National Research Program

2 3

Asthma Australia’s National Research Program

1

For over 50 years, Asthma Foundations throughout Australia have funded much needed asthma research, with each Foundation working locally with researchers to support people with asthma and their carers.

Many Foundation projects have made considerable contributions to global asthma research. Australian researchers are internationally recognised for their excellence in the field – of which we, our donors and supporters, can feel immensely proud. When someone elects to make a donation or bequest to asthma research, they are not only supporting important asthma research here in Australia. They are also contributing to our global understanding of asthma – what causes it, how it can be prevented and how it should be treated.

In 2012, the Asthma Foundations decided to combine their resources and, for the first time, to offer a combined grant funding opportunity on a national basis.

This booklet outlines the new National Research Program and acknowledges the very significant Foundation-supported research achievements of the past. It introduces the National Research Council, which is chaired by Professor Dick Ruffin. I thank Dick and the Council for their commitment to excellence in establishing our National Research Program.

Asthma Australia and its Member Asthma Foundations invite researchers, clincians and consumers; the business community; the general public; and our exisiting partners to work with us to build our National Research Program and together achieve our vision to free the community of asthma.

Terry Evans President Asthma Australia

Asthma Australia comprises the Asthma Foundations from each Australian state and territory working together on national policy, advocacy and programs and promoting research. It is a national, non-government, incorporated body with no political affiliations.

The Asthma Foundations have been supporting Australians with asthma for over 50 years. In 2009, the Foundations determined to work together on strategic national priorities to better help people with asthma. Since then they have developed national programs in education and training for the community and health professionals; community information; and research.

To find out more about our work:

1800 ASTHMA (1800 278 462)

asthmaaustralia.org.au

research@asthmaaustralia.org.au

Asthma Australia

4 5

Michael Abramson MB BS PhD FRACP FAFPHM Professor of Clinical Epidemiology, Monash University

Michael Abramson is a respiratory physician at the Alfred Hospital in Melbourne. He obtained his medical degree from Monash University and undertook physician training at Prince Henry’s and the Royal Newcastle Hospitals. He received his PhD from the University of Newcastle for a study of occupational asthma in aluminium smelter workers. He now leads a broad program of epidemiological research into environmental and genetic factors in chronic respiratory diseases, as well as the health effects of mobile phones. He has strong collaborations with the Alfred Hospital, University of Melbourne and other research institutions. He is epidemiological adviser to the journal Respirology and an Associate Editor of the International Journal of Tuberculosis & Lung Disease. He chairs the COPD-X Guidelines Committee of The Australian Lung Foundation. He has led training workshops for the Thoracic Society of Australia & New Zealand, the Asian Pacific Society of Respirology and the American Thoracic Society.

National Research Council

The National Research Council was formed in 2012 to establish the National Research Program and ensure independence and excellence in all aspects of this work. Asthma Australia is very appreciative of the time and expertise which all Council Members give voluntarily to support this work.

Richard Beasley CZNM MBChB FRACP DM(Southampton) FAAAAI FRCP(London) DSc( Otago) FFOM(Hon)

Richard Beasley is a physician at Wellington Hospital, Director of the Medical Research Institute of New Zealand, and Deputy Chair of the Health Research Council of New Zealand. He is an Adjunct Professor at the Universities of Canterbury, Otago and Victoria University of Wellington, New Zealand, and Visiting Professor, University of Southampton, United Kingdom. His research interests in respiratory medicine are primarily in the fields of epidemiology and clinical management. In 2002 he was awarded the American Thoracic Society World Lung Award, in recognition of contributions to research, education and patient care in global lung health.

Professor Judith Black AO, MB BS Hons PhD FRACP (Hon), Professor of Pharmacology, University of Sydney

Judy is currently National Health and Medical Research Council Senior Principal Research Fellow and Professor, Discipline of Pharmacology, University of Sydney. She is Head, Cell Biology Group, Woolcock Institute of Medical Research and Associate Physician, Department of Respiratory Medicine, Royal Prince Alfred Hospital. Judy has held senior positions in the National Health and Medical Research Council and has been influential in promoting the research agenda. Judy heads a team of more than 25 students, postdocs and research assistants who are investigating the cellular and molecular aspects of asthma, pulmonary fibrosis, lung transplantation medicine and lymphangioleiomyomatosis (LAM).

