Diagnosis

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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.

 

Diagnostics 2019 round

 

New blood test detects miRNA molecules to diagnose asthma

  • Researcher: Dr Ramesh Kurukulaaratchy
  • Institution: University of Southampton
  • Grant amount: £208,276
  • Grant duration: 36 months
  • Start date: August 2020

Project title: Circulating miRNAs as a diagnostic test for asthma and to identify asthma severity risk

Dr Ramesh Kurukulaaratchy is aiming to develop a revolutionary way of diagnosing asthma – via a simple blood test. The blood test is based on new evidence that small molecules, called microRNAs (miRNAs), are different in people who are asthmatic compared to non-asthmatics. miRNAs can have a big impact on the activities of immune cells that cause inflammation of the airways. Although how they do this exactly is still unknown, miRNAs circulate in the blood and are easily detectable. Using cutting-edge technologies, the researchers can identify the differences in these miRNAs to provide an accurate diagnosis of asthma and gain an insight into how severe the asthma is.

Potential Impact: The research will allow the development of a new diagnostic blood test for asthma that is accurate, reliable and relatively non-invasive. Therefore, the miRNA blood test has the potential to transform asthma diagnosis.

 

Using your personalised ‘breath print’ to diagnose asthma.

  • Researcher: Dr Thomas Brown
  • Institution: Portsmouth Hospitals NHS Trust
  • Grant amount: £234,221
  • Grant duration: 24 months
  • Start date: January 2021

Project title: Diagnosing and phEnotyping asThma using thE InflammacheCk™ Breath-PrinT - The DETECT Study.

Dr Thomas Brown is aiming to use the InflammacheckTM device to create a personalised ‘breath print’ for individuals with asthma. InflammacheckTM devices can accurately measure levels of important chemicals in the breath, such as hydrogen peroxide (H2O2), which is known to be different in asthmatic and non-asthmatic individuals. The measurements of these chemicals are then compiled to make a personalised ‘breath print’ that is also able to identify the type of asthma an individual has. This highly specific method could lead to the tailoring of each patient’s treatment.

Potential Impact: By generating a personalised ‘breath print’ for asthma patients to understand what type of asthma they have, this will be extremely helpful in providing effective treatment to asthmatic patients.

 

New diagnostic devices determine if wheezing in children is due to asthma

  • Researcher: Dr Clare Murray
  • Institution: University of Manchester
  • Grant amount: £233,283
  • Grant duration: 36 months
  • Start date: February 2021

Project title: Novel diagnostic approaches to asthma in children - a feasibility study

Currently there are no reliable tests that can tell whether wheezing in children is due to asthma or an unrelated condition. A lot of the tests currently used are designed for adults, making them difficult to carry out in children. Dr Clare Murray wants to take advantage of two new diagnostic devices, the InflammacheckTM and Ventica® system, to revolutionise the diagnosis of asthma in young children. Importantly, the devices will both be specifically looking at ‘tidal breathing’ (inhaling and exhaling during normal restful breathing), which is easier to measure in children than the traditional forced exhaling required by devices commonly used in adults. The InflammacheckTM breath test is a new “bed-side” device that can measure hydrogen peroxide (H2O2) levels in the breath with immediate results. Previous studies have shown this to be highly elevated in patients with Asthma. The Ventica® system measures how much breathing changes from one breath to another during sleep, using electrodes (like sticking plasters). Early tests suggest that breathing out is much more irregular in very young children with asthma.

Potential impact: This research will determine if ‘tidal breathing’ measurements could improve the diagnosis of asthma in young children to the level already seen in adults.

 

Diagnostics 2018 round

 

 Testing a new device to measure gases in exhaled breath to diagnose asthma in hospitals and GP surgeries

  • Researcher: Dr Hitasha Rupani
  • Institution: Queen Alexander Hospital, Portsmouth
  • Grant amount: £213,991
  • Grant duration: 36 months
  • Start date: September 2019

Project title: A study of the N-TiDal B devIce in Asthma diaGNOsiS in routine clinical carE (DIAGNOSE)

A company called Cambridge Respiratory Innovations Limited (CRiL), a collaborator in this research, has developed a low-cost, hand-held device called N-Tidal C, which measures the CO2 that a patient breathes out. The device measures the CO2 pattern when a patient is breathing in and out normally, without causing discomfort. The device could be used in a GP surgery or a hospital outpatient clinic, alongside the other tests that patients normally have for breathing problems. Although the CO2 patterns for a few patients suggest that there are differences between people with and without asthma, researchers do not yet know for sure if this is the case for everyone. In this study, Dr Rupani and her team will compare the results of this test with the results of the breathing tests that patients have to do at the moment to assess whether waveform can be used to diagnose asthma independently or whether it can improve the current diagnosis when used together with other diagnostic tests.

Potential Impact: At the end of this study, we will know how the N-Tidal CO2 test can help healthcare professionals to diagnose asthma. This will help make the journey to diagnosis quicker, better and cheaper.

 

A system to help doctors and nurses in general practice diagnose asthma more easily 

  • Researcher: Professor Hilary Pinnock
  • Institution: University of Edinburgh
  • Grant amount: £210,258.50
  • Grant duration: 36 months
  • Start date: May 2019

Project title: A clinical decision support system to improve asthma diagnosis in primary care: delivering a more accurate, personalised and understandable diagnostic experience

Professor Pinnock and her team want to find out more about what healthcare professionals need and want from a Clinical Decision Support System (CDSS), remembering that to be successfully adopted into practice the software has to integrate with how they work, be easy to use and ideally save time. They want to learn more from patients about their experience of being diagnosed with asthma so that the CDSS can then help individuals with asthma find out more about the diagnostic process through their part of the software. They then want to develop a prototype CDSS that can work within general practice electronic health records software. They will then find out how useful the CDSS is when used in normal everyday healthcare by testing it in a small number of general practices to check that it works. The results of this test will inform a future full scale trial. Professor Pinnock’s team will work closely with their technical partners, Optimum Patient Care (database experts) and Tactuum (software developers) to feed all the information gathered from the patients and professionals into a prototype CDSS. 

Potential Impact: The outcomes of this research will aim to improve asthma diagnostic pathways, including Better assessments of asthma, more personalised treatment and better diagnosis information.

 

Can we improve the way that asthma is diagnosed using new tests?

  • Researcher: Dr Clare Murray
  • Institution: University of Manchester
  • Grant amount: £236,090
  • Grant duration: 36 months
  • Start date: February 2019

Project title: Novel tests of small airway physiology and biomarkers for asthma diagnosis and predicting response to inhaled corticosteroids (ICS)

Dr Murray’s research aims to study whether the tests of small airway function, and the breath tests in individuals with a history suggestive of asthma, will be better than the traditional large airways tests, i.e., better at determining if asthma is present or not. She also wants to find out whether the results of these new tests will improve faster in people when they have been treated with inhaled corticosteroids (ICS; first line treatment for persistent asthma) than the traditional tests; so that these tests can be used to predict early-on if someone is likely to respond to steroid treatment.

Dr Murray and her team have developed a method for the collection and analysis of exhaled breath (breath that is blown out), which is non-invasive, safe and reliable. This breath can then be analysed for different types of chemicals within the breath (Volatile Organic Compounds; VOCs)

Potential Impact: This research will determine whether measurements of the small airways can improve asthma diagnosis and whether we can predict who will and won’t respond to treatment.

 

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.

 

 

Understanding the underlying biology of asthma

Developing better medicines and treatments for asthma