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MAGNIFY

Maximising Adherence and Gaining New Information for Your COPD

MAGNIFY is an R&D programme seeking medical scientific advancements in the methods used to remotely monitor adherence in patients with Chronic Obstructive Pulmonary Disease (COPD) consulting in the community who are at high risk of emergency health care and with the highest carbon footprint. The NHS Long-Term Plan includes commitments related to respiratory disease, including the use of digital tools that should be offered to provide support to a wider group of people with COPD with self-management.

Summary

The baseline level of science that was known when the R&D programme commenced in 2018 included:

  • 59% of patients with persistent asthma adhere to oral treatments vs 44% for inhaled treatments

  • 22–78% of patients with asthma and COPD are poorly adherent to their medication

  • 46.7% (122/261) of COPD patients performed critical errors with inhalers

  • Randomised trial in asthma patients using a connected inhaler system was shown to improve adherence to maintenance therapy in patients; however, such system did not show an improvement in clinical outcomes

  • There is no validated approach to identifying sub-groups of patients who are high-risk and will use adherence support technologies to improve implementation in clinical practice

 

The advance in science that this programme will be measured against, has been defined by global working groups on adherence in respiratory medicine (consisting of 11 Competent Professionals). By implementing a digital tool in over 176 GP sites across the UK to monitor inhaler use in patients with COPD we will be able to address the following uncertainties:

  • Explore moderators of implementation intervention effectiveness

  • Identify target patient groups for the ‘’use’’ of electronic measuring devices

  • Identify clinical outcomes that can be improved from adherence interventions

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​These advancements in scientific knowledge will inform the implementation of a complex intervention that will be tested in an experimental trial with the research question: Is it possible to improve clinical outcomes for patients with COPD by developing a new complex intervention that can be tailored to the individual person’s needs and likelihood of implementation success using medical records and patient user data from digital adherence support technologies?

To-date, we have already published initial scientific studies as abstracts at

  • Primary Care Respiratory Society 2021: Poor adherence in exacerbating COPD patients: magnitude and related factors at baseline in the MAGNIFY pragmatic trial.

  • ERS 2022: Patient-reported barriers to accepting a technological adherence package i MAGNIFY.

  • British Thoracic Society 2023: Technophobia is not the most significant patient-reported barrier to accepting a digital adherence package.

  • ERS 2024: Excess SABA prescribing in respiratory patients and social deprivation: a study in 4 million respiratory patients


These work packages will result in physical outputs by way of several publications which will aim to disseminate new knowledge to Competent Professionals. By applying the new scientific knowledge gained as part of the R&D programme a combined package of medical algorithms will be developed as part of a new complex intervention capable of integrating data to improve COPD patient outcomes.
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​MAGNIFY Team and Steering Committee

Experts contributing to national guidelines (NICE), international COPD strategies (GOLD) and UK primary care, form the MAGNIFY study investigators:

Professor David Price

David Price is Primary Care Respiratory Society Professor of Primary Care Respiratory Medicine at the University of Aberdeen (UK). He was awarded Fellow of ERS (FERS) in 2016. He is also a member of the World Health Organization (WHO) Allergic Rhinitis and its Impact on Asthma (ARIA) executive committee, the World Allergy Organization (WAO), Committee on Asthma, and the WAO Education Council. Professor Price was the founding president of the Respiratory Effectiveness Group (http://www.effectivenessevaluation.org/), a not-for-profit, investigator-led initiative which uses an international collaborative approach to explore the optimum role of real-life research in informing clinical guidelines and improving patient care. Professor Price completed his medical degree at Cambridge University in 1984. He was previously Affiliate Associate Professor in the Department of General Practice at the University of Adelaide, Australia and held an Honorary Chair at the University of East Anglia, UK. He is extensively involved in respiratory and allergy research; his areas of special interest are the ‘real-life’ effectiveness and cost-effectiveness of interventions, clinical trial design, adherence, and patient attitudes to their disease. He has authored more than 490 peer-reviewed publications and is responsible for approximately US$50 million in research and clinical development grants. He is currently Editor-in-Chief of the journal Pragmatic and Observational Research and member of the editorial board of several respiratory journals, including The Lancet Respiratory Medicine.

