Paul Robinson

Remote monitoring of Paediatric Asthma to Improve Asthma Diagnosis and Control

Childhood asthma mortality remains substantial, and rates of hospitalisation are increasing globally in young children. This is driven by poor asthma control (which affects 50% of asthmatics) and ongoing exacerbations (which affects 25%). Of the 40,000 admissions each year, 80% are preventable! Current symptom-based management approaches fail – limited by poor perception/reporting by children and parents - and conventional spirometry/peak flow is insensitive or too challenging for this setting. In addition, the preschool age range is a critical period in asthma pathogenesis: symptoms emerge, airway structure changes, and a window for intervention exists before permanent lung function deficit is established by early school age. Preschool symptom-based diagnostic and/or predictive tools (for later asthma) perform poorly and ignore lung function due to spirometry’s limitations. Improved ability to differentiate early asthma phenotypes is a priority of international societies.

This research program consists of a series of projects to analyse existing, and collect new, data to define the clinical utility of a unique remote home-based monitoring strategy focused on the day-to-day variability of a novel and sensitive lung function test. Studies will investigate its ability to correctly identify evolving asthma, detect loss of asthma control and provide an early signal of an impending asthma exacerbation to improve long term asthma outcomes.

Improving detection of Pulmonary Graft-vs-Host Disease to facilitate earlier intervention

Chronic Graft-vs-Host Disease affects 60% of Haematopoeitic Stem Cell Transplant (HSCT) survivors by 6 years after their transplant, affecting multiple organs including skin, liver, gastrointestinal tract and lungs. Gold standard for pulmonary GVHD diagnosis is abnormal spirometry and subsequent CT-based imaging. Pulmonary GVHD is estimated to affect 20% of all subjects post HSCT yet this incidence is a gross underestimate due to the insensitivity of spirometry to detect peripheral lung changes. This leads to late diagnosis, poor response to treatment, and poor prognosis (5-year mortality is 85%). Better tools to detect and monitor pulmonary GVHD are urgently required.

This research program builds on previous work highlighting the potential utility of novel peripheral airway function test in this setting. It will analyse both local data and pooled international data across 12 international centres (including both paediatric and adult data) to define the utility of these tools to provide an earlier diagnosis of pulmonary GVHD to facilitate earlier invention and improve outcomes. It will also explore novel applications of these tests to enhance detection further in the initial period post HSCT to predict and detect those at risk.

Remote monitoring of Paediatric Asthma to Improve Asthma Diagnosis and Control

Childhood asthma mortality remains substantial, and rates of hospitalisation are increasing globally in young children. This is driven by poor asthma control (which affects 50% of asthmatics) and ongoing exacerbations (which affects 25%). Of the 40,000 admissions each year, 80% are preventable! Current symptom-based management approaches fail – limited by poor perception/reporting by children and parents - and conventional spirometry/peak flow is insensitive or too challenging for this setting. In addition, the preschool age range is a critical period in asthma pathogenesis: symptoms emerge, airway structure changes, and a window for intervention exists before permanent lung function deficit is established by early school age. Preschool symptom-based diagnostic and/or predictive tools (for later asthma) perform poorly and ignore lung function due to spirometry’s limitations. Improved ability to differentiate early asthma phenotypes is a priority of international societies. This research program consists of a series of projects to analyse existing, and collect new, data to define the clinical utility of a unique remote home-based monitoring strategy focused on the day-to-day variability of a novel and sensitive lung function test. Studies will investigate its ability to correctly identify evolving asthma, detect loss of asthma control and provide an early signal of an impending asthma exacerbation to improve long term asthma outcomes.

This program of research includes projects suitable for PhD, honours or masters students.

For more information, contact Professor Paul Robinson at paul.robinson@uq.edu.au.

Assessing the impact of a Complex Asthma model of care to service all eligible Queensland children

A significant driver of the huge healthcare burden of asthma is children with difficult-to-treat or severe asthma (5-10% of childhood asthma, termed collectively as “Complex Asthma”). A recent survey of Australian and New Zealand paediatric tertiary services has highlighted the lack of a standardised approach to services and issues adequately identifying these children affected to ensure access to recommended models of care. At Queensland Children’s hospital (QCH) we have established a unique multidisciplinary team (MDT) service, involving nine different medical teams: Respiratory, Allergy & Immunology, Psychology, Psychiatry, Adolescent Medicine, Speech Pathology, Physiotherapy, ENT and Social work. The research program will focus on evaluating the effectiveness of this approach through i) the creation of a complex asthma database to assess health outcomes, describe key factors predicting those outcomes and enable a cost-effectiveness analysis, ii) the evaluation of currently employed screening questionnaires to correctly identify important co-morbidities, and iii) using the established Project ECHO platform at QCH, the creation of a community of practice and an education module to educate and empower non-tertiary community-based services to better identify and contribute to ongoing management the impact of which will be formally assessed. This work coincides with the establishment of a national Australian and New Zealand Paediatric Severe Asthma Registry (led by QCH staff) which will enable benchmarking of outcomes to data collected at other tertiary centres.

This program of research includes projects suitable for PhD, honours or masters students

For more information, contact Professor Paul Robinson at paul.robinson@uq.edu.au