al.  Reproducibility of an airway tapering measurement in computed tomography with application to bronchiectasis.  Journal of Medical Imaging6(3). doi:10.1117/1.JMI.6.3.034003.
  3. Weight CM, et al. Epithelial control of colonisation by Streptococcus pneumoniae at the human mucosal surface.  Nature Communications 2019 10(1):3060.
  4. Javan RR et al. Prophages and satellite prophages are widespread among Streptococcus species and may play a role in pneumococcal pathogenesis.  Nature Communications10(1), 4852. doi:10.1038/s41467-019-12825-y.
  5. Periselneris J et al. Relative contribution of extracellular and internalised bacteria to early macrophage pro-inflammatory responses to Streptococcus pneumoniaeMBio10(5). doi:10.1128/mBio.02144-19.

Visit our new Justgiving page

Breathing Matters has a brand new Justgiving page.  We have transferring to a campaign page under the UCLH Charity Justgiving Page.  The new link is: https://www.justgiving.com/campaign/breathingmatters  This will save us on Justgiving fees for Breathing Matters, so more of your money goes directly to where it’s needed!

Please visit our new online donation page to donate, or to just have a look-see 🙂

Current open Justgiving pages on our old Justgiving Page will remain active, so you don’t need to do anything.

Together we can do more!