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Recruitment ongoing at Sappasithiprasong Hospital, Ubon Ratchathani, Thailand

To assess whether text-messaging on mobile phones can be used to communicate with young patients involved in primary care research without affecting the response rate that would be expected from using more traditional research methods such filling out a card and dropping it into a box placed in the practice

To increase recognition of airflow obstruction in primary care, two models of spirometry delivery in a target group at risk of chronic obstructive pulmonary disease (COPD) were compared in a qualitative/quantitative cluster randomised study in eight practices over 6 months; opportunistic spirometry by ‘‘visiting trained nurses’’ (TN) and optimised ‘‘usual care’’ (UC). In the eligible target population of smokers and ex-smokers aged over 35 years, 531/904 (59%) patients underwent spirometry in the TN model and 87/ 1130 (8%) patients in the UC model (p,0.0001). ATS spirometry standards for acceptability and reproducibility were met by 76% and 44% of tests in the TN and UC models, respectively (p,0.0001). GPs valued high quality spirometry and increased testing of patients at risk of COPD in the TN model. They identified limitations, including the need for better systematic follow-up of abnormal spirometry and support with interpretation, which may explain persisting underdiagnosis of COPD in practice records. Conclusions: Although opportunistic testing by visiting trained nurses substantially increased and improved spirometry performance compared with usual care, translating increased detection of airflow obstruction into diagnosis of COPD requires further support.

The OVERALL AIM of this project is to build on our recent demonstration that the reduction in airway inflammation following introduction of systemic corticosteroids (CS) during acute exacerbations of COPD (AECOPD) is rapid and significant at 48 hours. We will now compare two CS treatment regimens: short course (72 hours only) of high dose versus more conventional, moderate dose therapy over 14 days in terms of efficacy and adverse events (AE). At the same time, we will continue our work to delineate the aetiological factors and inflammatory processes underlying AECOPD. This project will test the following hypotheses: 1 Systemic CS are effective during AECOPD because of a rapid reduction in neutrophil chemotactic cytokines and down-regulation of neutrophil-related vascular adhesion molecules; this occurs over the first 2-3 days of therapy. 2. Thus, short-course, high-dose CS therapy is as efficacious in the treatment of AECOPD as a more conventional 14-day course of moderate dose CS, but with significantly less risk of AE and without rebound of inflammation after cessation. Hospital length of stay can be reduced. 3.Exacerbations over the subsequent one month (treatment failure) are no more frequent with short versus conventional course CS therapy. 4. Viral and bacterial organisms isolated from sputum during an AECOPD are associated with a greater inflammatory response within the airway than non-infective exacerbations, but both are responsive to CS therapy. Specific aims are: 1.To build on our preliminary findings of a rapid reduction in sputum neutrophilia and improvement in symptoms by systemic CS during AECOPD and to examine whether this relates to inhibition of neutrophil-related chemotactic factors and vascular adhesion molecules. 2.To compare short-course (3 day), high dose CS treatment and more conventional 14-day moderate dose CS therapy with focus on clinical outcomes, reductions in airway inflammation, rebound exacerbation and adverse events. 3.To identify bacterial and viral organisms as well as determine bacterial load at admission and to then relate these to airway inflammation, response to treatment and rate of rebound.

In this study the antibody response (immunity) to pertussis vaccination will be compared in 3 groups, those who have routine pertussis vaccination commmencing at 2 months old with those who have received pertussis vaccines at birth and 1 month old or only birth.