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Original Research: Bronchiectasis |

Respiratory Exacerbations in Indigenous Children From Two Countries With Non-Cystic Fibrosis Chronic Suppurative Lung Disease/BronchiectasisIndigenous Children With Bronchiectasis

Gregory J. Redding, MD, FCCP; Rosalyn J. Singleton, MD, MPH; Patricia C. Valery, MD, PhD, MPH; Hayley Williams, BSoc Sci, PGDipPsych; Keith Grimwood, MBChB, MD; Peter S. Morris, MBBS, PhD; Paul J. Torzillo, MBBS; Gabrielle B. McCallum, MPH, RN; Lori Chikoyak, RN; Robert C. Holman, MS; Anne B. Chang, MBBS, MPHTM, PhD
Author and Funding Information

From the Pulmonary and Sleep Medicine Division (Dr Redding), Seattle Children’s Hospital, Seattle, WA; the University of Washington (Dr Redding), Seattle, WA; the Alaska Native Tribal Health Consortium (Dr Singleton), Anchorage, AK; the Centers for Disease Control and Prevention (Dr Singleton), National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, Arctic Investigations Program, Anchorage, AK; the Menzies School of Health Research (Drs Valery, Morris, and Chang and Mss Williams and McCallum), Charles Darwin University, Darwin, NT, Australia; the Queensland Children’s Medical Research Institute (Dr Grimwood), The University of Queensland, Brisbane, QLD, Australia; the Queensland Paediatric Infectious Diseases Laboratory (Dr Grimwood), Royal Children’s Hospital, Brisbane, QLD, Australia; Royal Prince Alfred Hospital (Dr Torzillo), University of Sydney, Sydney, NSW, Australia; the Yukon Kuskokwim Health Corporation (Ms Chikoyak), Bethel, AK; the Centers for Disease Control and Prevention (Mr Holman), National Center for Emerging and Zoonotic Infectious Diseases, Division of High-Consequence Pathogens and Pathology, Atlanta, GA; and the Queensland Respiratory Centre (Dr Chang), Royal Children’s Hospital, Queensland Children’s Medical Research Institute, Queensland University of Technology, Brisbane, QLD, Australia.

CORRESPONDENCE TO: Gregory J. Redding, MD, FCCP, Pulmonary and Sleep Medicine Division, Room OC.7.720, Seattle Children’s Hospital, Seattle, WA 98105; e-mail: gredding@u.washington.edu


FUNDING/SUPPORT: This work was supported by the National Health and Medical Research Council of Australia (NHMRC) [Grants 389837, 1040830], Telstra Foundation [seeding grant – Telstra Community Development Grant, 2004]. Dr Valery was supported by an Australian Research Council Future Fellowship [100100511], and Dr Chang was supported by Australian NHMRC fellowship [545216]. Dr Singleton received funding from the National Institutes of Health, National Heart, Lung, and Blood Institute [Grant U26IHS3000001/01]. This work was produced as part of the In-Kind activities of the Lowitja Institute incorporating the Cooperative Research Centre for Aboriginal and Torres Strait Islander Health.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(3):762-774. doi:10.1378/chest.14-0126
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BACKGROUND:  Acute respiratory exacerbations (AREs) cause morbidity and lung function decline in children with chronic suppurative lung disease (CSLD) and bronchiectasis. In a prospective longitudinal cohort study, we determined the patterns of AREs and factors related to increased risks for AREs in children with CSLD/bronchiectasis.

METHODS:  Ninety-three indigenous children aged 0.5 to 8 years with CSLD/bronchiectasis in Australia (n = 57) and Alaska (n = 36) during 2004 to 2009 were followed for > 3 years. Standardized parent interviews, physical examinations, and medical record reviews were undertaken at enrollment and every 3 to 6 months thereafter.

RESULTS:  Ninety-three children experienced 280 AREs (median = 2, range = 0-11 per child) during the 3-year period; 91 (32%) were associated with pneumonia, and 43 (15%) resulted in hospitalization. Of the 93 children, 69 (74%) experienced more than two AREs over the 3-year period, and 28 (30%) had more than one ARE in each study year. The frequency of AREs declined significantly over each year of follow-up. Factors associated with recurrent (two or more) AREs included age < 3 years, ARE-related hospitalization in the first year of life, and pneumonia or hospitalization for ARE in the year preceding enrollment. Factors associated with hospitalizations for AREs in the first year of study included age < 3 years, female caregiver education, and regular use of bronchodilators.

CONCLUSIONS:  AREs are common in children with CSLD/bronchiectasis, but with clinical care and time AREs occur less frequently. All children with CSLD/bronchiectasis require comprehensive care; however, treatment strategies may differ for these patients based on their changing risks for AREs during each year of care.

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