About the Research Academic Unit

The Respiratory, Sleep and Environmental Health Research Academic Unit was formed from researchers within the Department of Respiratory and Sleep Medicine and the Environmental Health Research Group at Liverpool Hospital and comprises physicians, respiratory nurses, allied health care workers, and clinical research scientists.

Our research primarily focus on clinical problems that cause a high burden of disease in the SWS community, require substantial health care resources including in-patient stays and ED visits, and/or are locally-relevant problems in the South West. A diverse range of research methods are being employed in the studies conducted by our unit and include randomised controlled trials, cohort and cross-sectional studies in the community-based and hospital based populations, and qualitative research methods.

Specifically research on chronic obstructive pulmonary disease (COPD) and asthma encompasses epidemiology, clinical trials of therapies and investigations of new models of care, including organisational frameworks and interdisciplinary care.
In the field of interventional pulmonology our team is elucidating the clinical role of a range of procedures for the management of cancer, interstitial lung disease, and pleural disease. The procedures are important, either because they represent a minimally invasive alternative to surgery or because they allow diagnostic and therapeutic options that were not previously available for these serious, life-threatening conditions.

In the field of sleep disorders a major focus of sleep research is on improved pathways to diagnosis and care for people with sleep disordered breathing. In particular, research focuses on evaluating simple screening tools that can be used to identify those with significant sleep disordered breathing, and particularly those with respiratory failure, so that they can be fast tracked to diagnosis and treatment implementation.

Our research on tuberculosis (TB) has significantly contributed to the understanding of the TB epidemiology in Australia and has addressed questions to improve the clinical care of patients with latent (dormant) TB infection as well as active TB.  A decision support tool has been developed to assist doctors in advising patients about the whether or not take treatment for latent TB infection. Researchers from our RSEH academic unit are also actively engaged in research on the global control of tuberculosis.
 
Over many years interdisciplinary members of RSEH have, and continue to, undertake research on the environmental factors that affect respiratory health. Among the studies of environmental factors, allergens, thunderstorm-related asthma, dietary factors, including fatty acids in the diet, unflued gas heaters in homes and schools, traffic-related air pollution and other ambient air pollution have been investigated for their effect on human health .   Asbestos-related lung diseases (including mesothelioma) are a major problem in South West Sydney. We are collaborating in epidemiological studies on asbestos exposure and lung disease. In addition our research utilises applied biostatistics, in particular, applying novel statistical models to longitudinal data.

To engage in collaborative research which will translate to improved respiratory and sleep health outcomes in a complex multi-cultural population in South Western Sydney.

Research

The RSEH research group focuses on clinical problems that cause a high burden of disease in the South Western Sydney community, require substantial health care resources including in-patient stays and emergency department visits, and/or are locally-relevant problems in the South West. A diverse range of research methodologies are being employed including randomised controlled trials, cohort studies and cross-sectional studies in the community-based populations and in patient populations, and qualitative research methods.

Members of the unit are investigators or other participants in three NHMRC Centres of Research Excellence (CRE): for severe asthma, tuberculosis and air pollution.

Chronic Obstructive Pulmonary Disease and Asthma

Our research encompasses epidemiology, clinical trials and new models of care. Investigators from this group are working on the following topics

• The epidemiology of COPD in Australia
• New drug therapies, new drug combinations and novel models of care for patients with COPD, asthma and bronchiectasis
• Patient-reported outcomes (e.g. quality of life) in people with chronic respiratory disease
• Better management of oxygen therapy
• An interventional pulmonology approach to managing COPD (bronchoscopic lung volume reduction)
• Better strategies for pulmonary rehabilitation.
• Post-operative pain perception and exercise tolerance in patients undergoing thoracic surgery.
• Nursing clinical handover practices in the management of in-patients with respiratory disease.

Interventional Pulmonology

Research to elucidate the clinical role of a range of interventional pulmonology procedures is taking place at Liverpool Hospital, either as single site studies or as part of multicentre studies. These procedures, which are relevant to the management of

• cancer
• interstitial lung disease and
• pleural disease

are important because they represent a minimally invasive alternative to surgery or because they allow diagnostic and therapeutic options that were not previously available for these serious, life-threatening conditions.

