National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people

Chapter 9: Respiratory health
Bronchiectasis and chronic suppurative lung disease
×
☰ Table of contents

Recommendations: Bronchiectasis and chronic suppurative lung disease

Preventive intervention type

Who is at risk?

What should be done?

How often?

Level/ strength of evidence

References

Immunisation

 All children and adults, including pregnant women Ensure timely immunisation is provided As per National Immunisation Program Schedule (NIPS) and state and territory schedules IA 1

Screening

 People with pneumonia and lower acute respiratory infections(ARIs) (particularly hospitalised episodes) Ensure primary healthcare providers review the patient after the ARI episode

If wet or productive cough* is present, consider the diagnosis of bronchiectasis/ chronic suppurative lung disease (CSLD).‡ Recommence antibiotics and undertake investigations as per management guidelines (refer to ‘Resources’) or refer to a specialist (Box 2)1		 3–4 weeks postepisode, then two-weekly until symptoms resolve or the patient is referred IA (antibiotics efficacy in treatment of wet cough in children)
III–IIB (screening for bronchiectasis post– lower ARI episode)		 37, 38, 39
People with recurrent lower ARIs (in children, this is >2 episodes of hospitalised chest X-ray proven pneumonia ever), and/or with persistent chronic (>4 weeks) wet cough† Consider a diagnosis of bronchiectasis. Repeat a chest X-ray

Refer children to a specialist if there is persistent wet cough and/or abnormal CXR (Box 2)		 Opportunistic III–II (screening for bronchiectasis post– lower ARI episode)

IA (antibiotics efficacy in treatment of wet cough in children)

GPP B (for effectiveness of screening and antibiotics in adults)		 1, 37, 39, 40, 47
People with history of tuberculosis Clinically assess for chronic lung disease symptoms,‡ and undertake spirometry Opportunistic III–II 48
Adults with chronic obstructive pulmonary disease (COPD) Undertake spirometry (refer to Chapter 9: Respiratory health, ‘Chronic obstructive pulmonary disease’). Assess for bronchiectasis symptoms and consider referral to specialist if:
  • there is a history of daily sputum production
  • sputum has persistent infection, especially with Pseudomonas aureginosa
  • there are increasing exacerbations
  • there is lung function decline
 Opportunistic III–II (screening for bronchiectasis in adults with COPD) 7, 8, 49

Behavioural

 All Infants Promote and encourage breastfeeding At postnatal checks III–IIB (breastfeeding protective) 1, 37
All children Promote good hygiene practices to reduce burden of infections (refer to Chapter 7: Hearing loss) Opportunistic GPP B 45
People with CSLD or known bronchiectasis Assess cough severity, quality of life, and exacerbating factors.

Undertake regular review to prevent and manage complications and comorbidities (Box 1)		 Three-monthly clinic review
Six-monthly specialist review		 GPP B 1, 2
Infants at risk of exposure to environmental tobacco smoke both in-utero and in the postnatal period Advise and assist pregnant women to avoid smoking (refer to Chapter 2: Antenatal care)

Advise parents/carers who smoke about the harms of environmental tobacco smoke and the need to limit childhood exposure, particularly in confined spaces (eg homes and motor vehicles) (refer to Chapter 1: Lifestyle, ‘Smoking’)		 Opportunistic IIIC 43, 44
Mothers with, or at risk of having, babies with low birth weights and/ or premature infants Promote increased access to comprehensive antenatal care (refer to Chapter 2: Antenatal care) Opportunistic GPP
III–IIC (premature and low birth weight infants developing CSLD)		 1, 6, 37
People with CSLD or known bronchiectasis Consider maintenance antibiotics on discussion with the person’s specialist As per clinical practice guidelines1 IA 50, 51

Chemo-prophylaxis

          
*Cough is usually underreported.41
†Children do not usually produce sputum and hence the term ‘wet cough’ (rather than ‘productive cough’) is used.1
‡Bronchiectasis refers to symptoms of CSLD in the presence of high-resolution computed tomography (HRCT) chest scan findings of airway dilatation when clinically stable.2 CSLD is diagnosed when symptoms and/or signs of bronchiectasis are present without availability of an HRCT to confirm bronchiectasis, or, in children, without the HRCT features of bronchiectasis.2 These symptoms and/or signs are recurrent (>3 episodes) wet or productive cough, each lasting for >4 weeks, with or without other features (eg exertional dyspnoea, symptoms of airway hyper-responsiveness, recurrent chest infections, growth failure, digital clubbing, hyperinflation or chest wall deformity).2

 

Box 1. Reviewing patients who have chronic suppurative lung disease/bronchiectasis1 

Regular review consists of at least an annual review in adults and six-monthly in children. A multidisciplinary team is preferable, especially at the initial evaluation.

