This research by The University of Manchester and 91ֱ�� University NHS Foundation Trust (MFT) scientists is the first of its kind to show people who stop using a prescribed treatment for COPD are at significantly higher risk of exacerbations than expected for their disease.

COPD is the name for a group of lung conditions that cause breathing difficulties, including emphysema and chronic bronchitis. COPD is a common condition, affecting about 1 in 20 people aged over 40 in England, and is a major cause of death and disability.

People with COPD often experience ‘exacerbations’ – sudden flare-ups of breathlessness and coughing that make their condition much worse. These exacerbations are a leading cause of emergency hospital admissions.

Treatment for COPD can help slow the progression of the condition, control symptoms and prevent flare-ups. This includes taking inhalers which deliver medicine into the lungs to help make breathing easier.

91ֱ�� lead Dr Alexander , researcher in the NIHR 91ֱ�� BRC’s Respiratory Theme and a Senior Clinical Lecturer at The University of Manchester, said: “Many people with COPD use inhalers every day, but some only use them for a short time and then stop. They may feel better and think they no longer need them, they may struggle to afford them if they are not free of charge, or they may simply forget to use them. Overall, that around half of all prescribed doses are missed.”

In this new study, 91ֱ�� researchers analysed data from the 2013-2016 FLAME trial, a large international research project sponsored by Novartis which investigated how patients respond to different COPD treatments. Novartis shared these trial data as per standard data sharing practices with the independent research team in 91ֱ�� to answer additional research questions beyond the original study.

The FLAME trial compared 2 types of in more than 3,300 participants with COPD – these are effective treatments used to open up the airways and reduce inflammation in COPD.

The team found that when people with COPD stop their inhalers, they face a significantly increased risk of flare-ups for around 3 months. Importantly, during this period the risk is higher not only compared with their own usual level of risk, but also compared with people who were not taking these medicines at all.

The study followed patients for a full year after stopping treatment and showed that this increase in risk is temporary. The excess risk of flare-ups is concentrated in the first 3 months after stopping inhalers, over and above what would normally be expected following treatment discontinuation. After this period, the risk settles and does not persist beyond 3 months.

The study, published in , showed for the first time that stopping a common type of inhaler called a LAMA (long-acting muscarinic antagonist) can lead to these withdrawal effects. It also confirmed that stopping inhalers containing another medication called inhaled corticosteroids (ICS) can increase the risk of flare-ups.

Dr Mathioudakis, who is also an Honorary Consultant Respiratory Physician at MFT and completed his PhD in COPD research at 91ֱ�� BRC, said: “There are situations where clinicians may need to change or stop an inhaler for specific medical reasons, and in these cases it is important to be aware that short-term “withdrawal effects” can occur.

“More importantly, many people with COPD stop their inhalers on their own, often repeatedly, without medical advice. Each time this happens, it can trigger a period of particularly high risk of exacerbations. These new findings highlight the need to clearly communicate the risks of stopping treatment to patients, to help prevent avoidable flare-ups and hospital admissions.”

• The paper “Disproportionate increase in COPD exacerbation risk for 3 months after discontinuing LAMA or ICS: insights from the FLAME trial” is available : DOI:

A team of researchers from The University of Manchester, Salford Royal and Res Consortium, have shown that a significant proportion of people in the UK- over 25% - is likely to have been infected already by the COVID-19 virus.

The study - published this week in the International Journal of Clinical Practice - is the first to use the published local authority data to assess the cumulative impact of infection since the COVID-19 outbreak began.

This has enabled them to calculate the R-value - the number of people infected by one person with COVID-19 - within each local authority area.

The published case data from the 144 Local Authorities analysed by the team now gives an R value of well below 1.

The value – which was over 3 at the start of the outbreak in the middle of March 2020 – fell as a consequence of social distancing combined with the natural consequences of cumulative community infection.

Daily reported cases peaked at the beginning of April 2020 and hospital deaths a week later in England. By the second half of April, based on extrapolating the variation in infection rate between local authorities with more or less cases reported depending on location, over 25% in the UK population could already have had the virus, the team have found.

Dr Adrian Heald from The University of Manchester, one of the researchers, said: “COVID-19 is a highly infectious condition and very dangerous for a small group of people. However a much larger group seem to have low or no symptoms and have been unreported.

“This study tries to provide an estimate of the number of historic infections – and gives us all a glimmer of hope that there may be light at the end of the tunnel.

“We show how effective Social Distancing and Lockdown has been. Though this is a tragedy, it could have been far worse”.

The Consultant Physician in Diabetes and Endocrinology at Salford Royal NHS Foundation Trust, part of the Northern Care Alliance NHS Group, added: “We also demonstrate that like any virus, COVID-19 has taken its natural course and infected a significant percentage of the UK population.

“The more people that are exposed to this - or any - virus, the less easy it is for further transmission to occur.

“Government policy can only moderate the impact using measures like widespread testing, social distancing and personal protective equipment.

“The social and economic impacts of Lockdown have been very difficult, but we believe this analysis may aid policy makers in a smoother transition to reducing social containment and sustainably managing the COVID-19 disease.

“This will allow policy makers to avoid a ‘one size fits all’ approach to pandemic policy, which does not consider the variation in both infection rates and impact across localities.”

Mike Stedman from Res Consortium who carried out the data analysis said: “Using our experience working with the NHS on improving patient services, we conducted this work in our own time as we felt we could make a valuable contribution to the public and policy makers by calculating the progression in the local and national daily infection rate.

“The figures are not perfect, with the numbers of severely ill patients as a proportion of the total cases being used as a market for estimates of wider infection.

“Only extensive antibody testing could give us a more accurate picture - but as that is only just becoming available, we believe this form of modelling is important in informing the best approach to unlocking the population.”

Dr Heald and Mike Stedman argue that incremental lifting of current social restrictions as soon as possible is vital to minimise further damage to the economy and the impact of prolonged social containment.

However, they add, this must be balanced against containing the current pandemic and minimising future waves of infection.​

​The paper “A phased approach to unlocking during the COVID-19 pandemic – Lessons from trend analysis” is available 

The University of Manchester has a growing list of scientists and academics who are either working on aspects of the COVID-19 outbreak or can make a valuable contribution to the national discourse. Please check out our . 

Our people are also  and with partners from across society to understand coronavirus (COVID-19) and its wide-ranging impacts on our lives.  to support the University’s response to coronavirus or visit the University’s  to lend a helping hand