Scientists to Solve Hard-to-Treat Asthma Mystery

As seen on Channel 9 News. Click here to watch the full story. 

An enduring scientific mystery - why puffers don’t work for thousands of asthmatics - is set to be solved by Australian researchers.

Scientists at the Woolcock Institute of Medical Research in Sydney are studying the lungs of people with hard-to-treat asthma to better understand the problem and find a way to beat it.

Using cutting-edge 3D imaging technology, the team will pinpoint where in the lungs abnormal constrictions typically occur in so-called ‘refractory’ asthmatics, people whose asthma does not respond fully to preventer puffers.

“Australia has two million asthmatics, including 200,000 who sadly don’t respond to the standard preventer puffer medications they need to keep their condition under control,” says Catherine Farrow, a key investigator in the iARIA study. 

“Our hope is that by reducing constrictions in the airways we’ll be able to improve medication effectiveness on asthma control, allowing these people to live happier, healthier lives.”

About 10 per cent of all asthma sufferers don’t respond to standard treatment. Those most at risk of this perplexing asthma subtype tend to get frequent asthma attacks, have airways that narrow and close frequently and may depend on steroid tablets to control their asthma.

There are several possible reasons for why puffers don’t work for those with difficult to treat asthma, Woolcock Respiratory Physician and Principal Investigator Professor Greg King explains. These include irregular puffer use, poor technique, differences in inflammation type, and other contributing issues like obesity and hay fever.

“With this new study, we’re adding a new, possibly critical factor to this list - that there are specific areas in the lung that for some unknown reason, do not respond to treatment,” he says. “If we prove this, then this opens up a new avenue of improving treatment outcomes in these patients.”

The Woolcock research team is enlisting 50 people with uncontrolled, hard-to-treat asthma to pinpoint where and how much of their lungs are affected by over-reactive or constricting airways.

“Using a 3D imaging technique that was developed right here at the Woolcock, we can see where in the lung abnormally reactive airways constrict to cause the asthmatic symptoms,” says Professor King, who also works with the Sydney Medical School, Royal North Shore Hospital and NHMRC Centre of Excellence in Severe Asthma.

The team will then test whether optimal puffer treatment can reduce the number of reactive airways.

“If our hypothesis is correct, that is that reducing the number of reactive airways in the lung improves asthma control, then we should be able develop ways in which to target those offending airways to better treat asthma,” Professor King says.

“Such a breakthrough will bring huge relief to those who, at the moment, must go through their day with uncontrolled symptoms and the risk of a dangerous asthma flare-up.”

The team is recruiting 50 people with symptomatic, poorly controlled asthma to take part in the Asthma Control and Airway Hyperresponsiveness (iARIA) study. Recruits must be aged 18-55, otherwise healthy, non-smoking and experience asthma symptoms most days. Study visits occur at Royal North Shore Hospital, St Leonards, and Macquarie University Hospital, North Ryde. Travel expenses will be reimbursed.

To participate in this study please click here.

Asthma in Australia 

  • Two million Australians have asthma.
  • Asthma is a chronic lung condition that inflames and narrows the airways, causing wheezing, shortness of breath, chest tightness and coughing.
  • The causes are still not well understood, but triggers are known to include viral infections, exercise, and exposure to allergens and irritants.
  • Adherence to medications is poor, with many people, especially young people, failing to use their preventer inhalers as often as needed to manage their condition.
  • Ten per cent of sufferers, about 200,000 Australians, have hard-to-treat asthma that doesn’t respond at all to standard puffer medication.