Airway Disease

Contact


Carolyn Green
+44 (0)20 7594 7959
c.p.green@imperial.ac.uk

Lead academic
Peter Barnes

Study with NHLI

What we do

Our research is focused on chronic obstructive pulmonary disease (COPD) and severe asthma. We aim to translate basic discoveries in science through to clinical studies in patients and the section is made up of approximately 50% basic scientists and 50% clinical scientists.  We take a multidisciplinary approach from molecular and cellular biology through to clinical studies, and supported by a systems biology approach.

Why it is important

There is an enormous unmet need in COPD and severe asthma as current therapies are relatively ineffective in patients suffering from these diseases. By better understanding of the underlying disease mechanisms and the endotypes of these diseases, we aim to identify new therapeutic targets in order to develop new and better treatments for the future.

COPD
COPD is a major global epidemic that is increasing as people live longer, now affecting about 10% of people over 40 years old. It has become the third commonest cause of death in the UK and is also the commonest reason for emergency admission to hospital as a result of acute exacerbations, imposing an enormous burden on the NHS. Current therapy is symptomatic with long-acting bronchodilators to reduce symptoms and exacerbations, but these drugs have no effect on the underlying disease process and do not reduce disease progression, mortality or treat associated comorbidities. It is only by understanding the underlying mechanisms of this disease that more effective therapies will be developed in the future. We recognise that there are distinct phenotypes of COPD and are developing biomarkers to distinguish them so that we may apply future therapies more precisely in the future.

Asthma
Although asthma is usually easy to treat and control about 5% of patient's symptons remain difficult to manage. Even after excluding cases where this may be explained by poor adherence to therapy or incorrect use of inhaler devices. Because asthma is the most prevalent long-term disease in the UK, this amounts to a considerable number of patients suffering from persistent symptoms, incurring high healthcare costs over many years. As in COPD, it is necessary to understand the underlying disease processes in patients with severe asthma in order to identify new more effective treatments and to identify biomarkers that will be useful in deciding which therapy is most likely to be effective in which phenotype. Understanding the treatable traits within airways diseases that encompass aspects of both severe asthma and COPD is an active area of interest. 

Other diseases
Many chronic lung diseases share common features, such as chronic inflammation, abnormal repair mechanisms, abnormal immune responses and altered response to therapy. We also study other chronic lung disease, such as idiopathic pulmonary fibrosis (IPF), bronchiectasis and cystic fibrosis in order to investigate common disease pathways, so that our research may be relevant to the treatment of these other diseases as well. Many of these diseases occur together (called comorbidity) and are diseases of ageing that share common pathways, indicating that if we can correct the abnormal signalling through these pathways we may be able to treat several chronic diseases in parallel. Similarly there are cardiovascular and metabolic diseases that appear to share the same molecular pathways. We also have a particular interest in examining metabolic and epigenetic aspects of pulmonary hypertension.  

Impact of our research

Our research has provided greater insights into understanding asthma and COPD. Our work on inhaled drug delivery and novel airway assessments have fundamentally changed the way we understand therapeutic aerosol deposition and clinical effectiveness in asthma and COPD.  We have defined molecular mechanisms of corticosteroid resistance in severe asthma and COPD and with a spin-out company RespiVert developed novel inhaled therapies which are in clinical development.  Our research has also discovered that existing drugs are able to reverse corticosteroid resistance in asthma and COPD and one of these drugs, theophylline, is currently being studied in large controlled trials in COPD patients in UK and in China.

Our research has identified new phenotypes of asthma using an -omics approach (incorporating the latest techbologies such as genomics) that is currently being applied to COPD. Identification of accelerated ageing and defective immunity pathways is leading to the identification of novel therapeutic targets that are currently being assessed. Our research identified inflammatory biomarkers in the breath and the first of these exhaled nitric oxide is currently in clinical use in the differential diagnosis of asthma, checking adherence with therapy and for assessing new treatments. We are further pursuing this by examining the signature of breath (breathomics).

Our research on cholinergic pathways in asthma and COPD has been instrumental in accelerating the development of long-acting muscarinic antagonists, such as tiotropium bromide and glycopyrrolate that we first demonstrated had a long duration of action and are now first choice in the treatment of COPD as well as being used in severe asthma. 

Summary of current research

  • Accelerated ageing in airway diseases
  • Abnormal innate immunity on airway diseases
  • Defining phenotypes and endotypes of airway disease
  • Oxidative stress
  • Corticosteroid resistance
  • Epigenetics in airways Disease
  • Drug delivery to the airways
  • Translational studies
  • Skeletal muscles in COPD 

Read about our research in detail

Connections

Collaborators

We collaborate extensively with people inside and outside of Imperial College and internationally. For a full list please see our Collaborators page.

Patient and public engagement

Imperial College has an institutional commitment to public engagement with research, and section members play a very active role in these activities taking part in:

We also actively engage our patients in research. There are regular meetings with COPD patients through BreathEasy Groups and with patients and volunteers undertaking research, with regular get-togethers and newsletters.


Our researchers