Indigenous children in remote Australia have extremely high rates of pneumonia; some get better while others develop bronchiectasis (a chronic suppurative lung disease characterised by chronic wet cough).

Chronic wet or moist cough is common among Indigenous children. Bronchiectasis is a severe disease that, once established, affects individuals throughout their life. While this condition was recognised frequently in Australians up to 50 years ago, it is now usually limited to those with cystic fibrosis or immunodeficiency.

Unfortunately, bronchiectasis still contributes to the unacceptably high burden of respiratory disease in Indigenous Australians. The optimal treatment of bronchiectasis in this population is not known. The similarity of bronchiectasis among Indigenous populations in affluent countries has resulted in this collaborative study of Indigenous children (Aboriginal and Torres Strait Islander and New Zealand Maori or Pacific Islander). The study design is identical in the two participating countries.

By documenting the epidemiology and natural clinical course of chronic wet cough and bronchiectasis in Indigenous children, this project will provide a much-needed rationale for the management of these conditions. If effective, a simple treatment prophylactic regimen (an antibiotic taken orally once/week that does not require refrigeration) would be a substantial and achievable advance.

Aims: 

• To provide a rationale for the management of bronchiectasis due to the high rates of bronchiectasis among Indigenous populations in affluent countries.

This resulted in the first collaborative and international study of Aboriginal and Torres Strait Islanders, New Zealand Pacific Islanders and Maori, and Alaskan Natives with the study design identical in the three participating countries.

Objectives:

There were two study arms:

• The Observational Study (BOS)
• The Interventional Study (BIS)

The Observational Study (BOS):

• To define the natural history of chronic moist cough and bronchiectasis.
• To identify the risk factors associated with progression from early/mild disease to bronchiectasis. 

The Interventional Study (BIS):

• To perform a randomised double-blind placebo controlled trial comparing maintenance antibiotic treatment (azithromycin 30 mg/kg once/week) versus placebo in children aged 12 months to eight years with bronchiectasis in the attempt to prevent pulmonary exacerbations, pneumococcal and H. influenzae carriage and antibiotic resistance.

Our research has found:

There is a need for culturally appropriate respiratory resources to be available to communities. As a result, a reference group consisting of Indigenous members from our Menzies Indigenous Reference group, Department of Health and Families (DHF), remote health staff, the Asthma Foundation, the Australian Lung Foundation and Menzies respiratory staff was developed to advise the Menzies Child Health Division Respiratory team. This group has been instrumental in developing much needed respiratory resources.

Funding: NHMRC

Chief Investigators: Morris P, Valery PC, Chang AB, Grimwood K, Singleton R, Torzillo PJ

Main papers

Chest. 2014; 146(3):762-74

Lancet Respir Med. 2013; 1: 610-620