Children’s Lung Study in Dhulikhel A longitudinal multidisciplinary approach in children’s lower respiratory tract infections

Childhood respiratory tract infections are a major global health problem. These infections are responsible for 20-30% of visits to healthcare facilities and 20-30% of hospital admissions in Nepal among children under 5 years old. Viral respiratory tract infections early in life can also contribute to the development of asthma and chronic lung diseases later in life. This is likely dependent on the virus, exposure to environmental factors and host genetics. With C-LUNG we're leveraging a long-standing collaboration between NTNU/StOlav, Dhulikhel Hospital/Kathmandu University Hospital (DHKUH) researchers and healthcare professionals in a new research project. Our goal is to improve the health of children who suffer from respiratory infections and to find affordable ways to prevent childhood asthma and chronic lung diseases. At DHKUH we will establish diagnostic testing for the most common respiratory viruses to identify the cause of infection in children admitted to the hospital with respiratory infections. We will collect clinical information about the children and take blood samples to analyze their immune response. The long-term goal is to uncover how respiratory infections during childhood affect long-term lung health and the development of chronic lung diseases in Nepal. In addition, we're going to investigate whether a short course of steroids given to children who are admitted to the hospital with respiratory tract infections can prevent the development of chronic lung diseases. On a local level, we aim to establish a Center for Childhood Respiratory Tract Infections at DHKUH to strengthen their capacity to do research and access to molecular diagnostic testing. Ultimately, our efforts are geared towards safeguarding the health of Nepali children and advancing our understanding of respiratory health in resource-constrained settings.

The project's ambition is to improve outcomes in early childhood lower respiratory infections (cLRTI) and to develop affordable prevention of childhood asthma and chronic lung disease in Nepal. The project capitalizes on the long-term collaboration between NTNU/StOlav and Dhulikhel Hospital (DH) researchers and clinicians and our experience in conducting large cohort studies in this patient group in Norway and Nepal. The project builds on a timely local ambition to establish a Center for childhood respiratory tract infections to strengthen local molecular diagnostics and research capacity. To meet our ambition we have designed a clinical prospective C-LUNG Study to establish state-of-the-art knowledge to reveal the role of LRTI in childhood as a determinant of long-term lung health/chronic lung disease in a low-income country (LIC). We will assess etiology patterns in children with LRTI. By strengthening local molecular diagnostic and biobanking of samples for retrospective viral tests, the basis for future surveillance capacity has also been formed. In C-LUNG will follow up children after early-life LRTI, to assess the rate of recurrent LRTIs, wheezing episodes, lung function and compare them to a control group of children without LRI. We will extend traditional outcome assessments including family and child-related QoL effects. In a selection of the LRTI study participants with the highest risk of asthma development, we will evaluate the effects of corticosteroids in a RCT. In addition, we will do in-depth immune profiling of blood from children with different viral infections both at admission and one year later to identify and assess immune dysregulations associated with the development of chronic lung disease.