Holland - Respiratory Care group
Respiratory care group
- respiratory; physiotherapy; pulmonary rehabilitation; COPD; pulmonary fibrosis; exercise training; supportive care; access to care; physical activity; telerehabilitation; clinical trials; implementation
2020 Respiratory Care group. Back row, L-R: Angela Burge, Christie Mellerick, Anthony May, Carla Malaguti. Middle row: Gabriella Tikellis, Aroub Lahham, Narelle Cox, Mariana Hoffmann, Joanna Lee. Front row: Julianna Dreger, Anne Holland, Janet Bondarenko. Absent: Leona Dowman, Arwel Jones.
Group leader - Prof Anne Holland
Senior Research Fellow
Dr Narelle Cox
Ms Julianna Dreger
Ms Christie Mellerick
Ms Helen Boursinos
Ms Janet Bondarenko
Mr Cade Ringin
Ms Sarah Rawlings
Ms Amanda Nichols
In 2020 there were 11 PhD students and 4 Masters students undertaking clinical research projects within the Respiratory Research team.
Our research aims to improve the lives of people with chronic lung disease through novel non-drug treatments and optimal supportive care.
Our work starts with understanding the supportive care needs of people living with lung disease, developing new non-drug treatments, testing these in clinical trials, and then implementing effective treatments into clinical practice. We have a strong focus on pulmonary rehabilitation for people with chronic lung disease. This includes developing new pulmonary rehabilitation models to improve access and uptake (e.g. low-cost home-based rehabilitation and telerehabilitation) and optimizing pulmonary rehabilitation for patients with complex needs, such as those with pulmonary fibrosis. Our research builds the evidence underpinning a wide range of non-drug treatments for chronic lung disease including oxygen therapy, self-management, and peer support. We have strong links to the Department of Physiotherapy and Department of Respiratory Research@Alfred, providing valuable opportunities to embed research into clinical practice.
Participants sought - research studies
People with chronic obstructive pulmonary disease (COPD) experience distressing breathlessness and high health care utilisation. There is compelling evidence that pulmonary rehabilitation improves symptoms and reduces hospitalisation, but is delivered to <10% of patients who would benefit. In this cluster randomised implementation trial we will test whether offering patients the choice of pulmonary rehabilitation location (hospital or home) will improve program completion and reduce hospital admissions. Fourteen pulmonary rehabilitation programs located in 5 Australian states will recruit people with COPD who are referred to pulmonary rehabilitation. Programs allocated to the intervention cluster will offer people with COPD the choice of centre-based pulmonary rehabilitation or our HomeBase model. In programs allocated to the control cluster only the existing centre-based model will be offered. This implementation trial will evaluate the real-world effectiveness of putting patient choice at the heart of the pulmonary rehabilitation model.
After a period of hospitalisation, pulmonary rehabilitation can improve symptoms and function and reduce healthcare costs in people with chronic obstructive pulmonary disease (COPD). Yet less than 10% of people with COPD access pulmonary rehabilitation after a hospital stay. This multi-site randomised controlled trial, involving health service partners across NSW and Victoria, will examine the benefits and costs of home-based pulmonary rehabilitation undertaken immediately following hospitalisation, compared to usual care, for people with COPD.
The fibrotic interstitial lung diseases (fILD) are characterised by lung scarring, distressing breathlessness and poor health-related quality of life. Low blood oxygen during exercise) is a hallmark of fILD and is sometimes treated with ambulatory oxygen therapy, which involves breathing supplemental oxygen from a gas cylinder during physical activity. However there is little evidence to support this treatment and adherence is poor. Recently new devices called portable oxygen concentrators (POCs), have become available, which are lighter and more maneuverable than a cylinder. This clinical trial will determine the effects of ambulatory oxygen therapy, delivered with a portable oxygen concentrator, for people with fILD and low blood oxygen during exercise. The trial will recruit 260 people with fILD in Australia and Sweden. Results of this research will broaden our understanding of whether ambulatory oxygen therapy improves how people with fILD feel and function, and how much it costs to deliver. Our study partners are Alfred Health and Austin Health, Victoria; Royal Prince Alfred Hospital, NSW; The Prince Charles Hospital, Qld; Lund University Hospital and New Karolinska Hospital, Sweden.
