Advancing Bronchiectasis Care in Adult Indigenous People – An Australian Rural and Remote Perspective

Purpose of Review
Bronchiectasis is a significant health burden among Australian Indigenous adults and global Indigenous populations, particularly those in rural and remote communities. This review synthesizes the current literature and integrates insights from local and national experts to inform a culturally appropriate and clinically effective approach to bronchiectasis management in this population.

Recent Findings
Recent findings highlight a high prevalence of bronchiectasis among Australian Indigenous adults (14.9 per 1,000), with common symptoms including chronic cough, sputum production, and dyspnoea. Clinical signs may include coarse crackles, digital clubbing, and reduced BMI, often accompanied by coexisting COPD and other comorbidities. While chest CT remains the diagnostic gold standard, clinical features and chest X-rays can support a presumptive diagnosis where access is limited. Spirometry typically reveals restrictive patterns, and sputum cultures frequently identify Haemophilus influenzae, Pseudomonas aeruginosa, and non-Aspergillus fungi. The Indigenous Bronchiectasis Assessment Scale (IBAS) may assist in evaluating disease burden. Key management strategies include patient education, airway clearance, smoking cessation, nutritional support, physical activity, and vaccination. Pharmacologic therapies such as long-acting bronchodilators, azithromycin, and N-acetylcysteine may be beneficial, whereas inhaled corticosteroids should be used cautiously.

Summary
This report proposes a tailored clinical framework aimed at reducing morbidity and mortality in Indigenous adults with bronchiectasis.