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• W3203337889 abstract "FOR RELATED ARTICLE, SEE PAGE 1200Bronchiectasis, a chronic pulmonary disorder, is an umbrella term for a clinical syndrome characterized by abnormal bronchial dilatation on chest CT scans that is generally associated with recurrent or persistent airway infections and inflammation that affect lung function and quality of life. In the last decade, awareness of bronchiectasis in adults and children has grown due to an increase in clinical research. Moreover, the leading international respiratory societies recently have developed guidelines for the diagnosis and management of bronchiectasis. An important milestone in this field was the foundation of the European Multicentre Bronchiectasis Audit and Research Collaboration, which has been promoted by J.D. Chalmers (United Kingdom), E. Polverino (Spain), and S. Aliberti (Italy) to facilitate multidisciplinary collaborative research in non-cystic fibrosis bronchiectasis with substantial patient and physician involvement.1Chalmers J.D. Aliberti S. Polverino E. et al.The EMBARC European Bronchiectasis Registry: protocol for an international observational study.ERJ Open Res. 2016; 2: 00081-2015Crossref PubMed Scopus (114) Google Scholar Although these advances in the management of bronchiectasis are positive developments, there remain persistent ethnic, socioeconomic, and geographic disparities in the diagnosis and management of bronchiectasis. Studies have revealed a role of ethnicity, as a marker of ancestry and often of culture, as well as other sociodemographic traits, in the characterization of patients with respect to medical care. In recent years, First Nations People’ has emerged as a name that recognizes Aboriginal and Torres Strait Islander people as the first people of Australia. FOR RELATED ARTICLE, SEE PAGE 1200 In 2002, prompted by the finding of a high prevalence of bronchiectasis in children <15 years old (14.7/1000) in the First Nations population and the general opinion that nothing could be done to address this finding, a Working Group on Indigenous Pediatric Respiratory Health chaired by Anne Chang developed consensus recommendations on bronchiectasis that were restricted to First Nation children in remote Australian communities.2Chang A.B. Grimwood K. Mulholland E.K. Torzillo P.J. Bronchiectasis in indigenous children in remote Australian communities.Med J Aust. 2002; 177: 200-204Crossref PubMed Scopus (162) Google Scholar Since then, a multiteam effort to improve clinical assistance and research in Australia has been ongoing. Australia, with its First Nation and non-First Nation populations, represents a distinctive ethnogeographic laboratory for the study of bronchiectasis. In this issue of CHEST, McCallum et al3McCallum GB Oguoma VM Versteegh LA et al.Comparison of First Nations and non-First Nations children’s profiles with bronchiectasis over two five-year periods from the Northern Territory, Australia.Chest. 2021; 160: 1200-1210Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar report the prospective analysis of the profiles of 299 children with CT-confirmed bronchiectasis in two 5-year time periods in First Nations and non-First Nations children. In the First Nations population, the number of children with bronchiectasis remained persistently high, whereas the number of non-First Nations children with bronchiectasis more than doubled. These data indicate some promising results regarding the awareness of bronchiectasis in Australia. The Australian and New Zealand bronchiectasis guidelines have had multiple updates (2008, 2010, and 2015) to ensure they are aligned with current knowledge. Additionally, the study reported that, in children with the clinical features of bronchiectasis, specifically recurrent lower respiratory infections, referral for earlier evaluation led to reductions in the occurrence of chronic wet cough and the use of azithromycin among First Nations children. As reported in this study, infection in bronchiectasis varies with age. However, it is still difficult to compare cases of bronchiectasis in childhood and adulthood accurately because of the existence of gaps in the research. Although a 5-year period of observation is relatively short to enable the identification of a turning point in the control and management of bronchiectasis in Australia, the following question should be asked: What can the Australian experience tell us about First Nations children? Bronchiectasis has a major impact on patients regarding the symptoms, lung function, exacerbations, and quality of life. Moreover, health care costs, such as the costs of hospitalization due to exacerbations, are high for children.4Goyal V. McPhail S.M. Hurley F. et al.Cost of hospitalization for bronchiectasis exacerbation in children.Respirology. 