Category: Research

Early days of ITARA: perspectives from across three countries on integrating TB and respiratory care

ITARA is a four-year programme, funded by the National Institute for Health and Care Research (NIHR), which is using transdisciplinary research methods to develop novel approaches to integrate tuberculosis (TB) and respiratory care in Africa.

Project staff are based internationally, with researchers in Kenya, Tanzania, Nigeria, the UK, and The Netherlands coming together to develop renewed frameworks for integrated person-centred services for TB and respiratory patients across Africa.

ITARA staff are also pleased to work with charity organisations in this effort. Education for Health Africa is delivering targeted training to healthcare staff across participating sites, strengthening local capacity in respiratory diagnostics and providing ongoing expertise in quality assurance and the interpretation of lung function and related clinical tests. Additionally, Worldwide Radiology is contributing expert radiology services by interpreting chest X-rays, which allows us to gain valuable insights into key lung diseases affecting communities in Africa.

Here, a number of those working on ITARA – including NHLI’s Dr Jamilah Meghji, Dr Joshua Parker Allen and Nicola Yates – reflect on progress so far, and their hopes for the project.

Dr Jamilah Meghji

NHLI, UK

ITARA Co-lead

Our aim in ITARA is to understand how we might bring together tuberculosis and respiratory services to deliver truly person-centered care, in the African context.

This is a complex problem, that demands a genuinely multidisciplinary response. On the clinical side, we’re uncovering which chronic respiratory diseases are most overlooked. Our social science colleagues are investigating the lived experiences, economic implications, and potential pathways to coordinated patient care.

One of the most rewarding aspects of this work has been collaborating with three exceptional female clinical academic leads from our partner sites, an engaged multi-disciplinary team of co-investigators, as well as our PhD and post-doctoral colleagues. Together, we’ve been exploring how differences across settings influence care pathways and what this might mean for future implementation work.

My hope is that the careful, observational work we’re doing at this stage of the grant will lay the foundation for robust, context specific interventions – and that these will genuinely strengthen respiratory care and improve long term patient outcomes.

 

Dr Wanjiku Kagima

Centre for Respiratory Diseases Research (CRDR), KEMRI, Kenya

ITARA CO-I and Kenya site lead

I particularly value the transdisciplinary nature of ITARA, which allows us to combine clinical, social and health economics to solve complex health system challenges.

I want ITARA to provide a roadmap for integrated care. This may lead to a lasting shift in policy where ‘lung health’ is viewed as a single, integrated priority within national health strategic plans.

 

Dr Joshua Parker Allen

NHLI

ITARA Health Systems PDRA

I am the health systems lead, investigating what integrated respiratory care could consist of, what people think about it, and how it could be implemented.

I’m enjoying working with a team of such experienced clinicians and researchers who have so much to teach me. Likewise for the health systems research assistants, who have been fantastic contributors right from the start.

I hope that ITARA can encourage actors to consider complex health systems research and interventions as exactly that – complex, requiring deep contextual knowledge. Terms like integration get thrown around, but its potential to deliver improvements to people’s lives hinges on how it is deployed, who is involved, and what exactly it consists of (and why). I hope that ITARA can demonstrate that doing the slow and careful contextual research can lead to much better healthcare solutions – and better-described problems for them to solve.

 

Dr Adewale Ogundare

College of Medicine, University of Lagos, Nigeria

ITARA Clinical PhD student

The completion of investigations and sharing of results have contributed positively to the diagnosis and treatment for certain participants at the partner sites. Such outcomes are gratifying from a physician’s perspective.

Educating health workers about chronic respiratory diseases (CRDs) improves their awareness and can lead to better patient outcomes through early diagnosis and management.

As mentioned earlier, ITARA is already having an impact. The project is demonstrating the burden of CRDs; developing a framework for TB-CRD integration, as we have set out to do; and making a lasting improvement in chronic respiratory disease care at the partner sites after study completion.

