Respiratory Physiology & Medicine

This group aims to better our understanding of respiratory physiology in health & disease with the aim of improving clinical care. Through collaborative research incorporating expertise in basic, applied and clinical respiratory physiology, we aim to develop, and apply, innovative research methods to the areas of:

Respiratory physiology in extremes
Exercise physiology in health & disease
Impact of respiratory disease in critical care and rehabilitation

Research areas include:

Understanding human responses to acute and chronic respiratory stress
- Mechanisms of respiratory failure in clinical populations
- Regulation of human responses to hypoxia
Exercise limitation in health & disease
- Respiratory muscle & breathing mechanics
- Neurophysiology of breathlessness
Understanding respiratory support and monitoring
- Chronic disease
- Critical care
Cardiorespiratory interaction and control
- Role of cardiorespiratory interaction in exercise, the effect of chronic disease and contribution to breathlessness and exercise intolerance
Development of new non-invasive technologies to monitor cardio-respiratory function
- Novel analysis techniques to allow remote monitoring of pulmonary function
Mechanisms, monitoring and treatment of cough
Respiratory physiology, sleep-disordered breathing and the development of new treatments in sleep apnoea

Members

Richard Bruce

Senior Lecturer in Cardiorespiratory Physiology

Luigi Camporota

Consultant and Honorary Reader

Federico Formenti

Reader in Physiology

Stephen Harridge

Professor of Human & Applied Physiology

Peter Hodkinson

Head of Aerospace Medicine (Clinical and Education)

Caroline Jolley

Senior Lecturer in Human Physiology

Ross Pollock

Lecturer in Aerospace Physiology

Gerrard Rafferty

Reader in Human & Translational Physiology

Michelle Ramsay

Consultant in respiratory and ventilation medicine

Thomas Smith

Reader in Aerospace Medicine and Head of Aerospace Medicine Research

Joerg Steier

Professor of Respiratory and Sleep Medicine

First-in-man evaluation of a rapid, real-time continuous arterial PO2 sensor in the critically ill

Continuous oxygen monitoring performed with a novel fibre optic sensor affords the real time study of dynamic cardiopulmonary physiology, providing detailed information on pulmonary gas exchange. The main aim of the study is to determine the utility and potential of dynamic arterial oxygen tension measurement in critically ill patients.

Respiratory Physiology & Medicine Project 1

Lobar gas exchange

An accurate prediction of post-operative lung function is fundamental to determine lung cancer patients’ suitability for surgery (resection). Methods currently used for this prediction provide an overall index of lung function, but cannot distinguish between individual lobes’ contributions during spontaneous breathing. We are developing an entirely novel approach to measure lobar gas exchange, combining computed tomography and bronchoscopy, already in widespread use, with rapid-responding fibre optic oxygen sensing technology. The proposed method can determine the relative lobar contribution to overall pulmonary gas exchange, potentially offering a more accurate prediction of post-operative lung function.

Respiratory Physiology & Medicine Project 2

The use of Symmetric Projection Attractor Reconstruction (SPAR) as a novel assessment tool in Asthma

Optimal asthma care relies on accurate and detailed assessment of the patient's clinical condition. A cornerstone of assessment is pulmonary function testing. Such testing frequently involves measuring airflow at the mouth during maximal breathing efforts. Although widely employed, such measurements are relatively insensitive and often relate poorly to overall disease severity. Lack of sensitivity leads to difficulty diagnosing early lung disease or early intervention following mild deterioration, which may ultimately affect prognosis. Existing diagnostic techniques can also be challenging to perform by patients resulting in inaccurate or difficult to interpret measures and potential misdiagnosis. Symmetric Projection Attractor Reconstruction (SPAR) is a novel analysis tool to quantify morphology changes from physiological waveforms such as respiratory flow and transforms high-fidelity waveform data into a simpler, quantifiable image (termed an attractor). This approach could be of potential benefit in diagnosis and monitoring of patients with asthma.

Understanding the physiological basis of breathlessness in health and disease

Breathlessness is a common and highly distressing symptom of lung disease. We have demonstrated the close relationship between patient-reported breathlessness and neural respiratory drive measured using respiratory muscle EMG, in health and chronic lung disease such as COPD. Current work seeks to understand the clinical utility of electromyography and chest wall mechanomyography, in the diagnosis and monitoring of disease severity and response to treatment. Interdisciplinary collaborations include Professor Irene Higginson, (Palliative Care) funded by the EU Horizon2020 research and innovation programme.

