Bronchiectasis in indigenous and non‐indigenous residents of Australia and New Zealand

Blackall, Sean; Hong, Jae Beom; King, Paul T.; Wong, Conroy; Einsiedel, Lloyd; Rémond, Marc; Woods, Cindy; Maguire, Graeme

doi:10.1111/resp.13280

Cited by 52 publications

(82 citation statements)

References 22 publications

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“…Crucially, our lung function data are in stark contrast to that reported recently in Indigenous Australian and New Zealand adults with bronchiectasis 31 . In the aforementioned study, Indigenous adults from Central Australia with bronchiectasis (a region where 31/131 [23.6%] of our cohort resided) were relatively young (mean age = 43.7 [SD: 12.3] years), had poor lung function (median FEV 1% predicted = 30% [IQR: 42.8‐65.7]) and died prematurely (median age = 50.1 years [IQR: 41.8‐54.6]) 31 . The Indigenous New Zealand cohort within the same study had a mean age of 58.2 (SD: 15.2) years, median FEV 1 % predicted = 42% (IQR: 31.0‐56.0), and median age of death = 70.8 (IQR: 60.4‐76.6) years 31 .…”

Section: Discussioncontrasting

confidence: 99%

“…In the aforementioned study, Indigenous adults from Central Australia with bronchiectasis (a region where 31/131 [23.6%] of our cohort resided) were relatively young (mean age = 43.7 [SD: 12.3] years), had poor lung function (median FEV 1% predicted = 30% [IQR: 42.8‐65.7]) and died prematurely (median age = 50.1 years [IQR: 41.8‐54.6]) 31 . The Indigenous New Zealand cohort within the same study had a mean age of 58.2 (SD: 15.2) years, median FEV 1 % predicted = 42% (IQR: 31.0‐56.0), and median age of death = 70.8 (IQR: 60.4‐76.6) years 31 . Rather than assuming these data reflect an age cohort effect, they highlight the need to understand the reasons for deteriorating lung health and function between adolescence and adulthood in these vulnerable populations.…”

Section: Discussionmentioning

confidence: 99%

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A decade on: Follow‐up findings of indigenous children with bronchiectasis

McCallum

Singleton

Redding

et al. 2020

Pediatric Pulmonology

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Objective The sole prospective longitudinal study of children with either chronic suppurative lung disease (CSLD) or bronchiectasis published in the current era was limited to a single center. We sought to extend this study by evaluating the longer‐term clinical and lung function outcomes and their associated risk factors in Indigenous children of adolescents from Australia, Alaska, and New Zealand who participated in our previous CSLD or bronchiectasis studies during 2004‐2010. Methods Between 2015 and 2018, we evaluated 131 out of 180 (72.8%) children of adolescents from the original studies at a single follow‐up visit. We administered standardized questionnaires, reviewed medical records, undertook clinical examinations, performed spirometry, and scored available chest computed tomography scans. Results Participants were seen at a mean age of 12.3 years (standard deviation: 2.6) and a median of 9.0 years (range: 5.0‐13.0) after their original recruitment. With increasing age, rates of acute lower respiratory infections (ALRI) declined, while lung function was mostly within population norms (median forced expiry volume in one‐second = 90% predicted, interquartile range [IQR]: 81‐105; forced vital capacity [FVC] = 98% predicted, IQR: 85‐114). However, 43 out of 111 (38.7%) reported chronic cough episodes. Their overall global rating judged by symptoms, including ALRI frequency, examination findings, and spirometry was well (20.3%), stable (43.9%), or improved (35.8%). Multivariable regression identified household tobacco exposure and age at first ALRI‐episode as independent risk factors associated with lower FVC% predicted values. Conclusion Under our clinical care, the respiratory outcomes in late childhood or early adolescence are encouraging for these patient populations at high‐risk of premature mortality. Prospective studies to further inform management throughout the life course into adulthood are now needed.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A decade on: Follow‐up findings of indigenous children with bronchiectasis

McCallum

Singleton

Redding

et al. 2020

Pediatric Pulmonology

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“…1 Regarding chronic respiratory illnesses, the disparity between Aboriginal and non-Aboriginal patients with bronchiectasis is particularly marked. 2 A recent study reported that the average age of death in patients with bronchiectasis was 22 years younger in…”

