Advancing asthma research

Britain's first mobile asthma unit and major advances in the genetics of asthma are just two of the many accomplishments of the University's Asthma and Allergy Research Group, which comprises 12 people including doctors, nurses, technicians, and scientists at both Ninewells and Perth Royal Infirmary sites.

Established by Dr Brian Lipworth almost ten years ago, the team seek ways to improve the quality of life for people suffering from asthma and related airway allergies.

Through public awareness initiatives, education and research, the team continue play a leading role in Scotland in the prevention, treatment and advancement of knowledge of these common conditions. Contact explores some projects the group are currently leading.

Asthma is an inflammatory disease of the airways that leads to shortness of breath, wheezing and coughing. An estimated 300 million people worldwide have asthma, and this is expected to increase by a further 100 million by 2025.

Scotland has the highest prevalence rates in the world for childhood asthma symptoms and the third highest for adults - about one in 12 have the disease.

Ninety-five per cent of adult asthmatics have symptoms that could be better controlled and this is one area where Professor Lipworth and his team are focussing their research efforts.

"Patients previously thought to be well controlled asthmatics can have ongoing airway inflammation, even though they may not experience any symptoms," Professor Lipworth said.

"The main reason for this is that, currently, the dose and combination of medicines for treating asthma is dictated by the severity of the disease symptoms at the time of testing. But these tests do not always reveal underlying disease symptoms, such as inflammation."

"We do have methods for testing airway inflammation but these techniques tend to be time consuming, resource dependent and impractical for everyday use in the clinic or primary care."

He and his team have been involved with Swedish company Aerocrine in developing a novel portable mini nitric oxide analyser (MINO), which they hope will provide an inexpensive and portable method of testing for underlying inflammation of the airways that will help doctors to improve the treatment of asthma.

The test is simple. It measures the levels of nitric oxide in exhaled breath, which has been shown to be linked to airway inflammation.

Pilot tests to investigate the feasibility of using this technique to guide treatment decisions are currently underway, in collaboration in primary care with Dr Catherine Jackson from TCGP, with the device being used by asthma nurses in the community.

Another method that has been shown to be a reliable indication of airway inflammation is airway hyper-responsiveness - which measures the twitchiness of the bronchial tubes to various stimuli. Professor Lipworth and colleagues are investigating whether a simple test that involves inhaling mannitol dry powder through a simple inhaler device could be a way of measuring airway hyper-responsiveness. A large scale prospective study in primary care is underway to assess if the mannitol test is a better way to adjust the patients asthma medication as compared to conventional British Society Guidelines, looking at exacerbations over one year.

The researchers hope their findings will reveal another simple and reliable testing method that will help doctors in selecting the best treatment options for asthma sufferers.

The Asthma and Allergy Research Group are committed to ongoing assessment of the incidence and symptoms of these diseases in the community and what can be learned from changes in the environment.

The introduction of the smoking ban in Scotland in March this year saw the launch of a major project led by Dr Daniel Menzies, a Clinical Research Fellow in the Asthma and Allergy Research Group.

"A lot of the research up to now has focussed on the effects of smoking and passive smoking on the lungs and airway. But data on smoking cessation and changes in airway damage is not as forthcoming," Dr Menzies said.

"Studies in bar workers in North America and Ireland have demonstrated an improvement in symptoms related to smoke exposure and a reduction in metabolites of nicotine in the blood and saliva after the implementation of the ban in these countries, suggesting the smoking ban may have a rapid effect on bar workers' respiratory health." We are evaluating the effects of smoking on other important outcomes like inflammation and airway calibre in both asthmatics and non asthmatics, which has not been done before.

Dr Menzies is currently conducting a ten week study to evaluate whether the introduction of the ban in Scotland will have a beneficial effect on the respiratory health, lung function and airway inflammation in the bar workers of Tayside.