Dr Helen Reddel Research Leader Clinical Management
To carry out research studies about issues relevant to the clinical management of patients with airway diseases.
• Completion of first stage of Cooperative Research Centre (CRC) for Asthma and Airways “needs of older people with asthma” study. Questionnaire developed and tested, in 191 subjects over age 55, and in 44 subjects < 40 yrs old. Informative data about the experience of older adults with asthma was obtained, a poster has been accepted at TSANZ ASM and a paper is being drafted.
• Award of our first NHMRC grant (please see section below).
• Recruitment of an international post-doc (Juliet Foster) to join the group for a short-term project. Juliet was subsequently attracted to remain at the Woolcock for a long-term (3 year) position with the Clinical Management Group.
• Successful completion of the attitudes and adherence project (funded by Asthma Foundation NSW).
• Development of national web-based resources for teaching inhaler technique.
• Increasing local and international research collaborations
The main project for 2009 is the NHMRC-funded study of general practice strategies for improving asthma control. This project will be managed by Juliet Foster.
Several projects are being developed which are likely to attract funding and will encourage international collaborations. These include a multinational study in mild asthma, a study to validate electronic monitoring devices for assessing adherence with inhaled medications, and studies of inhaler technique in Jordan.
In December 2008, the group submitted a NHMRC Partnership grant application in collaboration with the Australian General Practice Network and Asthma Foundation NSW, together with researchers from University of Sydney, University of NSW, and the George Institute. If funded, this project will evaluate two interventions to improve the quality use of asthma medications.
There is an opportunity for collaboration between the Clinical Management Group and the Australian Centre for Asthma Monitoring, in a large web-based survey of people with asthma. We will undertake the planned intervention study to ascertain whether our tool can be used to enhance adherence and asthma outcomes in older people with asthma.
Asthma Needs Questionnaire: Factor analysis to enable refinement of our needs questionnaire to replace it with a brief version, renamed “concerns of older people with asthma” is under way. Once complete this version will be piloted with a group of GPs and may be revised to incorporate GP priorities. We will trial this “tool” for accessing and addressing the concerns of older people with asthma, to determine whether its use results in better asthma outcomes and adherence in this group with poorer outcomes than other age groups in Australia. We found that older people have significantly more symptoms (breathlessness, cough and limitation of usual activities) than younger in our sample, and were more likely to have had an emergency department visit and a course of oral steroids in the previous year. Despite this, > 50% believed their asthma was well controlled. Those with higher education level, who are in the workforce, and who are younger prefer more autonomy in decision making. Older people self reported a high level of compliance, > 50% stating that they always took their asthma medication as their doctor advised. A high proportion was concerned about having a bad attack, but only 36% owned an action plan. A paper reporting on the findings from the study and the validation of the questionnaire is currently being drafted.
Breathing techniques presentation: Production of a presentation that demonstrates breathing exercises designed to help reduce the use of asthma inhalers (available to the general public for free from the Cooperative Research Centre for Asthma and Airways website). The production was made in response to research conducted by the Woolcock Institute and Melbourne’s Alfred Hospital, (published in the August 20061 edition of Thorax), which showed that asthmatics who undertook regular breathing exercises reduced their preventer medication levels by up to half and reliever use by up to 86%. The presentation demonstrates the breathing exercise techniques used in the study, and outlines our current understanding of asthma, and the potential role of breathing techniques in helping to control asthma symptoms.
NSW Asthma Survey: This was the largest survey of the attitudes and needs of people with asthma in NSW (n=689), and was completed in early 2008. A report was provided to Asthma Foundation NSW, and the results were presented to AFNSW staff. The results were subsequently used by AFNSW for the development of resources for patients and health care professionals about asthma control, in the design of AFNSW projects, and in lobbying of stakeholders about asthma. The results were presented at the TSANZ and ATS meetings in 2008, and a manuscript is in preparation.
Attitudes and adherence: This study was funded by Asthma Foundation NSW, and was run by Dr Juliet Foster after her arrival from the Netherlands in mid 2008. Juliet did an outstanding job in recruiting 100 patients with asthma for this study, obtaining questionnaire data about their attitudes relating to asthma and medications, then following up their adherence with their asthma medications over 2 months with an electronic monitoring device. Analysis of the study findings have commenced; it will provide valuable background information for the development of research tools for other studies. Experience gained with the electronic monitoring device will be applied to other studies.
Inhaler technique resources for patients with asthma or COPD: This project was funded by Dept Veterans Affairs and coordinated by National Asthma Council. The output was a brochure providing evidence-based advice about teaching inhaler technique, with details of the correct technique and common errors for currently-available inhalers; plus web-based videos demonstrating correct technique for each type of inhaler. These resources were downloaded over 8,000 times in the first 3 months after the launch of the “Prevent Puffer Problems” campaign.
Role of the pharmacist in asthma management: Our previous research on inhaler technique and on pharmacist strategies for asthma management led to a further two publications during 2008, the development of resources for health professionals and patients (see above), and the methods were incorporated into an intervention to promote asthma management by community pharmacists. After a lengthy review process, the team of investigators from the Faculty of Pharmacy (University of Sydney) and Woolcock was awarded a $1million+ tender by Department of Health and Ageing to commence national implementation of this program. Roll-out of this project commenced in late 2008 and will continue, together with process evaluation, in 2009.
Studies of tools for monitoring asthma: Six separate studies are underway relating to monitoring asthma control and exacerbations in clinical trials and clinical practice. These involve collaborations with investigators from University of Sydney, Woolcock and Europe/South Africa/North America. Three of the studies involve using sophisticated new methods of statistical analysis to identify predictors of adverse outcomes, using electronically-recorded data from previous Woolcock studies.One study is being conducted to confirm previously published observations about the interpretation of peak fl ow charts (Reddel et al, Thorax 2005); software has been developed to present data sequentially in different formats, and ethics approval has been obtained for this to be tested in a computer lab in 2009 with medical students from the University of Sydney. Two studies involve the retrospective analysis of Asthma Control Questionnaire data, one from several large multi-national trials and the other from a NSW study of asthma in pregnancy.
American Thoracic Society/European Respiratory Society Task Force on asthma control and exacerbations: Standardised outcomes for clinical trials and clinical practice. The report of this Task Force, which was funded by ATS and ERS, underwent extensive peer review, and a revised report was submitted to ATS in July (approved March 2009). Helen Reddel has been invited by NHLBI/NIAID to assist with the design of a workshop in Washington DC in March 2010 for further development of relevant outcome measures. During 2008, the Task Force published a paper in European Respiratory Journal which provided new definitions for asthma control and severity. These are expected to be adopted at an international level. Identifying the Needs of people with Asthma: Contract research for Asthma Foundation NSW. A total of 689 people with asthma completed this survey.
What is the role of the pharmacist within a multidisciplinary asthma clinic?: Pharmacy Honours project, collaboration between Faculty of Pharmacy University of Sydney and Asthma Clinic RPAH.
Inhaler technique in adults with asthma or COPD: This National Asthma Council project involved the development of webbased and print resources for teaching correct inhaler technique. Funded by Department of Veterans Affairs.
Clinical Assoc Prof Helen Reddel MBBS PhD FRACP Research Leader
Prof Christine Jenkins AM MD FRACP Project Manager
Dr Juliet Foster PhD Research Psychologist
Ms Melanie Crane Research Assistant
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