Sejal Saglani

Sejal Saglani is a Professor of Paediatric Respiratory Medicine and Head of the Inflammation, Repair and Development Section at the National Heart and Lung Institute.

Serendipitous scientist

I did not ever plan to be an academic. At 18 years old I decided I was going to be a doctor, I liked sciences and I wanted to do something applied – that would have a practical outcome - so I went into medicine. But I had no idea that I would be an academic until after I did my postgraduate degree. In fact, even by the end of that, although I’d really enjoyed it I thought I would be a full time clinician. However it just happened that there was an opening at the Royal Brompton Hospital as a clinical academic with the National Heart and Lung Institute (NHLI). I was asked if I might be interested, at which point I was completely shocked, because I didn't think I'd ever be good enough to do that. I was then lucky enough to get a fellowship, and it went from there. It wasn't something that was planned by any stretch.

I'm definitely British, I guess British Asian. I was born in Tanzania. Then my parents moved to England for economic reasons. I came here when I was two years old, so I don't really remember Tanzania at all. I grew up in Leicester. We were a working class family, my father and mum both worked in a factory. My father did nights, and mum did days. I went to the local primary school, but luckily my headmistress thought I was bright and encouraged me to go for a scholarship for the 11 plus so I went to quite a good secondary school. Then my family moved to London when I was 13 and I started at the local comprehensive, then six form college in London, and back to Leicester for university.

When I did my first paediatrics placement as part of my medical training, I thought “this is for me”. And my first year as a Junior House Officer I was lucky enough to get another paediatrics placement. It happened to be a firm that specialised in respiratory disease. My mum has asthma and I also have asthma, so I guess there's a bit of a connection there, but it was respiratory from that point on. I chose asthma I think just because it interested me the most - because it's common, but we're not very good at managing it despite it being so common. Also I think it's sometimes underplayed, it's seen as “just asthma” - but it can have severe and lasting impacts on people’s lives.

I’m looking at structural changes that happen in children’s lungs because of asthma. These changes are probably what determine lifelong damage"

Without teamwork and support from everyone in my Section, I would not be a successful leader, but I also don't think any of the Principal Investigators would be as successful in their research"

We all have good days and bad days. Chocolates are the thing I turn to"

Object one: Inhaler with spacer

My research focuses on breathing problems in children, and very specifically asthma in children from very early in their life. So preschool aged children up to school age, focusing mainly on very severe asthma. What we're trying to do in the very young ones is work out what makes them have the symptoms of wheezing. And what determines which of those preschool wheezers will develop asthma, because not all of them will - only about a third. We're trying to work out what drives symptoms and wheezing, to find new treatments for the attacks that they get, but also to prevent them from going on to get asthma. We already know from lots of studies that the earlier children start to wheeze, the more frequently they wheeze, and the more severe their episodes, the more likely they are to have a loss in their lung function really early on in childhood. This then carries on with them through to adulthood - there's a lifelong impact – so the earlier we can intervene, the better. For the older school aged kids again it's about what's driving their attacks and their disease, to try and find new therapies with the aim of essentially trying to find what I would say is a ‘cure for asthma’, because at the moment, all we've got are treatments that reduce asthma symptoms.

One of my main interests is looking at the structural changes that happen in the lungs because of asthma, we call this remodelling. Not many people around the world look at that in children so it's quite a unique thing that we do. And we think that those structural changes are probably what determine the lifelong damage. I think we were probably amongst the first to say that. The next thing is what do we do about it? How can we improve it? For some children the things that cause symptoms are allergens, for lots it’s viruses, and nowadays for a lot of children it’s pollution. What we think is it's probably all those factors that come together and end up in the final attack for a child, and all the damage that occurs.

The inhaler I chose for the photograph was an inhaled corticosteroid inhaler, which is usually the one that is used as a preventer for children with asthma. The reason I chose that is because it's a huge challenge for us to get the children to take their medicines regularly. It’s hard convincing them to take their treatment when they're well - so that when they get a cold, they don't have an attack, because they're protected. The inhaler pictured is the one kids have to take even if they're feeling well, and because they're well, they don't take it. And I chose the yellow spacer because, again, a lot of children don't benefit from their treatment because they don't use the inhaler properly. I think up to 60% of our children aren't benefiting from their treatment because they're not using it properly. So they don't use a spacer, for example, something as simple as that. With the inhaler alone, you have to press to release the medication and breathe in at the same time - the coordination of that is tricky for an adult let alone a young child. But if you just press to release the medicine into the spacer, and then breathe in and out normally, it goes into the lungs effectively. It's very, very simple. But so many people get it wrong. So that's the reason I chose to have the spacer.

Object two: Photograph

I think as you get more senior in your career, the one thing you realise is you have to learn to manage people and a team. And actually the success of you and your research is almost totally dependent on your team, and how you manage them, and work with them. For me being Head of Section is an honour, I'm very happy to have the role, but I also need to make sure the Section is successful. That involves me making sure that I am communicating effectively with the team. To ensure that people want to be in the Section, and like how I am fulfilling the role of Section Head, because if they don't, they won't work and be productive. Without all the people in the photograph, not only would I not be successful as a Section Head, but I don't think any of us PIs would be as successful as we are in our research. And be able to move forward as we do.

