Publications by authors named "Peter G Middleton"

Background: Asthma characterization using blood eosinophil count (BEC) (among other biomarkers and clinical indices) is recommended in severe asthma (SA), but the masking effect of oral corticosteroids (OCS), makes this challenging.

Aim: Our aim was to explore the effect of OCS use (both intermittent [iOCS] and long-term [LTOCS]) prior to biologic initiation on SA phenotype and biomarker profile in real-life and to characterize the burden of SA among patients prescribed LTOCS by biomarker profile.

Methods: This was a registry-based cohort study, including data from 23 countries collected between 2003 and 2023 and shared with the Internatonal Severe Asthma Registry (ISAR).

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Background: Haemoptysis is common in adults with cystic fibrosis (CF). Tranexamic acid (TA), an antifibrinolytic agent, blocks the binding of plasminogen and plasmin to fibrin to inhibit clot breakdown. Despite its theoretical benefits, there is limited data on the use of inhaled TA for management of haemoptysis in CF.

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Although clinical trials have documented the oral corticosteroid (OCS)-sparing effect of biologics in patients with severe asthma, little is known about whether this translates to a reduction of new-onset OCS-related adverse outcomes. To compare the risk of developing new-onset OCS-related adverse outcomes between biologic initiators and noninitiators. This was a longitudinal cohort study using pooled data from the International Severe Asthma Registry (ISAR; 16 countries) and the Optimum Patient Care Research database (OPCRD; United Kingdom).

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Background: For severe asthma (SA) management, real-world evidence on the effects of biologic therapies in reducing the burden of oral corticosteroid (OCS) use is limited.

Objective: To estimate the efficacy of biologic initiation on total OCS (TOCS) exposure in patients with SA from real-world specialist and primary care settings.

Methods: From the International Severe Asthma Registry (ISAR, specialist care) and the Optimum Patient Care Research Database (OPCRD, primary care, United Kingdom), adult biologic initiators were identified and propensity score-matched with non-initiators (ISAR, 1:1; OPCRD, 1:2).

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Pulmonary graft versus host disease (GVHD) is a common and serious complication of hematopoietic stem cell transplantation (HSCT). Early diagnosis is essential for rapid treatment before irreversible changes in lung function occur. The National Institutes of Health (NIH) support that a decline in forced expiratory volume in 1 second (FEV) of ≥10% from baseline values requires further investigation and close monitoring post HSCT.

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Background And Objective: Antimicrobial resistance (AMR) is a global crisis, however, relatively little is known regarding its impact in chronic respiratory disease and the specific challenges faced by healthcare workers across the world in this field. We aimed to assess global healthcare worker views on the challenges they face regarding AMR in chronic respiratory disease.

Methods: An online survey was sent to healthcare workers globally working in chronic respiratory disease through a European Respiratory Society clinical research collaboration (AMR-Lung) focussed on AMR in chronic lung disease.

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Background: Regular airway clearance techniques (ACTs) and exercise are recommended for children with bronchiectasis, but current clinical practice and their predictors are unknown.

Objective: We aimed to describe current use of ACTs and exercise among Australian children with bronchiectasis and identify associated predictors.

Methods: Physiotherapy-specific data of 397 children (median age = 8 were extracted from the Australian Bronchiectasis Registry.

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Background: Factors associated with severe COVID-19 infection have been identified; however, the impact of infection on longer-term outcomes is unclear. The objective of this study was to examine the impact of COVID-19 infection on the trajectory of lung function and nutritional status in people with cystic fibrosis (pwCF).

Methods: This is a retrospective global cohort study of pwCF who had confirmed COVID-19 infection diagnosed between January 1, 2020 and December 31, 2021.

