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Hospital-Based Case-Control Study of Bronchiectasis in Indigenous Children in Central Australia

Valery, Patricia C. MD, MPH, PhD*†; Torzillo, Paul J. MBBS, FRACP; Mulholland, Kim MD, FRACP#; Boyce, Naomi C. BN**; Purdie, David M. BSc, PhD*‡; Chang, Anne B. MBBS, FRACP, PhD§∥

The Pediatric Infectious Disease Journal: October 2004 - Volume 23 - Issue 10 - p 902-908
doi: 10.1097/01.inf.0000142508.33623.2f
Original Studies

Background: Childhood pneumonia has been reported to be associated with the development of bronchiectasis but there are no case-control studies that have examined this. This study examined the relationship between hospital admission for episode(s) of pneumonia and the risk of radiologically proven bronchiectasis.

Methods: A medical record-based case-control study of bronchiectasis in Indigenous children was conducted in Central Australia. Controls (183), matched to cases (61) by gender, age and year of diagnosis, were Indigenous children hospitalized with other conditions.

Results: There was a strong association between a history of hospitalized pneumonia and bronchiectasis [odds ratio (OR), 15.2; 95% confidence interval (95% CI) 4.4–52.7]. This was particularly evident in recurrent hospitalized pneumonia (P for trend < 0.01), severe pneumonia episodes with longer hospital stay (P for trend < 0.01), presence of atelectasis (OR 11.9; 95% CI 3.1–45.9) and requirement for oxygen (P for trend < 0.01). The overall number of pneumonia episodes, rather than its site, was associated with bronchiectasis. Although the total number of pneumonia episodes in the first year of life did not increase the risk of bronchiectasis, more severe episodes early in life did. Malnutrition, premature birth and being small for gestational age were more common findings among cases. Breast-feeding appeared to be a protective factor (OR 0.2; 95% CI 0.1–0.7).

Conclusions: Although we cannot fully answer the question of why bronchiectasis is much more common in Indigenous children, we have provided strong evidence of an association between bronchiectasis and severe and recurrent pneumonia episodes in infancy and childhood.

From the *Queensland Institute of Medical Research, Population Studies and Human Genetics, Brisbane, Australia; the †Australian Centre for International and Tropical Health and Nutrition, the ‡School of Population Health, and the §Department of Paediatrics, University of Queensland, Brisbane, Australia; the ∥Department of Respiratory Medicine, Royal Children’s Hospital Foundation, Brisbane, Australia; the ¶University of Sydney-Royal Prince Alfred Hospital-Nganampa Health Council, Sydney, Australia; the #Centre for International Child Health, Royal Children’s Hospital, Melbourne, Australia; and **Flinders University NT Clinical School, Alice Springs, Australia

Accepted for publication May 12, 2004.

Reprints not available.

© 2004 Lippincott Williams & Wilkins, Inc.