New Director Set to Transform Lung Cancer Future

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Esteemed cancer researcher Professor Maija Kohonen-Corish has been appointed to lead a new dedicated lung cancer centre into an exciting future of disease discovery.

The Lung Cancer Centre, at the Woolcock Institute of Medical Research in Sydney, will run cutting-edge programs across all areas of lung cancer research, including genetics, drug discovery, delivery of medications and future developments for patient care. Our cross-disciplinary approach will ensure that today’s research in lung cancer is translated into tomorrow’s outcomes for patients.

Professor Kohonen-Corish brings with her a 24-year track record of discovery in cancer research, including the genetic basis of colon cancer, and translational research in colon and lung tumours.

Among projects to be established at the centre is the new director’s own work investigating lung bacteria and their role in disease. “One of the brightest hopes for better lung cancer treatments lies in research on the microbiome, naturally-occurring microorganisms found in the human body,”  Professor Kohonen-Corish says. “We know that gut bacteria play an important role in cancer and the success of cancer therapies, but what we are just discovering now is that the microorganisms found naturally in the lung itself may be vital too,” she says.

“It’s possible that bad lung bacteria or an altered balance of bacterial species, called dysbiosis, could be promoting lung disease, and could even be stopping some lung cancer treatments working effectively.”

Professor Matthew Peters, chair of the Lung Cancer network, says this new frontier of research shows great promise. “Discoveries in this area could dramatically alter our whole approach to lung cancer and improve outcomes for the 10,000 Australians diagnosed with lung cancer every year,” he says. “Lung cancer screening could be focussed on those who have a high-risk microbiome. Understanding the relationship between microbiome patterns and response to treatments will allow precision medicine and improve outcomes.”

Breakthrough innovations are desperately needed for lung cancer, a disease that kills 8,000 Australians every year, more than breast and prostate cancer combined. The past decade has seen the introduction of some new treatments that are effective for a minority of lung cancer patients.

“Survival rates will remain low unless we fund research and implement new treatments that are effective for the majority,” Professor Peters says. “What will hold us back more than anything is the mistaken belief that discovery is impossible and that investment is futile.”

Professor Kohonen-Corish says lung cancer receives just a tiny fraction of the funding of other cancers, largely due to its negative links to smoking. “This stigma is misplaced though, when you consider that many people who get lung cancer have never picked up a cigarette, but may have been exposed to other risk factors in the environment,” she explains.

The new state-of-the-art facility includes a patient database and biobank to give researchers access to valuable cells, de-identified patient information and fresh experimental results in the areas of molecular biology and drug discovery. The facility is a focus for the lung cancer network, an initiative which includes multiple research and clinical groups devoted to improve lung cancer outcomes.  “We are a hub for researchers, clinicians, respiratory physicians, oncologists, radiologists, thoracic surgeons, and advocates for lung cancer - basically all those driven to help fast track a cure for lung cancer,” the researcher says.

Professor Kohonen-Corish’s own work on microorganisms forms an key part of this disease discovery. Through a new collaboration with the Microbiome Research Centre at the University of New South Wales Sydney and St George Hospital in Sydney, researchers are investigating how gut and lung bacteria affect cancer development and interfere with treatment.

It is thought that an imbalance of the bacterial composition somehow weakens the effectiveness of potentially life-saving immunotherapy drugs that have shown promise in the treatment of metastatic lung cancer. “However, the genetic or epigenetic make-up of the tumour may also play a role. This is the challenge of the type of research we do, to determine which factors are the most important, in order to discover how the therapy can be improved,” says Professor Kohonen-Corish, who holds a joint appointment at the UNSW Sydney and the Woolcock Institute.  

Microbiome Research Centre Director Professor Emad El-Omar, from UNSW Sydney, says there are hundreds of different types of microbes in the lung that clearly impact on health, risk of disease and response to treatment. “The microbiome is the new frontier of medicine and it offers real opportunities for reducing the disease burden in society,” Professor El-Omar says. “Research on the lung microbiome has lagged behind but I am delighted to see this exciting new programme led by Professor Kohonen-Corish.“

He says progress in medicine can only happen if researchers challenge dogma, dedicate resources and work together across different disciplines. “This is why I am so excited about this collaboration between the Woolcock Institute and UNSW Sydney’s Microbiome Research Centre,” Professor El-Omar says.

