RESEARCH AND DEVELOPMENT

Asthma Research in Australia

We are invested in respiratory research and the development of a new clinical tool for Australian primary care physicians. Our tools will improve asthma patient outcomes and generate more effective asthma management strategies and protocols for healthcare professionals.

Key Activities

Investigation

Investigations and analysis of current data and world’s best practice programmes (e.g. quality improvement programs in UK, USA and worldwide), as applied to Australia

Information

Information gathering and GP liaison activities. Design and development of information gathering systems

Development

Development of algorithms and database programming to achieve appropriate information gathering for the analysis phase

Testing

Testing of conclusions based on analysis of the evidence gathered.  Concept development of preliminary theoretical treatment protocols to reduce the incidence and severity of asthma in Australia. 

Our Research

Our research aims to reduce the incidence and severity of asthma in Australia through the faster identification of patients who do not respond to standard asthma therapies, those who may benefit from enhanced biologic treatment or specialist referral and the tailoring of asthma management plans to account for complex factors such as environmental triggers.

Our aim is to highlight patients who are self-managing their asthma with over the counter Inhaler device when a more optimal course of action would be an asthma review or specialist referral.

Our focuses are on improving patient outcomes by implementing more effective asthma management strategies and earlier intervention to control the disease before it worsens.

Our research will be used to improve asthma patient outcomes in Australia.

Our research is governed by the highest ethical standards and is subject to a rigorous review process. Past research references are included below.

Improper use of inhaler device is a common and well-established reason for failure to achieve asthma control. Previously, however, there was no study investigating the impact of each inhalation error towards asthma outcome. The CRITical Inhaler mistaKes and Asthma (CRITIKAL) project was thus initiated to answer the pertinent question of which inhaler technique errors represent the “critical” errors which were common and negatively impacts asthma outcomes.

This is a systematic, investigative and experimental project conceived using our expertise in real-life respiratory research in-collaboration with iHARP (initiative Helping Asthma in Real-life Patients). The iHARP is an asthma review service supported by the Respiratory Effectiveness Group, which prospectively collects data from primary care practices encompassing Australia and 7 European countries. The iHARP conducts questionnaire-led and practitioner-led assessments to collect extensive information about patients’ demographic characteristics, asthma symptoms, lung function, inhaler technique, and occurrence of exacerbations.

A cross-sectional, real-life study was conducted using data collected for iHARP asthma review. More than 5,000 patients with asthma who were using either dry powder inhalers (DPI) or metered-dose inhalers (MDI) for delivery of fixed-dose inhaled corticosteroid and long-acting beta-agonist were recruited. A checklist of predefined inhaler technique errors was also created with inputs from multiple respiratory experts involved in this project. Patients’ inhaler technique was assessed in reference to this checklist.

Insufficient inspiratory effort was identified as one of the critical errors among DPI users. This error was common (32-38% of users) and was observed to be associated with uncontrolled symptoms and increased exacerbation rates. Within MDI users, actuation of medication before inhalation was identified as one of the critical errors, observed in 24.9% patients and associated with uncontrolled asthma. Several other errors were also identified as critical errors.

This project is the first in the world to identify the “critical” inhaler technique errors which were frequent and associated with poor asthma outcomes. Findings from this study were published in the Journal of Allergy and Clinical Immunology: In Practice (Impact factor: 7.0). Results of this project will enable healthcare practitioners to formulate effective training strategies to reduce these critical errors.

Oral Corticosteroids Increase Risks of Onset of Diabetes Mellitus and Osteoporosis in a UK Patient Population
For more information, click HERE

Inhaled corticosteroids in COPD and onset of type 2 diabetes and osteoporosis: matched cohort study
For more information, click HERE

Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients with Moderate-to-Severe Asthma
For more information, click HERE

Defining severe obstructive lung disease in the biologic era: an endotype-based approach
For more information, click HERE

David Price, Mario Castro, Arnaud Bourdin, Sebastian Fucile and
Pablo Altman

Short courses of systemic corticosteroids (SCS), both oral and injectable, are very effective for the resolution of acute asthma symptoms, including exacerbations. However, the benefits of SCS, even short courses, must be balanced against the impact of their side-effects. While the adverse consequences of long-term use are widely recognised, there appears to be a perception in the medical community that short courses of SCS are safe. Limited but growing evidence in the literature suggests that even very brief dosing periods (3–7 days) of SCS are enough to cause significantly negative outcomes for patients. Short courses of SCS are associated with increased risk of adverse events including loss of bone density,  hypertension and gastrointestinal ulcers/bleeds, in addition to serious impacts on mental health. Strategies to improve asthma control are recommended, including:

  1. As-needed combination therapies in mild asthma,
  2. Risk factor reduction,
  3. Improving adherence/inhaler technique;
  4. Earlier initiation of add-on therapies;
  5. Use of biologics in appropriate patients;
  6. Development of new therapies to better control the disease; and
  7. Widespread education of the medical community.

This study proposes that patients and primary care physicians should consider a cumulative SCS dose of 1g per year as a highly relevant and easy-to-recall threshold.

Click Here to see the full report.

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