Upper Bedding As A Prevention Measure In Childhood Asthma: A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$198,075.00
Summary
Asthma has recently been identified as a National health Priority (1) by the Australian Government in view of the increasing prevalence of asthma and its great importance as a public health problem. The total health system costs of asthma are estimated to be in excess of $600 million (2). Recently, feather pillows have been shown to have more than five times less house dust mite allergen than other pillows. To date, several population-based studies have shown that children using feather upper be ....Asthma has recently been identified as a National health Priority (1) by the Australian Government in view of the increasing prevalence of asthma and its great importance as a public health problem. The total health system costs of asthma are estimated to be in excess of $600 million (2). Recently, feather pillows have been shown to have more than five times less house dust mite allergen than other pillows. To date, several population-based studies have shown that children using feather upper bedding are also reported by their parents to have less severe wheeze. These findings call into question the National Asthma Council recommendation that people with asthma who are allergic to house dust mite should use synthetic quilts rather than feather or down (3). However, concerns remain that these important findings may only have occurred because unmeasured factors, such as the socioeconomic status or child diet may be closely related to feather bedding use, and in themselves, protective against asthma. Alternatively, parents of a child with asthma symptoms may be more likely to have chosen non-feather bedding. The best way to address these concerns is to conduct a randomised controlled trial to evaluate whether the use of new feather upper bedding is associated with reduced asthma severity among house dust mite-sensitised children with severe asthma. This study is underway and has support in 2001-2002 from the Financial Markets Foundation for Children. The research will address the following NHMRC Primary Health Care project grant thematic research areas: Evidence based primary health care practice; Quality of primary care; and Illness prevention and health promotion as a primary health care strategy. (1) National Health Priority Areas: Asthma. http:--www.health.gov.au-hsdd-nhpq-asthma-index.htm (2) NH and MRC Evidence Based Clinical Practice Research Program Workshop - December 16-17, 1999. (3) National Asthma Campaign Asthma Management Handbook 1998Read moreRead less
The prevalence of asthma in Australia is amongst the highest in the world yet no trials of primary prevention have been conducted which address the most common known causative agent (housedust mite allergens) and the most common known protective factor (dietary omega-3 fatty acids). Until the effectiveness of interventions which address these factors is certain, the value of the wide array of advice given to asthmatics by various health institutions will not be known. We are applying to continue ....The prevalence of asthma in Australia is amongst the highest in the world yet no trials of primary prevention have been conducted which address the most common known causative agent (housedust mite allergens) and the most common known protective factor (dietary omega-3 fatty acids). Until the effectiveness of interventions which address these factors is certain, the value of the wide array of advice given to asthmatics by various health institutions will not be known. We are applying to continue the Childhood Asthma Prevention Study (CAPS) which has been underway since mid-1997. CAPS is a randomised controlled trial in which 616 infants at high risk of developing asthma because of a family history have been enrolled. The interventions include allergen reduction and dietary supplementation with omega-3 fatty acids. The interventions are designed to have maximum effect but be simple to implement by parents. Several measures of compliance are being collected and regular contact is maintained though telephone calls and frequent home visits. Objective and subjective measurements of exposures, atopy, diet and asthmatic symptoms are being collected at 3 month intervals and at medical assessments when the children are 18 months, 3 and 5 years old. It is essential that we continue the study until all children are aged 5 and we will be able to test conclusively whether the interventions have had a positive effect. If so, CAPS will form the basis for a nationwide public health campaign which will have the potential to reduce the incidence of childhood asthma in Australia.Read moreRead less
Inhibition Of Allergic Airway Inflammation By Nanoparticles
Funder
National Health and Medical Research Council
Funding Amount
$540,075.00
Summary
Inhaled air pollution particulate matter causes asthma exacerbations, with 'ultrafine' nanoparticles thought to play a major role. Unexpectedly, we recently found that, by contrast, administration of inert ultrafine nanoparticles prevents allergic airway inflammation. We will identify the key particle physical and chemical properties associated with this novel type of disease inhibition, study particle effects in clinically-relevant disease models and identify mechanisms of action.
