The ‘ABC’ of respiratory disorders among adult Indigenous people: asthma, bronchiectasis and COPD among Aboriginal Australians – a systematic review

Abstract

BackgroundAboriginal Australians are reported to have higher presence of chronic respiratory diseases. However, comprehensive evidence surrounding this is sparse. Hence, a systematic review was undertaken to appraise the current state of knowledge on respiratory health in the adult Aboriginal Australians, in particular among the three most common respiratory disorders: asthma, bronchiectasis and chronic obstructive pulmonary disease (COPD).MethodsA systematic review of primary literature published between January 2012 and October 2022, using the databasesPubMedandScopus, was conducted. Studies were included if they reported adult Aboriginal Australian prevalence’s or outcomes related to asthma, bronchiectasis or COPD, and excluded if adult data were not reported separately, if Aboriginal Australian data were not reported separately or if respiratory disorders were combined into a single group. Risk of bias was assessed by both Joanne Briggs Institute checklists and Hoys’ bias assessment. Summary data pertaining to prevalence, lung function, symptoms, sputum cultures and mortality for each of asthma, bronchiectasis and COPD were extracted from the included studies.ResultsThirty-seven studies were included, involving approximately 33 364 participants (71% female). Eighteen studies reported on asthma, 21 on bronchiectasis and 30 on COPD. The majority of studies (94%) involved patients from hospitals or respiratory clinics and were retrospective in nature. Across studies, the estimated prevalence of asthma was 15.4%, bronchiectasis was 9.4% and COPD was 13.7%, although there was significant geographical variation. Only a minority of studies reported on clinical manifestations (n=7) or symptoms (n=4), and studies reporting on lung function parameters (n=17) showed significant impairment, in particular among those with concurrent bronchiectasis and COPD. Airway exacerbation frequency and hospital admission rates including mortality are high.DiscussionAlthough risk of bias globally was assessed as low, and study quality as high, there was limited diversity of studies with most reporting on referred populations, and the majority originating from two centres in the Northern Territory. The states with the greatest Aboriginal Australian population (Victoria and New South Wales) reported the lowest number of studies and patients. This limits the generalisability of results to the wider Aboriginal Australian population due to significant environmental, cultural and socioeconomic variation across the population. Regardless, Aboriginal Australians appear to display a high prevalence, alongside quite advanced and complex chronic respiratory diseases. There is however significant heterogeneity of prevalence, risk factors and outcomes geographically and by patient population. Further collaborative efforts are required to address specific diagnostic and management pathways in order to close the health gap secondary to respiratory disorders in this population.

Cystic lung disease in adult Indigenous Australians in the Northern Territory of Australia

“…Indigenous patients are reported to have a heightened burden of chronic respiratory diseases, alongside lower lung function parameters, including quite advanced and complex radiology findings 6,18–27 . In this case study, a significant proportion of patients were observed to have emphysema or bronchiectasis and to demonstrate cysts that in the majority were considered to be distinct either from emphysema or bronchiectasis.…”

Hospital admission rates and related outcomes among adult Aboriginal australians with bronchiectasis – a ten-year retrospective cohort study

“…In the global non-Indigenous populations, hospital admission data and factors associated with mortality, including the economic burden secondary to bronchiectasis are well documented [ 3 – 7 , 19 – 23 ]. Among the adult Indigenous population however, literature surrounding hospital admissions is sparse – despite a higher burden of chronic respiratory disease [ 10 , 24 ]. On the backdrop of poorer socioeconomic environment, alongside geographic, social and systemic barriers to healthcare, Indigenous people typically display a greater degree of multimorbidity, which in turn may alter the way in which respiratory diseases manifest in comparison to their non-Indigenous counterparts [ 28 , 31 , 42 – 48 ].…”

“…Presence of bronchiectasis can lead to a greater number of hospitalisations and associated mortality both as direct results of bronchiectasis exacerbations per se or as an indirect contributor to other comorbidities [ 19 – 23 ]. Among both Aboriginal Australians and among Indigenous populations worldwide the prevalence of multimorbidity is high [ 24 – 27 ]. Indeed, concurrent presence of bronchiectasis and chronic obstructive pulmonary disease (COPD) has been reported in up to 50% of adult Aboriginal Australians [ 28 – 33 ].…”

“…However, although a higher hospitalisation frequency amongst Indigenous patients with bronchiectasis has been described in the existing literature, there is little data regarding other pertinent factors such as principal reasons for hospital presentation, length of hospital stays, utilisation of intensive care unit (ICU) or mechanical ventilation and therapeutic interventions, in particular use of inhaled pharmacotherapy. In the recent past, a significant prevalence of chronic respiratory disorders, including bronchiectasis among adult Aboriginal Australians in the Northern Territory (NT) of Australia has begun to be elucidated [ 10 , 24 ]. Hence, it is timely to investigate in greater detail hospital presentations and related outcomes among adult Aboriginal Australians with bronchiectasis.…”

Intergenerational trauma and long‐term lung dysfunction: Early life exposures and pulmonary function in Indigenous Australian adults

“…Despite different ancestries, different histories and huge differences in environmental exposures, there is a remarkably consistent pattern of morbidity, including hypertension, diabetes mellitus, mental health disorders and high rates of suicide, and chronic respiratory disease 1 . Lung diseases that have been particularly well characterized in Indigenous populations include bronchiectasis and chronic obstructive pulmonary disease (COPD) 2 …”