CHEP projects

​​​​​​Despite our relatively clean air in Australia, it has been found that large numbers of children live in areas that exceed the WHO air quality guideline limits. Our study explores exposure to air quality in early life and the risk of poor respiratory health in childhood. We focus on the role of air pollutants in inflammatory and oxidative stress responses, as well as understanding whether risk of adverse respiratory health is higher in children with a genetic susceptibility to oxidative stress.

Contact: Dwan Vilcins 

Least developed countries (LDCs) are characterised by low incomes, low education levels, and high birth rates. In LDCs, children’s health is compromised by low access to environmental assets such as safe water and clean cooking fuel, the effects of unsustainable urbanisation and the impacts of climate change. This project uses a dynamic modelling approach to examine causal relationships between children’s health and its environmental, social, and economic influences in LDCs. Simulation modelling is performed for a case study LDC, Solomon Islands, and is used to simulate a range of children’s environmental health policy scenarios and predicted children’s health outcomes. 

Contact Paul Jagals 

Children with Cystic Fibrosis (CF) are born with structurally normal lungs but as they grow older, they are at risk of repeated respiratory infections that can damage the lungs.  Despite the advances in treatment and the overall better outcomes for children with CF, older children and adults still lose lung function. There is growing concern that CF lung disease begins very early in life and there has been much focus recently on trying to better understand early CF lung disease.

The Early Life Origins of CF Disease (ELO) Study is an observational study (no drug or therapy interventions) that is being conducted at The Queensland Children’s and Prince Charles Hospitals. Patients will be followed for three years and information relating to clinic and annual review visits will be collated. Our specific aims are (i) to better understand the mechanisms of early disease onset and how CF lung disease progresses throughout a patients’ life and (ii) improve/develop appropriate clinical outcome measures (lung function testing, biomarkers, imaging techniques) to improve CF management.

Contact: CLEAR@uq.edu.au.

Respiratory infections are the most commonly experienced illnesses throughout life, but especially during the first two years when infants may have six to eight infections each year. Emerging evidence indicates infections early in life along with other insults to developing airways in susceptible children may contribute to later development of chronic respiratory conditions such as asthma and chronic bronchitis.

We have previously collected detailed information on respiratory infections in the first two years of life for children who have participated in the ORChID study. The purpose of this study is to follow these children in early childhood up to the age of 7 years and track their lung function as a measure of respiratory health, as well as their immune response to common environmental allergens.

Contact: Dwan Vilcins

Collaborations with Queensland Alliance for Environmental Health Sciences (QAESH), The University of Queensland has already been established combining expertise in quantifying exposures to harmful chemicals in the environment with paediatric epidemiology and health outcome expertise. Strong collaborative links have been established, in particular with Professor Jochen Mueller, Professor Kevin Thomas and Dr Fisher Wang. 

Collaborative studies underway or in the planning include:

• Optimising techniques for assessing exposure of infants and young children to environmental chemicals
• Measuring biomarkers of environmental exposures
• Measuring environmental exposures and their health consequences in birth cohort studies.
• Determining the impact of bushfire smoke on indoor air quality and associated health impacts for residents. 

Evidence is accumulating that climate change is resulting in a change in the distribution of infections, especially food, water, and vector-borne diseases.

Such changes will result in Australia facing an increase in diseases our work force is not trained to handle. Collaborations within CHRC (Infection, Inflammation and the Environment theme) and with The University of Queensland Australian Infectious Disease (AID) Research Centre will see CHEP well placed to contribute to an improved outcome for Australian children.

In addition, we have seen the impact on human health of zoonoses. Existing collaborations between CHRC and the School of Veterinary Science, The University of Queensland can be extended to help address such issues in children's health.

Contact Paul Jagals

Pollution caused three times more deaths in 2015 than AIDS, tuberculosis and malaria combined.  Exposure to air pollution and other environmental stressors have adverse effects on human health, including increasing susceptibility to acute respiratory illnesses (ARI) and chronic respiratory diseases.

While the epidemiological evidence is strong, the mechanism(s) underlying this phenomenon remains uncertain. Children exposed to second-hand tobacco smoke are at increased risk of ARI, including acute viral bronchiolitis, pneumonia and middle ear infections. Children exposed to household air pollution have increased rates of pneumonia and tuberculosis and exaggerated respiratory symptoms and ARI occur more frequently in children exposed to traffic related air pollution (TRAP). A common factor linking these combustion products is that they contain environmentally persistent free radicals (EPFRs). The premise of this research is that EPFRs cause adverse health consequences by inducing oxidative stress (OS). 

