Paediatric Chronic Suppurative Lung Disease

Introduction The true prevalence of chronic suppurative lung disease (CSLD) and other respiratory illness in Indigenous children is unknown. There is however little doubt that the burden of CSLD is disproportionately high in remote and rural Indigenous communities. In Central Australia the prevalence of high resolution computed tomography (HRCT) proven bronchiectasis in children (<15 years) is at least 4.2 per 1000 children (denominator based on ABS statistics for 2000 and includes population of the Anangu Pitjantjatjara Lands). This far exceeds the prevalence of children with cystic fibrosis in non-Indigenous Australian centres, yet there is no concerted program or resources to manage these children who succumb to premature death from their lung disease and have significant morbidity in childhood and adulthood. Many children remain undiagnosed and there is wide variation in the management of those identified with CSLD, varying from a minimalist approach (no treatment) to intensive physiotherapy and antibiotics. Reasons for the minimal approach include the perception that ‘nothing can be done’, and the lack of resources, both in the community and hospital levels, not dissimilar to community attitudes for cystic fibrosis several decades ago. The value of early recognition and intervention/management of these disease processes for the regression (where possible), and prevention and/or slowing down, of the advancement of the disease process is increasingly recognised in asthma, chronic lung infections and chronic obstructive airway disease (COAD). Based on this principle, national and international programs currently exist for other respiratory diseases such as asthma, chronic airflow limitation, cystic fibrosis and non-respiratory diseases such as diabetes and chronic heart disease. In late August 2001, a workshop to discuss the issues around CSLD in remote Indigenous children was attended by adult and paediatric respiratory physicians, general physicians and paediatricians, researchers, and public health physicians from around Australia and New Zealand. The management approach outlined in this article was reached by consensus of the group.