Selective use of long-term antibiotics for chronic lung obstructive disease in Aboriginal adults: A multi-centre trial

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Indigenous Australians suffer from well-documented health disadvantage. This is demonstrated particularly for chronic obstructive lung disease (COPD-COAD). In remote communities nearly 15% of Aboriginal Australians suffer from COPD. This is reflected in death rates that show Aboriginal Australians as 6 times more likely to die from COPD and to be hospitalised much more frequently for this condition. Treatment options for COPD once it is established are however limited. Although smoking is a well recognised cause of COPD it is becoming clear that in Aboriginal Australians additional factors are likely to be important. Aboriginal Australians have higher rates of bacterial respiratory infections compared non-Indigenous Australians and it is likely that this is an important preventable factor in the establishment and progression of COPD. The aim of this study is thus to determine if the judicious use of regular antibiotics will be effective in treating Aboriginal adults with COPD. Particularly we aim to determine if this treatment can prevent acute exacerbations, which are associated with hospitalisation and death, and reduce inflammation in the airways, which is associated with continuing damage to the lungs and progressive disability. The involvement of 4 Aboriginal communities in this well-designed clinical trial is an important advance in the methods used to evaluate interventions in Aboriginal health. The project will also provide local training and equipment to improve the assessment and management of respiratory disease in remote Aboriginal communities. Finally the results of this study will be directly relevant to evidence-based guidelines that are currently utilised for the management of COPD in Aboriginal and Torres Strait Islander populations.