6 7

Professor Louis Landau OA MBBS, MD, FRACP, Hon D Litt, Emeritus Professor and Honorary Senior Research Fellow, The University of Western Australia

Louis graduated from the University of Melbourne in 1965 and subsequently trained and practiced as a Paediatric Respiratory Physician. He has worked at the Royal Children’s Hospital in Melbourne and at Princess Margaret Hospital for Children in Perth where he was a Professor in Paediatrics. Professor Landau was the Executive Dean of the Faculty of Medicine and Dentistry at The University of Western Australia from 1996 to 2004. He is currently Chair of the Postgraduate Medical Council of WA and Emeritus Professor and Honorary Senior Research Fellow, The University of Western Australia. He is the founding Chairman of the Institute for Child Health Research and the Western Australian Institute for Medical Research, and has served on committees of the National Health and Medical Research Council, the Australian Drug Evaluation Committee, the Australia Medical Council, the Confederation of Postgraduate Medical Education councils, the Cystic Fibrosis Association and the National Asthma Campaign. He is past Chair of the Postgraduate Medical Council of WA and currently Medical Advisor to the WA Department of Health. Professor Landau has over 200 publications in international journals on respiratory physiology, asthma and cystic fibrosis and presents regularly at international scientific meetings. Louis was awarded the Order of Australia, a Centenary Medal and an Honorary Doctorate of Letters for his contributions to paediatrics, medical education and research in respiratory medicine.

Dr Kay Price RN BN Dip T (Nurse Education) MN PhD Associate Professor Nursing and Midwifery

Kay brings to the team qualitative expertise and in particular her capacity to theorise and challenge taken-for-granted viewpoints. Her expertise is in applying critical analytical approaches to complex questions, integrating biomedical, political and social understandings and interrogating findings from different theoretical perspectives. As Chief Investigator of the North West Adelaide Health (Cohort) Study [NWAHS] she has linked with colleagues on several mixed method research designs receiving funding from National Health and Medical Research Council and Australian Research Council schemes. She continues to receive international recognition through her being an active peer reviewer for the A* nursing journal (Journal of Advanced Nursing) and two A journals (Journal of Clinical Nursing, Qualitative Health Research) and an invited reviewer for the McMaster Online Rating of Evidence System [MORE], an international network operated through McMaster University. She represents the nursing perspective in national forums related to Australia’s Medicine Policy and her competitive national selection as a Board Director – Nursing, National Prescribing Service Ltd (Oct, 2008 - current) identifies her as a recognised national leader in nursing and quality use of medicines.

Prof Richard Ruffin AM, MD, FRACP, Emeritus Professor Medicine, University of Adelaide

Richard is Chair of the National Research Council. He is a respiratory physician in part time private practice and part time consultant at the The Queen Elizabeth Hospital (TQEH) working with junior doctors. Richard graduated from Monash University MBBS Hons after BSc Hons at Melbourne University. He trained as physician in Melbourne, followed by 3.5 year research fellowship at McMaster University in Canada. He was then Consultant Respiratory Physician at Flinders Medical Centre; Director of Respiratory Medicine TQEH; and Professor of Medicine at TQEH. Major research interests have been in asthma and COPD encompassing basic science, clinical practice, therapeutics and epidemiology.

8 9

Research has been a priority of the Asthma Foundations since their conception in 1961, with the first research grants awarded in 1964. At that time, a group of visionary Australians conducted what was then the biggest ever community fundraising appeal in Australia’s history. This initiated a fifty year history in which research has been a major priority. Some of the world’s most eminent asthma researchers received early career grants from an Asthma Foundation. Since that time, the Foundations have provided millions of dollars in research grants, making a unique and strategic contribution to national and global thinking about asthma and its treatment.