Inspired Sinewave

An NIHR i4i funded study in collaboration with the University of Oxford examining the performance of a new lung function device, the ‘inspired sinewave test’ (IST). This non-invasive technique is simple to perform and requires only passive cooperation, with the patient breathing a tracer gas during normal tidal breathing. IST measures lung volume, pulmonary blood flow, and ventilatory heterogeneity. The study will initially phenotype patients with COPD but will also be tested in asthma CF and critical care. Testing will take place in the CHAPS laboratories, King’s College Hospital, Denmark Hill Campus.

Camporota, L., J.N. Cronin, M. Busana, L. Gattinoni, and F. Formenti, Pathophysiology of coronavirus-19 disease acute lung injury. Curr Opin Crit Care, 2021 DOI: 10.1097/MCC.0000000000000911.
Cronin, J.N. and F. Formenti, Experimental asynchrony to study self-inflicted lung injury. Br J Anaesth, 2021 DOI: 10.1016/j.bja.2021.11.020.
Hummer, E.V., J.H.N. Soares, D.C. Crockett, A.J.A. Aguiar, M.C. Tran, J.N. Cronin, R.J. Brosnan, C. Braun, and F. Formenti, Continuous measurement of arterial oxygenation in mechanically ventilated horses. Equine Vet J, 2021 DOI: 10.1111/evj.13542.
Gallifant, J., J. Zhang, M. Del Pilar Arias Lopez, T. Zhu, L. Camporota, L.A. Celi, and F. Formenti, Artificial intelligence for mechanical ventilation: systematic review of design, reporting standards, and bias. Br J Anaesth, 2021 DOI: 10.1016/j.bja.2021.09.025.
Cronin, J.N., L. Camporota, and F. Formenti, Mechanical ventilation in COVID-19: A physiological perspective. Exp Physiol, 2021 DOI: 10.1113/EP089400.
Pollock, R.D., C.J. Jolley, N. Abid, J.H. Couper, L. Estrada-Petrocelli, P.D. Hodkinson, S. Leonhardt, S. Magor-Elliott, T. Menden, G. Rafferty, G. Richmond, P.A. Robbins, G.A.D. Ritchie, M.J. Segal, A.T. Stevenson, H.D. Tank, and T.G. Smith, Pulmonary Effects of Sustained Periods of High-G Acceleration Relevant to Suborbital Spaceflight. Aerosp Med Hum Perform, 2021. 92(8): p. 633-641 DOI: 10.3357/AMHP.5790.2021.
Suh, E.S., R.F. D'Cruz, M. Ramsay, J. Steier, C.J. Jolley, C.C. Reilly, N. Hart, J. Moxham, P.B. Murphy, and G.F. Rafferty, Second intercostal space electromyography as a measure of neural respiratory drive: Clinical utility and validity. Respir Physiol Neurobiol, 2021. 290: p. 103683 DOI: 10.1016/j.resp.2021.103683.
Lozano-Garcia, M., L. Estrada-Petrocelli, A. Torres, G.F. Rafferty, J. Moxham, C.J. Jolley, and R. Jane, Noninvasive Assessment of Neuromechanical Coupling and Mechanical Efficiency of Parasternal Intercostal Muscle during Inspiratory Threshold Loading. Sensors (Basel), 2021. 21(5) DOI: 10.3390/s21051781.
Bruce, R.M., P.A. Phan, M. Rigolli, M.C. Tran, E. Pacpaco, N.M. Rahman, and A.D. Farmery, Assessment of Ventilatory Heterogeneity in Chronic Obstructive Pulmonary Disease Using the Inspired Sinewave Test. Int J Chron Obstruct Pulmon Dis, 2021. 16: p. 401-413 DOI: 10.2147/COPD.S264360.
Hadfield, D., L. Rose, F. Reid, V. Cornelius, N. Hart, C. Finney, B. Penhaligon, C. Harris, S. Saha, H. Noble, J. Smith, P.A. Hopkins, and G.F. Rafferty, Factors affecting the use of neurally adjusted ventilatory assist in the adult critical care unit: a clinician survey. BMJ Open Respir Res, 2020. 7(1) DOI: 10.1136/bmjresp-2020-000783.
Lozano-Garcia, M., C.M. Davidson, C. Prieto-Ramon, J. Moxham, G.F. Rafferty, C.J. Jolley, and R. Jane, Spatial Distribution of Normal Lung Sounds in Healthy Individuals under Varied Inspiratory Load and Flow Conditions. Annu Int Conf IEEE Eng Med Biol Soc, 2020. 2020: p. 2744-2747 DOI: 10.1109/EMBC44109.2020.9175992.
