John Hurst
@ProfHurst
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NIHR Global Research Prof | Vice Dean (International), UCL Medical Sciences | Professor of Respiratory Medicine UCL/Royal Free. COPDologist. NCDs. Runs. Trains.
London, England
Joined August 2015
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Grant rejection from MRC. Months of work. Six sentence rejection email explaining there will be no feedback. You know what, this isn’t right.
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👀it’s out! The llatest 2023
@GOLD_COPD
guidance has been released...
🌟There are BIG changes this year. Here are my first thoughts… but lots to digest:
TL/DR:
1. Revised
#COPD
defn
2. Etiotypes
3. ABCD is out, ABE is in
4. Farewell ICS-LABA
5. New exacerbation defn
1/n👇
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I’m a big fan of ‘triple therapy’ for
#COPD
.
By which I mean support for smoking cessation, influenza vaccination and
#pulmonary
rehabilitation. Obvs.
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This came up at
#morningreport
today and may not be widely appreciated.
In tachypnoea (RR>30), need to increase Venturi flow to maintain FiO2.
More on this in the
@BTSrespiratory
Emergency Oxygen Guideline:
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POST
#COVID
ー19 RECOVERY.
How do you know if someone is on an expected trajectory post hospital discharge?
Here is a first look at our needs assessment and service evaluation, from a collaboration across
@RoyalFreeNHS
and
@uclh
.
We wanted to help others doing similar work 1/n:
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We continue to see very few
#COPD
exacerbations, and not just because people aren’t coming to hospital.
I’d often wondered what ‘intrinsic’ exacerbation frequency might look like with cleaner air and much reduced transmission of (regular) viruses.
The art of the possible...
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Morning all. These cheered me up...
Who’s the coolest guy in the hospital?
The ultrasound guy. And there’s more...
Who’s the coolest guy in the hospital when the ultrasound guy is off?
The hip replacement guy.
You’re welcome. I’m literally here all week.
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Expressing the FEV1/FVC ratio as a % of predicted should be BANNED.
(I feel a bit better now).
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Another night covering
#COVID
wards. Only it’s not really about the COVID, it’s about decompensated
#multimorbidity
- diabetes, chronic lung disease, depression, ischaemic heart disease, heart failure and more... Our teams have never needed their general medical skills more.
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Today I consented and prescribed
#COVID19
#vaccine
for around 0.00003% of the 🇬🇧 population here
@RoyalFreeNHS
- our local older people and colleagues. A long way to go but today is a brighter day.
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The disconnect between the (appropriately rigorous) way I obtain informed consent to take part in research, and the labyrinthine process to opt out of NHS data sharing for those who do not wish to take part is stark.
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Here’s some helpful advice. In the same way you shouldn’t let a barber do your cataract, don’t let an ophthalmologist cut your hair. You’re welcome.
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Send help. The research I established my career on has become a meme…
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The simple ideas are often the best...
Innovation case study:
#Oxygen
wristband pilot Do you have a study or example of best practice we can share?
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What a privilege to sit with Dr Mohan in his clinic today. Fifty consultations in the time it takes me to see ten, and with far more varied pathology.
I always learn so much about my own practice when visiting others.
No EPR, no admin and no dictation = more clinical time.
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It must be 25 years since I last saw a
#class50
leave London
#Paddington
. Utterly magnificent. Wish I was on for the ride to Penzance...
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April Fool?
#newnormal
If you’d told me at New Year that by April I’d be doing resident night shifts for the first time in fifteen years I wouldn’t have believed you.
Not only that, but passing the car keys to
@LondonEyeDoc
who’s been first on call for emergency ophthalmology.
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So excited to be starting a 3 month
#sabbatical
today.
I’m going to be based in Delhi.
I can’t wait to learn more about
#COPD
care in other health systems, build new academic collaborations, talk about studying
@ucl
and meet some of our amazing
@UCLAlumni
.
