Ninety six surveys were returned (90 projects and six fellowships) giving a response of 59% and we successfully completed the full complement of 14 case studies. The findings of both the survey and case studies are presented according to the categories of impact from the Payback Framework, and then briefly summarised to demonstrate the impact from each type of funding.
Impacts relating to each impact category
The 90 projects recorded an average of four peer-reviewed journal articles per project, but four of these projects did not record producing any articles. There is a possible bias in the results as there is some evidence from Asthma UK’s database of publications, as described in the full report (see End Notea), showing that the average number of publications already known to Asthma UK is slightly higher for the projects on which surveys were returned, than for those that were not. The research fellows who completed the survey recorded an average figure of 11 peer-reviewed articles. This higher average figure reflects the view of some fellows that because their career at that time was being funded by Asthma UK, all, or at least most, of their resulting publications could be counted as having some link with the fellowship. Since their appointments in 1988, the two Asthma UK professorial chairs, Tak Lee at King’s College London, and Tim Williams, at Imperial College London, published a total of over 500 publications.
For example, Tim Williams, conducted a major stream of research in the search for the chemoattractants for eosinophils, a type of white blood cell regarded as being as of considerable importance. Williams and his colleagues identified a potent endogenous chemoattractant with high specificity for eosinophils. Williams named this chemokine Eotaxin; the main paper describing it was published in the Journal of Experimental Medicine (Jose, 1994)  and has been cited over 600 times. It has helped target considerable further research including by Williams and his colleagues. They also successfully sought patents on their work that they have been granted worldwide on Eotaxin and antibodies to it. Further examples of key publications from Asthma UK-funded chairs, projects and fellowships [16–18] are described in the case studies summarized in Additional files 3, 4 and 5.
Research training and capacity building
The 90 PIs who completed surveys claimed that at least 62 higher degrees have been obtained or were expected at least in part as a result of Asthma UK’s project funding. An additional 15 are linked to the six fellowships covered in this analysis. These 77 higher degrees include 45 PhDs and 21 MDs. Asthma UK has now funded PhD studentships at the MRC-Asthma UK Centre (and several elsewhere jointly with the MRC). According to the case study analysis, this is making an important contribution to the substantial advances in research training in asthma coming from the Centre.
In addition, the researchers from 64% of the funded projects that participated in the survey reported details of career development for at least one team member as a result of the Asthma UK project funding. This included assisting promotion for PIs, and also project researchers moving forward to gain fellowships from major funders and continue their research in the asthma field.
Targeting further research and attracting further income for asthma research
In total Asthma UK invested some £9.2 million in the 90 projects included in the analysis. The PIs claimed that such investment helped to target, i.e. identify relevant research questions for, 99 follow-on projects conducted by themselves or members of their team. These follow-on projects received almost £25 million in funding from funders other than Asthma UK. However in the survey, the PIs indicated that the intellectual contribution from the original Asthma UK project to some of the largest follow-on grants was often only moderate, or sometimes small. Taking this into account, in the manner described above, the £25 million of total follow-on funding could, at a best estimate, be counted as equivalent to £12.9 million follow-on funding linked to Asthma UK’s £9.2 million original investment, So, every pound invested by Asthma UK in the research projects funded between 1996 and 2006 is likely to have attracted at least £1.40 in follow-on research funding from sources other than Asthma UK. In addition, in at least 35 cases, other researchers were reported to have built on the findings from the Asthma UK funded projects.
In some instances Asthma UK funding played a ‘pump-priming’ role, enabling the researcher to leverage larger sums from other health research funding bodies, a major example of which is described in the case study on peptide-based immunotherapy research  [See Additional file 5]. On occasions where Asthma UK itself funded the follow-on research this has, at least in retrospect, amounted to a programme of work according to survey and case study data. Sometimes these major streams of work, involving a succession of project grants from Asthma UK undertaken over many years (including some dating back before 1996), have been important in helping to move towards the wider impacts (policy or product development, and health gains), often supplemented by funding from other sources. Examples include the research that started with an Asthma UK-funded project on IL-10 and glucocorticoid responsiveness in asthma which was outlined on Asthma UK’s web site as follows: ‘A series of Asthma UK funded projects led by Professor Catherine Hawrylowicz in Professor Lee’s department has attracted particular interest, as the work has resulted in a clinical trial to explore whether vitamin D can improve the effectiveness of steroid treatments for asthma in those who are normally resistant to their benefits’ .
