Bronchiectasis in Children from Qikiqtani (Baffin) Region, Nunavut, Canada

Das, Lopamudra; Kovesi, Thomas

doi:10.1513/annalsats.201406-257oc

Cited by 35 publications

(38 citation statements)

References 21 publications

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“…Many YK children have atypical asthma characterized by wheezing with LRTIs, yet poorly associated with atopy. In a study of 17 Canadian Inuit children with bronchiectasis, asthma was identified as the most common comorbidity . Since asthma involves lower airway inflammation, mucous production, and remodeling, it may be an additional risk factor for worsening bronchiectasis .…”

Section: Discussionmentioning

confidence: 99%

Clinical course of chronic suppurative lung disease and bronchiectasis in Alaska Native children

Kinghorn

Singleton

McCallum

et al. 2018

Pediatric Pulmonology

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Introduction Alaska Native (AN) children from the Yukon Kuskokwim (YK) Delta region have high rates of chronic suppurative lung disease (CSLD), including bronchiectasis. We characterized the clinical progress of an AN adolescent cohort with CSLD/bronchiectasis, and estimated bronchiectasis prevalence trends in this region. Methods The original cohort comprised 41 AN children (originally aged 0.5‐8 years) with CSLD/bronchiectasis, recruited between 2005 and 2008, with follow‐up in 2015‐2016. Clinical assessments, lung function, radiography, medical chart review, and spirometry were obtained. We also conducted data queries of bronchiectasis diagnoses in YK individuals born between 1990 and 2010 to estimate prevalence. Results Thirty‐four (83%) of the original cohort aged 7.3‐17.6 years were reviewed, of whom 14 (41%) had high‐resolution computed tomography (HRCT)‐confirmed bronchiectasis, eight (24%) had no evidence of bronchiectasis on HRCT scans, while 12 (35%) had not undergone HRCT scans. Annual lower respiratory tract infection (LRTI) frequency decreased with age, although 27 (79%) still had respiratory symptoms, including all with HRCT‐confirmed bronchiectasis, who were also more likely than those without confirmed bronchiectasis to have recent wheeze (80 vs 25%, P = 0.005), auscultatory crackles (60 vs 0%, P < 0.001), and lower mean forced expiratory volume in 1‐second/forced vital capacity ratio (73 vs 79%, P = 0.03). The bronchiectasis prevalence for YK AN people born during 2000‐2009 was 7 per 1000 births, which was lower than previously reported. Conclusion Despite reduced LRTI frequency, most AN children with CSLD/bronchiectasis had symptoms/signs of underlying lung disease as they entered adolescence. Close clinical follow‐up remains essential for managing these patients as they transition to adulthood.

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Section: Discussionmentioning

confidence: 99%

Clinical course of chronic suppurative lung disease and bronchiectasis in Alaska Native children

Kinghorn

Singleton

McCallum

et al. 2018

Pediatric Pulmonology

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“…In the US, immune dysfunction was frequently associated with bronchiectasis including that among stem-cell transplant recipients who suffered graft versus host disease [33]. Outside of indigenous Canadian cohorts, where high rates of childhood bronchiectasis are reported, data on aetiology of adult Canadian non-CF bronchiectasis is rather limited and the precise nature of aetiology in this country is largely uncertain [34,35]. In Latin America aetiology is, like elsewhere, driven by infection and influenced by infectious disease epidemiology such as that in endemic TB regions or against backdrops of higher rates of pertussis and measles which in turn relate to the lower vaccine uptake rates.…”

Section: Bronchiectasis In the Americasmentioning

confidence: 99%

“…The most striking variation in bronchiectasis epidemiology is observed among indigenous children of Australia, Alaska, Canada and New Zealand [34,35,[38][39][40]. Here, paediatric populations exhibit exceptionally high rates compared to non-indigenous groups with infant or childhood pneumonia cited as the primary cause in many cases.…”