Professor David Halpin

David Halpin trained at Oxford & St Thomas Hospital Medical School: completing a D.Phil. in the Department of Human Anatomy, Oxford, before finishing his clinical training at St Thomas. He completed his postgraduate training in respiratory medicine at the Brompton Hospital. Professor Halpin is a Fellow of Royal College Physicians, Member British Thoracic Society, European Respiratory Society & American Thoracic Society. Professor Halpin continues to undertake research in respiratory medicine & has published widely. He lectures frequently around the world on COPD. Until recently Professor Halpin was an Associate Editor of Thorax. Professor Halpin is one of the 10 Directors of the WHO/NIH Global Initiative for Obstructive Lung Disease (GOLD) and a member of the GOLD Science Committee. Professor Halpin was the Chairman and Clinical Expert for the COPD Guideline Development Group of the National Institute of Clinical Excellence (NICE) in the UK. Until 2015 Professor Halpin was also Respiratory Clinical Lead for the NHS in the South West.

Dr Alan Kaplan

Alan Kaplan is a Family Physician working in York Region, Ontario, Canada and the Chairperson of the Family Physician Airways Group of Canada (www.fpagc.com), the Past- Chairperson of the Respiratory Section of the College of Family Physicians of Canada, and Senate member of the International Primary Care Respiratory Group. He co-chaired the Community Standards of COPD program for Health Quality Ontario. He is the medical director of the Pulmonary Rehabilitation program for the local health integration network.

Dr Kai Beeh

Kai Michael Beeh, MD studied medicine and the history of arts in Frankfurt, Germany. He was trained in clinical skills at Mainz University Hospital (Depts. of Hematology/Oncology, Pulmonary Medicine, Cardiology and Critical Care) from 1997 to 2004 and received board certifications in Internal Medicine (2003) and Pulmonary Medicine (2004). In 2004, Dr. Beeh received the venia legendi from the medical faculty of Mainz University and serves as adjunct Professor ("Privatdozent") of Medicine. Dr. Beeh was awarded the Merck, Sharp & Dohme grant "Asthma" in 1999 and spent several months of basic research at the Department of Thoracic Medicine, National Heart and Lung Institute, Imperial College, London, UK (Prof. P.J. Barnes) in 2000. Dr. Beeh has designed and conducted over 100 clinical trials in asthma, COPD and rhinitis as Principal Investigator or Clinical Trial Leader (LKP) according to german drug law (AMG). 2015 he received a degree in Market Access Management from the European Business School (EBS) in Oestrich-Winkel. He is a consultant and advisor to several international biomedical companies and the pharmaceutical industry. Dr. Beeh has published or co-authored over 100 peer-reviewed articles on inflammation and pharmacotherapy of inflammatory airway diseases. He is Editor of "Pulmonary Therapy" and peer-reviews scientific articles for New England Journal of Medicine, Lancet, American Journal of Respiratory and Critical Care Medicine, European Respiratory Journal and others. He has edited a textbook monography on COPD Exacerbations in 2014 and is author of the international popular non-fiction Book "The breathtaking World of the Lungs" published by Random House in 2018. Dr. Beeh is a member of the German Society of Pneumology and the German Society for Market Access (DFGMA).

Professor  James Chalmers

James Chalmers is a Professor and Consultant Respiratory Physician at the School of Medicine, University of Dundee. His laboratory works primarily on the interaction between neutrophils and bacteria during acute and chronic airway infections. Major areas of research with relevance to AMR include phase 1 and phase 2 studies of non-antibiotic alternative therapies for respiratory infections, the development of diagnostics to reduce antibiotic use by more accurately identifying bacterial infections and work to understand the selective drivers of antimicrobial resistance in chronic airways diseases such as bronchiectasis and cystic fibrosis where multidrug resistant Gram-negative infections are common. His work is funded by the Wellcome Trust, Medical Research Council, Scottish Government, EU and the pharmaceutical industry.

Dr Allan Clark

Allan Clark is a statistician with an interest in the application of statistical methods to clinical trials, mainly in stroke and respiratory diseases.

Dr Konstantinos Kostikas

Konstantinos Kostikas is Respiratory Physician with long-standing clinical and research experience in different Greek and international setting (academic, clinical, research and industry), with excellent skills in communication, patient management, publication planning and study design and execution. Dr. Kostikas has been involved in several posts of the European Respiratory Society (ERS), including HERMES Examination Committee and the role of Learning Resources Director. Dr. Kostikas’ research activities focus on asthma and COPD (biomarkers, phenotyping, comorbidities and exacerbations). Dr. Kostikas is a member of the Editorial Board of PLoS ONE, and peer reviewer for all major respiratory journals. Dr. Kostikas has more than 170 publications in PubMed (over 3,300 citations and h-index 29) and contributed several chapters to medical textbooks, focusing on asthma, COPD and biomarkers.

