When a child's cough doesn't stop

Professor Anne Chang is a powerhouse medical doctor and researcher who leads the Cough and Airways Research Group at QUT’s Australian Centre for Health Services Innovation.

With her then PhD scholar Julie Marchant, she is recognised globally for describing for the first time the diagnosis of a chronic wet cough condition in children called Protracted Bacterial Bronchitis (PBB), that, without treatment, can lead to permanent lung damage.

A senior consultant on the wards at the Queensland Children’s Hospital and a paediatric respiratory researcher based at Brisbane’s Centre for Children’s Health Research, Professor Chang’s dual roles give her a unique ability to fulfill her life’s guiding principle of ‘making a difference’.

“When you do clinical medicine, you see what’s needed and obviously you make a difference to individual patients, but you make a bigger difference by doing research that changes things,” she said.

And change things she has.

Professor Chang and her research team changed the management standard for PBB - that is now used worldwide – to at least a two-week course of the antibiotic, amoxicillin-clavulanate. This overturned the former standard of a short course of antibiotics.

Over her career, Professor Chang and her close-knit, long-time research team have garnered more than $95.8 million as chief investigators in peer-reviewed research funding into early childhood preventable chronic cough, preschool wheezing, bronchiectasis (damage to the airways) and other collaborative projects.

“These are conditions that can plague children and their parents alike with sleepless nights, multiple doctor and hospital admissions and nagging anxiety,” she said.

“When (co-researcher) Associate Professor Julie Marchant first did her PhD under Professor Chang in the early 2000s, 20 per cent of patients saw doctors more than 20 times for their chronic cough and 80 per cent of them saw a doctor more than five times.

“The quality of life for parents of children with chronic cough is as bad as for those whose children have diabetes.

“In the old days they (doctors) said children should be treated like adults if they had chronic cough and were given medicine for asthma which didn’t help.

“Children’s lungs are still growing so if you don’t treat them properly at the right time, you end up with lower lung function; it might not be abnormally low but is enough to predispose you to a future of further problems, not only for respiratory but also cardiovascular problems.”

In 2023, Professor Chang and her research group received a $2.6 million National Health and Medical Research Council (NHMRC) grant for the LEAP-Cough multi-centre study to investigate if nine months of treatment with antibiotic azithromycin reduces recurrent PBB at 12 and 24 months of age in high-risk children.

“This is the next step in our large body of research on bronchiectasis,’’ Professor Chang said.

“We did a study with Aboriginal and Torres Strait Islander and Maori people and found that azithromycin halved exacerbations of bronchiectasis and the need for hospital, and so we changed management accordingly.

“Our LEAP-Cough study will also determine whether this nine-month treatment could also improve future lung health.

“Staving off bronchiectasis would lead to huge health cost savings and much improved quality-of-life for children and their families.”

Professor Chang has a long history of working in Indigenous communities. After medical school at the University of Melbourne, she completed a Master of Public Health and Tropical Medicine and spent two years working in Central Australia, later volunteering in Timor-Leste and in Sabah, a remote region of East Malaysia.

An international review led by Professor Chang, with researchers from Canada, Uganda, New Zealand, Guatemala, Spain, South Africa and Australia, found Indigenous peoples around the world bear a disproportionate burden of chronic respiratory diseases, which is associated with increased risks of morbidity and mortality. The results were published in the journal, Lancet Respiratory Medicine, in April.

The article calls for prevention of respiratory disease in Indigenous children to start before they are conceived.

Professor Chang says any changes must be “multi-factorial’’ and go beyond just medical treatment, including societal changes such as decent housing, better nutrition and poverty alleviation.

Studies are also underway to improve children’s respiratory health before they are born with an NHMRC-funded antenatal vitamin D study, led by Associate Professor Michael Binks through the Menzies School of Health Research in Darwin where Professor Chang leads the Child and Maternal Health Division.

“Vitamin D improves your immunity system,’’ Professor Chang said.

“This research involves giving mothers daily vitamin D from 32 weeks (gestation) to birth, and to babies from birth to four months to see if it reduces acute lower respiratory infection in infants’ first year of life.’’

In another study Professor Chang leads, mothers in Australian First Nations, Maori and Pasifika communities are given a pneumococcal vaccine to try to prevent their babies getting lung infections.

“If mums get the vaccine, it goes into the baby through the blood and breast milk which should protect them up to six months,” she said.

Professor Chang is also working on the common health problem of pre-school wheeze, thanks to a $2.5 million Medical Research Future Fund grant.

The multicentre study will use an AI-developed tool called WheezeScan to objectively identify a child’s wheeze, with the aim of reducing unscheduled doctor visits and hospitalisation and improve quality of life.

“We are using a commercial tool for this study to help parents recognise wheezing in their child who is unwell. The cost of pre-school wheeze cost is higher than that of asthma with time off work for doctor visits,’’ Professor Chang said

“What constitutes wheeze is contentious – doctors and parents disagree more than 50 per cent of the time on whether wheezing is present in a child.

“In my clinic some children have been seven times to hospital for the wheeze and have been in ICU (intensive care unit) but if they were only managed properly, they wouldn’t have to come back to ICU anymore.

“When they come to ICU there’s so much anxiety, there’s a risk of death, there’s complications. It’s a major thing for parents.’’

Working 80-to-100-hours a week, Professor Chang keep fits a daily regimen of “60 push-ups and 100 sit-ups”.

“It doesn’t take long. I exercise for only 10 minutes a day at home, and I scoot to work,” Professor Chang said.

“Every day I’m doing something for post docs, looking at grants, helping them write applications. I love my work, I’m very lucky because I work with great people. I have an amazing team.

“That’s the good thing about doing clinical medicine plus research. I wouldn’t want to do one and not the other. It’s very exciting when you make a difference.”