Sleep Disorders

Due to the large unmet need with SWSLHD, a major focus of sleep research is on improved pathways to diagnosis and care for people with sleep disordered breathing. In particular, research focuses on evaluating simple screening tools that can be used to identify those with significant sleep disordered breathing, and particularly those with respiratory failure, so that they can be fast tracked to diagnosis and treatment implementation.

Specific projects include:

• assessing the utility of awake supine oximetry as a screening tool for severe sleep disordered breathing, particularly hypoventilation and respiratory failure, in super-obese patients, and
• investigating the impact that different oximetry software programs on the diagnostic utility of oximetry alone compared with full polysomnography.

Tuberculosis

Research conducted by the Chest Clinic team has significantly contributed to the understanding of the TB epidemiology in Australia and has addressed questions to improve the clinical care of patients with latent (dormant) TB infection as well as active TB. A number of Australia-wide or NSW-wide cohort studies conducted by our group have addressed the question of TB risk, including the risk of developing TB in

• refugees screened after arrival in Australia
• migrants screened on application to migrate to Australia
• people who have completed treatment for TB
• people who have been in contact with other patients with active TB
• people with diabetes or chronic renal failure.

A decision support tool has been developed to assist doctors in advising patients about the whether or not take treatment for latent TB infection.

Researchers from this Department are also actively engaged in research on global control of tuberculosis. This work focuses on Mongolia and Vietnam and is being undertaken in collaboration with the National TB Control programs (Ministries of Health) in those countries.

Environmental research

Over many years our team has undertaken research on the environmental factors that affect respiratory health. Among the environmental factors we have investigated are:

• allergens, in particular, house dust mite but also moulds (Alternaria)
• thunderstorms in late spring (“thunderstorm” asthma)
• dietary factors, including fatty acids in the diet
• unflued gas heaters in homes and schools
• traffic-related air pollution
• other ambient air pollution

Our research has included randomised controlled trials of environmental interventions and observational studies

Occupational lung disease

Asbestos-related lung diseases (including mesothelioma) are a major problem in South West Sydney because of the occupational exposure of many workers in the area and also becauseof the potential for domestic exposure during home renovations. We are collaborating in epidemiological and epidemiological studies on asbestos exposure and lung disease.

Biostatistics

Our research has focused on applied biostatistics, in particular, applying novel statistical models to longitudinal data. This work has enabled the identification of data-derived classes (or “phenotypes”) in complex heterogeneous disease entities (such as asthma). The integration of this research expertise within this clinical and epidemiological research team will enhance the research capacity of the team as whole as well as serving as a basis for advanced biostatistical research and training.