 

Dr Nora Engel

Athena Institute, Vrije University, The Netherlands

ITARA CO-I and Qualitative research lead

I am leading the social science work across ITARA and support the qualitative and health system work packages.

I really enjoy the ambition and commitment by all the ITARA partners to work in a multidisciplinary and transdisciplinary manner, involving societal actors in co-creation of frameworks and tools. This is not easy but necessary to tackle such a complex problem as chronic respiratory disease and care integration which has biomedical, socio-political, environmental, public health and economic dimensions to it.

Approaching this from a systems, multidisciplinary and multi-actor perspective is essential and is paying off in various ways, including the type of knowledge and insights and additional research questions being generated, the mutual benefit in terms of capacity strengthening within the teams and the strengthened ability of all of us to look and think beyond our own disciplinary or institutional boundaries.

ITARA can deliver knowledge on chronic respiratory disease epidemiology, patient and provider experience and economic implications, on avenues for integration with existing care and health systems, and on frameworks of how to adapt approaches to chronic respiratory disease to specific contexts.

 

Professor Stellah Mpagama

Kibong’oto Infectious Diseases Hospital (KIDH), Tanzania

ITARA CO-I and Tanzania site lead

I am serving as the local PI for ITARA, ensuring study is implemented according to good clinical practice in Tanzania.

ITARA is a truly multidisciplinary project, and I greatly enjoy the process of linking and triangulating findings from clinical, social science, and economic components. I also value the continuous reflection and engagement within the team, as well as with external stakeholders, which together embody the essence of real implementation research.

The ITARA initiative will provide practical solutions for many low and middle-income countries (LMICs) on how to effectively organize and implement integrated care for tuberculosis (TB) and chronic lung disease (CLD). While significant progress has been made at the policy level, there remains a critical gap in translating these policies into practice. ITARA aims to address this gap by offering a practical implementation guide to support countries in operationalizing integrated TB and CLD services.

For example, Tanzania has already taken an important step by incorporating lung health into its national TB program. Building on such advances, ITARA will provide the ‘how-to’ guidance needed to strengthen and scale these efforts, ultimately accelerating the integration process in LMIC settings.

 

Elizabeth Joekes

Worldwide Radiology, UK

Contributing to better integrated care of patients with lung diseases in Africa is exactly the kind of work that Worldwide Radiology is all about. Using Chest X-rays to their full potential to learn about key lung diseases in Africa, beyond TB. We are very excited to partner in this project and contribute Radiology expertise.

 

Professor Jason Madan

Warwick Medical School, Warwick University

ITARA CO-I and Health Economics lead

I am a health economist based at Warwick Medical School in the UK. I am an ITARA co-investigator and also mentor a health economist who is completing a PhD in the health economics of integration, based on our work in ITARA.

This has been a very rewarding and stimulating project to work on. I have enjoyed learning more about the practicalities of lung health care in Kenya, Tanzania, and Nigeria. It has been a pleasure working alongside colleagues from different backgrounds and sharing our perspectives on how to improve care.

I hope and expect that ITARA will identify ways that integrating care can improve the lives of people with chronic lung disease, and those of their families. The ITARA health economists aim to contribute by highlighting how integration can be made affordable and how enhancing care can protect people financially as well as medically.

 

Professor Obianuju Ozoh

College of Medicine, University of Lagos, Nigeria

ITARA Co-I and Nigeria Site lead

I am enjoying seeing how capacity is being strengthened among the PHC staff and the research staff. I am also enjoying the nurturing environment we are creating for the ECR and the research staff. Additionally, I am enjoying overseeing the data collection process.  The study set makes it easy to monitor and identify errors early. I’m enjoying working with the management team and the equitable and transformation partnership that we have all established.

ITARA can increase awareness for CRD among healthcare workers and the general population and foster considerations on how these services should be delivered.

