TY - JOUR
T1 - Factors associated with “Frequent Exacerbator” phenotype in children with bronchiectasis
T2 - The first report on children from the Australian Bronchiectasis Registry
AU - Kapur, Nitin
AU - Stroil-Salama, Enna
AU - Morgan, Lucy
AU - Yerkovich, Stephanie
AU - Holmes-Liew, Chien-Li
AU - King, Paul
AU - Middleton, Peter
AU - Maguire, Graeme
AU - Smith, Daniel
AU - Thomson, Rachel
AU - McCallum, Gabrielle
AU - Owens, Louisa
AU - Chang, Anne B.
N1 - Funding Information:
Grant support: None for the study. The ABR is an initiative of the Lung Foundation of Australia. AC is supported by a National Health and Medical Research Council senior practitioner fellowship (grant APP1154302 ).
Publisher Copyright:
© 2021
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/11
Y1 - 2021/11
N2 - Introduction: In adults with bronchiectasis, multicentre data advanced the field including disease characterisation and derivation of phenotypes such as ‘frequent exacerbator (FE)’ (≥3 exacerbations/year). However, paediatric cohorts are largely limited to single centres and no scientifically derived phenotypes of paediatric bronchiectasis yet exists. Using paediatric data from the Australian Bronchiectasis Registry (ABR), we aimed to: (a) describe the clinical characteristics and compare Indigenous with non-Indigenous children, and (b) determine if a FE phenotype can be identified and if so, its associated factors. Methods: We retrieved data of children (aged <18-years) with radiologically confirmed bronchiectasis, enrolled between March 2016–March 2020.Results: Across five sites, 540 children [288 Indigenous; median age = 8-years (IQR 6–11)] were included. Baseline characteristics revealed past infection/idiopathic was the commonest (70%) underlying aetiology, most had cylindrical bronchiectasis and normal spirometry. Indigenous children (vs. non-Indigenous) had significantly more environmental tobacco smoke exposure (84% vs 32%, p < 0.0001) and lower birth weight (2797 g vs 3260 g, p < 0.0001). FE phenotype present in 162 (30%) children, was associated with being younger (ORadjusted = 0.85, 95%CI 0.81–0.90), more recent diagnosis of bronchiectasis (ORadjusted = 0.67; 95%CI 0.60–0.75), recent hospitalization (ORadj = 4.51; 95%CI 2.45–8.54) and Pseudomonas aeruginosa (PsA) infection (ORadjusted = 2.43; 95%CI 1.01–5.78). The FE phenotype were less likely to be Indigenous (ORadjusted = 0.14; 95%CI 0.03–0.65). Conclusion: Even within a single country, the characteristics of children with bronchiectasis differ among cohorts. A paediatric FE phenotype exists and is characterised by being younger with a more recent diagnosis, PsA infection and previous hospitalization. Prospective data to consolidate our findings characterising childhood bronchiectasis phenotypes are required.
AB - Introduction: In adults with bronchiectasis, multicentre data advanced the field including disease characterisation and derivation of phenotypes such as ‘frequent exacerbator (FE)’ (≥3 exacerbations/year). However, paediatric cohorts are largely limited to single centres and no scientifically derived phenotypes of paediatric bronchiectasis yet exists. Using paediatric data from the Australian Bronchiectasis Registry (ABR), we aimed to: (a) describe the clinical characteristics and compare Indigenous with non-Indigenous children, and (b) determine if a FE phenotype can be identified and if so, its associated factors. Methods: We retrieved data of children (aged <18-years) with radiologically confirmed bronchiectasis, enrolled between March 2016–March 2020.Results: Across five sites, 540 children [288 Indigenous; median age = 8-years (IQR 6–11)] were included. Baseline characteristics revealed past infection/idiopathic was the commonest (70%) underlying aetiology, most had cylindrical bronchiectasis and normal spirometry. Indigenous children (vs. non-Indigenous) had significantly more environmental tobacco smoke exposure (84% vs 32%, p < 0.0001) and lower birth weight (2797 g vs 3260 g, p < 0.0001). FE phenotype present in 162 (30%) children, was associated with being younger (ORadjusted = 0.85, 95%CI 0.81–0.90), more recent diagnosis of bronchiectasis (ORadjusted = 0.67; 95%CI 0.60–0.75), recent hospitalization (ORadj = 4.51; 95%CI 2.45–8.54) and Pseudomonas aeruginosa (PsA) infection (ORadjusted = 2.43; 95%CI 1.01–5.78). The FE phenotype were less likely to be Indigenous (ORadjusted = 0.14; 95%CI 0.03–0.65). Conclusion: Even within a single country, the characteristics of children with bronchiectasis differ among cohorts. A paediatric FE phenotype exists and is characterised by being younger with a more recent diagnosis, PsA infection and previous hospitalization. Prospective data to consolidate our findings characterising childhood bronchiectasis phenotypes are required.
KW - Bronchiectasis
KW - Children
KW - Frequent exacerbator
KW - Phenotypes
KW - Registry
UR - http://www.scopus.com/inward/record.url?scp=85115911267&partnerID=8YFLogxK
U2 - 10.1016/j.rmed.2021.106627
DO - 10.1016/j.rmed.2021.106627
M3 - Article
C2 - 34592538
AN - SCOPUS:85115911267
VL - 188
SP - 1
EP - 8
JO - Respiratory Medicine
JF - Respiratory Medicine
SN - 0954-6111
M1 - 106627
ER -