In a similar manner, the chairs directly brought in additional funding for asthma research. Since 1995, Tak Lee successfully applied for grants from the MRC, Wellcome Trust and NHS R&D Programme alone worth about £6 million, in addition to the £2.7 million from the MRC to the MRC-Asthma UK Centre. King’s College also made considerable infrastructural investment into Lee’s department and the Centre. Overall Lee built up a substantial research division. Similarly, Tim Williams secured three major programme grants from the Wellcome Trust to support his streams of asthma related research and has secured university funding for various posts. Those interviewed for the case study consistently claimed that the creation of the MRC-Asthma UK Centre has helped secure additional funding for asthma research. This is both in terms of the core funding provided by the MRC for additional facilities at the Centre, and the various other ways in which PIs at the Centre are successfully applying for funding (including through Asthma UK), partly by demonstrating the strength of the environment within which the research would be undertaken.
Informing policy development
In the survey just 13% of projects claimed to have made an impact on policy already, and 17% expected such an impact in the future. As part of the triangulation process, checks were made of the impacts on guidelines claimed in surveys by PIs of projects on which case studies were later conducted. Generally exaggerated claims had not been made. Indeed, the case studies often identified additional examples of the research having been cited on guidelines. On the basis of this analysis, we broadly accepted the claims made in the surveys on which case studies were not conducted.
According to the survey and case studies, three of the six fellows claimed already to have made an impact on policies and/or guidelines - longer-term salary funding can allow fellows to develop a distinct role or focus which lends itself more to policy development. For example, a key paper by Mike Thomas  is already being used in recent guidelines from the British Thoracic Society/Association of Chartered Physiotherapists in Respiratory Care  to support the use of breathing exercises for improved control of asthma and quality of life.
Using the methods described above we were able to establish that not only were papers from some Asthma UK-funded research cited on international and national guidelines, and other policy statements, but we also identified some examples when they supported key points and were either the only evidence used to support the point, or an important part of it. Some examples are given in the case study on research on immunotherapy that was part funded by Asthma UK [22, 23] [see Additional file 4]. Other examples of national and/or international guidelines (or specific sections) influenced by Asthma UK-funded research, along with the Asthma UK-funded paper cited in the guideline, include ones on: cough [24, 25]; asthma diagnosis in children [26, 27]; and inhaled corticosteroid resistance [26, 28].
Whilst there are often time lags involved in achieving an impact on policy, Asthma UK also supported some explicit and successful attempts to provide evidence for guidelines in areas in which there were gaps. In such situations there could be a rapid uptake of the findings. For example, Richard Hubbard specifically applied to Asthma UK for funding to develop stronger evidence on the safety of asthma medicines during pregnancy, an area where expert analysis of existing guidelines indicated the evidence was weak . The findings from this project were published in late 2008 , and were almost immediately incorporated into an update of the 2008 guidelines from the British Thoracic Society and Scottish Intercollegiate Guidelines Network published in June 2009 .
Informing product development
In the survey only a small minority of projects – just 17% - included in this research claim an impact on product development already, and 31% claim to expect some future impact. The impact on product development from Asthma UK projects and from chair funding takes various forms, including helping to identify new roles for existing products, contributing to the evidence base for the development and application of major new drugs, and contributing to new therapies being developed by university spin-off companies.
