Respiratory Health
Our primary goal is to find new, less toxic treatments, which could significantly improve patient outcomes.
Experts in respiratory medicine are driving research and innovation with global impact
Gerard
Seeking commercialisation to bring technological advances into clinical practice, Professor of Respiratory Medicine Richard Costello discusses his innovative approach to the management of asthma, which affects around 1 in 13 people in Ireland alone. “There is no simple test for asthma, and we typically still use traditional testing methods — but our understanding is more advanced now,” he says.
“We are using the strengths of new digital technologies for home monitoring, which enables us to see the lived experience of the patient, including their response to treatment,” he adds. “Through the use of digital technology, we reduce the cost of prescribing by 60%, but we need more funding to bring this technology into practice.”
Award-winning respiratory health discoveries
Professor of Medicine Gerry McElvaney’s work has been instrumental in advancing the understanding and treatment of respiratory diseases, such as cystic fibrosis and alpha-1 antitrypsin (AAT) deficiency. His team’s work on genetic therapies, particularly altering the faulty genes responsible for severe forms of AAT deficiency, has been not only groundbreaking but award-winning.
“As a direct result of our discoveries, we have spearheaded the national targeted detection programme for alpha-1 antitrypsin deficiency, providing free diagnostics for individuals with chronic obstructive pulmonary disease (COPD), asthma or unexplained liver disease,” cites McElvaney. “The potential to cure diseases rather than merely alleviate symptoms is within reach, but we need more support for sophisticated clinical trials. We need the government to look at areas of excellence and support them if we are to integrate key developments into our health system.”
Key innovations in critical care
Professor
Making considerable progress in key areas of critical care medicine, Professor of Anaesthesia and Critical Care
Gerard Curley is focusing efforts on acute respiratory distress syndrome (ARDS), a condition affecting approximately 10% of all patients admitted to the ICU. “This condition has a high mortality burden, and survivors tend to have neurocognitive and physical disabilities,” explains Curley. “Unfortunately, there is no magic bullet for the condition, and current treatment remains supportive.”
He adds: “Our primary focus is on the development of therapies, particularly through the use of translational medicine or ‘bench to bedside’ approaches, which use
The collaborative efforts of experts in anaesthesia, critical care and respiratory medicine are leading groundbreaking discoveries, driving innovation and improving patient outcomes.
a detailed study of patients to identify characteristics that might better predict responses to specific therapies. These precision medicine strategies will help to improve patient outcomes. We’re exploring alpha-1 antitrypsin as a potential treatment in specific cohorts of patients with ARDS, leveraging ex vivo lung perfusion models to test and refine therapies.”
Focusing on pulmonary fibrosis
Focusing on the genetic and molecular complexities of pulmonary fibrosis, Consultant Respiratory Physician Killian Hurley discusses his work, exploring why some families are genetically predisposed to the condition in an attempt to shape potential treatment approaches. “These patients have an extremely poor prognosis, and new treatments typically work to slow disease progression rather than cure the disease,” says Hurley.
“Working closely with patients and patient advocacy groups, our primary goal is to find new, less toxic treatments, which could significantly improve patient outcomes,” he adds. “For patients with pulmonary fibrosis, a comprehensive national care programme is essential if they are to access the support they need. This type of national approach could coordinate efforts in research and treatment development and facilitate the advancement of potential new therapies.”
Maintaining high standards of respiratory research
None of this would be possible without the RCSI Clinical Research Centre, which provides the facilities and expertise needed for investigators to conduct clinical research to the highest standard. “You can’t take new technology and discoveries into clinics without first asking: does this work? The clinical research centre is helping us to generate the proof,” insists Costello.
“The experienced nurses, administrators and trial experts add immeasurable value.” As McElvaney aptly describes in one of his many expert TED talks: ‘Lung disease has Ireland fighting for breath,’ but with the help of the RCSI Clinical Research Centre, there is real hope. Find
Curley Professor of Anaesthesia and Critical Care at the RCSI, and Consultant in Anaesthesia and Intensive Care at Beaumont Hospital
Killian Hurley Associate Professor at RCSI, and Consultant Respiratory Physician at Beaumont Hospital
Gerry McElvaney Professor of Medicine, and Head of the Department of Medicine and Respiratory Research Division at Beaumont Hospital
Richard Costello
of Respiratory Medicine at the RCSI, and Consultant Respiratory Physician at Beaumont Hospital
for by RCSI
Image provided by RCSI
WRITTEN BY Bethany Cooper
PPI, adaptive trials and precision therapeutics changing the face of lung failure management
Research networks advance innovation for ICU lung failure patients requiring mechanical ventilation by enhancing biological insights, conducting adaptive trials and involving patients and the public.