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First
@LDNOverground
#class378
on first run in new
#class710
livery as per the new
@RidingtheGoblin
units. Spied at
#CallyRoad
this evening.
@RAIL
I thought you might like this! Yellow end re-applied.
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This
#WorldCOPDDay
I’m speaking at the All Party Parliamentary Group on Respiratory Health.
#speakupforCOPD
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20 years ago today I was appointed as a locum Registrar in Respiratory Medicine, at Basildon. A little terrified at being Med Reg, I had great support from the Consultants. It’s that ‘family’ feel that makes me as passionate about respiratory today as I was green back then.
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These graphic interpretations of
#AECOPD
were created by the artist in response to descriptions of exacerbations by people living with
#COPD
. Highly original and provocative.
@EuroRespSoc
#ERSCongress
#ERS2019
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Never understood bringing an in patient to a busy out patient clinic. Not fair to the person. Always happy to go to the ward... have expertise, will travel.
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Okay I will say this only once.
#COPD
is NOT an ☂️. COPD is a physiological diagnosis.
#Emphysema
is an anatomical diagnosis.
#ChronicBronchitis
is a clinical diagnosis. They often occur together in a susceptible person exposed to sufficient inhaled toxin, but need not. Thank you
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Dear
#Respiratory
/
#Pulmonology
twitter friends, I thought it might be useful to have a
#COPD
#exacerbation
hashtag to make it easier to find all the amazing stuff on that topic that appears on here. No one seems to have bagsied or be using
#exCOPD
... join me?
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Ah, the dying art of chest x-ray interpretation. Such a simple test providing so much information. Thank you for for this!
#resped
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1K
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It’s national
#pulmonaryrehab
week.
Why not implement a small test of change?
Ask EVERY patient with
#COPD
you see this week about previous attendance and beliefs, ADVISE and advocate strongly for the benefits of
#PR
, and ACT by making that referral.
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Repeat after me...
...it’s not just the drug, it’s the DEVICE!
There’s no point prescribing an inhaler in
#COPD
without the person knowing how to use it properly...
Multiple devices, poorer outcomes.
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Last day as Editor of the
@EuroRespSoc
ERS Monograph, which I pass to the capable 👋🏻 of Peter Calverley.
It’s been a privilege to work with enthusiastic guest editors and talented authors.
And huge thanks to unsung heroes too- reviewers and
@ERSpublications
staff. You were 🌟.
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2
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Without a shadow of a doubt, that was the most intense week of clinical medicine I have ever experienced (and I was a Med Reg in Essex DGHs, back in the day).
And this was all so, well, preventable.
Hope this finds you all well.
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An estimated 1227 fewer deaths in London, January through August 2020 with improvements in air quality (and 4644 in Delhi), but pollution already now back to near ‘normal’. This shouldn’t be normal, everyone deserves to breathe clean air.
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The
#NHS
is at its glorious best when working across institutional and professional boundaries.
Like many others, I’m heartily sick of all I’m reading denigrating primary care. Primary care is the bedrock and backbone of the system. Always had been. Always will be.
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First
@VirginTrains
#class221
221101
#Voyager
in new colours passes
#Highbury
this evening working
#Ilford
to
#Euston
.
@RAIL
@Clinnick1
- note yellow end re-applied!
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And they’re off!
Emotional scenes at
#KingsCross
this morning as
@GNRailUK
say goodbye to the trusty
#class313
units after 46 years!
Credit to all those involved in returning this DMSO to
#NSE
livery
@NSE_RailSociety
👏🏻
#Class313farewell
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The multi-professional respiratory community has stood up, and stood together to lead follow-up of those discharged after
#COVID19
. We did this because it was the right thing to do. We did this when we were tired. Such inspiring stories at
@BTSrespiratory
#BTSWinter
#respisbest
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Would a definition by any other name smell as sweet?🌹🤦🏻♂️
ROSE: radiology, obstruction, symptoms and exposure – a Delphi consensus definition of bronchiectasis - COPD overlap by the
@EMBARCnetwork
Airways Working Group.
