Teachers' notes - Professor Ann Woolcock (1937-2001), medical scientist

Professor Ann Woolcock

Contents

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Introduction

Professor Ann Woolcock was interviewed in 2000 for the Interviews with Australian scientists series, before her untimely death the following year. By viewing the interviews in this series, or reading the transcripts and extracts, your students can begin to appreciate Australia's contribution to the growth of scientific knowledge.

The following summary of Woolcock's career sets the context for the extract chosen for these teachers notes. In the extract she discusses her epidemiological studies on asthma and the risk factors that are associated with the development of asthma. Allergens are high on the list, but not all allergic people have asthma. Use the focus questions that accompany the extract to promote discussion among your students.

Summary of career

Professor Ann Woolcock was born in Reynella, South Australia in 1937. She was educated at Reynella Public School and Walford Church of England Girls Grammar School in Adelaide. She graduated in medicine from the University of Adelaide and pursued postgraduate studies in respiratory medicine at the University of Sydney. Her MD thesis, awarded in 1967, was on the mechanical behaviour of the lungs in asthma.

From 1966 to 1968 she worked at McGill University in Canada then returned to the University of Sydney to continue her work on asthma. She became a Member of the Royal Australian College of Pathology in 1970 and a Fellow of the Royal Australasian College of Physicians in 1975.

Her interest in asthma and epidemiology continued with research showing that asthma was caused by allergens but that there is a genetic component. Teams under her direction have defined asthma for epidemiological studies, documented the changing prevalence of asthma in childhood and described important risk factors (eg, diet, parental asthma and an inherited tendency to be hypersensitive to certain allergens). In 1989, she wrote, with others, the world’s first national guidelines for asthma management, the Australian Asthma Management Plan.

In 1984 Professor Woolcock was appointed to a personal chair of Respiratory Medicine. She founded the Institute of Respiratory Medicine, based at the Royal Price Alfred Hospital in Sydney, and opened in 1985. The Institute was renamed the Woolcock Institute of Medical Research in her memory in August 2002.

Woolcock was elected a Fellow of the Australian Academy of Science in 1992. She was a founding member of the Asian Pacific Society of Respirology and served as its president from 1999 to 2000. She was a member of the Organising Committee of the World Lung Conference in 2000 and served as Director of the Cooperative Research Centre for Asthma from 1999 to 2001.

In 1989 Woolcock was made an Officer of the Order of Australia. In 1998 she was awarded both the Society Medal of the Thoracic Society of Australia and New Zealand and the Distinguished Achievement Award of the American Thoracic Society.

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Extract from interview

Most of asthma is driven by allergy

Perhaps your longest-term interest has been asthma. It is a challenging enigma of a disease, with all sorts of genetic and environmental factors. Clearly, one that has been important in your work is allergens, particularly those related to insects. How did that story unfold?

Working with my husband in New Guinea had taught me a lot about epidemiology, a useful tool to find out what things were changing and what the risk factors were. Then we started thinking about the epidemiology of asthma, setting up some epidemiological studies really properly to get a test of airway hyperresponsiveness which we could do in schools. We used a questionnaire and we had the skin prick tests to look at allergens, and airway hyperresponsiveness tests. We set up a protocol but we had lots of stops and starts in getting the methods right. By 1982 we had funding and things were ready. With Jenny Peat, we did studies in Wagga Wagga and a suburb of Newcastle, Belmont.

At about the same time, Wes Green was over in the Department of Medicine measuring house dust mites. Then Euan Tovey came to work with us too – he had done a doctorate with Brian Baldo at North Shore before working overseas with Tom Platts-Mills, the leading house dust mite person in the world, and had returned to North Shore. He was the person who discovered that the major allergen in house dust mite is in their faeces, and he has been interested in that ever since.

Do antibodies to that turn up in asthma patients?

Yes. So when we were doing these epidemiological studies, not only did we measure what was in the children but we went to their houses and vacuumed their beds, or got them to bring dust from their vacuum cleaners, so we could know how much house dust mite they were exposed to. Throughout the 1980s a big controversy raged about whether asthma caused allergy or allergy caused asthma, or whether they were two phenomena in the community that happened to be related. It was clear to me by 1990 that allergy is the hugest risk factor. If you do a logistic analysis on all this epidemiological data from children, there is no escaping that the major risk factor and therefore cause of asthma is being allergic. It is allergens.

