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Reflux in Bronchiectasis - update

I am greatly enjoying my time at Newcastle University and have made significant progress in a number of laboratory techniques, including growing cells taken from patients’ lungs. This has allowed experiments with bacterial agents and products of reflux and lung secretion, which we think are important factors in increasing severity in bronchiectasis. Bringing this technique back to Ireland will extend lung cell research in Galway, adding to current expertise with the use of cell lines in respiratory and critical care medicine.

How has the research project enabled you to develop your skills?

I have also gained experience in cell counting techniques and in processing broncheoalveolar lavage fluid samples, taken when water is put into a patient’s lungs and then removed for testing. I have developed ELISA (enzyme-linked immunosorbent assay) skills, a test using antibodies and colour change to discover the presence of a substance, and mass spectrometry, a way of finding out the mass of different molecules in a substance. These tests will help me explore levels of proteins and acids in the lungs to learn more about how reflux develops.

I have formed active and meaningful collaborations with various other professionals and research teams working in the area of reflux disease, including gastrointestinal, surgical and ear, nose and throat colleagues. Our overall aim is to standardise research techniques and enable collaboration between different research centres in Europe.

How could your research impact patients in the future?

I am currently working alongside Rhys Jones, who specialises in surgery related to the stomach and intestines. His supervisory team aim to introduce a fast-track, “one stop” service for patients with co-existing reflux and chronic lung disease in Newcastle, UK.  Previous research in Newcastle has mainly focussed on cystic fibrosis and idiopathic pulmonary fibrosis but is now being applied to bronchiectasis to learn more about this disease. I will transfer this knowledge to Ireland as a direct result of my ELF funding. We are currently working together on a review to determine the best questionnaires on reflux, to identify which patients are most likely to benefit from treatment.

The relationship between reflux and chronic respiratory disease is poorly understood, so investigation and expertise is needed in hospitals. Combined 24-hour pH-impedance testing is the gold standard investigation of choice and is available at Newcastle, UK but not yet in Galway, Ireland. I am receiving training for this technique, which tests the amount of acidity coming up from the stomach into the throat, as well as the direction of the reflux. We hope to use this technique in Galway to investigate reflux in patients with worsening respiratory disease when typical respiratory treatments no longer work.

We will continue to investigate the effects of reflux in patients with bronchiectasis who do not also have cystic fibrosis and will continue to provide updates over the coming months.  It is already clear that the partnership between Galway and Newcastle has been greatly helped by the ELF fellowship funding, which will help us develop best practice for patients across health services.