Symptoms such as cough, wheeze, and breathlessness are among the most common reasons for general practitioner or emergency department visits in the UK. Such symptoms have a profound impact on patients' ability to live a fulfilled life, often rendering people unable to work and socialise. Azithromycin (a type of antibiotic) improves symptoms and reduces flare-ups of diseases such as asthma and chronic obstructive pulmonary disease (COPD). The reason why it works is unclear. Many people believe that it either decreases the number of bacteria in the lungs or reduces inflammation in the lungs and the upper airways. Neither theory is proven. Another possible mechanism that has been much less studied is that Azithromycin encourages the body to move food and fluid through the gut more quickly, thus preventing reflux and aspiration of small food particles and stomach acid. It has been shown that lung damage can occur when gut contents enter the airways, which may contribute chronic lung disease patients' symptoms In this study the investigators will test the effect of azithromycin on the gut in patients with chronic lung diseases. The investigators will measure the strength of a patients swallow by measuring the pressures in their gullet, using high-resolution oesophageal manometry (HROM), before and after treatment, in people being started on azithromycin as part of their routine care. The investigators will also measure the effect that azithromycin has on their symptoms and observe whether there is a relationship between the strength of their swallow and their symptoms. At the end of this study, the investigators hope to better understand the way in which azithromycin helps to improve the symptoms of patients with chronic lung diseases. The investigators also hope to open the door to investigate the effect of other drugs that improve gut function in patients with chronic lung diseases.
Study Type
OBSERVATIONAL
Enrollment
30
High Resolution Oesophageal manometry assesses how well the muscles of the oesophagus are working when you swallow. It also checks the relaxation of the valves at the top and bottom of the oesophagus.
Castle Hill Hospital
Hull, Yorkshrie, United Kingdom
Eligibility to consent ratio
The ratio of participants deemed eligible to participate in the study to the number of those who provide consent to take part
Time frame: 1 year
Recruitment rate
The number of participants successfully recruited per month
Time frame: 1 year
Participant retention to follow-up
The proportion of those participants who consent to take part that compete all study measures to follow-up
Time frame: 1 year
Acceptability of assessment
Quantify the proportion of participants who judge the study investigations, principally HROM, to be acceptable.
Time frame: 1 year
Distal Contractile Integrity
To evaluate the effect of azithromycin on the contraction vigour and swallow coordination. This will be evaluated by investigating patients with HROM before and 1 month after initiation of azithromycin as part of routine clinical care. Measured in mmHg/sec/cm.
Time frame: 1 month
Lower Oesophageal Sphincter Pressure
To evaluate the effect of azithromycin on the pressure of the lower oesophageal sphincter as measured by HROM. This will be evaluated by investigating patients with HROM before and 1 month after initiation of azithromycin as part of routine clinical care. Measured in mmHg.
Time frame: 1 month
Distal Latency
To evaluate the effect of azithromycin on the timeframe of the wave from the beginning of the swallow to an inflection of the peristaltic axis, as measured by HROM. This will be evaluated by investigating patients with HROM before and 1 month after initiation of azithromycin as part of routine clinical care. Measured in seconds.
Time frame: 1 month
Integrated Relaxation Pressure.
To evaluate the effect of azithromycin on the oeosphageal pressure topography metric that is used for assessing the adequacy of oesophageogastric junction relaxation, as measured by HROM. This will be evaluated by investigating patients with HROM before and 1 month after initiation of azithromycin as part of routine clinical care. Measured in seconds.
Time frame: 1 month
Chicago Classification
A composite classification based on all HROM measurements. We will be using the current version 4.0.
Time frame: 1 month
Hull Airway Reflux questionnaire
A validated tool for assessing symptoms of reflux. A likert scale questionnaire. Scored out of 70 with higher score representing worse symptoms.
Time frame: 1 month
Breathlessness, cough, and sputum scale
A validated tool for assessing symptom burden. A 5-point likert scale that is scored out of 12. A higher score representing worse symptoms.
Time frame: 1 month
MRC dyspnoea scale
A validated tool for measuring breathlessness. It is scored out out of 5 with a higher score representing worse symptoms.
Time frame: 1 month
Visual analogue scale - cough severity
A visual scale of 100mm in length. Participants will mark on the scale from 0-100 how bad their cough is currently with 100mm representing worst cough imaginable.
Time frame: 1 month
COPD Assessment test (COPD patients only)
An 8 item questionnaire which quantifies the symptom burden participants with COPD and how it impacts their life. Scored out of 40, with a higher score signifying worse control.
Time frame: 1 month
Asthma control questionnaire (asthma patients only)
An 7 item questionnaire which quantifies the symptom burden participants with asthma and how it impacts their life. Scored 5-25 - a score of 5 is very poorly controlled asthma and a score of 25 is very well controlled asthma.
Time frame: 1 month
Numerical rating scale - breathlessness severity
A horizontally arranged scale numbered 0-10 with 0 representing no breathlessness and 10 representing the worst breathlessness imaginable
Time frame: 1 month
Leicester Cough Questionnaire
A 19-item questionnaire with a 7-point Likert scale used to assess the impact of cough on physical, social, and psychological welfare of the patient. It is scored out of 133 with a higher score representing better health.
Time frame: 1 month
St. George's Respiratory Questionnaire
A 50-item questionnaire which assess impact of overall health, daily life, and well-being in patients with obstructive airways disease. Scores range from 0-100, with higher scores indicating more limitations.
Time frame: 1 month
King's Brief Interstitial Lung Disease Questionnaire (ILD Patients only)
A 15-item 7-point Likert scale questionnaire aimed to measure the impact of ILD on quality of life and health status. It is scored out of 100, with 100 representing the best health status.
Time frame: 1 month
Relationship between oesophageal motility and symptoms
The change in oesophageal functioning and presence of respiratory symptoms will be examined in each participant. The relationship between these two parameters will then be examined using statistical analysis
Time frame: 1 month
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