Adult outcomes of childhood bronchiectasis

• Published in: International journal of circumpolar health 2020-01, Vol.79 (1), p.1731059
• Main Authors: Sibanda, Dawn, Singleton, Rosalyn, Clark, John, Desnoyers, Christine, Hodges, Ellen, Day, Gretchen, Redding, Gregory
• Format: Article
• Language: English
• Subjects: adolescence; Adolescent; Adult; Adults; Age; Alaska; Alaska Natives - statistics & numerical data; Asthma; bronchiectasis; Bronchiectasis - epidemiology; Bronchiectasis - physiopathology; Child; Child development; Childhood; Chronic illnesses; Chronic lung disease; Chronic obstructive pulmonary disease; Comorbidity; Consortia; Cystic fibrosis; Female; Health care access; Hospitals; Humans; indigenous; Indoor air quality; Lung diseases; Lung Diseases - epidemiology; Male; Medical records; Morbidity; Native American; Pediatrics; Pneumonia; Prevalence; Recurrence; Respiratory Tract Infections - epidemiology; Teenagers; transition; Vital Capacity; Young Adult
• ISSN: 2242-3982; 1239-9736; 2242-3982
• DOI: 10.1080/22423982.2020.1731059

Recent literature has highlighted the importance of transition from paediatric to adult care for children with chronic conditions. Non-cystic fibrosis bronchiectasis is an important cause of respiratory morbidity in low-income countries and in indigenous children from affluent countries; however, there is little information about adult outcomes of childhood bronchiectasis. We reviewed the clinical course of 31 Alaska Native adults 20-40 years of age from Alaska's Yukon Kuskokwim Delta with childhood bronchiectasis. In patients with chronic suppurative lung disease, a diagnosis of bronchiectasis was made at a median age of 4.5 years by computerised tomography (68%), bronchogram (26%), and radiographs (6%). The patients had a median of 75 lifetime respiratory ambulatory visits and 4.5 hospitalisations. As children, 6 (19%) experienced developmental delay; as adults 9 (29%) experienced mental illness or handicap. Four (13%) patients were deceased, four (13%) had severe pulmonary impairment in adulthood, 17 (54%) had persistent or intermittent respiratory symptoms, and seven (23%) were asymptomatic. In adulthood, only five were seen by adult pulmonologists and most had no documentation of a bronchiectasis diagnosis. Lack of provider continuity, remote location and co-morbidities can contribute to increased adult morbidity. Improving the transition to adult care starting in adolescence and educating adult providers may improve care of adults with childhood bronchiectasis.