Dr Mike Thomas

Position
Dr Mike Thomas is a GP and Hospital Practitioner, and GPIAG Research Fellow at the University of Aberdeen.
Dr Mike Thomas is an Asthma UK Senior Research Fellow.

Research:

Primary Care Asthma Management: Diagnosis, Assessments and Effective Therapy.

Start date: 1 June 2005
End date: 31 May 2008

Research outline:

Although most people with asthma receive effective treatment from current drug therapies under the guidance of their community healthcare practitioners (GPs, nurses and respiratory specialists), many individuals continue to experience avoidable symptoms and impaired quality of life.

Some patients have concerns about the long-term use of asthma medication, particularly inhaled steroids, and may wish to use alternative non-drug therapies to alleviate their symptoms. At present, there is limited evidence of the effectiveness of non-drug therapies. In addition, decisions about anti-inflammatory treatment (usually with inhaled steroids) are often made by GPs who cannot accurately determine the levels of inflammation in their patients' lungs.

There are a number of reasons that explain why people with asthma may not receive effective treatment from conventional drug therapies. Although a small number of patients have genuinely severe and therapy-resistant disease, it is likely that factors such as not taking their preventative treatment correctly, inadequate inhaler technique, co-existing diseases such as hay fever and eczema and misdiagnosis may play a significant role for some patients.

Better assessment of the individual patient, including assessments of objective parameters such as airways inflammation, hyper-reactivity or 'airway twitchiness', co-existing conditions, breathing pattern and psycho-social factors relevant to the condition may lead to better understanding of the factors driving an individual's symptoms and more appropriate and targeted treatment.

It is now possible to objectively measure the underlying inflammation and hyper-reactivity in the airways, but at present these assessments are only performed in hospital and research settings.

Dr Mike Thomas' Research Fellowship awarded by Asthma UK aims to build on his preliminary studies to develop objective methods to diagnosis and assess asthma in the community. There is now great interest in determining the value of breathing exercises to improve asthma symptoms, and identify patients who might benefit from this non-drug therapy that could be easily adopted in a community setting. Dr Thomas' team have reported preliminary research in this area and are undertaking further studies to evaluate whether breathing exercises can be used to identify as well as treat irregular breathing patterns in people with asthma.

His research is also investigating the feasibility and usefulness of monitoring airway inflammation and hyper-reactivity in patients in primary care settings such as GP surgeries. It is hoped that these studies will allow better assessment of the individual's symptoms and identify the most appropriate treatment for each patient. For example, this may involve breathing exercises for patients with evidence of abnormal breathing patterns, or increased anti-inflammatory treatment for patients who show evidence of inflamed airways.

Dr Thomas' team plan to conduct a variety of studies through collaborations between primary care and hospital units. One trial will investigate whether physiotherapy breathing exercise programmes for patients with mild or moderate asthma will help to improve their breathing technique and their asthma. Other studies will investigate the use of newly developed equipment for measuring inflammation and hyper-reactivity in the airways in routine general practice asthma clinic settings.

Over the next three years these studies will help to clarify the relationship between the patient's experience and objective methods used to assess asthma, and so help to target appropriate drug and non-drug treatments to people with asthma.

Project ID number: RF09T