Optimising bubble continuous positive airway pressure (CPAP) for preterm infants. Synchrotron imaging will be used to see how the lungs of newborns are aerated and move when they are supported by continuous positive airway pressure (CPAP) breathing support. This project will provide fundamental biological information that will contribute to refinement of devices to support breathing in babies.
Parent Initiated Oral Prednisolone For Acute Asthma In Children Aged 5-11 Years: Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$139,250.00
Summary
The objective of this trial is to determine whether parents should commence prednisolone (a steroid anti-inflammatory drug) for an asthma attack in their child without waiting to see a doctor first. This strategy could be described as parent initiated prednisolone in asthma (PIPA). PIPA is an important consideration in every child's asthma management plan, but because of a lack of research evidence the role of PIPA is not clarified in any of the international asthma guidelines. Hence prednisolon ....The objective of this trial is to determine whether parents should commence prednisolone (a steroid anti-inflammatory drug) for an asthma attack in their child without waiting to see a doctor first. This strategy could be described as parent initiated prednisolone in asthma (PIPA). PIPA is an important consideration in every child's asthma management plan, but because of a lack of research evidence the role of PIPA is not clarified in any of the international asthma guidelines. Hence prednisolone is rarely commenced without waiting for a preceding medical review. PIPA has the potential to significantly reduce the health and economic burden of the disease by increasing the proportion of asthma exacerbations managed at home rather than in the emergency department or hospital. Prednisolone has been shown to be an effective drug when it is given to children with an asthma attack that is severe enough for them to attend hospital. Whilst it would seem logical that PIPA should be an effective strategy it is important to recognise that mild attacks are far more common than severe ones, and the promotion of PIPA as standard practice would be associated with a significant increase in the frequency prednisolone administration. As such it is important to determine if prednisolone is safe and effective when commenced in the home setting. The PIPA trial has many unique features: It is community based, where the vast majority of asthmatic children are managed. The eligibility criteria and dosing schedule have been chosen to mimic 'real world' management and it will be easy for clinicians and families to interpret and apply the results. A very large number of children will be involved (308) which has been made feasible by the trial setting and recruitment methods. Furthermore the protocol has been designed in accordance with the highest standards specified by the international research community and has been submitted to 'The Lancet' for pre-trial publication.Read moreRead less
Effects Of Upper Versus Lower Respiratory Infections On The Induction Of Atopic Asthma.
Funder
National Health and Medical Research Council
Funding Amount
$386,483.00
Summary
Asthma is more common now in developed countries than it was 20-30 years ago. Many fewer children have asthma in developing countries and there does not appear to have been the same increase in asthma in recent years. Children in developed countries tend to have fewer respiratory infections and recent studies suggest that this may be partly responsible for the increase in asthma. An understanding of why asthma has increased in developed countries may lead to strategies to prevent asthma. In orde ....Asthma is more common now in developed countries than it was 20-30 years ago. Many fewer children have asthma in developing countries and there does not appear to have been the same increase in asthma in recent years. Children in developed countries tend to have fewer respiratory infections and recent studies suggest that this may be partly responsible for the increase in asthma. An understanding of why asthma has increased in developed countries may lead to strategies to prevent asthma. In order to understand the role that respiratory infections may play in the induction of asthma, it is necessary to study babies from birth, documenting each respiratory inflection and monitoring their diet. In a recent large study we have shown that parental reports of common colds and chest infections do influence how many children have asthma at age 6. Also in this study, breast feeding for at least 4 months seemed to be protective against developing asthma. However, we were not able to verify how many infections the children in that study actually had. We are currently studying a population of 236 infants, all of whom are at high risk of developing asthma and allergies. At the end on November 1998, 163 of these infants had reached one year of age. During the first year of life, these infants had a total of 669 respiratory infections, with individual babies having between 0 and 11 infections. We now plan to monitor these children until they turn 5, when we will determine how many have asthma and allergies. In this way we will be able to determine whether children who have more respiratory infections early in life are more or less likely to have asthma and allergies at 5 years of age. We will also be able to tell whether breast-feeding is able to decrease the chance of developing asthma and allergies.Read moreRead less
Amoxycillin For Persistent Nasal Discharge In Rural And Remote Aboriginal Children: A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$226,738.00
Summary