 Lung Cancer: The Facts

·         Lung cancer is the 4th most common cancer in Australia and has the highest mortality rate

·         More than 10,000 Australians are diagnosed with it each year

·         It kills more women than breast, uterine, and ovarian cancer combined

·         Unlike breast or prostate cancer, lung cancer has no diagnostic tests for early detection

·         It is the leading cause of cancer in the Aboriginal population

·         Just 15 per cent of those diagnosed with lung cancer are still alive five years later

Nicotine Addiction and Smoking Cessation 3 Day Course

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Did you know that Australia has one of the lowest smoking rates in the world?

HOW DID WE ACHIEVE THIS? LEARN FROM THE EXPERTS

Join our Nicotine Addiction and Smoking Cessation Course in Sydney, Australia, to gain indepth knowledge and skills to work as a Tobacco Treatment and Smoking Cessation Specialist.

Hosted by A/Prof Renee Bittoun,Tobacco Treatment Specialist, Adjunct Associate Professor Medical School, University of Notre Dame Australia, along with other experts in the field of smoking cessation. A/Prof Bittoun has been teaching this course for over 15 years, regularly updating the content and has many years of experience in clinical practice and professional training regarding smoking cessation.

Topics: Causes, consequences, treatment and research of smoking cessation, nicotine addiction and appropriate evidence based smoking cessation techniques in practical application. Our aim is to improve the implementation and evaluation of programs in smoking cessation. This 3 day course includes a USB stick with course materials and a certificate of attendance is awarded on completion.

This course is suitable for health practitioners who have an undergraduate degree in medical/para medical allied health and intend on dedicating a large component of their professional career to smoking cessation. This is a post-graduate level course. There will be an end of course assessment.

Course Dates: 26-28 March | 18-20 June | 28-30 October 2019

Ticket Price: $1,700 excl GST

Location: Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe NSW 2037

Fish Oil May Prevent Allergies in Kids: Study

paediatric allergies

A popular food supplement linked to heart health may help protect your child from developing allergies, Australian research has revealed.

A study by the Woolcock Institute of Medical Research in Sydney, in collaboration with researchers from Imperial College London, found that amongst children who lived in higher traffic areas, those who took fish oil supplements in their first five years of life were less likely to develop allergies to common house dust mites. This is despite living in traffic-dense areas known to drive up allergy rates in young people.

“Our work is the first to suggest that taking fish oil supplements in childhood may have a protective effect against allergies for kids living in heavy traffic pollution areas where allergy rates can be higher,” explains Dr Christine Cowie, co-author of the study published in the journal Environmental Health. “While our work is preliminary, it’s very exciting to find a potential aid for parents keen to shield their children from developing common household allergies.”

House dust mites are microscopic parasites that are one of the most common triggers of allergic conditions globally, and particularly so in Australia. Many people with asthma, atopic eczema and allergic rhinitis are allergic, and this eight-legged arthropod is one of the worst offenders. Mites feed off dead skin cells from humans, and make their home in bedding, mattresses, carpets and upholstered furniture.

A recent study by the same team found that children exposed to higher traffic within 50 metres of their home were at greater risk of having house dust mite allergy. So the group, led by Professor Anna Hansell from Imperial College, London, set out to investigate whether fish oil, a commonly-used supplement, could help minimise the effects of traffic pollution on the risk of being allergic.

The team examined data collected from a long-running longitudinal study on asthma in children. This analysis looked at the childrens’ data at eight years of age, along with data on traffic density as a measure of exposure to traffic-related air pollution, and allergic responses, lung function, and reported asthma and rhinitis. Half of the children in the study had been randomly allocated to take regular fish oil (omega-3) supplements throughout the first five years of life.

“We found that, among children exposed to high traffic at home, those that hadn’t been allocated the fish oil supplements had a greater risk of being allergic to house dust mites at eight years of age than children who had been given them,” Dr Cowie explains. “Put simply, taking fish oil supplements early in life may protect you from developing house dust mite allergy, if you live in an area with higher traffic.”

The study is one of the first to examine the interactive effects of air pollution with fish oil supplementation. The results are important because they suggest simple protective measures that may protect against the effects of pollution. “It would be a wonderful discovery if parents could protect their children from this common allergy simply by taking a food supplement,” Dr Cowie says.

