Aboriginal children need extra lung care

Morbidity associated with chronic lung disease in Aboriginal children could be reduced with appropriate follow-up care after hospitalisation for pneumonia, according to research published in the most recent edition of the Medical Journal of Australia.

The research, was published by Associate Professor Anne Chang and Dr John Masel from the Royal Chidlren's Hospital in Brisbane, Naomi Boyce from Flinders University Northern Territory Clinical School in Alice Springs, and Associate Professor Paul Torzillo at the Royal Prince Alfred Medical Centre in Sydney.

It found that Aboriginal children admitted to hospital with alveolar changes on chest x-rays are particularly susceptible to chronic respiratory illness and should be followed up for early detection and management of diseases such as bronchiectasis.

The study examined 109 Aboriginal children aged between two months and thirteen and a half years, admitted to Alice Springs Hospital between October 2000 and April 2001 with pneumonia.

Seventy-eight of the children received complete follow-up care, and a new, treatable chronic respiratory condition was found in over 25 per cent of those children.

The study found that pre-discharge chest x-rays that showed no or only minimal resolution of alveolar changes predicted all chronic respiratory disease identified at the follow-up visit 12 months later.

"It is common practice for children hospitalised in Australian paediatric centres to have an initial and follow-up chest x-ray," said Dr Chang.

"But for children in remote communities, a follow-up chest x-ray often involves a plane flight, overnight accommodation, major disruption to family life and high costs," she said.

"A pre-discharge x-ray could potentially reduce the economic and social costs of following up all children.

"There are several reasons that may explain the high rates of disease found on follow-up, and one important reason is the children's living environment. Thus, the increased risk of lower respiratory infection is associated with inadequate and poor quality housing, inadequate water supply and exposure to tobacco smoke.

"A critical question for future research is whether treatment with antibiotics for five days is inadequate, resulting in persistent low-grade bacterial bronchitis. It is possible that incomplete eradication of bacteria in early bacterial pneumonia, as well as persistent airway inflammation, promotes the development of bronchiectasis," she said.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT: Associate Professor Anne Chang, 0411 699022

Judith Tokley, AMA, 0408 824 306