Background

Asthma affects an estimated 300 million people worldwide with a population prevalence of approximately 15% in the UK. In subjects with mild disease, currently available treatments work well but, in 10–20% of patients with asthma, their condition is difficult to control. These patients consume 50–60% of the healthcare costs attributed to asthma and cost approximately five-times more than patients with mild stable disease.

This project aims to gain a better understanding of the clinical pathway and disease trajectory of severe asthma patients, how these differ from those with mild/moderate disease, and how patients with distinct trajectories differ in terms of their healthcare outcomes and treatment response. The results of this study could enable improved management and optimisation of treatment in patients at risk of poor health outcomes.

Outline plan of investigation

Phase 1: Systematic review

The initial phase will involve conducting a systematic review of previously published studies which have explored the disease trajectory in asthma, and the impact of this on healthcare outcomes. This review will identify important gaps in knowledge and inform the design of later parts of the project.

Phase 2: Comparing disease trajectories between mild/moderate and severe asthmatics

The quantitative aspect of the study will use routinely collected data from UK general practitioners providing data to the Optimum Patient Care Research (OPCR) dataset. This includes demographic, clinical and treatment variables which will allow robust identification of disease status and enable adjustment for potential confounders (e.g. age, comorbidities). The OPCR dataset contains historical data collected on patients for up to 20 years allowing a detailed investigation of the trajectory of lung function (e.g. FEV1), inflammatory markers (e.g. blood eosinophils), treatment (e.g. corticosteroid dose) and adverse outcomes (e.g. hospital admissions) for patients that progress to severe disease. These trajectories will be compared to those in patients with mild/moderate disease to understand the key differences between the populations.

Phase 3: Identifying severe asthma phenotypes

Cluster analysis will be used to identify distinct phenotypes of progression to severe disease. For example, some patients may experience a slow and steady decline in lung function, whilst others may be characterised by a more rapid deterioration.

Phase 4: Exploring the prognostic value of severe asthma phenotypes

The progression phenotypes (derived from phase 3) will be applied to OPCR data to examine if they are useful in predicting future outcomes. Key questions to this strand will include ‘do certain clusters have a better response to asthma therapies?’, or, ‘are certain clusters admitted to hospital more frequently?’ To better estimate causal relationships this analysis will use linear and logistic regression, and survival analysis, to adjust for potential confounders including age, gender and comorbidities.  

Funding 

*FUNDING CONFIRMED – Department for the Economy (DfE)*

Eligibility for both fees (£4260 for 2018/19) and maintenance (£14,777 for 2018/19) depends on the applicants being either an ordinary UK resident or those EU residents who have lived permanently in the UK for the 3 years immediately preceding the start of the studentship.

Non UK residents who hold EU residency may also apply but if successful may receive fees only.

For further details re eligibility criteria (including academic, citizenship and residency criteria) please click on the following link: View Website

Entry Requirements 

Candidates should have or expect to obtain a 2:1 or higher Honours degree or equivalent in a relevant public health, psychology, economics or social sciences subject

English Language

Candidates applying from countries where the first language is not English should produce evidence of their competence through a qualification such as IELTS or TOEFL score.

The minimum recommended score for the School of Medicine, Dentistry and Biomedical Science is:
• IELTS score of 6.0 with not less than 5.5 in each of the four component elements of listening, reading, speaking and writing taken within the last 2 years;
• TOEFL score of 80+ (internet basted test), taken within the last 2 years, with minimum component scores of; Listening 17, Reading 18, Speaking 20, Writing 17);
• A valid Certificate of Proficiency in English grade A or B;
• A valid Certificate of Advanced English grade A; or
• A first or upper second class honours degree from a university based in the UK, Republic of Ireland or other suitably quality assured location in a country deemed by the UK Border Agency to be majority English speaking.

For a list of English Language qualifications also accepted by the School and University please see the following link:
http://www.qub.ac.uk/International/International-students/Applying/English-language-requirements/#English

The English Language Unit (ELU) offers both pre-sessional and in-sessional courses in English for academic purposes and study skills. Courses vary in length and full information can be obtained from the ELU http://www.qub.ac.uk/tefl/

Supervisors

Dr J Busby

Dr L G Heaney 

How to Apply

Please refer to 'Entry Requirements' for specific admissions criteria.

Apply online via the Queen's on-line application portal .  Guidance is available on the University’s Prospective Student pages.

When applying for a project, please choose ‘MEDICINE’ as your subject area/School.

Please ensure you adhere to the closing dates.

If you have any further queries please contact:  pgoffice.smdb@qub.ac.uk  or +44 (0) 28 9097 2619/2042.

Please visit the School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, website for further details about the Centre