The review includes assessment of:

  • severity, which includes oximetry and spirometry
  • sputum culture (when available) for routine bacterial and annual mycobacterial culture
  • management of possible complications and comorbidities, particularly for gastroesophageal reflux disease/aspiration, reactive airway disease/asthma, chronic obstructive pulmonary disease (COPD), otorhinolaryngeal disorders, urinary incontinence, mental health and dental disease; less commonly, patients require assessments for sleep-disordered breathing and cardiac complications
  • adherence to therapies and knowledge of disease processes and treatments.

 

Box 2. In children, triggers for referral to a specialist1

Triggers include one or more of the following:

  • persistent wet cough not responding to four weeks of antibiotics
  • >3 episodes of chronic (>4 weeks) wet cough per year responding to antibiotics
  • a chest radiograph abnormality persisting >6 weeks after appropriate therapy.

 

Background

The diagnosis of bronchiectasis, defined as irreversible airway dilatation, is based largely on the findings of highresolution computed tomography (HRCT) chest scans. The use of such a radiological definition can be problematic for several reasons. This is particularly the case for Aboriginal and Torres Strait Islander people living in remote areas where access to CT scanning can be limited, and for very young children who need a general anaesthetic.1 Nonetheless, the increasing availability of CT scanners means a CT-based diagnosis should be pursued where feasible. Given these limitations, in clinical guidelines specific to Aboriginal and Torres Strait Islander people living in remote regions and in the national guidelines,1,2 an additional term of chronic suppurative lung disease (CSLD) is used when symptoms and/or signs of bronchiectasis are present without available confirmation of HRCT features.2 In this document, bronchiectasis will be used to refer to both bronchiectasis and CSLD.

The symptoms and/or signs of bronchiectasis include recurrent (>3 episodes) wet or productive cough, each lasting for >4 weeks, with or without other features including exertional dyspnoea, symptoms of airway hyper-responsiveness, recurrent lower respiratory tract infections (including pneumonia), growth failure, digital clubbing, hyperinflation and chest wall deformity.2

Bronchiectasis has had a declining incidence over the last century. However, in the last decade, it is increasingly recognised as an important contributor to chronic respiratory morbidity in both Aboriginal and Torres Strait Islander people1 and non-Indigenous children and adults in Australia,3,4 as well as globally.5,6 It is also increasingly recognised as an alternative or concomitant diagnosis to common respiratory conditions such as ‘difficult asthma’ and chronic obstructive pulmonary disease (COPD).7,8 In a cohort of newly referred adults with ‘difficult asthma’, bronchiectasis was detected in 40%.9 In part, this greater prevalence of disease may be related to the increasing availability of a highly sensitive diagnostic tool, namely HRCT. Systematic reviews have described a prevalence of bronchiectasis in COPD of 20–69%.8 However, there are no such studies among Aboriginal and Torres Strait Islander people with COPD.

In Aboriginal and Torres Strait Islander people, CSLD and bronchiectasis is anecdotally common but there is little published data. In the Northern Territory, the incidence in Aboriginal and Torres Strait Islander infants (first year of life) is 1.18 per 1000 child years (95% confidence interval [CI], 0.60–2.16)10 and the prevalence is one in every 68 children aged <15 years.11 Hospitalisation rates for patients with bronchiectasis are increasing in Queensland (age standardised rate of ~65/100,000 in 2005 to ~90/100,000 in 2009),12 with the rate in Aboriginal and Torres Strait Islander peoples about 2.7 times that for non-Indigenous Queenslanders in 2009.12 There are no data for urban-dwelling Aboriginal and Torres Strait Islander peoples, but a national multicentre study that included Central Australia, Darwin and the Torres Straits found that among children newly presenting to a respiratory service with chronic cough, Aboriginal and Torres Strait Islander children have a significantly higher incidence of radiological bronchiectasis compared to non-Indigenous children:29.4% versus 6.7% respectively, P = 0.001.13

The morbidity of people with bronchiectasis includes increased hospitalisation, excess days off work/ school, poor quality of life, and complications associated with chronic cough.14 Complications associated with bronchiectasis extend beyond the respiratory system and include cardiac problems (eg impaired left ventricular diastolic function,15 cor pulmonale), systemic effects (eg reduced wellbeing and increased acute phase reactants),16 sleep disturbance4 and psychological difficulties associated with anxiety and depression.17,18 Furthermore, chronic endobronchial infection, which is present in CSLD and bronchiectasis, is an independent risk factor for atherosclerosis, coronary heart disease and coronary deaths.19–21

