New Zealand national incidence of bronchiectasis "too high" for a developed country

Abstract

Aims: To prospectively estimate the incidence of bronchiectasis among New Zealand (NZ) children, to consider aetiology and severity, and to evaluate regional and ethnic variation. Methodology: NZ paediatricians were surveyed monthly for new cases of bronchiectasis during 2001 and 2002 via the NZ paediatric surveillance unit (with coverage of .94% of NZ paediatricians). Notified cases had their computed tomography scans reviewed and scored for severity. Confirmed cases were followed up by postal questionnaire one year after diagnosis. Demographic, aetiological, and severity data were collected. Results: Ninety nine notifications were received. Sixty five cases were confirmed. An overall incidence of 3.7 per 100 000 under 15 year old children per year was estimated. Incidence was highest in Pacific children at 17.8 compared with 4.8 in Maori, 1.5 in NZ European, and 2.4 other per 100 000 per year. Incidence varied significantly by region. The median age at diagnosis was 5.2 years; the majority had symptoms for more than two years. Eighty three per cent had bilateral disease, with a median of three lobes affected, mean FEV1 of 77% predicted, and modified Bhalla HRCT score of 18. Conclusions: The incidence of bronchiectasis is high in NZ children, nearly twice the rate for cystic fibrosis and seven times that of Finland, the only other country reporting a childhood national rate. Incidence varied substantially between ethnicities. Most cases developed disease in early childhood and had delayed diagnosis.

Atopy in Patients with Bronchiectasis: More than Coincidence

“…However we suppose that atopy may be a causative or contributing effect on development of bronchiectasis, as well as a coincidence, since the incidence of bronchiectasis can be higher than expected in countries where atopy prevalence is also high (Twiss et al 2005). Furthermore atopy might be deteriorating factor for bronchiectasis since atopy score has been positively correlated with HRCT score, in other words, the more atopy is the more extended bronchiectasis.…”

“…Criteria for the diagnosis of bronchiectasis utilizing HRCT included the following: 1) dilatation of bronchi as determined by an increased bronchial/adjacent pulmonary artery ratio (ratio > 1) when imaged in cross section (signet-ring sign), 2) parallel bronchial walls when seen in longitudinal section (tram sign), and 3) demonstration of bronchi in the peripheral third of the lung (Pifferi et al 2004). Bronchiectasis was scored as previously described (Twiss et al 2005) using the modified Bhalla scoring system (Bhalla et al 1991;Roberts et al 2000). This score has been validated in adult and pediatric patients with bronchiectasis and assigns a value to each lobe and the lingula as follows: bronchiectasis extent (0-3), bronchial wall dilatation (0-3) and thickness (0-3), presence of mucus in large (0-1) and small airways (0-1), air trapping (0-4), atelectasis (0-1) and consolidation (0-1) resulting in a worst possible score of 102 (Roberts et al 2000).…”

Bronquiectasias en pediatría, aproximación diagnóstica y tratamiento

“…En países desarrollados han disminuido en las últimas décadas debido a los programas de vacunación infantil, mejoras en el tratamiento antituberculoso y el uso precoz de antibioticoterapia en infecciones pulmonares. 15,16 Estudios como el de Symajankangas et al, 17 desarrollado en Finlandia, y el de Twiss et al, 18 en Nueva Zelanda, sitúan la prevalencia en menores de 18 años entre el 0,5 y 3,7/100 000 habitantes, respectivamente. Existen además determinantes genético-raciales que condicionan una mayor prevalencia.…”

“…2,4,18,24 La etiología, según los distintos mecanismos patogénicos y su distribución, se recoge en las Tablas 1 y 2, respectivamente.…”

“…Su frecuencia oscila, en adultos y niños, en 0-17%. 18,[40][41][42] Dentro de las adquiridas, además de la inmunodepresión farmacológica, destaca la infección VIH (sida). Las bronquiectasias son más frecuentes en pacientes con neumonía intersticial linfoide, neumonías bacterianas o protozoarias recurrentes, o mayor grado de inmunodepresión, especialmente si los linfocitos CD 4+ son menores de 100/mcL.…”