Section: What This Paper Addsmentioning

confidence: 99%

“…Respiratory illnesses account for 12% of the age‐standardised gap in mortality between Aboriginal and other Australians . Regarding chronic respiratory illnesses, the disparity between Aboriginal and non‐Aboriginal patients with bronchiectasis is particularly marked . A recent study reported that the average age of death in patients with bronchiectasis was 22 years younger in Aboriginal patients than non‐Aboriginal patients .…”

mentioning

confidence: 99%

“…Regarding chronic respiratory illnesses, the disparity between Aboriginal and non‐Aboriginal patients with bronchiectasis is particularly marked . A recent study reported that the average age of death in patients with bronchiectasis was 22 years younger in Aboriginal patients than non‐Aboriginal patients . In the Kimberley region of Australia, the median age at death for Aboriginal adults hospitalised with bronchiectasis is 33 years …”

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Chronic wet cough in Aboriginal children: It's not just a cough

D'Sylva

Walker

Lane

et al. 2018

J Paediatrics Child Health

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Aim Chronic respiratory disease is common among Aboriginal Australians. Chronic wet cough is an early marker of chronic disease in children but often goes undetected due, in part, to delayed health seeking by families. Currently, no studies have examined the reasons for delayed health seeking for children's chronic cough. To identify the barriers to, and enablers for, seeking medical help for chronic wet cough in Aboriginal children. Methods This was a qualitative study, gathering data through individual semi‐structured, in‐depth interviews and focus groups to ascertain Aboriginal family knowledge, attitudes and beliefs about seeking health care for chronic wet cough in children in a regional Kimberley town, Western Australia between October 2017 and March 2018. Results Forty Aboriginal community members participated. The three key barriers identified were: ‘Cough normalisation’, that is, 70% of participants considered chronic cough normal (with 53% of participants' previous interactions with doctors informing their understanding of chronic cough); the lack of health literacy information; and a sense of disempowerment (belief that no medical action would be taken and inability to challenge doctors). The key expressed enablers were provision of health literacy information and health practitioner training to assess and treat chronic wet cough in children. All participants reported that they would seek help for chronic wet cough once they were informed that it could signify underlying disease. Conclusion Results highlight the need for a culturally appropriate information and education to inform Aboriginal families and their health practitioners of the importance of chronic wet cough in children.

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Children with bronchiectasis have poorer lung function than those with cystic fibrosis and do not receive the same standard of care

Prentice

Wales

Doumit

et al. 2019

Pediatric Pulmonology

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Background Children with cystic fibrosis (CF) are routinely managed in a multidisciplinary clinic at tertiary pediatric centers. However, children with bronchiectasis may not be managed in the same way. We sought to compare the management model and clinical outcomes of children with bronchiectasis with children diagnosed with CF, in a single pediatric center. Methods We identified patients with bronchiectasis from hospital medical records at an urban tertiary pediatric hospital and identified a sex‐ and age‐matched CF patient at the same center to compare lung function, nutritional status, frequency of physiotherapy and respiratory physician visits, and number of microbiological samples taken for bacterial culture. Results Twenty‐two children with bronchiectasis were identified, mean (standard deviation [SD]) age was 11 (3) years. The most common known etiology for bronchiectasis was postinfective (6 of 22) but was unknown in 8 of 22. The cohort with bronchiectasis had poorer lung function (FEV1 mean [SD] percent predicted 78.6 [20.5] vs 94.5 [14.7], P = .005) and had less outpatient reviews by the respiratory physician (P < .001) and respiratory physiotherapist (P < .001) when compared to those with CF. Nutritional parameters did not differ between the groups. Many children (10 of 22, 45%) with bronchiectasis did not have any microbiological respiratory tract samples taken for evaluation. Conclusion Children with bronchiectasis at this institution have poorer lung function than children with CF, and are deserving of improved multidisciplinary care.

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Bronchiectasis in indigenous and non‐indigenous residents of Australia and New Zealand

Abstract: Bronchiectasis is not one disease. It has a significant impact on healthcare utilization and survival. Differences between populations are likely to relate to differing aetiologies and understanding the drivers of bronchiectasis in disadvantaged populations will be key.

Cited by 52 publications

References 22 publications

A decade on: Follow‐up findings of indigenous children with bronchiectasis

A decade on: Follow‐up findings of indigenous children with bronchiectasis

Chronic wet cough in Aboriginal children: It's not just a cough

Children with bronchiectasis have poorer lung function than those with cystic fibrosis and do not receive the same standard of care

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