The only published Australian mortality data for bronchiectasis are from Central Australian hospital-based cohorts (note: some people were in both cohorts). In the first study of 61 adults (97% were Aboriginal), 11.5% of people died within 12 months.22 The cohort comprised predominantly middle-aged adults (mean age 42 years, standard deviation [SD] 15 years), and most had not received standard care (eg only 13 [21.3%] had lung function tests performed).22 The second study23 reported the prevalence of hospitalised bronchiectasis as 103 per 10,000 population, and 34% of the cohort died at a median age of 42.5 years. Overseas, mortality rates vary widely from four year survival of 58% (Turkey) to 75% survival at 8.8 years (Finland).24


Interventions

Despite the considerable prevalence and disease burden, services for bronchiectasis are under-resourced when compared with other chronic respiratory diseases.25 The European Respiratory Society regards bronchiectasis as one of the most neglected chronic respiratory diseases.26 Effective clinical management reduces both short-term27 and long-term morbidity associated with bronchiectasis.28,29 There is increasing evidence that intensive treatment of children who either have bronchiectasis, or who are at risk of developing severe bronchiectasis, prevents poor lung function in adulthood.14,30 Cohort data have shown that approximately 80% of newly diagnosed adults with bronchiectasis were symptomatic since childhood, and that the duration of chronic cough (the most common symptom of bronchiectasis2) is inversely related to lung function at diagnosis. This means that the longer the duration of cough, the poorer the lung function at diagnosis based on forced expiratory volume at one second (FEV1).31 Optimal overall management and treatment can potentially prevent chronic respiratory disease in a substantial number of people.32 Although robust trials are needed, primary care health providers can play a crucial role in the recognition and early detection of disease as well as in long-term management to prevent complications and premature death.1
Immunisation (pneumococcal, influenza) is effective in preventing severe and recurrent acute respiratory illnesses (ARIs);33 however, data of its effectiveness specific to the Aboriginal and Torres Strait Islander health context are lacking.34 Delayed immunisation (ie poor timeliness)35 is one postulate why 7-valent pneumococcal conjugate vaccine (7vPCV) did not reduce ARIs in Aboriginal peoples and Torres Strait Islander children. This is in contrast to global data that has shown substantial ARI reduction post–PCV.36

Aboriginal and Torres Strait Islander children hospitalised with pneumonia are 15 times more likely to develop bronchiectasis than non-Indigenouschildren, and for recurrent pneumonia the risk increases further.37 One cohort study described that 25.6% of Aboriginal children hospitalised for lobar pneumonia had a new diagnosis and treatable chronic respiratory illness (18% bronchiectasis) on follow-up.38 In a follow-up study of Aboriginal children hospitalised with bronchiolitis, the presence of cough at three weeks postdischarge increased the odds of having bronchiectasis diagnosed by 13 months.39 Differentiating between bronchiectasis as a cause or consequence of an earlier admission diagnosed as pneumonia or bronchiolitis can be problematic. Nevertheless, given the likely link between lower ARIs and bronchiectasis,37,38 as well as the association between duration of chronic cough and lung function decline in adults,31 it is good clinical practice for all children and adults with lower ARIs to be reviewed in primary care at least three to four weeks post-ARI, especially post-hospitalisation. They should be screened for the presence of chronic cough and persistence of other respiratory symptoms and signs (eg wheeze and crackles in chest auscultation).

When chronic (>4 weeks) wet cough is present, appropriate antibiotics (covering common respiratory pathogens – Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae) are recommended. In a Cochrane meta-analysis, the cure rate in children who received antibiotics was significantly higher than in controls, and the number of children needed to treat to demonstrate a benefit at two weeks was three.40 Further, progression of illness, defined by requirement for further antibiotics, was significantly lower in the treatment group.40

The most common symptom of CSLD/bronchiectasis is chronic cough.1 Data has shown that Aboriginal people and Torres Strait Islander children newly referred with chronic cough have a significantly higher likelihood of bronchiectasis on further assessment.13 As chronic cough is considered ‘normal’, it tends to be underreported by carers of Aboriginal children.41 Anecdotally, adult Aboriginal people and Torres Strait Islanders also under-report their cough. In children, triggers for referral to a specialist include:

