Respiratory morbidity and lung function in two Aboriginal communities in Western Australia

Abstract

Our findings show a low prevalence of asthma in children, a high prevalence of respiratory symptoms and low levels of lung function in remote Aboriginal communities. The greater prevalence of respiratory morbidity in the desert community was not explained by diagnosed asthma, airway hyperresponsiveness or cigarette smoking. The role of infection requires further investigation. The results suggest that the lower lung function observed in Aboriginal communities (compared with non-Aboriginal communities) results at least partly from environmental factors.

Spirometry reference values in Indigenous Australians: a systematic review

“…However, there was a large variation in the differences observed. For example, Chandler and colleagues 20 noted Indigenous FEV 1 and FVC values to be ≤ 15% lower, whereas the studies by Verheijden and colleagues 15 and Veale and colleagues 17 reported results to be as much as 30% lower. Musk and colleagues 13 and Bucens and colleagues 14 noted that their spirometry results were similar to previous studies and lower than those in people of European ancestry, but did not specify how much lower.…”

“…All included studies involved prospective cohort groups and all followed appropriate ATS–ERS criteria when performing spirometry. The aims of the studies differed and included observing lung function, 20 examining influencing factors 13 ‐ 15 and developing reference equations for spirometry in Indigenous Australians ( n = 5) 16 . ‐ 19 , 21 None of the included studies followed all the ATS–ERS and GLI criteria needed to develop reference equations or validate the spirometry results (Box 4).…”

“…The possible reasons given by the studies' authors for the lower spirometry values observed in Indigenous Australians included external factors (ie, asthma, smoking, cough, repeated childhood infections) affecting lung growth during childhood 13 , 14 , 16 and suboptimal environmental conditions causing a faster decline in lung function during adulthood 17 , 18 . Differences between participant recruitment sites were considered the primary factor causing variation in spirometry results in Verheijden and colleagues' study, 15 as they noted lower spirometry values and more prevalent respiratory symptoms in the desert community compared with the tropical community. These factors, as well as access to quality health care, malnutrition, high levels of smoke exposure, premature birth and low birthweight, have been acknowledged in previous studies 27 , 32 ‐ 34 as negatively influencing respiratory health in these populations.…”

Global Lung Function Initiative‐2012 ‘other/mixed’ spirometry reference equation provides the best overall fit for Australian Aboriginal and/or Torres Strait Islander children and young adults

“…The GLI-2012 African-American equations are 14-16% lower than Caucasian values. Therefore, if previously conducted studies [21][22][23][24] on Indigenous Australian reference values were accurate (FEV 1 and FVC values up to 25% lower than Caucasians), then the African-American equation may be more appropriate. However, we found spirometry values for all Australian Indigenous ethnicities to be higher than the African-American values, with 15-18% of participants having z-scores above the ULN (>1.64).…”

“…Previous studies [21][22][23][24][25] have reported Australian Aboriginals to have forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC) values up to 25% and 30% lower, respectively, than healthy Caucasians. However, our systematic review 26 found that in these studies, spirometry was not performed according to the current American Thoracic Society (ATS), European Respiratory Society (ERS) or GLI guidelines.…”