This review article focuses on common lower respiratory infections (LRIs) in indigenous populations in both developed and developing countries, where data is available. Indigenous populations across the world share some commonalities including poorer health and socioeconomic disadvantage compared with their nonindigenous counterparts. Generally, acute and chronic respiratory infections are more frequent and more severe in both indigenous children and adults, often resulting in substantial consequences including higher rates of bronchiectasis and poorer outcomes for patients with chronic obstructive pulmonary disease (COPD). Risk factors for the development of respiratory infections require recognition and action. These risk factors include but are not limited to socio-economic factors (e.g. education, household crowding and nutrition), environmental factors (e.g. smoke exposure and poor access to health care) and biological factors. Risk mitigation strategies should be delivered in a culturally appropriate manner and targeted to educate both individuals and communities at risk. Improving the morbidity and mortality of respiratory infections in indigenous people requires provision of best practice care and awareness of the scope of the problem by healthcare practitioners, governing bodies and policy makers.

Swyer–James–MacLeod syndrome (SJMS) is a rare syndrome of acute obliterative bronchiolitis following an early childhood infective insult to the lungs. This causes arrest of alveolarization, affecting lung development with hypoplasia of the ipsilateral pulmonary artery and results in a characteristic radiological pattern, such as a unilateral hyperlucent lung with expiratory air‐trapping and pruned‐tree appearance on pulmonary angiogram. The clinical presentation is either recurrent chest infections, exertional dyspnoea or it may be an incidental finding. Management involves early prevention of infection, airway clearance, and regular vaccinations.We describe two adult patients with SJMS: A 51‐year‐old female of Indian ethnicity presenting with recurrent haemoptysis and a 40‐year‐old Indigenous male presenting acutely with sepsis and background history of recurrent chest infections.These cases highlight the importance of being aware of and accurately recognizing this rare condition, to be able to manage patients appropriately and avoid incorrect and unnecessary treatment.

Although new platforms are exciting and do offer the promise of finally moving beyond our current very limited scope of microbiological tests, empiric therapy based on knowledge of local epidemiological data is likely to remain the standard of care until the hurdles of proven accuracy, physician acceptance and cost-effectiveness are successfully negotiated.

Background: Lung cancer is the most common cause of cancer-related mortality for both Indigenous and non-Indigenous Australians, and the death rate of lung cancer in Indigenous Australians is increasing.Aims: To provide a comprehensive description of patterns of lung cancer presentation, diagnosis, treatment and outcomes in Indigenous and non-Indigenous Australians in the Top End of the Northern Territory.Methods: Retrospective cohort study of adult patients with a new diagnosis of lung cancer in the Top End between January 2010 and December 2014. Unadjusted survival probabilities by indigenous status were calculated. The primary end-point was all-cause mortality.Results: Despite receiving similar diagnostic procedures and treatment, Indigenous Australians with lung cancer have poorer 1-and 5-year survival (25.0% and 9.4% respectively), when compared to non-Indigenous Australians included in the study (42.0% and 16.2% respectively). Indigenous lung cancer patients were more likely to be female (51.6% of indigenous patients were female, compared to 30.5% non-indigenous), be current smokers (61.3% vs 36.9%), have more comorbidities (73.6% vs 52.7%, 24.2% vs 5.3% and 30.8% vs 14.2% for respiratory disease, renal insufficiency and diabetes mellitus respectively), and live in more socio-economically disadvantaged (66.7% vs 14.2%) and very remote areas (66.1% vs 6.8%). They were also more likely to die at home, compared to their non-indigenous counterparts (64.3% vs 26.7%).Conclusions: Indigenous patients from the Top End diagnosed with lung cancer were more likely to have poorer survival outcomes when compared to non-indigenous people. Potential reasons for the discrepancy in survival need to be addressed urgently.

Pulmonary infections from the environmental fungus Cryptococcus gattii (C. gattii) are notable for cryptococcomas, which are usually solitary and can be very large. As with infections with Cryptococcus neoformans (C. neoformans) patients can have concomitant cryptococcal meningitis; however, unlike for C. neoformans, infections with C. gattii often occur in immunocompetent patients. The highest published incidence of C. gattii infection has been in the Indigenous Australian population of Arnhem Land in the tropical north of the country. More recently C. gattii has been responsible for outbreaks of cryptococcosis in the Pacific Northwest of Canada and the United States of America (USA). A previously healthy Indigenous male from Arnhem Land presented with pulmonary cryptococcosis with chest imaging showing >50 bilateral lung nodules. This unusual occurrence was attributed to probable inhalation of fungal elements from prior use of a high-pressure leaf blower to clear eucalyptus and other debris in a remote bush camp.

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