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Adult outcomes of childhood bronchiectasis
Dawn Sibanda1,2, Rosalyn Singleton1, John Clark3
1Research Department, Yukon Kuskokwim Health Corporation, Bethel, AK, USA.
Insights
Childhood bronchiectasis can lead to significant adult respiratory issues and developmental challenges. Improving care transitions and provider education is crucial for better long-term outcomes in these patients.
Area of Science:
- Pulmonology
- Pediatric Medicine
- Public Health
Background:
- Childhood bronchiectasis is a significant cause of respiratory morbidity, particularly in low-income and indigenous populations.
- Limited data exists on the long-term adult outcomes for individuals with childhood-onset bronchiectasis.
- Effective transition from pediatric to adult healthcare is critical for managing chronic conditions.
Purpose of the Study:
- To investigate the adult outcomes of individuals diagnosed with bronchiectasis in childhood.
- To identify factors contributing to morbidity in adults with a history of childhood bronchiectasis.
- To highlight the need for improved transition of care and adult provider education.
Main Methods:
- Retrospective review of the clinical course of 31 Alaska Native adults (aged 20-40) with childhood bronchiectasis.
- Data collection included diagnostic methods (CT, bronchogram, radiographs), healthcare utilization (ambulatory visits, hospitalizations), and adult health status.
- Analysis of developmental, mental health, and pulmonary outcomes in adulthood.
Main Results:
- Bronchiectasis was diagnosed in childhood at a median age of 4.5 years.
- Adult patients experienced significant respiratory morbidity (13% severe impairment, 54% persistent symptoms) and developmental/mental health issues (19% childhood delay, 29% adult mental illness/handicap).
- Only 5 adults were seen by pulmonologists, with poor documentation of their bronchiectasis diagnosis, indicating a care gap.
Conclusions:
- Childhood bronchiectasis is associated with substantial long-term respiratory and developmental morbidity into adulthood.
- Lack of provider continuity, geographic isolation, and comorbidities exacerbate adult health issues.
- Enhancing adolescent-to-adult care transition and educating adult healthcare providers are essential for improving outcomes.
Abstract:
Recent literature has highlighted the importance of transition from paediatric to adult care for children with chronic conditions. Non-cystic fibrosis bronchiectasis is an important cause of respiratory morbidity in low-income countries and in indigenous children from affluent countries; however, there is little information about adult outcomes of childhood bronchiectasis. We reviewed the clinical course of 31 Alaska Native adults 20-40 years of age from Alaska's Yukon Kuskokwim Delta with childhood bronchiectasis. In patients with chronic suppurative lung disease, a diagnosis of bronchiectasis was made at a median age of 4.5 years by computerised tomography (68%), bronchogram (26%), and radiographs (6%). The patients had a median of 75 lifetime respiratory ambulatory visits and 4.5 hospitalisations. As children, 6 (19%) experienced developmental delay; as adults 9 (29%) experienced mental illness or handicap. Four (13%) patients were deceased, four (13%) had severe pulmonary impairment in adulthood, 17 (54%) had persistent or intermittent respiratory symptoms, and seven (23%) were asymptomatic. In adulthood, only five were seen by adult pulmonologists and most had no documentation of a bronchiectasis diagnosis. Lack of provider continuity, remote location and co-morbidities can contribute to increased adult morbidity. Improving the transition to adult care starting in adolescence and educating adult providers may improve care of adults with childhood bronchiectasis.
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