In light of World Asthma Day, News-Medical interviewed Dr. Samantha Walker from Asthma UK and the British Lung Foundation about some of the common misconceptions surrounding asthma.
Please could you introduce yourself and tell us about your expertise in asthma?
My name is Samantha Walker. I am Director of Research & Innovation at Asthma UK and the British Lung Foundation, based in London. I trained as a nurse in the late ‘80s and then worked as a research nurse at the world-leading Allergy & Clinical Immunology Department at the National Heart & Lung Institute (NHLI), based at Imperial College London, assisting in and eventually running research studies testing new asthma and allergy treatments.
At the same time, I completed a diploma in asthma management and as part of my research role worked in allergy, severe asthma, and ENT clinics at the Royal Brompton Hospital. I then completed a Ph.D. supervised by Prof. Stephen Durham at Imperial College, graduating in 2000. This gave me a good grounding in understanding the mechanisms of asthma and in particular, allergic asthma. It also exposed me to brilliant scientists from around the world who were themselves training at NHLI, but who now form an amazing network of researchers driving forward asthma research globally.
What inspired your career into asthma?
In my years of treating and talking to people with asthma, I have found that the real danger asthma poses is regularly underestimated. This sadly leads to attacks and deaths that could have been prevented.
As a nurse, I became interested in helping people to manage their asthma as well as possible, whilst developing a fascination with the mechanisms that cause and trigger symptoms and attacks. Working in a world-leading clinical immunology lab amongst talented scientists allowed me to contribute to some of the ground-breaking trials of the mid-90s. This left me with an ongoing interest in trying to understand and treat asthma more effectively and eventually cure it.
The theme for World Asthma Day 2021 is ‘uncovering asthma misconceptions’. What do you believe to be some of the most common misconceptions surrounding asthma?
There are so many dangerous misconceptions about asthma, including that people grow out of their asthma. People simply stop experiencing symptoms, they don’t grow out of them. These symptoms can, and frequently do, return later in life. In women, hormonal changes, like those that take place during pregnancy, or menopause, can trigger a sudden return of asthma symptoms, as can lifestyle changes, such as moving to a more polluted area.
Another common misconception is that people only need to use their inhalers when they are having an asthma attack, when in fact, preventer inhalers should be used every day to prevent an attack and to manage symptoms.
Reliever inhalers should only be used to ease symptoms as they occur, and they work by widening the airways. A reliever inhaler shouldn’t be used more than three times a week and if it is, this is a sign that the person’s asthma is not well-controlled, and they should book an urgent asthma review with their GP.
There are so many dangerous misconceptions about asthma, including that people grow out of their asthma.
Asthma. Image Credit: Antonio Guillem/Shutterstock.com
Every day 3 people die from an asthma attack in the UK and many of these deaths could be preventable with effective treatment options. Why are there still asthma sufferers around the world that do not have effective treatment options?
There are many effective treatments, but unfortunately, one of the key issues we face is people collectively not taking their treatments as prescribed when they are not displaying symptoms. People’s behavior in relation to their asthma is complex, but it is often due to a general lack of understanding about asthma and its severity. Through a better understanding of people’s behaviors, we can help people to self-manage their symptoms.
We have recently developed personas based on deep clinical and behavioral insights and analysis which we hope will help tech developers design better digital applications that could radically improve self-management to prevent asthma attacks and deaths.
That said, there is a sizeable minority of people who, even if they take their medicine as prescribed, still have bad symptoms. This is because there are many different types of asthma, a few of which we know don’t respond very well to current treatments.
Examples include symptoms driven by hormonal changes (including puberty, menstruation, pregnancy, and menopause) and symptoms driven by obesity. We have a long way to go to understand the mechanisms causing these symptoms, but we are working hard to make the case for greater financial investment and focus in these areas.
Asthma UK is an organization set up to make a difference for asthma sufferers. What are some of the ways you help to fight asthma?