Many approaches to the prevention and treatment of allergy and associated asthma are dependent on the identification of the allergens producing the inflammation. This applies to new methods of determining the exposure to allergens and measuring the effectiveness of procedures which minimise allergen exposure. Diagnostic and immunotherapeutic measures require reliable preparations of allergens. The presence of important allergens in extracts however can be variable and often low so it important t ....Many approaches to the prevention and treatment of allergy and associated asthma are dependent on the identification of the allergens producing the inflammation. This applies to new methods of determining the exposure to allergens and measuring the effectiveness of procedures which minimise allergen exposure. Diagnostic and immunotherapeutic measures require reliable preparations of allergens. The presence of important allergens in extracts however can be variable and often low so it important that the allergens be identified and monitored. It is also important that new forms of immunotherapy being developed consider the responses to all allergens. Allergy to the cat is, behind house dust mite, the second most frequent allergy associated with asthma in most developed countries and brief exposure to a cat frequently induces life-threatening attacks. Almost all of the study of cat allergens have concentrated on a single allergen called Fel d 1. Although it importance is undisputed critical reading of the literature show it is only responsible for 50% of the IgE binding in cat extracts and recent work on cross allergy to cat and dogs and experimental therapy based on Fel d 1 point to the importance of other allergens. Experience with other source of allergens has shown that at least several allergens are usually important. It is also apparent from other studies that some allergens which are difficult to detect in extracts, and cannot be readily studied by immunochemistry are important. This project will use both cDNA cloning and immunochemistry to identify and characterize the other cat allergens and determine there relative importance. In particular it intended that they can be used, along with Fel d 1, to develop new types of immunotherapy.Read moreRead less
Mimotopes For The Investigation And Therapy Of Allergic Disease
Funder
National Health and Medical Research Council
Funding Amount
$203,296.00
Summary
10% of children now use regular asthma medication. The current treatments dampen allergic inflammation but 25% of asthmatic children, all under high medication, need multiple visits to the doctor, emergency treatment or hospitalisation,. Immunotherapy has, since 1911, used repeated injections of allergens. The end result has often been successful and lasting but the response has been unpredictable and requires years of multi-injection treatment. The challenge is to develop effective, applicable ....10% of children now use regular asthma medication. The current treatments dampen allergic inflammation but 25% of asthmatic children, all under high medication, need multiple visits to the doctor, emergency treatment or hospitalisation,. Immunotherapy has, since 1911, used repeated injections of allergens. The end result has often been successful and lasting but the response has been unpredictable and requires years of multi-injection treatment. The challenge is to develop effective, applicable immunotherapy which, like vaccines use few injections. Mimotopes provide a new opportunity. Studying the parts of the allergens recognized by the immune system (epitopes) can reveal important phenomena undetectable with whole allergens; and single epitopes may be a powerful avenue to effective immunotherapy. The therapy can be targeted to a selected arm of the immune system for maximal effect and the immediate side effects induced by cross linking antibodies with two epitopes can be avoided. Allergens interact with two types of lymphocyte, the T and B cells. T-cell epitopes can be easily studied because they comprise short regions of proteins which can be synthesized. B-cell (and antibody) epitopes are shapes formed by the interaction of several parts of a protein which cannot be represented by a simple sequence. The mimotope technology uses random peptides to obtain a shape which mimics the B-cell epitope. Here mimotopes will be produced and used to study the common specificities recognized in allergic responses to house dust mite allergens to develop new types of therapy. Importantly recent information shows that B-cell epitopes can be used to modify both T and B-cell function.Read moreRead less
Environmental Influences On Allergic Airways Disease From Birth To 8yrs: Long-term Outcomes Of A Randomised Trial (CAPS)
Funder
National Health and Medical Research Council
Funding Amount
$530,000.00
Summary
