Category: National Heart and Lung Institute

The importance of annual reviews for COPD care

Man at COPD review

Currently, there are considerable gaps in the care of people with chronic obstructive pulmonary disease (COPD). Parris Williams, PhD student at the National Heart and Lung Institute (NHLI), highlights why improving the access, delivery and quality of annual COPD reviews is crucial to supporting 1.4 million patients in the UK with the condition.

Chronic obstructive pulmonary disease (COPD), a chronic condition causing restricted airflow and breathing problems, is the second most common lung disease in the UK. Currently 1.4 million people in the UK have a COPD diagnosis. Recommended by the British Thoracic Society and NICE guidelines, annual COPD reviews are a key element in COPD care. These reviews are an opportunity for the patient to discuss their condition with their medical team, alongside inhaler/medication revisions and opportunities for onward referrals if needed. When delivered correctly, COPD annual reviews increase the health and reduce exacerbation risk for patients.

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World No Tobacco Day – how to get where we need to be?

Nick HopkinsonThe path to a smokefree generation demands decisive action and innovative strategies. To mark World No Tobacco Day, Professor Nick Hopkinson from the National Heart & Lung Institute (NHLI) offers his insights, drawing on years of dedicated research to suggest ways in which we can achieve this. 

Smoking is the leading preventable cause of premature disability and death; two out of three people who continue to smoke will die from a smoking-related disease. Ending this requires two things: First, ensuring that people don’t start to smoke in the first place; and second, supporting the more than six million people in the UK who still smoke to quit.

‘Stopping the start’ involves making smoking less appealing,less affordable, and less available to children and young people. A key step to creating a smokefree generation will be steadily raising the age of sale, ensuring that tobacco products can never legally be sold to people born on or after 1 January 2009. The General Election has paused the progress of this legislation, but the policy has enjoyed cross-party support, so is almost certain to become law. We can be confident that it will be effective – youth smoking rates fell when the age of sale in the UK was increased from 16 to 18 in 2007, and similarly where it has been increased to 21 in the US. The year-on-year increase will also prevent the tobacco industry from addicting people later in life.

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Breaking stereotypes and creating role models

Fama MannehTo mark Women at Imperial Week, we’re spotlighting Fama Manneh, a 2nd-year PhD student, from the Department of Bioengineering and the National Heart and Lung Institute (NHLI) and her recent invite by the British Embassy in Madrid to speak on the topic of breaking stereotypes as a woman. As the President of Women in STEM she is a driving force inspiring women within and outside the University community. Read more about her experience in Madrid below.  

Recently, I had the honour of being invited by the British Embassy in Madrid to speak at an event organised by Beatriz Herranz. The event, “Women in Science: Breaking stereotypes and creating role models” was held at Fundación Ortega-Maranon. This historic venue, dating back to the early 20th century, was a Girls’ Residence (Residencia de Señoritas) that provided both housing and educational opportunities for young women pursuing higher education. It offered a supportive environment for female students to pursue arts, sciences, and humanities, fostering intellectual growth and independence.

The selection of this venue for the Women in Science event holds symbolic significance, as it reflects the continuation of the Girl’s Residence mission to empower women through education and knowledge. The choice pays homage to the pioneering women who once resided there, aiming to inspire current generations of female scientists, engineers, and technologists.

At the event, Teresa Guerrero of El Mundo Science expertly moderated a thought-provoking roundtable discussion. I shared the panel with distinguished figures, including Silvia Rueda Pascual, a Cabinet Advisor at the Ministry of Science and Innovation and Director of the Women and Science Unit; María A. Blasco, the Director of the Spanish National Cancer Research Centre (CNIO); and Cynthia Cabanas, a PhD student and representative of the Spanish Researchers in the United Kingdom (SRUK/CERU).

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From Britpop to breakthroughs: Reflecting on 30 years of HIV testing and treatment

Born on what would eventually be recognized as World AIDS Day in the 1970s, Dr Mike Emerson, now affiliated with the National Heart and Lung Institute, relocated to vibrant London during the early 1990s amidst the fervour of the Britpop era. In the backdrop of Blur and Pulp melodies, 1990s London faced the AIDS crisis. Three decades later, he is at the helm of a team investigating cardiovascular ailments in people with HIV. In this piece, Dr Emerson reflects on the advancements in HIV diagnosis and therapy, and reiterates the ongoing importance of  National HIV Testing Week. 