It is our mission to stop asthma attacks and cure asthma and whilst we work towards that, we want to improve the lives of the 5.4 million people in the UK already living with the condition. We offer a range of services designed to support people with asthma, including our dedicated Helpline and WhatsApp service. We also fund many research projects and innovations, including:
The Asthma Health Technology Fund:
Launched in October 2020, this multi-million-pound fund, in partnership with two large Government funding bodies (NIHR and EPSRC), was created to help us solve the biggest unmet need in asthma self-management technology.
We know that great innovation often comes from different disciplines working together, and the team has been working hard to attract applications from people outside our usual networks. We’ve already had interest, which is an encouraging sign that we’re reaching new research and innovation communities who hopefully, in partnership with respiratory experts, can offer exciting new approaches.
We estimate that approximately 46,000 people with severe asthma may benefit from biologics, hailed as a “game-changer” by those suitable for the treatment. To ensure more people are receiving this treatment, we developed an online tool and launched a campaign to help people to find out if they are eligible. Biologics are genetically engineered proteins that target specific parts of the immune system that fuel inflammation.
Clinical trials found that for those with severe asthma, using biologics can reduce asthma attacks by up to half and can reduce and even stop the need for steroid tablets. We also published a hard-hitting policy report, 'Do no harm: safer and better treatment options for people with asthma', to help persuade clinicians to manage, identify and refer people with suspected severe asthma to a specialist.
Patient and public involvement:
Developing treatments and care for people with asthma demands understanding their needs and experiences. That's why we are constantly working to provide deeper insights into challenges that people face, and sharing those insights with researchers, policymakers, and innovators.
With over 5.4 million people with asthma in the UK, we strive to be truly representative by employing a range of tools including surveys reaching thousands, focus groups, and in-depth interviews.
COVID-19 has taken up a huge amount of research and resources over the last year with many scientists and healthcare professionals working together to develop effective treatment strategies. How could this level of collaboration be used to develop effective treatment strategies for asthma sufferers?
COVID-19 has seen many respiratory specialists tackling the immediate crisis through successive waves of the virus, and at the center of efforts to understand the emerging syndrome of Long COVID. This response could result in long-term benefits for asthma science.
In the UK, a flagship study into Long COVID, PHOSP-COVID, has seen the development of rapid cross-disciplinary collaboration between respiratory scientists and experts in other fields such as cardiovascular disease and renal disease. These collaborations have been underpinned by unprecedented secure sharing of data, to quickly reveal insights into different phenotypes of Long COVID. With breathlessness being one of the major symptoms of Long COVID, respiratory disease has been afforded a significantly higher profile in the research funding environment and is now well-positioned to build on these collaborations for the benefit of people with asthma.
The COVID-19 pandemic has meant a drive towards increased use of remote monitoring tools to continue research trials without relying on frequent visits to specialists. If these advancements in remote monitoring technology can be applied to asthma - an inherently seasonal and variable disease - researchers might better be able to track fluctuations in asthma symptoms. In turn, this could lead to a better understanding of patient need and treatments better tailored to actual experience.
How has the ongoing COVID-19 pandemic impacted asthma sufferers?
Through our helplines and social media, we have been hearing first-hand about the range of anxieties people have been faced with throughout the pandemic, from the uncertainty about shielding to people who are now finding that their asthma symptoms are harder to control after having COVID-19. In March 2021, we surveyed 4,752 people with lung conditions.
Over half told us their wellbeing was worse now than at the start of the pandemic. When asked to rate their anxiety on a scale of 0-10, there was an average score of 7.47. The way people interact with care has also changed markedly due to the pandemic, with 86.4% saying that have had their care done differently since October 2020 – through delays, cancellations, or care done remotely. Worryingly, nearly a quarter told us that their symptoms had got worse due to their care being canceled.
Air Pollution. Image Credit: aapsky/Shutterstock.com
The levels of air pollution across the globe have been increasing annually. What impact does air pollution have on asthma sufferers and is air pollution causing more people to develop asthma?
