1. Monitoring the Burden of Severe Asthma in Australia
1.1 Development And Validation Of National Severe Asthma Indicators
1.2. Phenotypic Heterogeneity And Illness Burden In Severe Asthma
1.3. Concordance And Goal Setting In Severe Asthma Care
1.4. Managing Novel Targeted Therapies In Severe Asthma
1.1 Development And Validation Of National Severe Asthma Indicators
Severe asthma is a high-cost, high-burden disease, but very little is known about the burden of disease in Australia. We aim to develop and validate ways to monitor illness burden, by quantifying symptoms, impacts on quality of life, adverse effects of treatments, healthcare utilisation and costs. This approach will be linked with existing networks including the Severe Asthma Network (SAN), the Australian Xolair Registry, state and territory hospital inpatient datasets, Pharmaceutical Benefits Scheme (PBS) data and the National Death Index.
1.2. Phenotypic Heterogeneity And Illness Burden In Severe Asthma
There is increasing recognition that disease phenotype (the pathway that leads to disease in each individual patient) effects responses to treatment. However, the patterns of disease in Australia remain poorly understood. Our CRE will use data generated by the Severe Asthma Network (SAN) to determine severe asthma phenotypes in the Australasian population. This dataset will also provide information about how disease phenotype changes response to treatments and inform future management of patient groups.
1.3. Concordance And Goal Setting In Severe Asthma Care
A lack of concordance (agreement) on how to self-manage disease symptoms often exists between patients and healthcare providers. In severe asthma patients this results in poor disease control, excess healthcare usage and inappropriate prescriptions. We have developed a patient-centred goal-setting intervention to support self-management. Our CRE will identify goals that are important to patients and healthcare providers, provide resources to improve self-management training and develop new goal-setting interventions to improve symptom control.
1.4. Managing Novel Targeted Therapies In Severe Asthma
Many new targeted therapies are in clinic trials or have recently been approved for the treatment of severe asthma. However, there is currently very little information on which patients will respond to each treatment and how to integrate new therapies into patient care. Due to the high cost of these treatments, it is important that only subgroups of patients that are likely to respond to targeted therapy are treated. Our CRE will identify predictive markers for patient identification and monitor the efficacy and side-effects of treatment to develop better models for the introduction and management of targeted therapies in the clinic.
2. Initiatives To Aid Management Of Severe Asthma
2.1. Multidimensional Management Of Severe Asthma
2.2. Accessible Severe Asthma Biomarkers: Validation
2.3. Severe Asthma Algorithm
2.4. Exacerbation Risk In Severe Asthma
2.5. Small Airway Physiology
2.1. Multidimensional Management Of Severe Asthma
Severe asthma results from a diverse range of processes and is linked to many different conditions (termed co-morbidities) and psychological factors that impact patient health and disease management. Our CRE will determine whether “multidimensional” approaches and personalised management improve patient health. These approaches are aimed at treating the patient as a whole, rather than treating severe asthma as a single disease.
2.2. Accessible Severe Asthma Biomarkers: Validation
After a diagnosis of severe asthma has been confirmed, the next step is to identify disease pathways that are most relevant for an individual patient. However, these methods are not used consistently between centres and are not widely available. Our CRE will identify and validate biomarkers in blood and sputum samples that provide information about patient-specific disease processes. These approaches can be broadly applied to improve symptom management and inform treatment with new targeted therapies.
2.3. Severe Asthma Algorithm
Identifying patient-specific changes and biomarkers provides information about disease. However, this knowledge alone does not provide the best management approach. To improve patient health, an integrated approach is required that recommends the best treatment strategy based on the diagnostic test results (an algorithm). Our CRE will develop and validate treatment algorithms and provide guidelines on how to use diagnostic tests to optimise patient treatment and identify patients that will benefit from different therapies.
2.4. Exacerbation Risk In Severe Asthma
Severe asthma patients frequently experience exacerbations (worsening of disease symptoms) after virus infection. Exacerbations have negative impacts on patient quality of life, but why this occurs is poorly understood. Our CRE will analyse processes and markers that predict poor responses to infection. These findings will be used to inform patient management strategies and the best approach to treat virus infections and exacerbations in severe asthma patients.
2.5. Small Airway Physiology
Severe asthma results in variable changes within the airways, with many structural changes within the small airways. However, current treatments often fail to target these airways. Our CRE will assess the usefulness of new treatment strategies designed to improve therapeutic delivery into the small airways.
