Smoking may be the leading cause of Chronic Obstructive Pulmonary Disease (COPD), yet one in three Singaporean patients with this often fatal condition is a non-smoker, a rate that is higher than in the US or UK. Other common chronic lung diseases too affect Singaporeans and Asians differently from Caucasian patients.
Taking on the challenge to understand the unique characteristics of lung diseases in Singapore and improve prevention, treatment and services, LKCMedicine formed The Academic Respiratory Initiative for Pulmonary Health (TARIPH).
Officially launched by the Director of Medical Services at the Ministry of Health Associate Professor Benjamin Ong at the 2nd International Symposium on Respiratory Research on 19 March, TARIPH will help Singaporeans breathe more easily through bench-to-bedside research.
In launching the initiative, A/Prof Ong said, “Given the very high burden of lung diseases, the importance of upstream interventions in reducing healthcare burden should be emphasised.”
These do not just include public health policies and educational campaigns, but also research and innovation.
“We will continue to invest in research and innovation for better health outcomes for our patients. Research and innovation can potentially discover better ways to maintain healthy lungs and prevent disease,” he added.
Elaborating on the vision behind TARIPH, LKCMedicine Dean Professor James Best said, “TARIPH will focus on the full spectrum of research – from bench to bedside and to the population.”
An interdisciplinary, international partnership
For a start, TARIPH will bring together more than 30 investigators from local and international institutions to generate evidence on how lung diseases present and develop in local patient populations. They come from diverse backgrounds, ranging from engineering and data analytics to epidemiology and clinical medicine.
The investigators represent Singapore’s research agencies, hospitals, and polyclinics, as well as international partners such as the University of Newcastle, Australia; Imperial College London; University of British Columbia, Canada; and the Karolinska Institutet, Sweden.
Slated to start sometime during the third quarter of this year, TARIPH’s flagship project Phenotypes of Respiratory Disease will detail the characteristics, behaviours and progression of respiratory diseases specific to Singapore.
At the launch of TARIPH, LKCMedicine Executive Vice-Dean Professor Lionel Lee said, “Lung diseases, we now know, affect patients of different ethnicities differently, and yet...in Asia, treatment guidelines and recommendations are largely based on evidence from Caucasian cohort studies.”
Other TARIPH projects
TARIPH brings together investigators from Singapore and overseas to tackle chronic lung diseases in a collaborative and interdisciplinary way. Projects span the whole research chain – from bench to bedside and service delivery, and include:
Fungal Profiling of Bronchiectasis
This study is led by investigators from LKCMedicine and involves TARIPH members from Tan Tock Seng Hospital, Singapore General Hospital, Changi General Hospital, A*STAR Institute of Molecular & Cell Biology and Genome Institute of Singapore. The team has found that the rate of fungal infections underlying bronchiectasis, a disease in which there is permanent enlargement of parts of the airways of the lung, is remarkably high in Asian populations. As well as causing irreversible lung damage, these infections also induce greater allergic responses in Asian patients that need to be treated. In addition to setting out localised guidelines that take these factors into consideration, the team is also looking into developing new rapid diagnostics to identify patients early, so that further damage to 'already damaged lungs' can be prevented.
Barriers to accessing care in the community
Many patients with chronic lung diseases, such as asthma and chronic obstructive pulmonary disease (COPD), seek help very late, when they are already unwell and need urgent treatment. A team of TARIPH collaborators at LKCMedicine and in the polyclinics will study the factors that prevent patients here from seeking help early, and identify potential touchpoints for meaningful interventions, which will be evaluated through nationwide clinical trials.
Understanding early inflammatory, infectious and immune changes in COPD
This project examines the molecular mechanisms of early COPD using a novel cohort of Singaporean smokers at risk of lung function decline and thus COPD. Participants will be recruited through collaboration with local TARIPH clinicians, primary care leaders and NTU’s newly established Centre for Population Health Sciences. The study aims to identify early signs of COPD to develop new biomarkers and targets for therapeutic intervention.
LKCMedicine Assistant Professor of Molecular Medicine Sanjay Haresh Chotirmall, who is the Academic Co-Lead of TARIPH together with Associate Professor of Exercise Physiology Fabian Lim, said, “We must understand why Asian respiratory disease is different, and dedicated research is the optimal way to do this. Our flagship project addresses this need and aims to bring the benefits of academic research closer to our patients.”
The project will allow medical decisions, practices and interventions to be tailored to Asians and the individual rather than the disease. It will develop new DNA-based tests for common lung infections.
TARIPH will also study the economic and social costs of respiratory disease in Singapore and examine how to improve the ways chronic lung disease patients access care.
In a special session just after the launch, a group of TARIPH members from academic as well as primary and tertiary healthcare institutions presented the latest research and data on lung health and disease in Singapore.
With Singapore’s rapidly ageing population and contributing factors such as environmental pollution, the prevalence of respiratory diseases is likely to worsen. United under the TARIPH initiative, the members made a strong case that they will be ideally placed to spearhead applicable and relevant research to address this challenge.