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 COPD research projects we are currently funding. Interested in applying for a research award? Learn about our opportunities here.
COPD Research Projects
A mHealth Hub to Address Patients’ Support Needs in Coping with COPD
The use of mobile health applications (mHealth apps) has increased over the last few years, making it an attractive and convenient method to fulfill self-management needs, especially during the COVID-19 pandemic. Due to the restrictions to healthcare access and resources, patients are encouraged to seek virtual care whenever possible. The delivery format of mHealth apps makes virtual care possible, and they have been reported to be feasible, remote resources for self-management plans. However, mHealth apps are rarely evaluated for their adequacy in evidence-based information and fulfillment of patients’ self-management needs. Thus, consistent verification of the quality of their information and contents are necessary. Currently, available chronic obstructive pulmonary disease (COPD) apps vary in features, contents and evidence, making it difficult for patients and healthcare providers to identify acceptable apps that can be effectively integrated into their care.
Objective: To evaluate the quality of current self-management apps in the market for people with COPD and to integrate these high quality apps into one centralized resource hub to support patients’ needs.
Methods: Readily available COPD apps in the Apple Appstore, Google Play store, and Android market will be searched, downloaded and reviewed using the Technology Evaluation and Assessment Criteria for Health Apps (TEACH-Apps) framework. This framework assesses apps’ contents using the American Psychiatric Association App Evaluation framework, the apps’ privacy and security, ease of use, data integration and implementation. The list of high-quality apps will be reported.
Clinical significance: Living with COPD negatively impacts one’s physical and social life. Though mHealth apps are promising, their effects are uncertain. This assessment of the available apps is a crucial component in informing the next steps of a multi-phase trial in designing and implementing an evidence-based COPD resource hub system. Having a resource that is widely accepted by patients and clinicians as a support tool will be beneficial in addressing patients’ support needs to empower them to improve their self-management.
Dr. Laurent Brochard
A Strategy to Improve Diagnosis and Management of Sleep Abnormalities in Patients with Chronic Obstructive Pulmonary Disease Exacerbations: The SIMPLIFY Project
Acute Hypercapnic Respiratory Failure is a very frequent cause of hospitalization and corresponds to a major public health problem, causing multiple unplanned admissions and prolonged hospital stays; in addition, readmission rate after a first episode is ≥70% per year. Hypercapnic respiratory failure is mostly caused by diseases referred to as Chronic Obstructive Pulmonary Disease (COPD) and/or obesity hypoventilation, but also frequently with cardiac dysfunction in elderly patients. Most patients have several medical conditions (comorbidities). Surprisingly, the few studies assessing sleep after discharge found that up to 80% of these patients have sleep disorders. Sleep disorders remain undiagnosed in up to 70% of the cases for different reasons. For example, 1) suspicion is low because sleep symptoms may not be apparent in the context of more prominent respiratory symptoms; and 2) because of the way sleep studies are traditionally performed: patients will only be referred to a sleep study a few months after they are discharged from the hospital and will need to spend one night in the sleep laboratory. Up to 50% of the patients admitted with hypercapnic respiratory failure are uncomfortable to do so after hospital discharge.
Our research has shown that during hospitalization, sleep disorders increase the chances that patients’ breathing will fail and they will need help from a breathing machine (mechanical ventilator), with a greater risk of dying in the hospital. After hospital discharge, untreated sleep disorders increase the chances that these patients will need another hospitalization up to 28 times. We have previously shown that minimally supervised sleep studies can be performed in the hospital using a new portable sleep monitoring system (Prodigy System, Cerebra with thoracic movements and oximetry) already well validated against classical techniques. We propose a strategy to SIMPLIFY sleep diagnosis in this population by assessing their sleep while in the hospital. We will then test a new technique referred to as high-flow nasal cannula (HIGH-FLOW) already used for many patients with some forms of respiratory distress: it corresponds to the placement of a small flexible tube under the nose to deliver air with oxygen, heated and humidified at body temperature, and which usually makes breathing easier; therefore it might improve patients sleep during their hospital stay.
The objectives are twofold:
Study 1: to investigate if the sleep study performed during hospitalization can be used to identify if patients have sleep disorders at home
Study 2: to investigate if HIGH-FLOW can improve sleep in patients hospitalized due to hypercapnic respiratory failure.
