What does it take to outwit lung disease? Bold, brave research! Our investigators are involved in projects that cover all the bases, from studying how diseases work to developing real-world therapies.
Below, you’ll learn more about the asthma research projects we are currently funding. Interested in applying for a research grant? Learn about our opportunities here.
Asthma Research Projects
Dr. Azadeh Yadollahi
How Does Obstructive Sleep Apnea Worsen Asthma?
Asthma and obstructive sleep apnea (OSA) cause disability, morbidity, and poor quality of life. Both asthma and OSA are highly prevalent. Among Canadian adults, 8% have asthma and 10% have OSA. OSA is caused by the repetitive collapse of pharynx during sleep. Asthma is characterized by reversible airflow obstruction and disability due to lower airway inflammation and bronchoconstriction. In 2016, the report by Canadian Lung Association showed that asthma is not completely prevented in 90% of Canadians with asthma. For unknown reasons, asthma and OSA co-exist in more than 30% of patients with either disorder. OSA triples the risk of poor asthma control, and treating OSA with positive airway pressure (PAP) improves asthma.
Although OSA and asthma are thought of as independent disorders, we hypothesize that one mechanism by which OSA can predispose to lower airway narrowing in asthma is by increasing fluid accumulation in the thorax during sleep. During OSA, the pharynx collapses; causing strong inspiratory efforts against the occluded pharynx which results in large negative intra-thoracic pressures. The consequence is increased blood return to the heart that increases thoracic blood volume, drives blood from the pulmonary vasculature into the airway wall, narrows lower airways, and worsens asthma.
The objective of our project is to determine whether in patients with asthma, using positive airway pressure (PAP) treatment to prevent pharyngeal collapse will reduce overnight lower airway narrowing.
Asthma subjects will complete one home sleep test to screen for OSA. They will then participate in a randomized cross-over study with two overnight studies. They will receive an auto-titrating PAP (APAP, intervention arm) or Sham-PAP (control arm). They will cross-over to the other study arm within 3 days. Thoracic fluid volume and airway resistance will be measured before and after sleep. We expect in asthma subjects with OSA, the use of APAP will reduce overnight fluid accumulation in the thorax and will consequently reduce lower airway narrowing.
This research has two main novelties. First, this is the first study to investigate the role of fluid accumulation in the thorax on airway narrowing in adult asthma population. Second, this study will establish a novel protocol to investigate one mechanism that OSA therapy can minimize nocturnal airway narrowing in asthma. An important application of this proposal can be in obese adults, children, and pregnant women with asthma. In both adults and children, obesity is a major risk factor for OSA, poor control of asthma, and more use of asthma medication. As obese asthmatics may be at higher risk of airway narrowing due to fluid shift, they will benefit from treatments to improve OSA and manage fluid overload.
The clinical translation of our research is clear. OSA is one of the most under-diagnosed respiratory disorders. Also, the overlap between asthma and OSA is poorly recognized. Thus, both patients and physicians may not attribute sleep problems and poor asthma control to the OSA. Understanding the mechanism by which OSA worsens airway narrowing in asthma, and whether APAP improves airway narrowing can help to reduce asthma exacerbations in asthma patients with OSA who are difficult-to-control.
Dr. Samir Gupta
Shared Decision-making in Mild Asthma: Developing a Patient Decision Aid for a New Therapeutic Paradigm
Asthma affects one out of ten Canadians, leads to serious respiratory symptoms, and costs our healthcare system one billion dollars per year. We developed the Electronic Asthma Management System (the eAMS) to help doctors to easily check their patients’ asthma control level, adjust medications, and give them a plan (an asthma action plan) for what to do if their asthma flares up. Patients answer simple questions about their asthma control on their computer, tablet, or smartphone, and this information is processed and transmitted to their doctor’s computer, along with recommendations for best care. When the patient is in the office, the doctor can see these recommendations and approve the asthma action plan.
About three quarters of people with asthma have a mild form of the condition. For years, asthma guidelines have recommended that such patients take anti-inflammation medication daily to prevent major flare-ups of their asthma. However, recently, 4 major studies have been published, all of which showed that the risk of major asthma flare-ups is similar for these patients whether they take an anti-inflammation medication daily or simply take it whenever they have symptoms. Although both treatment approaches are reasonable, each has certain benefits (pros) and risks (cons). We believe that it is very important for patients and doctors to work together to choose the best option for each patient. To make this possible, we plan to improve the eAMS by developing and testing a “decision aid” – a tool that will help patients and doctors to make shared decisions about which medication patients should take for their mild asthma.