Dr Hilary Pinnock

Hilary Pinnock is Professor of Primary Care Respiratory Medicine at The University of Edinburgh and plays a key role at the Asthma UK Centre for Applied Research. A practicing primary care doctor, her research interests focus on the delivery of respiratory care within the real-life primary care setting. Professor Hilary Pinnock has been elected as Head of Assembly 1 - General Pneumology at the European Respiratory Society (ERS).

Professor Nicolas Roche

Nicolas Roche is Professor of Respiratory Medicine at Cochin Hospital, University of Paris Descartes, Paris, France. He graduated in medicine in 1994 and obtained his PhD in 2003. He spent a year as a research fellow at Imperial College London, London, UK. His major areas of interest are chronic obstructive pulmonary disease (COPD), asthma, inhaled therapy and real-life research. Professor Roche coordinates epidemiological research projects as well as a dedicated nationwide clinical research group. His clinical research topics include the study of disease phenotypes, the development of new clinical assessment tools and the evaluation of treatment strategies for COPD and asthma. He is involved in national public health initiatives on COPD. He participated in the development of French guidelines on asthma and education of asthmatic adults, coordinates the French guidelines on COPD. He is a member of the Global Initiative on Obstructive Lung Disease science committee and the executive committee of the Respiratory Effectiveness Group. Professor Roche has authored more than 250 articles in international peer-reviewed journals and edited or co-edited several books on COPD, including articles on inhalation therapy for asthma and COPD. He is Vice-President of Société de Pneumologie de Langue Française, member of the Clinical Research Collaboration working group of the European Respiratory Society and member of the American Thoracic Society. He has been Chief Editor of Revue des Maladies Respiratoires and is Associate Editor of the European Respiratory Review and the Clinical Respiratory Journal.

Dr Omar Usmani

Omar Usmani MB BS, PhD, FHEA, FRCP, is Reader in Respiratory Medicine and Consultant Physician at the National Heart and Lung Institute (NHLI), Imperial College London & Royal Brompton Hospital (RBH). He is an International Authority on Aerosol Science and Inhalation Medicine whose research has fundamentally contributed to the understanding of therapeutic aerosol deposition and clinical effectiveness in inhaled drug delivery to the lungs. In 2015, he was awarded one of the highest accolades in Aerosol Science, the Thomas T Mercer Award from the American Association of Aerosol Research (AAAR) and the International Society of Aerosols in Medicine (ISAM), recognising his International Research Excellence in Pharmaceutical Aerosols and Inhalable Materials. Dr. Omar Usmani’s Clinical Specialist Interests are Asthma, COPD and Chronic Cough. He is Group Leader of the Clinical Research Group within the Airway Disease Section at NHLI and a Principal Investigator. He is part of the Consultant-led RBH specialist Chronic Cough Service. In 2012, Dr Usmani was awarded a UK - National Institute for Health Research (NIHR) Career Development Fellowship to investigate the lung deposition behaviour of inhaled bronchodilator aerosols of different particle size within the airways of patients with Chronic Obstructive Pulmonary Disease (COPD). This was the first time this award category was given to Respiratory Science research in the UK. In 2017, Dr Usmani was elected to the world's largest respiratory society as ERS Secretary of Assembly 5 - Airway Diseases. He also became Chair of the UK Inhaler Group (UKIG), having taken over the role from Monica Fletcher OBE. In 2016, he was appointed to lead and chair the second updated version of the International ERS/ISAM Taskforce Consensus Statement on "What the pulmonary physician should know about inhaled therapy".

Dr. Job van Boven

Job van Boven is an expert in health economics (e.g. cost-effectiveness, burden of disease) and real-world drug outcomes (e.g. (pharmaco)epidemiology, medication adherence, compliance, persistence), mainly applied to lung diseases (asthma, COPD, TB, lung cancer).

Dr. Katherine Hickman

Katherine Hickman is a GP partner in Bradford and a respiratory health expert. She qualified from Leeds University in 2000 and initially pursued a Medicine Rotation, earning her MRCP, before transitioning into General Practice. Dr. Hickman is currently a GP Partner in Bradford. Dr. Hickman holds several prominent roles, including being the Respiratory Lead for West Yorkshire Integrated Care Board (ICB), the Primary Care Clinical Lead for the National Respiratory Audit Programme (NRAP), and the Executive Chair of the Primary Care Respiratory Society (PCRS). She has also contributed to various respiratory health initiatives and collaborates globally to improve respiratory health.

