Channel 9 News: New mild asthma medication

A combination inhaled treatment, that is currently able to be prescribed for people with moderate-severe asthma, was recently registered for adults and adolescents with milder asthma. This follows the results of large studies showing that this treatment reduces the risk of serious flare-ups in people with mild or infrequent asthma symptoms.

Globally, an estimated 339 million people are living with asthma. In Australia, the prevalence of asthma is considered high, with 2.7 million people living with the condition. One million of these Australians have a mild form of the disease.

Click play to view the full story with Professor Helen Reddel from the Woolcock Institute, who has been closely involved in studies of treatment options for mild asthma.

Prime 7 News: Sleeping Brain Offers Vital Dementia Clues

Your memory not what it used to be? Your sleeping brain could be to blame, Australian researchers believe.

Scientists at the Woolcock Institute of Medical Research in Sydney are peering into the sleeping brains of older Australians to find new ways of stopping cognitive decline in its tracks, in new efforts to tackle the problem of dementia.

The unique research uses powerful neurotechnology to observe the brain throughout the night to find out which parts aren’t ‘sleeping well’, explains sleep specialist Dr Angela D’Rozario. “What your brain does when you sleep holds vital clues about the state of your cognitive thinking and your ability to form memories,” she says. “We believe we can link these problem areas of the sleeping brain with specific brain and memory issues, and ultimately develop new treatments that can slow or even halt the cognitive decline.”

The Woolcock team are recruiting 40 older Australians aged 50-90, either with or without signs of mild cognitive impairment, to reveal secret links between brain wave behaviour and cognitive problems.

The work was inspired by recent landmark discoveries showing normal sleep clears out damaging “toxins” that build up in the brain during wakefulness.

“Sleep protects the brain from all the toxic by-products that build up while we’re awake by using the glymphatic system, which acts like the brain’s plumbing system, to clear out the accumulated waste,” the sleep expert explains. “This active process during sleep is thought to restore the efficiency of the brain cells and promote optimal functioning ready for the next day. If this process is disrupted either by lack of sleep or disturbed sleep through sleep disorders then toxins can build up and potentially cause brain injury.”

The research team will use topographical analysis of brain wave activity using a neurotechnology called high-density EEG to watch these waves in great detail throughout the night. The high tech scan is able to sample from 256 cortical sites compared to the standard six during an overnight sleep study, offering up results far more sophisticated and detailed than previously seen.

Observing their volunteers, the researchers will work to pinpoint which areas in the brain have abnormal sleep and, using the results of an MRI scan, tie these to specific cognitive deficits. Recruits are invited back for a follow-up 1-2 years later to assess their cognitive trajectory over the longer term.  

Dr D’Rozario is excited by the study’s potential. “We know sleep is strongly linked to cognitive function but with this study we have the opportunity to understand the mechanisms that underlie this relationship in aging” she says. “In doing this we have the potential to target sleep with brand new treatments that, for instance, boost these sleep brain waves with drugs or devices like brain stimulation. If we pick the decline up early, we can target it and potentially delay or even stop dementia developing.”

The work is all the more important given Australia’s aging population and rising rates of dementia. “It’s predicted that a quarter of Australia’s population will be over the age of 65 by 2056,” Dr D’Rozario says. “Any findings that can help improve sleep in this huge population and ultimately slow cognitive decline would be enthusiastically welcomed.”

Those interested in joining the study should visit the Woolcock website (see “Exploring the links between poor sleep, memory impairment and cognitive decline”). Volunteers can have a diagnosis of mild cognitive impairment, or concerns about changes to their memory and thinking. Researchers also welcome participants with no cognitive concerns to act as controls for the study. You will be required to stay overnight at the Woolcock Sleep Lab in Glebe, and undergo an MRI scan as well as a range of cognition and memory tests. Recruits are compensated for time spent in the clinic.