Exercise Induced AsthmaClinical Professor Sandra Anderson led a 3 year study (1979-1981) funded by Asthma Foundation NSW, investigating the respiratory heat and water loss in patients with asthma while they were exercising. They found exercise induced asthma increased as the inspired water content of the air was decreased. It was suggested that the muscle spasm caused by water loss from the airways during exercise could be due to a change in osmolarity in the respiratory tract fluid. This research contributed significantly to international thinking, and led to an enormous amount of research over the subsequent 2 or more decades with a total of 205 citations. It was the first time the concepts of asthma and osmolarity were connected and led to the identification of the Exercise Induced Asthma (EIA) phenomenon, as well as research resulting in effective treatments for EIA.

Airway Smooth MuscleIn the 1980’s, Professor Judy Black received a number of research grants from Asthma Foundation NSW. Her first study explored why asthmatic airways are hyperresponsive, or “twitchy”. The research found that there was no relationship between reactivity to histamine in vivo and in vitro, suggesting there was an additional factor which was responsible for the “twitchy airways”. The paper from this work was published in the top respiratory journal and cited 139 times.She then investigated the effect of allergy, which proved to be a very important influence. The findings

showed that asthmatic cells grow at nearly twice the rate of non asthmatic cells, and dramatically changed thinking about the airway smooth muscle in asthma. The paper from this work has been cited more than 200 times.

Novel immunotherapies for suppressing asthmaAsthma Foundation NSW contributed close to $250,000 over 5 years to the work of Phil Hansbro and his research team at the University of Newcastle which found that infection with a certain type of bacteria (Streptococcus pneumoniae) suppresses asthma-like disease in mice. Vaccines made from components of this bacteria have been developed that have suppressed asthma in mice. Human clinical trials are planned based on this work and have the potential to lead to the development of new therapies.

Asthma and PregnancyAssociate Professor Vicki Clifton received $245,000 worth of grants over 5 years during 1998-2007 to explore the links between asthma, pregnancy and the placenta function, including the effect of maternal asthma medication on the foetus. This research found that inhaled corticosteroids used in the treatment of pregnant women with asthma do not cross the placenta and affect the foetus. Most pregnant women worry their medications may hurt their baby and stop taking them, putting both themselves and their unborn baby at risk. This research led to the development of educational resources and a major health promotion

Did you know?Some highlights of Asthma Foundation funded research in Australia

10 11

campaign by the Asthma Foundation to obstetricians, midwives and pregnant women to ensure pregnant women continue taking their medications and manage their asthma whilst pregnant.

ICS PrescribingIn 2004, Asthma Foundation Queensland provided a $120,000 grant to Dr Glenn Rice-McDonald of the Mater Hospital to study the effectiveness of doubling inhaled corticosteroids (ICS) for the treatment of mild to moderately severe attacks. This treatment was based on expert opinion however there was not any trial evidence to support the recommendation. Based on the strength and findings of the Asthma Foundation funded study and similar national and global studies, the recommendation to double ICS to treat exacerbations has subsequently been dropped from asthma management guidelines. Dr Rice-McDonald said, ‘Whilst ICS remain a very important treatment for asthma, their use has now been rationalised to avoid inappropriate and ineffective doubling to treat asthma attacks.’

Asthma and PollenInvesting in research has been a priority of Asthma Foundation South Australia since its inception in the early 1960’s. A major fundraising appeal ‘Operation Breathe Easy’ raised funds for early career researchers to undertake research projects overseas and locally. One of the first recipients was Dr Allen Gale who studied pollens, moulds and airborne allergens and irritants. Dr Gale provides Asthma Foundation SA with the daily pollen count readings to this day.

Vacation ScholarshipsThe Alex Ramsay Essay Prize set up in South Australia in the late 1960’s became a Vacation Scholarship where valuable work was carried out under supervision in hospitals.

Early Career GrantsMany recipients of Asthma Foundation South Australia’s early career research grants have gone on to become some of Australia’s most respected research and respiratory physicians and most have retained a close supportive relationship with the Asthma Foundations. These include Professor Dick Ruffin, Professor Peter Frith, Professor Ral Antic and Professor Bob Heddle.

In 2010 Asthma Foundation South Australia provided an Early Career Research Grant of $25,000 to Dr Violet Mukaro from Adelaide University to further her research into severe asthma focusing on a non-eosinophilic asthma, which is often less responsive to traditional preventer medications. This has led to new insights into the development of new and emerging medications and management strategies.

