Infections

Better news with bronchiectasis in Indigenous children


A long-term follow-up of Indigenous children with chronic suppurative lung disease (CSLD) or bronchiectasis across three countries has shown encouraging respiratory outcomes.

The study was able to follow up 73% of 180 children from Australia, New Zealand and Alaska, at a median of 9.0 years after their recruitment to earlier local studies.

It found that despite ongoing exposure to household smoke and overcrowding, no children had deteriorated compared to baseline in the previous studies.

On a physician’s global rating for clinical impression, children were either well (20.3%), stable (43.9%) or improving (35.8%).

The number of acute lower respiratory infections were reducing with increasing age however more than a third of children (35.1%) still had at least one ALRI in the previous 12 months. Only 6.9% had recurrent (>3) episodes.

Available lung function measures were mostly in the normal range.

However caregivers reported that daily cough for longer than four weeks (39%), wheeze  (31.9%) and school absenteeism due to respiratory symptoms (46.9%) were still common in the preceding 12 months.

“In the current era of children receiving more intensive treatment for bronchiectasis, our cohort generally received standardized care (based on current CSLD or bronchiectasis guidelines) and with improved vaccine programs, and access to healthcare these factors may have contributed to overall lung function stability,” the study said.

“Importantly, other recent retrospective cohort studies in predominantly nonindigenous pediatric populations have also shown lung function stability over 3 to 5 years.”

However the authors including Professor Anne Chang, from the Queensland Children’s Hospital, said the relatively positive outcomes were “in stark contrast” to those reported recently in Indigenous Australian and New Zealand adults with bronchiectasis.

“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.”

“Notwithstanding the urgent need to address social inequalities and social determinants of disease, strategies are also required to optimize ongoing clinical management and transitioning from pediatric to adult care to help reduce long‐term morbidity and mortality of bronchiectasis in Indigenous populations.”

The findings are published in Pediatric Pulmonology.

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