Prevalence and nature of lung function abnormalities among Indigenous Australians referred to specialist respiratory outreach clinics in the Northern Territory

Schubert, Jonathon P; Kruavit, Anuk; Mehra, Sumit; Wasgewatta, Sanjiwika; Chang, Anne B.; Heraganahally, Subash S.

doi:10.1111/imj.14112

Cited by 31 publications

(62 citation statements)

References 31 publications

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“…A previous study from our centre on spirometry data in Indigenous Australian patients showed relatively poor lung function, particularly reduced FEV 1 (55% of predicted) and FVC (61% of predicted), but with a preserved FEV 1 /FVC ratio. 17 This current study further confirms poor lung function in Aboriginal patients with COPD. In our study a high proportion of patients had underlying bronchiectasis along with COPD.…”

Section: Discussionsupporting

confidence: 83%

“…All lung function tests were performed according to the standard published protocol and as described in a recent report from our centre. 17 Hospital records were also reviewed for exacerbation of COPD, admission frequency and mortality. Exacerbations were defined as presentation to either a clinic or the hospital emergency department with acute worsening of respiratory symptoms.…”

Section: Clinical Parametersmentioning

confidence: 99%

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

Heraganahally¹,

Wasgewatta²,

McNamara³

et al. 2019

COPD

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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.

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Section: Discussionsupporting

confidence: 83%

Section: Clinical Parametersmentioning

confidence: 99%

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

Heraganahally¹,

Wasgewatta²,

McNamara³

et al. 2019

COPD

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“…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.…”

Section: Dovepressmentioning

confidence: 99%

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

Mehra

Ghimire

Mingi

et al. 2020

NSS

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Background: In this study, we assessed the clinical and polysomnographic (PSG) characteristics according to gender among Australian Aboriginal men and woman diagnosed to have obstructive sleep apnea (OSA). Methods: In this retrospective study, all adult Aboriginal patients over 18 years of age diagnosed to have OSA with an apnea hypopnea index (AHI) > 5/hour over a 5 year period were included. Results: Of the 337 patients (168 females and 169 males), who underwent a diagnostic PSG, 297 (88%) were diagnosed to have OSA (AHI) >5/hour), 154/297 males (52%) and 143/297 females (48%). Amongst male and female patients with OSA, 63% and 37% were in the severe spectrum (AHI>30/hour). The male cohort had higher stage N1 NREM sleep (P<0.001), reduced N3 NREM sleep (P<0.001), higher AHI severity (P<0.001), higher NREM AHI (P<0.001), and high arousal index (P<0.005). REM sleep-related AHI was higher among female patients with all severity of OSA, along with severe oxygen desaturation during REM sleep. Among patients with severe OSA, the female cohort were younger (age 46 years vs 49 years, P=0.030) and had higher BMI with all severity of OSA, while males had larger neck circumference compared to females. Hypertension increased the odds of severe OSA versus the combined odds of mild and moderate OSA for both genders. Conclusion: This study highlights some important differences in the way sleep apnea manifests in Australian Aboriginal males and females and further studies are warranted to explore avenues to look for a physiological basis for these observations and targeted interventions.

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“…Lung function results/criteria were not used as a diagnostic marker for COPD, as there is no established normative predictive value that is currently established for Aboriginal Australians of the NT. 23 Only patients who had either chest X-ray or computed tomography (CT) scan available to evaluate the presence or absence of bronchiectasis as per the reporting radiologist were included in the study. Chest CT scan results were considered to provide a definitive diagnosis for the presence of bronchiectasis when available.…”

Section: Study Participantsmentioning

confidence: 99%

“…All lung function tests were performed according to the standard published protocol and as described in a recent report from our centre. 23 Hospital records were also reviewed for exacerbation of COPD/bronchiectasis, admission frequency and mortality. Exacerbations were defined as either presentation to community health centre or to hospital emergency department with acute worsening of respiratory symptoms.…”

Section: Clinical Parametersmentioning

confidence: 99%

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

Heraganahally

Wasgewatta

McNamara

et al. 2020

Internal Medicine Journal

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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.

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Prevalence and nature of lung function abnormalities among Indigenous Australians referred to specialist respiratory outreach clinics in the Northern Territory

Cited by 31 publications

References 31 publications

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

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

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

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

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