Dr Eve Jessica Denton

Eve Jessica Denton is a specialist in Allergy, Asthma, and Clinical Immunology at Alfred Health in Melbourne, Victoria, Australia. She completed her M.B.B.S. with honors in 2008 and then pursued Basic Physician Training at the Alfred Hospital. She further specialized in Respiratory and Sleep Medicine, training at both the Alfred and St. Vincent’s Hospitals in Melbourne, becoming a qualified Respiratory and Sleep Physician in 2016. Dr. Denton also holds a Masters of Public Health from Monash University, with a focus on clinical research, particularly lung cancer epidemiology. Her clinical interests cover a broad range of respiratory issues, including asthma, allergies, pulmonary hypertension, sleep disorders, lung transplants, and lung cancer. Additionally, she has expertise in diagnostic and therapeutic lung ultrasound and pleural procedures​

Dr Njira Lugogo

Njira Lugogo is a Clinical Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at the University of Michigan. She also serves as the Medical Director of the Michigan Clinical Research Unit and the statewide quality improvement initiative INHALE (Inspiring Health Advances in Lung Care). Dr. Lugogo's clinical focus is on asthma, especially severe asthma, and she runs a busy clinical practice dedicated to managing asthma of all severities. Dr. Lugogo completed her medical degree at the Virginia Commonwealth University School of Medicine, followed by an Internal Medicine residency at Wake Forest University Medical Center, and a Pulmonary and Critical Care fellowship at Duke University. At Duke, she was promoted to Assistant Professor and served as the Medical Director of the Duke Asthma Allergy and Airways Center. Dr. Lugogo is involved in multiple asthma clinical trials and is the Principal Investigator of the Michigan site for the NHLBI PrecISE network, which focuses on precision medicine for severe and exacerbating asthma. Her research interests include developing biomarkers to risk-stratify patients and select therapies based on individual biology

Professor Nikos Papadopoulos

Nikos Papadopoulos joined the University of Manchester in 2014. He is also Professor of Allergy and Pediatric Allergy at the University of Athens, and Past President of the European Academy of Allergy and Clinical Immunology (EAACI, www.eaaci.org). His main research focus is the role of infections in respiratory (asthma, rhinitis), as well as food allergy, with extensive collaborations in the context of EU Projects, such as SynAir-G, CURE, EARIP, iFAAM, FAST and PreDicta. He has published more than 500 papers (h-index: >100), has received a number of international awards and is invited to speak at international scientific meetings some 30 times a year. He has served in committees of EAACI, GA2LEN, WAO, EFA and ARIA.

Professor Peter Smith

Pete Smith is a leading allergist in Australia. Pete commenced his medical studies at the University of Tasmania and went on to specialise in paediatrics in Adelaide, before completing his PhD in molecular immunology with Flinders University. He has worked as an allergy specialist at the Great Ormond Street Hospital for Children in London, and was a senior lecturer at the Institute of Child Health, University College London. In 2002, Pete set up Queensland Allergy Services in Southport, on the Gold Coast. Here he provides patients the highest level of quality medical care in the diagnosis and treatment of allergies. Pete is an active member of the Australasian Society of Clinical Immunology & Allergy, and a regular expert commentator in the media. He is a member of the World Allergy Organization, the American Academy of Allergy, Asthma & Immunology, and the European Academy of Clinical Immunology & Allergy. He sits on several national and international advisory boards and is involved in medical education, frequently speaking at national and international meetings and conferences.

Professor Janwillem Kocks

Janwillem W.H. Kocks is a prominent figure in respiratory medicine, serving as a General Practitioner and Assistant Professor at the University Medical Center Groningen (UMCG) in the Netherlands. He is also the Director of the General Practitioners Research Institute (GPRI) in Groningen and holds the position of Professor of Inhalation Medicine at the Observational and Pragmatic Research Institute (OPRI) in Singapore. Prof. Kocks completed his medical degree at the University of Groningen in 2004 and has since focused his research on respiratory conditions such as asthma and COPD. His work includes developing tools for better disease management and improving inhalation techniques and adherence to medication in respiratory patients. He has served as the Past President of the International Primary Care Respiratory Group (IPCRG), where he contributed significantly to global initiatives aimed at improving respiratory health through primary care.

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