Advancing equity: six-year respiratory outcomes in young Indigenous children following early respiratory disease detection.

BACKGROUND: Protracted bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD) and bronchiectasis are parts of a disease spectrum characterised by chronic wet cough (CWC). Untreated PBB can develop into CSLD/bronchiectasis. Community-based data are limited, and longitudinal studies of children with CWC/PBB may provide insights into risks of developing CSLD/bronchiectasis and associations with lung function, particularly in priority populations. Our aim was to characterise the six-year respiratory outcomes of young Indigenous children with CWC/PBB, and risk factors associated with chronic respiratory disease. METHODS: In a whole-available population observational community-based cohort study in four-remote Western Australian communities, we undertook respiratory screening of Indigenous children aged <eight-years. The children were followed-up six-years later. RESULTS: Of the 203 children recruited in 2018-2019, 191 (94.1%) were re-screened in 2024, where 33/191(17.3%) had a chronic respiratory condition; their median forced expiratory volume in-one-second and forced vital capacity z-scores were significantly lower than their healthy peers, mean-difference (MD) was -0.78(95%CI -1.30, -0.30), and -1.30(95%CI -1.90, -0.77) respectively. Of the 26 children with CWC in 2018-2019, nine (34.6%) had CSLD/bronchiectasis six-years later, with the risk of CSLD/bronchiectasis being 28.6(95%CI 6.6, 124.9) times higher than those without CWC. Previous acute lower respiratory tract infection (ALRI) hospitalisation was associated with CSLD/bronchiectasis (prevalence odds ratio=7.8, 95%CI 2.1, 41.6). CONCLUSIONS: In this first whole-available community longitudinal study of remote-based Indigenous children, there was high prevalence of chronic respiratory disease with corresponding low lung function. CWC in the first eight-years of life and previous ALRI-related hospitalisation were associated with significantly increased risk of CSLD/bronchiectasis.