Now published in
@ERSpublications
;
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Great news about 1st approval for a vaccine easier to give in diverse settings.
But 981 🇬🇧deaths today. Every single one a daughter, a son, a brother, a sister, a parent, a partner, a friend.
And death isn’t the half of it. Impact of
#LongCovid
can be profound.
What a mess.
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Ever tried to plan a conference during a pandemic? SO good to be back
@BTSrespiratory
HQ today with
@e_sapey
@drphilmol
and
@CathrynStokes2
. Better yet, go sign up for the winter meeting (Feb) because it’s going to be a belter. Excellent respiratory science and clinical abstracts
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Can
Only
Plan
Daily
I heard this from a patient advocate and don’t think there’s a better way of describing to someone with healthy lungs just a little bit of what it’s like to live with
#COPD
.
#WorldCOPDDay
People living with COPD, clinicians and researchers stand with you.
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So the cat is out of the bag...
I’m proud to work
@UCLRespiratory
and promotion to Professor here is a huge honour.
Success in academia is dependent on students, collaborators and colleagues. Thank you.
->normal service now resumes
Congratulations
@DrJRHurst
for his promotion to Professor, very deserved
@UCLRespiratory
@RoyalFreeNHS
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So caught up with c*vid that I’d missed this *SUPER* important paper looking at the prevalence of PE in people presenting to ED with deterioration in
#COPD
symptoms
#AECOPD
- PE in 6%, with greatly increased mortality.
How to find them?
via
@JAMA_current
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New on the main corridor
@RoyalFreeNHS
over the weekend is this... I think it really captures the spirit of a Trust I’m proud to be a part of during
#COVID19
wave one.
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Thank you to all my colleagues
@RoyalFreeNHS
running the COVID staff antibody testing service this Sunday morning. You were lovely. I want to know, even if I don’t know what knowing means.
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I’ve had a request to post a link to my recent
#inaugural
lecture (😊). It has COPDology, trains and just a little bit of 🌈. You have been warned!
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I’ve had a number of requests for clarification on lamas and llamas following my presentation
@BTSrespiratory
#BTSWinter2017
yesterday. The lama is on the left. Only one reduces exacerbations in
#COPD
. Pics not mine...
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I pass this advert every day, and since the railways were nationalised in 1948 it must be 70 years old.
@MrTimDunn
I think you'd like this.
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Today sees final publication of our 🇬🇧
#LongCovid
#Covid_19
hospital follow-up data in 384 people. A partnership across
@RoyalFreeNHS
@uclh
and
@uclmedsci
-you can read the paper here: , or see the thread below👇🏻. Pleased to partner with
@ThoraxBMJ
in this.
POST
#COVID
ー19 RECOVERY.
How do you know if someone is on an expected trajectory post hospital discharge?
Here is a first look at our needs assessment and service evaluation, from a collaboration across
@RoyalFreeNHS
and
@uclh
.
We wanted to help others doing similar work 1/n:
23
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318
3
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It’s twenty years this week since I first worked in Respiratory Medicine and I love my specialty
#respisbest
. So much need, so much variety, so much innovation and so much opportunity for multi-professional working.
#resped
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It’s Burns Night. So I definitely didn’t travel to Inverness with my Father just to catch the Caledonian Sleeper back to London. That would be madness.
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Repeat after me...
Early COPD is not necessarily the same as Mild COPD.
Early= timing. Mild= severity.
@atscommunity
#ATS2019
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Finally, you can read more in the GOLD document itself:
🔗:
I hope you found this useful – and I’m really keen to hear your thoughts!
Oh, and please remember to
#speakupforCOPD
– I have and always will:
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This is good news, led by the excellent team in Leicester.
