Characteristics of children with chronic suppurative lung disease (CSLD): A prospective 10-year study

Abstract

Introduction/Aim While largely preventable, CSLD (including bronchiectasis), remains highly prevalent amongst disadvantaged Indigenous populations in high income countries. Adult studies with CSLD have shown that persistent airway infection and inflammation, and longer duration of chronic productive cough result in poorer clinical outcomes. There are however, no prospective studies in children with CSLD in the last 50‐years to help guide long‐term clinical care and management. We evaluated the long‐term clinical outcomes of Indigenous children with CSLD who participated in our previous study, ‘Multicentre Bronchiectasis Study (BOS)' (2004‐2012).

Methods During 2015–17, we re‐assessed as many children as possible from BOS (Australia n=97, Alaska n=41, New Zealand n=42). Research staff administered standardised questionnaires and undertook medical note review, clinical examination and spirometry. Medical history was extracted from the original dataset and current medical records. Based on their clinical assessment, physicians classified children into 4 overall categories (well, better, stable, worse).

Results 120/180 (67%) children (current median age 11.5‐years (IQR 5.9‐18.6); 46% males) were reviewed. From birth until their current age, children had a median of 20 (IQR 14‐30) community‐treated acute lower respiratory infections and 4 (IQR 3‐7) respiratory hospitalisations. Respiratory infections decreased with age. At examination, wheeze was present in 10%, wet cough in 26% and digital clubbing in 17% of children. The children's summary clinical status were: well (22%); better (32%); stable (46%) or worse (0%). Airway obstruction on spirometry was present in 36% and restrictive pattern in 19%, with only 45% having normal spirometry values within population norms.

Conclusion In a 10‐year follow‐up of children with CSLD and on‐going clinical care, most were stable or improved by adolescence. However, as many still experience respiratory symptoms and demonstrate impaired lung function, clinical follow‐up is recommended during adolescence to optimise clinical management.