While the results are promising, the researcher cautioned against immediate action. “It’s certainly exciting but our findings need to be replicated in larger studies before we can advise parents to race out to the pharmacy,” she says.

The paper, Weighted Road Density and Allergic Disease in Children at High Risk of Developing Asthma, has been published in Environmental Health. To view, visit https://ehjournal-biomedcentral-com.ezproxy1.library.usyd.edu.au/articles/10.1186/s12940-018-0370-5

Lifesaving Tuberculosis Project Shortlisted for Top Science Gong

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An innovative screening program that is transforming the global fight against tuberculosis (TB) has been shortlisted for one of Australia’s most prestigious science awards.

The project led by Woolcock Institute of Medical Research in Sydney, is a finalist for the 2018 Australian Infectious Diseases Research Centre Eureka Prize for Infectious Diseases Research.

The Act Now for Tuberculosis Control Team, made up of researchers from both the University of NSW and University of Sydney, is testing innovative screening approaches that promise to help eliminate the killer disease.

“Ten million people a year develop tuberculosis, one in three of whom are not diagnosed,” says Woolcock researcher Professor Guy Marks. “We believe that using existing tools, including some newly developed technologies, in new and better ways can make a big impact on this disease.”

Many people believe that we have already conquered tuberculosis because it is not common in Australia. However, globally, it is the leading infectious cause of death. It is a major problem in many low and middle income countries, including many of our neighbours in the Indo-Pacific region. The Act Now team has been working in collaboration with colleagues in one of those countries, Vietnam, for over a decade.

So far the researchers have screened more than 100,000 local people for TB in Vietnam. “We’ve taken innovative tuberculosis screening approaches developed through our own robustly-designed clinical trials and applied them at the grassroots, screening people who share households with tuberculosis patients,” explains Professor Marks. “These are people who are at very high risk of getting TB. By detecting TB early and referring them for treatment we are preventing the spread of TB and reducing the risk of death due to TB.”

Our findings promise to transform the approach prevention of TB in developing nations, he says.

The team is made up of Professor Marks and PhD student Jennifer Ho, both from University of NSW, and Professor Warwick Britton and Associate Professor Greg Fox from University of Sydney. 

The researchers say they feel privileged to be shortlisted for a Eureka Prize, an annual award to reward excellence in the fields of research & innovation, leadership, science engagement and school science. The winners will be announced on August 29.

TB: The Facts

  • Tuberculosis is a curable bacterial infection that is spread through inhaling tiny droplets from the coughs or sneezes of an infected person

  • Despite being preventable and curable, TB is common and deadly, particularly in poor countries

  • Every year, nine million develop TB, including 500,000 children. A further 1.8 million die from it

  • The World Health Organization says the death toll from the disease is still unacceptably high and efforts to combat it must be accelerated

Woolcock Centre for Lung Cancer Research

We would like to thank everyone who attended the launch of the Woolcock Centre for Lung Cancer Research on Wednesday, 18 April 2018. The event, held at the Woolcock Institute of Medical Research in Glebe, was officially opened by NSW Health Minister Brad Hazzard.

Woolcock Success

Professor Greg King

Professor Greg King

Professor Greg King has been awarded 2018 Dr. Robert Crapo Memorial Lifetime Achievement Award in Pulmonary Diagnostics from the Respiratory Structure and Function (RSF) assembly of American Thoracic Society.

The RSF Assembly honors the life achievements of Robert Crapo, M.D., an international leader in the study of pulmonary function diagnostics. It is a great testament to Greg’s work and achievements in this area.

Dr David Chapman has been awarded the American Thoracic Society Ann Woolcock Memorial Award, again by the Respiratory and Structure Assembly. 

The award honours Ann Woolcock's achievements in the field of asthma in areas of epidemiology, physiology and medicine, and recognises young emerging investigators in the field of obstructive airway disease, for overall accomplishments and future promise.

Dr David Chapman

Dr David Chapman

Clinic Helps Aussies Catch Their Breath

Breathlessness – that frightening feeling when you can’t get enough air into your lungs – is one of the most common reasons Australians call an ambulance.