Our main goal is to work with patients and doctors to develop a decision aid that presents all the medication options in an understandable way, helps patients to think about the pros and cons of each option, and helps them to consider which issues are most important to them, in order to reach the best decision. Next, we plan to build a computerized version of this tool and to incorporate it in the eAMS, so that doctors can use the tool with their asthma patients as part of their regular care routine. Lastly, we will study whether this tool is actually used by patients and doctors in the real world, if patients and doctors are satisfied with it, and how the tool affects the care that patients receive.
First, we will design a paper version of the tool with the help of a graphic designer. Then, we will organize several discussions with patients and doctors to gather feedback about our tool. Based on the opinions that patients and doctors express, we will make changes to the tool. When this process is finished and we are confident that we have a tool that patients and doctors are satisfied with, we will build the computerized version of our tool and then incorporate it in the existing eAMS. Finally, we will make the system available to patients and doctors in family practice clinics. We will measure how often patients and doctors used the tool to discuss asthma medications over the course of one year. We will also ask both patients and doctors how satisfied they were with the tool, and how the tool affected the way they reached their decisions about asthma medications.
The eAMS is a cutting-edge technology that revolutionizes how doctors care for their patients with asthma, by bringing care in line with the latest scientific research. Information from new asthma studies now needs to be applied in real-world care, and the eAMS is a powerful way to achieve this. By building a decision aid into the eAMS, not only will we help doctors to apply the newest scientific research when they care for their patients with asthma, but we will also make it possible for patients to become partners in their own care by allowing them to share their views and priorities when choosing their treatment. This has the potential to transform how asthma patients are cared for. 4 / 14 Application for Ontario Lung Association (OLA) – Team Breathe Research Award (Grant-in-Aid for Basic Science or Clinical Research)
The Ontario Lung Association aims to improve the health of Ontarians with lung diseases such as asthma. Our decision aid will directly help patients with asthma by allowing them to take a more active role in their care. It will help their doctors to better understand their care preferences. Ultimately, it will improve treatment decisions that are reached, so that patients are more likely to understand the benefits of their medications and more likely to use those medications to improve their health. By building this decision aid into the innovative eAMS technology, we have a unique strategy to spread it across the province and country, with a goal of improving not only the way that healthcare is delivered, but also the everyday health of Canada’s 3.8 million asthma sufferers.
Dr. Amy Plint
Risk of Asthma in Children Diagnosed With Bronchiolitis During Infancy: A Longitudinal Study Linking Emergency Department-Based Clinical Data to Provincial Health Administrative Databases
Bronchiolitis is a viral illness that affects infants during winter months causing fever, cough, wheezing and difficulty breathing. It is the most common disease of the lungs during the first year of life. Asthma is the most common pediatric lung disorder in North America with one in five children being diagnosed with asthma by age 10. Evidence has suggested that bronchiolitis during infancy is associated with development of asthma in later life. Better understanding of the relationship between bronchiolitis and future asthma is needed.
Our objective is to generate evidence on the long-term respiratory health of children diagnosed with bronchiolitis during infancy, specifically the development of asthma at a later stage of childhood.
We propose a study that will link clinical data from two emergency department-based (ED) bronchiolitis studies to provincial health administrative databases (HAD). Through linkage of ED-based clinical data to health administrative datasets, we will have a rich source of data from which to enhance our understanding of the long-term respiratory effects of interventions used to treat bronchiolitis and also identify risk factors and predictors associated with future development of asthma in children with bronchiolitis.
Our study is a unique opportunity to link data from a clinical trial with long term follow-up data available in two provincial HAD (Ontario and Alberta). It will provide important evidence on risk factors and predictors for the development of asthma among infants with bronchiolitis. Furthermore, it will be the only study able to assess the long-term respiratory impact of interventions used to treat bronchiolitis during infancy.
Asthma and bronchiolitis are the two most common pediatric respiratory disorders affecting Ontario’s children. Our study aims to identify whether the use of two common medications (epinephrine and a steroid) among young children with bronchiolitis can reduce the risk of future asthma development and thus improve the long term respiratory health of these children. We also seek to identify risk factors and predictors of asthma in children diagnosed with bronchiolitis during infancy. Predicting which children are at risk of asthma after bronchiolitis will allow the identification of specific populations of children who may benefit from targeted interventions. Finally predicting which children are at risk of asthma after bronchiolitis will also allow health care providers and parents to better anticipate future healthcare needs.