2020; 25: 1250-1256Crossref PubMed Scopus (12) Google Scholar Although the management of non-cystic fibrosis bronchiectasis is a fundamental objective of the health system in Australia, this condition still receives less attention than cystic fibrosis.5Prentice B.J. Wales S. Doumit M. Owens L. Widger J. Children with bronchiectasis have poorer lung function than those with cystic fibrosis and do not receive the same standard of care.Pediatr Pulmonol. 2019; 54: 1921-1926Crossref PubMed Scopus (9) Google Scholar First Nations people, like other ethnic minorities worldwide, are often hesitant to access health services because of the fear of discrimination, misunderstandings, poor communication, a lack of trust in service providers, and discomfort in the hospital environment. It may take decades to overcome these obstacles. Success is achievable, as demonstrated by the case of vaccination,6Beard F.H. Clark K.K. High rates of vaccination of Aboriginal and Torres Strait Islander Australians: an underappreciated success?.Med J Aust. 2019; 211: 17-18Crossref PubMed Scopus (2) Google Scholar and the efforts of the Australian Working Group are laudable. However, there is no reason to expect that continuing to focus efforts on diagnosing and managing bronchiectasis will change the relatively static statistics. There is a need to adopt other means of addressing the problem simultaneously. The finding of airway dilatation that serves as the basis for the diagnosis of bronchiectasis does not provide the entire clinical picture, and additional investigations are needed. The persistently high prevalence of postinfectious causes of bronchiectasis, not only in Australia but also worldwide, need to be examined.7Chalmers J.D. Chang A.B. Chotirmall S.H. Dhar R. McShane P.J. Bronchiectasis.Nat Rev Dis Primers. 2018; 4: 45Crossref PubMed Scopus (84) Google Scholar Prevention of the transmission of infectious diseases is a key step in the reduction of the burden of bronchiectasis. Addressing TB, a major cause of bronchiectasis in developing countries, with better therapeutic agents and vaccines and developing a vaccine against non-typeable Haemophilus influenzae are not impossible goals in the current global climate if government institutions, nonprofit advocacy organizations, big pharma, and academia invest in pursuing them. Australia has an advantage because its health care system was not affected severely by the COVID-19 pandemic and had the resources to take on this challenge. Pathologic conditions in which the clinical syndrome is evident before the development of bronchial dilatation, such as protracted bacterial bronchitis, primary ciliary dyskinesia, and immunodeficiency, can be diagnosed in early infancy. The high prevalence of idiopathic bronchiectasis is an unexplored topic in respiratory disease research.7Chalmers J.D. Chang A.B. Chotirmall S.H. Dhar R. McShane P.J. Bronchiectasis.Nat Rev Dis Primers. 2018; 4: 45Crossref PubMed Scopus (84) Google Scholar Genomics, metabolomics, and microbiomics can be used to predict the risk of disease and treatment response, and advances will no doubt continue to improve their accuracy, with the ultimate goal of the achievement of personalized approaches based on an individual’s biology and not their ethnicity. The median age at death of First Nation adults with bronchiectasis is 20 years younger than that of non-First Nation adults with bronchiectasis.8Blackall S.R. Hong J.B. King P. et al.Bronchiectasis in indigenous and non-indigenous residents of Australia and New Zealand.Respirology. 2018; 23: 743-749Crossref PubMed Scopus (27) Google Scholar First Nation children should not share the fate of the Bil-bil brothers of Australian Dreamtime mythology, who failed to find shelter from the heavy rain in their grandmother’s gunyah because she had too many dogs and instead ran into the mouth of Goorialla (the Rainbow Serpent), who swallowed them. Comparison of Profiles of First Nations and Non-First Nations Children With Bronchiectasis Over Two 5-Year Periods in the Northern Territory, AustraliaCHESTVol. 160Issue 4PreviewBronchiectasis remains high particularly among First Nations children. Important changes in their profiles that arguably reflect improvements were present, but overall, the profiles remained similar. Although vitamin D deficiency was uncommon, its role in children with bronchiectasis requires further evaluation. HTLV-1 infection was nonexistent and is unlikely to play any role in First Nations children with bronchiectasis. Full-Text PDF" @default.
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