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While the problem lands thousands in hospital emergency departments every year, too few people are able to get their breathlessness problem resolved quickly, respiratory specialists warn.

Woolcock Institute of Medical Research in Sydney has launched a Breathlessness Clinic to fast track diagnosis and treatment for the many people suffering from this worrying, anxiety-inducing complaint. “The problem is breathlessness can be a very challenging clinical problem,” explains Woolcock respiratory physician Dr Tracy Smith. “The heart, lungs, muscles and the brain can all be involved, making the cause a tricky puzzle to solve.”

Breathless patients are often referred to a respiratory physician or a cardiologist first, only to be sent to the other specialist later, she says. “This process can be time-consuming and frustrating for all involved,” Dr Smith says. On top of this, treatment recommendations for conditions which can lead to breathlessness are constantly changing, and there are few clinical guidelines to help specialists manage problems which affect more than one organ system, for instance patients with both heart AND lung disease.

The Woolcock Breathlessness Clinic seeks to solve this problem with a new and innovative model of care. The multispecialty approach will see patients see a cardiologist and a respiratory physician at the same time to allow rapid, comprehensive assessment.

“We’re creating the state’s first one-stop-shop for breathlessness, promising to investigate, diagnose and treat all patients under one roof and in a timely fashion,” Dr Smith says. “We’ll collaborate closely with GPs to ensure they are kept informed about the patient’s assessment and treatment recommendations.”

Getting breathless when walking up a steep hill or running is normal, however when you get more out-of-breath than expected for the amount of exercise you have done, it can suggest a medical problem.

“Getting out of breath when you don’t expect to be puffed out can be a frightening experience,” Dr Smith says. “It can also be embarrassing and stops many people from doing exercise, which can actually make the problem worse. There’s also a perception among many people that breathlessness is part of getting older and not something a doctor can help with.”

The problem, known in clinical circles as dyspnoea, has many potential causes. “For people with irregular bouts of breathlessness it could be a flare-up of a long-standing lung disease, like asthma,” explains the clinic’s chief cardiologist Professor Len Kritharides.

“There’s also the chance it’s linked to a heart condition such as coronary disease or an abnormal heart rhythm, which is why I get involved,” Professor Kritharides says. For those with daily, long-term breathlessness, it may be caused by a range of lung, heart or muscle conditions, obesity, poor fitness or a combination of things.

“Understanding the problem is the essential first step to treatment,” Professor Kritharides says. “We hope that we can help patients identify their treatment options as quickly as possible and help them live a better, healthier, more active life.”

The Woolcock Breathlessness Clinic is for patients who have been breathless for more than four weeks despite treatment by their GP. Patients must be referred by their doctor.

Nicotine Addiction & Smoking Cessation Update Day

 

We have secured a number of notable speakers to present at our Nicotine Addiction and Smoking Cessation Update Day on 21 November 2017, 9am - 5pm.

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One of the highlights of the day will feature a group of medical experts from a range of clinical specialties presenting both their views and the evidence around the pros and cons of vaping. This will conclude with a panel discussion and the opportunity to ask questions. Full program to follow.

Date: 21 November 2017

Registration fee: $120 ($100 for AASCP members)

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Location:
Woolcock Institute of Medical Research
431 Glebe Point Road, Glebe NSW 2037

Wake-Up Drug May Get Insomniacs Snoozing

AS SEEN ON CHANNEL 9 NEWS: 

A drug used to keep narcoleptics awake may also help insomniacs sleep better, Sydney researchers hope.

Scientists at the Woolcock Institute of Medical Research are investigating whether a popular wakefulness drug could be used to make an important insomnia treatment, sleep restriction therapy, more effective. The trial, a world-first, could hand Australia’s 1.5 million insomniacs a better, more appealing treatment plan to get them snoozing through the night.

“Sleep restriction therapy is one of the best treatments we have for people with insomnia but sadly the side effects – extreme daytime sleepiness – make it difficult for patients to stick to,” explains Study Doctor and Sleep Specialist Daniel Judge. “If we can show that using a wakefulness-promoting drug in the day improves side effects of sleep restriction therapy then the treatment will become far easier for patients to use.”

