Assessment Of Physical Therapies To Improve Secretion Clearance In Patients With Cystic Fibrosis
Funder
National Health and Medical Research Council
Funding Amount
$302,310.00
Summary
People with cystic fibrosis (CF) produce thick mucus that is not cleared normally from the lungs. This retained mucus often becomes infected, which progressively damages the lungs. Various physical therapies which may help clear secretions are being used in CF. These include several types of devices which provide positive pressure to the airways. However, it is not known to what extent these devices, or other interventions such as manual chest physiotherapy and exercise, enhance mucus clearance. ....People with cystic fibrosis (CF) produce thick mucus that is not cleared normally from the lungs. This retained mucus often becomes infected, which progressively damages the lungs. Various physical therapies which may help clear secretions are being used in CF. These include several types of devices which provide positive pressure to the airways. However, it is not known to what extent these devices, or other interventions such as manual chest physiotherapy and exercise, enhance mucus clearance. As a result, it is not currently possible to scientifically prescribe intervention(s) to enhance mucus clearance in CF. This is partly because much of the research that has been performed in this area has been poorly-designed or has used inaccurate measures. Also, recent research has shown that these therapies may have significant effects beside their effect on mucus clearance. For instance, bacterial infection and the exchange of oxygen and carbon dioxide between the blood supply and air in the lung may all be affected by these interventions. Notably, the extent of benefit or detriment seen in these parameters does not always correlate with the effect on mucus clearance. We therefore believe a series of experiments is necessary to provide evidence upon which the scientific selection of mucus clearance therapies may be based. We have developed a new technique which allows clearance of mucus from the airways to be objectively measured in three-dimensions (3D). We intend to use the 3D technique to examine the effects of three different positive pressure devices, exercise, and manual chest physiotherapy on mucus clearance. Based on the outcomes of this research, we intend to compare the most appropriate therapy to performing no mucus clearance therapy in a short term trial. This trial will assess changes in the following: bacterial infection, mucus plugging in the airways, how well the lungs move air and exchange oxygen and carbon dioxide, and the patient's quality of life.Read moreRead less
Expanding The Role For Non-Invasive Ventilation In Cystic Fibrosis (CF)
Funder
National Health and Medical Research Council
Funding Amount
$315,375.00
Summary
Many patients with Cystic Fibrosis (CF) have disturbed breathing during sleep and poor sleep quality. Our preliminary data shows the problems may be worse during flare ups of the disease, with patients having less dreaming (REM) sleep causing reduced daytime attention and concentration. This could have adverse consequences for exam performance, work ability and driving skills. Also, even with maximum treatment, flare ups can result in permanent loss of lung capacity and quality of life. We propo ....Many patients with Cystic Fibrosis (CF) have disturbed breathing during sleep and poor sleep quality. Our preliminary data shows the problems may be worse during flare ups of the disease, with patients having less dreaming (REM) sleep causing reduced daytime attention and concentration. This could have adverse consequences for exam performance, work ability and driving skills. Also, even with maximum treatment, flare ups can result in permanent loss of lung capacity and quality of life. We propose a novel approach to treat the flare ups with short-term portable assisted ventilation (nBVS) as well as standard treatment as we strongly believe that the portable ventilator will improve gas exchange with better matching of ventilation and blood flow and will hasten recovery. We believe that long term nBVS will be superior to oxygen therapy alone in delaying the onset of respiratory failure and improving survival. We have convincing evidence to suggest that nBVS improves ventilation perfusion distributions rapidly and that this benefit increases over 6 months of regular use. The likely explanation is that it keeps the airways open and reduces mucus plugging. In short, nBVS is a treatment in its own right for abnormal gas exchange in CF. The ideal time for nBVS is during sleep when it can be used for a long time period when patients are most at risk of falls in oxygen saturation. In summary, we believe that nBVS is likely to have a major impact in delaying the progession of disease and improving patient outcomes. Almost all patients with CF have evidence of sinus disease and many have nasal polyps. We have convincing questionnaire data showing an association between sinusitis, nasal obstruction and poor sleep quality. Our preliminary sleep study data in patients with active sinusitis confirm multiple arousals and sleep fragmentation. We plan to examine the impact of sinus surgery in improving sleep disordered breathing and quality of life in patients with CF.Read moreRead less
Biomechanical, Neural And Sensory Phenotyping Of The Upper Airway In Obstructive Sleep Apnoea
Funder
National Health and Medical Research Council
Funding Amount
$746,138.00
Summary
Obstructive sleep apnoea (OSA) is a common disorder where the upper airway closes repeatedly during sleep. It results in daytime sleepiness, increased risk of accidents and cardiovascular disease. But not all patients are the same, and individually tailored treatments are needed. This project will develop new ways to identify the causes of OSA in individual patients, using new MRI imaging methods, sensory testing, and measurements of the neural activity in the muscles that keep the airway open.
Predicting The Long Term Lung Health Outcomes In Young Adults Born Very Preterm
Funder
National Health and Medical Research Council
Funding Amount
$854,201.00
Summary
Preterm birth and its resulting lung problems can lead to breathing problems during childhood and into adult life. There are very few lung health studies that have tracked preterm individuals from childhood and into early adult life. This study will conduct a detailed lung health assessment in a follow-up of a group of preterm individuals at 19 years of age. We aim to identify if information we obtained in the group at 6 and 11 years can predict how the lungs look and behave at 19 years of age.
Regional Mechanisms Of Ventilator Induced Lung Injury: Insights From Dynamic Lung Imaging
Funder
National Health and Medical Research Council
Funding Amount
$623,323.00
Summary
Mortality rates due to acute respiratory distress syndrome (ARDS) are high (>30%). While ARDS requires mechanical ventilation as a lifesaving intervention, it is clear that mechanical ventilation itself can contribute to the high mortality rates. We will use a new lung imaging technology (CTXV) to visualize the damage that occurs to the lung as a result of mechanical ventilation in order to design better ventilation strategies and reduce mortality rates in these critically ill patients.
Predicting Treatment Response To Mandibular Advancement Splints: A Novel Biomechanical Imaging Method
Funder
National Health and Medical Research Council
Funding Amount
$689,062.00
Summary
Mandibular advancement splints are an alternative to continuous positive airway pressure for patients with Obstructive Sleep Apnoea (OSA). However, they are effective for only about half of OSA patients, and it is not currently possible to predict who will benefit. This project will explore a new magnetic resonance imaging method to see if it can predict who will respond to mandibular advancement splint therapy.
Is Asthma In The Elderly A Disease Of The Peripheral Airways?
Funder
National Health and Medical Research Council
Funding Amount
$502,437.00
Summary
Elderly asthmatics have poorer clinical outcomes compared with younger asthmatics. The reasons for this are unclear but may involve age-related changes in the disease itself. In this project we aim to show that asthma in the elderly is dominated by abnormalities of very small peripheral airways, in contrast to younger patients where the abnormalities occur in larger airways. The results will provide the basis for new and better targeted treatment strategies for asthma in the elderly.
How Do Thick Airway Walls Affect Airway Hyperresponsiveness In Asthma?
Funder
National Health and Medical Research Council
Funding Amount
$382,538.00
Summary
Asthmatic airways narrow too easily, a characteristic called airway hyperresponsiveness (AHR). To understand the cause of asthma we need to understand the cause of AHR. Thickened airway walls could amplify airway narrowing and increase AHR. However, thick airway walls are also stiff, and stiff walls could reduce narrowing and AHR. This project will examine the relationships between AHR and airway wall thickness and stiffness during and after treatment that reduces airway wall thickness.