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Research Projects: Improving diagnosis and the care that people with asthma receive

These research projects aim at improving the diagnosis and care that people with asthma receive.

There is currently no single, simple way to diagnose asthma. Research is essential to changing that and ensuring that people receive the most accurate diagnosis and the high-quality care that they need.

Asthma UK funds research projects aimed at improving the diagnosis and care that people with asthma receive. These are the current projects that we fund in this area.

Asthma UK Centre for Applied Research

The Asthma UK Centre for Applied Research is one of our flagship research centres, supporting cutting-edge, world-leading research. Asthma UK funded the Centre for Applied Research in May 2014, to complement the MRC-Asthma UK Centre. The Applied Centre includes researchers from all over the country and from universities and NHS organisations.

Developing a 21st century approach to tackling severe asthma

  • Researcher: Dr Salman Siddiqui is a Clinical Senior Lecturer at the University of Leicester
  • Start date: December 2013
  • How long will this project run for? 36 months
  • Project type: Project grant
  • Cost: £163,626

Project title: Endotyping Asthma for the Benefit of Patients

Leading a team of world-class asthma researchers, Dr Salman Siddiqui from the University of Leicester will apply a unique three-pronged approach to developing personalised medicines for severe asthma. This involves identifying the right patient that may respond to a particular treatment, using the right treatment in the patient group and ensuring the right outcomes are measured in clinical trials to test whether the medicine is working or not. The team also plan to explore how the immune system interacts with the airways and leads to three sub-types of asthma that have been identified based on the pattern of genes that are active. This research aims to inform the development of new medicines for these different groups of asthma patients and may also lead to the development of new bedside tests to spot these patients when they come to clinic.

Transforming care for young people with asthma

  • Researcher: Professor Graham Roberts is a Consultant Paediatrician at the University of Southampton
  • Start date: January 2014
  • How long will the project run for? 36 months
  • Project type: Project grant
  • Cost: £177,701

Project title: Empowering teenagers to self-manage their asthma

Asthma is one of the most common long-term conditions affecting adolescents and teenagers are at increased risk of asthma deaths even more so than younger children. Professor Graham Roberts is one of the few experts in the UK focussed on delivering specific care for young people with asthma. Previous research has demonstrated that patients with the best self-efficacy have the best asthma symptom control. Self-efficacy is one way of describing self-management skills. Self-efficacy is the belief and the ability to self-manage specific tasks, such as managing asthma. Working with young people, Professor Roberts plans to use self-efficacy theory to help develop a new adolescent approach that healthcare professionals can use for adolescent patients with asthma. Good self-management plays a vital role in preventing asthma attacks, hospitalisations and deaths.

Why is asthma worse at night?

  • Researcher: Dr Hannah Durrington is a Senior Lecturer at the Institute of Inflammation and Repair at the University of Manchester.
  • Start date: July 2014
  • How long will the project run for? 36 months
  • Project type: Research Fellowship
  • Cost: £131,608

Project title: Asthma and the circadian clock

About three-quarters of people with asthma will wake during the night at least once a week because of shortness of breath, cough or wheeze, and symptom worsening during the night is one of the most common features of asthma.

Children with night time asthma miss more time from school and their parents more time from work than healthy children. School and work performance can suffer when the family can't sleep.

Dr Hannah Durrington will be looking at whether asthma symptoms are controlled by the biological clock involved in regulating lung function. She will look at whether this clock plays a role in the variation of asthma symptoms and also its role in the inflammation of the lungs, a crucial part of the development of asthma.

The role of the circadian clock in asthma is a newly emerging and exciting area of research.

Better understanding of the influence of this biological clock on asthma symptoms will give us more information to make better use of current asthma treatments. This study will also provide information about whether the time of day that we experience an asthma attack has a bearing on the time it takes to recover from the attack. This information can be used to guide current asthma management plans and might change the way we use current medicines.

Can warming air during exercise benefit the lungs of people with asthma?