I am split across clinical and basic science with my work, but the nice thing about being Section Head is I get much more contact with the basic scientists. I also see the whole range of our scientific community from undergraduate students to PhDs to postdocs all the way up to Principal Investigators (PIs). PIs who are more senior than me, those at my level, and the ones that we're building up and mentoring. And the nice thing is, I also have some say in recruitment, so some influence on who comes into the Section. Hopefully people want to come into the Section and contribute. And I guess my role as Head is generating a bit of an atmosphere where people want to contribute, and we all want to be successful and stay.

Object three: Chocolate

I don't drink alcohol. Obviously, I don't smoke. I wouldn't ever do that. But we all have good days and bad days. I think chocolate is the thing I tend to turn to when I'm having a particularly bad day. And the one thing people will say to you is that they'll recognise my desk because of the chocolates and sweets that are on there. I'm fairly neutral about types of chocolate, I will take all types – I’m not too fussed!

The other thing that's quite important to me is my religion. I'm a practicing Hindu, which is why I don’t drink alcohol. I do have quite a lot of cultural roots in that respect. I don't think many people know this about me, but I'm a volunteer at the Neasden temple, a big traditional Hindu temple in northwest London. I lead all the health care activities nationally for them which takes up quite a lot of my time. It involves raising awareness about diseases that affect South Asians, like diabetes and cardiovascular disease, alongside promoting organ donation for Asians, that kind of thing. Things that people should be doing for their health but often don't understand. We present the education and awareness in a culturally sensitive environment, in a trusted place, to try to reach out to members of the community who might not engage with standard healthcare messages. We organise cardiovascular screenings, diabetes screenings, talks and seminars on health – all that kind of thing.

Darl chocolate sitting on table with toy cars

"You're treated as you should be - like everybody else"

And I’m feeling good

I definitely like the clinical academic translational component that's pushed at NHLI, I think that's really a priority for the Department. NHLI has good quality basic science, but also really good quality clinical applications, which is really important. Obviously, the fact that our heart and lungs are a priority for me is great, because lungs matter.

The nice thing is we go right from preclinical models to the lab and then into treatment in clinics - and then all the way back again! We've got a bronchoscopy programme at Brompton where children with severe asthma who need a bronchoscopy get recruited, and any of the samples are taken over to the lab at Imperial where we look at them using all kinds of cutting-edge scientific techniques. I don't think I would be able to do research without having that clinical back and forth to make the questions relevant. Questions change all the time, as well as new treatments coming out as things change. If I didn't have that feedback, I think I'd go down a bit of a rabbit hole and my research wouldn't be as relevant.

The other thing for me is the research culture and the acceptance of me for who I am. As a woman, as an ethnic minority, it's not been an issue. You're treated as you should be - like everybody else. For me NHLI has always been a very fair place in that sense, if you're good at what you do, then you'll progress.

On the horizon

So more and more, although my research is on childhood asthma, I see myself focusing on those younger children who are the real challenge. And what would be great in ten years’ time would be a clinical trial that shows benefit for that young age group. Even if it's just how we can improve their current attacks and symptoms. From age one upwards we see children with very severe attacks, being hospitalised frequently – sometimes almost every month. The parents - they just don't know what to do. And it's really hard as a doctor because a lot of medicines don't work for them.

I think the other thing I'd really like to have achieved in ten years is to have trained somebody else up to take this research on. Finding and attracting clinical academics is a real challenge, because clinical academia is perceived as a difficult career, without the job security of the NHS. It's really difficult to find the right person and somebody who's motivated. But for me, if I could achieve that in ten years, I'd be very happy.

Imagine if you can

For me the big thing is money for research, or more specifically for improving respiratory conditions, which is scarce. Money for paediatric research is also scarce, so if you put those two together, it's an uphill struggle. It doesn't mean you don't take it on, but it would be nice for children's health and respiratory health to be recognised as a priority. For cystic fibrosis, it's happened and it's been great with the new modulator drugs - that's really transformed the disease. For me something like that for asthma would be amazing. There isn't even necessarily a children's asthma specialist at every hospital in the UK, severe asthma in children isn't treated the same as in adults. The fact that it's such a common disease - everybody knows what asthma is - and yet we're not good at doing anything about it perhaps shows it needs more of a spotlight. That recognition would be great.

I also feel quite passionately about the fact that there isn't a Department of Paediatrics at Imperial - we need to make sure children don't get forgotten. But I think that's changing. I think the current Dean of Medicine, Professor Jonathan Weber, has been supportive. And we've now got the Centre for Paediatrics and Child Health that I’ve just taken on the role as director of. So I think next would be to get children centre stage at Imperial. In terms of College being recognised for excellence in child health research.

Visit my portrait in meeting room 427/428 of ICTEM
on the Hammersmith Campus and see others 'Making Waves' below