The EPFR project is in collaboration with LSU Superfund Research Center and is funded by National Institutes of Health (NIH). 

The project aims to understand the mechanisms by which EPFR exposure increases susceptibility to respiratory viral infections and to investigate mitigation strategies. It also looks at the EPFR role in the induction of steroid insensitive asthma. 

This project contains a human exposure study which aims to access the presence of EPFRs in household dust, and to understand which household characteristics affect the level of EPFRs in the home. This study uses an environmental monitoring protocol to visit homes in Brisbane and collect information on air quality, EPFRs and child health. 

Contact: Ayaho Yamamoto | Dwan Vilcins

You are welcome to read our children's book on Eddie the EPFR! 

Children are uniquely vulnerable to harmful environments, due to their physiology, developmental windows of susceptibility and age-related behaviours. The urban environment is undergoing rapid transformation, as populations grow, children spend more time indoors, and the effects of climate change are starting to be experienced worldwide. Urban green space, the area of an urban area occupied with photosynthetic vegetation such as grass, shrubs and trees, is perhaps the best example of an environmental factor that may act as a public health good. Research has identified health benefits associated with green space, such as improvement in mental wellbeing, reduction in cortisol, an increase in physical activity, improved neighbourhood cohesion, and exposure to beneficial microbiota. Green space may play a role in ameliorating hazardous environmental exposures, such as air pollution and temperature extremes.

The aim of this study is match environmental data to a cohort of Australian children and examine the association between maternal and child exposure to environmental factors with the health of the child. Birth outcomes, lung health and neurodevelopmental outcomes will be explored.

Contact: Dwan Vilcins  

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 10% of all subjects post HSCT yet this incidence is a gross underestimate due to the insensitivity of spirometry to detect peripheral lung changes where this process arises. This leads to late diagnosis, poor response to treatment, and poor prognosis (2-year and 5-year survival of 60% and 50%, respectively). 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 tests (multiple breath washout and oscillometry) in this setting. It will look at what we can learn from studies already performed by analysing both local data and pooled historical international data across 12 international centres (including both paediatric and adult data) – we will define the utility of these tools to detect pulmonary GVHD and their ability to provide earlier detection to facilitate earlier invention and improve outcomes. It will also explore novel applications of these tests in a prospective cohort to enhance detection further in the initial period post HSCT to predict and detect those at risk.

Lower respiratory illnesses in the first year or two of life, especially those associated with wheeze and/or fever, are major risk factors for poor respiratory health. Recent data suggests that bacteria and viruses commonly found in the nose in early life may increase the risk of subsequent disease.

This project will take advantage of a unique, community-based birth cohort (ELLF), in whom the presence of respiratory viruses and bacteria in the upper airway and respiratory symptoms during the first 2 years of life have been determined from weekly nasal swabs and a daily symptom diary. This project will determine how nasal cells obtained from either adults (asthmatic or healthy) and the children birth cohort respond in laboratory-based culture when infected with bacteria, in addition to assessing the cell response when co-infected with respiratory viruses.

Contact: Ayaho Yamamoto

The airway epithelium provides the first line of innate immune protection to defend against environmental stressors and infections. A decline in airway epithelial innate immune system functionality is associated with many medical conditions and can result in chronic inflammation and compromised immunity of the lung. Oxidative stress can be generated by environmental exposure. Increase in oxidative stress cause airway and lung damage, which may initiate or worsen respiratory disease. Redox regulation maintains the equilibrium of pro-oxidant/anti-oxidant reactions but can be disturbed by environmental exposures. How this impacts on respiratory disease and whether anti-oxidants can provide protection is unknown.

This project aims to investigate the innate immune responses in environmental exposure; how the airway epithelium response to oxidative stress; and examine the utility of antioxidants to restore redox homeostasis.

The preschool years represent a crucial period in lung development. Longitudinal studies have shown that deficits in lung function start in early life with long term consequences into adulthood. This highlights the importance of being able to reliably and accurately measure the lung function of preschool aged children to aid in the diagnosis, treatment and management of children with suspected or known respiratory disease.