GINA 2019 Pocket Guide and new Severe Asthma Guide (ver2.0)

Asthma pocket guide 2019

Today the Global Initiative for Asthma (GINA) is happy to release the 2019 updates to the Pocket Guide for Asthma Management and Prevention, as well as an updated version (2.0) of the Pocket Guide on “Diagnosis and Management of Difficult-to-treat and Severe Asthma in adolescent and adult patients”. These important resources are now available on the GINA website www.ginasthma.org/reports

Landmark Changes in the 2019 GINA Asthma Strategy Report

The 2019 GINA strategy report represents the most significant change in asthma management in over 30 years. The key changes in GINA 2019 are first, that for safety, GINA no longer recommends starting treatment of asthma with short-acting beta2-agonist reliever inhalers on their own. Instead, GINA recommends that all adults and adolescents with asthma should receive either symptom-driven (for mild asthma) or daily inhaled anti-inflammatory controller treatment, to reduce their risk of serious exacerbations and to control symptoms. A summary of the changes implemented in 2019, and the evidence and rationale supporting them, can be found starting on page 16 of the GINA 2019 Pocket Guide, or by downloading the “What’s new in GINA 2019?” slide set, also found at  www.ginasthma.org/reports. The full GINA 2019 report, which contains multiple practical resources for clinicians, and the 2019 online Appendix, will be available shortly.

Prof. Helen Reddel, Chair of the GINA Science Committee and a research leader at the Woolcock Institute of Medical Research in Sydney, Australia, stated “The new GINA recommendations represent the outcome of a 12-year campaign by GINA to obtain evidence for strategies to reduce the risk of serious asthma-related exacerbations and death, including in patients with so-called mild asthma. Our aims were also to avoid establishing a pattern of patient reliance on quick-relief medications early in the course of the disease, and to facilitate consistent messaging about the goals of asthma treatment from the time of first diagnosis.”

Summary of Changes for Severe Asthma ver2.0  

The GINA Pocket Guide on the “Diagnosis and Management of Difficult-to-treat and Severe Asthma in adolescent and adult patients” has proved extremely popular in both hard copy and pdf format since it was first published in November 2018. The Pocket Guide provides practical evidence-based advice for clinicians in both low and high income countries about how to assess and treat patients for whom conventional asthma therapies don’t seem to be working, and about how treatment strategies, including biologic therapies if available, can be implemented into patient care.

The second version of this Pocket Guide includes important additions to the treatment algorithm for severe asthma, including the availability of an additional biologic treatment (dupilumab, an antibody against interleukin-4 receptor alpha), and advice about extension of a treatment trial of biologic therapy to 6-12 months if the initial response is unclear.

Asthma Experts Urge GPs to Talk Money

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Doctors should school up on costs of asthma drugs to help Australians with the breathing condition access better value medications, new research has found.

A study by Woolcock Institute of Medical Research in Sydney has found that many patients aren’t well informed about which treatment choices are low-cost. The work, based on interviews with dozens of asthma patients, was published today in the Australian and New Zealand Journal of Public Health.

“Some asthma preventer medications have a lower cost for patients than others, but our research showed many patients didn’t know that different types of preventer inhalers are available, or the price differences,” says lead author Dr Sharon Davis. “We’re encouraging GPs to get informed about costs and have empathetic conversations with their patients to ensure they’re prescribing the best option for them.”

About 2.3 million Australians have asthma but relatively few use well manage their condition with daily use of an anti-inflammatory preventer inhaler as recommended in national guidelines. Studied show adherence is as low as 16 percent for those aged 35 to 64, and just seven per cent for younger adults.

“Those with poorly managed asthma are more likely to have severe exacerbations, ER department visits and hospital stays, so it’s vitally important we understand what is stopping people taking their medication,” Dr Davis says.

Researchers conducted in-depth interviews with 24 adults with asthma and 20 carers of children with the condition. They found that while most appreciated the benefits of regular preventer use, many didn’t take their preventer regularly, for various reasons.

“Some felt that it wasn’t needed every day, or they were concerned about side effects, while others simply forgot,” the lead researcher says. “Cost was also an issue for some, with complaints that some medications were quite expensive.”

In their findings, researchers encouraged patients to take a more proactive role with their health care professional, seeking information on medication options, costs, benefit and potential side effects.