The prevalence of asthma in Australia is among the highest in the world yet no trials of primary prevention have been conducted which address the most common known causative agent (housedust mite allergens) and the most common known protective factor (dietary omega-3 fatty acids). Until the effectiveness of interventions which address these factors is certain, it will not be possible to give confident advice about how to prevent asthma. We are applying to continue follow up of the cohort of the ....The prevalence of asthma in Australia is among the highest in the world yet no trials of primary prevention have been conducted which address the most common known causative agent (housedust mite allergens) and the most common known protective factor (dietary omega-3 fatty acids). Until the effectiveness of interventions which address these factors is certain, it will not be possible to give confident advice about how to prevent asthma. We are applying to continue follow up of the cohort of the Childhood Asthma Prevention Study (CAPS) which has been underway since mid-1997. CAPS is a randomised controlled trial in which 616 infants at high risk of developing asthma because of a family history have been enrolled. The interventions include allergen reduction and dietary supplementation with omega-3 fatty acids. The interventions are designed to have maximum effect but be simple to implement by parents. Objective and subjective measurements of exposures, atopy, diet and asthmatic symptoms are being collected at 3 month intervals and at medical assessments when the children are 18 months, 3 and 5 years old. The interventions are stopped at age 5 years. The continued follow up of the cohort to age 8 will enable us to test conclusively if the interventions have had a positive effect. If so, CAPS will form the basis for a nationwide public health campaign which will have the potential to reduce the incidence of childhood asthma in Australia.Read moreRead less
The Role Of Pulmonary Macrophages In The Pathogenesis Of An Acute Exacerbation Of Chronic Asthma
Funder
National Health and Medical Research Council
Funding Amount
$495,710.00
Summary
We will examine the role of lung defence cells, known as macrophages, in triggering the inflammation of acute severe asthma. The experimental work will use unique mouse models of mild chronic asthma and of an acute exacerbation of the illness, which have been developed in our laboratories. We will study the mechanisms of activation of the asthmatic response and assess whether treatment with drugs that suppress the function of macrophages can help to control steroid-resistant exacerbations.
The Pathogenesis Of Distinct Endophenotypes Of Asthma Is Underpinned By The Collaborative Activation Of Specific PRRs.
Funder
National Health and Medical Research Council
Funding Amount
$678,754.00
Summary
Asthma is a chronic airway disease caused by inflammation. Although asthmatics can be sub-typed based on the type of inflammatory cells present in the lungs, medication specific for the treatment of these sub-types is not yet available. In this grant we will investigate the immune processes that orchestrate the development of the distinct inflammatory sub-types of asthma. This information will help us develop new therapies that will be tailored to target the appropriate type of inflammation.
Establishing The Safety And Effectiveness Of A Diagnostic Therapeutic Trial For Asthma In Community Elderly
Funder
National Health and Medical Research Council
Funding Amount
$397,155.00
Summary
Asthma is a major Australian health priority affecting over 2 million people. It is under-diagnosed and a source of significant morbidity in older people. Previous work by the investigators for the Commonwealth of Australia has shown that in the over 55-year age group approximately 40% of asthma is undiagnosed. In this age group severity is comparable with those diagnosed and worse than those diagnosed under the age of 55 years. Most (80%) of asthma deaths occur in the people aged greater than 5 ....Asthma is a major Australian health priority affecting over 2 million people. It is under-diagnosed and a source of significant morbidity in older people. Previous work by the investigators for the Commonwealth of Australia has shown that in the over 55-year age group approximately 40% of asthma is undiagnosed. In this age group severity is comparable with those diagnosed and worse than those diagnosed under the age of 55 years. Most (80%) of asthma deaths occur in the people aged greater than 55 years. There are clear patient and system factors that contribute to under diagnosis. The patient factors are currently being addressed in a general practice patient pilot study. System issues make the diagnosis of asthma in general practice a difficult task. The study is important, as older people are more likely to access the general practitioner than a specialist for respiratory problems. Spirometry in general practice is not common and is of variable quality. The most common approach to diagnosis by the general practitioner is a diagnostic trial of medication to provide evidence of asthma. This can be broken down into four elements of: entry criteria to a therapeutic trial; choice of drug in a therapeutic trial; length of time for a therapeutic trial, and; assessment criteria in a therapeutic trial. No evidence-based guidelines are available to assist the general practitioner in each of these stages making the therapeutic trial a safety and effectiveness issue of major importance, especially in the older person. The purpose of the study proposed is to conduct a randomised controlled trial in a representative population sample of older people to determine the evidence-based components of a diagnostic therapeutic trial for the guidance of general practitioners. The study will also assess which diagnostic questions and medical tests provide greatest assistance to the general practitioner in diagnosing asthma in the older person.Read moreRead less