 

Yusufu Kionga

KIDH, Tanzania

ITARA Qualitative PhD student

I am a PhD student and social scientist working within the ITARA programme, focusing on understanding how patients, communities and healthcare providers perceive and respond to respiratory exposures, symptoms, and diseases, and co-development of person-centered tools for integrated TB and respiratory care.

What I enjoy most about ITARA is its strong spirit of teamwork and collaboration. The programme fosters meaningful engagement among Early Career Researchers (ECRs) and overall team, encourages knowledge sharing across disciplines, and provides excellent supervision and support. As a student, I greatly value the guidance and mentorship from supervisors, as well as the collaborative environment that allows us to learn from each other and grow together.

ITARA aims to establish a comprehensive framework for integrating tuberculosis (TB) and chronic respiratory diseases (CRDs) within the TB care cascade. The programme has the potential to strengthen health systems by improving early detection, care pathways, and patient-centered management of respiratory conditions. I hope ITARA will contribute to more accessible, responsive, and sustainable respiratory care, ultimately improving health outcomes and quality of life for affected communities.

 

Idah Kinya

CRDR KEMRI and Strathmore University, Kenya

ITARA Health Economics PhD Student

My work focuses on understanding the economic burden faced by people with presumptive TB, alongside the costs incurred by health systems in diagnosing respiratory conditions. But this work goes beyond numbers and models, it is about real people making difficult choices: between seeking care and paying school fees, between buying medication and putting food on the table.

One of the things I enjoy most about ITARA is its truly transdisciplinary nature. Working alongside clinicians, qualitative researchers and health systems experts means we approach the same problem from different angles. Clinicians understand the diagnostic challenges, qualitative researchers capture lived experiences, and I translate these into economic realities. Together, we are not just studying disease, we are studying people, systems and the realities in between.

I hope ITARA helps shift the conversation from disease-specific care to integrated, patient-centered care. Through the health economics work, we aim to generate evidence on the true economic burden of chronic respiratory diseases, highlight the resource implications of integrated care, and develop frameworks that guide decisions on what works, for whom and at what cost.

Ultimately, I hope our work contributes to health systems that do not stop at ruling out TB, but also go further to ensure every respiratory patient receives appropriate, affordable and timely care.

 

Nicola Yates

NHLI, UK

ITARA Programme Manager

I am the Programme Manager, working closely with three enthusiastic Project Managers based in Kenya, Tanzania and Nigeria to ensure the successful delivery of the ITARA Programme.

I enjoy observing and supporting the relationship development between the partners, and their engagement with stakeholders and community members, each bringing their own expertise and knowledge to the project.

The ITARA team, which consists of members from various disciplines and levels of expertise, has consistently encouraged an open exchange of knowledge, ideas, and opinions since the beginning of the programme. I believe this approach has enabled diverse perspectives and lived experiences to guide the programme, ensuring that the observational studies and research will lead to the development of practical and suitable solutions.

 

Okocha Richard Obinna

College of Medicine, University of Lagos

ITARA Qualitative Research Assistant

I am a social scientist for the Nigeria site of the ITARA project based at the University of Lagos, where I contribute to the Health Systems Work Package. My role primarily focuses on health system mapping, a critical component of understanding how care is delivered and how it can be strengthened.

In Lagos, I have been actively involved in mapping healthcare delivery across key facilities, including Ayantuga PHC, Palm Avenue PHC, Mushin General Hospital, as well as the DOT Unit and respiratory clinics at LUTH. Through this work, I engage closely with providers and stakeholders to understand patient pathways, service coordination, and the structural realities of care. This process has been both insightful and rewarding, as it provides a real-world view of how TB and chronic respiratory diseases (CRD) services currently operate.

What I find most meaningful about ITARA is its strong commitment to integrating TB and CRD care to optimize service delivery. In a context like Nigeria, where health systems are often fragmented, this integrated approach has the potential to significantly improve patient outcomes and efficiency of care.