Contact: Paul Robinson

Macrophages are key cells in innate immune responses and play a critical role in orchestrating both initiation and resolution of pulmonary inflammation. In response to immune insults or injury, monocytes originated from bone-marrow migrate to the tissues, differentiate into macrophages (M0) and polarize into pro-inflammatory (classically activated or M1) or inflammation-resolving (alternatively activated or M2) phenotypes. These two compartments are well characterized in mouse model. In human, the border line between M1 and M2 polarization was vague until recently. Therefore macrophage responses in cystic fibrosis (CF) were mostly studied in mouse model. We have developed an ex-vivo model of human macrophages that reliably separates un-polarized (M0), M1 and M2 macrophages. Using this model we recently reported that activation of inflammation-resolving M2 macrophages were impaired in CF. In addition, we observed early expression of pro-inflammatory M1 macrophage markers in monocyte-derived M0 macrophages in patients with CF. Similar M1 and M2 markers expression was observed when macrophages from healthy donors were treated with CFTR channel inhibitor suggesting that defection M2 polarization is CFTR-dependent. We are aiming to study the link between CFTR function and macrophage polarization and functions.

Contact: Abdullah Tarique 

CHEP is collaborating on several projects investigating the impact of environmental exposures on neurodevelopment and mental health in children. CHEP and Queensland Alliance for Environmental Health Sciences (QAESH) are providing expertise in environmental monitoring to the Barwon Infant Study, co-ordinated by Dr. Peter Vuillermin and Professor Anne-Louise Ponsonby, Murdoch Children's Research Institute, Melbourne.

The OBSTRUCT study is run by Dr Matthew Wong and commenced in 2019, to date 126 wheezy children and 57 healthy children have completed the initial stage of this study. Nearly 50% of preschool children worldwide experience an episode of asthma-like symptoms, but only 30% with recurrent wheeze go on to develop asthma past 6 years of age.

In this study we want to better understand the complex link between early childhood wheezing and asthma.

The goal of OBSTRUCT is to assess the longitudinal changes in intra-breath respiratory impedance and explore if temporal oscillometry can help identify which children are at risk of developing asthma later in life and, subsequently, which young children may benefit from asthma medications. Recruitment for the initial stage of this study has closed and plans to conduct follow-up home monitoring visits at 1 and 2 years post initial recruitment are underway. These follow-up visits through to early school age will further investigate the relationship between early childhood wheezing and persistent asthma.

For further information regarding this study please contact Dr Matthew Wong: matthew.wong@uq.edu.au

There is an increasing body of evidence showing an association between plasticisers and allergic disease. Exposure to phthalates during pregnancy has been associated with increased risk of allergic diseases in resulting offspring. This study explores the association between phthalates and BPA measured in maternal urine during pregnancy, and the risk of allergic disease in children up to 4 years of age. Mediating factors will be explored, to test for potential casual mechanisms. Most notably the role of oxidative stress and genetic predisposition to oxidative stress will be explored as a potential modifying variable. This study is being conducted in collaboration with the Murdoch Children’s Institute and uses data from the Barwon Infant Study, longitudinal cohort of children in Australia.

Contact: Dwan Vilcins 

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.

Contact: Paul Robinson 

Air pollution is a major killer and cause of considerable burden of disease. The burden falls unevenly, affecting vulnerable groups, especially children, living in low and middle-income countries excessively. Also, children living in big cities are exposed to high levels of traffic-related air pollution (TRAP), especially when travelling to and from school. In these countries, public transport is poor, and most children travel to and from school on motorbikes, increasing TRAP exposure. Such exposure increases the risk of acute and chronic respiratory diseases, such as pneumonia and asthma, and increases their risk of hospitalization. Such exposure is avoidable, at least in theory. Facemasks can reduce exposure and prevent symptoms in adults with cardiovascular disease; however, similar data are absent for children. In our project, we aim to develop the capacity of Vietnamese researchers to measure children’s exposure to TRAP, assess the effect of TRAP exposure on children’s respiratory health and to undertake a randomized control trial of wearing a mask to reduce TRAP exposure. In research methodology, we will measure lung function in young children, use induced sputum to assess personal TRAP exposure and measure urinary biomarkers to assess the mechanisms by which TRAP exposure reduces respiratory health.

This is a collaborative research project between CHEP and University of Medicine and Pharmacy in Ho Chi Minh City, Vietnam, and is funded by National Health and Medical Research Council (NHMRC - Grant ID. APP1155241) and Vietnam National Foundation for Science and Technology Development (NAFOSTED - Grant ID. NHMRC.108.03-2018.04).

We have a number of opportunities for parents and children to participate in our research.

Current studies are listed on the Participate in our research section of our website.