Do New Zealand children with non‐cystic fibrosis bronchiectasis show disease progression?

Munro, Karen; Reed, Peter; Joyce, H; Perry, David E.; Twiss, Jacob; Byrnes, Catherine A; Edwards, Elizabeth A.

doi:10.1002/ppul.21331

Cited by 42 publications

(49 citation statements)

References 37 publications

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“…However, other studies also report S. pneumoniae in <10 % of respiratory cultures from NZ children with bronchiectasis [22,23], which contrasts with rates of 29-43 % reported in young healthy or otitis-prone NZ children [24]. Although S. pneumoniae carriage was lower in the azithromycin groups, it had recovered by the end of the Fig.…”

Section: Carriage and Resistance During The Interventionmentioning

confidence: 52%

Nasopharyngeal carriage and macrolide resistance in Indigenous children with bronchiectasis randomized to long-term azithromycin or placebo

Hare

Grimwood

Chang

et al. 2015

Eur J Clin Microbiol Infect Dis

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Although long-term azithromycin decreases exacerbation frequency in bronchiectasis, increased macrolide resistance is concerning. We investigated macrolide resistance determinants in a secondary analysis of a multicenter randomized controlled trial. Indigenous Australian children living in remote regions and urban New Zealand Māori and Pacific Islander children with bronchiectasis were randomized to weekly azithromycin (30 mg/kg) or placebo for up to 24 months and followed post-intervention for up to 12 months. Nurses administered and recorded medications given and collected nasopharyngeal swabs 3-6 monthly for culture and antimicrobial susceptibility testing. Nasopharyngeal carriage of Haemophilus influenzae and Moraxella catarrhalis was significantly lower in azithromycin compared to placebo groups, while macrolide-resistant Streptococcus pneumoniae and Staphylococcus aureus carriage was significantly higher. Australian children, compared to New Zealand children, had higher carriage overall, significantly higher carriage of macrolide-resistant bacteria at baseline (16/38 versus 2/40 children) and during the intervention (69/152 versus 22/239 swabs), and lower mean adherence to study medication (63 % versus 92 %). Adherence ≥70 % (versus <70 %) in the Australian azithromycin group was associated with lower carriage of any pathogen [odds ratio (OR) 0.19, 95 % confidence interval (CI) 0.07-0.53] and fewer macrolide-resistant pathogens (OR 0.34, 95 % CI 0.14-0.81). Post-intervention (median 6 months), macrolide resistance in S. pneumoniae declined significantly in the azithromycin group, from 79 % (11/14) to 7 % (1/14) of positive swabs, but S. aureus strains remained 100 % macrolide resistant. Azithromycin treatment, the Australian remote setting, and adherence <70 % were significant independent determinants of macrolide resistance in children with bronchiectasis. Adherence to treatment may limit macrolide resistance by suppressing carriage.

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Section: Carriage and Resistance During The Interventionmentioning

confidence: 52%

Nasopharyngeal carriage and macrolide resistance in Indigenous children with bronchiectasis randomized to long-term azithromycin or placebo

Hare

Grimwood

Chang

et al. 2015

Eur J Clin Microbiol Infect Dis

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“…While pediatric bronchiectasis mortality data from developing countries are limited, a Malaysian study observed considerable morbidity with a negative impact upon growth, lung function, and quality of life (QoL) . Similar adverse effects were observed in New Zealand Maori and Pacific Island children, despite receiving treatment at a tertiary center, while in contrast in children from England treatment stabilized lung function . Furthermore, bronchiectasis has been associated with increased cardiac morbidity, malnutrition, osteopenia, and even cancer …”

Section: Burden Of Diseasementioning

confidence: 97%

“…Of the 5,745 deaths attributed to bronchiectasis in England and Wales between 2001 and 2007, only 12 were in the 0–14 year age group . In contrast 6 (7%) of 91 children (59% Pacific Island, 24% Maori) with bronchiectasis died while attending a single New Zealand center between 1991 and 2006 . Importantly, the premature mortality in high‐risk pediatric populations carries over into adulthood.…”

Section: Burden Of Diseasementioning

confidence: 99%

Pediatric bronchiectasis: No longer an orphan disease

Goyal

Grimwood

Marchant

et al. 2016

Pediatric Pulmonology

137

140

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Bronchiectasis is described classically as a chronic pulmonary disorder characterized by a persistent productive cough and irreversible dilatation of one or more bronchi. However, in children unable to expectorate, cough may instead be wet and intermittent and bronchial dilatation reversible in the early stages. Although still considered an orphan disease, it is being recognized increasingly as causing significant morbidity and mortality in children and adults in both affluent and developing countries. While bronchiectasis has multiple etiologies, the final common pathway involves a complex interplay between the host, respiratory pathogens and environmental factors. These interactions lead to a vicious cycle of repeated infections, airway inflammation and tissue remodelling resulting in impaired airway clearance, destruction of structural elements within the bronchial wall causing them to become dilated and small airway obstruction. In this review, the current knowledge of the epidemiology, pathobiology, clinical features, and management of bronchiectasis in children are summarized. Recent evidence has emerged to improve our understanding of this heterogeneous disease including the role of viruses, and how antibiotics, novel drugs, antiviral agents, and vaccines might be used. Importantly, the management is no longer dependent upon extrapolating from the cystic fibrosis experience. Nevertheless, substantial information gaps remain in determining the underlying disease mechanisms that initiate and sustain the pathophysiological pathways leading to bronchiectasis. National and international collaborations, standardizing definitions of clinical and research end points, and exploring novel primary prevention strategies are needed if further progress is to be made in understanding, treating and even preventing this often life-limiting disease.

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“…[21][22][23] In most studies, the average age at diagnosis of bronchiectasis was 5 to 9 years, but all series included children diagnosed at , 1 year of age. 4,[23][24][25] One-half of the children in our study were , 3 years old at enrollment, and our report represents a unique insight into the longitudinal course of children with CSLD/bronchiectasis diagnosed early in life.…”

Section: Predisposing Factors For Recurrent and Severe Aresmentioning

confidence: 99%

Respiratory Exacerbations in Indigenous Children From Two Countries With Non-Cystic Fibrosis Chronic Suppurative Lung Disease/Bronchiectasis

Redding

Singleton

Valery

et al. 2014

Chest

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Do New Zealand children with non‐cystic fibrosis bronchiectasis show disease progression?

Abstract: In our experience despite management in a tertiary multidisciplinary bronchiectasis clinic, progression of lung disease continues in a group of children and young adults.

Cited by 42 publications

References 37 publications

Nasopharyngeal carriage and macrolide resistance in Indigenous children with bronchiectasis randomized to long-term azithromycin or placebo

Nasopharyngeal carriage and macrolide resistance in Indigenous children with bronchiectasis randomized to long-term azithromycin or placebo

Pediatric bronchiectasis: No longer an orphan disease

Respiratory Exacerbations in Indigenous Children From Two Countries With Non-Cystic Fibrosis Chronic Suppurative Lung Disease/Bronchiectasis

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