Studies estimate 13 to 33 per cent of the adult population have insomnia, defined as difficulty falling asleep, staying asleep, or both.[1] Sedatives are the most common treatment but they should only be used short term and may not treat the underlying cause of the condition.

Delivered by a sleep psychologist, sleep restriction therapy (SRT) is a non-drug option in which time in bed is restricted each night. The partial sleep deprivation makes you more tired the next night, setting you up for a deeper sleep which is gradually lengthened as the therapy progresses.

“The concept of reducing sleep in order to increase it might seem absurd but studies show it’s actually just as effective as sleeping tablets at getting you sleeping better,” Dr Judge says. “The trouble is you feel so groggy and sleepy during the day that so many people drop out of treatment before they see the benefits.”

The Woolcock team is enlisting 30 people with insomnia to trial the therapy alongside the drug armodafinil, marketed as Nuvigil, which is approved in Australia to treat patients with excessive sleepiness associated with narcolepsy, obstructive sleep apnea or shift work disorder.

“If it works to keep these patients awake during the day then we’re hoping it will have the same alerting effect on people with insomnia, ultimately making it easier for them to recover from their condition,” Dr Judge says.

Volunteers will take the drug daily over four weeks alongside sleep restriction therapy. Sleep diaries and actiwatches will be used to monitor sleep and track progress.

It is not a placebo-controlled trial so all participants will receive the active drug. If results are positive, the Woolcock will run a much larger study before specialists could consider widespread use of armodafinil for insomnia, Dr Yee says.

If you are an insomnia patient seeking treatment, contact the study coordinator Parisa Hassan on (02) 9114 0469, email woolcock.moderate@sydney.edu.au, or visit https://woolcock.org.au/new-2/do-you-have-insomnia-2 to register your interest.

Woolcock Wins $2.2M Grant to Support Asthma Battlers

Australians living with poorly controlled asthma will get a boost from their local pharmacist thanks to a $2.2million grant that backs an innovative Woolcock initiative. 

The Federal Government has announced it will fund a new Pharmacy Asthma Service trial that targets patients most at risk of dangerous asthma flair-ups.

The Woolcock Institute of Medical Research will establish the service in partnership with University of Sydney, Curtin University, University of Tasmania, National Asthma Council,  Asthma Australia, Pharmacy Guild of Australia, Pharmaceutical Society of Australia and The George Institute.

Woolcock Executive Director Professor Carol Armour says the service offers a unique opportunity to get asthma under control in the community. “We’ll be focused squarely on that at-risk group of patients that carry the highest burden of disease and are most likely to wind up in emergency departments with out-of control asthma symptoms,” Professor Armour says. “Under this new model, community pharmacists working at the coal face will be skilled up to identify these patients, find out why their asthma is poorly controlled and help them manage their condition.”

The pharmacists will support these at-risk patients with three private consultations over 12 months to make sure they don’t keep falling through the cracks. “Central to this support is ensuring they’re taking their medication regularly, using their inhaler correctly, and checking their hay fever to see if it could be exacerbating their asthma,” Professor Armour says. Those patients with complex issues or unknown causes will be referred to their GP.

If the trial proves successful the consortium hope to roll out the trial to more communities across Australia.

The grant, entitled Getting Asthma Under Control Using the Skills of the Community Pharmacist, will be funded to the tune of $2,199,100 over two years. It was announced by the Federal Minister for Health Greg Hunt at the Pharmaceutical Society of Australia Conference in Sydney on July 28.

Respiratory Physiology Education Day - July 2017

Photo by Tom Psomotragos

Photo by Tom Psomotragos

Covering the intermediate to advanced aspects of pulmonary physiology with a focus on airways disease, this education day will provide a basis by which attendees can further learn about complex physiology, in relation to airways disease. 

This comprehensive education day is primarily aimed at respiratory medicine trainees, physicians and respiratory scientists. However, the content may be of interest to all respiratory healthcare professionals.

Click here to view the program.

When: Saturday, 29 July 2017. 9am - 5pm

Location: Level 5, Woolcock Institute, 431 Glebe Point Road, Glebe NSW 2037

Cost: $20 Catering provided. Places limited.

This educational activity is supported by an independent educational grant from GlaxoSmithKline Australia. 

