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Robinson PD, Salimi F, Cowie CT, Clifford S, King GG, Thamrin C, Hardaker K, Mazaheri M, Morawska L, Toelle BG, Marks GB. Ultrafine particle exposure and biomarkers of effect on small airways in children. Environ Res 2022; 214:113860. [PMID: 35820650 DOI: 10.1016/j.envres.2022.113860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
The small size and large surface area of ultrafine particles (UFP) enhance their ability to deposit in the lung periphery and their reactivity. The Ultrafine Particles from Traffic Emissions and Children's Health (UPTECH) cross-sectional study was conducted in 8-11-year-old schoolchildren attending 25 primary (elementary) schools, randomly selected from the Brisbane Metropolitan Area, Queensland, Australia. Main study findings outlined indirect evidence of distal airway deposition (raised C reactive protein) but as yet, there is no direct evidence in the literature of effects of UFP exposure on peripheral airway function. We present further UPTECH study data from two sensitive peripheral airway function tests, Oscillometry and Multiple Breath Nitrogen Washout (MBNW), performed in 577 and 627 children (88% and 96% of UPTECH study cohort) respectively: mean(SD) age 10.1(0.9) years, 46% male, with 50% atopy and 14% current asthma. Bayesian generalised linear mixed effects regression models were used to estimate the effect of UFP particle number count (PNC) exposure on key oscillometry (airway resistance, (Rrs), and reactance, (Xrs)) and MBNW (lung clearance index, (LCI) and functional residual capacity, (FRC)) indices. We adjusted for age, sex, and height, and potential confounders including socio-economic disadvantage, PM2.5 and NO2 exposure. All models contained an interaction term between UFP PNC exposure and atopy, allowing estimation of the effect of exposure on non-atopic and atopic students. Increasing UFP PNC was associated with greater lung stiffness as evidenced by a decrease in Xrs [mean (95% credible interval) -1.63 (-3.36 to -0.05)%] per 1000#.cm-3]. It was also associated with greater lung stiffness (decrease in Xrs) in atopic subjects across all models [mean change ranging from -2.06 to -2.40% per 1000#.cm-3]. A paradoxical positive effect was observed for Rrs across all models [mean change ranging from -1.55 to -1.70% per 1000#.cm-3] (decreases in Rrs indicating an increase in airway calibre), which was present for both atopic and non-atopic subjects. No effects on MBNW indices were observed. In conclusion, a modest detrimental effect of UFP on peripheral airway function among atopic subjects, as assessed by respiratory system reactance, was observed extending the main UPTECH study findings which reported a positive association with a biomarker for systemic inflammation, C-reactive protein (CRP). Further studies are warranted to explore the pathophysiological mechanisms underlying increased respiratory stiffness, and whether it persists through to adolescence and adulthood.
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Affiliation(s)
- Paul D Robinson
- The Children's Hospital at Westmead, Sydney, Australia; Airway Physiology and Imaging, Woolcock Institute of Medical Research, University of Sydney, Australia; University of Sydney, Sydney, Australia
| | - Farhad Salimi
- University of Sydney, Sydney, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Centre for Air Pollution, Energy and Health Research (CAR), Australia
| | - Christine T Cowie
- Centre for Air Pollution, Energy and Health Research (CAR), Australia; Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, University of Sydney, Australia; South Western Sydney Clinical Campus, University of New South Wales, Australia; Ingham Institute of Applied Medical Research, Sydney, Australia
| | - Samuel Clifford
- Centre for Air Pollution, Energy and Health Research (CAR), Australia; London School of Hygiene and Tropical Medicine, London, UK; International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia
| | - Gregory G King
- Airway Physiology and Imaging, Woolcock Institute of Medical Research, University of Sydney, Australia; University of Sydney, Sydney, Australia
| | - Cindy Thamrin
- Airway Physiology and Imaging, Woolcock Institute of Medical Research, University of Sydney, Australia; University of Sydney, Sydney, Australia
| | - Kate Hardaker
- Airway Physiology and Imaging, Woolcock Institute of Medical Research, University of Sydney, Australia; University of Sydney, Sydney, Australia
| | - Mandana Mazaheri
- Centre for Air Pollution, Energy and Health Research (CAR), Australia; Department of Planning, Industry and the Environment, Sydney, Australia
| | - Lidia Morawska
- Centre for Air Pollution, Energy and Health Research (CAR), Australia; International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia
| | - Brett G Toelle
- University of Sydney, Sydney, Australia; Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Sydney Local Health District, Sydney, Australia.