More than half of people with asthma tell us air pollution exacerbates their symptoms, with potentially life-threatening consequences, and we know that there is an established link between high pollution days and respiratory-related hospital admissions. There is also growing evidence to suggest that air pollution can cause new incidences of asthma.
In the case of London schoolgirl Ella Kissi-Debrah, who had severe asthma, a recent inquest found that dangerous levels of pollution where she lived had contributed to her death. This ground-breaking ruling meant that for the first time in the UK, and potentially the world, air pollution was formally recognized as a cause of death.
In our recent report, The Invisible Threat, we examined the ways in which air pollution is disproportionately impacting those most at risk from harm, including adults and children with asthma and other pre-existing lung conditions. We found that these people are being exposed to dangerously high levels of particulate pollution in places they have no choice but to be, including at over a third of all schools, colleges, and GP surgeries in England.
During busier times of year, when traffic levels increase and air quality is worse, I can’t go near the center of town as I have severe asthma and it can trigger my symptoms to flare up.
If I’m exposed to high levels of air pollution my chest and breathing can be really bad even the day after the exposure. I do my best to avoid high pollution levels, using various apps to track the air quality around me and try to protect my lungs as much as I can.”
Olivia (34) from Edinburgh
What can governments be doing to reduce the risk of people developing asthma due to high levels of air pollution?
It is without a doubt that air pollution is the biggest environmental threat to human health and bold action must be taken to protect people on a national and global scale. That is why as a charity, we are calling on the government to urgently produce an air pollution National Health Protection Plan and commit to stronger clean air laws, that are in line with World Health Organization (WHO) guidelines.
Your research has been published in a range of research journals and you have run and designed many successful research projects, what has been your proudest career achievement so far?
The research I am most proud of was showing a study that adolescents with hay fever and an asthma diagnosis performed less well in their GCSEs than people without hay fever. This has since been used internationally to promote better allergy and asthma management and to argue for moving the timings of summer exams in the UK.
I am also proud of the EU-funded, pan-sector, pan-European collaboration I pulled together, with support and insights from people with asthma. This resulted in a series of published papers highlighting the unmet needs in asthma research, development, and innovation (R, D&I). From basic mechanisms to self-management, culminating in a list of R, D & I priorities agreed by all relevant stakeholders including thousands of people with asthma across Europe. These papers have been used worldwide to drive focus and investment in areas with the greatest unmet need.
Do you believe that with continued funding and research into the mechanisms of asthma, we could finally develop a cure for asthma?
Asthma is complex and has many causes and so it vital that we continue to fund life-saving research. I believe in time, there will be cures available for all asthma sub-types.
We are Asthma UK
What can people do to get involved and support Asthma UK’s mission?
Support us by Donating, Fundraising, or Participating at events https://www.asthma.org.uk/support-us/
Get involved as a Research and Policy Volunteer: https://www.asthmaandlung.org.uk/
Where can readers find more information?
Blogs: https://blog.asthma.org.uk/ | https://news.asthma.org.uk/
About Dr. Samantha Walker
Samantha Walker is Director of Research & Innovation at the Asthma UK and the British Lung Foundation Partnership, a patient charity and research funder based in London.
Samantha is passionate about the importance of focusing on the needs of real people in the charity’s research and innovation activities in a way that avoids tokenism and enables an equitable share of voice and parity of esteem. Building on Asthma UK’s successful patient-led European asthma research prioritization exercise in 2016 (funded by the European Commission’s FP-7 funding program), she has pioneered patient involvement in the development of several ambitious research collaborations (leading to successful multi-£m funding applications) across the UK and Europe.
Samantha holds an honorary lectureship (non-clinical) in the Division of Community Health Sciences, University of Edinburgh, and has published broadly on asthma and allergy for over 25 years in high impact research journals including papers on the mechanisms of allergic inflammation, the impact of allergen immunotherapy on clinical and immunological outcomes and the impact and management of allergic rhinitis including a seminal paper linking hayfever to poor exam performance in teenagers.