I also value the collaborative nature of the project. Working alongside colleagues such as Josh Parker Allen and the qualitative research teams from Kenya and Tanzania, including Irene Agot and Esther Mokoro, has enriched my perspective and strengthened cross-country learning. The guidance and support from Professors Ozoh and Adewale Ogundare have also been instrumental in ensuring smooth implementation at the Nigeria site.

So far, my experience on the project has been very positive, with no major challenges encountered. I am optimistic about the impact ITARA aims to achieve and proud to contribute to a project that is shaping the future of integrated respiratory care.

 

Joy Obasi-Ehirim

College of Medicine, University of Lagos

ITARA Project Manager, Kenya

In my role as the Project Manager at the Nigeria site, I support the coordination of activities at the site. I work with the team to organize trainings, manage day-to-day implementation, and ensure good communication between everyone involved in the project.

What I really enjoy about ITARA is the focus on teamwork and community engagement. It’s encouraging to see how the project is trying to make real improvements in patient care at the primary healthcare level.

One of the challenges has been retaining participant involvement throughout the study, especially for follow-ups. However, it has pushed us to think of better ways to engage participants and keep them involved.

So far, my experience has been very positive, and I believe the project can make a real difference in improving respiratory care and early TB detection. ITARA is a timely project that addresses major health gaps in respiratory care. Linking TB with other chronic respiratory disease ensures holistic care and support for patients who often face such conditions.

 

Cynthia Marcillinus

University of Lagos

ITARA Clinical Coordinator, Nigeria

The challenges I have experienced include stigma around TB, which causes some patients to avoid testing or drop out of treatment. Some participants require extra patience and long convincing before they can participate. We have also come up against delayed diagnosis at health centers, due to reduced knowledge on disease process.

On the more positive side, I have learnt from other team members from different health care systems by observing their approach to service delivery. Working on ITARA has helped me to understand the importance of developing a good relationship with the community workers and participants too.

You can find out more about ITARA on their project webpage.

Reflections on the 22nd International Vasculitis Workshop

“It was remarkable to see how my work resonated with others and stimulated meaningful academic dialogue.”

Annie Alocious, a fifth-year medical student at Imperial College London, recently received the Justin Mason Travel

Grant from NHLI to present her First Class BSc project (completed at NHLI last year) at the International Vasculitis Workshop two weeks ago. Here, she shares her reflections on traveling internationally to share her work for the first time.

I am deeply grateful for the support of the Justin Mason Memorial Fund, which enabled me to attend the 22nd International Vasculitis Workshop in Melbourne, Australia from February 21–25, 2026. I presented my intercalated BSc project, awarded First Class Honours, titled “Impact of immunosuppression on collateral formation in Takayasu arteritis”. This opportunity proved to be a profoundly enriching experience, both personally and professionally.

I never imagined that my journey as a medical student would take me across the world, and visiting Melbourne for the first time was a highlight. In my short time there, I experienced the unique beauty of Australia, from kangaroos and koalas to witnessing the little penguins native to Melbourne’s Phillip Island. This vibrant setting made the professional milestone even more memorable.

This conference marked my first oral presentation at an international meeting, representing a pivotal moment in my academic journey. Having dedicated the past year to my research, often working in isolation and sharing updates mainly with my supervisors, I found it both daunting and exhilarating to present my findings to a global audience. I remember taking a deep breath before looking out at the room of over a hundred attentive faces. Their encouraging smiles and photographs they took of my slides felt like a validation of the work’s significance, strengthening my confidence not only in public speaking but also in the academic rigour of the project itself.

After the presentation, clinicians from around the world stood to offer their perspectives, sparking thoughtful discussions that broadened my understanding of a subject I had previously considered niche. It was remarkable to see how my work resonated with others and stimulated meaningful academic dialogue. I was also honoured to contribute to asubsequent panel discussion among leading researchers in the field.

