Aboriginal 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 Aboriginal 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.

Aim/goal of project

The high rates of bronchiectasis among Indigenous populations in affluent countries has resulted in the first collaborative and international study of Aboriginal and Torres Strait Islanders, New Zealand Pacific Islanders and Maori, and Alaskan Natives. The study design is identical in the 3 participating countries. There are 2 study arms:

THE OBSERVATIONAL STUDY (BOS)

A prospective cohort study of Indigenous children with bronchiectasis or chronic moist cough (with and without CXR infiltrates).  Indigenous children aged 6 months to 8 years will be eligible to participate. 

Aims: 

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

Total numbers enrolled in bos 



THE INTERVENTIONAL STUDY (BIS)

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 8 years with bronchiectasis 

Aims:

1. the prevention of pulmonary exacerbations 
2. pneumococcal and H. influenzae carriage; and
3. antibiotic resistance

This study will help determine policy initiatives to reduce morbidity and mortality associated with chronic and recurrent respiratory illness in Aboriginal and Torres Strait Islander children.

89 children were enrolled in this arm of the trial from sites (Australia and New Zealand). All children completed their trial requirements by July 2012. All data has been entered, cleaned and is being analysed for feedback and publication.

Outcomes
As part of this study, there was a great need identified of the lack of culturally appropriate respiratory resources. As part of the Menzies Child Health Division Respiratory team in 2010, a reference group consisting of Indigenous members from our Menzies Indigenous Reference group, DHF, remote health staff, asthma foundation, and Australian Lung Foundation and Menzies respiratory staff has been developed. This group has been instrumental in developing much needed respiratory resources. We are completing the development of the below resources. Once they are completed, we will distribute to all participating communities in the Bronchiectasis Study. 

Respiratory resources