Our better breathing research focuses on individuals and includes all conditions related to breathing that impair health and wellbeing.
We study asthma, chronic obstructive pulmonary disease (COPD), vocal cord dysfunction, nose and upper airway disorders, sleep disorders and sleep quality, pleural disease, interstitial lung diseases, airway infections and allergies, and symptom management.
Our program addresses the global disease burden caused by breathing disorders. We take an inclusive approach, addressing the whole respiratory system, including the upper, middle and lower airways and the lungs.
Disorders of this system account for a large global burden, including rhinitis, asthma, chronic lung diseases from premature birth and environmental exposures. These breathing conditions cause significant quality of life impairment and are a major cause of hospitalisation and unscheduled healthcare presentations.
Breathing conditions are frequently incorrectly diagnosed and treated, leading to reduced treatment response, side effects of ineffective treatments and further erroneous treatments. One in three Australians (over 7 million people) has a chronic condition affecting their breathing (Source – Australian Institute of Health and Welfare). These conditions affect the airways which include the lungs, as well as the passages that transfer air from the mouth and nose into the lungs.
Asthma is an inflammatory disease of the airways which makes breathing difficult, and produces symptoms such as wheezing, cough, tightness in the chest and shortness of breath. It's one of the most widespread chronic health problems in Australia with approximately 10% of all Australians having asthma, at some stage in the life.The burden of asthma continues to be high and tragically more than one Australian dies every day from asthma (Source – Australian Institute of Health and Welfare). The prevalence of asthma in Australia is among the highest in the world (Source – Global Asthma Report) and people can develop it in childhood, or as an adult.
The cornerstone of asthma treatment is with inhaled bronchodilators (reliever inhalers) and inhaled corticosteroids (controllers inhalers). However, not all people with asthma are able to control their symptoms and attacks with these therapies and more personalised approaches are needed. Our research program focuses on improving asthma outcomes for all people with asthma, using individualised therapies.
Chronic Obstructive Pulmonary Disease (COPD) is a term used to describe a number of lung conditions, the most common of which are emphysema and chronic bronchitis. These chronic, long-term respiratory diseases are marked by breathlessness, cough and recurrent infection. COPD is a leading cause of disease burden in Australia and the fifth leading cause of death (Source – Australian Institute of Health and Welfare).
COPD is treated with inhaled medications, including long-acting bronchodilators (LABA) and inhaled corticosteroids in people with more severe disease. Pulmonary rehabilitation that involves exercise training is a highly effective adjunct treatment for COPD.
Vocal Cord Dysfunction (VCD) is defined as involuntary and episodic closure of the vocal folds during inspiration which leads to symptoms of shortness of breath, cough, voice disorders and noisy breathing (Source – Severe Asthma Toolkit). VCD occurs in up to 50% of people with chronic cough and around 30% of people with difficult to treat asthma. VCD symptoms are often mistaken for asthma symptoms, which can lead to an inappropriate increase in asthma treatment. Speech pathology treatment is effective in relieving symptoms of VCD.
Sleep disorders prevent people from getting a restful night's sleep and so may result in daytime sleepiness and difficulty functioning. Symptoms include irregular breathing or movement during sleep, difficulty going to sleep or staying asleep or daytime sleepiness. Common sleep disorders include obstructive sleep apnoea (OSA), insomnia and snoring. OSA occurs when breathing is reduced during sleep or breathing stops and starts repeatedly during sleep, leading to a reduction in blood oxygen levels (Source – Sleep Health Foundation).
OSA can occur in children (often as a result of enlarged tonsils or adenoids), and in adults, being more common in middle age and older people. Treatment for people with mild OSA can involve weight loss, and adjusting the sleeping position. Treatment for moderate or severe OSA involves nasal continuous positive airway pressure (CPAP) or an oral appliance fitted by a dentist to keep the airway open.
Pleural disease affects 60,000 patients per year in Australia (Source – pleura.com.au). Pleural disorders affect the tissue that covers the outside of the lungs (the pleura), and lines the inside of the chest cavity. Pleurisy is a condition which occurs when inflammation of the pleura causes these membranes to run against each other. This can be caused by bacterial or viral infections, pulmonary embolus or cancer. Treatments can include anti-inflammatory medications, antibiotics for bacterial infections or draining off the excess fluid, when there is a pleural effusion.
Interstitial lung disease (ILD) is a term used to describe a group of diseases that cause scarring or fibrosis of the lungs, such as Idiopathic Pulmonary Fibrosis and Sarcoidosis. The scarring causes stiffness in the lungs making it difficult to breathe, and lung damage is often irreversible, getting worse over time.
Some forms of ILD remain untreatable. Management options for others include pulmonary rehabilitation, smoking cessation, oxygen therapy, and lung transplantation.
Developing targeted therapies for the treatment of asthma is a major focus of HMRI researchers. Although around 50% of people with asthma can gain some relief from the use of inhaled corticosteroids for the treatment of their asthma, another 50% of patients do not see the same therapeutic benefit of this treatment due to the specific molecules that are involved in the development of the disease. Specific asthma inflammation pathways can be targeted in a similar way to how cancer treatment can be targeted to the specific genetic or molecular factors.
By ensuring that the right therapy is given to the right person at the right time, targeted therapy for asthma aims to give existing treatments to patients who will benefit from it the most and develop new treatments for patients whose disease cannot be adequately controlled with existing treatments.
Lung diseases such as asthma and COPD develop during the life as a result of abnormal functioning of the lung which starts early in life, even before the first breath is taken! Our researchers are following up three large birth cohorts to understand, prevent and treat what interferes with normal functioning of the lung. The data collected so far suggests that asthma during pregnancy, smoke exposure (from tobacco or particulate matter such as from bushfires) an abnormal distribution of the microbiota and an allergic immune response, are interrelated and potentially modifiable factors in the early development of lung disease.
Dr Adam Collison
Dr Adam Collison from the HMRI Asthma and Breathing Research Program received a grant for his study into bronchiolitis, a severe viral infection that is the leading cause of babies under 12 months being admitted to the John Hunter Children’s Hospital.
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