I was born on what was to become World AIDS day way back in the 1970s, and moved to the big smoke in the early 90s. London was exploding with Britpop excitement, and in the absence of mobile tech, we went out every night to the sounds of Blur and Pulp. 90s London was also the epicentre of the UK’s bit of the global AIDS crisis. People in their early 20s, as I was, were dying (of ignorance the government told us). I quickly learnt not to hold birthday celebrations in Soho; celebrating and mourning young friends and sons don’t mix well. Exactly 30 years later, I lead a team investigating cardiovascular disease as people live with HIV for decades and succumb to the diseases of old age. This week is HIV testing week, so it’s a good time to reflect on how far we have come and remind ourselves of the importance of HIV testing. 

Back in 1981, a couple of obscure articles noted incidences of fatal pneumonia and rare skin cancers in otherwise healthy young American men. Oddly, these men were all gay. Within months, there was an explosion of terrifying fatal illness amongst the gay communities of New York, San Francisco and, not far behind, London. People became infected with HIV following blood transfusions, and babies were born with the condition and died. When HIV tests became available, the prospect of one was terrifying, involving a week-long wait for results and a recommendation to take a friend when results were due to be delivered. 

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Unravelling the mystery of smaller lungs in low- and middle-income countries

Andre Amaral

In low- and middle-income countries (LMICs), a notable number of individuals have smaller lungs for their sex, age, and height, especially in South and East Asia, as well as sub-Saharan Africa. The key question: Why does this pattern persist in these regions?

This phenomenon extends beyond physiological concerns, and as indicated by recent studies, reveals a troubling link between smaller lungs and heightened risks of suffering from heart disease and diabetes. Dr André Amaral, an epidemiologist at the National Heart and Lung Institute (NHLI), explores this phenomenon.

The BOLD study

Chronic lung diseases affect millions of people of all ages worldwide. Approximately 20 years ago, the Burden of Obstructive Lung Disease (BOLD) study was set up by Imperial College London to find out more about the prevalence and determinants of chronic obstructive pulmonary disease (COPD), which back then, was already considered a leading cause of disability and death.

The BOLD study was conducted in 41 sites across Africa, Asia, Australia, Europe, the Caribbean and North America, and recruited more than 30,000 adults aged 40 years and over. The large coverage of world regions, and ethnic groups, as well as the large number of participants, all answering the same questions and undergoing the same measurements in a standardised manner, makes the BOLD study unique. Participants in this study provided information on several characteristics of their life. This included whether they had been diagnosed with lung disease, a heart disease, or diabetes, whether they smoke or ever smoked, their weight and height, and their highest level of education. The level of their lung function was measured through a medical test called spirometry, which measures how much air a person can breathe out in one forced breath.

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Nurturing hope: Understanding Dilated Cardiomyopathy and transforming heart failure prospects

As the leading cause of heart failure in young individuals, dilated cardiomyopathy presents a unique set of challenges and implications. It is an intrinsic heart muscle disease that is the most common reason for needing a heart transplant. The origins of this condition are diverse, spanning genetic predispositions, external triggers that subject the heart to undue stress, or often, a combination of both. Dr Brian Halliday, a Clinical Senior Lecturer and British Heart Foundation Intermediate Fellow at the National Heart and Lung Institute sheds light on this disease and how medical advancements have enabled some patients to go into remission.

Heart failure can be a devastating diagnosis. The prognosis has been shown to be worse than many of the most common cancers. The words themselves often create a sense of doom for patients.

Dilated cardiomyopathy is the most common cause of heart failure in young people and the most common reason to need a heart transplant. It is an intrinsic heart muscle problem where the heart becomes baggy and weak. It may be due to genetic susceptibility, extrinsic acquired triggers that put the heart under stress, or a combination of the two. At the National Heart and Lung Institute, we have a particular interest in dilated cardiomyopathy.

The heart of a patient with dilated cardiomyopathy
The same patient’s heart after undergoing remission

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Getting to the Heart of the Matter: Sex Differences in Cardiomyopathy

Artwork by Mengmeng Tu, MSc Science Communication student

This festive period, Three Wise Women from the Faculty of Medicine will be giving us the gift of wisdom.

Could variation in the architecture of men and women’s hearts explain why their risk of cardiomyopathy differs? Dr Paz Tayal, Clinical Senior Lecturer in Cardiology at the National Heart and Lung Institute is investigating this with the aim of improving outcomes for patients affected by this disease of the heart muscle. Dr Tayal also discusses the ‘juggle struggle’ of balancing work and family life, and the importance of truth telling in academic medicine.

As winter sets in, I start to pack away the summer dresses and bring out the woolly jumpers and sturdy boots. When I do this, I will not be going into my husband’s closet to find things that fit me, nor indeed will I be wearing his shoes.

