Institute of Cellular Medicine

Staff Profile

Dr Stephen Bourke

Honorary Clinical Senior Lecturer

Background

I am a member of the Respiratory Medicine Research Group

I have a major interest in COPD, and in motor neuron disease, as outlined in more detail in the adjacent RESEARCH section.

Research

My interests include clinical research in chronic obstructive pulmonary disease (COPD) and respiratory aspects of motor neurone disease.

COPD exacerbation is the 2nd commonest reason for hospitalisation. NICE guidelines endorse hospital at home and early (supported) discharge services in this condition, recommend that selection should be informed by risk of death but acknowledge the (previous) lack of a robust prognostic score. I led development of the DECAF prognostic score to risk stratify such patients, with multicentre validation, in 2,645 patients consecutively admitted to participating sites. DECAF is simple to apply at the bedside, offers excellent discrimination for in-hospital death and outperforms other tools sometimes used in this setting. Routine use to inform care is endorsed by: UK COPD Audit Report and BTS COPD Specialist Advisory Group 2015 and an independent Thorax Editorial 2016. I conceived and supervised a RCT of hospital at home selected by low risk DECAF score (RfPB funded); up to 50% of admitted patients are eligible thus the potential clinical and cost benefits are large. Based on this research, I won a NIHR Clinical Research Impact of the year award 2016.

Following preliminary pilot work, I performed a RCT of NIV in motor neurone disease (MND) / amytrophic lateral sclerosis (Lancet Neurology 2006). NIV was associated with substantial improvements in survival and quality of life. Regarded by NICE, Cochrane and others as the best available evidence, this trial has changed worldwide practice. Surveys conducted in the UK spanning publication of the RCT showed a 3.4 fold increase in the number of patients successfully established on NIV, with similar improvements elsewhere. This programme of research was included by Newcastle University in the 2014 Research Excellence Framework submission. I am currently working with NICE Quality Standards Committee and was previously involved in the development of guidelines on NIV in MND. I was a co-applicant and on the steering group for a RCT showing that diaphragmatic pacing reduced survival by eleven months (Lancet Neurology 2015). The device had previously been granted FDA approval on humanitarian grounds and was in clinical use. The results of this trial will prevent further harm to patients and highlights the importance of strict adherence to scientific method.

Recently completed studies:

1. Internal and external validation of the DECAF scoring system; a prognostic tool to predict inpatient mortality in acute exacerbations of COPD (UKCRN 14214). CI.
2. A randomised controlled trial of hospital at home compared to conventional in-patient care in patients presenting with an acute exacerbation of COPD and at low risk of death by the DECAF prognostic score. CI.
3. HOT HMV in COPD: Randomised controlled trial of home mechanical ventilation in hypercapnic COPD patients post acute hypercapnic exacerbation (UKCRN 8059). PI..
4. A randomised controlled trial in patients with respiratory muscle weakness due to motor neurone disease of the NeuRx RA/4 Diaphragmatic Pacing System (DiPALS) (HTA 09/55/33; UKCRN 10660). Co-applicant and steering group.
5. A 52-week treatment, multi-center, randomized, double blind, double dummy, parallel-group, active controlled study to compare the effect of QVA149 (indacaterol maleate / glycopyrronium bromide) with salmeterol/fluticasone on the rate of exacerbations in subjects with moderate to very severe COPD (UKCRN 7132). PI.
6. A Clinical Outcomes Study to compare the effect of Fluticasone Furoate/Vilanterol Inhalation Powder 100/25mcg with placebo on Survival in Subjects with moderate Chronic Obstructive Pulmonary Disease (COPD) and a history of or at increased risk for cardiovascular disease. PI.

COLLABORATORS
External
Dr Nicholas Hart, Lane Fox Respiratory Unit, St Thomas' Hospital and the members of the HOT HMV steering group.
Dr  Christopher McDermott, University of Sheffield, and the members of the DiPALS steering group.
Dr Robert Rutherford, Consultant Respiratory Physician, University Hospital Galway.
Dr Richard Harrison, University Hospital of North Tees.
Dr Meme Wijesinghe, Royal Cornwall Hospitals Trust.

Internal
Prof John Gibson, Emeritus Professor of Respiratory Medicine, Newcastle University.
Dr David Cooper, Consultant Respiratory Physician, North Tyneside General Hospital.
Dr Sean Parker, Consultant Respiratory Physician, North Tyneside General Hospital.
Dr Gbenga Afolabi, Consultant Respiratory Physician, North Tyneside General Hospital.
Dr Catherine O’Neill, Consultant in Palliative Care, North Tyneside General Hospital.
Dr Tim Williams, Consultant Neurologist, Royal Victoria Infirmary, Newcastle.
Dr Christopher Stenton, Consultant Respiratory Physician, Royal Victoria Infirmary, Newcastle. 

Teaching

I regularly teach undergraduate students from the Newcastle undergraduate medical curriculum.

PhD students
Current : Dr Carlos Echevarria
a) Internal and external validation of the Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF) prognostic score in acute exacerbations of COPD, triaged to hospital admission.
b) Randomised controlled trial of hospital at home compared to conventional in-patient care in patients presenting with an acute exacerbation of COPD and at low risk of death by the DECAF prognostic score.

Publications