MULTICENTRE BRONCHIECTASIS STUDY: A collaborative and international study of bronchiectasis in Indigenous children.

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Aboriginal children have repeated pneumonia episodes; some get better while others develop bronchiectasis (a chronic lung disease). The risk factors associated with progression to bronchiectasis, and the natural history of bronchiectasis in this population is little known. Given the similarities of these diseases among indigenous populations of affluent countries and to increase study size, a collaborative and international study of Indigenous children (Aboriginal and Torres Strait Islander, New Zealand Maori or Pacific Islander and Alaskan Native) has been initiated. In Indigenous children, we aim to define the natural history of chronic moist cough (those at risk of developing bronchiectasis) and bronchiectasis, identify the risk factors associated with progression from early-mild disease (chronic moist cough) to bronchiectasis and to define the role of continuous antibiotic treatment in the prevention of recurrent pulmonary infections that are very common in these children. We plan to follow up Aboriginal children aged 12 months to 8 years diagnosed with bronchiectasis or chronic moist cough. For those diagnosed with bronchiectasis, after fully informed consent is obtained from the parent(s), the child will be allocated by chance to one of the 2 treatment regimes: (1) Azithromycin once-week or (2) placebo once-week. Children will receive the medication or the placebo for a period of 24 months. All these children will be clinically seen 2x-year by the study's paediatrician and 2x-year by the research nurse for the duration of the study. By documenting, for the first time, the epidemiology and natural history of children with chronic moist cough and bronchiectasis, the study will provide a much-needed rationale for their management. If we can scientifically show that this is true, that Azithromycin is effective in reducing the number of respiratory infections, this would be an achievable advance in the treatment in the field for these children.