Smooth Muscle in Asthma‘Over a period of more than 5 years we have been developing methods of measuring the number and size of airway smooth muscle cells in the airways of patients with moderate or severe asthma and comparing them with people who do not have asthma. With the help of the Asthma Foundation of Western Australia (AFWA) we have been able to show that patients with asthma have more smooth muscle cells and bigger smooth muscle cells. This suggests that at some stage in the life of asthmatics, stimuli occur that make more cells appear or make the cells grow bigger. Of great interest is that we also showed that the number (not the size) of cells was related to the severity of asthma. However neither the size or number of smooth muscle cells was related to how long asthma was present or at what age the asthma started. This suggests that the increase in number or size of smooth muscle cells occurs very early in the course of developing asthma or that may have been there before symptoms began. This very much agrees with the observation that abnormal lung function is present soon after birth in children who develop asthma and that the abnormal lung function generally persists through life and is related to the severity of asthma. We thank the AFWA for their help in getting the techniques going and allowing us to generate data that helped us obtain national competitive funding from the National Health and Medical Research Council.’ Prof. Alan James, Consultant Respiratory Physician, Sir Charles Gairdner Hospital

Regulation of IgE ResponsesIn 1985 the Asthma Foundation of Western Australia awarded a grant to Professor Patrick Holt for “The regulation of IgE responses to inhaled allergens: Studies of on the mechanism to tolerance induction” for $25 000. This underpinned the launch of Professor Holt’s 25-year and continuing research to refine and apply the principles of immune regulation to treat asthma winning major support for two programs grants from the National Health and Medical Research Council of Australia and for a clinical trial from the Immune Tolerance Network of the American National Institutes for Health. Adj/Prof. Wayne Thomas, University of WA, Head of Molecular BiotechnologyTelethon Institute for Child Health Research.

Bushfire Smoke and AsthmaAsthma Foundation Northern Territory has provided in-kind support to researchers. One such project was on “Bushfire Smoke and Asthma” conducted by Dr Fay Johnston, Prof Ross Bailie, Prof Louis Pilotto and Prof David Bowman (2003- 2006). This study was important as it found a clear association between asthma symptoms, increased use of medication and exposure to bushfire smoke at levels well below current air quality standards. A summary was published in Issue 30 of the Asthma Update in June 2006. Fay has since moved to Tasmania and works closely with the Asthma Foundation there.

12 13

Reminder Asthma Management Program (RAMP)

This project will evaluate a ‘reminder’ management approach designed to improve asthma control in 6-16 year old children with asthma.

The study

The researchers will use an electronic monitoring device that records when preventive medication is taken and also reminds the subject to take their medication through the use of a preset alarm. They will measure participants’ adherence and asthma control at a subsequent medical consultation.

Potential impact

This study will help us to better understand the difficulties experienced by children in adhering to use of their preventer medication; the aim is to explore the various barriers and needs of this group to inform a subsequent intervention.

Research team

Chief Investigator, Dr Scott Burgess and Assoc Professor Carolyn Dakin work at the Mater Children’s Hospital. Carolyn is the acting director of the Respiratory and Sleep Unit. Scott is a staff specialist and the clinical lead for the Difficult Asthma Clinic at the Mater Children’s Hospital. Scott’s main interest is the clinical management of childhood lung conditions, with a focus on supporting families and improving treatment outcomes in children with chronic disease. Dr Alina Morawska is a clinical child psychologist and director of research at the Parenting and Family Support Centre at the University of Queensland. Professor Peter Sly is the Dept Director of the Queensland Children’s Medical Research Institute and is a Paediatric Respiratory Physician at the Royal Children’s Hospital, Brisbane and Dr Andrew Tai is a Paediatric Respiratory Physician at the Women and Children’s Hospital, Adelaide.

The study

The study explores whether Vitamin D levels during early childhood are associated with:

— frequency and severity of lower respiratory tract infections, especially during the first two years of life;

— risk for sensitisation to aeroallergens, particularly early sensitisation;

— wheezing symptoms during infancy, and its progression to asthma;

— rate of post-birth development of respiratory function, and hence risk for asthma development.

Potential impact

This study will help us understand better whether vitamin D in childhood can help prevent or protect against asthma and allergy.

