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Health-resource use and quality of life in children with bronchiectasis: a multi-center pilot cohort study
Yolanda G Lovie-Toon1, Keith Grimwood2,3, Catherine A Byrnes4,5
1Institute of Health & Biomedical Innovation @ Centre for Children's Health Research, Queensland University of Technology, 62 Graham Street, South Brisbane, Queensland, 4101, Australia. y.lovietoon@qut.edu.au.
Insights
Pediatric bronchiectasis significantly impacts children's quality of life and incurs high healthcare costs. This study highlights the substantial health resource use associated with this under-researched chronic lung disease in children.
Area of Science:
- Pediatric Pulmonology
- Chronic Respiratory Diseases
- Health Services Research
Background:
- Bronchiectasis in children is an under-researched chronic pulmonary disorder.
- It negatively impacts health-related quality of life, often overlooked compared to cystic fibrosis.
- This study quantifies health resource use and quality of life in pediatric bronchiectasis.
Purpose of the Study:
- To measure health resource utilization in children with bronchiectasis over a 12-month period.
- To assess the health-related quality of life in this pediatric cohort.
- To identify factors associated with disease burden in pediatric bronchiectasis.
Main Methods:
- Prospective cohort study of 85 children (<18 years) with CT-confirmed bronchiectasis.
- Data collected: healthcare attendances, medication use, parent/carer work and child school/childcare absences, quality of life, and cough severity.
- Exclusions: cystic fibrosis and cancer treatment.
Main Results:
- High rates of exacerbations (3.3/child-year), hospitalizations (11.4%), healthcare attendance, and antibiotic use.
- Significant parental work and child school/childcare absences were recorded.
- Child and parent/carer quality of life scores were correlated and negatively associated with cough severity.
Conclusions:
- Children with bronchiectasis experience high health resource use, indicating a severe disease burden.
- Further research is needed to determine direct and societal costs.
- Interventions to reduce disease burden, especially hospitalizations, require evaluation.
Background:
Bronchiectasis in children is an important, but under-researched, chronic pulmonary disorder that has negative impacts on health-related quality of life. Despite this, it does not receive the same attention as other chronic pulmonary conditions in children such as cystic fibrosis. We measured health resource use and health-related quality of life over a 12-month period in children with bronchiectasis.
Methods:
We undertook a prospective cohort study of 85 children aged < 18-years with high-resolution chest computed-tomography confirmed bronchiectasis undergoing management in three pediatric respiratory medical clinics in Darwin and Brisbane, Australia and Auckland, New Zealand. Children with cystic fibrosis or receiving cancer treatment were excluded. Data collected included the frequency of healthcare attendances (general practice, specialists, hospital and/or emergency departments, and other), medication use, work and school/childcare absences for parents/carers and children respectively, and both parent/carer and child reported quality of life and cough severity.
Results:
Overall, 951 child-months of observation were completed for 85 children (median age 8.7-years, interquartile range 5.4-11.3). The mean (standard deviation) number of exacerbations was 3.3 (2.2) per child-year. Thirty of 264 (11.4%) exacerbation episodes required hospitalization. Healthcare attendance and antibiotic use rates were high (30 and 50 per 100 child-months of observation respectively). A carer took leave from work for 53/236 (22.5%) routine clinic visits. Absences from school/childcare due to bronchiectasis were 24.9 children per 100 child-months. Quality of life scores for both the parent/carer and child were highly-correlated with one another, remained stable over time and were negatively associated with cough severity.
Conclusions:
Health resource use in this cohort of children is high, reflecting their severe disease burden. Studies are now needed to quantify the direct and societal costs of disease and to evaluate interventions that may reduce disease burden, particularly hospitalizations.
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