The opportunity to meet and learn from renowned experts, many of whose names I recognised only by their publications, was invaluable. It was a privilege to speak with several of Professor Mason’s colleagues and friends, who fondly recalled his character and expressed admiration for his contributions. Similarly moving was the connection with patient representatives from Vasculitis UK, who emphasised the real-world impact of our research. These conversations echoed my experience the previous year at Hammersmith’s Large Vessel Vasculitis clinic, where I had met many patients who had been under Professor Mason’s care.

I remain especially thankful to Professor Mason, whose legacy endures through the mentorship of my supervisors, Dr Taryn Youngstein and Dr Andrew Porter. Their guidance, which began during my BSc project and continued through this presentation, has been foundational to my development. I am certain that their supportive and insightful approach reflects Professor Mason’s own dedication to teaching and nurturing future clinicians and researchers. This generous travel grant, awarded in his name, covered essential costs including flights, accommodation and conference registration.

This experience has inspired me and solidified my desire to pursue a career in academic medicine. The encouraging reception of my work has further motivated me to continue this project and pursue its publication as my debut first-author paper. Being exposed to leaders across rheumatology, vascular medicine, cardio-immunology and other specialties highlighted the vital role of interdisciplinary collaboration and provided much to reflect on as I weigh my future specialty path. Above all, it renewed my belief in the importance of remaining curious, engaged and dedicated to research that tangibly improves people’s lives.

Dr Adela Constantinescu-Bercu on life as a Postdoctoral Research Associate

“The ability to present complex findings in a structured and accessible way is fundamental to advancing science.”

Dr. Adela Constantinescu-Bercu is an MRC-funded postdoctoral research associate at the NHLI, currently investigating the effects of Von Willebrand Factor (VWF) on vasculature as part of Professor Anna Randi’s research group. She has presented her research at a number of conferences, including the International Society for Thrombosis and Haemostasis (ISTH) Congress in Washington DC, US, the GRC in Vascular Cell Biology in Maine, US, and the BIC International Conference in Padua, Italy, and recently saw her work published in Blood.

We spoke to Adela about her research, her experience at Imperial, and what she has learnt in her time as a postdoctoral fellow.

What is Von Willebrand disease, and what is the focus of your current research into it?

Von Willebrand Disease (VWD) is the most common inherited bleeding disorder. It occurs when there is either a deficiency of Von Willebrand Factor (VWF), or when its function is affected. Patients with VWD can present vascular abnormalities (angiodysplasia) in the gut, which leads to gastro-intestinal bleeding – a major unmet need in these patients, as this often does not respond to conventional therapies.

VWF plays a crucial role in haemostasis, preventing us from bleeding during vessel injury. Our lab has previously shown that VWF also regulates angiogenesis (the formation of new blood vessels from existing ones). My research focuses on understanding how VWF affects angiogenesis with the aim of identifying new therapeutic targets for angiodysplasia in VWD. As part of my MRC postdoctoral project in Professor Anna Randi’s lab, I developed a vascularised ‘gut-on-chip’ model to study angiodysplasia in VWD. This is a personalised approach using patient-derived endothelial cells called ECFCs and revealed that patients lacking VWF present vascular remodelling defects that can be corrected with an anti-angiogenic drug, against angiopoietin-2.

Do you have any morning rituals to set you up for the day?

My mornings are largely structured around my daughter, who is in Year 1. Preparing her for school, having breakfast together and talking about the day ahead are central to our routine. It is safe to say she knows a lot more about blood vessels that other 5-year-olds do!

Once I drop her off at school, I start my workday properly. I take a few minutes to review my own priorities, look over the experiments planned and any deadlines pending. This brief moment of reflection helps me transition into work with clarity and focus.

Do your working days follow a similar pattern, or are they quite varied?