  • >3 episodes of chronic (>4 weeks) wet cough per year responding to antibiotics
  • chest X-ray abnormality persisting >6 weeks following appropriate therapy (Box 2).2 Frequent exacerbations of bronchiectasis, especially when hospitalisation is required, is a risk factor for lung function decline.3,42 Thus when exacerbations are frequent (four or more per year non-hospitalised episodes, or two per year hospitalised episodes), consider use of maintenance antibiotics in collaboration with specialists.1

Exposure to in-utero tobacco smoke is associated with lower birth weights, increased ARI and other respiratory morbidity.43,44 Breastfeeding is protective against development of bronchiectasis, while being born premature or small for gestation is a risk factor.37 Primary prevention strategies to reduce these factors and increase breastfeeding would be beneficial (refer to Chapter 3: Child health). The association between poor hygiene and the excessive burden of infections (especially respiratory and gastrointestinal) has been well demonstrated.45,46 However, data specific to Aboriginal and Torres Strait Islander peoples as well as evidence-based interventions are sparse45 (refer also to Chapter 7: Hearing loss).
 

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people

 





 
 
  1. Chang AB, Bell SC, Torzillo PJ, et al. Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand Thoracic Society of Australia and New Zealand guidelines. Med J Aust 2015;202(3):130.
  2. Chang AB, Bell SC, Torzillo PJ, et al. Chronic suppurative lung disease and bronchiectasis in children and adults in Australian and New Zealand: Clinical practice guideline. Thoracic Society of Australia and New Zealand, 2014. [Accessed 29 November 17].
  3. Kapur N, Masters IB, Chang AB. Longitudinal growth and lung function in pediatric non-CF bronchiectasis – What influences lung function stability? Chest 2010;138:158–64.
  4. King PT, Holdsworth SR, Freezer NJ, Villanueva E, Gallagher M, Holmes PW. Outcome in adult bronchiectasis. COPD 2005;2:27–34.
  5. Quint JK, Millett ER, Joshi M, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: A population-based cohort study. Eur Respir J 2015;47(1):186–93.
  6. Singleton RJ, Valery PC, Morris P, et al. Indigenous children from three countries with non‐cystic fibrosis chronic suppurative lung disease/bronchiectasis. Pediatr Pulmonol 2014;49(2):189–200.
  7. Du Q, Jin J, Liu X, Sun Y. Bronchiectasis as a comorbidity of chronic obstructive pulmonary disease: A systematic review and metaanalysis. PloS One 2016;11(3):e0150532.
  8. Ni Y, Shi G, Yu Y, Hao J, Chen T, Song H. Clinical characteristics of patients with chronic obstructive pulmonary disease with comorbid bronchiectasis: A systemic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2015;10:1465.
  9. Gupta S, Siddiqui S, Haldar P, et al. Qualitative analysis of high resolution computed tomography scans in severe asthma. Chest 2009;136:1521–28.
  10. O’Grady KA, Torzillo PJ, Chang AB. Hospitalisation of Indigenous children in the Northern Territory for lower respiratory illness in the first year of life. Med J Aust 2010;192(10):586–90.
  11. Chang AB, Masel JP, Boyce NC, Wheaton G, Torzillo PJ. Non-CF bronchiectasis-clinical and HRCT evaluation. Pediatr Pulmonol 2003;35:477–83.
  12. O’Grady KA, Revell A, Maguire G, et al. Lung health services for Aboriginal and Torres Strait Islander peoples in Queensland. Brisbane: Queensland Health, 2010.
