Respiratory Current Research

The ASPECT (Aspirin after hospitalisation with Pneumonia to prevent cardiovascular Events randomised Controlled Trial) is the largest ever pneumonia trial.

It will investigate whether aspirin can reduce the risk of a heart attack or stroke in patients who are admitted to hospital with pneumonia. Led by the University of Bristol, sponsored by North Bristol NHS Trust (NBT) and supported by the Bristol Trials Centre, the trial has been awarded funding of over £2.3 million by the National Institute for Health and Care Research (NIHR). 

The randomised controlled trial will recruit 22,600 patients from over 60 hospitals across England.  Findings from the four-year study will support future treatment guidelines, if appropriate, for patients with pneumonia. If aspirin is shown to be effective it could prevent up to 3,000 heart attacks and strokes a year in England alone.

Adults over 50 years of age admitted to hospital with pneumonia will be invited to take part in the trial. Those who agree will be split into two groups. Every person joining the study will have an equal chance of being in either group, so both groups will be made up of similar people.

One group will be prescribed a three-month course of low-dose aspirin, the other group will not. In all other respects, both groups will receive the standard pneumonia treatment. Participants will be followed up after three months.

The researchers will assess the participants recovery, specifically whether they have had a heart attack or stroke, or any serious side effects from the aspirin. This will be done by reviewing the 'usual care' health records of participants held by NHS hospitals.

Following up participants like this has been shown to be robust, reduces the burden on participants and makes the research much less expensive. To ensure participants are not getting side effects that would not be picked up in their health records, the research team will contact the first 2,000 participants, this follow up will include questions about whether they took the medication prescribed.

Dr David Arnold, NIHR Academic Clinical Lecturer in Respiratory Medicine in Bristol Medical School: Translational Health Sciences (THS) and Respiratory Registrar at NBT, who is joint lead of the trial, said: "Pneumonia is the commonest cause of unplanned hospital admissions worldwide. It has been shown that patients recovering from pneumonia have an increased risk of a heart attack or stroke due to the stress of infection on the body.

"Aspirin has been used for decades to reduce the chance of having a heart attack or stroke in patients at high risk of either event.  We hope our trial will show it reduces the risk to patients with pneumonia and that it can save lives too."

Pneumonia is an inflammation of one or both lungs, usually caused by infection. Pneumonia is very common with 270,000 patients admitted as an emergency to hospital in England every year. Most people recover completely but some have complications. Two of the most significant complications are heart attack or stroke. Around 1 in 13 patients (8%) who are admitted to hospital with pneumonia have a heart attack or stroke within three months.

'Aspirin after hospitalisation with Pneumonia to prevent cardiovascular Events randomised Controlled Trial' (ASPECT) is a four-year trial.

Project Details

Principal Investigator: Dr Nick Maskell

Planned End Date: 31/08/2025

Local Ref: 5019

There is a high prevalence of anxiety, depression and neurocognitive dysfunction which impacts on the wellbeing of patients with severe asthma. These factors may be the result of poorly controlled asthma, the effects of asthma treatments, but also themselves impact on asthma severity. The relationship between these factors is not well understood.

Magnetic resonance imaging (MRI) of the brain demonstrates structural and functional differences between the brains of people with asthma and those without. Though not extensively studied, a small number group of trials have shown a 'normalisation' of brain activity after cognitive behavioural therapy in patients with asthma and depression. The effect of asthma treatments on brain structure and activity requires further investigation.

Mepolizumab is amongst a group of injectable treatments that have revolutionised the treatment of poorly controlled severe eosinophilic asthma. Randomised controlled trial and real-world data shows reduced exacerbations and oral corticosteroid use in patients taking mepolizumab. Trials also show improved asthma-specific quality of life, though there have not been studies that have assessed anxiety, depression, well-being and cognition in detail.

In this observational study we propose to examine the MRI structure and function of the brains of people with severe eosinophilic asthma before and six months after starting mepolizumab as part of routine clinical practice. We will collect detailed health and neurocognitive information to evaluate changes in psychological health and cognition with mepolizumab. We will compare these data, to results in patients with well-controlled asthma. We will assess whether changes seen on MRI brain imaging relate to the direct effect of the mepolizumab on the brain, or of the secondary effects of improved asthma control that is known to be achieved by mepolizumab.

To become participate in this study, find out more information here.

Project Details
Principal Investigator: James Dodd
Planned End Date: TBC
Local Ref: 5409

Many people with chronic obstructive pulmonary disease (COPD) remain very breathless and limited. In some patients, with the appropriate pattern of emphysema, an operation called lung volume reduction surgery is effective at removing the worst affected area of lung. New techniques have been developed where emphysema can be treated using a fibre-optic camera called a bronchoscope. Trials have shown that using a bronchoscope to place endobronchial valves into the airways can be very effective in carefully selected patients and the technique is now being adopted in hospitals across the UK.

This study will collect data from people undergoing these procedures at hospitals across the UK to evaluate how well they work in practice and what factors at baseline influence response. Baseline, three month and 12 month follow up data will be collected. This will include lung function data, measures of exercise capacity, questionnaires about health status and CT scan results. Questions addressed will include:

• What lung function improvement is seen in clinical practice?
• What factors determine who is most likely to respond?
• How safe are the procedures and what is the rate of complications?
• What proportion of people undergoing bronchoscopic procedures require repeat procedures or surgery subsequently?
• Does long term survival differ between people undergoing the different treatments?

