Breathing easier
People with respiratory diseases often struggle to breathe. Research on the mechanisms of respiratory diseases and the development of new methods for diagnosis and treatment could help them breathe easier.
Story by Connie Bryson/Illustrations by Karen Klassen
Trouble breathing. It’s the simplest description of how respiratory diseases affect people, and it sounds almost innocuous. It’s not, of course. Even a mild lung infection can take a normally healthy person down for the count; the impacts of chronic diseases like asthma or chronic obstructive pulmonary disease (COPD) can be life altering.
According to the Public Health Agency of Canada, more than 3 million Canadians cope with one of five serious respiratory diseases: asthma, COPD, lung cancer, tuberculosis, and cystic fibrosis. These and other respiratory diseases, such as influenza, pneumonia, bronchiolitis, respiratory distress syndrome, and apnea, affect people of all ages. All have major impacts on the people with the diseases as well as on families and on the healthcare system. In 2007, almost 6.5% of total healthcare costs were related to respiratory diseases (not including lung cancer). This accounted for nearly $5.70 billion in direct costs of health care, for such things as hospitalization, physician visits, research, and drugs, as well as an additional $6.72 billion for indirect expenses associated with disability and mortality.
Alberta researchers study a wide range of lung disorders: immunological diseases such as asthma, infections such as tuberculosis, other breathing problems such as apnea, and, of course, lung cancer. Their work covers basic research on genetics and molecular biology of lung diseases to clinical research on new methods for diagnosis and treatment.
“Respiratory diseases have a massively complex biology,” says Dr. Robert Newton, a researcher at the University of Calgary. “While a lot of research has been done, there is still a lot more to figure out. For example, we are still at an early stage in understanding what genes do and how they interact in respiratory disease.”
Dr. Newton is a member of the Airways Inflammation Research Group at the University of Calgary. The group takes a collaborative approach to studying the underlying mechanisms of respiratory diseases with a focus on finding better treatments. Dr. Newton’s work looks at the drugs used to treat asthma and COPD. Asthma is generally treated with two main types of drug: glucocorticoids (also known as corticosteroids), which are inhaled to treat inflammation in the airways, and beta-2 adrenoceptor agonists, which combat the airway constriction that occurs during asthma attacks.
Clinical evidence suggests that inhalers containing both a glucocorticoid and a long-acting beta-2 adrenoceptor agonist (LABA) improve the anti-inflammatory benefits of the glucocorticoid. “The effect is more than simply adding the two drugs together,” says Dr. Newton. “Additional things are going on to improve outcomes such that you can actually reduce the dose of glucocorticoid and still control the asthma.”
This enhanced effect is poorly understood, which makes it difficult to improve these drugs. Dr. Newton is working toward understanding the genes involved in the anti-inflammatory actions of glucocorticoids. The expression of some of these genes (there are hundreds of them) are enhanced when a LABA is given. “We want to understand the basic mechanisms behind this,” he says. “We don’t necessarily want to enhance the expression of all these genes, because some of them could result in undesirable effects. We need detailed information of each gene so we can use that as the means to select for improved drugs.”
Improved drugs should particularly benefit people with asthma that is difficult to control. They must take higher doses of inhaled glucocorticoids and sometimes oral glucocorticoids. Side effects, such as hypertension, osteoporosis, weight gain, and mood disorder, are a serious concern for these patients.
Dr. Newton’s research could also have implications for treating COPD. Patients with COPD are also given a glucocorticoid–LABA combination, but it is less effective than in asthma. “If we can understand the biology better, we can maybe understand why these drugs don’t work as well for COPD and what we can do to improve them,” he says.
Quick facts
Chronic obstructive pulmonary disease (COPD) is a chronic lung disease that includes chronic bronchitis and emphysema. COPD is typically caused by smoking.