  13. Chang AB, Robertson CF, Van Asperen PP, et al. A multicenter study on chronic cough in children: Burden and etiologies based on a standardized management pathway. Chest 2012;142(4):943–50.
  14. Goyal V, Grimwood K, Marchant J, Masters IB, Chang AB. Pediatric bronchiectasis: No longer an orphan disease. Pediatr Pulmonol 2016;51(5):450–69.
  15. AkalIn F, Koroglu TF, Bakac S, Dagli E. Effects of childhood bronchiectasis on cardiac functions. Pediatr Int 2003;45(2):169–74.
  16. Hill SL, Burnett D, Hewetson KA, Stockley RA. The response of patients with purulent bronchiectasis to antibiotics for four months. Q J Med 1988;66(250):163–73.
  17. Kapur N, Masters IB, Newcombe P, Chang AB. The burden of disease in pediatric non-cystic fibrosis bronchiectasis. Chest 2011;141(4):1018–24.
  18. O’Leary CJ, Wilson CB, Hansell DM, Cole PJ, Wilson R, Jones PW. Relationship between psychological well-being and lung health status in patients with bronchiectasis. Respir Med 2002;96(9):686–92.
  19. Navaratnam V, Millett ER, Hurst JR, et al. Bronchiectasis and the risk of cardiovascular disease: A population-based study. Thorax 2016;72(2):161–66.
  20. Simons L, Simons J, Friedlander Y, McCallum J. Chronic bronchitis and risk of coronary heart disease. Lancet 1996;348(9038):1388–89.
  21. Kiechl S, Egger G, Mayr M, et al. Chronic infections and the risk of carotid atherosclerosis: Prospective results from a large population study. Circulation 2001;103(8):1064–70.
  22. Steinfort DP, Brady S, Weisinger HS, Einsiedel L. Bronchiectasis in Central Australia: A young face to an old disease. Respir Med 2008;102:574–78.
  23. Einsiedel L, Fernandes L, Spelman T, Steinfort D, Gotuzzo E. Bronchiectasis is associated with human T-lymphotropic virus 1 infection in an Indigenous Australian population. Clin Infect Dis 2011;54(1):43–50.
  24. Loebinger MR, Wells AU, Hansell DM, et al. Mortality in bronchiectasis: A long-term study assessing the factors influencing survival. Eur Respir J 2009;34:843–49.
  25. Chang AB, Marsh RL, Upham JW, et al. Towards making inroads in reducing the disparity of lung health in Australian Indigenous and New Zealand Māori children. Front Pediatr 2015;3:9.
  26. European Respiratory Society. Bronchiectasis: European Lung White Book.  [Accessed 29 November 2017].
  27. Chalmers JD, Smith MP, McHugh BJ, Doherty C, Govan JR, Hill AT. Short-and long-term antibiotic treatment reduces airway and systemic inflammation in non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med 2012;186(7):657–65.
  28. Haidopoulou K, Calder A, Jones A, Jaffe A, Sonnappa S. Bronchiectasis secondary to primary immunodeficiency in children: Longitudinal changes in structure and function. Pediatr Pulmonol 2009;44(7):669–75.
  29. Dogru D, Nik-Ain A, Kiper N, et al. Bronchiectasis: The consequence of late diagnosis in chronic respiratory symptoms. J Trop Pediatr 2005;51(6):362–65.
  30. Chang A, Redding G, Everard M. Chronic wet cough: Protracted bronchitis, chronic suppurative lung disease and bronchiectasis. Pediatric Pulmonol 2008;43(6):519–31.
  31. King PT, Holdsworth SR, Farmer M, Freezer N, Villanueva E, Holmes PW. Phenotypes of adult bronchiectasis: Onset of productive cough in childhood and adulthood. COPD 2009;6(2):130–36.
  32. Chang AB, Byrnes CA, Everard ML. Diagnosing and preventing chronic suppurative lung disease (CSLD) and bronchiectasis. Paediatr Respir Rev 2011;12:97–103.
  33. Grijalva CG, Nuorti JP, Arbogast PG, Martin SW, Edwards KM, Griffin MR. Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: A time-series analysis. Lancet 2007;369(9568):1179–86.