Often, ICU patients need breathing support, known as mechanical ventilation. Research on treatments for acute respiratory distress syndrome (ARDS) is often complicated due to its diverse causes, broad definition and varying patient responses.
Few advances in ICU care for lung failure
Professor Alistair Nichol, Director of Irish Critical Care-Clinical Trials Network (ICCCTN), explains: “There have been few, if any, new therapies brought to the ICU to improve outcomes for patients needing respiratory support, particularly those with ARDS,” he says. “We are looking into optimal ways to manage mechanical ventilation and identify drug therapies for ARDS patients.”
Adaptive trial design for precision medicine
The ICC-CTN coordinates all-Ireland research and collaborates internationally to enhance ICU respiratory care. “We are seeking to overcome the limitations in methods of existing research by using adaptive platform trials, allowing us to ask multiple questions for the same disease at the same time with quicker answers within one established trial infrastructure,” says Prof Nichol. “Trials require collaboration to answer questions globally and efficiently, which was highlighted at our recent meeting with organisations InFACT, ISARIC and attendees from platform trials and all continents,” he adds. Different patient groups exhibit varying responses to the disease and its treatments, highlighting the potential for precision medicine, led by Professor Danny McAuley in Northern Ireland.
Patient and public involvement
Dr Leanne Hays, Respiratory and PPI Programme Manager, highlights how active partnerships between researchers, patients and the public, are essential for meaningful progress. “We have established a programme of PPI, which is an extremely important part of how we inform our research,” she says.
Julianne Ahern, a member, shares her and husband Paul Deane’s experience with the PPI. “Over six years ago, I found myself in ICU by my husband’s bed; he was in a coma with an uncertain outcome,” she explains. “PPI gives patients and families a voice and an opportunity to ask questions, voice concerns and, importantly, shed light and provide valuable input into trials. It’s always patient-first with the PPI team: Kathy, Leanne and Alistair.”
To help drive clinical research in the ICU, email criticalcareppi@ucd.ie or find out more at iccctn.org
Top tips for asthma management this winter
This time of the year can be challenging for those with asthma. Here’s how you can manage your condition over the winter months.
Ireland has one of the highest rates of asthma in the world — approximately 450,000 people in the country currently have asthma, and almost 890,000 people will experience the condition at some stage of their life.
Effects of winter on asthma
Winter can be particularly challenging for people living with asthma, with cold weather triggering symptoms and an increased prevalence of other conditions such as flu, RSV and COVID-19, which can exacerbate the condition. This is why it is essential to monitor your (or your child’s) asthma and be aware of any changes, particularly over the winter months.
What to watch out for
If you have increased symptoms of cough, wheezing, shortness of breath, exercise intolerance or waking at night, this means your asthma is getting worse and you should see your doctor. If you are using your reliever inhaler more than twice a week, this means your asthma is poorly controlled and you need a review. If your symptoms worsen and do not respond to your reliever inhaler, this could be an asthma attack — follow the ‘5 Step Rule’ (a checklist for an asthma attack, available on asthma.ie) and seek medical help.
Top asthma tips
1. Take your medications as prescribed, even when you are well
2. Have an updated written Asthma Action Plan (available on asthma.ie)
3. Get your vaccinations as recommended by your GP
4. Get an asthma review and have your inhaler/spacer technique checked
5. Eat a balanced diet
6. Exercise regularly
7. Don’t smoke
8. Wrap up well when out in the cold weather
9. Know the ‘5-Step Rule’
The Asthma Society is there for you, whether you’re worried about your asthma or you need help supporting someone with asthma. We have a team of expert nurses ready to provide free advice and support if you have any questions or worries over the Christmas period.
New approaches to treat lung inflammation in CF and COPD
Cystic fibrosis (CF) is a progressive, genetic disease caused by mutations in cystic fibrosis transmembrane regulator (CFTR). Defective CFTR causes a salt/water imbalance, leading to a buildup of mucus in the lungs.
As part of a clinical/translational research programme at the Royal College of Surgeons in Ireland and the Children’s Health Ireland, Dr Judith Coppinger and her research team have been investigating new mechanisms of inflammatory cell communication in respiratory diseases such as CF and chronic obstructive pulmonary disorder (COPD).