Section: Geographic Variation In the Epidemiology Of Bronchiectasis Bmentioning

confidence: 99%

Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis

et al. 2018

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Bronchiectasis is a disease associated with chronic progressive and irreversible dilatation of the bronchi and is characterised by chronic infection and associated inflammation. The prevalence of bronchiectasis is age-related and there is some geographical variation in incidence, prevalence and clinical features. Most bronchiectasis is reported to be idiopathic however post-infectious aetiologies dominate across Asia especially secondary to tuberculosis. Most focus to date has been on the study of airway bacteria, both as colonisers and causes of exacerbations. Modern molecular technologies including next generation sequencing (NGS) have become invaluable tools to identify microorganisms directly from sputum and which are difficult to culture using traditional agar based methods. These have provided important insight into our understanding of emerging pathogens in the airways of people with bronchiectasis and the geographical differences that occur. The contribution of the lung microbiome, its ethnic variation, and subsequent roles in disease progression and response to therapy across geographic regions warrant further investigation. This review summarises the known geographical differences in the aetiology, epidemiology and microbiology of bronchiectasis. Further, we highlight the opportunities offered by emerging molecular technologies such as -omics to further dissect out important ethnic differences in the prognosis and management of bronchiectasis.

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“…However, among Aboriginal infants from Central Australia incidence rates reach 200 per 100,000 child‐years . Similarly, although the prevalence of bronchiectasis in those aged 0–14 years in New Zealand is 33 per 100,000; for Pacific Island children in New Zealand it is 160 per 100,000; in Canadian Inuit children in Banff region it reaches 200 per 100,000; while for Aboriginal children from Central Australia and South‐West Alaskan Native children rates are about 1,500 per 100,000 . Thus bronchiectasis remains an important problem among socially disadvantaged indigenous groups, and by extrapolation, for children in developing countries where there is overcrowding, poor hygiene, and limited access to healthcare …”

Section: Burden Of Diseasementioning

confidence: 99%

Pediatric bronchiectasis: No longer an orphan disease

Goyal

Grimwood

Marchant

et al. 2016

Pediatric Pulmonology

133

140

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Bronchiectasis is described classically as a chronic pulmonary disorder characterized by a persistent productive cough and irreversible dilatation of one or more bronchi. However, in children unable to expectorate, cough may instead be wet and intermittent and bronchial dilatation reversible in the early stages. Although still considered an orphan disease, it is being recognized increasingly as causing significant morbidity and mortality in children and adults in both affluent and developing countries. While bronchiectasis has multiple etiologies, the final common pathway involves a complex interplay between the host, respiratory pathogens and environmental factors. These interactions lead to a vicious cycle of repeated infections, airway inflammation and tissue remodelling resulting in impaired airway clearance, destruction of structural elements within the bronchial wall causing them to become dilated and small airway obstruction. In this review, the current knowledge of the epidemiology, pathobiology, clinical features, and management of bronchiectasis in children are summarized. Recent evidence has emerged to improve our understanding of this heterogeneous disease including the role of viruses, and how antibiotics, novel drugs, antiviral agents, and vaccines might be used. Importantly, the management is no longer dependent upon extrapolating from the cystic fibrosis experience. Nevertheless, substantial information gaps remain in determining the underlying disease mechanisms that initiate and sustain the pathophysiological pathways leading to bronchiectasis. National and international collaborations, standardizing definitions of clinical and research end points, and exploring novel primary prevention strategies are needed if further progress is to be made in understanding, treating and even preventing this often life-limiting disease.

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Bronchiectasis in Children from Qikiqtani (Baffin) Region, Nunavut, Canada

Cited by 35 publications

References 21 publications

Clinical course of chronic suppurative lung disease and bronchiectasis in Alaska Native children

Clinical course of chronic suppurative lung disease and bronchiectasis in Alaska Native children

Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis

Pediatric bronchiectasis: No longer an orphan disease

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