Prevalence of chronic wet cough and protracted bacterial bronchitis in Aboriginal children

Abstract

BackgroundChronic wet cough, the most common symptom of a disease spectrum that encompasses protracted bacterial bronchitis (PBB) and bronchiectasis, is common among Aboriginal children. In the absence of any community prevalence data, and with the high burden of respiratory disease and the European Respiratory Society task force's recommendation to identify disease burden, we determined the prevalence of chronic wet cough and PBB in young Aboriginal children in four remote communities in north Western Australia.MethodsA whole-population, prospective study was conducted. Aboriginal children aged ≤7 years were clinically assessed for chronic wet cough by paediatric respiratory clinicians between July 2018 and May 2019. Where children had a wet cough but parents reported a short or uncertain cough duration, children were followed up 1 month later. A medical record audit 6 weeks to 3 months later was used to determine those children with chronic wet cough who had PBB (based on response to antibiotics).ResultsOf the 203 children, 191 (94%; median age 3.5 years, range 0–7 years) were enrolled. At the initial visit, chronic wet cough was present in 21 (11%), absent in 143 (75%) and unknown in 27 (14%). By follow-up, the total prevalence of chronic wet cough was 13% (95% CI 8–19%) and 10% (95% CI 7–17%) for PBB. Chronic wet cough was more common in the two communities with unsealed roads (19%) compared to the two with sealed roads (7%).ConclusionGiven the relatively high prevalence, strategies to address reasons for and treatment of chronic wet cough and PBB in young Aboriginal children in remote north Western Australia are required.

Conducting decolonizing research and practice with Australian First Nations to close the health gap

“…We suggest that KT science and PAR are two appropriate and promising methodologies in First Nation contexts [ 28 , 30 ] to facilitate systems changes and improve health outcomes. We will describe how the successful combination of KT/PAR applied in four remote Aboriginal communities [ 33 ] and a regional town [ 34 ] resulted in improved health outcomes. The researchers addressed and quantified a chronic health problem by engaging with Aboriginal communities, health practitioners and key stakeholders.…”

Frequency of protracted bacterial bronchitis and management pre‐respiratory referral

“…[6][7][8][9][10][11] If the wet cough persists, specialist respiratory referral is recommended. [9][10][11] PBB is a highly prevalent disease in some settingsa recent study reported 10% prevalence of PBB in an Aboriginal community setting, 12 and another study reported that up to 40% of children referred to tertiary care for chronic cough had PBB. 5 Prompt and effective management of PBB in primary care could arrest disease progression and reduce the need for specialist respiratory referral.…”

Recent progress in the management of chronic cough

“…Amongst various conditions, PBB is considered to be a distinct common entity in infants and young children with chronic wet cough [ 99 ]. The prevalence of PBB is not reported in Korean children, but the data from Australia, Turkey, and China indicate that it is one of the most common causes of chronic wet cough in young children [ 99 - 101 ]. In the recent ERS Task Force report, a consensus definition has been formulated as the following: (1) presence of chronic (> 4 weeks’ duration) wet or productive cough; (2) absence of symptoms or signs (i.e., specific cough pointers) suggestive of other causes of wet or productive cough; and (3) cough resolved following a 2 to 4-week course of an appropriate oral antibiotic [ 99 ].…”