We will undertake the work in the following manner:
Study 1: Patients (n=25) hospitalized due to hypercapnic respiratory failure will perform two simplified sleep studies (Prodigy System, Cerebra), one during their hospitalization using their standard oxygen therapy and one at their homes two months after hospital discharge. We will quantify the ability of the sleep study performed during hospitalization to identify patients with sleep disorders at home (sensitivity).
Study 2: Patients (n=25) with similar disorders and who do not require noninvasive ventilation anymore will be studied while in the hospital one night under standard oxygen therapy and one night under HIGH-FLOW in random order (Prodigy System, Cerebra) with a similar oxygenation target.
The sleep studies will be performed from 5:00 pm to 8:00 am the next morning using the Prodigy System (Cerebra), a portable wireless device to measure how well these patients sleep during each sleep study. The Prodigy System uses small external sensors (electrodes) placed on the patients’ forehead and face (chin and beside the eyes) to monitor the brain’s electrical activity and sleep depth. The Prodigy System quantifies sleep stages (deep or light sleep) or the degree of wakefulness. It also identifies abnormal sleep or pathological wakefulness – for instance, when the brain’s electrical activity indicates sleep but the patient is behaviorally awake. It can also identify sleep apnea, which is when the patient stops breathing during sleep, by measuring thoracic (chest) movements with a belt and the oxygen levels in the blood with a finger sensor (oximetry).
This project will provide a strategy to improve the diagnosis and treatment of sleep problems in patients with AHRF while in the hospital. It could also open the field of testing high-flow nasal cannula as a new alternative in hypercapnic respiratory failure for long-term treatment. Lastly, it will inform the design of a large randomized clinical trial aiming to reduce readmission in this population by promoting an early diagnosis (during hospitalization) of sleep problems and providing adequate treatment (e.g., HIGH-FLOW or CPAP).
By identifying patients with sleep problems during hospitalization, these patients can be placed in a treatment track before they leave the hospital. Providing adequate treatment for sleep problems has the greatest potential to reduce readmissions in this population. Moreover, HIGH-FLOW can be a simple, well-tolerated and feasible alternative to improve sleep in these patients during hospitalization, avoid breathing failure, and reduce the need for help from a breathing machine.
Dr. Denis E. O’Donnell
The Effect of Inhaled Nitric Oxide (iNO) on Inspiratory Neural Drive and Dyspnea during Exercise in Mild Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is the 4th leading cause of death in Canada and affects about 10% of individuals over forty years of age. People with Early or Mild COPD often experience distressing breathlessness during physical activity, and this results in a sedentary lifestyle, reduced quality of life and even poor survival. The reasons for this are not fully understood. Most studies so far have focused on abnormal function of the small airways, injured by inhaled tobacco smoke, but this is only part of the problem. We believe, based on several studies conducted in our own research center, that the delicate small blood vessels that lie close to the small airways and air sacs, are also damaged by smoking. We need to develop new ways to detect this small blood vessel injury in the lungs of individuals with Mild COPD and to find new treatments to reverse this damage and positively impact the natural history of this disease.
The main purpose of this application is to determine if by using an inhaled gas (nitric oxide), that is known to relax smooth muscle in the walls of blood vessels, we can increase blood flow in these narrowed vessels in individuals with mild COPD and therefore, make oxygen and carbon dioxide transport between the lung and the atmosphere (respiration) more effective. This, in turn, would reduce the increased drive to breathe and breathlessness during activity. We also want to find the best tests to identify individuals with Mild COPD who have extensive small vessel damage in their lungs. Our aim is to check that the tests we use: 1) tests of oxygen transfer in the lungs, 2) breathing efficiency during exercise and 3) structural abnormalities of the lung and vessels that can be detected using computed tomography (CT scan), can reliably identify individuals with Mild COPD who have widespread vessel injury due to smoking.
We will invite 28 volunteers with Mild COPD to undertake breathings tests and a cycle exercise stress test in our clinical research laboratory with the expectation of 8 drop-outs/wash-outs. We hope to recruit 20 participants with mild COPD and compare the effect of inhaled Nitric Oxide and placebo (room air) during exercise. We will study the effect of the inhaled medication on the intensity of breathlessness, lung gas exchange efficiency, pattern of breathing and electrical activity in the main muscle of breathing (the diaphragm), which tells us about the magnitude of the drive to breathe. This will allow us to test the hypothesis that inhaled nitric oxide will improve breathing efficiency, lower the heightened drive to breathe and reduce breathing discomfort in participants who significant small vessel damage.