There is a general rhythm to my week, but my days are quite varied. Some are spent in the laboratory running experiments, or supervising Masters students. Others are focused on data analysis, writing or meeting collaborators. We also have weekly group meetings as well as section meetings where we present our results, engage in interesting discussions and receive constructive feedback. I also regularly attend webinars or seminars led by internationally recognised researchers, organised by NHLI, and participate in national and international conferences.

The multi-disciplinary aspect of this project also included a more unique start. I began working on this project by moving to Milan, to join our collaborator’s laboratory at Politecnico di Milano. Here I worked with Professor Marco Rasponi, in the Bioengineering Department, learning how to design and produce the microfluidic organ-on-chip devices I then implemented at Imperial. I was there for 3 months, which proved to be an adventure not only due to the steep learning curve of a field I never worked in before (bioengineering), but also from a personal perspective, as I moved there with my husband, daughter (who was 3 years old at the time) and dog. It was a true team effort, which proved to be very rewarding, culturally and professionally.

What do you enjoy the most about being part of Professor Anna Randi’s research group?

What I value most about being part of Professor Randi’s research group is the combination of high scientific standards and a genuinely collaborative atmosphere. There is a strong emphasis on critical thinking, and discussions are both rigorous and supportive. Group meetings and one-to-one discussions are spaces where ideas are encouraged and challenged, so that these are strengthened and refined. I also really enjoy the highly collaborative environment, which facilitates a multidisciplinary approach to the research.

Professor Randi’s mentorship is also essential, given her genuine investment in the professional growth of everyone in the group. I have greatly benefited from her guidance regarding my long-term career development, particularly this year, when I am preparing to apply for my first fellowship. I consider her a role model for the researcher I hope to become. Being part of her group has shaped both my scientific perspective as well as my aspirations as a researcher.

What are the next steps in developing the vascular “organ-on-a-chip” model?

The next steps for the vascularised ‘gut-on-chip’ focus on increasing its physiological relevance and experimental robustness. Our immediate priority is to refine the system so that it more closely reflects the gut microenvironment. This includes integrating intestinal epithelial cells to recreate the interface between the epithelium and underlying vasculature, enabling us to study the crosstalk between epithelial and endothelial cells.

In parallel, we aim to introduce controlled mechanical stimulation to mimic peristalsis. This work in progress is achieved using an actuation pump to recapitulate the dynamic conditions of the intestinal environment and study how mechanical cues influence vascular integrity and tissue homeostasis.

The long-term goal is to also establish a reliable platform for translational research, which can be used to study disease mechanisms and assess potential therapeutic strategies in a system that more closely reflects physiological conditions.

Why is this research important to you, and what do you hope it could achieve?

This research is particularly meaningful to me because it connects fundamental vascular biology with real clinical implications. A deeper mechanistic understanding of the link between VWF and vascular abnormalities not only has the potential to refine the management in VWD, but also to inform broader vascular and haemostatic disorders where endothelial dysfunction plays a central role.

What are the most important things you have learnt from presenting and publishing your research?

One of the most important lessons I have learnt is that clear communication of the data is crucial. The ability to present complex findings in a structured and accessible way is fundamental to advancing science.

Presenting my work at conferences and seminars has also shown me how valuable networking is. Meeting experts from all over the world has led to new ideas, fresh perspectives and, in some cases, the beginning of new collaborations. The informal conversations after a talk or during a poster session are very important, especially at a career stage where developing an international network can shape future projects and opportunities.

The peer-review publication process has taught me resilience and openness to feedback. Constructive feedback strengthens the quality of the research and often provides perspectives that improve the final work. Publishing feels not like an endpoint, but rather like contributing to an ongoing scientific conversation.

Trialling Nalbuphine ER as a treatment for Cough in Idiopathic Pulmonary Fibrosis: An interview with Professor Philip Molyneaux

“Finding a specific treatment for chronic cough in IPF could have a huge impact on patients’ lives.”

