Centre for Primary Care and Public Health Research Ideas Forum 2016/2017

Centre for Primary Care and Public Health Research Ideas Forum 2016/2017

From October 19, 2016 12:15 until October 19, 2016 13:15

Categories: CPCPH Seminar

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Speaker: Chris Newby, Asthma UK Lecturer

Bio: Chris joined QMUL in March 2016 as a lecturer in the Asthma UK Centre for applied research AUK CAR. Before this he worked as a research associate statistician at the respiratory biomedical research unit at the University of Leicester looking at severe asthma. His interests include data sharing, defining asthma phenotypes and personalised medicine.

Title: The use of holding chambers/spacers in obese asthmatic management: a stratified meta-analysis approach.

Abstract Background:

Asthma is a heterogeneous inflammatory disease of the airways characterised by reversible airway obstruction, airway hyper responsiveness, inflammation and remodelling of the airways. Obesity is a risk factor for developing asthma as well as being a consequence of living with asthma for a long time. Obese asthmatics have worse asthma control and different inflammatory biomarkers. The pathology of obese asthma is unknown at present but there are two main theories linking obesity to outcomes in asthma.

1. Systematic Inflammation due to increased adipose tissue which contributes or alters lung inflammation

2. Mechanistic reduction of FRC and RV due to the burden of abdominal obesity on the lungs.

We look at the mechanistic reduction of FRC and RV and how this arises in smaller lumen area of the lower airways for obese patients and increased resistance in the lower airways measured by R5-R20. Trials of holding chambers have been carried out predominately in children as a means of easy intake of inhaled treatment that doesn’t rely on coordination of breathing and activation of inhaler. One of the consequences of using a holding chamber however is that the medication does not get stuck at the back of the throat but can actually reach the lower airways. In obese asthmatics these lower airways are more constricted than non-obese patients so if a treatment could reach that far down the lungs it would be more beneficial for obese asthmatics.

Aim: To determine if holding chambers can improve asthma outcomes in obese adult asthmatics compared to Non-obese adult asthmatics.

Methods: By searching for trials of holding chambers in adults we can obtain trial data and stratify for obesity as nearly every asthma trial also records BMI. By separating holding chamber trials in adults into non obese and obese we can assess the impact on obese individuals though a stratified meta-analysis approach.

Clinical Impact: If positive results were found this would be the first asthma delivery system that is specially targeted to obese asthmatics, allowing for the wide syndrome of asthmatics to be narrowed down using personalised medicine.