  34. O’Grady KA, Carlin JB, Chang AB, et al. 7-valent pneumococcal conjugate vaccine effectiveness against WHO defined radiologically diagnosed pneumonia in Indigenous Australian infants research. WHO bulletin 2009;88:139–46.
  35. Lovie-Toon YG, Hall KK, Chang AB, Anderson J, O’Grady KF. Immunisation timeliness in a cohort of urban Aboriginal and Torres Strait Islander children. BMC Public Health 2016;16(1):1159.
  36. Shiri T, Datta S, Madan J, et al. Indirect effects of childhood pneumococcal conjugate vaccination on invasive pneumococcal disease: A systematic review and meta-analysis. Lancet 2017;5(1):e51–e59.
  37. Valery PC, Torzillo PJ, Mulholland EK, Boyce NC, Purdie DM, Chang AB. A hospital-based case-control study of bronchiectasis in Indigenous children in Central Australia. Pediatr Infect Dis J 2004;23:902–08.
  38. Chang AB, Masel JP, Boyce NC, Torzillo PJ. Respiratory morbidity in central Australian Aboriginal children with alveolar lobar abnormalities. Med J Aust 2003;178(10):490–94.
  39. McCallum GB, Chatfield MD, Morris PS, Chang AB. Risk factors for adverse outcomes of Indigenous infants hospitalized with bronchiolitis. Pediatr Pulmonol 2016;51(6):613–23.
  40. Marchant JM, Petsky H, Morris P, Gaffney J, Chang AB. Antibiotics for prolonged moist cough in children. Cochrane Database Syst Rev 2017.
  41. Morey MJ, Cheng AC, McCallum GB, Chang AB. Accuracy of cough reporting by carers of Indigenous children. J Paediatr Child Health 2013;49(3).
  42. Martinez-Garcia MA, Soler-Cataluna JJ, Perpina-Tordera M, Roman-Sanchez P, Soriano J. Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest 2007;132(5):1565–72.
  43. Jaakkola JJ, Jaakkola MS. Effects of environmental tobacco smoke on the respiratory health of children. Scand J Work Environ Health 2002;28(Suppl 2):71–83.
  44. Glasgow NJ, Goodchild EA, Yates R, Ponsonby AL. Respiratory health in Aboriginal and Torres Strait Islander children in the Australian Capital Territory. J Paediatr Child Health 2003;39(7):534–39.
  45. McDonald E, Bailie R, Brewster D, Morris P. Are hygiene and public health interventions likely to improve outcomes for Australian Aboriginal children living in remote communities? A systematic review of the literature. BMC Public Health 2008;8:153.
  46. Curtis V, Schmidt W, Luby S, Florez R, Toure O, Biran A. Hygiene: New hopes, new horizons. Lancet Infect Dis 2011;11(4):312–21.
  47. Chang AB, Oppenheimer JJ, Weinberger M, Rubin BK, Irwin RS. Children with chronic wet or productive cough – treatment and investigations: A systematic review. Chest 2016;149(1):120–42.
  48. Byrne AL, Marais BJ, Mitnick CD, Lecca L, Marks GB. Tuberculosis and chronic respiratory disease: A systematic review. Int J Infect Dis 2015;32:138–46.
  49. Finch S, McDonnell MJ, Abo-Leyah H, Aliberti S, Chalmers JD. A comprehensive analysis of the impact of Pseudomonas aeruginosa colonization on prognosis in adult bronchiectasis. Ann Am Thorac Soc 2015;12(11):1602–11.
  50. Valery PC, Morris PS, Byrnes CA, et al. Long-term azithromycin for Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease (bronchiectasis intervention study): A multicentre, double-blind, randomised controlled trial. Lancet Respir Med 2013;1(8):610–20.
  51. Hnin K, Nguyen C, Carson KV, Evans DJ, Greenstone M, Smith BJ. Prolonged antibiotics for non‐cystic fibrosis bronchiectasis in children and adults. Cochrane Database Syst Rev 2015;(8):CD001392.