GP Seminar

SLEEP, MOOD AND NEURODEGENERATIVE DISORDERS: IDENTIFICATION AND MANAGEMENT IN GERIATRIC PATIENTS

The Woolcock NeuroSleep Clinic, invites you to a special free GP Seminar on 21 June 2017 at the Brain and Mind Centre.

Join us as we consider and discuss issues commonly faced by GPs when treating older adults including the assessment, treatment and management of common sleep, psychiatric, neurological and neurodegenerative disorders. We will also introduce you to our specialised research clinics, which offer free assessments and interventions to eligible participants. Come along to hear the latest research, discuss relevant case studies and identify alternative assessments and treatments that may assist your practice.

Click here to view the program. 

About this course: This Category 2 activity has been approved by the RACGP QI&CPD Program. Total Points: 4 CPD points. Activity Number: 102425.

When: Wednesday, 21 June 2017. 5.45pm - 8.30pm

Location: Brain and Mind Centre, Lecture Theatre, Level 5, 94 Mallett Street, Camperdown NSW 2050

Cost: Free. Light refreshments provided.

Institute Celebrates Trailblazing Women Scientists

Australia’s top respiratory health institute will mark International Women’s Day with a lecture from one of the world’s most esteemed women scientists in honour of its own celebrated female founder.

The Woolcock Institute of Medical Research in Sydney has invited world-leading respiratory physician Dirkje Postma, Professor of Pathophysiology at the University of Groningen in the Netherlands, to speak on March 8.

The Ann Woolcock Lecture commemorates the institute’s own trailblazing female founder, whose work revolutionised asthma treatment worldwide. With four women on its board and a female director at its helm, the Woolcock has shown it’s serious about nurturing and promoting women in science.

“We’re excited to be able to host such an eminent female researcher at the Woolcock on such important occasion as International Women’s Day,” Executive Director Professor Carol Armour says.

“Like our own Ann Woolcock, Dirkje Postma enjoys international recognition as a scientist who revolutionised our understanding of respiratory illnesses and how to treat them. Thanks to their work, and the work of a growing number of influential women scientists around the world, we’re closer than ever to beating these diseases.”

Professor Postma will use the lecture to talk about exciting developments in chronic obstructive pulmonary disease or COPD, the generic term for a number of lung diseases, including emphysema and chronic bronchitis that cause coughing, wheezing and shortness of breath.

The disease affects 14 per cent of Australians aged 40 or over, and 29 per cent of those aged 75 or over.[i] There is no cure and while cigarettes are recognised as a key trigger, one in five patients have never smoked.

Professor Postma will detail exciting new developments in the field that are revealing just how complex the condition is. Far from a simple ‘smoker’s disease’, COPD can also be triggered by chemical exposure, premature birth, genetics, ageing, or a combination of these factors. She will explain how this deeper understanding of COPD and its many faces will pave the way to personalised treatment that better suits the individual patient’s disease history.

“To consider a time when patients with COPD will get tailored care specific to their disease is exciting indeed,” Professor Armour. “It heralds the beginning of better, faster, more effective treatment that helps sufferers retain good quality of life for longer.”

The Ann Woolcock Lecture series honours the contribution of Professor Woolcock to the research community. Invited researchers share their ideas with industry, policy makers, fellow academics, doctors, specialists and patients with a view to prompting new collaborations to improve respiratory health.

The lecture, COPD: A Disease With Many Faces, will be held on Wednesday, 8 March at 5.30pm, at the Woolcock Institute of Medical Research headquarters in Glebe, Sydney. RSVP to woolcock.admin@sydney.edu.au or phone 02 9114 0408.

[i] Toelle, B. G., Xuan, W., Bird, T. E., Abramson, M. J., Atkinson, D. N., Burton, D. L., James, A. L., Jenkins, C. R., Johns, D. P., Maguire, G. P., Musk, A. W., Walters, E., Wood-Baker, R., Hunter, M. L., Graham, B. J., Southwell, P. J., Vollmer, W. M., Buist, A., & Marks, G. B. (2013). Respiratory symptoms and illness in older Australians: The Burden of obstructive Lung Disease (BOLD) study. Medical Journal of Australia, 198(3), 144-148.

Mild Asthma Study

Asthma

A NEW INHALER FOR MILD ASTHMA? 

Do you have mild asthma and are using mainly a blue reliever? 

