Bronchiectasis among Australian Aboriginal and non-Aboriginal patients in the regional and remote population of the Northern Territory of Australia

Abstract

Introduction: Chronic respiratory disorders are highly prevalent among Australian Aboriginal people living in the Top End Health Service region in the Northern Territory, Australia. Bronchiectasis is a heterogenous disease that features among these chronic respiratory conditions in this population. However, there are sparse comparative data between Aboriginal and non-Aboriginal patients with bronchiectasis from this region. Methods: In this retrospective study, demographics, clinical characteristics and relevant laboratory parameters were compared among adult Aboriginal and non-Aboriginal patients diagnosed with bronchiectasis between 2012 and 2017.Results: A total of 388 adults had radiology-confirmed bronchiectasis and 258 (66%) were Aboriginal. Compared to non-Aboriginal patients, Aboriginal patients were significantly younger (mean age 54 v 67 years), the majority lived in rural and remote communities (80% v 9 %), had higher rates of self-reported smoking (52% v 19%), alcohol consumption (29% v 12%) and co-occurrence of chronic obstructive pulmonary disease (65% v 38%) and other chronic co-morbidities. Sputum microbiology was also different between the groups with Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis being more common in Aboriginal patients, while Pseudomonas aeruginosa, Aspergillus species and non-tuberculous mycobacteria were higher in non-Aboriginal patients. Further, Aboriginal patients had poorer lung function compared to non-Aboriginal patients (forced expiratory volume after 1 second predicted 33% v 53%, forced vital capacity predicted 49% v 60% respectively), higher exacerbation rates (29% v 18%) and poorer overall outcomes (age at death 60 v 76 years). Conclusion:Within a single health service, Aboriginal patients with bronchiectasis have significantly poorer outcomes with differing manifestations and higher comorbidities than non-Aboriginal patients. This warrants further studies to identify feasible interventions to reduce this inequity.

The Effects of Inhaled Airway Directed Pharmacotherapy on Decline in Lung Function Parameters Among Indigenous Australian Adults With and Without Underlying Airway Disease

“…Indigenous people around the world experience a higher burden of chronic health conditions, including advanced respiratory conditions. [44][45][46] Despite evidence in the literature to suggest chronic respiratory conditions along with poor LFPs are highly prevalent among Indigenous population, including in the adult Indigenous Australians, 1,4,[7][8][9][10][11][12][13][14][15][16] there is no published data examining the effects of airway directed inhaled pharmacotherapy on LFPs trajectory in this population. Hence, we believe our current study is of significant value in addressing this gap in our knowledge.…”

“…[55][56][57][58][59] These aspects are of significant clinical relevance in the Australian setting, where a significant proportion of Australian Indigenous patients demonstrate concurrent presence of COPD and bronchiectasis. [7][8][9]12 Hence, lack of established evidence may give rise to an unprecedented treatment management dilemma and challenges for this Indigenous population.…”

“…However, excessive yearly decline in FEV 1 is noted to be higher among patients using ICS containing pharmacotherapy alongside higher all-cause mortality in comparison to patients with non-ICS containing inhaled pharmacotherapy or no pharmacotherapy. In the light of this study, and the authors several years of experience in managing Indigenous patients with chronic health conditions, [7][8][9][10][11][12][13][14][15][16]54,[65][66][67][68][69][70][71][72] until and unless further prospective large scale studies are available to prove or disprove if ICS pharmacotherapy is a friend or foe in the management among Indigenous people, we sincerely recommend and advocate extreme caution in utilising…”

“…5,6 Chronic airway diseases, such as COPD and bronchiectasis are noted to be highly prevalent in the NT Indigenous population. [7][8][9][10][11] Moreover, recently published data has shown that co-occurrence of COPD and bronchiectasis along with poor lung function parameters (LFPs) are highly prevalent among Indigenous people living in the Top end health service (TEHS) region of the NT of Australia. [12][13][14][15][16] LFTs 17 play an integral role in the diagnosis, management and monitoring of several respiratory conditions.…”

“…This is despite overwhelming evidence in the literature documenting a higher burden of respiratory disease among the adult Indigenous Australian population. 4,[7][8][9][10][11][12] Furthermore, LFPs are noted to be significantly reduced among Indigenous Australians in comparison to non-Indigenous Australians. [13][14][15][16] Thus, considering these aforementioned factors together (reduced LFPs, high burden of chronic respiratory disorders along with potential higher use of airway directed pharmacotherapy), there appears to be a critical need to investigate LFPs trajectory with and without radiological evidence of chronic airway diseases and the effects of inhaled pharmacotherapy on LFPs' among the adult Indigenous Australian population.…”