Cystic Fibrosis (CF) is a complex, progressive, life-limiting disease that predominantly affects children and young adults. ‘Flare-ups’ of CF lung disease are common in people with this condition and often lead to admission to hospital and decline in lung capacity, imposing considerable burden on patients, their families and the healthcare system. Physical activity (PA) participation is a low-cost, easily accessible treatment option that has the potential to reduce the impact and progression of chronic lung disease in CF and may help reduce ‘flare ups’ of lung disease. However uptake and adherence to PA and exercise rehabilitation programs by young people with CF is poor. The aim of this project is to determine whether use of an online program to track PA participation and provide feedback (www.ActivOnline.com.au), is more effective than usual care at improving PA participation, exercise capacity and quality of life, and prolonging the time to next hospital admission in young people with CF. Our study partners are Alfred Health, Monash Health, Royal Children’s Hospital, Victoria; Children’s Hospital at Westmead, Westmead Hospital, Royal Prince Alfred Hospital, NSW; Royal Hobart Hospital, Tasmania; Royal Adelaide Hospital, South Australia.
The fibrotic interstitial lung diseases (fILD) t are characterised by scarring of lung tissue, breathlessness on exertion and poor exercise capacity. Exercise training is recommended for people with fILD, but not all patients experience benefits.. High intensity interval training (HIIT), consisting of short bouts of high-intensity exercise regularly interspersed with periods of rest or light exercise, is an alternate exercise training that may be better suited to people with fILD, resulting in less breathlessness and better oxygen levels during exercise. This randomized controlled trial will determine to whether HIIT is better than moderate intensity, continuous training in improving exercise tolerance, breathlessness and quality of life in people with fILD.. If this trial demonstrates that HIIT is effective, it will provide an exercise training strategy that can readily be implemented in practice to maximise the outcomes of exercise training for people with fILD.
Chronic lung diseases, including chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), bronchiectasis and asthma, are characterised by breathlessness, reduced exercise tolerance and impaired quality of life. ‘Flareups’ of chronic lung disease are common in people with this condition and often lead to admission to hospital and decline in lung function, imposing considerable burden on patients and the healthcare system. Pulmonary rehabilitation is known to be effective at improving exercise tolerance and function, and helping to prevent ‘flareups’. However, it is often difficult for people to access these group exercise training programs, particularly in regional areas of Australia. Advances in internet technology and accessibility have made it possible for people to receive specialist medical care and rehabilitation therapy directly to their home. This project aims to determine whether pulmonary rehabilitation undertaken at home, using internet based technology, is at least as effective as centre-based pulmonary rehabilitation in improving quality of life, breathlessness and exercise capacity in people with chronic lung disease. Our study partners are Alfred Health, Austin Health and Wimmera Health Care Group.
Skeletal muscle wasting is common in people with COPD and pulmonary fibrosis, and is linked to poor quality of life and reduced survival. The mechanisms of muscle wasting are poorly understood in people with chronic lung disease – whilst physical activity is important, it is likely that other mechanisms are at play. Pulmonary rehabilitation (exercise training) is currently the best treatment for skeletal muscle wasting in chronic lung disease, but its mechanisms are unknown. In this study we are collaborating with researchers from RMIT to determine whether the benefits of pulmonary rehabilitation in people with COPD and pulmonary fibrosis are associated with a reduction in oxidant-dependent mechanisms that drive skeletal muscle wasting.
Current project funding
|2019||A Holland, C McDonald, A Mahal, N Lannin, N Cox, G Hepworth, P O’Halloran. Medical Research Future Fund, Australia. Transforming pulmonary rehabilitation to reduce hospital admissions in COPD|
|2018||N Cox, A Holland. National Health and Medical Research Council. Early HomeBase pulmonary rehabilitation after hospitalisation in chronic obstructive pulmonary disease|
|2018||L Dowman, A Holland. Institute for Breathing and Sleep. High intensity interval training in fibrotic interstitial lung disease: a randomised controlled trial|
|2017||R Vlahos, S Bozinovski, A Holland. National Health and Medical Research Council. Targeting oxidant-dependent pathways to treat skeletal muscle wasting in COPD|
|2017||A Holland, C McDonald, T Corte, D Chambers, A Palmer, M Ekstrom, I Glaspole, N Goh, G Hepworth. National Health and Medical Research Council. Ambulatory oxygen for interstitial lung disease|
|2016||T Corte, D Knight, G Laurent, A Holland, D Chambers, Y Moodley, E Walters, G Westall, I Glaspole, A Palmer. National Health and Medical Research Council. Centre for Research Excellence in Pulmonary Fibrosis|
|2016||D Brooks, RS Goldstein, M Beauchamp, AL Lee, J Alison, P Camp, G Dechman, S Harrison, AE Holland, A Marquez, J Sanchez, E Skinner, L Spencer, J Sanchez, M Stickland. Canadian Institute for Health Research. What is the effect of balance training on falls in people with COPD?|
- Lahham A, McDonald CF, Cox NS, Nichols A, Liacos A, Rawlings S, Moore R, Holland AE. The impact of home-based pulmonary rehabilitation on people with mild chronic obstructive pulmonary disease: a randomised controlled trial. The Clinical Respiratory Journal. Accepted December 18 2019.
