Research Projects - Department of Occupational and Environmental Medicine at Royal Brompton Hospital, London and National Heart and Lung Institute (Imperial College)

Department of Occupational and Environmental Medicine, Royal Brompton and Harefield NHS Trust, National Heart and Lung Institute, Imperial College, London

Research Projects

Paul Cullinan, Jo Szram, Wing Commander Dr Ian Mollan, Wing Commander Dr Gary Davies, Group Captain David Bruce

Asthma in Royal Air Force personnel: measuring severity, control and impact on service careers

Research into the causes and treatment of chest diseases, in particular amongst members or ex-members of the Armed Forces of the Crown.
This study is part of a larger project to develop a stronger evidence base for RAF policy, initially through cross-sectional work to examine the characteristics of disease in the current population of asthmatics in the RAF, relating these to the impact of the disease on their work and career, with comparison to other individuals without asthma. Further work will help to identify key predictors at application that will predict asthma recurrence, together these findings will provide key evidence to help shape future policy.

Meinir Jones, Paul Cullinan

Laboratory animal allergy

To determine whether the prevalence of laboratory animal allergy is reduced in workers working with individual ventilated cages (IVC's) compared to those working with open cages.

Andrew Brant, Paul Cullinan, Professor Sir Anthony Newman Taylor

Baker's asthma

Investigations into the prevalence, determinants and 'location' of baker's asthma in the UK. In addition, assessment of standard and new methods for routine health surveillance in this workforce.

Andrew Brant, Professor Paul Cullinan, Professor Sir Anthony Newman Taylor

Detergent enzyme asthma

Investigations into the determinants of detergent-enzyme asthma including examination of its exposure-response functions.

Professor Paul Cullinan, Jennifer Welch

Egg Allergy

A study of egg allergy in egg research workers.

Jo Szram, Susie Schofield, Stephanie MacNeill, Professor Paul Cullinan

A study examining the relationship between occupation and asthma in an adult population has surveyed 9000 adults with asthma through general practice, in collaboration with Education for Health. The aim is to ascertain the proportion (frequency) of asthma attributable to occupation in the UK population as well as report any regional variations observed. This project is funded by the Royal Brompton and Harefield Charitable Trust.

Paul Cullinan, George Rachiotis

Systematic review of the outcomes of occupational asthma.

Angela Jones, Professor Paul Cullinan, Professor Sir Anthony Newman Taylor, Stephanie MacNeillPre-employment guidance for job candidates with asthma (PEGASUS) (Pre-employment guideline re. asthmatics for use in screening)

Dr Angela Jones, with the help of this project's Steering Group and Expert Advisory Panel, is working on producing guidance for the pre-employment assessment of job candidates with asthma. She is also studying certain research questions, including what concerns occupational health professionals when employing job candidates with asthma in certain jobs and whether a person's asthma trajectory can be predicted by their past asthma experience. To examine these research questions, she is using: a Survey; various systematic reviews; and The Health Improvement Network (THIN) database. This study is generously funded by the British Occupational Health Research Foundation (BOHRF) and the Royal Brompton and Harefield Charitable Trust. Jo Szram, Susie Schofield, Paul CullinanPre-employment assessment of firefighters and RAF recruits

Outcome of pre-employment assessment of firefighters and RAF recruits.
Paul Cullinan, Jessica Harris, Professor Sir Anthony Newman TaylorAMICS

A multi-centre birth cohort in four European populations; concerned with the aetiology of childhood asthma and allergy. Professor Paul Cullinan, Stephanie MacNeill, Professor Sir Anthony Newman TaylorAtopy in Crete

Cross-sectional surveys of rural Cretan populations to examine dietary, infective and other determinants of childhood respiratory allergy. Professor Paul Cullinan, Jessica Harris, Professor Sir Anthony Newman TaylorAshford

Birth cohort (n=642) recruited in Ashford Kent with the purpose of examining the role of allergen and other domestic exposures in the development of childhood respiratory disease. Professor Paul Cullinan, Stephanie MacNeillALEGRO / GABRIEL

Cross-sectional survey of atopic disease in two neighbouring populations of people living in Lower Silesia, south west Poland; recently expanded to large survey of schoolchildren in the same area – in collaboration with four Alpine research groups. Jessica Harris, Professor Paul Cullinan, Angela Simpson (University of Manchester), Graham Devereux (Aberdeen Royal Infirmary)STELAR (Study Team for Early Life Asthma Research)

A review of the Ashford cohort children at ages 12 to 13 years will be pooled with data collected from two other major UK birth cohorts based in Manchester (MAS) and Aberdeen (SEATON). Funding has been secured by the MRC.
Professor Paul Cullinan, Jo Szram, Andrea MarongiuOccupational lung and heart disease in welders

A cross-sectional and panel study looking at the effects of welding fume exposure on welders’ lungs and heart who are working in a repair shipyard in the Middle East; specifically looking at obstructive lung disease and arterial stiffness.
Analysis of historical longitudinal data of welders from the same shipyard.
Literature review and meta-analysis of cross-sectional obstructive lung disease and panel studies on cardiovascular diseases in welders.

