2004 chronic obstructive pulmonary disease with and without bronchiectasis in Aboriginal Australians: a comparative study

Abstract

Background: Chronic respiratory disorders are highly prevalent in Aboriginal Australian population, including chronic obstructive pulmonary disease (COPD) and bronchiectasis. However, there is paucity of information in the literature among Aboriginal patients with underlying COPD with and without bronchiectasis. Aims: In this retrospective study we evaluated the demographic and clinical characteristics of adult Aboriginal Australian patients with a clinical diagnosis of COPD with and without bronchiectasis from the remote communities of the Northern Territory of Australia. Methods: Clinical records were reviewed to extract information on demographics, respiratory and medical comorbid conditions, COPD directed treatment, hospital admission frequency and exacerbations. Chest radiology were reviewed to evaluate the presence or absence of bronchiectasis. Spirometry results, sputum culture and cardiac investigations were also recorded. Results: Of the 767 patients assessed in the remote community respiratory outreach clinics 380 (49%) patients had a clinical diagnosis of COPD. Chest X-ray and computed tomography scan were available to evaluate the presence of bronchiectasis in 258 patients. Of the 258/380 patients, 176/258 (68.2%) were diagnosed to have COPD alone and 82/258 (31.8%) had bronchiectasis along with COPD. The mean age was 56 and 59 years among patients with and without bronchiectasis, respectively, and 57% were males with bronchiectasis. Patients with bronchiectasis had lower body mass index (22 vs 24 kg/m 2), frequent hospital admissions (2.0 vs 1.5/year) and productive cough (32.1% vs 28.9%). Spirometry showed 77% had forced expiratory volume in 1 s (FEV 1)/forced vital capacity ratio <0.7. In 81% and 75% of patients with and without bronchiectasis the FEV 1 /forced vital capacity ratio was <0.7 and the mean FEV 1 was 39% and 43% respectively. Conclusions: About 32% of Aboriginal Australians had co-existent bronchiectasis with COPD. Lower body mass index, productive cough, frequent hospital admission and marginally more severe reduction in lung function were noted among patients with COPD and bronchiectasis compared to those with COPD in isolation.

<p>Gender Differences in the Clinical and Polysomnographic Characteristics Among Australian Aboriginal Patients with Obstructive Sleep Apnea</p>

“…Chronic health conditions are noted to be highly prevalent in Indigenous populations, including Australian Aboriginal people. [40][41][42][43][44][45][46] Under diagnosis or untreated OSA in this population may give rise to adverse health outcome. 47 Ethnic and gender differences need to be considered in the clinical assessment of patients with OSA, which may itself represent a different phenotype.…”

The Effects of Inhaled Airway Directed Pharmacotherapy on Decline in Lung Function Parameters Among Indigenous Australian Adults With and Without Underlying Airway Disease

“… 7–11 Moreover, recently published data has shown that co-occurrence of COPD and bronchiectasis along with poor lung function parameters (LFPs) are highly prevalent among Indigenous people living in the Top end health service (TEHS) region of the NT of Australia. 12–16 …”

“…[7][8][9][10][11] Moreover, recently published data has shown that co-occurrence of COPD and bronchiectasis along with poor lung function parameters (LFPs) are highly prevalent among Indigenous people living in the Top end health service (TEHS) region of the NT of Australia. [12][13][14][15][16] LFTs 17 play an integral role in the diagnosis, management and monitoring of several respiratory conditions. 18,19 Though natural decline in LFPs with aging is well recognised, [20][21][22] there is evidence in the literature to suggest that decline in LFPs could be accelerated with smoking, and in the presence of pre-existing chronic respiratory conditions, in particular asthma, COPD and bronchiectasis.…”

“…This is despite overwhelming evidence in the literature documenting a higher burden of respiratory disease among the adult Indigenous Australian population. 4,[7][8][9][10][11][12] Furthermore, LFPs are noted to be significantly reduced among Indigenous Australians in comparison to non-Indigenous Australians. [13][14][15][16] Thus, considering these aforementioned factors together (reduced LFPs, high burden of chronic respiratory disorders along with potential higher use of airway directed pharmacotherapy), there appears to be a critical need to investigate LFPs trajectory with and without radiological evidence of chronic airway diseases and the effects of inhaled pharmacotherapy on LFPs' among the adult Indigenous Australian population.…”

Comparison of diffusing capacity of carbon monoxide (DLCO) and total lung capacity (TLC) between Indigenous Australians and Australian Caucasian adults

“…Indigenous Australians experience a significantly higher burden of respiratory disease in comparison to their non-Indigenous peers [ 1 – 4 ]. Multiple factors underpin this high burden of respiratory disease in this population, from higher rates of premature birth and low birth weight [ 5 ], to childhood infections [ 6 ] and higher rates of smoking [ 7 , 8 ].…”