In the stream of Asthma UK-funded projects on IL-10 and glucocorticoid responsiveness in asthma described above, the important new therapy being tested – vitamin D for steroid resistant asthma  – might involve using existing products in a new way. The background and significance of a stream of work in supporting the development of anti-leukotriene medicines [16, 33, 34] is explained in more detail in an additional file taken from the case study on Tak Lee’s work as an Asthma UK professorial chair [see Additional file 3].
Based on the projects included in this analysis, Asthma UK-funded research has also contributed to product development now being trialled by university spin-out companies founded by the researchers in several cases. The stream of research that showed T cell peptides have potential in the treatment of cat allergies led to the establishment of Circassia, an Imperial College London spin-out company. The progress made, including successful phase II trials, is described in an additional file which provides further details about the research and contains updates on the important findings published from a subsequent joint Canadian/UK study that is continuing this stream of work [see Additional file 5].
Many years of research by Stephen Holgate and colleagues led to the ideas behind the development of Interferon-beta treatment for rhinoviruses (common cold infections) that cause many asthma exacerbations. At a crucial time Asthma UK provided project funding for Holgate that contributed to key advances, although the MRC had supported much of the stream of work . The spin-out company, Synairgen, successfully completed Phase 1 trials of the treatment and started Phase II in March 2010 . The significant further progress made after the formal end of the retrospective impact analysis is described in the Discussion.
Health gain and broader economic benefits
Of the funded projects included in this research, again only a small minority (10%) claim to have already made an impact in any of the various forms this could take, with 6% of projects believing they had made an impact specifically in relation to health gains. Thirty-one percent of projects suggested that they expected to make some impact on health in the future, though it is recognised that the time lags, and their unpredictable nature, means a real impact on health gain can take many years to materialise and is extremely difficult to measure. Nevertheless, many of the examples described previously in which Asthma UK-funded research is making an impact on clinical policies, and on product development, are likely already, or in future, to be leading to health benefits. This is described in detail in the full report on this impact analysis but a few key examples are contained in Additional files 3, 4, and 5 which respectively describe the health gains that have arisen from the Asthma UK-funded contributions to research on leukotriene receptor antagonists  and on immunotherapy for allergic rhinitis, and the potential health gains from the research on peptide immunotherapy.
Health gains resulting from improved therapies are likely to have broader economic benefits in terms of reducing the working days lost through ill-health . In addition, school children sitting exams during the hay fever season can suffer ; they might benefit from immunotherapy.
There have also been broader economic benefits to the UK from some of the cases of product development, including from the work of Tim Williams, because UK companies have been involved in undertaking some of the development. Furthermore, the two spin-out companies described above, Circassia and Synairgen, are UK based.
A summary of impacts from each type of funding
The long-term funding for the professorial chairs has resulted in many impacts across the full range of payback categories, and the establishment of the MRC-Asthma UK Centre is a major additional benefit that can be at least partially attributed to the professorial chairs. Interview and case study evidence suggests both chairs showed considerable leadership in building up their multi-disciplinary departments that formed core elements of the Centre.
The case study approach identified the success of the MRC-Asthma UK Centre in Allergic Mechanisms of Asthma in making scientific and medical breakthroughs, training the next generation of scientists and doctors focused on asthma research, promoting collaboration, and attracting funding from other sources and increasing the funds available for asthma research. Interview evidence confirmed the documentary evidence from the House of Lords Science and Technology Committee which stated: ‘We visited a striking example of effective collaboration at the MRC-Asthma UK Centre in Allergic Mechanisms of Asthma’ . Asthma UK’s strategy documents  help inform the Centre’s strategies. These successes and the pioneering nature of the collaborative Centre are further analysed in an additional file which summarises key points from the case study based on the Centre [see Additional file 6]. The creation of the Centre reflects current thinking on the importance of both translational health research, and the collaborations between researchers and service providers and across institutions and disciplines [40–42].
The medium-term funding for the fellowships enabled some of them to develop a strand of research that made a range of impacts. Various individual projects and fellowships provided a very small return according to the survey, but others contributed considerably according to both the surveys and the case studies.