- Burge AT, Holland AE, McDonald CF, Abramson MJ, Hill CJ, Lee AL, Cox NS, Moore R, Nicolson C, O'Halloran P, Lahham A, Gillies R, Mahal A. Home‐based
- pulmonary rehabilitation for COPD using minimal resources: An economic analysis. Respirology. 2019; 1– 8. https://doi.org/10.1111/resp.13667 Epub ahead of print.
- Nakazawa A, Dowman LM, Cox NS, McDonald CF, Hill CJ, Lee AL, Holland AE.
- Factors predicting progression of exercise training loads in people with interstitial lung disease. ERJ Open Research. Accepted August 3 2019.
- Tarrant B, Snell G, Ivulich S, Button BM, Thompson BT, Holland AE. Dornase alfa during lower respiratory tract infection post lung transplantation: a randomized controlled trial. Transplant International, In Press, published online 10th January 2019, doi: 10.1111/tri.13400.
- Liang J, Abramson MJ, Russell G, Holland AE, Zwar NA, Bonevski B, Mahal A, Eustace P, Paul E, Phillips K, Cox NS, Wilson S, George J. Interdisciplinary COPD intervention in primary care: cluster randomised controlled trial. European Respiratory Journal 2019; 53(4), pii: 1801530.
- Ward N, Stiller K, Rowe H, Morrow S, Morton J, Greville H, Holland AE. Airway Clearance by Exercising in mild Cystic Fibrosis (ACE-CF): a feasibility study. Respiratory Medicine, 2018; 142:23-28. doi: 10.1016/j.rmed.2018.07.008.
- Tarrant B, Button BM, Thompson B, Snell G, Holland AE. The timing and extent of acute physiotherapy involvement following lung transplantation. An observational study. Physiotherapy Research International, 2018; 23(3): e1710
- Lahham A, McDonald CF, Mahal A, Lee AL, Hill CJ, Burge AT Cox NS, Moore R Nicolson C, O'Halloran P, Gillies R, Holland AE. Home-based pulmonary rehabilitation for people with COPD: a qualitative study reporting the patient perspective. Chronic Respiratory Disease, 2018; 15(2) 123-130. doi: 10.1177/1479972317729050.
- Alison JA, McKeough ZJ, Johnston K, McNamara RJ, Spencer LM, Jenkins SC, Hill CJ, McDonald VM, Frith P, Cafarella P, Brooke M, Cameron-Tucker HL, Candy S, Cecins N, Chan ASL, Dale M, Dowman LM, Granger C, Halloran S, Jung P, Lee A, Leung R, Matulick T, Osadnik C, Roberts M, Walsh J, Wootton S, Holland AE. Australian and New Zealand Pulmonary Rehabilitation Guidelines. Respirology, 2017, 22 (4):800–819.
- Cox NS, Oliveria CC, Lahham A, Holland AE. Pulmonary rehabilitation referral and participation are commonly influenced by environment, knowledge and beliefs about consequences: a systematic review using the Theoretical Domains Framework. Journal of Physiotherapy 2017, 63 (2): 84–93.
- Khor YH, Goh NSL, McDonald CF, Holland AE. Oxygen Therapy for Interstitial Lung Disease: A Mismatch Between Patient Expectations and Experiences. Annals of the American Thoracic Society, published online 7th March 2017, http://dx.doi.org/10.1513/AnnalsATS.201611-934OC
- Dowman LM, McDonald CF, Hill CJ, Lee AL, Barker K, Boote C, Glaspole I, Goh NSL, Southcott AM, Burge AT, Gillies R, Martin A, Holland AE. The evidence of benefits of exercise training in interstitial lung disease: a randomized controlled trial. Thorax 2017;72: 610–619.
- Morris N, Kermeen F, Holland AE. Exercise based rehabilitation programs for pulmonary hypertension (review). Cochrane Database of Systematic Reviews 2017; CD011285. doi: 10.1002/14651858.CD011285.pub2
- Holland AE, Mahal A, Hill CJ, Lee AL, Burge AT, Cox NS, Moore R, Nicolson C, O'Halloran P, Lahham A, Gillies R, McDonald CF. Home-based rehabilitation for chronic obstructive pulmonary disease using minimal resources: a randomised, controlled equivalence trial. Thorax 2017;72:57-65. http://dx.doi.org/10.1136/thoraxjnl-2016-208514
- Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE et al. An Official American Thoracic Society / European Respiratory Society Statement: Key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188(8): e13-64.
- Holland AE, et al. An Official ERS / ATS Technical Standard: Field Walking Tests in Chronic Respiratory Disease. European Respiratory Journal 2014; 44(6):1428-46.