Lozano-Garcia, M., J. Nuhic, J. Moxham, G.F. Rafferty, C.J. Jolley, and R. Jane, Performance Evaluation of Fixed Sample Entropy for Lung Sound Intensity Estimation. Annu Int Conf IEEE Eng Med Biol Soc, 2020. 2020: p. 2740-2743 DOI: 10.1109/EMBC44109.2020.9176215.
White, M. and R. Bruce, The role of muscle mechano and metaboreflexes in the control of ventilation: breathless with (over) excitement? Exp Physiol, 2020. 105(12): p. 2250-2253 DOI: 10.1113/EP088460.
Sylvester, K.P., N. Clayton, I. Cliff, M. Hepple, A. Kendrick, J. Kirkby, M. Miller, A. Moore, G.F. Rafferty, L. O'Reilly, J. Shakespeare, L. Smith, T. Watts, M. Bucknall, and K. Butterfield, ARTP statement on pulmonary function testing 2020. BMJ Open Respir Res, 2020. 7(1) DOI: 10.1136/bmjresp-2020-000575.
Hadfield, D.J., L. Rose, F. Reid, V. Cornelius, N. Hart, C. Finney, B. Penhaligon, J. Molai, C. Harris, S. Saha, H. Noble, E. Clarey, L. Thompson, J. Smith, L. Johnson, P.A. Hopkins, and G.F. Rafferty, Neurally adjusted ventilatory assist versus pressure support ventilation: a randomized controlled feasibility trial performed in patients at risk of prolonged mechanical ventilation. Crit Care, 2020. 24(1): p. 220 DOI: 10.1186/s13054-020-02923-5.
Jacunski, M. and G.F. Rafferty, The effects of hypoxia and fatigue on skeletal muscle electromechanical delay. Exp Physiol, 2020. 105(5): p. 842-851 DOI: 10.1113/EP088180.
Bruce, R.M., C. Jolley, and M.J. White, Control of exercise hyperpnoea: Contributions from thin-fibre skeletal muscle afferents. Exp Physiol, 2019. 104(11): p. 1605-1621 DOI: 10.1113/EP087649.
Cook, H., C.C. Reilly, and G.F. Rafferty, A home-based lower limb-specific resistance training programme for patients with COPD: an explorative feasibility study. ERJ Open Res, 2019. 5(2) DOI: 10.1183/23120541.00126-2018.
Shastri, L., M. Alkhalil, C. Forbes, T. El-Wadi, G. Rafferty, K. Ishida, and F. Formenti, Skeletal muscle oxygenation during cycling at different power output and cadence. Physiol Rep, 2019. 7(3): p. e13963 DOI: 10.14814/phy2.13963.
Lozano-Garcia, M., L. Sarlabous, J. Moxham, G.F. Rafferty, A. Torres, R. Jane, and C.J. Jolley, Surface mechanomyography and electromyography provide non-invasive indices of inspiratory muscle force and activation in healthy subjects. Sci Rep, 2018. 8(1): p. 16921 DOI: 10.1038/s41598-018-35024-z.
Lozano-Garcia, M., L. Sarlabous, J. Moxham, G.F. Rafferty, A. Torres, C.J. Jolley, and R. Jane, Assessment of Inspiratory Muscle Activation using Surface Diaphragm Mechanomyography and Crural Diaphragm Electromyography. Annu Int Conf IEEE Eng Med Biol Soc, 2018. 2018: p. 3342-3345 DOI: 10.1109/EMBC.2018.8513046.
Bruce, R.M., P.A. Phan, E. Pacpaco, N.M. Rahman, and A.D. Farmery, The inspired sine-wave technique: A novel method to measure lung volume and ventilatory heterogeneity. Exp Physiol, 2018. 103(5): p. 738-747 DOI: 10.1113/EP086867.
Phan, P.A., C. Zhang, D. Geer, F. Formenti, C.E.W. Hahn, and A.D. Farmery, The Inspired Sinewave Technique: A Comparison Study With Body Plethysmography in Healthy Volunteers. IEEE J Transl Eng Health Med, 2017. 5: p. 2700209 DOI: 10.1109/JTEHM.2017.2732946.
Connolly, B., M. Maddocks, V. MacBean, W. Bernal, N. Hart, P. Hopkins, and G.F. Rafferty, Nonvolitional assessment of tibialis anterior force and architecture during critical illness. Muscle Nerve, 2018. 57(6): p. 964-972 DOI: 10.1002/mus.26049.