On this page:

• Research program
• Research support (2008/09)

Research program

• Cystic Fibrosis
• Asthma
• Other lung diseases

Cystic Fibrosis

1. The Australasian Bronchoalveolar Lavage (BAL) Study - The focus of this study is the examination of the long-term pulmonary outcomes of treatment directed against Pseudomonas aeruginosa found in respiratory cultures obtained by BAL as opposed to suction of sputum. This 10 year long multi-centre study is due to finish at the end of 2010.
2. Respiratory pathogens and their transmission - This Australia-wide NH&MRC-funded study examines the prevalence of clonal forms of Pseudomonas aeruginosa and the influence of these strains on respiratory health over a 4 year period.
3. Detecting respiratory pathogens - In collaboration with the Aerosol Research Group at the Woolcock Institute of Medical Research we are examining the utility of a face mask composed of a novel material in collecting exhaled viral and bacterial organisms for detecting respiratory infections.
4. Detecting early airway disease - We are currently assessing the relative utility of a variety of non-invasive measures of lung function to detect early airway disease and measure response to interventions which might be potentially used in young children unable to perform conventional spirometric techniques used to assess lung function in older children.
5. Disease modifying factors - We are currently involved in research collaborations attempting to identify factors which may influence outcome in CF patients including mannose binding lectin levels, ACE gene polymorphisms, modifier gene types in siblings with CF, and micro-RNAs.
6. Studies of Aztreonam Lysinate - The third multi-centre study of this new inhaled anti-PsA antibiotic developed by Gilead Sciences has recently been completed. Previous studies have confirmed the benefit of this medication in patients with moderate to severe CF and this most recent study assessed benefit for CF patients with milder disease.
7. Dry Powder Mannitol (DPM) - after participation in a successful study of the short-term effectiveness of DPM in CF in 2005, we have recently completed a year-long study of this mucolytic.
8. Dry powder mannitol (DPM) in children with acute pulmonary exacerbation requiring in hospital treatment. This is a randomised double blind placebo controlled study assessing the utility of DPM in children with an acute pulmonary exacerbation.
9. Vibration Plate Therapy - in conjunction with the endocrinology department we are assessing the effect of this non-invasive non-pharmaceutical therapy on lung function and the function of tendons, bones and muscle.
10. Titropium Study – We are currently investigating the potential benefit of a long acting inhaled anticholinergic agent in a three month long study in children with CF.
11. Bronchodliator Responsiveness in CF - We are examining lung function test results in our CF population to determine the percentage of patients who demonstrate significant bronchodilator reversibility and whether there are any factors predicting this. We then intend to perform a pilot study on patients with significant bronchodilator reversibility to determine if the time to maximal bronchodilator response differs in our CF patients when compared to children with asthma.
12. Tiger Study – This study examines the long-term effectiveness and safety of a novel approach to the basic defect in CF via activation of alternate chloride channels in the epithelial cells by an inhaled agent
13. Treatment of Aspergillus fumigatus in patients with cystic fibrosis: A Randomized, Double-Blind, Placebo-Controlled Trial – this study assesses the clinical impact of treating aspergillus fumigatus that is isolated in routine sputum culture in children with CF. The study is funded through the Canadian CF Foundation.

Asthma

1. The pathophysiology of asthma - We maintain a large collection of lung tissue from children with and without a history of lung disease which has been donated for research by the children's parents and this tissue is currently being used in collaborative studies to investigate the development and progression of asthma in early childhood as well as the normal growth and development of the airways from birth to maturity using computer-assisted morphometric techniques.
2. New modes of measuring lung function in children - Conventional methods of measuring lung function require the co-operation of a child as well as the mastery of often difficult techniques. In recent years, methods for measuring lung function in younger children have been developed which no longer require either co-operation or technical mastery but do require administration of sedative medications. In conjunction with other groups internationally and the Woolcock Institute of Medical research locally, we are currently developing and validating equipment, based on effort independent techniques, which are feasible for use in children as young as the preschool age group. The clinical utility of these techniques is being evaluated in a number of important respiratory conditions.
3. Optimising Management of Asthma – We have a number of ongoing projects designed to implement and evaluate strategies to improve asthma management including health professional education on asthma, provision of asthma action plans and nurse initiated reduction of bronchodilators in children with acute asthma. We have also been involved with the Adolescent Unit in the development of an online learning resource for health professionals on Smoking Cessation Interventions which we will be evaluating. We are also evaluating the views of parents of children with asthma about complementary and alternative medicines (CAM) and what they feel their doctor should know about CAM therapy.

Other lung diseases

1. Chronic cough - Cough is the most common symptom presenting to general practitioners in Australia and internationally. The burden of cough is great – both in terms of the quality of life experienced by the child concerned, and in substantial medication costs as these children are often treated inappropriately with repeated doses of antibiotics, with high dose anti-asthma medication or cough preparations. The cause of chronic cough is poorly understood and we are involved in a NH&MRC funded multi-centre study designed to evaluate the utility of a protocol for the diagnosis and management of cough in a tertiary setting, and the feasibility of deploying the protocol in a general practice setting.
2. Survivors of preterm birth - Over the last 5 years, our group has been conducting a long-tern follow up of 10 year old children who were born extremely prematurely. Our studies have indicated that while these children do have subtle reductions in their lung function at 10 years of age, they have substantially reduced exercise capability. Our current work in this field will continue to monitor their progress and also attempt to find the cause for this exercise impairment. Moreover, the effect of an early fitness training program in such children is an area we would like to explore.
3. Cardiopulmonary fitness - Our group has members with expertise in exercise physiology and thus we are involved in collaborative studies of cardiopulmonary fitness in children with other chronic illnesses such as haemophilia and insulin-dependent diabetes, which, while not being diseases of the lung, affect functioning of the cardio-pulmonary system during exercise. Our interests extend beyond children with chronic illness to those who are junior elite athletes, and studies include an examination of the relationships between fitness and muscle functioning and the presence of certain genes relating to muscle function.

Research support (2008/09)

Multicentre evaluation of a clinical pathway for the evaluation of chronic cough in children – can its use improve clinical outcomes?
NHMRC Project Grant ($48,100)

A multicentre, randomised, controlled trial of BAL-directed therapy in young children with cystic fibrosis
NHMRC Project Grant ($26,450)

Clinical trials of aztreonam lysinate
Gilead Sciences ($104,108)

Clinical trials of DPM in CF
Pharmaxis Pty Ltd ($156,610)

Clinical trial of tiotropium in CF
Boehringer Ingelheim ($47,550)

Robinson P
NHMRC postgraduate scholarship ($28,000 p.a. over 3 years)
TSANZ Allen & Hanbury Paediatric Grant in Aid award ($40,000 p.a. over 2 years)