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Why do we ‘tolerate’ exacerbations In
#COPD
given that people living with COPD say they are the most disruptive aspect of the condition?
I cannot imagine a cardiologist saying ‘only one MI last year’, so low risk this year.
Time for zero tolerance?
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This is exciting news: the first new drug treatment for COPD approved in Europe for more than a decade.
Type 2 high and frequent exacerbations.
👀 ⬇️
Dupixent approved in the EU as the first-ever targeted therapy for patients with COPD
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More on this abhorrent, egregious takeover saga.
Tobacco companies should not profit further by treating diseases they themselves have caused.
You couldn’t make this up.
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NEW
Yesterday we published our first combined asthma and COPD 'Drawing Breath'
@NACAPaudit
report.
I thought I'd highlight a few key themes.
First, it's important to note that these data reflect care during the pandemic period when front line clinical teams were stretched...
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COPD is the third leading cause of death worldwide, but only four countries have some form of national
#COPD
Quality Standards. These new proposed Quality Standards could help health systems transform the way they care for COPD. What do you think?
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Too often, indeed more likely than not, people with
#COPD
are being managed for an exacerbation in hospital without evidence of that diagnosis being available on previous spirometry. A key finding and QI priority from the latest
@NACAPaudit
report.
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🆕 - our paper to design and implement a tool to guide inhaler selection at the point of discharge for hospitalised exacerbation of
#COPD
has now been published in
@ERSpublications
ERJ Open Research.
👀👇🏻
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I can’t begin to tell you how much I enjoyed F2F teaching
@UCLMS
students this morning. It’s a good day.
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Congratulations to
@JaberSQ
who successfully* defended his PhD today, investigating
#COPD
readmission risk (*subject to minor amendments).
We are proud of you here
@UCLRespiratory
.
And on behalf of
@lung_live4eva
, thanks to
@COPDdoc
and
@LungConsultant
for the rigorous viva.
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Hey
@atscommunity
#ATS2018
, fancy a quiz?
On the left is a LAMA, on the right we have a llama. It’s important not to get them confused. Only one is clinically proven to reduce exacerbations in
#COPD
. But which is it?
Retweet for the LAMA.
Like for the llama.
(Not my pics).
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A full 24hrs since my
#COVID19Vaccine
second dose...
... just a bit of a sore arm.
That’s it. That’s the Tweet.
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Even one exacerbation of
#COPD
in “low risk” groups A and B is associated with worse outcomes.
We are too tolerant of exacerbations.
People living with COPD deserve better.
👀⬇️
Exacerbation Risk and Mortality in Global Initiative for Chronic Obstructive Lung Disease Group A and B Patients with and without Exacerbation History
🔗
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You are going to be hearing a lot more about the term ‘cardiopulmonary risk’ in
#COPD
. Out now and free in
@LancetRespirMed
,
@cpgale3
and I write on mitigating
#MACE
in COPD on behalf of the GWGoCPR.
❤️💥🫁
MACE in COPD: addressing cardiopulmonary risk
10
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Apologies if you’re here for the COPD or the trains, and I can’t take any credit for this, but it made me laugh and I need a laugh right now.
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It’s eight years this week since our civil partnership here at
#StPancras
and the mighty station sleeps. Gates locked. No crowds for the Tube. Unattended luggage trolley. Coffee shop closed. Not a soul to see. Even the skies were stormy. But we will be back. Stronger.
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Such a privilege to have been appointed National
#COPD
Clinical Lead within the
@RCPLondon
@NACAPaudit
programme. Great Kick Off meeting today... watch this space for more
#QI
.
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What is the evidence for
#nutrition
supplementation during
#PR
for
#COPD
?
You can read all about it in
@abdulelahinter
’s recent systematic review in
@CRD_Journal
or, trying something new, here is a short
#vabstract
(?) of Abdulelah explaining his work.
