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Bronchiectasis in children: orphan disease or persistent problem?
Charles W Callahan1, Gregory J Redding
1Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii 96859-5000, USA. charles.callahan@amedd.army.mil
Insights
Childhood bronchiectasis, once rare in developed nations, remains prevalent in lower socioeconomic groups and developing countries due to infections and environmental factors. Public health initiatives may be more impactful than medical treatments for this condition.
Area of Science:
- Pediatrics
- Pulmonology
- Epidemiology
Background:
- Bronchiectasis unrelated to cystic fibrosis was considered an orphan disease due to its rarity in developed countries.
- However, it remains prevalent in lower socioeconomic classes and developing nations, linked to infections, environmental irritants, and malnutrition.
- Persistently high rates are observed in specific populations, such as Southern Pacific and Alaska Native children, highlighting the need for updated global epidemiology.
Purpose of the Study:
- To reassess the global importance of childhood bronchiectasis.
- To explore the unclear reasons behind its development in some children.
- To investigate the impact of asthma therapy in children with coexisting bronchiectasis and asthma.
Main Methods:
- Review of existing epidemiological data and clinical observations.
- Analysis of pathophysiological mechanisms including inflammation, mucus production, and airway obstruction.
- Discussion of current treatment approaches, including antibiotic use and public health interventions.
Main Results:
- Childhood bronchiectasis is more common in lower socioeconomic groups and developing countries.
- Recurrent respiratory infections, environmental irritants, poor immunization, and malnutrition are presumed contributing factors.
- The coexistence of asthma is associated with more severe disease, but its treatment impact is unstudied.
Conclusions:
- Better global epidemiologic data is required to understand childhood bronchiectasis.
- The underlying causes for disease development in susceptible children remain unclear.
- Public health measures focusing on living conditions and infection prevention, such as antiviral vaccines, may offer greater future impact than current medical treatments.
Abstract:
More than a decade ago, bronchiectasis unrelated to cystic fibrosis was termed an "orphan disease", because it had become an uncommon clinical entity among children in the developed world. Bronchiectasis is more common among children in lower socioeconomic classes and in developing countries, presumably due to more frequent and recurrent respiratory infections, environmental airway irritants, poor immunization rates, and malnutrition. Reports from the Southern Pacific and from Alaska Native children reveal persistently high rates of childhood bronchiectasis. Better epidemiologic data throughout the world are needed to reassess the importance of this condition. The pathophysiology includes airway inflammation, mucus production, and regional airway obstruction, yet the reasons why some children develop bronchiectasis while other do not is unclear. The coexistence of asthma with bronchiectasis is associated with more severe disease, yet the impact of asthma therapy in children with both disorders has not been studied. Similarly, the pattern of antibiotic use for children with bronchiectasis varies by region with little data to justify one particular approach. It may be that public health measures aimed at improving living conditions for children and prevention of respiratory infections with antiviral vaccines will have more impact on childhood bronchiectasis than medical treatments in the future.