The Rising Relationships in Common Lung Diseases and the Enlightenment of Rare Lung Diseases
BY: Ingrid Campbell
Supervisor Name: Dr. Kenneth R. Chapman
In the summer of 2019, I had the pleasure of working under the supervision of Dr. Kenneth R. Chapman in the Asthma & Airways Centre at the Toronto Western Hospital. The lab studied lung diseases, such as asthma and Alpha-1 Antitrypsin Deficiency (Alpha-1).
Asthma is a chronic lung disease causing difficulty breathing.1 In the clinic, asthma patients performed a Fractional Exhaled Nitric Oxide (FeNO) test. Inflamed airways produce increased amounts of nitric oxide.2 FeNO levels alone cannot diagnose asthma; however, airway inflammation is related to asthma symptoms.3 Previous work suggested a positive correlation between residual volume (RV) and post-bronchodilator response (BDR).4 Subsequently, the FeNO project sought to clinically investigate the relationship between FeNO measurements and asthma biomarkers such as RV and BDR.
The FeNO project was exciting to undertake with its engaging methodology. The methodology began by measuring patients’ FeNO data. A retrospective chart review was developed for confirmed asthma patients who completed a pulmonary function test (PFT), followed by regression analysis. Furthermore, the lab’s results confirmed the previous work and found a significant positive correlation between FeNO readings (ppb) and BDR (%), as well as a significant positive correlation between FeNO readings (ppb) and RV (% predicted). These results will contribute to the rise of FeNO testing in airways clinics.
Often Alpha-1 patients are misdiagnosed with asthma. I gained valuable exposure to the rare disease Alpha-1. Alpha-1 is a genetic disorder that may result in serious lung disease or liver disease.5 Alpha-1 occurs when there is insufficient alpha-1 antitrypsin (AAT) protein in the blood. The only existing targeted Alpha-1 treatment is Augmentation Therapy, where patients receive a weekly intravenous infusion of AAT protein purified from human donors’ blood with normal levels of AAT.5 Some private insurance policies cover Augmentation Therapy. Consequently, Alpha-1 patients in Ontario may endure complications with private insurance supporting treatment due to different criteria for drug authorization.
As a student in McMaster University’s Arts & Science Program, my undergraduate degree encompasses the stimulation of interdisciplinary learning; therefore, I was intrigued by the Alpha-1 project. The Alpha-1 project integrated healthcare and legal disciplines. The project required the scientific and healthcare knowledge to understand the patient’s genotype, AAT serum levels and PFT data. Additionally, the project required legal information to recognize transparency issues between insurance companies and patients when inquiring about the Augmentation Therapy criteria. The different criteria are currently being analyzed.
I am grateful for Dr. Kenneth Chapman and his team’s mentorship in an enriched environment. I am thankful for the Institute of Medical Science at the University of Toronto for allowing me to gain valuable clinical research experience in the Summer Undergraduate Research Program. This engaging experience gave me the chance to connect with asthma and Alpha-1 patients. I learned how to interpret FeNO and PFT data. I was enlightened to the significance of research for common and rare diseases. My insightful experience attending a Respirology Research Day prompted my desire to submit an abstract to the 2020 Canadian and American Thoracic Society Conferences.