Najib Rahman: Respiratory Medicine

What are the challenges of respiratory medicine in the UK?

Respiratory medicine is a very common cause of disease in the UK – a report in 2006 suggests that it will kill one in five people in the UK. We have a very big mountain to climb in terms of how common respiratory disease is. One of the main issues is that respiratory disease encompasses a large number of common diseases like pneumonia, asthma, emphysema, lung cancer, and within respiratory medicine we need to try and advance the care of all of these particular diseases. In addition to that, I'd say that amongst Europe we are one of the worst, in the UK, in terms of our outcomes for respiratory medicine, and that includes very common conditions like lung cancer. There's a lot of work to do to try and improve the outcomes for patients, with this very common set of diseases.

What is pleural disease?

Pleural disease is the area that I specialise in, and that means disease in the pleural space. The pleural space is a gap between the lung and the chest wall. All of us have a very small pleural space, and the pleural space normally contains just one or two mls of normal lubricating fluid. Pleural disease occurs when a large amount of fluid or air accumulates inside that space, causing breathing difficulties, chest pains, and problems for the patient – people can have up to two or three litres of fluid or air trapped inside the chest cavity. The commonest causes of that are conditions of the heart, problems with infection and problems with cancer. My research is focused on how to improve our treatment of people with pleural disease.

With obesity on the rise, are we more at risk of contracting diseases like pneumonia?

Obesity is a very common problem, and obesity in and of itself causes very specific problems with the respiratory system. One of them is that the pump mechanism – the way in which we move air in and out of the chest – is affected by obesity. Also we are now just discovering that there are problems with people sleeping overnight, in terms of their respiratory system, if they have obesity. My colleague John Stradling has been doing some work in this area, looking into how to improve people's sleep and sense of wellbeing if they have obesity and under-breathe because of that. If people have obesity then that can cause collapse at the bottom parts of the lungs, simply because of the weight in the abdomen, leading to problems with trapped secretions and then pneumonia. So obesity itself causes respiratory disease, and on top of that, I think it will probably cause increased problems with things like pneumonia.

What are the most important lines of research that have developed in the past 5 or 10 years?

Within respiratory medicine there have been very significant advances in our understanding of how to treat patients with a broad range of respiratory disease. In the fields of what we call 'airways disease', meaning asthma and emphysema, there's been significant advances in our understanding that patients are different, different people are different, and we shouldn't be treating everybody in the same manner, or indeed with the same medication. So we are slowly moving towards personalising treatment for these people. Our understanding of lung cancer, how it forms, and more targeted treatments for lung cancer are increasing as well, and I think that's a major step forward. And the third area, in my view, is increasing our understanding of sleep apnoea and how it works, and we now have a very affective treatment for sleep apnoea.

Why does your line of research matter, why should we put money into it?

Plural disease, which is what I particularly specialise in, but also respiratory trials and clinical trials in respiratory medicine, are of particular importance I think, because firstly there's a huge burden of respiratory disease in the UK. Given how common respiratory disease is, we are very underfunded in terms of how much money is put into research, and that's a great pity – there is a lot of suffering and poor quality care going on out there, that we could improve with some fairly straightforward, fairly simple investigations and research. The sort of studies that myself, and my trials unit, conduct are aimed specifically at improving patient care. We do the clinical trial end of things, and in that, what we try to do is answer questions that will change how doctors, everyday in the UK, practise medicine to the benefit of patients. So we translate the benefit of the funding into real outcomes for patients very quickly.

Is that how your work fits into Translational Medicine within the Department?

Translational medicine is the improvement of patient health and patient care and well being, through initially scientific understandings, maybe understanding of data or from the laboratory, all the way through to patient care – clinical trials are the ultimate expression of that. It's fine to find out something interesting and biological, but unless one can take that all the way through, and treat patients to their benefit, then one is not going to improve patient care. My unit and the work that we do is aimed at improving care through those understandings. A good example of that is a study that we did quite recently, looking at new treatments injected into the chest to clear infected fluid. The initial data from that came from experimental models, but we then had to test it in patients and we did so three or four years ago. We proved that the combination of drugs tested improves drainage from the chest, and can reduce the time in hospital. The sort of work that we do fits very nicely into the top end of translational medicine.