I gave a talk at the 1990 meetings of the American Thoracic Society in which I dared to say that I thought asthma was caused by allergens. This was at a pulmonary meeting, not an allergy meeting, and pulmonologists are pretty conservative people. The audience gasped, that I would dare to say something so dramatic. But now, 10 years later, everyone accepts that most of asthma is driven by allergy, even though we don't understand the relationship.

But not all allergic people get asthma

What is the current buzz in allergens?

The problem is that up to 50 per cent of the population and 40 per cent of children are allergic, but only 10 per cent have asthma as we know it. Not all allergic people have asthma, and that is still not explained. There seem to have to be two abnormalities: being allergic and having some other abnormality that turns the airways on to being hyperresponsive.

It seems that to become allergic you have to have a gene (which runs in families) to make a specific IgE when you inhale an allergen. But that gene seems to be present in about half of the population – and it does not seem to be related to race. All races can become allergic, although there is some suggestion that Chinese might be more allergic. The ability to actually get asthma is much smaller, and it is infinitesimal to zero in some populations. For example, children of Australian Aborigines living in the desert in Central Australia virtually have no asthma. In Papua New Guinea village life, they have no asthma. In an Eastern Suburbs home in Sydney, however, you find that up to 30 per cent of the children have wheezed at some time, and probably 11 or 12 per cent of them actually have asthma.

The reason for the huge difference seems to be environmental. The Aborigines are less allergic as children but the parents have the same degree of allergy, of skin test positivity, as Caucasians. So it is as if they acquire the atopy later. And acquiring it later in life does not seem to have as big an effect as getting it as a child. So we know that if you could delay the onset of atopy it would be important.

Whether atopy is actually increasing in the world is not known, because no-one besides us has done serial measurements on the same population cohorts. In Australia it does not seem to be increasing much; it seems that what is happening is that more of the allergic people are getting asthma now. But some of the factors – not just genetic but environmental – associated with being atopic are becoming clearer. There's some interesting data. For example, in large families, the fourth and fifth siblings are very rarely atopic or allergic. If you send your child to child-care, they are less likely to get allergies than if they stay at home.

Some data from New Zealand shows that the more antibiotics given, the more likely children are to be atopic. And the fewer the antibiotics, the less likely they are to be atopic. That suggests that if you get infections, particularly bacterial infections, early in life, you are a bit protected from becoming atopic. More recently, the Italians found that recruits going into the army who were positive – had antibodies – to Hep A and to E. coli and other bacterial gut pathogens were less likely to be atopic. So something to do with eating a little bit of dirt or being exposed to bacterial infections seems to protect you from being atopic.

We still don't know what makes only some people who are allergic get asthma, but those things seem to be related to exposure and to diet. It's a bit complicated. If it was easy, someone would have solved it.

Focus questions

  • Woolcock notes that allergy is the biggest risk factor for asthma. Are you aware of any other risk factors?
  • What does Woolcock mean by 'serial measurements on the same population cohorts'?

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Activities

Select activities that are most appropriate for your lesson plan or add your own. You can also encourage students to identify key issues in the preceding extract and devise their own questions or topics for discussion.

  • Woolcock was associated with a study in 1972 showing that smoking in school-children affected lung function. Other studies have shown that smoking can also adversely affect the heart, the eyes, the throat, the urinary tract, the digestive organs, the bones and joints, and the skin. Ask students to choose one of these organs or organ systems and find out how it is affected by smoking. They present their findings to the class.
  • Using library and internet resources, students find out more about the drugs that are used to treat asthma and how they work. They write a short report on their findings.
  • Students find out more about why the house dust mite is important to asthmatics and write a paragraph on their findings.
  • The rise and rise of asthma (Australian Academy of Science)
    This Nova: Science in the news topic looks at many aspects of asthma – its causes and symptoms and prevention and management. The site contains a glossary of associated terms, a list of activities to help reinforce student learning, suggestions for further reading and a list of other useful sites for learning about asthma.
  • Excellence in curriculum integration through teaching epidemiology (Centers for Disease Control, USA)
    This is a collection of teaching materials that introduce students to the principles and practises of epidemiology, basic biostatistics and outbreak investigation. Includes exercises that allow students to apply information learned during the unit.
  • Asthma (Newton's Apple, USA)
    In this activity students learn about why people with asthma find it hard to breathe. They create a simple model of the respiratory system and then use it to measure the effect of narrowed air passages.

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Keywords

  • allergen
  • asthma
  • atopy
  • epidemiology
  • gene
  • hyperresponsive
  • IgE
  • pulmonologists

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© 2018 Australian Academy of Science

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