Importantly, the paper also encourages GPs to study up on options and actively engage patients in discussions around the right choices. In many cases, doctors could inform patients about a lower-cost alternative preventer inhaler option.

“If our patients are more empowered and informed they’re more likely to fill their scripts and take their medication regularly, and live life with better managed asthma,” Dr Davis says.

The study was carried out in collaboration with University of Sydney, University of Wollongong, Asthma Australia and NPS Medicinewise.

The paper, “You’ve got to breathe, you know” – asthma patients and carers’ perceptions around purchase and use of asthma preventer medicines, can be viewed here:

Honours Trifecta Win for Woolcock

Three top Woolcock scientists have been awarded national honours for their trailblazing work in the fields of asthma, lung medicine and sleep research.

Executive Director Professor Carol Armour, Sleep and Circadian Research Group Leader Professor Ron Grunstein and Board Member Professor Matthew Peters have each been made a Member of the Order of Australia for significant services to medical education in the 2019 Honours list.

“It’s a privilege to be honoured in this way for our efforts to improve the lives of Australians living with sleep conditions and respiratory diseases,” Professor Armour says. “Every day at the Woolcock we strive to advance diagnosis and treatment options and ultimately find cures for these common, life-limiting conditions. To be recognised for our work three times over is exciting and greatly rewarding.”

Professor Armour’s honour was awarded for her significant service to medical education, and to asthma management. She has headed up the Woolcock since 2012 and also holds positions with the Sydney Medical School, the National Health and Medical Research Council (NHMRC) and the National Asthma Council. An internationally renowned respiratory pharmacologist, Professor Armour is author, co-author or editor of approximately 200 scientific articles.

Professor Grunstein was recognised for his significant service to medical education and research in the field of sleep disorders. He also holds a role with the NHMRC and the Cooperative Research Centre for Alertness, Safety and Productivity. A pioneer in the field of sleep medicine, Professor Grunstein has published more than 300 peer reviewed articles and 41 book chapters throughout his career.

Professor Peters’ award honours his significant service to thoracic medicine, to medical education, and to professional organisations. Aside from sitting on the Woolcock board, he has roles with Macquarie University, the Thoracic Society of Australia and New Zealand and the Global Lung Cancer Coalition.

The Woolcock congratulates its esteemed colleagues on their achievement.

Woolcock Helps Doctors Solve Breathlessness Puzzle

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Breathless patients often present a clinical challenge for doctors. Is it the heart or the lungs behind the complaint, or perhaps it’s the muscles, or even the brain?

To tackle this common and complex clinical problem, the Woolcock Institute of Medical Research in Sydney has launched a Breathlessness Clinic. Its mission is to make a doctor’s job easier by fast tracking a diagnosis for this worrying, anxiety-inducing complaint.

Woolcock respiratory physician Dr Tracy Smith said breathlessness, or dyspnoea, is one of the most common reasons Australians call an ambulance. Despite this, too few patients are able to get their breathlessness problem resolved quickly.

“Breathless patients are often referred to a respiratory physician or a cardiologist first, only to be sent to the other specialist later,” Dr Smith said. “This process can be time-consuming and frustrating for all involved. 

“On top of that, 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,” she explained.

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

“This is NSW’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 said. “We’ll collaborate closely with GPs to ensure they are kept informed of the patient’s assessment and treatment recommendations.”

Dyspnoea has many potential causes. It can be triggered by long-standing lung disease like asthma, or it could be linked to heart conditions like coronary disease or arrhythmia, said the clinic’s chief cardiologist Professor Len Kritharides. “And 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,” Professor Kritharides said. “The fact there can be multiple inputs can make this a difficult clinical problem to solve in primary care.”

The Woolcock Breathlessness Clinic is for patients who present to their GP with breathlessness persisting for 4-8 weeks or longer. The GP is recommended to conduct baseline tests and treatments for any underlying asthma, COPD or heart disease. If no improvements are seen, they can be referred to the Clinic where patients will complete a screening questionnaire, full lung function testing and chest x-ray prior to seeing specialist doctors. “All our patients see a cardiologist and respiratory physician simultaneously,” Dr Smith said. “GPs will receive detailed correspondence regarding recommendations after each clinical assessment.” 

