I have been involved with the London Chronic Obstructive Pulmonary Disease (COPD) Cohort Study since its inception in 1995. I have an international reputation of the analysis of data and have produce a number of innovative and important analyses in COPD research. My role involves data management and the conception of statistical analysis. We showed the relationship of COPD exacerbations to quality of life (1998) and disease progression (2002) and thus exacerbations have become key outcomes in the management of COPD and in clinical trials. Our work on the relation between presentation time and COPD exacerbation outcome showed that early therapy reduces exacerbation severity and prevents hospital admission (2004). This has led to development of early intervention strategies that is one of the objectives of the COPD National Services Framework. Our research has strong clinical and basic components and we have shown the importance of infection at exacerbation, interaction of bacteria and viruses and the rationale for the use of antibiotics at COPD exacerbation in collaboration with Microbiology and Virology at the Royal Free Hospital. We were the first to show the relationship between airway inflammatory markers and decline in lung function. We were also the first group to define the presence of COPD patients with a history of frequent exacerbations and these patients are most prone to have recurrent COPD admissions and pose a considerable cost to the NHS. The division of patients into frequent and infrequent exacerbation phenotypes has been incorporated into disease management guidelines for the prescription of maintenance therapy. An analysis of a pharmoco-epidemiological database (2010) showed the relationship between COPD exacerbation and acute myocardial infarction, and this work has been a stimulus for better treatment of cardiovascular disease in COPD. I also showed that exacerbations clustering together in time and wrote the first five drafts of the manuscript

Pulmonary Disease, clinical trials, respiratory diseases