At each assessment, a structured interview will be conducted with the parent/primary caregiver covering respiratory symptoms, major infections, hospitalisations and use of medications, growth will be assessed by measuring weight, length/height and head circumference, and a clinical examination will be conducted focused on the detection of respiratory disorders. Lung function will be assessed at 6 weeks using ST-FOT and it would be desirable to also measure the Multiple-Breath Washout (this application is for the remainder of the funding required to purchase this apparatus to make this measurement) Atopy will be assessed with skin prick testing. A standardised questionnaire will be completed by the parent/primary caregiver (12 months).
To determine the severity of RTIs assessments will be conducted by a Paediatric Nurse with the support and guidance of an advanced trainee (Fellow) in Paediatric Respiratory Medicine (Dr Biarta Rhys-Jones, PhD candidate) supervised by a Consultant (Prof Joerg Mattes) within 48 hours of being contacted by parents on the development of an upper or lower RTI symptoms such as a runny nose, cough or wheeze. These visits will continue each 24 hours for the duration of the infection. A general examination will be conducted and severity of infection will be scored, for instance on a bronchiolitis severity scale including oxygen saturation. Nasal swabs and stool samples will also be collected for later multiplex PCR testing of respiratory virus identification between treatment groups in subsequent studies (we will seek other funding for virus PCRs).
Multiple-Breath washout is particularly helpful tool for investigating the respiratory health of children who are too young to have sufficient control of exhalation to successfully perform other lung function tests such as spirometery. The data generated will provide proof of concept data for an NHMRC application for ongoing follow-up of this co-hort at high-risk of developing asthma in early life to determine if better treatment practices for maternal asthma have ongoing benefits for their children’s respiratory health. We have preliminary data to suggest this is the case (Mattes et al Thorax 2014) , however, better evaluation of lung function in early life using Multiple-Breath washout will allow this to be directly demonstrated in a prospective study in this new co-hort.
Here we propose to fund in collaboration with the Faculty of Health and Medicine at The University of Newcastle the acquisition of an Ecomedics Exhalyser-D capable of measuring the multiple-breath washout and determining the Lung Clearance Index (LCI) at 6 weeks of age. We have been granted $64,000 of the $81,047.55 Total (excl. G.S.T.) required to purchase the equipment leaving the outstanding $17,047.55 requested here.