A new inhaler for mild asthma is being tested at the Woolcock Institute. 

  • Free inhalers, lung function tests and assessment of your asthma 
  • You will be reimbursed for study visits 

Do you want to participate in this study?

Click here to register online.

Email: novelstart@woolcock.org.au

For more information about this study click here.

Daily Puff Protects Mild Asthmatics from Deadly Wheeze

Hundreds of thousands of Australians with mild asthma could halve their risk of a severe flare up with a low-dose daily puffer, a ground-breaking new analysis has found.

Work led by Sydney’s Woolcock Institute of Medical Research and published in the prestigious international medical journal The Lancet, is challenging the long-standing assumption that it’s okay to leave mild asthma untreated.

The study found that people experiencing asthma symptoms less than two times a week can halt lung decline and protect themselves from asthma attacks and severe wheezing by taking low dose preventer medication every day. “The benefits were seen even in people with very infrequent symptoms, once a week or less, suggesting there is a lot to gain from getting even the mildest of asthma sufferers onto treatment,” says study leader Professor Helen Reddel.

About a million Australians have mild asthma but most are not being treated according to the national guidelines which recommend they use a preventer inhaler every day, even when they have no symptoms. Instead, most of these people resort to reliever-only medication – the ‘ambulance at the bottom of the cliff’ solution – which leaves their condition poorly managed.

Without their condition in check, sadly many adults with mild asthma end up in hospital with an attack they could have prevented, and some of these attacks can be fatal,” Professor Reddel says.  

Woolcock researchers set out to investigate whether people with mild asthma could benefit from daily low dose preventer medication. They analysed the results of the randomized inhaled Steroid Treatment As Regular Therapy (START) which assessed outcomes for 7,138 mild asthma patients.

Half were given the once-daily anti-inflammatory treatment budesonide, or Pulmicort, while the remainder took a placebo puffer. Results showed that over three years, Pulmicort halved the risk of severe flare-ups, reduced lung function decline, and improved symptom control. “These results are strong enough to be recommending that even those with the mildest form of asthma start taking a low dose medication every day,” the researcher says.

But the solution is not that simple. Professor Reddel highlights that people with asthma who have few symptoms are reluctant to take daily medication, and GPs are often not keen to prescribe it, largely because many don’t understand how dangerous mild asthma can be. This was seen dramatically in the epidemic of thunderstorm asthma in Melbourne last year.

With this in mind, Professor Reddel and her team have set to work testing an ‘on demand’ inhaler treatment called Symbicort, currently prescribed for patients with moderate or severe asthma, that can be used when symptoms appear. This study, called Novel START, is in still in recruitment phase in New Zealand, Australia, Italy and the United Kingdom, but if successful, it could change the way the respiratory disease is treated worldwide.

Both studies are fully funded by AstraZeneca, the manufacturer of both Symbicort and Pulmicort, but both studies were initiated by external researchers.

Our new results show how preventer medication can benefit even mild asthma, leaving us more driven than ever to find an effective as-ended treatment that patients will actually use.”

People with mild asthma should talk to their GP about trying a low dose preventer treatment, and make sure that they have a written asthma action plan. People in Sydney and Newcastle who are using only a blue reliever inhaler can volunteer to help the Woolcock team investigate an alternative way of managing their mild asthma.

To volunteer for the Novel START study please click here to register online.

Click here to find out more about this study. 

About Mild Asthma

  • Two million Australians - one in ten – have asthma, and about half have a mild form of the condition.
  • Those with mild asthma develop symptoms, like wheezing, cough or breathlessness, from time to time, for instance, when they have a cold, when they exercise, or during hay fever season.
  • About one third of people presenting to Emergency Departments with severe asthma flare-ups report having symptoms less than weekly in the previous 3 months. 

 

A new inhaler for mild asthma?

To volunteer for this study please call 1300 303 725 or click here to register online.

Australians living with mild asthma could soon have a new puffer at their fingertips if results of a research study show the condition can be well managed without daily medication.

Asthma experts at the Woolcock Institute of Medical Research in Sydney are testing a new combination puffer treatment that could reduce asthma deaths and change the way the respiratory disease is treated worldwide.

More than a million Australians have mild asthma but most are not receiving treatment based on national guidelines, which recommend they use a daily preventer inhaler.

