Flexible bronchoscopy indications and outcomes between Indigenous and non-Indigenous patients in the Northern Territory of Australia

Background: There is sparse evidence in the literature in relation to indications and outcomes among adult Indigenous patients requiring a flexible bronchoscopy (FB). In this study, FB indications and outcomes between Indigenous and non-Indigenous patients were assessed. 

Aim: To assess the similarities and differences of FB indications and outcomes between Indigenous and non-Indigenous patients. 

Methods: Self-reported Indigenous status, resident locality and the primary indication for FB were assessed. The FB procedures details, results of microbiology, cytology and histopathology were compared between Indigenous and non-Indigenous patients. Chest computed tomography (CT) was also analysed for its relationship to FB outcomes. 

Results: Of the 403 patients, 111 (28%) were Indigenous, and Indigenous patients were younger (mean difference 11 years) and had a higher proportion of remote residence (70% vs 13%). Malignancy (40%) and infection (31%) were the most common indications for FB, although Indigenous patients reported significantly more haemoptysis (15% vs 9%). No differences were noted in findings of the preceding chest CT scans. For positive microbiology, Indigenous patients had a higher presence of Streptococcus pneumoniae (30% vs 9%), while non-Indigenous patients had a higher presence of Pseudomonas aeruginosa (43% vs 11%) and mycobacteria (15% vs 4%). There was no significant difference between Indigenous and non-Indigenous patients for a positive histopathology, particularly for a diagnosis of lung malignancy (58% vs 54%). 

Conclusions: This study has demonstrated that adult Indigenous patients requiring a FB are significantly younger, tend to reside in remote communities and demonstrate differing microbiology with no significant difference in the diagnostic outcomes for lung malignancy. Ethnic status or remoteness should not preclude Indigenous patients to undergo a FB if clinically indicated.