Philip Molyneaux is Professor of Interstitial Lung Disease at the National Heart and Lung Institute, the Asthma + Lung UK Chair of Respiratory Research, and Director of the NIHR Clinical Research Facility at the Royal Brompton Hospital, where he is also a Consultant in Interstitial Lung Disease.

We spoke to Professor Molyneaux about his ongoing research into the treatment of cough in Idiopathic Pulmonary Fibrosis (IPF), after the conclusion of a successful phase two trial.

Can you summarise your research and what you found in plain language?

We have been trialling a new drug, Nalbuphine ER, for the treatment of cough in patients living with Idiopathic Pulmonary Fibrosis (IPF). IPF is a scarring lung disease and around 80% of people with the condition suffer with chronic cough. This worsens their quality of life and currently there are no treatments available.

We recently ran a phase two clinical trial, in which 165 IPF patients with chronic cough were either given one of three different strength doses of Nalbuphine ER, or a placebo, for six weeks. We recorded the number of coughs-per-hour in each patient over the first and last 24 hours of the study and found that the cough count dropped across all three doses of the drug compared to the placebo, with the strongest dose proving to be the most effective. We also asked patients about their own perception of the rate and severity of their cough; those taking the two stronger doses of the drug noticed a significant decrease in their symptoms.

“Our research shows that the mechanisms we are targeting improve cough, helping us to gain a deeper understanding of IPF and its symptoms.”

Why is this research important? What problem does it address? 

Finding a specific treatment for chronic cough in IPF could have a huge impact on patients’ lives. Current treatments are simply borrowed cough treatments for other respiratory conditions. They are often ineffective and trialling them wastes time – something which is in short supply when it comes to IPF, which has a life expectancy of only three and a half years. 

Previous studies have shown that cough has a detrimental effect on the lives of patients with IPF. It can contribute to anxiety and depression, as well as causing incontinence and even blackouts. Plus, in the aftermath of the Covid-19 pandemic, coughing has been socially stigmatised. All these things can threaten IPF patients’ quality of life, which is why finding a disease-specific treatment is so important. 

What are the most significant findings or outcomes? 

Our trial, which recruited at the Royal Brompton Hospital’s Cardiorespiratory clinical research facility, is the first positive head-to-head placebo-controlled study into IPF cough. It shows that there is potentially a treatment which could improve IPF patients’ quality of life, as opposed to simply slowing down the progression of the disease. We hope that Nalbuphine ER could become a useful treatment for IPF cough, but more research is needed to confirm this, and to check the drug’s long-term safety.  

How might this research impact policy or the public? 

Policy, as all medical researchers will know, must change when a new drug is approved. Nalbuphine ER is a drug that has been used previously, as an injectable post-operative painkiller; our version is in a tablet format, with a different indication. If Nalbuphine ER is approved as a treatment for IPF cough after a phase three trial, treatment guidelines would hopefully change rapidly as there are no other options.  

When it comes to the public, cough takes up a lot of healthcare resources, including some people might not expect, such as occupational and speech and language therapists. If IPF patients’ coughs improve, these finite resources will be freed up for others who may need support. 

How do these findings advance knowledge or practice in your field? 

Our research shows that the mechanisms we are targeting improve cough, helping us to gain a deeper understanding of IPF and its symptoms. While this is crucial as it gives us clues into how IPF cough works and how it can be best treated, there are still many questions to ask. 

We are unsure whether Nalbuphine ER will work for all patients with IPF and cough. We don’t know if reducing cough can slow disease progression, nor do we know why some IPF patients cough more than others; perhaps this knowledge will arise tangentially from the work we are doing. Moreover, we are currently only looking at idiopathic pulmonary fibrosis, so there is a possibility that Nalbuphine ER may work for those living with non-idiopathic or familial pulmonary fibrosis too. 

Does your work tie into any wider research? 

There is so much great research happening around the impact of cough and whether it is the same across all fibrotic lung diseases. From what we can tell, it seems to be very similar to IPF, which suggests that Nalbuphine ER could be used to treat cough in a range of respiratory conditions. 