Research team

Chief Investigator, Dr. Elysia Hollams, has worked in the field of asthma and allergy research in the Division of Cell Biology at the Telethon Institute for Child Health Research since 2002. Her research during this time has focused on asthma and immunity.

Co Chief Investigator, Professor Prue Hart, heads the Inflammation Division at the Telethon Institute, where her research includes studies examining the effects of UV radiation exposure on immunity.

Investigator, Associate Professor Guicheng Zhang, is a researcher in the School of Paediatrics and Child Health (SPACH) at the University of Western Australia. His expertise lies in the area of biostatistics.

Advisor, Professor Patrick Holt, is internationally recognised for his work on asthma and immunity.

Dr Elysia Hollams

For over 50 years, Asthma Foundations throughout Australia have funded much needed asthma research, with each Foundation working locally with researchers to support people with asthma and their carers.

Many Foundation projects have made considerable contributions to global asthma research. Australian researchers are internationally recognised for their excellence in the field – of which our donors and supporters can feel immensely proud.

In 2012, the Asthma Foundations decided to combine their resources and, for the first time, offer a combined grant funding opportunity on a national basis. We have recently announced the three successful applicants for our inaugural national grants. An overview of each of their projects follows.

2012 Grant Recipients

Vitamin D links to childhood development of asthma and allergy

This study will investigate whether inadequate Vitamin D during infancy promotes development of persistent wheeze and/or asthma. It will focus on two major asthma risk factors: respiratory infection and allergic sensitisation.

14 15

Anti-Smoking Asthma Program (ASAP) for high schools - a pilot study

Asthma and respiratory diseases are the second most common reason for hospitalisation of Aboriginal and Torres Strait Islander people. Smoking and asthma are both substantial risk

factors for preventable hospitalisation and progressive lung disease. This study involves a peer-led education program to improve asthma outcomes and prevent tobacco smoking in Aboriginal and Torres Strait Islander and disadvantaged young people.

The study

This pilot study is based on the Triple A (Adolescent Asthma Action) program with an added smoking prevention module. It will use Peer Leaders from Years 10 to educate Year 7 students about asthma using videos, games and activities. They will guide them to critically analyse the issues faced by young people with asthma, such as taking medication, risk taking behaviours such as smoking, visiting their doctor and have them propose ways to address these barriers and present key messages through creative performances or art work.

Potential impact

The project addresses two national priority areas: asthma, and smoking relating to Aboriginal and Torres Strait Islander peoples. This study will help us to better understand how to minimise smoking uptake and how this relates to respiratory health risks for young people, in particular Aboriginal and Torres Strait Islander students, and through schools in disadvantaged communities.

Research Team

Chief Investigator, Associate Professor Smita Shah, will work closely with the Northern Territory Asthma Foundation through CEO Jan Saunders and Asthma Educator Jill McGee. Smita has developed and sustained the Triple A program in NSW. She has previously trialled the program in several secondary schools in Western Sydney that have high proportions of students from Indigenous backgrounds. She has expertise in peer education programs and working with urban Aboriginal communities in asthma education. Professor Anne Chang has expertise in clinical and research issues on respiratory conditions in children and multicentre randomised controlled trials particularly those involving Aboriginal and Torres Strait Islander children. Professor Peter Gibson is the Director of the Asthma, Priority Research Centre at the Hunter Medical Research Institute and will provide expertise with regard to asthma phenotypes and sputum analysis. He co-led the Adolescent Asthma Action Program (Triple-A) program with Smita. Jill McGee is the Education Manager at the Asthma Foundation NT and will work as a part time project officer to assist with data collection and program implementation.

Associate Professor Smita Shah and Professor Anne Chang

How can I support research?

Asthma Australia is Australia’s leading charity dedicated to freeing the community of asthma through research.

Thanks to this ground breaking work more people are living better with their asthma than ever before as we continue to search for a cure.

You can support this important work by donating to Asthma Australia’s National Research Fund.

To find out how you can get involved and help us continue this important work please contact us at research@asthmaaustralia.org.au.

16

1800 ASTHMA (1800 278 462)

asthmaaustralia.org.au

research@asthmaaustralia.org.au