Advanced Diagnosis and Monitoring

Asthma and airway diseases manifest via a common pathway of airflow obstruction that leads to symptoms, impaired quality of life and lost productivity. Current approaches to diagnosis and treatment are based on the assessment of symptoms and occasionally lung function. These measures are not specific to the underlying pathophysiology of the different airway diseases and consequently current diagnostic approaches and treatments are flawed. This results in several well characterised problems for patients and their health care providers. There is under diagnosis where people may be denied effective therapy. There is also over treatment where excessive drug dosages or an excessive number of drug classes are used to treat airway disease. This places a significant economic burden on the community resulting from lost productivity due to the denial of effective treatment, the cost of funding unnecessary therapy, and the cost of side-effects associated with unnecessary therapy. These problems are even more frequent in other airway diseases such as COPD, chronic cough, and overlap airway diseases such asthma in smokers, or asthma with fixed airflow obstruction. In these conditions inhaled steroid therapy is less efficacious and hence higher drug doses and more drug classes are used to seek symptom control. This program will develop diagnostic products and devices based on novel biochemical and physiological measures. It is made up of two sub-programs:

Functional Measurements

	Professor Norbert Berend Woolcock Institute

Airways disease is one of the most common diseases managed by general practitioners. Medical management decisions are often made on the basis of symptoms which are an unreliable guide to diagnosis and treatment. Existing objective tools such as spirometry are not user friendly, may give unreliable information about airway calibre, cannot be used in young children and are under-utilised. There are currently no tools available for the assessment of airway inflammation suitable for use in general practice. Consequently, management is suboptimal, misdiagnosis may occur and inaccurate assessment of treatment response can result in over-and under-treatment. In the Functional Measurements Program devices are being developed for the measurement of nitric oxide (NO) as an index of airway inflammation and parameters derived from the forced oscillation technique (FOT) to assess airway properties, including those related to airway remodelling. These devices need to be simple to operate and cost-effective to be used in a general practice setting. In collaboration with other CRCAA partners a set of normal reference values across the whole age range is being developed and clinical studies are being undertaken to develop diagnostic and clinical management algorithms. The tests and devices will be able to be used to facilitate the development of new candidate treatments in the Therapeutics Program.

Markers of Disease Activity

	Professor Peter Gibson University of Newcastle

Advances in the understanding of asthma have emphasised the importance of airway inflammation in asthma and other airway diseases. There is now a need to bring tests of inflammation to the clinic to improve diagnosis, monitoring and management of these conditions. This project will enable improved therapy in airway disease as new markers are developed to better describe the nature of airway inflammation. New ways of diagnosing asthma are being developed as both point-of-care and laboratory based tests. The process involves the discovery of new markers as well as improving methods for collecting samples. The CRCAA team has international expertise in both of these areas. New markers that may be developed into asthma diagnostics are being identified using a broad-based screening approach involving known pathways, immune transcriptosome analysis, and proteomics. This is a powerful approach made available by recent technological advances, and represents a highly novel application of these technologies in the CRCAA. The targets discovered will be paired with appropriate test platforms to create novel asthma diagnostics which will be validated by direct study in the relevant patient populations. Future extension of the work will create new markets as new clinical applications are identified.