This will be the first study to determine the short-term effects of inhaled Nitric Oxide treatment on breathing efficiency, the drive to breathe, the intensity of breathlessness and exercise capacity in individuals with mild COPD. This study will hopefully define the characteristics of a specific pattern of lung function impairment in individuals with vessel injury, breathlessness and reduced exercise capacity. This discovery would set the stage for future studies which expose the pathological (cellular, molecular, genetic) underpinnings of small vessel injury that will guide development of novel approaches for personalized treatment.
The Lung Health Foundation is committed to advocate for patients with COPD and to support research aimed at improving the health status of Canadians afflicted by the disease. The ultimate objective of this application is to develop and test novel individualized treatments to reduce the symptom burden and to favorably alter the natural history of this devastating disease. Therefore, the current application is entirely consistent with the admirable mission of the Lung Health Foundation.
Dr. Sunita Mulpuru
Validating the Use of Frailty Measurements to Predict Deteriorations in Quality of Life and Care Expectations Among People with COPD: A Prospective Cohort Study
Chronic Obstructive Pulmonary Disease (COPD) is an incurable progressive inflammatory lung disease that affects more than 2 million Canadians. It is associated with poor quality of life, progressive disability, mortality, and high health care costs. Research has shown that high care costs for patients with COPD are largely driven by frailty, which is partly caused by the progression of COPD. Despite this, assessments and treatments for frailty are largely missing from the guidelines for COPD care in Canada.
The concept of ‘Frailty’ describes a patient’s vulnerability to a health stressor such as a lung infection or flare-up of COPD. Frailty is measured on a continuum from ‘well’ to ‘severely frail’, and as frailty progresses, people with COPD have greater difficulty in recovering from even minor health events. Over time, this results in progressive loss of independence and poorer quality of life.
There are currently no large studies to determine how and whether lung health providers could use frailty measurements to accurately predict current and future decline in outcomes that are meaningful to patients. In this research proposal we aim to determine whether progressive increases in frailty can reliably predict quality of life and symptom burden, and to assess how frailty measurements could be incorporated into routine care for people living with COPD.
Our specific objectives are to:
(1) Determine the predictive value of increasing frailty on poor quality of life, high symptom burden, psychological well being, and use of health services (hospital care),
(2) Describe the differences in standard care expectations between patients and physicians within each degree of frailty,
(3) Assess agreement between patients’ self-evaluated frailty scores with those assigned by their healthcare providers, and
(4) To assess the reliability of repeated frailty measurements over the short term.
We will recruit and study individuals with COPD from the lung health clinics. Individuals will complete a frailty self-assessment, evaluation of care expectations, and collection of medical information. We will follow individuals for one year to determine measures of quality of life, symptom burden, psychological impacts, and the need for increased health care supports (i.e. hospitalization, emergency room visits) at 6 and 12 months. Individuals’ self-assessed frailty will be compared with their doctor’s frailty assessment, and we will describe differences in care expectations between individuals and their doctors based on varying degrees of frailty. We will use statistical models to determine how increasing frailty measurements predict poor quality of life and perform statistical tests to map patient care expectations to varying degrees of frailty.
To our knowledge, this is the first study of its kind to assess frailty measurement as an innovative approach to predicting quality of life and prognosis among people with COPD. We will also engage our patients to better understand their expectations of care within each degree of frailty, and identify any key differences in expectations between patients and their physicians. If we find frailty to be a useful tool in predicting poor health status, our next steps will focus on developing and testing interventions targeted to people with varying degrees of frailty, with the goal of improving overall quality of life, and long-term costs to the health system.
While COPD is primarily considered a lung disease, we know that signs and symptoms of COPD are not confined to the lungs. Patients with COPD often have many medical conditions (i.e. heart disease, cancer, kidney disease), muscle inflammation and weakness, poor nutrition, and experience psychological distress such as depression and anxiety. Frailty is a comprehensive health measure which takes all of these factors into account, and this is why understanding and measuring frailty during clinical encounters could help doctors and their patients work together to plan treatments, assign care resources, and to anticipate poor outcomes.
The results of this work will determine if and how we should incorporate frailty measurements into standard COPD care, and will provide the foundation for future studies to develop and test comprehensive and personalized interventions to treat frailty and COPD. Ultimately, our goal is to use the results of this work to plan and develop health-system level changes which will provide the right resources, to the right patients, at the right time, and in turn improve the quality of life for Canadians living with COPD.