| | - Guy B Marks
- Centre for Air Pollution, Energy and Health Research (CAR), Australia; Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, University of Sydney, Australia; South Western Sydney Clinical Campus, University of New South Wales, Australia; Ingham Institute of Applied Medical Research, Sydney, Australia
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2
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de Gouveia Belinelo P, Collison AM, Murphy VE, Robinson PD, Jesson K, Hardaker K, de Queiroz Andrade E, Oldmeadow C, Martins Costa Gomes G, Sly PD, Usemann J, Appenzeller R, Gorlanova O, Fuchs O, Latzin P, Gibson PG, Frey U, Mattes J. Maternal asthma is associated with reduced lung function in male infants in a combined analysis of the BLT and BILD cohorts. Thorax 2021; 76:996-1001. [PMID: 33632766 DOI: 10.1136/thoraxjnl-2020-215526] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/26/2021] [Accepted: 02/12/2021] [Indexed: 12/22/2022]
Abstract
RATIONALE Asthma in pregnancy is associated with respiratory diseases in the offspring. OBJECTIVE To investigate if maternal asthma is associated with lung function in early life. METHODS Data on lung function measured at 5-6 weeks of age were combined from two large birth cohorts: the Bern Infant Lung Development (BILD) and the Australian Breathing for Life Trial (BLT) birth cohorts conducted at three study sites (Bern, Switzerland; Newcastle and Sydney, Australia). The main outcome variable was time to reach peak tidal expiratory flow as a percentage of total expiratory time(tPTEF:tE%). Bayesian linear hierarchical regression analyses controlling for study site as random effect were performed to estimate the effect of maternal asthma on the main outcome, adjusting for sex, birth order, breast feeding, weight gain and gestational age. In separate adjusted Bayesian models an interaction between maternal asthma and sex was investigated by including an interaction term. MEASUREMENTS AND MAIN RESULTS All 406 BLT infants were born to mothers with asthma in pregnancy, while 193 of the 213 (91%) BILD infants were born to mothers without asthma. A significant interaction between maternal asthma and male sex was negatively associated with tPTEF:tE% (intercept 37.5; estimate: -3.5; 95% credible interval -6.8 to -0.1). Comparing the model posterior probabilities provided decisive evidence in favour of an interaction between maternal asthma and male sex (Bayes factor 33.5). CONCLUSIONS Maternal asthma is associated with lower lung function in male babies, which may have lifelong implications on their lung function trajectories and future risk of wheezing and asthma.
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Affiliation(s)
- Patricia de Gouveia Belinelo
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, New South Wales, Australia.,Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Adam M Collison
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, New South Wales, Australia.,Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Vanessa E Murphy
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, New South Wales, Australia.,Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kathryn Jesson
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kate Hardaker
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Ediane de Queiroz Andrade
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, New South Wales, Australia.,Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Christopher Oldmeadow
- Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Gabriela Martins Costa Gomes
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, New South Wales, Australia.,Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Peter D Sly
- Centre for Children's Health Research, University of Queensland, South Brisbane, Queensland, Australia
| | - Jakob Usemann
- Department of Pulmonology, University Children's Hospital (UKBB), Basel, Switzerland.,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Rhea Appenzeller
- Department of Pulmonology, University Children's Hospital (UKBB), Basel, Switzerland.,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Olga Gorlanova
- Department of Pulmonology, University Children's Hospital (UKBB), Basel, Switzerland.,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Oliver Fuchs
- Department of Pulmonology, University Children's Hospital (UKBB), Basel, Switzerland.,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Philipp Latzin
- Department of Pulmonology, University Children's Hospital (UKBB), Basel, Switzerland.,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Peter G Gibson
- Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre for Healthy Lungs, University of Newcastle, Callaghan, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Urs Frey
- Department of Pulmonology, University Children's Hospital (UKBB), Basel, Switzerland .,Paediatric Respiratory Medicine, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Joerg Mattes
- Priority Research Centre GrowUpWell, University of Newcastle, Callaghan, New South Wales, Australia .,Viruses, Infections, Vaccines & Asthma Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia
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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 in Pediatric Asthma. Am J Respir Crit Care Med 2020; 199:1156-1160. [PMID: 30822109 DOI: 10.1164/rccm.201809-1659le] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alexander Wong
- 1 The Children's Hospital at Westmead Westmead, Australia
| | - Kate Hardaker
- 1 The Children's Hospital at Westmead Westmead, Australia.,2 The University of Sydney Sydney, Australia and
| | - Penny Field
- 1 The Children's Hospital at Westmead Westmead, Australia
| | | | - Gregory G King
- 2 The University of Sydney Sydney, Australia and.,3 The Woolcock Institute for Medical Research Glebe, Australia
| | - Helen Reddel
- 3 The Woolcock Institute for Medical Research Glebe, Australia
| | - Hiran Selvadurai
- 1 The Children's Hospital at Westmead Westmead, Australia.,2 The University of Sydney Sydney, Australia and
| | - Cindy Thamrin
- 2 The University of Sydney Sydney, Australia and.,3 The Woolcock Institute for Medical Research Glebe, Australia
| | - Paul D Robinson
- 1 The Children's Hospital at Westmead Westmead, Australia.,2 The University of Sydney Sydney, Australia and.,3 The Woolcock Institute for Medical Research Glebe, Australia
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Lin B, Kennedy B, McBride J, Dalla‐Pozza L, Trahair T, McCowage G, Coward E, Plush L, Robinson PD, Hardaker K, Widger J, Ng A, Jaffe A, Selvadurai H. Long-term morbidity of respiratory viral infections during chemotherapy in children with leukaemia. Pediatr Pulmonol 2019; 54:1821-1829. [PMID: 31393087 PMCID: PMC7167615 DOI: 10.1002/ppul.24456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/06/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Respiratory viruses are a common cause of infection in immunosuppressed children undergoing cancer therapy. Pulmonary sequelae have been documented following respiratory viral infections (RVIs) in hematopoietic stem cell transplant (HSCT) recipients; however potential late effects in children undergoing nonmyeloablative chemotherapy have not been investigated. AIM To evaluate the long-term pulmonary morbidity of respiratory viral infections during chemotherapy in children with acute lymphoblastic leukemia (ALL). METHODS Childhood ALL survivors, aged 7 to 18 years, greater than 6 months posttreatment were recruited. Exclusion criteria included HSCT or proven bacterial/fungal respiratory infection during treatment. Subjects were classified into "viral" or "control" groups according to retrospective medical records that documented the presence of laboratory-proven RVIs during chemotherapy. Symptom questionnaires (Liverpool, ISAAC) and lung function testing (spirometry, plethysmography, diffusing capacity, forced oscillation technique to ATS/ERS standards) were then performed cross-sectionally at the time of recruitment. RESULTS Fifty-four patients (31 viral, 23 control) were recruited: median (range) age 11.2 (7.2-18.1) years, and at 4.9 (0.5-13) years posttherapy. Abnormalities were detected in 17 (31%) individuals (8 viral, 9 control), with the most common being DLCO impairment (3 viral, 4 control) and reduced respiratory reactance at 5 Hz (5 viral, 6 control). Children with RVIs during chemotherapy reported more current respiratory symptoms, particularly wheeze (odds ratio [OR], 3.0; 95% confidence interval [CI]: 0.9-10.0; P = .09) and cough (OR, 2.7; 95% CI: 0.8-9.5; P = .11). No differences in lung function tests were observed between the two groups. CONCLUSIONS Our study found children with RVIs during chemotherapy developed more long-term respiratory symptoms than controls; however, differences did not reach statistical significance. No differences in static lung function were found between the two groups. Overall, pulmonary abnormalities and/or significant ongoing respiratory symptoms were detected in nearly a third of ALL survivors treated without HSCT. Larger, prospective studies are warranted to evaluate the etiology and clinical significance of these findings.