That seems obvious right, because we are different sizes.

We don’t think twice about that, yet in medicine, we are only just beginning to realise that male and female patients might need to have tailored ways to diagnose and treat disease.

Even in health, male and female hearts are not the same. At birth, the hearts of male and female babies are about the same size. However, at puberty, male hearts have a faster period of growth compared to female hearts. Whilst this eventually settles down, throughout adult life the mismatch persists, and the female heart remains smaller.

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Tackling syncope – a significant diagnostic challenge for many

Syncope–a transient loss of consciousness–occurs in 42% of people by the age of 70. Professor Richard Sutton, Emeritus Professor of Clinical Cardiology, discusses this common medical problem, and how he has pioneered a “true but still insufficiently small interest” in it.

I have been Emeritus Professor of Clinical Cardiology at Imperial since 2011. Prior to that, I had trained in Cardiology at St George’s Hospital, the University of North Carolina, and the National Heart Hospital in London, becoming Consultant Cardiologist at Westminster Hospital in 1976. There I focused on cardiac pacing as a subspecialty. From a clinical perspective, cardiac pacing eradicated syncope (transient loss of consciousness) in patients with conduction tissue disease of the heart. So, I sought to extend the role of pacing into related syncope conditions.

My primary interest therefore became the symptom of syncope. I began this in the late 1970s, and formed a close relationship with Worthing Hospital which carried a heavy load of older patients, many of whom presented syncope. I founded an outreach clinic at Worthing which led to the receipt of many challenging patients with syncope in whom there was no obvious cause.

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Margaret Turner Warwick Centre: Can we take your breath away?

The Great Exhibition Road Festival is a free annual celebration of science and the arts each summer in South Kensington. The event showcases a diverse range of activities for people of all ages.  One of those activities, led by researchers from the Margaret Turner Warwick Centre and volunteers from the charity Action for Pulmonary Fibrosis, included an interactive activity that gave the public the opportunity to walk in the shoes of someone living with pulmonary fibrosis. Find out first-hand from Elisabeth Pyman, what happened on the day and hear from pulomary fibrosis patient, Andy, what it’s like to live with the condition.

The June weekend of the Great Exhibition Road Festival was one of quintessential British summertime weather. This celebration of science was hosted by Imperial College London in collaboration with the local community and provided a wide range of topics for people of all ages to explore. Under intermittent spells of rain, crowds of a multitudinous diversity explored the “awe and wonder” of science, the theme of this year’s festival. To welcome the public, artists and scientists populated the streets and buildings surrounding Imperial’s South Kensington campus like a sudden desert bloom.

Meanwhile, another transformation was taking place in a stand tucked away at the end of the road in the Creative Science zone. Researchers from the Margaret Turner Warwick Centre and volunteers from the charity Action for Pulmonary Fibrosis were on a mission to spread awareness about a rare lung condition known as pulmonary fibrosis. This condition is associated with a build-up of scar tissue that leads to a steady decline in lung function, with many patients becoming terminal only five years after diagnosis. Currently, there are 32,500 UK residents living with a diagnosis, but the actual number of people affected is estimated at around 100,000.

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HIV antiretroviral therapy: Getting to the heart of the matter

The HIV landscape has completely transformed since the start of the pandemic. A HIV diagnosis in the 1980s was considered fatal, as people usually progressed to AIDS due to the lack of available treatments. 42 years later, we have an array of different drug options and as a result, people diagnosed with HIV today can now expect to have near-normal life expectancies. Here, Dr Akif Khawaja from the National Heart & Lung Institute (NHLI), highlights the impact of HIV treatment over the last 42 years and how it influences cardiovascular research today.

HIV Treatment: from AZT to U=U

At the start of the pandemic, there were no available treatments. Patients would progress to AIDS and were only offered palliative care. It wasn’t until 1987 that the first antiretroviral drug, zidovudine (AZT), was licenced for the treatment of HIV. A major challenge with HIV treatment soon became apparent, as the virus can rapidly mutate and change its genetic code to become resistant to the drug supressing its replication. This challenge was quickly seen by clinicians as their patients would start to rebound from antiretroviral monotherapy (one drug regimens) as HIV became drug resistant and was able to replicate again. The introduction of combination antiretroviral therapy in 1996 has been monumental to HIV management. A change in treatment guidelines meant that patients who would have previously been given one drug, were now given three drug combinations, each targeting different parts of the HIV life cycle. This approach meant that patients could suppress HIV replication and achieve a sustained undetectable viral load, meaning that the level of virus in their blood is so low, it can no longer be detected by diagnostic tests.

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