Lung inflammation and neutrophil damage
Although very different causes, CF is a rare genetic disease, and COPD is caused primarily by smoking. Respiratory symptoms, such as mucus buildup and coughing, are common in both diseases. Both are characterised by inflammation in the lung airways and a high number of white blood cells called neutrophils, which help fight bacteria. Neutrophils are key to a healthy immune response. However, they behave abnormally in diseases such as CF and COPD, causing damage to the lungs.
Targeting neutrophils with EVs
Our research group focuses on discovering new ways to target neutrophils and reduce lung inflammation using small particles called extracellular vesicles (EVs). These are small sacs of protein and RNA released by every cell containing information about that cell. When EVs come from diseased cells, we can gain important insights into that disease. Our group has shown EVs are higher in number in lung samples from persons with CF and COPD undergoing exacerbation (worsening) of symptoms. We have also shown that EVs can attract neutrophils in the lungs. Understanding how EVs recruit neutrophils now helps us therapeutically target them and reduce inflammation.
Future therapeutic solutions
New CF therapies like Kaftrio have been crucial in targeting the CFTR defect in CF, but they do not fully reduce inflammation or reverse existing lung damage. Our research shows that Kaftrio can alter vesicles, suggesting that EVs could serve as markers of therapeutic response for patients on these treatments. With help from the Science Foundation of Ireland and CF Foundation, we investigate these EVs both as biomarkers of treatment and therapeutic targets to reduce neutrophil inflammation in CF and COPD.
Eilís Ni Chaithnía CEO, Asthma Society of Ireland
Sponsored by RCSI
Judith Coppinger Associate Professor, RCSI
Sponsored by ICC-CTN
Dr Leanne Hays Respiratory Programme Manager, ICC-CTN
Prof Alistair Nichol Director, ICC-CTN
WRITTEN BY Bethany Cooper
Why people should get tested for common condition Alpha-1
Foundation in Ireland raises awareness of Alpha-1 antitrypsin deficiency, signposting their targeted detection programme, specialised care and ongoing research and innovation that is improving lives.
Alpha-1 antitrypsin deficiency (AATD, or more simply known as Alpha-1), once considered rare, is more common than one might expect in Ireland, estimated to affect 3,000 people with severe (ZZ) and 250,000 with moderate (MZ) forms. This liver-produced protein shields the lungs from infections and irritants, so its deficiency increases the risk of serious lung disease.
Dr Tomás Carroll, Senior Lecturer at the RCSI, discusses the scale of the issue. “Alpha-1 is not widely known and is often misdiagnosed; it is the most common genetic cause of COPD (chronic obstructive pulmonary disease),” he says.
“If you smoke and have Alpha-1, you are at a much greater risk of developing COPD, emphysema and liver disease, particularly in those with severe deficiency.”
Importance of AATD testing
for Alpha-1 for free. When we diagnose someone with Alpha-1, the patient can be referred to the National Centre for AATD at Beaumont Hospital for specialist assessment and management,” she explains. “If you have a diagnosis of asthma or COPD which is not responding well to treatment, think Alpha-1. If you have a family history of COPD or lung disease, think Alpha-1.
“Our role is to support patients with Alpha-1 and their families, providing information, support and advocacy while driving advancements in diagnosis and access to better treatments.”
If you have a diagnosis of asthma or COPD which is not responding well to treatment, think Alpha-1.
Early detection empowers individuals to make life-saving changes and most importantly to quit smoking, which significantly protects their lung health. Founded in 2001, the Alpha-1 Foundation Ireland based in the RCSI Education and Research Centre at Beaumont Hospital, is dedicated to raising awareness, increasing diagnosis, promoting research and improving the treatment of Alpha-1.
Anne Marie O’Dowd, CEO, urges people to get tested for the condition. “We run a national targeted detection programme, funded by the HSE, which provides the test
Research and innovation
Ignoring this condition comes at a tremendous cost to both individuals and the healthcare system. Investing in affordable screening and patient education could lead to substantial longterm benefits, reducing the burden and improving people’s quality of life.
“We have found that a diagnosis of Alpha-1 is one of the biggest motivators to stop smoking,” Carroll explains. “We can provide a letter, which can be taken to your GP and outlines the reason for you seeking the test, to streamline the whole process. For the patient, it is a simple blood test.”
O’Dowd adds: “The Alpha-1 clinic every Wednesday at Beaumont Hospital is compiling a national registry, gathering data for ongoing and future research. The registry helps the team research new and innovative therapies for AATD and supports clinical trials at Beaumont Hospital.”
Anne Marie O’Dowd CEO, Alpha-1 Foundation Ireland
Dr Tomás Carroll Senior Lecturer, RCSI