     

  52. Chang AB, Bell SC, Torzillo PJ, et al. Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand Thoracic Society of Australia and New Zealand guidelines. Med J Aust 2015;202(3):130.
  53. Chang AB, Bell SC, Torzillo PJ, et al. Chronic suppurative lung disease and bronchiectasis in children and adults in Australian and New Zealand: Clinical practice guideline. Thoracic Society of Australia and New Zealand, 2014.  [Accessed 29 November 17].
  54. Kapur N, Masters IB, Chang AB. Longitudinal growth and lung function in pediatric non-CF bronchiectasis – What influences lung function stability? Chest 2010;138:158–64.
  55. King PT, Holdsworth SR, Freezer NJ, Villanueva E, Gallagher M, Holmes PW. Outcome in adult bronchiectasis. COPD 2005;2:27–34.
  56. Quint JK, Millett ER, Joshi M, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: A population-based cohort study. Eur Respir J 2015;47(1):186–93.
  57. Singleton RJ, Valery PC, Morris P, et al. Indigenous children from three countries with non‐cystic fibrosis chronic suppurative lung disease/bronchiectasis. Pediatr Pulmonol 2014;49(2):189–200.
  58. Du Q, Jin J, Liu X, Sun Y. Bronchiectasis as a comorbidity of chronic obstructive pulmonary disease: A systematic review and metaanalysis. PloS One 2016;11(3):e0150532.
  59. Ni Y, Shi G, Yu Y, Hao J, Chen T, Song H. Clinical characteristics of patients with chronic obstructive pulmonary disease with comorbid bronchiectasis: A systemic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2015;10:1465.
  60. Gupta S, Siddiqui S, Haldar P, et al. Qualitative analysis of high resolution computed tomography scans in severe asthma. Chest 2009;136:1521–28.
  61. O’Grady KA, Torzillo PJ, Chang AB. Hospitalisation of Indigenous children in the Northern Territory for lower respiratory illness in the first year of life. Med J Aust 2010;192(10):586–90.
  62. Chang AB, Masel JP, Boyce NC, Wheaton G, Torzillo PJ. Non-CF bronchiectasis-clinical and HRCT evaluation. Pediatr Pulmonol 2003;35:477–83.
  63. O’Grady KA, Revell A, Maguire G, et al. Lung health services for Aboriginal and Torres Strait Islander peoples in Queensland. Brisbane: Queensland Health, 2010.
  64. Chang AB, Robertson CF, Van Asperen PP, et al. A multicenter study on chronic cough in children: Burden and etiologies based on a standardized management pathway. Chest 2012;142(4):943–50.
  65. Goyal V, Grimwood K, Marchant J, Masters IB, Chang AB. Pediatric bronchiectasis: No longer an orphan disease. Pediatr Pulmonol 2016;51(5):450–69.
  66. AkalIn F, Koroglu TF, Bakac S, Dagli E. Effects of childhood bronchiectasis on cardiac functions. Pediatr Int 2003;45(2):169–74.
  67. Hill SL, Burnett D, Hewetson KA, Stockley RA. The response of patients with purulent bronchiectasis to antibiotics for four months. Q J Med 1988;66(250):163–73.
  68. Kapur N, Masters IB, Newcombe P, Chang AB. The burden of disease in pediatric non-cystic fibrosis bronchiectasis. Chest 2011;141(4):1018–24.
  69. O’Leary CJ, Wilson CB, Hansell DM, Cole PJ, Wilson R, Jones PW. Relationship between psychological well-being and lung health status in patients with bronchiectasis. Respir Med 2002;96(9):686–92.
  70. Navaratnam V, Millett ER, Hurst JR, et al. Bronchiectasis and the risk of cardiovascular disease: A population-based study. Thorax 2016;72(2):161–66.
  71. Simons L, Simons J, Friedlander Y, McCallum J. Chronic bronchitis and risk of coronary heart disease. Lancet 1996;348(9038):1388–89.
  72. Kiechl S, Egger G, Mayr M, et al. Chronic infections and the risk of carotid atherosclerosis: Prospective results from a large population study. Circulation 2001;103(8):1064–70.
  73. Steinfort DP, Brady S, Weisinger HS, Einsiedel L. Bronchiectasis in Central Australia: A young face to an old disease. Respir Med 2008;102:574–78.
  74. Einsiedel L, Fernandes L, Spelman T, Steinfort D, Gotuzzo E. Bronchiectasis is associated with human T-lymphotropic virus 1 infection in an Indigenous Australian population. Clin Infect Dis 2011;54(1):43–50.
  75. Loebinger MR, Wells AU, Hansell DM, et al. Mortality in bronchiectasis: A long-term study assessing the factors influencing survival. Eur Respir J 2009;34:843–49.
  76. Chang AB, Marsh RL, Upham JW, et al. Towards making inroads in reducing the disparity of lung health in Australian Indigenous and New Zealand Māori children. Front Pediatr 2015;3:9.
  77. European Respiratory Society. Bronchiectasis: European Lung White Book.  [Accessed 29 November 2017].
  78. Chalmers JD, Smith MP, McHugh BJ, Doherty C, Govan JR, Hill AT. Short-and long-term antibiotic treatment reduces airway and systemic inflammation in non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med 2012;186(7):657–65.
