David Lo

Project: Development of an Integrated Pathway for Preschool Asthma/wheeze Management (IP2AM): a mixed methods study

Episodes of difficulty in breathing with whistling breath sounds (wheeze) are extremely common in preschool children. Most episodes get better on their own, but many children continue to have frequent wheezing. These can lead to emergency hospital visits, missed preschool, and continuous symptoms that stop them doing the things they enjoy.  Regular “preventer” medications can help, but there is evidence these are underused, which means many children suffering from regular wheeze may be undertreated. Families often report being given different information, not being listened to, not knowing who to believe, and feeling confused.

The purpose of this study is to develop a practical care guide for preschool wheeze that is shared by all doctors and nurses. It will include clear and consistent information and practical advice for parents. The expected benefits include:

• Making it easier for doctors and nurses to identify children at risk of regular wheeze
• Allow doctors and nurses to start regular treatments with more confidence
• Improve communication with families
• Improve quality of life in preschool children with wheeze

There are four parts to this research:

1. Identify children with the highest burden of wheeze
2. Identify children who are more likely to have a further wheeze attack
3. Understand what families and healthcare professionals want from a care guide
4. Test how this care guide will work in real life

Families of children with preschool wheeze have helped to design this study. They will also have continued input during the running of the study.

About me

Dr David Lo is an Associate Professor at the University of Leicester, and an Honorary NHS Consultant at the Leicester Children’s Hospital. His clinical and research interests are in the treatment of childhood respiratory diseases, with a focus on difficult asthma and preschool wheeze. David currently holds an Advanced Research Fellowship award from the National Institute of Health and Care Research (NIHR)

Publications

• Lo DK, Muhlebach MS, Smyth AR. Interventions for the eradication of meticillin-resistant Staphylococcus aureus (MRSA) in people with cystic fibrosis. Cochrane Database Syst Rev. 2022 Dec 13;12(12):CD009650.
• Devani P, Lo DKH, Gaillard EA. Practical approaches to the diagnosis of asthma in school-age children. Expert Rev Respir Med. 2022 Sep;16(9):973-981
• Lo D, Beardsmore C, Roland D, Richardson M, Yang Y, Danvers L, Wilson A, Gaillard EA. Risk factors for asthma attacks and poor control in children: a prospective observational study in UK primary care. Arch Dis Child. 2022 Jan;107(1):26-31.
• Yang Y, Lo DK, Beardsmore C, Roland D, Richardson M, Danvers L, Wilson A, Gaillard EA. Implementing spirometry and fractional exhaled nitric oxide testing in childhood asthma management in UK primary care: an observational study to examine training and implementation cost and impact on patient's health use and outcome. Arch Dis Child. 2022 Jan;107(1):21-25.
• Ramphul M, Lo DKH, Gaillard EA. Precision Medicine for Paediatric Severe Asthma: Current Status and Future Direction. J Asthma Allergy. 2021 May 20;14:525-538. doi: 10.2147/JAA.S265657. Erratum in: J Asthma Allergy. 2021 Jul 02;14:785-787. PMID: 34045872; PMCID: PMC8144021.
• Gaillard EA, Kuehni CE, Lo DKH, Moeller A et al. European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years. Eur Respir J. 2021 Apr 19:2004173. doi: 10.1183/13993003.04173-2020. Epub ahead of print. PMID: 33863747.
• Roland D, Teo KW, Bandi S, Lo D, Gaillard EA. COVID-19 is not a driver of clinically significant viral wheeze and asthma. Arch Dis Child. 2021 Apr;106(4):e22. doi: 10.1136/archdischild-2020-320776. Epub 2020 Oct 16. PMID: 33067308.
• Nenna R, Slaats M, Ersu R, Lo D, Grigg J et al. ERS International Congress, Madrid, 2019: highlights from the Paediatric Assembly. ERJ Open Res. 2020 Jul 20;6(2):00063-2020. doi: 10.1183/23120541.00063-2020. PMID: 32714968; PMCID: PMC7369464.
• Lo D, Beardsmore CS, Roland D, Richardson M, Yang Y, Danvers L, Wilson A, Gaillard EA. Feasibility and Acceptability of Spirometry and FeNO Testing for Children’s Asthma in UK Primary Care: A Prospective Observational Cohort Study. Br J Gen Pract. 2020;29;70(700):e809-e816
• Lo D, Beardsmore CS, Roland D, Richardson M, Yang Y, Danvers L, et al. Lung function and asthma control in school-age children managed in UK primary care: a cohort study. Thorax. 2020;75(2):101-7.
• Lo D, Maniyar A, Gupta S, Gaillard E. High prevalence of bronchiectasis on chest CT in a selected cohort of children with severe Asthma. BMC Pulmonary Medicine 2019 19:136.
• Lo D, Till A, Mckimm J. Transformational Leadership: Is this still relevant to clinical leaders? Br J Hosp Med (Lond). 2018 Jun 2;79(6):344-347.
• Lo D, Till A, Mckimm J. What do doctors and nurses think about development of clinical leadership? Br J Hosp Med (Lond). 2017,78(9):523-528
• Lo D, Bullous L, Gaillard B, Gaillard EA. Diagnosis and management of childhood asthma in primary care. Practice Nursing. 2016 Oct;27(10):488-493

Research Activity

In the past 5 years, David’s work has led to 15 peer-reviewed publications (8 as lead author), and national and international collaborations with academics and health policymakers. Additional activities have included:

• National and international oral presentations at the European Respiratory Congress, British Thoracic Society Conference, East Midlands Paediatric Respiratory Society Meeting, and the Northern Paediatric Respiratory Forum
• Member of the European Respiratory Task Force for the Diagnosis of Asthma in Children
• Member of BTS/SIGN 2019 Asthma Guideline update
• Member of the NHS England Working Group for improving services for Children and Young People (CYP) with asthma (early and accurate diagnosis theme).

Follow David

David's ResearchGate profile

David's LinkedIn profile

David's Twitter profile