5
27
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London hasn’t changed from up here on the 12th floor. I’ll never tire of this view.
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This 3 month sabbatical in 🇮🇳 has been a literal and metaphorical journey, personally and professionally.
To new friends and colleagues, thank you.
To colleagues back home in 🇬🇧, thank you for supporting me.
And if anyone wants to talk about a
#sabbatical
please be in touch.
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The
@NICEComms
#COPD
Quality Standards have been updated today, and are now available online:
👉🏻
What changes have been made?
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Talking on the overlap between
#COPD
and
#bronchiectasis
today. So much confusion here, and the assumption that vessel calibre doesn't change means risk of both false positive and false negative findings:
Hypoxic vasoconstriction false +
Pulmonary hypertension false -
Thoughts?
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What terminology in your specialty do you really, really dislike? Here’s mine:
‘End Stage COPD’
Just awful.
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My asthma hasn’t been this bad for years. Really, really feeling the pollution just now. It’s affecting millions living with lung disease in the UK.
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In the spirit of new style guidelines pioneered
@EuroRespSoc
#ERSCongress
#ERS2019
yesterday, here is the first iteration of a new
#COPD
guideline.
1. Exposure reduction. ALWAYS.
2.
#PR
. OBVIOUSLY
3. Vaccinations. OF COURSE.
4. Pharmacotherapy. AS APPROPRIATE.
You’re welcome😃
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The GOLD definition and diagnostic criteria are inconsistent.
GOLD 'etiotypes' and Lancet Com 'types' are not aligned.
What is going on?
A pleasure to write with
@DrSachinAnanth
for
@ERSpublications
Definitions and Diagnosis of
#COPD
: State of the Art
1
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There is no greater privilege than acting as external examiner on a
#PhD
and I’m off to Copenhagen today to do just that. It’s an excellent thesis.
And tempted, as I leave this dark, divided Island for the last time as a European citizen, to not really bother coming back 🇪🇺🇬🇧
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I’m in Dammam 🇸🇦 for less than 24 hours so what are the chances of an old PhD student emailing me and being free to meet?? Thank you for showing me your city
@DrAlqahtani_JS
, and congratulations on all you’ve achieved.
#proudexsupervisor
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Good morning from a City by the Sea.
I hope this finds you well.
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Pleased to see
@bmj_latest
highlighting lack of access, and inequity in access to spirometry across the 🇬🇧.
'Clinical diagnosis of COPD'...😱
👏🏻
@rammyamathew
@WanderingSal
“Silent scandal” of missing lung diagnostics where disease is most prevalent:
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Today is
#WorldCOPDDay
and I’m pleased to support the launch of a new Patient Charter for
#COPD
. It sets out the principles of great care and is designed to empower patients to expect that, and to ask for it if care falls short. The six principles...
1
27
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More than fifty years ago now. Fascinating. Terrifying. How far we’ve come, yet how far we still have to go in addressing the harms of tobacco smoke exposure.
And please, be careful watching this, you could cut yourself on those accents.
#OnThisDay
1962: As a Royal College of Physicians report linked smoking to serious health problems, the BBC hit the streets to find out what the general public made of it. Several smokers seemed somewhat unfazed.
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It’s thirty years to the day since I left home for
@EdinUniMedicine
.
And as a pretty green and geeky teenager, I will forever be thankful for the teaching and training I received which didn’t so much create a new junior doctor as a wholly more functional human being.
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3
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Really interesting SR and meta-analysis of
#LongCovid
symptoms by
@sandralopezleon
and colleagues now available
@medrxivpreprint
. Usual pre-print caveats apply. Includes our
@UCLRespiratory
data, led by
@lung_live4eva
.
Great figure.
#COVID19
1
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Out latest paper from
@UCLRespiratory
is now online as a preprint.
Meta-analysis shows 50% reduction in severe
#COPD
exacerbations in association with
#COVID19
pandemic restrictions.
#AECOPD
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