  79. Haidopoulou K, Calder A, Jones A, Jaffe A, Sonnappa S. Bronchiectasis secondary to primary immunodeficiency in children: Longitudinal changes in structure and function. Pediatr Pulmonol 2009;44(7):669–75.
  80. Dogru D, Nik-Ain A, Kiper N, et al. Bronchiectasis: The consequence of late diagnosis in chronic respiratory symptoms. J Trop Pediatr 2005;51(6):362–65.
  81. Chang A, Redding G, Everard M. Chronic wet cough: Protracted bronchitis, chronic suppurative lung disease and bronchiectasis. Pediatric Pulmonol 2008;43(6):519–31.
  82. King PT, Holdsworth SR, Farmer M, Freezer N, Villanueva E, Holmes PW. Phenotypes of adult bronchiectasis: Onset of productive cough in childhood and adulthood. COPD 2009;6(2):130–36.
  83. Chang AB, Byrnes CA, Everard ML. Diagnosing and preventing chronic suppurative lung disease (CSLD) and bronchiectasis. Paediatr Respir Rev 2011;12:97–103.
  84. Grijalva CG, Nuorti JP, Arbogast PG, Martin SW, Edwards KM, Griffin MR. Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: A time-series analysis. Lancet 2007;369(9568):1179–86.
  85. O’Grady KA, Carlin JB, Chang AB, et al. 7-valent pneumococcal conjugate vaccine effectiveness against WHO defined radiologically diagnosed pneumonia in Indigenous Australian infants research. WHO bulletin 2009;88:139–46.
  86. Lovie-Toon YG, Hall KK, Chang AB, Anderson J, O’Grady KF. Immunisation timeliness in a cohort of urban Aboriginal and Torres Strait Islander children. BMC Public Health 2016;16(1):1159.
  87. Shiri T, Datta S, Madan J, et al. Indirect effects of childhood pneumococcal conjugate vaccination on invasive pneumococcal disease: A systematic review and meta-analysis. Lancet 2017;5(1):e51–e59.
  88. Valery PC, Torzillo PJ, Mulholland EK, Boyce NC, Purdie DM, Chang AB. A hospital-based case-control study of bronchiectasis in Indigenous children in Central Australia. Pediatr Infect Dis J 2004;23:902–08.
  89. Chang AB, Masel JP, Boyce NC, Torzillo PJ. Respiratory morbidity in central Australian Aboriginal children with alveolar lobar abnormalities. Med J Aust 2003;178(10):490–94.
  90. McCallum GB, Chatfield MD, Morris PS, Chang AB. Risk factors for adverse outcomes of Indigenous infants hospitalized with bronchiolitis. Pediatr Pulmonol 2016;51(6):613–23.
  91. Marchant JM, Petsky H, Morris P, Gaffney J, Chang AB. Antibiotics for prolonged moist cough in children. Cochrane Database Syst Rev 2017.
  92. Morey MJ, Cheng AC, McCallum GB, Chang AB. Accuracy of cough reporting by carers of Indigenous children. J Paediatr Child Health 2013;49(3).
  93. Martinez-Garcia MA, Soler-Cataluna JJ, Perpina-Tordera M, Roman-Sanchez P, Soriano J. Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest 2007;132(5):1565–72.
  94. Jaakkola JJ, Jaakkola MS. Effects of environmental tobacco smoke on the respiratory health of children. Scand J Work Environ Health 2002;28(Suppl 2):71–83.
  95. Glasgow NJ, Goodchild EA, Yates R, Ponsonby AL. Respiratory health in Aboriginal and Torres Strait Islander children in the Australian Capital Territory. J Paediatr Child Health 2003;39(7):534–39.
  96. McDonald E, Bailie R, Brewster D, Morris P. Are hygiene and public health interventions likely to improve outcomes for Australian Aboriginal children living in remote communities? A systematic review of the literature. BMC Public Health 2008;8:153.
  97. Curtis V, Schmidt W, Luby S, Florez R, Toure O, Biran A. Hygiene: New hopes, new horizons. Lancet Infect Dis 2011;11(4):312–21.
  98. Chang AB, Oppenheimer JJ, Weinberger M, Rubin BK, Irwin RS. Children with chronic wet or productive cough – treatment and investigations: A systematic review. Chest 2016;149(1):120–42.
  99. Byrne AL, Marais BJ, Mitnick CD, Lecca L, Marks GB. Tuberculosis and chronic respiratory disease: A systematic review. Int J Infect Dis 2015;32:138–46.
  100. Finch S, McDonnell MJ, Abo-Leyah H, Aliberti S, Chalmers JD. A comprehensive analysis of the impact of Pseudomonas aeruginosa colonization on prognosis in adult bronchiectasis. Ann Am Thorac Soc 2015;12(11):1602–11.
  101. Valery PC, Morris PS, Byrnes CA, et al. Long-term azithromycin for Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease (bronchiectasis intervention study): A multicentre, double-blind, randomised controlled trial. Lancet Respir Med 2013;1(8):610–20.
  102. Hnin K, Nguyen C, Carson KV, Evans DJ, Greenstone M, Smith BJ. Prolonged antibiotics for non‐cystic fibrosis bronchiectasis in children and adults. Cochrane Database Syst Rev 2015;(8):CD001392.

Downloads

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people (PDF 9.8 MB)

 Evidence base to a preventive health assessment in Aboriginal and Torres Strait Islander people (PDF 9.4 MB)

 National Guide Lifecycle chart (child) (PDF 555 KB)

 National Guide Lifecycle chart (young) (PDF 1 MB)

 National Guide Lifecycle chart (adult) (PDF 1 MB)