“Our ultimate goal is to help patients identify their treatment options as quickly as possible so they can get back to living a healthy, fulfilled life,” she said.

GPs can download referral forms online at www.woolcock.org.au/referral or email the Woolcock on info@woolcock.org.au to request a referral pad.

Christmas Holidays

The Woolcock Clinic closes for the festive season from midday on Friday, 21 December 2018 and re-opens at 8am on Wednesday, 2 January 2019.

The last night of sleep studies will be held on Friday, 14 December 2018, starting up again on 2 January 2019.

The Woolcock NeuroSleep Clinic in Camperdown will be closed from Wednesday, 19 December 2018 and will reopen on Wednesday, 14 January 2019.

Merry Christmas and Happy Holidays from all of us!

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Centre Gives Lung Patients Hope for Brighter Future

Ms Lillian Leigh at the Woolcock Centre for Lung Cancer Research launch on Wednesday, 18 April 2018.

Ms Lillian Leigh at the Woolcock Centre for Lung Cancer Research launch on Wednesday, 18 April 2018.

Lillian Leigh gives thanks for every extra day she gets.

The 37-year-old Sydney mother is living with lung cancer, a deadly disease for which there is no cure and few effective treatments. But thanks to drug trials, her tumours have shrunk, her energy has returned and she’s been given the chance to see her daughter start kindy.

“Every time I open my eyes in the morning, I'm so grateful,” says Lillian, a lawyer turned lung cancer advocate. “I'm so grateful for every breath I take, for every extra day I get with my family, every extra day I get to be a school mum. Every single day counts.”

Lillian has thrown her support behind NSW’s first lung cancer centre dedicated to finding new treatments and ultimately a cure for the disease with the highest mortality rate of any cancer. The Centre for Lung Cancer Research, run from the Woolcock Institute of Medical Research in Sydney, will shine a spotlight on the condition that is so often neglected by funders and hidden behind the banners of ‘no smoking’ campaigns.

Its opening ushers in a new era of lung cancer research to extend the lives of the 12,000 Australians – many young, fit and non-smoking - who are diagnosed with the condition every year.

Lillian, a beneficiary of a lung cancer drug trial launched in Melbourne, says the Centre launch can’t happen soon enough. “Think of breast cancer, prostate cancer, pretty much any other cancer and there’s a wealth of medical research underway into every aspect of the disease and how to beat it - but not so for lung cancer,” she says. “Lung cancer is the hidden cancer. We don’t have powerful lobby groups or celebrities backing our cause. Research funding opportunities are rare and the stigma, that victim-blaming mentality, is sadly alive and well in our community.”

The Centre, which opened on Wednesday, 18 April, will work to lift the profile of the disease, sending a clear message to funders, policy makers and the public that the lung cancer battle is a worthy cause, just like every other cancer.

The Centre for Lung Cancer Research will support large-scale research projects run from its high-tech purpose-built Glebe facilities, and act as a hub for a network of researchers, clinicians, respiratory physicians, oncologists, radiologists, thoracic surgeons and advocates for lung cancer. It’s high-tech laboratory, database and bio-bank will allow an unprecedented level of information sharing, ensuring patients get to benefit from new discoveries quicker than ever before. Several projects are already underway, including work to develop non-invasive diagnosis, innovative drug delivery and 3D-printed airway stents for patients with breathing difficulties.

Lillian, who is working with the Woolcock to establish the Network, says the centre gives her hope for future lung cancer patients. “It’s very exciting to see so much energy and expertise being poured into an area where it is so desperately needed,” she says. “It gives me hope that our voices, the voices of people with lung cancer, will finally be heard and that we can dare to wish for a better outcome than the status quo.”

“I want nothing more than to see my daughter start high school. Let’s make that dream a reality.”

John Cottam's Story

It wasn’t always easy for me. As a child, I was very shy and often not alert in class. I can’t tell you whether that had anything to do with a disorder or what, but had there been more awareness in terms of paediatric sleep disorder, I think, my parents would have done their best to address some of the difficulties I had during my childhood.

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