The APSR fellowship funded me, Dr Diane Gray (Paediatric Pulmonologist, University of Cape Town) to travel to Perth, Australia, to train in infant lung function (ILF) testing under A/Prof Graham Hall and the paediatric respiratory physiology group at the Telethon Institute for Child Health Research (TICHR). I was accompanied by Ane Alberts, a respiratory technologist from the University of Cape Town, who will assist in ILF testing on my proposed collaborative research project: Early Life Determinants of infant lung function and chronic lung disease at two years.
Telethon Institute for Child Health Research, Perth
We arrived at the TICHR early November 2011 to begin the training. We were greeted by A/Prof Graham Hall who heads the Paediatric Respiratory Physiology group at the TICHR and were immediately made to feel welcome. It was clear A/Prof Hall and his expert team were ready and willing to guide and teach as a great deal during our 3 week training visit. We were introduced to the team and completed all administration details efficiently which meant we could start out training immediately. A/Prof Graham Hall is head of the Paediatric Respiratory Physiology research group in Perth, Australia and is also responsible for the management of the Respiratory Laboratory in Princess Margaret Hospital for children. He has been directing an independent research group since 2005 and has initiated and led a number of research themes related to paediatric respiratory physiology. As the Senior Respiratory Scientist of the clinical respiratory laboratory at Princess Margaret Hospital for Children he has raised the research profile and activities of the group with a strong focus on producing high impact research with direct clinical applications. Thus our training placement within his unit was ideal for training us in the setting up of an infant lung function laboratory in Cape Town. In addition it would allow time for discussion and supervision around the initiation and execution of my planned research project. The latter is a study nested within a novel birth cohort study, the Drakenstein Child Health Study (DCLS), starting in Cape Town, South Africa, early 2012. This study will provide valuable new insights into the origin and outcomes of lung disease in children from low and middle income settings.
Graham Hall (back left) and the Paediatric Respiratory Physiology Group
Much of the research undertaken by Graham Hall's respiratory physiology research team deals with adaptation of existing physiological testing methods for use in infants and young children and has striven to objectively characterise the strengths and weaknesses of these methods, as is evident in the many high quality papers published in this area from their unit. Thus we were well placed to receive an excellent background into the various infant lung testing techniques - the implementation, undertaking and interpretation of the tests and the practical and theoretical utility to our planned research in Cape Town. This was critical in the planning of our research methodology for the DCLS. Graham Hall and his team are currently involved in two birth cohorts, the Raine birth cohort and the Peel Child Health study. The Raine birth cohort is internationally recognised for its valuable contribution to our understanding of asthma in children. The Peel Child Health study is focussed on maternal exposure to indoor air pollution and its impact on lung growth and development. The infant lung function techniques for the planned DCLS project have been informed by the experiences in these cohorts as well as other international experiences. Thus I was able to learn from their extensive and relevant experience in the translation of these infant lung function techniques to the context of a low to middle income country for the DCLS.
Dr Diane Gray learning with the Peel Study Infant Lung Function team
The team training us included a post-doctoral scientist, Dr Shannon Simpson, doctoral and masters students, research assistants and the manager of the respiratory physiology laboratory at Princess Margaret Hospital (PMH). The respiratory lung function department included both the clinical and research laboratories. The testing undertaken at the unit included plethsmography, forced oscillation techniques, tidal breathing measures of volume, multiple breath washout testing, exercise testing and nasal nitric oxide amongst others. We were able to join in the weekly Wednesday clinic where we observed the preschool clinical testing. However the majority of our time in the laboratory was focussed on the infant lung function testing. This began with learning how to set up and calibrate the equipment confidently and accurately. We were encouraged to practise extensively to become very familiar with the process and were provided with a step by step written guide on equipment calibration and testing which had been put together by Graham Hall's team. This is a unique and essential resource for us to bring back to our laboratory.
Our ILF training included:
- equipment calibration (EcoMedics Exhalyzer including MBW system, exhaled nitric oxide, infant oscillometry system)
- obtaining infant lung function measures (tidal breathing measures, MBW using SF6, exhaled nitric oxide, forced oscillation technique)
- collecting and storing data and familiarising ourselves with the software
- Analysing the results
Equipment calibration was done both at PMH and at the Mandurah Community Health Clinic site. Testing was undertaken predominantly at the Mandurah site, which was very useful as this testing protocol will be most like what we are planning to implement back in Cape Town. The analysis training was completed at the TICHR by Dr Simpson and consolidated with an analysis teaching package which included many examples of testing that had been validated by the team and compiled for training purposes. This was excellent training in the analysis of results, and laid the foundation for ongoing supervision once we setup our testing for the project. Once again, the team were very expert and efficient in their training and supervision of our progress. By the end of the time we both felt confident in the calibration of equipment, reliable collection of quality ILF data and the analysis thereof.
Ane Alberts with the team at the Princess Margaret Hospital Infant Lung Function Laboratory
In addition to the above training we took part in the weekly academic program which included: Thursday morning presentations, Friday Lung Club, Wednesday presentation from the broader TICHR research groups. We were also privileged to join the annual paediatric respiratory research congress at Rottnest Island (17-18 November). Dr Gray presented a paper at the conference on respiratory disease in Sothern African children, contextualising the challenges faced in low and middle income countries like South Africa, informing the rationale for the planned ILF project in the DCLS.
Delegates at the annual Paediatric Respiratory Research Congress, Rottnest Island
The APSR award has facilitated my training in infant lung function testing, a highly specialised skill and one that as yet is not being done anywhere in Southern Africa. The TICHR paediatric respiratory physiology group were excellent trainers and have given as solid foundation and understanding of the complexities of ILF for us to build on in our learning as we set up out local laboratory. The collaboration between the Universities of Western Australia and Cape Town is an excellent example of sharing of research skills and training that will facilitate the development of high quality research that further science with a global benefit.