Introduction
The NIHR Oxford BRC Respiratory Theme studies respiratory conditions that are common and responsible for significant morbidity, mortality and health care costs.
Patients in the UK have amongst the worst asthma outcomes in developed countries and non-malignant respiratory conditions are responsible for 62 million prescriptions, 1 million admissions and costs of £6.6 billion per year.
- Asthma, chronic obstructive pulmonary disease (COPD) and pneumonia are the main cause of winter pressures on the NHS.
- Idiopathic pulmonary fibrosis (IPF) is a distinctive and progressive fibrotic disease of the lungs with exceptionally severe prognosis and a median survival of three to five years from diagnosis.
- Pleural infection has a mortality of 20 per cent and average hospital stay of two weeks.
- Respiratory diseases are the third most common cause of death in the UK.
Unlike many other chronic health conditions, key outcomes for these conditions have not improved over the last 10 years and, until recently, there have been few genuine therapeutic advances.
The NIHR Oxford BRC Respiratory Theme believes that progress has been slow and outcomes have stalled because treatment guidelines have encouraged generic one-size-fits-all treatment. This has led to poor targeting of treatment. Our overall vision is to develop a new classification of these common respiratory diseases that will allow more accurate assessment and more effective treatment by matching new treatments with the specific groups of patients that are most likely to benefit from them.
The primary aims of the NIHR Oxford BRC Respiratory Theme are:
- To investigate established mechanistic pathways of airway disease and to determine novel treatment methods.
- To develop new immunological, imaging and physiological biomarkers of mechanisms known to be important drivers of respiratory diseases and to determine whether the use of these techniques provides a better prediction of treatment response.
- To investigate the mechanisms and pathways responsible for pneumonia and progression to empyema.
We focus on common respiratory diseases responsible for significant morbidity and mortality and where progress against important outcomes has been slow. Since 2017 we have:
- Established an infrastructure for conducting trials in airways disease in the setting where key management decisions are made (primary and emergency care)
- Used biobanks to identify biomarkers and test validity and feasibility of measurement in relevant settings
- Developed new methods for stratifying lung disease including assessment of lung homogeneity using laser gas analysis and DNA sequence-based assessment of the respiratory microbiome
- Carried out ‘direction-defining’ clinical experimental studies, which have changed clinical practice (i.e. decisions about corticosteroid use in COPD are now biomarker-based).
Our ambition is to build upon our previous success in identifying subsets of patients with respiratory disease that will benefit the most from being given a specific treatment. To do this we will carry out more data-rich, low patient number, early phase trials in highly characterised patients using the reliable surrogate biological, imaging and physiological measures that we develop. We believe the results from these early phase trials will allow us to design and conduct studies that will change the way in which patients with respiratory disease are treated and improve their lung function and quality of life.
We will increase our capacity to carry out early phase interventional trials. This will be supported by our involvement with the NIHR Respiratory Diseases Translational Research Collaboration, where we will champion the concept of precision medicine. This will allow us to enhance local and national capacity, and to encourage better integration with industry.
Research across the theme falls into three main areas:
These sub-themes are supported by our theme lead’s links to these units:
- Oxford Respiratory Trials Unit (ORTU)
- Oxford Pleural Unit
- MRC Human Immunology Unit
- Novel Clinical Imaging Research