Professor Andy Bush has been at the forefront of paediatric respiratory medicine and research for over three decades. Most recently, he was awarded the Royal College of Paediatrics and Child Health’s highest honour – the James Spence medal – for his outstanding contribution to the field. He spoke to Julie Penfold about his career highlights, his passion for improving children’s respiratory health and campaigning to ban the promotion of e-cigarettes to young people, and his research into the early origins of asthma.
At the outset of his career in respiratory medicine, Professor Andy Bush initially worked in adult medicine as a trainee chest physician. At the time, he didn’t have any intention of going into paediatrics.
What changed the course of his career was working in a research role in the physiology laboratory led by the late Professor David Denison in the field of pulmonary circulatory physiology. He credits the nearly five years he worked with Professor Denison as being one of his standout career highlights.
‘David Denison was undoubtedly one of the main influences on my career. He was a brilliant respiratory physiologist. At the time, he was collaborating with Dr Elliot Shinebourne who was a great paediatric cardiologist, and I got involved with their research,’ explains Professor Bush.
‘As the research became more and more paediatric, I decided to dip my toe in the water and take on a paediatric job. I went to University College Hospital in London, UK, where I worked as a very junior trainee in the neonatal intensive care unity headed by the legendary Professor Os Reynolds. The job nearly killed me, but it was terrific, and I’ve been in paediatrics ever since.’
Indeed, Professor Bush has been a consultant paediatric chest physician at the Royal Brompton Hospital in London for more than 30 years. He is also professor of paediatrics and paediatric respirology at Imperial College London.
Recently, he was ‘immensely surprised and thrilled’ to learn he had been awarded the Royal College of Paediatrics and Child Health’s (RCPCH) highest honour, the James Spence Medal, for 2024, alongside an honorary fellowship. This highly prestigious medal is awarded by the RCPCH for outstanding contributions to the advancement of knowledge and understanding in paediatrics and child health. But he says it’s an award for his whole team.
‘I had no idea anyone had nominated me for it,’ he says. ‘I’m part of an incredibly brilliant team that also includes nurses, physiotherapists, pharmacists, psychologists and dietitians. If you’re going to look after a child who has a complex condition properly, no one person can do it flying solo.’
Professor Bush and public health campaigning
Campaigning on public health issues is something that’s very important to Professor Bush. ‘As clinicians, we see the consequences, we read the scientific literature, we see the studies and we can actually produce the evidence,’ he explains. ‘We can and should use this to convince the policy makers that, actually, something needs to be done.’
Professor Bush has had longstanding involvement in a campaign to introduce legislation to stop the advertising and promotion of e-cigarettes to young children, based on a concern that ‘nobody actually knows what they contain’.
He says: ‘There’s a statement that they are 95% safer than cigarettes and it’s based on no evidence whatsoever. What we do know is if you inhale e-cigarettes, you can get an acute lung injury and end up in intensive care.
‘For young people to be inhaling these toxic chemicals into their lungs is really frightening, particularly since there’s evidence of vulnerability. There’s enough animal data to make me really worried about the safety of e-cigarettes. It’s a subject I feel very strongly about.’
In 2024, the UK Government confirmed the marketing, sale and supply of disposable vapes will be banned in the UK from 1 April 2025.
While this is welcome news, Professor Bush feels enforcement is needed to really make the ban work, which is also something a British Medical Association report recently championed.
Treatment cost challenges
There are plenty of opportunities to make a difference to children and young people’s health in terms of the range of treatments clinicians in the UK can now offer. However, prohibitive costs for some of these is creating barriers to treatment.
‘Basic science is delivering us the most fantastic new treatments such as the new medications for cystic fibrosis such as Kaftrio, Symkevi and Orkambi. These are absolute game changers as these modulator drugs work by correcting basic defects and making the abnormal proteins work. It’s really fantastic science. But one of the challenges of offering these treatments is the cost as the NHS spends around £1bn annually on them,’ Professor Bush explains.
‘Another example is a promising treatment for the rare condition spinal muscular atrophy. In its most severe form, a baby will never sit up or walk independently, but this now seems to be curable with gene therapy,’ he continues. ‘But a single injection of gene therapy costs the NHS £1.7m. In this country, we are getting a lot of these expensive medications, but across the world, there are places that just simply can’t afford them, so cost is a big challenge.’
Promising asthma origins research
Professor Bush’s research interests include the invasive and non-invasive assessment and measurement of airway inflammation in asthma and cystic fibrosis. This includes the use of endobronchial biopsy in the management of severe asthma, and also respiratory mass spectrometry.
He and his team are currently focused on researching the early origins of asthma. ‘There is a lot of evidence that if as a baby you are in an environment of high bacterial diversity, such as on a farm, you are less likely to develop asthma,’ Professor Bush explains.
‘Collaboration with a team led by Professors Saglani and Lloyd at Imperial College has led to beginning to unpick how specific environmental bacteria suppress the development of allergic disease in babies, and the next step after understanding the pathways to allergy and asthma is to design treatments to prevent it – not all babies are going to be brought up on a farm!’
As such, with support from the Wellcome Foundation, his team has recruited a birth cohort of over a thousand mothers and their babies. Samples, such as brushings from the inside of the lung and nose, are taken in the first two weeks of life, analysed for infection and then followed up as they get older.
‘What we’re learning is when you look at a child when they’re first born, those who are going to go on to have asthma will have reduced lung function compared to normal,’ Professor Bush explains. ‘Over the first five or six years of their life, they lose more lung function. They go through a phase of routine viral colds with wheezing and not much in the way of allergy to then developing allergic asthma. But what drives that? If we could find a pathway to stop a child going down the route to develop asthma, it would be such a major thing to do.’
Similar research was undertaken by the Tucson research group in which they followed up 849 of the 1,246 newborn babies who were enrolled in their original children’s respiratory study. They found for some participants the onset of asthma started from their mid-teens to early 20s. Yet this wasn’t a new onset as these individuals had previously experienced asthma symptoms such as wheezing and airway obstruction when they were aged four to six years.
‘What drives those who go into remission and stay in remission is fascinating. If we could switch someone to go into remission who would otherwise go on to have asthma, it would be really exciting,’ Professor Bush adds.
Looking to the future with Professor Bush
On the horizon, Professor Bush sees more care and monitoring taking place in a patient’s home so regular trips to hospital can be phased out. For conditions such as bronchiolitis, his team is currently looking to find subgroups with particular problems so they can devise a targeted therapy. ‘I also think, increasingly, we will see a move to personalising medicine rather than having a one-size-fits-all approach,’ he says.
Training the next generation of paediatricians is also important to Professor Bush. He has co-supervised more than 50 doctoral students, and more than 100 of his trainees now occupy senior clinical and academic positions.
‘What you really want to do is train people up to be much brighter than you and that, I think I can say without fear of contradiction, I’ve managed to do,’ he says. ‘I’ve been lucky in my career to work some very bright young people who are absolutely soaring ahead in their careers now which is brilliant.’
This article is part of our Clinical Excellence series, which offers valuable first-hand insights into how experts from renowned Centres of Excellence are pursuing innovative approaches to optimise patient care across the UK and Europe.
