Chronic Obstructive Pulmonary Disease In Aboriginal Patients Of The Northern Territory Of Australia: A Landscape Perspective

Abstract

Subash S Heraganahally,1–4 Sanjiwika L Wasgewatta,1 Kelly McNamara,2,3 Carla C Eisemberg,5 Richard C Budd,1 Sumit Mehra,1,3,6,6 Dimitar Sajkov2,6,7 1Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, NT, Australia; 2Flinders University - College of Medicine and Public Health, Adelaide, SA, Australia; 3Northern Territory Medical School, Charles Darwin University, Darwin, NT, Australia; 4Darwin Respiratory and Sleep Health, Darwin, NT, Australia; 5Research Institute for the Environment and Livelihoods, Charles Darwin University, Darwin, NT, Australia; 6Respiratory and Sleep Medicine, Flinders Medical Centre, Adelaide, SA, Australia; 7Australian Respiratory and Sleep Medicine Institute, Adelaide, SA, AustraliaCorrespondence: Subash S HeraganahallyDepartment of Respiratory and Sleep Medicine, Royal Darwin Hospital, 105, Rocklands Drive, Tiwi, Darwin, NT, AustraliaTel [phone], Fax [phone]Email [email protected]: The Aboriginal population of Australia has a higher burden of chronic health conditions than non-Aboriginal Australians. However, there is a paucity of data on clinical and demographic characteristics of chronic obstructive pulmonary disease (COPD) in this population.Method: In this retrospective study we evaluated the clinical, demographic and environmental influences in adult Aboriginal patients with COPD living in the regional and remote communities of the Northern Territory of Australia.Results: There were 380 patients (49%) with a diagnosis of COPD of the 767 patients referred to specialist respiratory outreach clinics. The mean age was 57 years (56% were female) and mean±SD BMI was 24.30±7.01 kg/m2. Smoking history was noted in 93% of the study cohort. The most common respiratory symptom was shortness of breath in 62%, and inhaled medications (salbutamol, tiotropium, salmeterol/fluticasone) were used by 79%, 44% and 58% of patients, respectively. Spirometry showed obstructive impairment (FEV1/FVC <0.7) in 79% (0.56±0.17), with mean FEV1 42% of predicted, and a bronchodilator response was present in 28.6%. Comorbid bronchiectasis was diagnosed in 49.8% along with COPD. The relationship between COPD and community demography showed a higher proportion of smokers and those with underlying bronchiectasis to have lower FEV1/FVC ratios. Communities with a higher proportion of asthma were younger and had higher smoking rates. Mortality increased with increasing number of exacerbations and hospital admissions.Conclusion: The Aboriginal population with COPD has a higher prevalence of smoking, moderate to severe airflow obstruction on spirometry and frequently co-diagnosed bronchiectasis with increased severity of ventilatory impairment.Keywords: Aboriginal, bronchiectasis, chronic obstructive pulmonary disease, Indigenous, spirometry

Keywords

• Aboriginal
• Bronchiectasis
• Chronic obstructive pulmonary disease
• Indigenous
• Spirometry.