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Affiliation(s)
- Beryl Lin
- Faculty of MedicineUniversity of New South WalesSydneyAustralia
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyAustralia
| | - Brendan Kennedy
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyAustralia
| | - Jamie McBride
- Department of Respiratory MedicineSydney Children's HospitalSydneyAustralia
| | - Luciano Dalla‐Pozza
- Cancer Centre for ChildrenThe Children's Hospital at WestmeadSydneyAustralia
| | - Toby Trahair
- Faculty of MedicineUniversity of New South WalesSydneyAustralia
- Kids Cancer CentreSydney Children's HospitalRandwickAustralia
| | - Geoffrey McCowage
- Cancer Centre for ChildrenThe Children's Hospital at WestmeadSydneyAustralia
| | - Emma Coward
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyAustralia
| | - Leanne Plush
- Department of Respiratory MedicineSydney Children's HospitalSydneyAustralia
| | - Paul D. Robinson
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyAustralia
- Discipline of Paediatrics and Child HealthUniversity of SydneySydneyAustralia
| | - Kate Hardaker
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyAustralia
- Discipline of Paediatrics and Child HealthUniversity of SydneySydneyAustralia
| | - John Widger
- Faculty of MedicineUniversity of New South WalesSydneyAustralia
- Department of Respiratory MedicineSydney Children's HospitalSydneyAustralia
| | - Anthea Ng
- Cancer Centre for ChildrenThe Children's Hospital at WestmeadSydneyAustralia
| | - Adam Jaffe
- Department of Respiratory MedicineSydney Children's HospitalSydneyAustralia
| | - Hiran Selvadurai
- Department of Respiratory MedicineThe Children's Hospital at WestmeadSydneyAustralia
- Discipline of Paediatrics and Child HealthUniversity of SydneySydneyAustralia
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5
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Jensen R, Stanojevic S, Klingel M, Pizarro ME, Hall GL, Ramsey K, Foong R, Saunders C, Robinson PD, Webster H, Hardaker K, Kane M, Ratjen F. A Systematic Approach to Multiple Breath Nitrogen Washout Test Quality. PLoS One 2016; 11:e0157523. [PMID: 27304432 PMCID: PMC4909265 DOI: 10.1371/journal.pone.0157523] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 06/01/2016] [Indexed: 11/18/2022] Open
Abstract
Background Accurate estimates of multiple breath washout (MBW) outcomes require correct operation of the device, appropriate distraction of the subject to ensure they breathe in a manner representative of their relaxed tidal breathing pattern, and appropriate interpretation of the acquired data. Based on available recommendations for an acceptable MBW test, we aimed to develop a protocol to systematically evaluate MBW measurements based on these criteria. Methods 50 MBW test occasions were systematically reviewed for technical elements and whether the breathing pattern was representative of relaxed tidal breathing by an experienced MBW operator. The impact of qualitative and quantitative criteria on inter-observer agreement was assessed across eight MBW operators (n = 20 test occasions, compared using a Kappa statistic). Results Using qualitative criteria, 46/168 trials were rejected: 16.6% were technically unacceptable and 10.7% were excluded due to inappropriate breathing pattern. Reviewer agreement was good using qualitative criteria and further improved with quantitative criteria from (κ = 0.53–0.83%) to (κ 0.73–0.97%), but at the cost of exclusion of further test occasions in this retrospective data analysis. Conclusions The application of the systematic review improved inter-observer agreement but did not affect reported MBW outcomes.
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Affiliation(s)
- Renee Jensen
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
| | - Sanja Stanojevic
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
- * E-mail:
| | - Michelle Klingel
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
| | - Maria Ester Pizarro
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Graham L. Hall
- Telethon Kids Institute, Perth, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Kathryn Ramsey
- Telethon Kids Institute, Perth, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Australia
- University of North Carolina at Chapel Hill, Chapel Hill, United States of America
| | - Rachel Foong
- Telethon Kids Institute, Perth, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Clare Saunders
- Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
- Department of Gene Therapy, Imperial College London, London, United Kingdom
| | - Paul D. Robinson
- Department of Respiratory Medicine, The Children’s Hospital at Westmead, Sydney, Australia
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Hailey Webster
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
| | - Kate Hardaker
- Department of Respiratory Medicine, The Children’s Hospital at Westmead, Sydney, Australia
| | - Mica Kane
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
| | - Felix Ratjen
- Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Canada
- University of Toronto, Toronto, Canada
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6
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Thamrin C, Hardaker K, Robinson PD. Multiple breath washout: From Renaissance to Enlightenment? Pediatr Pulmonol 2016; 51:447-9. [PMID: 26418865 DOI: 10.1002/ppul.23316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 09/05/2015] [Accepted: 09/16/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Cindy Thamrin
- Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kate Hardaker
- Department of Respiratory Medicine, Children's Hospital at Westmead, Westmead, Sydney, Australia
| | - Paul D Robinson
- Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Respiratory Medicine, Children's Hospital at Westmead, Westmead, Sydney, Australia
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