Aboriginal children have the highest rates of acute and chronic respiratory diseases ever documented. While the underlying cause is socioeconomic disadvantage, the features of poverty that result in disease are not clear. Our current understanding of important risk factors like overcrowding, malnutrition and smoke exposure cannot completely explain the excessively high rates of disease seen in rural and remote Aboriginal communities. This randomised, double-blind, placebo-controlled clinical tri ....Aboriginal children have the highest rates of acute and chronic respiratory diseases ever documented. While the underlying cause is socioeconomic disadvantage, the features of poverty that result in disease are not clear. Our current understanding of important risk factors like overcrowding, malnutrition and smoke exposure cannot completely explain the excessively high rates of disease seen in rural and remote Aboriginal communities. This randomised, double-blind, placebo-controlled clinical trial will measure the impact of antibiotic treatment on persistent nasal discharge and rates of transmission of bacterial respiratory pathogens. An innovative study design will test the efficacy of twice daily doses of amoxycillin on newly developed clinical and bacteriological outcome measures. Both the investigators and the Aboriginal community have considerable experience in conducting this type of research and are committed to using a cooperative model of clinical research to reduce disease burden. Ongoing training of Aboriginal health workers in the principles of clinical epidemiology is an essential component of this process. This study will make an important contribution to the medical literature. Despite the deaths of around 10,000 children children from acute respiratory infections each day, very little is known about how antibiotics affect the transmission of some of the principal causative organisms. This project will greatly assist the development of appropriate antibiotic prescribing practices in high-risk populations.Read moreRead less
Domestic air quality: towards the setting of guidelines. Air quality standards have been developed to protect human health. Although people spend most of their time indoors there are no standards and only a few guidelines for indoor air pollution (IAP). The aim of this study is to investigate the levels of IAP that may worsen asthma in children. Childhood asthma will be used as a health indicator due to its high prevalence, cost to the healthcare system and implications for respiratory morbidity ....Domestic air quality: towards the setting of guidelines. Air quality standards have been developed to protect human health. Although people spend most of their time indoors there are no standards and only a few guidelines for indoor air pollution (IAP). The aim of this study is to investigate the levels of IAP that may worsen asthma in children. Childhood asthma will be used as a health indicator due to its high prevalence, cost to the healthcare system and implications for respiratory morbidity in adult life. We expect to identify levels of IAP that will represent a health risk as well as the factors that may contribute to increased IAP in homes.Read moreRead less
Evolution Of Airway Function And Inflammation In Early Cystic Fibrosis Lung Disease
Funder
National Health and Medical Research Council
Funding Amount
$494,447.00
Summary
Our goal is to evaluate if lung function can identify the onset of early lung disease in infants with cystic fibrosis (CF). We aim to evaluate: - Changes in lung function in infants with CF. - Associations between lung function and lung inflammation and infection. - Links between infant lung function and disease severity at 2 years of age. The long term aims are to determine how useful lung function will be in trials of novel treatments for the early treatment of CF.
Mechanisms Of Apnea And Periodic Breathing In The Newborn.
Funder
National Health and Medical Research Council
Funding Amount
$381,100.00
Summary
Breathing pauses referred to as apnea or periodic breathing occur frequently in the preterm infant, and often require intensive clinical vigilance to ensure survival. And yet the mechanisms that produce and terminate apnea are not understood. This study will investigate the mechanisms underlying infantile apnea and periodic breathing and the effectiveness of drugs and techniques currently used to control apnea by using a combination of infant animal model studies, mathematical modelling studies ....Breathing pauses referred to as apnea or periodic breathing occur frequently in the preterm infant, and often require intensive clinical vigilance to ensure survival. And yet the mechanisms that produce and terminate apnea are not understood. This study will investigate the mechanisms underlying infantile apnea and periodic breathing and the effectiveness of drugs and techniques currently used to control apnea by using a combination of infant animal model studies, mathematical modelling studies and studies in human preterm infants to improve our understanding of breathing control in infancy.Read moreRead less
Postviral Wheezing In Childhood: Disregulation Of Airway Tone?
Funder
National Health and Medical Research Council
Funding Amount
$577,040.00
Summary
Asthma is a very common childhood condition that is becoming increasingly more common. Wheezing is common in infants and young children following viral infections and is often thought of as the first manifestation of asthma. However, many children and infants who wheeze with viral infections appear to grow out of asthma in their teenage years. Asthma that persists into adult life is usually associated with allergies to common environmental allergens, such as house dust mite and grass pollens. Ho ....Asthma is a very common childhood condition that is becoming increasingly more common. Wheezing is common in infants and young children following viral infections and is often thought of as the first manifestation of asthma. However, many children and infants who wheeze with viral infections appear to grow out of asthma in their teenage years. Asthma that persists into adult life is usually associated with allergies to common environmental allergens, such as house dust mite and grass pollens. However, many infants who wheeze with viral infections, especially in the first year of life, do not develop allergies in later life, raising the possibility that they did not have the same type of asthma as those whose symptoms persist. This project will study the effects of viral infections on lung function to determine whether particular types of virus can have detrimental effects of lung function lasting for years. We will also examine whether the age at which the infection occurs and the severity of the infection influence the long-term outcome. The project involves studying infants during the recovery phase of respiratory viral infections, older children years after documented infections and experimental animal models that have been infected under controlled conditions. By determining whether respiratory viral infections can have long-term effects on lung function that can mimic asthma, we will advance our understanding of how asthma develops. In addition, specific treatment and preventative strategies could then be developed to prevent these long-term abnormalities, instead of relying on asthma medication (especially inhaled corticosteroids) as is the current practice. Preventative strategies could include encouraging the development of specific vaccines.Read moreRead less