An interview with Assoc Prof. Christian Osadnik on ‘Exercise training for bronchiectasis’

This content is part of the Research in Practice in Respiratory Diseases series of interviews with scientists, focusing on how their research work can have impact on medical practice. Click here to follow 'Research in Practice in Respiratory Diseases' - for free - on Researcher for more great interviews.

Can you give us a brief introduction to who you are, where you work, and what your focus is? 

I am Associate Professor Christian Osadnik, and I'm a physiotherapist based in Melbourne, Australia, working at Monash University. My research is focused on evidence-based personalized medicine for people who live with chronic lung diseases. Within that, a particular focus is on the ways that we can use physical activity and exercise to help improve the health and well-being of people affected by chronic lung disease. 

Can you tell us about your research paper and why this topic is so important? 

This particular study was a Cochrane Systematic Review undertaken in conjunction with two collaborators, Dr. Annemarie Lee, and Carla Gordon. We are all physiotherapists, clinicians, and researchers and we identified there was a discrepancy between what we observe in clinical practice and the evidence that underpins the recommendations for that practice. Pulmonary rehabilitation is an intervention that involves exercise and education, and it's one of the most important non-pharmacological management options for people with a range of lung diseases. It's important because it helps improve a range of clinically important outcomes such as people's fitness, their health and well-being, and it can even possibly reduce future hospital admission risk. The reason we started this research is that much of that evidence is based on other diseases, such as chronic obstructive pulmonary disease or COPD. People with bronchiectasis have a lot of similar issues to those with COPD, but they also have some differences in the way that they present to clinicians. For example, they often have more issues with lung secretions or sputum retention. Even though in Australia, we have guidelines that recommend pulmonary rehab as a treatment option for people with bronchiectasis, that evidence is based on a weak recommendation due to insufficient disease-specific evidence. We wanted to scrutinize exactly what was there was for bronchiectasis. In terms of summarising the key findings, we showed that this is still an under-researched area. We only had, for example, six randomized controlled trials that were directly relevant to our research question. But despite this small body of evidence that was specific to bronchiectasis, we showed that people who did undertake exercise training achieved benefits. The magnitude of improvement exceeds what we call clinically relevant thresholds. So, for fitness or exercise endurance and quality of life, two outcomes that are really important, it's quite relevant to clinicians. The final most important point is that, even though our review showed these benefits for these outcomes, it also highlighted gaps in knowledge. So not just the things that we did find were important but the content that we didn't find is also important. An example of that is that we found no studies involving exercise training for young people with bronchiectasis (children or adolescents), and we only found one study that was relevant to people who might have had a recent exacerbation of their bronchiectasis. So, as well as the things we did find it shows there's also a lot of room for improvement where future research is still needed.

What is the connection between your research and medical practice? And how do you help your work will have an impact on therapies, treatments, and patient outcomes in the future?

One of the nice things about this type of research is it's clinically relevant and therefore it's very translatable. What we mean is that if you were to look at the different stakeholders involved in caring for these people - there are the patients themselves, the health care professionals, and the health service providers - there's still a problem where there is limited awareness of what is out there in terms of evidence to underpin practice recommendations. So even though I mentioned that we highlighted gaps in knowledge and areas to work on for future research, what we also show is that because these benefits were actually of a large magnitude, we still think that it, therefore, casts an important spotlight on how we need to think about exercise as a front-and-center important component of people's health and well-being. We often find exercise is almost an afterthought that medical care is first managed, and perhaps when options are exhausted, we then defer to exercise. But this data, and also our previous lessons from COPD, help to confirm that. If you look at these important outcomes, they do seem to be beneficial in bronchiectasis, as well. If we think about exercise via a somewhat old analogy: it is a cheap intervention; it's got clear prescription guidelines; it has dosage and intensity; and it has minimal side effects like other medical management and pharmaceutical options. This non-pharmaceutical option has equal and important benefits that we should therefore think of as primary medicine, not just an afterthought.

Where could your work lead next? And what's the dream outcome or ultimate aim?

The first fact is that we've identified some gaps in our knowledge and there's certainly room for improvement across the board in terms of the spectrum of people involved in caring for these people. From a research perspective, the fact that we identified these gaps in people who are young, affected by bronchiectasis, and people who have had recent exacerbations means we still don't know exactly the right way to tackle those people. We can't just readily assume that in the studies that exist, the results would equally translate to other different groups. Even within that, there are feasibility issues. For example, in a single study of people who had a recent flare-up, there were practical issues in terms of trying to engage them in the intervention. So even though we might find data that shows benefit, we still have a lot to learn in terms of perhaps what is the right model of care, in terms of how we best engage people at different stages of their condition to make sure that they get the most potential benefit from this treatment. 

Personally, my dream goal from here is that this research underpins a movement that's happening in respiratory medicine at the moment, which is that there's a push for personalized medicine. There's no reason why rehabilitation is not also personalized. There's a future where we need to help people who have got different chronic lung diseases, that if we want to optimize their engagement with this form of treatment, we need to also then empower clinicians, we need to provide the knowledge and support and we need to make sure that we have these flexible programs for people with bronchiectasis who have very individual needs. We need to have the right tools in our belt so that the best treatment is tailored to the person based on their individual needs. That will involve researchers generating evidence for consumers to help inform and guide our direction forward and the healthcare providers to give us the support so that we can then actually implement these flexible models of care that aim to achieve the best outcome for our patients.

You can read and discover Assoc. Prof. Osadnik’s research here.

Exercise training for bronchiectasis is published in Cochrane Library 

Photo Credits: Monash University 

Disclaimer: This is a transcript of a video conversation. You can listen to the recording on Researcher.