Clinical Academic Training

Paediatrics

Portable oscillometry in the diagnosis of asthma in children with preschool wheeze

Supervisors/Collaborators

  • Dr Erol Gaillard
  • Dr David Lo
  • Professor Damian Roland

The problem

Severe wheezing attacks are common in preschool children and result in frequent emergency department visits and hospitalizations. This is a significant health care burden worldwide. Our current strategies of management of preschool wheezing disorders are ineffective.

Unmet need - Diagnosis and biomarkers

A key problem is the lack of a diagnostic test because young children are rarely able to perform spirometry. Portable oscillometry is a new technology that shows promise in preschool children. Oscillometry measures airway resistance and impedance and an increase in both parameters is associated with asthma. The test is quick, non-invasive and importantly does not require any effort on the part of the child.

Additionally, further phenotyping is required to establish the best way to treat preschool children. Many do not respond to corticosteroids. Objective biomarkers and the assessment of treatable traits including allergic sensitisation, and an assessment of airway infections are needed. 

Research plan

Observational study recruiting children with acute preschool wheeze from children’s ED, obtain oscillometry measurements pre and post bronchodilator and phenotype severe preschool wheeze on the basis of blood biomarkers and airway infection to pave the way for a clinical trial.

The ACF will also be expected to complete a systematic review.

Prospective analysis of extent of worry in parents and carers attending emergency care settings about their child

Supervisors/Collaborators

  • Professor Damian Roland

While the incidence of serious illness in children is very low; emergency care attendances continue to climb and this creates a challenge to recognise those children in need of ongoing treatment.

Serious case review often demonstrates that parents and carers have raised concerns about their child prior to being discharged from emergency care settings. This concern is reported to be either dismissed or ignored by health care professionals.

Research previously undertaken at the Leicester Royal Infirmary Children’s Emergency Department has demonstrated that 10% of those children with the lowest risk of illness on arrival are thought to be the most unwell the parent has ever seen that child. This may partly explain why health care professionals are perceived to, or do actually, dismiss parental concern.

In this work the ACF will undertake a prospective evaluation of parental concern at arrival in the Children’s Emergency Department and for seven days afterwards. The aim to understand how concerns changes over time and if a more precise lexicology can be development when parents and carers communicate with health care professionals.     

This project supports the production of evidence that can improve health service organisation and delivery and is aligned to previous work funded by a knowledge exchange grant.

Medical Education

If you are interested in progressing an educational research project within the speciality please visit the medical education project page

 

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