Our Team

Senior Academics

	Professor Guy Marks Professor of Respiratory Medicine, SWS Clinical School, UNSW Australia Respiratory Physician, Department of Respiratory Medicine, Liverpool Hospital NHMRC Senior Principal Research Fellow Research focus: asthma & COPD, tuberculosis, air pollution, epidemiology and biostatistics
	Professor Bin Jalaludin Conjoint Professor, UNSW Australia Director, Healthy People and Places Unit, SWSLHD Leader, Population and Health Services Stream, Ingham Institute of Applied Medical Research Research focus: air pollution, public health, epidemiology and biostatistics
	Professor Sheree Smith Professor of Nursing, School of Nursing and Midwifery, UWS. Research focus: asthma and COPD, patient report outcomes, health technology assessment
Other Academics
	Dr Melissa Baraket Conjoint Senior Lecturer, SWS Clinical School, UNSW Australia Staff Specialist, Department of Respiratory and Sleep Medicine, Liverpool Hospital Research focus: asthma, pulmonary vascular disease
	Dr Peter Buchanan Conjoint Senior Lecturer, SWS Clinical School, UNSW Australia Staff Specialist, Department of Respiratory and Sleep Medicine, Liverpool Hospital Research focus: sleep disorders
	Dr Peter Collett Conjoint Senior Lecturer, SWS Clinical School, UNSW Australia Staff Specialist, Department of Respiratory and Sleep Medicine, Liverpool Hospital Research focus: quality assurance, models of clinical care, sleep disorders
	Dr Christine Cowie Senior Research Fellow (Level C Academic), SWS Clinical School, UNSW Australia Epidemiologist Research focus: air pollution, environmental epidemiology
	Dr Claudia Dobler Conjoint Senior Lecturer, SWS Clinical School, UNSW Australia Staff Specialist, Department of Respiratory and Sleep Medicine, Liverpool Hospital Research focus: tuberculosis, research translation to clinical practice
	Dr Frances Garden Research Fellow (Level B Academic), SWS Clinical School, UNSW Australia Biostatistician Research focus: biostatistics
	Dr Zinta Harrington Conjoint Senior Lecturer, SWS Clinical School, UNSW Australia Head of Department and Staff Specialist, Department of Respiratory and Sleep Medicine, Liverpool Hospital Research focus: COPD and bronchiectasis, models of care and management
	Dr Graham Radford Conjoint Lecturer, SWS Clinical School, UNSW Australia Research focus: education and training
	Dr Hima Vedam Conjoint Senior Lecturer, SWS Clinical School, UNSW Australia Staff Specialist, Department of Respiratory and Sleep Medicine, Liverpool Hospital Research focus: sleep disorders, respiratory failure
	Dr Jonathan Williamson Conjoint Senior Lecturer, SWS Clinical School, UNSW Australia Staff Specialist, Department of Respiratory and Sleep Medicine, Liverpool Hospital Research focus: interventional pulmonology, lung cancer
Members of Research Group without current academic appointments
	Dr Hamish Crawford Senior Staff Specialist, Department of Respiratory Medicine, Liverpool Hospital Research focus: tuberculosis, pulmonary function testing
	Ms Serena Hong Senior Physiotherapist Research focus: post-operate pain management
	Dr Anthony Johnson Consultant Respiratory Physician Research focus: occupational lung disease
	Dr Stephen Parsons Senior Staff Specialist, Department of Respiratory Medicine, Liverpool Hospital Research focus: pulmonary vascular disease
	Ms Ana Schippers Senior Physiotherapist Research focus: pulmonary rehabilitation
	Mr Craig Wainwright Clinical Nurse Consultant Research focus: models of care
Higher Degree Candidates
	Ms Jennifer Ho PhD Topic: Host-pathogen interactions and disease severity in tuberculosis
Independent Learning Project (ILP) students
	Ms Maryam Hakim Title of Project: Thirty-day hospital readmissions in patients with chronic obstructive pulmonary disease Project Summary: Chronic obstructive pulmonary disease (COPD) has one of the highest rates of 30-day readmissions amongst other health conditions. In the last 10 years, Liverpool hospital has had 25.1% of every COPD admission followed by a readmission within 30-days and 65.2% within six months. The most common cause of readmission is COPD, bringing up the total number of COPD admissions to Liverpool hospital to nearly 6,000. To reduce these rates, interventions need to be offered to patients at high risk of readmission. To determine which patients are at high risk, an easy and simple predictive tool is being currently developed.  Supervisor: Dr Claudia Dobler
	Ms Nishta Kaushik Title of Project: Diagnostic yield of chest x-ray follow up in migrants on a tuberculosis undertaking (TBU) Supervisor: Dr Claudia Dobler
	Mr Nathan Harb Title of Project: Patients’ perception of treatment burden associated with chronic obstructive pulmonary disease   Supervisor: Dr Claudia Dobler

joy.tripovich@unsw.edu.au

General Enquiries:

Dr Joy Tripovich Research Manager Respiratory, Sleep and Environmental Health research group (RSEH) Ingham Institute of Applied Medical Research M: 0404044300 E: joy.tripovich@unsw.edu.au (Please note I work Tues-Thurs)

Location

Postal address:

PO Box 3151 (Westfields Liverpool)
Liverpool NSW 2170

Courier address:

1 Campbell Street
Liverpool NSW 2170