Instead, most of these people rely solely on a reliever-only medication (a blue inhaler such as Ventolin) which, while it makes them feel better at the time, does not treat the underlying inflammation of the airways and still leaves them at risk of severe flare-ups.

Sadly, people with apparently mild asthma make up 20 per cent of adults who die of asthma, and a third of people who need emergency asthma treatment,” says asthma specialist Professor Helen Reddel, who is heading the study in Australia. “Clearly we need new treatment options that are acceptable to patients, and that will protect them from severe attacks, or worse.

Novel START is a real-life randomised controlled study that will compare three different treatments over one year. Two of these are currently approved while the third is novel.

One group of patients will use Ventolin only for relief of symptoms, which is what most people with mild asthma currently do. A second group will use Pulmicort, which contains a low dose of the anti-inflammatory medication budesonide, twice a day, plus Ventolin for relief of symptoms; this is the current recommendation based on guidelines. A third group will use a combination Symbicort Turbuhaler, containing both a low dose anti-inflammatory budesonide preventer and a reliever in one inhaler, for relief of symptoms.

Symbicort is subsidized by the PBS and is widely used by people with more severe asthma. It can be used to relieve symptoms, but only if already prescribed for daily use. Its proposed use solely for the relief of symptoms (without daily treatment) is new,” Professor Reddel explains. “If we can show that it’s an effective new way to manage mild asthma then, taken with the results of other current studies, it’s likely to change the way authorities recommend mild asthma should be treated.

This international study is being conducted in Australia, New Zealand, United Kingdom and Italy and is fully funded by AstraZeneca, the manufacturer of both Symbicort and Pulmicort. It is, however, important to point out that this study was initiated by the investigators, and not by the manufacturer.

The Woolcock team will enrol and manage Australia’s 100 volunteers. Patients will have their lung function and asthma symptoms regularly tested and some will be interviewed to find out what they like or dislike about the treatments.

Researchers will be looking for a drop in asthma flare-ups over the course of a year, including severe flare-ups that need treatment with steroid tablets.

Professor Reddel says that if results, to be reported in 2019, show that those on as-needed Symbicort do better than the other two groups, more than a million asthma patients are set to benefit.

Currently we have a situation where patients with mild asthma don’t want to take a daily preventer medication, because they don’t feel it’s necessary, and their doctors may not prescribe it because they think it won’t be used regularly enough to be effective,” she says. “So we have patients relying on the blue inhaler, which relieves their symptoms for a few hours, but of course it doesn’t treat the underlying airway inflammation.

People with untreated airway inflammation, even if their symptoms are usually mild, are at risk of having severe flare-ups, for instance, when they get a cold, ending up in emergency departments around the country.

Statistics show that 35 per cent of adults presenting to emergency departments with acute asthma, 16 per cent of patients with near-fatal asthma, and 15–20 per cent of adults dying of asthma all had symptoms less than weekly in the previous three months.

Imagine a solution that means you just use your puffer as needed, and it would both relieve your symptoms and protect you from flare-ups. That would be a major shift in the approach to treatment for mild asthma, and one that would be warmly welcomed, I’m sure,” says Professor Reddel.

Researchers for this study are looking to enrol 100 NSW residents with mild asthma who haven’t used a preventer for at least three months to get involved in the study. 

To volunteer for this study please call 1300 303 725 or click here to register online.

About Mild Asthma

  • Two million Australians - one in ten – have asthma, and most have a mild form of the condition.
  • Those with mild asthma develop symptoms, like a wheeze, cough or some breathlessness, from time to time, for instance, when they have a cold, are exposed to allergens or irritants, when they exercise, or during hay fever season, but they don’t usually have symptoms every day.
  • Current asthma guidelines recommend that people who have asthma symptoms twice or more a month should take preventer medication every day to reduce the risk of flare-ups, but most patients opt not to, feeling their symptoms are too infrequent to warrant it.
  • Their preferred treatment, as-needed reliever use, doesn’t treat the underlying condition, leaving the disease poorly managed and the patient at risk of severe flare-ups.
  • Asthma specialists hope a combination treatment that is already widely prescribed as a daily use inhaler will prove effective as an as-needed treatment during the Novel START trial.