Professor Paul Cullinan, Lesley Rushton, Debbie Jarvis, Sara De Matteis, Jon Ayres, David Fishwick, Steven SadhraThe causes of occupational chronic obstructive pulmonary disease (COPD) in the UK

This project aims to provide rigorous, specific evidence on which may be developed a long-term strategy for the prevention of occupational COPD in Great Britain. We hope to achieve this through:

estimating the burden occupational COPD in Great Britain
using information from a large-scale national study (Biobank UK)
by obtaining full job histories and coding jobs to SOC codes for matching to a JEM (Job Exposure Matrix)
applying the above to UK Biobank cohort, initially at its cross-sectional phase; then developing an occupational module
analysing lifetime occupational exposures and COPD in the Biobank cohort.

Jo Szram, Susie Schofield, Professor Paul CullinanSystematic review of effect of welding on FEV decline in collaboration with The Welding Institute (UK). Nicola Cherry (University of Alberta); Gary Burgess (University of Manchester); Corbett McDonaldCohort mortality studies of Stoke on Trent pottery workers. Corbett McDonald, Jessica Harris

Cohort mortality study of gas mask workers exposed to crocidolite in 1940
Cohort mortality study of Montana vermiculite miners and millers exposed to fibrous tremolite

Corbett McDonald; Janet Hughes, Roy Rando, Hans Weill (Tulane University)Cohort mortality studies of workers in American industrial sand plants.
Jessica Harris, Professor Paul Cullinan (in collaboration with National Respiratory Training Centre, Warwick)Hayfever

A study of 1834 young adults sitting their GCSE exams in 2004 investigating associations between hayfever symptoms and exam performance.
Meinir Jones, with Hayley Jeal, Professor Sir Anthony Newman Taylor, Professor Paul Cullinan

Understanding the cellular and molecular mechanisms to both high and low molecular weight allergens in occupational asthma. In particular:
- the cellular and cytokine responses in peripheral blood and mapping of the T cell epitopes.
- the cellular and molecular response in the lungs of patients challenged with diisocyanates
Determining the genetic susceptibility to both high and low molecular allergens in occupational asthma. In particular we investigated:
- HLA association with the development of sensitisation
- IL-13 polymorphisms in the development of sensitisation to occupational allergens
Understanding the role of immunoregulation in occupational asthma since not everyone develops the disease. In particular we are investigating:
- Role of T regulatory cells
- Cytokine response
- IgG, IgG4, IgA antibodies and their possible blocking mechanism
- IgE-facilitated allergen binding (FAB) assay

Stephanie MacNeill, Professor Paul CullinanEMITS study (Environmental Monitoring of an Integrated Transport Strategy)

In June 1999, private vehicles were barred from parts of Oxford city centre and were re-routed to less central parts of the city in a scheme to reduce traffic. We assessed the impact this policy has had on public health by studying the respiratory health of children and routine hospitalisations for cardio-respiratory causes. Professor Paul Cullinan, Fan Chung, James McCreanorDiesel exhaust – Health Effects Institute study – A study of the health effects of diesel exhaust in asthmatics, comparing Oxford Street and Hyde Park. Corbett McDonald, Nicola Cherry (University of Alberta)Natural pollution of well water by arsenic in Bangladesh

Prevalence of arsenic-related skin lesions in 57 widely scattered Bangladeshi villages
Detailed case-control survey of identified skin lesions in relation to arsenic exposure measurements

Yiqun Chen (University of Manchester); Nicola Cherry (University of Alberta); Corbett McDonaldComprehensive analyses of ODIN surveillance data, 1989-2001
Jo Szram, Susie Schofield, Professor Paul Cullinan, Annette Woods, Tessa KasiaLungs At Work in Kent

A study, funded by the Colt Foundation, is examining the impact of respiratory symptoms, COPD and airflow obstruction (FEV1) on present and future employment in 51-60 year olds in Kent.

Phase 1: the initial postal cross-sectional survey of over 20,000 people was completed in 2007. Preliminary results have been presented at the European Respiratory Society meeting in Vienna, 2009; these data demonstrate a significant impact of breathlessness on work performance in this age group.

Phase 2: Just under 2000 volunteers in full time work from Phase 1 have been seen for a detailed clinical assessment, involving spirometry, exercise and muscle strength testing and measurement of fat free mass as well as blood sampling.

Phase 3: Is currently undergoing ethical review with study period planned for 2010-11. Phase 2 volunteers will be surveyed by postal questionnaire to gain information about any job changes that may have occurred and about a third of respondents will be seen for a further, shorter clinical assessment involving spirometry, muscle and exercise testing.