PhD opportunity, Edinburgh University

Responsiveness to oral corticosteroids in recurrent wheeze of early childhood

Project Description
Recurrent wheeze of early childhood (RWEC) is very common. Significant wheeze episodes require a hospital stay, and deaths occur but are uncommon. Some children develop asthma. Oral corticosteroids are frequently prescribed for acute attacks (of all severities), but appear to have no benefit and potential side effects. Clinical trials in the recent past have had contrasting results, reinforcing the clinical uncertainty when managing acute wheeze in this population [1,2]. Another recent trial failed as clinicians prescribed oral corticosteroids even in placebo randomised groups [3]. 

We wish to explore whether current trial data can provide better structured evidence to support clinical decision making in RWEC and to further explore whether additional clinical/biological data could more confidently identify those children with RWEC who may respond or not respond to oral corticosteroids in subsequent episodes. 

There will be two complementary components to the PhD: 

(1) To perform a meta-analysis of available data for the use of oral corticosteroids for children with acute wheeze age inclusive 2-6 years. 
(2) In children attending the Children’s Hospital in Edinburgh with acute wheeze, we will study biological factors in children at time of attendance/admission and subsequent at 4-6 weeks when recovered, to determine likelihood of RWEC and potential corticosteroid responsiveness. Clinical history, atopic status and eosinophils will be measured at each time point. 

Supervisors
Prof Steve Cunningham (Professor of Paediatric Respiratory Medicine, University of Edinburgh) 
Prof Steff Lewis (Professor of Medical Statistics, University of Edinburgh) 
Prof Steve Turner (Professor (Personal Chair) Clinical, University of Aberdeen) 

Requirements
This PhD will require high levels of clinical interaction with children and families and we would welcome applicants with a strong academic achievement who could confidently and independently work in a clinical setting as part of a multidisciplinary team. Given the nature of the studies, the appropriate candidate is likely to be a medical or nursing candidate with appropriate degree qualification or 2:1 or higher in a relevant undergraduate degree with desirable skills. 

It would be desirable to have a relevant postgraduate qualification, experience with working with children, computer skills and a willingness to learn clinical techniques including the ability to take blood samples in young children. 

The student would be expected to undertake meta-analysis of individual participant data, understand the pitfalls around responder analysis [4], and the underlying biological evidence for each predictor in the clinical studies. The appropriate student will need statistical experience or a willingness to learn these skills. 

Following interview, the selected candidate will need to apply and be accepted for a place on the PhD programme at an appropriate university 

Enquiries
Please contact Professor Steve Cunningham at [log in to unmask]

Details on application process available on the AUKCAR website: https://www.aukcar.ac.uk/what-we-do/postgraduate/vacancies/edinburgh-4
Closing date 4 Oct 2019
Interviews 23 Oct 2019

References
1. Panickar NEJM 2009 
2. Foster Lancet Resp Med 2018 
3. Guilbert JACI 2019 
4. http://www.rkstatistics.com/news-views/2012/04/23/What_is_a_Responder_Analysis_and_what_are_the_issues/ 

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