Last updated on 01/08/2023

 

Why was funding this research important?
Only a minority of children with ongoing asthma maintain good asthma control, and poor asthma control is a well-known risk factor for poor asthma outcomes such as asthma attacks and even death.  

Monitoring asthma control in children presents several challenges.  

  • The current best option for lung function monitoring – peak flow – is hard for children to perform reliably (as it depends on effort) and insensitive to the changes that occur with exacerbations and poor asthma control.  
  • As a result, doctors rely on reported symptoms, medication diaries and questionnaires, all of which can be affected by how both children and their parents perceive the symptoms and how well they are able to remember them.   
  • This lack of an objective and sensitive tool limits the ability of parents and doctors to make the right management decisions. 

Oscillometry (previously known as the Forced Oscillation technique, FOT) is an new lung function test that is easy to perform and does not depend on effort, providing information on respiratory system mechanics (e.g., how narrow the airways are and stiff the lungs are).  

  • It is performed during relaxed inhale and exhale (tidal) breathing and can be done by children from pre-school age and above.  
  • Oscillometry has exciting potential as a tool used at home with parent supervision to not only monitor asthma severity and control in children, but also help detect or predict asthma flare-ups early on.  

What did the researchers do? 
The researchers aimed to document the feasibility of oscillometry as an ‘at home’ asthma monitoring tool and if it can provide early clues into when a flare up (also called attack or exacerbation) is about to happen. They recruited 27 children aged 8 to 18 years of age, with persistent asthma and a history of at least 2 flare ups in the past year, and seven healthy controls.  

The research participants were monitored for four months using oscillometry in their home on a daily basis, under the supervision of their parents. Participants also completed the Asthma Control Questionnaire every week, quality of life questionnaire every month, and a daily record of respiratory symptoms and reliever use. After the four-month monitoring period, participants were followed for the rest of the year to find out whether oscillometry during the monitoring period could predict long term asthma control. 

What was the outcome?
The data collected in this study proved all the study hypotheses.  

  • The team have shown that home based oscillometry monitoring is not only highly feasible, but the results obtained during the periods without flare ups provided information about the level of asthma control and the number of flare ups experienced by the child afterwards.  
  • In addition, the results suggested that oscillometry can signal loss of asthma control early on.  
  • These findings confirm the exciting potential of this approach to improve future asthma outcomes. 

Related Publications and Presentations 

  1. Wong A, Hardaker K, Field P, Huvanandana J, King GG, Reddel H, Selvadurai H, Thamrin C, Robinson PD.  Home-based forced oscillation technique day-to-day variability during pediatric asthma exacerbations. AJRCCM 2019;119(9):1556-60.

Asthma Australia, Dr Paul Robinson and the research team from the Children’s Hospital at Westmead and The Woolcock Medical Research Institute, wish to pass on their heartfelt thanks to the Ross Trust for their support of the 2017-2019 project which will provide exciting insight into how asthma monitoring in children with ongoing asthma issues can be improved.

What’s next?
Thanks to a donation from The Neil and Norma Hill Foundation, the team are undertaking further research to confirm the ability to predict loss of asthma control. They will monitor children at risk of loss of asthma control. They will recruit children with good asthma control, who are eligible to reduce the strength of their asthma treatment (step-down). We know that about one third of those children will lose good control when they step down their medication. 

The project aims to find out  

  1. if the day-to-day change in oscillometry reliably increases when asthma control decreases,
  2. if this change occurs before asthma symptoms worsen and/or a flare up occurs, and
  3. define the oscillometry values indicating when we should act and change treatment in future studies. 

This will build on the results of the previous study to provide a better more sensitive tool for asthma.

“This project fulfils a vital next step in our efforts to provide a sensitive easy-to-perform tool for home-based monitoring. It will allow us to define whether a reliable early signal is seen with oscillometry indicating loss of asthma control and impending asthma exacerbation. Defining this signal will then allow us to design the future studies to show the utility of this monitoring approach on important asthma outcomes.  

This funding is vital and without it this proposed study would not be possible. It will provide key funds to support the research staff working on this project. We are incredibly grateful to the Hill Foundation for their generous support.” 

-Dr Paul Robinson

Robinson_Headshot Dr Paul Robinson 

Kids Research Institute 

Clinical Associate Professor Dr Paul Robinson is a clinician researcher working at the University of Sydney and The Children’s Hospital at Westmead. He is an established member of The Children’s Chest Research Centre within Kids Research, the research division of the Sydney Children’s Hospital Network.  

 

His work focuses on early detection and improved monitoring of lung disease in children, through the development of new tests to measure small (peripheral) airways function, and their use in clinical practice. These tests are can easily be performed throughout the paediatric age range (including infants and pre-schoolers). The “peripheral airways” these tools assess may be small in size but in fact represent almost 95% of the total lung volume. 

 

A/Prof Robinson’s research focuses on two  airway function techniques, Multiple Breath Washout (MBW) and Oscillometry (previously known as the Forced Oscillation technique, FOT).