Working towards earlier diagnosis and a more targeted approach for respiratory conditions
Author: Professor Jorgen Vestbo
Professor of Respiratory Medicine and an Honorary Consultant at Wythenshawe Hospital
Respiratory diseases are the second most common cause of hospital admissions in the UK. COPD is probably the most common lung disease being dealt with, not just in the North West of England, but on a global scale. It is the fourth leading cause of death and it is expected to be the third leading cause of mortality globally in 2025.
Our respiratory research covers four areas relating to common conditions:
- Chronic obstructive pulmonary disease (COPD)
- Improving respiratory symptoms, such as cough and breathlessness
- Asthma
- Severe respiratory infections, including fungal infections
Research will help to reduce disease progression and symptoms for those with respiratory conditions. Many people will be familiar with the term personalised medicine, which takes into account the individual variability in genes, environment, and lifestyle for each person. The P4 medicine strategy, underpinning all of the research funded by the BRC, takes personalised medicine one step further to deliver care which is: Predictive; Preventative; Personalised and empowers patients to Participate in healthcare.
How can we diagnose COPD and match patients to the right treatment more quickly?
One of the areas being looked at is the development of blood, sputum and breath tests to diagnose COPD and its subtypes.
Plans are also in place to monitor disease progression using advanced lung physiology techniques and imaging, and to identify biomarkers for predicting both progression of COPD and risk of exacerbations (“flare-up”) as well as lung cancer risk in COPD patients. A biomarker is any measurable diagnostic indicator, which can be found in tissue, blood and other bodily fluids, used to assess the risk or presence of disease.
Previous research has demonstrated that COPD progression differs from one individual to another. Work is now underway towards a more targeted approach, which diagnoses the condition earlier and matches an individual to the treatment most likely to work for them.
Effective treatments are lacking for cough and breathlessness, the main symptoms of chronic respiratory disease. What are we doing about this?
Coughing and breathlessness have a significant impact on quality of life for patients affected. Research will help to better understand how changes in the neuronal (nervous system) processing of respiratory sensations contribute to these symptoms and identify new drug targets including:
- developing techniques (immuno-histochemical staining and x-ray imaging) to enable measurement of changes in the neuronal system and better understand the connection with respiratory disease
- studying participant’s responses to airway challenges (e.g. exercise, allergens vs. control) to identify biomarkers and mediators capable of reducing the respiratory response
- identifying patterns of neuronal activation/transmission in respiratory disease and the interactions between sensations evoking cough and breathlessness using functional Magnetic Resonance Imaging (fMRI) and Positron Emission Tomography-magnetic Resonance Imaging (PET/MRI).
How can we better diagnose and treat asthma?
Over five million people in the UK receive treatment for asthma. However, there are concerns around the accuracy and complexity of existing diagnostic tests, which may result in under and over-diagnosis.
Research will simplify the process for diagnosing asthma and develop biomarkers to predict response and select the most appropriate treatment (e.g. exploring the use of exhaled Volatile Organic Compounds (VOCs) and inflammatory cells to diagnose, and the use of an individual’s biological clock to schedule and personalise treatment at a time when it is likely to have the best response).
The role of dendritic cells in initiating an immune response and that of a specific protein which may modulate this allergic response, will also to help identify new potential drug targets.
How will we revolutionise the way we diagnose and treat severe respiratory infections?
Research is also focusing on providing more accurate and rapid diagnosis for patients with respiratory infections, resulting from an imbalance of microorganisms (bacteria, fungi and viruses). An increasingly worrying barrier to treating serious fungal infections in the clinic is resistance to antifungal drugs. Techniques to evaluate and improve the ability of molecular methods to detect and track this resistance are being developed.
One condition of particular interest is aspergillosis (disease caused by infection of Aspergillus fungi) which can be challenging to diagnose. Development of genetic markers will spot the signs of aspergillosis in those who are also affected by underlying lung disease. These same tools may also help personalise the treatment offered to each patient.