  • Researcher: Dr John Dickinson
  • Institution: University of Kent
  • Grant amount: £31,635
  • Grant duration: 12 months
  • Start date: October 2016

Project title: The Use of a Heat and Moisture Exchange Mask to Reduce Exercise Induced Bronchoconstriction Severity and Improve the Airway Health of Individuals with Asthma

Exercise is a common trigger for asthma, and many people experience asthma symptoms after exercising especially in cold and dry conditions. This can lead to people with asthma avoiding exercise for fear that it will trigger their symptoms, especially if the air is cold and dry.

However, exercise has also been shown to be an important way to help people to manage their asthma - as a result, ways to increase people's ability to be active in all environments without triggering their asthma is desirable and could increase the lung health and quality of life of many people with asthma.

Some small studies have suggested that if people with asthma exercise in cold, dry conditions while wearing a specific lightweight face mask that warms and adds moisture to the air, the chance of the exercise triggering symptoms is reduced.

However, what is not known is whether wearing the mask during exercise has longer term positive benefits to people's asthma symptoms, the immune response in the lungs that causes the symptoms, or the amount of medication that people need to take.

In this project, the researchers will test people with asthma triggered by exercise in cold, dry air over many exercise sessions to see if this type of mask can have positive benefits for their lung health, and allow them to exercise and stay well.

This project will help us to discover if there are particular tools that can help people with asthma to exercise, even in cold and dry conditions, and so improve their asthma control and lung health without the risk of triggering symptoms. If so, this could be a practical system for people with asthma to use.

The researchers will also understand more about the biology of asthma, and how it reacts to exercise in cold, dry air – this will help us to know what is going on in the lungs when symptoms are triggered, and what happens when they’re reduced, providing avenues to explore further to develop new treatments.

Moving towards a blood test to diagnose airway hyperresponsiveness

  • Researcher: Dr Dominick Shaw
  • Institution: University of Nottingham
  • Grant amount: £49,702
  • Grant duration: 18 months
  • Start date: January 2017

 Project title: Blood biomarker signatures of airway smooth muscle activation in asthma

A key aspect of asthma is twitchy airways that narrow causing symptoms and obstructed breathing. This process (often known as airway hyperresponsiveness) occurs when the muscles in the airways tighten and make the airways narrower, normally after coming into a contact with a trigger such as cold air.

However, despite this being a common feature of asthma, there are currently no tests to see how ‘twitchy’ the airway muscles are – either as a way to diagnose asthma, or test to see if someone is responding to a particular treatment.

Currently, in order to test how twitchy the airway muscles are doctors need to give someone a 'challenge' test. This involves the patient inhaling an asthma trigger to test how the airways respond, and whether treatments reverse that effect. This test is not easy to conduct and requires a certain amount of expertise and specialised equipment.This means that people will often need to be referred to hospital for these tests, and so no everyone will be given them.

A blood test that can be more easily conducted and is a better measure of the activation of airway muscles is needed to improve and simplify the diagnosis of asthma.

The researchers will investigate what chemicals within the blood can act as a measure of airway muscle activation, with a view to then developing a blood test that can easily and accurately identify this.

There is currently no one, simple diagnostic test for asthma, With the development of a test that is easy to conduct by any doctor or asthma nurse, and is accurate and reliable, it is hoped that we could have an easier way of diagnosing asthma. The test will also help us to see what treatments are helping to control someone’s asthma well, and whether different treatments need to be tried.

This study is only the first stage in identifying these different chemicals – but this is a crucial first step towards such a blood test.

Testing if a new device is a good system for measuring inflammation in the lungs

    • Researcher: Professor Anoop Chauhan
    • Institution: Queen Alexandra Hospital, Portsmouth
    • Grant amount: £49,168
    • Grant duration: 18 months
    • Start date: October 2016

 Project title: A cross-sectional, pilot study to explore the use of a new device, 'Inflammacheck™', in detecting exhaled breath condensate Hydrogen Peroxide levels in people with asthma.

