<p>Chronic Obstructive Pulmonary Disease In Aboriginal Patients Of The Northern Territory Of Australia: A Landscape Perspective</p>

Abstract

Background: The Aboriginal population of Australia has a higher burden of chronic health conditions than non-Aboriginal Australians. However, there is a paucity of data on clinical and demographic characteristics of chronic obstructive pulmonary disease (COPD) in this population. Method: In this retrospective study we evaluated the clinical, demographic and environmental influences in adult Aboriginal patients with COPD living in the regional and remote communities of the Northern Territory of Australia. Results: There were 380 patients (49%) with a diagnosis of COPD of the 767 patients referred to specialist respiratory outreach clinics. The mean age was 57 years (56% were female) and mean±SD BMI was 24.30±7.01 kg/m 2. Smoking history was noted in 93% of the study cohort. The most common respiratory symptom was shortness of breath in 62%, and inhaled medications (salbutamol, tiotropium, salmeterol/fluticasone) were used by 79%, 44% and 58% of patients, respectively. Spirometry showed obstructive impairment (FEV 1 / FVC <0.7) in 79% (0.56±0.17), with mean FEV 1 42% of predicted, and a bronchodilator response was present in 28.6%. Comorbid bronchiectasis was diagnosed in 49.8% along with COPD. The relationship between COPD and community demography showed a higher proportion of smokers and those with underlying bronchiectasis to have lower FEV 1 /FVC ratios. Communities with a higher proportion of asthma were younger and had higher smoking rates. Mortality increased with increasing number of exacerbations and hospital admissions. Conclusion: The Aboriginal population with COPD has a higher prevalence of smoking, moderate to severe airflow obstruction on spirometry and frequently co-diagnosed bronchiectasis with increased severity of ventilatory impairment.

<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

“…Indigenous people around the world experience a higher burden of chronic health conditions, including advanced respiratory conditions. [44][45][46] Despite evidence in the literature to suggest chronic respiratory conditions along with poor LFPs are highly prevalent among Indigenous population, including in the adult Indigenous Australians, 1,4,[7][8][9][10][11][12][13][14][15][16] there is no published data examining the effects of airway directed inhaled pharmacotherapy on LFPs trajectory in this population. Hence, we believe our current study is of significant value in addressing this gap in our knowledge.…”

“…5,6 Chronic airway diseases, such as COPD and bronchiectasis are noted to be highly prevalent in the NT Indigenous population. [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.…”

“…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

“…However, measurement of DLCO and TLC values via body plethysmography would face significant challenges in this population, where 81% of Indigenous people reside in remote or very remote communities, many of which may be accessed only seasonally by light aircraft ( S1 and S2 Figs) within a vast geographic area of 245,000 km 2 (94,595.0 sq mi) and a population density of 0.16 people per kilometre, making such a study virtually infeasible [ 29 , 30 ]. Therefore, the use of a portable DLCO ndd device is the most reasonable method to assess LFP’s for Indigenous subjects during respiratory specialist outreach visits to remote Indigenous communities ( S3 Fig )—a unique model adopted for respiratory care in the TEHS region of NT of Australia [ 2 , 3 , 11 ]. The authors are also very aware and acknowledge that the sample size may be less than ideal for this study.…”