We would also like to look at whether cough comes from the brain, the nerves, or the lungs by conducting MRI scans to observe what happens in the brain when someone is coughing and examining lung volume changes in people with chronic cough. 

What are the next steps? 

The next step is a phase three trial, looking at a larger patient population for a longer duration to ensure the benefit is sustained. We are hoping to start this study later this year.  

Material deprivation increases the burden of COPD on individuals and the healthcare system

 

 

What does a future with better lung health look like — and what will it take to get there? On World COPD Day, Professor Nick Hopkinson and Dr Keir Philip from the National Heart and Lung Institute explore new evidence that highlights the urgent need for action. COPD is not just a disease of the lungs; it’s a condition deeply rooted in poverty and inequality. From early-life disadvantage to harmful exposures like tobacco smoke, air pollution, and poor housing, deprivation shapes both who develops COPD and how they live with it.

It is well established that chronic obstructive pulmonary disease (COPD) is linked to poverty and inequality[1] . The exposures that cause people to develop the disease – tobacco smoke and air pollution as well as occupational dust, fumes, and chemicals are linked to deprivation. Early life disadvantage – poor nutrition, infections and lack of access to healthcare, also hampers normal lung development, increasing the risk of COPD.

On World COPD Day, we have published the results of research done in collaboration with the charity Asthma + Lung UK demonstrating that material deprivation doesn’t only cause COPD. It also influences what happens to people once they have the condition, and how this in turn increases the burden on individuals and the NHS[2].

In a large national survey of 3,472 adults with COPD, we examined how material deprivation relates to emergency and unplanned healthcare utilisation (EUHU) such as attending A&E. Material deprivation refers to not being able to afford certain basic things in life like energy bills, adequate food, or keep your house warm. Many of these are basic requirements for living well with lung conditions and avoiding acute deteriorations. EUHU are costly for both the patient and the healthcare system, and accident and emergency departments are struggling to cope. In our study we found individuals experiencing material deprivation had a 27% higher odds of more frequent unplanned healthcare use, independent of age, gender and smoking status.

A particularly important finding was the strong association between inadequate home heating and cold or damp housing and increased EUHU. Over one in four participants reported being unable to keep their home adequately warm, and cold or damp living conditions were clearly linked to a higher likelihood of emergency care.

These results further extend findings that poor-quality housing—especially cold and damp environments—is closely linked to unplanned healthcare use in COPD[3]. Such living conditions are known to worsen respiratory symptoms, increase susceptibility to exacerbations, and limit the effectiveness of self-management.

The government was elected with a manifesto commitment to deliver a cross-government health mission. The introduction of Awaab’s Law requiring providers of social housing to address problems quickly is crucial step in the right direction, but it needs to be extended to private landlords as soon as possible, alongside broader redistributive policies to end poverty, in particular child poverty.

The findings of this research reinforce the need for comprehensive policy interventions to improve housing conditions and thus improve lung health, in order to reduce avoidable emergency care, alleviate pressure on the NHS, and improve the lives of the more than one million people living with COPD in the UK.

 

 

1               Williams PJ, Buttery SC, Laverty AA, et al. Lung Disease and Social Justice: Chronic Obstructive Pulmonary Disease as a Manifestation of Structural Violence. American Journal of Respiratory and Critical Care Medicine 2024; 209:938-946

2               Adesibikan A, Williams PJ, Cumella A, et al. Relationship of material deprivation with emergency or unplanned healthcare utilisation in adults with chronic obstructive pulmonary disease: analysis from an Asthma+Lung UK survey. BMJ Open Respir Res 2025; 12

3               Williams PJ, Cumella A, Philip KEJ, et al. Smoking and socioeconomic factors linked to acute exacerbations of COPD: analysis from an Asthma + Lung UK survey. BMJ Open Respiratory Research 2022; 9:e001290