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

土著儿童反复出现肺炎;有些好转，而另一些则发展为支气管扩张症（一种慢性肺病）。与进展为支气管扩张相关的危险因素，以及该人群中支气管扩张的自然史知之甚少。鉴于这些疾病在富裕国家土著人口中的相似性，并为了扩大研究规模，已经启动了一项关于土著儿童（土著和托雷斯海峡岛民、新西兰毛利人或太平洋岛民和阿拉斯加土著人）的国际合作研究。在土著儿童中，我们的目标是定义慢性潮湿咳嗽（有发生支气管扩张风险的儿童）和支气管扩张的自然史，确定与早期轻度疾病（慢性潮湿咳嗽）进展为支气管扩张相关的风险因素，并确定持续抗生素治疗在预防这些儿童中非常常见的复发性肺部感染中的作用。我们计划对被诊断患有支气管扩张症或慢性潮湿咳嗽的12个月至8岁原住民儿童进行随访。对于诊断为支气管扩张的患者，在获得父母的完全知情同意后，将随机分配至2种治疗方案之一：（1）阿奇霉素每周一次或（2）安慰剂每周一次。儿童将接受为期24个月的药物或安慰剂。在研究期间，所有这些儿童将由研究的儿科医生和研究护士每年进行2次临床观察。通过首次记录慢性湿咳和支气管扩张儿童的流行病学和自然史，该研究将为他们的管理提供急需的理论依据。如果我们能科学地证明这是真的，阿奇霉素能有效地减少呼吸道感染的数量，这将是一个可以实现的进步，在该领域的治疗这些儿童。

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.