title: Respiratory exacerbations in indigenous children from two countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis.
abstract: BACKGROUND
  Acute respiratory exacerbations (AREs) cause morbidity and lung function decline in children with chronic suppurative lung disease (CSLD) and bronchiectasis. In a prospective longitudinal cohort study, we determined the patterns of AREs and factors related to increased risks for AREs in children with CSLD/bronchiectasis.
  
  
  METHODS
  Ninety-three indigenous children aged 0.5 to 8 years with CSLD/bronchiectasis in Australia (n = 57) and Alaska (n = 36) during 2004 to 2009 were followed for > 3 years. Standardized parent interviews, physical examinations, and medical record reviews were undertaken at enrollment and every 3 to 6 months thereafter.
  
  
  RESULTS
  Ninety-three children experienced 280 AREs (median = 2, range = 0-11 per child) during the 3-year period; 91 (32%) were associated with pneumonia, and 43 (15%) resulted in hospitalization. Of the 93 children, 69 (74%) experienced more than two AREs over the 3-year period, and 28 (30%) had more than one ARE in each study year. The frequency of AREs declined significantly over each year of follow-up. Factors associated with recurrent (two or more) AREs included age < 3 years, ARE-related hospitalization in the first year of life, and pneumonia or hospitalization for ARE in the year preceding enrollment. Factors associated with hospitalizations for AREs in the first year of study included age < 3 years, female caregiver education, and regular use of bronchodilators.
  
  
  CONCLUSIONS
  AREs are common in children with CSLD/bronchiectasis, but with clinical care and time AREs occur less frequently. All children with CSLD/bronchiectasis require comprehensive care; however, treatment strategies may differ for these patients based on their changing risks for AREs during each year of care.
authors.affiliation: Pulmonary and Sleep Medicine Division, Seattle Children's Hospital, University of Washington, Seattle, WA. Electronic address: gredding@u.washington.edu.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Redding
authors.affiliation: Alaska Native Tribal Health Consortium, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Preparedness and Emerging Infections, Arctic Investigations Program, Anchorage, AK.
authors.forename: Rosalyn J
authors.initials: RJ
authors.lastname: Singleton
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Valery
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
authors.forename: Hayley
authors.initials: H
authors.lastname: Williams
authors.affiliation: Queensland Children's Medical Research Institute, The University of Queensland, Queensland Paediatric Infectious Diseases Laboratory, Royal Children's Hospital, Brisbane, QLD, Australia.
authors.forename: Keith
authors.initials: K
authors.lastname: Grimwood
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Morris
authors.affiliation: Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Torzillo
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
authors.forename: Gabrielle B
authors.initials: GB
authors.lastname: McCallum
authors.affiliation: Yukon Kuskokwim Health Corporation, Bethel, AK.
authors.forename: Lori
authors.initials: L
authors.lastname: Chikoyak
authors.affiliation: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of High-Consequence Pathogens and Pathology, Atlanta, GA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Holman
authors.affiliation: Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Queensland Respiratory Centre, Royal Children's Hospital, Queensland Children's Medical Research Institute, Queensland University of Technology, Brisbane, QLD, Australia.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Chang
mesh_terms: D000413:Alaska / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D001987:Bronchiectasis / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D003371:Cough / Q000453:epidemiology* / Q000208:ethnology*; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008171:Lung Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000208:ethnology*; D008297:Male; D044382:Population Groups; D011446:Prospective Studies; D012307:Risk Factors; D013492:Suppuration
chemical_list: D001993:Bronchodilator Agents