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Article Synopsis
  • This study investigates the current practices of airway clearance techniques (ACTs) and physical exercise among adults with bronchiectasis to better understand how they are utilized and what factors influence their use.
  • About 58% of the 461 patients regularly used ACTs, with the active cycle of breathing technique being the most common, while 46% engaged in regular exercise, mostly walking.
  • The findings indicate that quality of life and disease severity are significant predictors of participation in ACTs and exercise, suggesting potential for more tailored physiotherapy management for these patients.*
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Background: Lung inflammation is associated with tissue damage in cystic fibrosis (CF). LAU-7b, a novel oral drug candidate, was shown to control inflammation and stabilize CFTR protein in the epithelial membrane during inflammatory stress in preclinical models of CF.

Methods: A double-blind, randomized, placebo-controlled Phase 2 study was conducted to evaluate efficacy and safety of LAU-7b in adults with CF.

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This is the final of four papers updating standards for the care of people with CF. That this paper "Planning a longer life" was considered necessary, highlights how much CF care has progressed over the past decade. Several factors underpin this progress, notably increased numbers of people with CF with access to CFTR modulator therapy.

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Sputum induction is widely used in clinical settings for collection of biological samples from the lower airways. However, in recent years sputum induction has been associated with serious adverse events and even death. This position statement was commissioned by the Thoracic Society of Australia and New Zealand to address major adverse events of two deaths associated with sputum induction that have occurred in Australia in 2021, and outlines best practice for the safe use of sputum induction.

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Article Synopsis
  • - This paper is part of a series updating standards of care for cystic fibrosis (CF), emphasizing the importance of recognizing and managing various CF health issues despite advancements like CFTR modulators.
  • - It highlights the need for multidisciplinary care to address ongoing extrapulmonary issues such as diabetes, liver disease, and increased cancer risk, which require regular screenings.
  • - Mental and emotional support is crucial for individuals with CF and their families, especially during challenging times, and planning for end-of-life care should be approached with sensitivity and compassion.
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This is the second in a series of four papers updating the European Cystic Fibrosis Society (ECFS) standards for the care of people with CF. This paper focuses on establishing and maintaining health. The guidance is produced using an evidence-based framework and with wide stakeholder engagement, including people from the CF community.

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Background: Most males with cystic fibrosis (mwCF) are infertile but with CF transmembrane conductance regulator (CFTR) modulator-conferred benefits, more are utilizing assisted reproductive technologies (ART). Administration of normal human doses of modulators in animal reproductive models caused no genotoxicity; no human data exists. Potential health decline following modulator discontinuation makes the decision to withhold therapy during reproduction challenging.

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Article Synopsis
  • Advances in cystic fibrosis (CF) diagnosis focus on improvements in newborn bloodspot screening, gene analysis, and understanding CFTR-related disorders.
  • These developments highlight the importance of timely and accurate diagnosis for access to variant-specific therapy, which can significantly benefit those with eligible CFTR gene variants.
  • The guidance in this paper updates previous standards and emphasizes the growing necessity for proper diagnosis as future trials for variant-specific therapies are anticipated.
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Article Synopsis
  • Women transitioning to motherhood face physical, mental, social, and occupational changes, which are further complicated by chronic illnesses requiring increased healthcare during pregnancy and postpartum.
  • The scoping review investigates the impact of occupational engagement and balance on the well-being of women with chronic illnesses before, during, and after pregnancy, highlighting the need for a more comprehensive understanding of their experiences.
  • The analysis identified four themes relating to coping with motherhood amidst chronic illness, revealing that access to information, support, expert care, and financial resources positively influences quality of life and healthcare adherence.
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Background: In people with cystic fibrosis (CF), regular nebulisation of 6% or 7% saline improves lung function; however, these concentrations are not always tolerable. Clinically, some CF patients report using lower concentrations of saline to improve tolerability, yet the effects of lower concentrations are unknown. This study therefore aimed to evaluate the relative effectiveness and tolerability of 0.

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Bronchiectasis is often considered progressive and irreversible, so cases of regression or reversal are an important step in understanding the underlying pathophysiological mechanisms. Cystic fibrosis, (CF) caused by pathogenic variants in the () gene has been a success story in personalized medicine. The recent development of modulator therapies has revolutionized care.

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