Professor Paul Robinson

Conjoint Prof inResp&Sleep Medicine

Child Health Research Centre
Faculty of Medicine

Overview

Conjoint Professor Paul Robinson is the Deputy Director of the Children’s Health Environment Program within the Child Health Research Centre (CHRC), and Senior Staff Specialist in Respiratory and Sleep Medicine at the Queensland Children’s Hospital. His research program performs translational research outlining the role of peripheral airway function tests in early lung disease detection and ongoing monitoring of established disease.

He has led the development and standardisation of novel measures of lung function across the entire age range from infancy onwards, facilitating the development of commercial equipment available for widespread use. His research focuses on defining the clinical utility of two specific peripheral airway function tests (Multiple breath washout, MBW, and oscillometry) in important obstructive lung diseases (e.g., asthma, cystic fibrosis, and post bone marrow transplant pulmonary graft vs host disease) and in understanding the impacts of environmental exposures. Structure-function relationships have been explored using state-of-the-art imaging techniques, with the aim of also developing new strategies to reduce any radiation exposure associated with these to advance incorporation into clinical care (e.g., ultra-low dose CT).

These novel lung function tools not only in the hospital setting but also in the school and home setting, enabling the successful development of a parent-supervised remote monitoring strategy for asthma which has been shown to reflect clinically meaningful outcomes missed by conventional approaches. In collaboration with industry, this strategy is now being employed in a series of research projects.

Involvement in longitudinal birth cohorts has outlined the early lung function trajectories in health, and the identification of risk factors affecting normal lung development and contributing to the early development of asthma. Studies investigating environmental health have highlighted the adverse effects of ultrafine particle air pollution.

Professor Robinson’s standing as an international expert, both in terms of clinical and research experience, has led to broader leadership roles across national and international levels.

Research Interests

  • Cystic Fibrosis
    Understanding the mechanisms underlying the development of lung disease early in life and why and how this progresses. Optimising the detection of early lung disease to facilitate earlier effective intervention to improve outcomes.
  • Asthma
    Understanding mechanisms that underlie risks for developing asthma in susceptible children. Improving diagnosis of early asthma and monitoring of disease once established to prevent exacerbations and reduce risk of poor asthma outcomes.
  • Pulmonary Graft vs. Host Disease
    Understanding the mechanisms underlying the development of respiratory complications following Haematopoietic Stem Cell Transplantation and why and how this progresses. Optimising the detection of early Pulmonary Graft-vs-Host disease to facilitate earlier intervention and improved outcomes.
  • Impact of environmental exposures in early life
    Improving methods of assessing environmental exposures and their effects across the lifespan and understanding how these increase long-tern risk of chronic disease in the lungs and other organ systems

Research Impacts

Professor Robinson’s research program has informed a paradigm shift in management of chronic respiratory disease to ignore the reassurance of “normal” conventional lung function (spirometry) and target early lung disease detection arising in the peripheral airways and intervention through proactive (not reactive symptom-driven) strategies for 3 important obstructive lung conditions: (1) cystic fibrosis (CF); (2) asthma; and (3) post haemopoietic stem cell transplant (HSCT) pulmonary graft-vs-host disease (pGVHD).

Impact is evidenced by >80 manuscripts specific to this research program focus alone. A lead role on seminal consensus standards have resulted in a >4-times increase in MBW publications since their publication and widespread availability of robust commercial equipment (based on consensus recommendations adopted by all 4 global manufacturers). MBW has been formally as a primary outcome measure for CF intervention studies by independent institutions and integration into >30 international multicentre clinical trials. MBW has played a central role in registration of effective CFTR modulator therapy for young children, with significant projected survival benefits. Advances in oscillometry, including novel remote monitoring approaches targeting enhanced detection of disease exacerbation and prevention, have provided a platform for the first consensus clinical applications document for oscillometry.

Publications

View all Publications

Available Projects

  • 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.

  • 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 20% of all subjects post HSCT yet this incidence is a gross underestimate due to the insensitivity of spirometry to detect peripheral lung changes. This leads to late diagnosis, poor response to treatment, and poor prognosis (5-year mortality is 85%). 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 test in this setting. It will analyse both local data and pooled international data across 12 international centres (including both paediatric and adult data) to define the utility of these tools to provide an earlier diagnosis of pulmonary GVHD to facilitate earlier invention and improve outcomes. It will also explore novel applications of these tests to enhance detection further in the initial period post HSCT to predict and detect those at risk.

View all Available Projects

Publications

Book Chapter

  • Hutchison, Alastair A., Leclerc, Francis, Nève, Véronique, Jane Pillow, J. and Robinson, Paul D. (2015). The respiratory system. Pediatric and Neonatal Mechanical Ventilation: From Basics to Clinical Practice. (pp. 55-112) Berlin, Heidelberg: Springer Berlin Heidelberg. doi: 10.1007/978-3-642-01219-8_4

  • Robinson, Paul D. and Aurora, Paul (2013). Bronchiolitis obliterans syndrome in children. Bronchiolitis Obliterans Syndrome in Lung Transplantation. (pp. 237-250) Humana Press Inc.. doi: 10.1007/978-1-4614-7636-8_13

Journal Article

Conference Publication

Possible Research Projects

Note for students: The possible research projects listed on this page may not be comprehensive or up to date. Always feel free to contact the staff for more information, and also with your own research ideas.

  • 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.

  • 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 20% of all subjects post HSCT yet this incidence is a gross underestimate due to the insensitivity of spirometry to detect peripheral lung changes. This leads to late diagnosis, poor response to treatment, and poor prognosis (5-year mortality is 85%). 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 test in this setting. It will analyse both local data and pooled international data across 12 international centres (including both paediatric and adult data) to define the utility of these tools to provide an earlier diagnosis of pulmonary GVHD to facilitate earlier invention and improve outcomes. It will also explore novel applications of these tests to enhance detection further in the initial period post HSCT to predict and detect those at risk.