Can you describe the aim of your research in 10 words?
To help prevent and treat respiratory infections or lung diseases.
What have you learned about mechanisms and interventions for respiratory infections and lung disease so far?
Chronic obstructive pulmonary disease (COPD) exacerbations are often caused by viral infections, such as the common cold and influenza. People with COPD are susceptible to exacerbations due to imbalanced responses to viral infections, where deficient anti-viral immunity precedes excessive activation of the immune system and causes lung inflammation and symptoms. Whilst current treatments like steroid inhalers can help reduce symptoms in people with COPD, these drugs are immunosuppressive and can increase risk of secondary infection. Complementary treatments are needed that reduce reliance on steroids. Our research has shown that exercise programs can reduce the number of people experiencing a COPD exacerbation. The mechanisms underlying this protection are not clear.
You recently won a grant to assess whether exercise has anti-viral and anti-inflammatory effects in COPD. Can you tell me a bit about that project?
This project will recruit 30 people living with COPD who have frequent exacerbations. Half of these people will receive an exercise program while the other half will be placed on a waiting list for eight weeks. Using bronchoscopy, we will collect lung immune cells at the start of the project and after eight weeks, we will measure whether exercise can boost anti-viral responses of lung cells. Additionally, mice with COPD will either undergo treadmill running or rest alongside steroid or no-steroid treatment before infection with viruses that cause exacerbations. Lung tissue from the mice will be used to test whether exercise reduces inflammation during an exacerbation and increases anti-viral immunity with or without steroid treatment. I will lead this project under the mentorship of Professor Anne Holland (Monash University) and Associate Professor Nathan Bartlett (University of Newcastle) who are world-leading researchers in non-drug treatments and viral immunology, respectively, in COPD.
You mentioned the mechanisms behind exercise’s potential anti-viral and anti-inflammatory effects in COPD aren’t yet clear. Are there any proposed mechanisms? If so, what are they?
I hope to have a more definitive answer on this at the end of the project. There is accumulating evidence to suggest that exercise alone has independent effects on exacerbations versus other interventions it may be delivered alongside (e.g. education) in COPD. I think this is at least partly due to exercise modulating the immune system. My view is informed by two key areas. Firstly, prior research has shown regular exercise in previously-sedentary populations can result in reduced severity of self-reported respiratory infections and improved immune responses to viral vaccines (e.g. influenza). Secondly, previous research has shown that people living with COPD are more physically inactive than age-matched healthy counterparts and that this physical inactivity may be linked to systemic inflammation. Our project will test the effects of exercise on aspects of the immune system that have been shown to be linked with increased susceptibility to exacerbations.
How could this work affect patient care and how long until it does?
Unlike a brand-new drug or treatment, our work shouldn’t take long to affect patient care. If successful, I would anticipate impact within 5 years. This is because exercise programs are already being used in the care of people living with COPD. The key difference would be how the exercise programs are delivered. Currently, people with COPD are usually referred by their clinicians for exercise treatment to help with breathlessness or exercise intolerance. Confirming exercise’s anti-viral and anti-inflammatory effects in COPD would support exercise treatment in those susceptible to frequent exacerbations. Unfortunately, we know that too-few people living with COPD are currently able to access exercise treatments. Our body of work showing that exercise can reduce exacerbations alongside conclusive proof of mechanisms will provide a strong call for increased provision of exercise programs. Why do I think that? Because exacerbations are a leading cause of preventable hospitalisations in chronic disease and represent major costs of COPD treatment in health services.
What drew you to this line of research?