The study is supported by The British Lung Foundation and sponsored by Imperial College, London. By building collaboration, the establishment of the network will also produce a structure that will make evaluation of future bronchoscopic techniques easier bringing innovative treatments into play more quickly.

Project Details
Principal Investigator: Dr James Dodd
Planned End Date: 30/06/2026
Local Ref: 4076

When people get chest infections, fluid can sometimes build up around the lung. This is called a parapneumonic pleural effusion. In about 1 in 10 cases, the fluid itself becomes infected, this is called pleural infection. Pleural infection is usually treated by removing the infected fluid and using antibiotics to mop up the left-over infection.

Patients with pleural infection often receive long courses of intravenous antibiotics because doctors are uncertain of how well antibiotics reach the infected pleural fluid and whether bacteria are becoming resistant to them.

The Pleural Antibiotic Concentrations informing Treatment (PACT) study is observational and aims to see how well antibiotics are reaching the infected fluid, and how quickly the bacteria are being killed. To answer this, we will collect samples of pleural fluid from participants who are being treated for pleural infection with pleural drainage. This fluid will be tested to measure how much antibiotic has managed to get into it. We can then tell if the antibiotics are reaching high enough concentrations to kill bacteria. We will also be testing this fluid to see if the bacteria are being killed by the antibiotic or not. In the future, this information may shorten the time patients are treated with intravenous antibiotics and therefore how long they need to stay in hospital.

Project Details
Local Ref: 4581

Background and study aims

Pleural mesothelioma is a cancer that affects the lung lining, caused by asbestos. Despite recent treatment advances, the prognosis is often poor. Prompt diagnosis is vital. A biopsy can diagnose mesothelioma, guide treatment and support compensation claims. However, some people need multiple biopsies, increasing the risk of biopsy-related complications and prolonging the time to diagnosis. Doing additional tests on initial biopsies may increase the chance of diagnosing mesothelioma and avoid repeat biopsies. This would allow anti-cancer treatment to be started sooner and improve survival. The extra tests are not genetic but look for genetic changes in the cancer that allow it to grow and spread. The genetic markers in mesothelioma are called BAP1, p16 and MTAP. If they have disappeared on biopsy mesothelioma is diagnosed. Another study was previously conducted on people with suspected mesothelioma who required further biopsies as their first biopsy did not give a diagnosis  It took place in eight UK centres and recruited 59 patients. This study aims to perform these additional tests on their biopsy samples to see whether this would have made the diagnosis sooner and removed the need for further biopsies. It will investigate how many biopsies could have been avoided, how much time would have been saved, how this may have impacted survival and what cost-savings this would have offered the NHS.

Who can participate?

This study includes the 59 participants in the original TARGET study who were recruited between September 2015 and September 2018. No additional participants will be recruited. Should any participants of the original TARGET trial wish to opt-out, they can contact the main contact below.

What does the study involve?

Biopsy samples taken as part of the participants’ routine clinical care will be tested for the markers of genetic change in mesothelioma (BAP1, MTAP and p16). The ability to make a diagnosis using these tests will be compared with the original diagnostic pathway, which was before the use of these tests.

What are the possible benefits and risks of participating?

The benefits of enrolling are to future patients, whose diagnostic process could be improved, with no additional requirements of TARGET participants. As there are no additional interventions required of participants and this will not impact management, there are no risks identified.

Project Details
Principal Investigator: Prof Nick A Maskell
Duration: October 2022 - July 2025

Funded by the Southmead Hospital Charity

Main contact :  Geraldine.lynch@nbt.nhs.uk

IPF is a progressive scarring lung condition causing coughing and breathlessness. IPF patients often have reflux disease meaning stomach acid may be breathed into the lungs, potentially damaging them. Medicines which stop stomach acid production, proton pump inhibitors (PPIs), can be used to reduce reflux symptoms including heartburn. Some researchers suggest PPIs also reduce IPF progression.

This research aims to see if IPF progresses slower if treated with PPIs. Based on the results, we will be able to recommend whether or not IPF patients should take PPIs.

This trial will involve 298 IPF patients from approximately 37 UK hospitals. At the beginning of the study, we will ask patients to perform breathing tests, and ask those with a cough to use a device to count the number of times they cough in 24hours. We will ask them to answer two questions rating their coughing and breathlessness, and complete questionnaires on their coughing, IPF, sleep habits and general condition. People will be given a PPI, called lansoprazole, or dummy tablets, twice per day for 12 months. They will be given a leaflet telling them what to do about reflux symptoms. At the end of the study, we will repeat these tests and analyse the results. We will record any side effects people may get. If people suffer side effects, they can reduce the dose.

People taking medicines that interact with PPIs or have other serious medical conditions won’t be able to participate. People receiving PPIs will only be able to participate if they can stop taking their medication without their heartburn returning.

The study will be undertaken by doctors and researchers with experience of IPF, reflux disease, PPIs and coughing. We will publicise our results by writing reports for medical publications, media articles and social media.

Project Details
Local Ref: 4672