By Holly Giles | Deputy Editor
Chronic Obstructive Pulmonary Disease (COPD) is an obstructive lung disease that is predicted to affect over 1 million people in the UK. It is an umbrella term for a number of conditions that lead to damage to the air sacs in the lungs and inflammation of the airways making it hard to breathe; this is commonly seen in smokers.
Owing to its chronic nature COPD is a long-term condition and is often associated with flare ups that require medical attention. These are commonly treated with one of four antibiotics. However two thirds of these flare ups are not caused by bacterial infections, meaning the antibiotics have no effect. As well as not solving the problem, when antibiotics are administered unnecessarily it provides a selection pressure for the infection that contributes to antibiotic resistance. This is a growing problem in medical care as known medications are no longer effective in patients due to resistance.
In partnership with University of Oxford and King’s College Longdon, Cardiff University developed a finger-prick test that is able to check if the infection is bacteria prior to treatment, meaning antibiotics are only prescribed as required.
The test works by measuring levels of C-reactive protein in the blood which is a marker for inflammation that rises during serious bacterial infectious, indicating to clinicians that antibiotics are needed. Overall the study found the blood test resulted in a 20% reduction in antibiotics prescriptions, a figure which could save the NHS thousands, if not millions, annually.
Professor Nick Francis, formerly of Cardiff University’s School of Medicine, said:
“Governments, commissioners, clinicians, and patients living with COPD around the world are urgently seeking tools to help them know when it is safe to withhold antibiotics and focus on treating flare-ups with other treatments.
“This is a patient population that are often considered to be at high risk from not receiving antibiotics, but we were able to achieve a reduction in antibiotic use that is about twice the magnitude of that achieved by most other antimicrobial stewardship interventions, and demonstrate that this approach was safe.”
Professor Chris Butler, former professor of primary care medicine at Cardiff University, added: “This rigorous clinical trial speaks directly to the pressing issues of preserving the usefulness of our existing antibiotics; the potential of stratified, personalised care; the importance of contextually-appropriate evidence about point-of-care testing in reducing unnecessary antibiotic use and enhancing the quality of care for people with the common condition of chronic obstructive pulmonary disease.”
The study was published in 2019 and last week it was announced that the work had won research paper of the year from the Royal College of General Practitioners. When reflecting on the award Professor Butler told,
“We are obviously delighted on behalf of the universities involved (Cardiff, Kings and Oxford), the National Institute of Health Research Health Technology Assessment Program who funded the study, and the NIHR Clinical Research Network and Health and Care Research Wales.
“We would like to thank the GP practices who implemented the trial, and the some 600 patients who gave their time and data to implement the study and generate the findings, as well as the public contributors who helped with design and dissemination. We are deeply grateful for this wonderful recognition by the RCGP for a superb team effort by UK primary care research.”
The award is associated with a £1000 prize that the team donated to the British Lung Foundation in memory of Margarat Barnard, who was a patient in the study who died of lung cancer before it could be completed. The researchers hope this donation recognises the contribution made by Margarat and all the other patients who took part in the study.
The prize is well-deserved and the findings are of great magnitude in the scientific field; the study has wide reaching implications for the million people living in the UK with COPD and for clinicians. It is not known when these tests will be common practice in our hospitals but these findings open a door to more personalised and effective medicine, that can only be associated with an improvement in care.
Science and Technology Holly Giles