Inflammation in the lungs is a key cause of asthma symptoms, and the amount of inflammation can give doctors helpful information about how ill someone with asthma is, and how well treatments are working.

However, the only current reliable tests that can be easily performed and understood in clinics are invasive and unpleasant for people with asthma, and shouldn’t be performed only to measure inflammation.

A better test is needed that isn’t invasive, and can still be conducted easily be healthcare professionals and interpreted quickly. This will help healthcare professionals to support people with asthma more appropriately, giving them the right treatments at the right time. It will also help us to improve our understanding of what’s happening in the lungs of people with asthma.

A test has been developed that measures particular chemicals in exhaled breath, and can be conducted while someone breathes normally, rather than an invasive test. However, until now this test has required complicated analysis afterwards and is difficult to interpret quickly, and so has only been used by researchers rather than healthcare professionals.

To make this easier to get faster results from the test, researchers have developed a version that can be hand-held, and give results quickly – this machine is called the Inflammacheck™. This device now needs testing to see if it would be suitable for use by healthcare professionals in doctors’ surgeries or clinics, and if it can tell us more about what is happening in the lungs of people with asthma.

This will be an early-stage test with a small number of participants – if successful, the researchers will be able to run a larger study and move the device closer to being used by healthcare professionals.

This small study will show us whether the Inflammacheck™ is a promising device for the treatment and support of people with asthma, and can be used by healthcare professionals to support them.

If successful, this study will provide the evidence needed to run a larger trial of the Inflammacheck™ device, taking us closer to having a test to use in healthcare settings and better care for people with asthma.

Additionally, a new method of testing what is happening in the lungs of people with asthma will help us to learn more about the condition, providing us with new avenues to research to develop new treatments.

Developing an app with an interactive Asthma Action Plan

  • Researcher: Professor Andrew Bush
  • Institution: Royal Brompton & Harefield NHS Trust
  • Grant amount: £23,400
  • Grant duration: 12 months
  • Start date: October 2016

Project title: Dynamic Personalised Asthma Action Plan (PAAP) Smartphone Application, with paired, accessory Digital Peak Flowmeter.

The world of mobile health apps is growing at a great rate, with many people choosing to use widely available apps to track various health-related progress or outcomes, or help them to manage conditions.

However, the apps that currently exist to support people with asthma have not been shown to be helpful in a way that will result in real-life benefits to people with asthma – they have been developed without the input of people with asthma or doctors to ensure that the things measured will help people and lead to improvements in their condition. (see the report that Asthma UK wrote about technology and where the priorities should be in the future).

The current best tool that people with asthma have to track any deterioration in symptoms and to provide them with actions that they should take is an Asthma UK Personalised Asthma Action Plan.

However, this is usually paper-based (or even if digital is a static document) that may not always be available when needed. The Personalised Asthma Action Plan is also quite a 'passive' tool, and will help people when their symptoms deteriorate rather than playing a more ‘active’ role in helping people to track symptoms and better understand and manage their asthma.

The researchers will develop a useful, user-friendly app based on the Asthma UK Personalised Asthma Action Plan that will help people with asthma not only to use their Personalised Asthma Action Plan more routinely, but will also have features that help people to monitor and track their symptoms easily.

This monitoring will tie in with the Personalised Asthma Action Plan so that alerts will indicate whether action needs to be taken, all in one integrated system.

This app should make it easier for people to consistently use and remember to consult their Personalised Asthma Action Plan, and make it easier for people to track their asthma symptoms.

There are many people for whom better asthma control using techniques like this would greatly improve their quality of life, reduce the number of asthma attacks that they have, and as a result greatly reduce the risks that asthma attacks present.

Building an app for use within technology that is already such an embedded part of most people’s daily lives, and that importantly uses tools that have been shown to actually help people with asthma, could be the step that is needed to greatly improve quality of life for many people with asthma.