Health-resource use and quality of life in children with bronchiectasis: a multi-center pilot cohort study

Yolanda G Lovie-Toon, Keith Grimwood, Catherine A Byrnes, Vikas Goyal, Greta Busch, I Brent Masters, Julie M Marchant, Helen Buntain, Kerry-Ann F O'Grady, Anne B Chang, Yolanda G Lovie-Toon, Keith Grimwood, Catherine A Byrnes, Vikas Goyal, Greta Busch, I Brent Masters, Julie M Marchant, Helen Buntain, Kerry-Ann F O'Grady, Anne B Chang

Abstract

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.

Keywords: Bronchiectasis; Children; Health resource use; Health-related quality of life.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Goyal V, Grimwood K, Marchant J, Masters IB, Chang AB. Pediatric bronchiectasis: no longer an orphan disease. Pediatr Pulmonol. 2016;51(5):450–469. doi: 10.1002/ppul.23380.
    1. McCallum GB, Binks MJ. The epidemiology of chronic suppurative lung disease and bronchiectasis in children and adolescents. Front Pediatr. 2017;5:27.
    1. Chandrasekaran R, Mac Aogáin M, Chalmers JD, Elborn SJ, Chotirmall SH. Geographic variation in the aetiology, epidemiology and microbiology of bronchiectasis. BMC Pulm Med. 2018;18(1):83. doi: 10.1186/s12890-018-0638-0.
    1. Nathan AM, de Bruyne JA, Eg KP, Thavagnanam S. Quality of life in children with non-cystic fibrosis bronchiectasis. Front Pediatr. 2017;5:84. doi: 10.3389/fped.2017.00084.
    1. Schmets G, Rajan D, Kadandale S. Strategizing national health in the 21st century: a handbook. Geneva: WHO; 2016.
    1. Aliberti S, Masefield S, Polverino E, et al. Research priorities in bronchiectasis: a consensus statement from the EMBARC clinical research collaboration. Eur Respir J. 2016;48(3):632–647. doi: 10.1183/13993003.01888-2015.
    1. Kapur N, Masters IB, Newcombe P, Chang AB. The burden of disease in pediatric non-cystic fibrosis bronchiectasis. Chest. 2012;141(4):1018–1024. doi: 10.1378/chest.11-0679.
    1. Bibby S, Milne R, Beasley R. Hospital admissions for non-cystic fibrosis bronchiectasis in New Zealand. N Z Med J. 2015;128(1421):30–38.
    1. Goyal V, Grimwood K, Byrnes CA, et al. Amoxicillin–clavulanate versus azithromycin for respiratory exacerbations in children with bronchiectasis (BEST-2): a multicentre, double-blind, non-inferiority, randomised controlled trial. Lancet. 2018;392(10154):1197–1206. doi: 10.1016/S0140-6736(18)31723-9.
    1. Kapur N, Masters IB, Morris PS, Galligan J, Ware R, Chang AB. Defining pulmonary exacerbation in children with non-cystic fibrosis bronchiectasis. Pediatr Pulmonol. 2012;47(1):68–75. doi: 10.1002/ppul.21518.
    1. Valery PC, Morris PS, Byrnes CA, et al. Long-term azithromycin for indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease (bronchiectasis intervention study): a multicentre, double-blind, randomised controlled trial. Lancet Respir Med. 2013;1(8):610–620. doi: 10.1016/S2213-2600(13)70185-1.
    1. Newcombe PA, Sheffield JK, Juniper EF, Petsky HL, Willis C, Chang AB. Validation of a parent-proxy quality of life questionnaire for paediatric chronic cough (PC-QOL) Thorax. 2010;65(9):819–823. doi: 10.1136/thx.2009.133868.
    1. Newcombe PA, Sheffield JK, Petsky HL, Marchant JM, Willis C, Chang AB. A child chronic cough-specific quality of life measure: development and validation. Thorax. 2016;71(8):695–700. doi: 10.1136/thoraxjnl-2015-207473.
    1. Chang A, Newman R, Carlin J, Phelan P, Robertson C. Subjective scoring of cough in children: parent-completed vs child-completed diary cards vs an objective method. Eur Respir J. 1998;11(2):462–466. doi: 10.1183/09031936.98.11020462.
    1. Redding GJ, Singleton RJ, Valery PC, et al. Respiratory exacerbations in indigenous children from two countries with non-cystic fibrosis chronic suppurative lung disease/bronchiectasis. Chest. 2014;146(3):762–774. doi: 10.1378/chest.14-0126.
    1. Bayram C, Harrison C, Charles J, Britt H. 'The kids are alright'-Changes in GP consultations with children 2000–15. Aust Fam Physician. 2015;44(12):877.
    1. Hall KK, Chang AB, Anderson J, Arnold D, Otim M, O’grady KF. Health service utilisation amongst urban aboriginal and Torres Strait islander children aged younger than 5 years registered with a primary health-care service in south-East Queensland. J Paediatr Child Health. 2018;54(6):671–676. doi: 10.1111/jpc.13812.
    1. Lovie-Toon YG, McPhail SM, Au-Yeung YT, et al. The cost of acute respiratory infections with cough among urban Aboriginal and Torres Strait Islander children. Front Pediatr. 2018;6:379.
    1. Gadzhanova S, Roughead E. Prescribed antibiotic use in Australian children aged 0-12 years. Aust Fam Physician. 2016;45(3):134.
    1. Hobbs MR, Grant CC, Ritchie SR, et al. Antibiotic consumption by New Zealand children: exposure is near universal by the age of 5 years. J Antimicrob Chemother. 2017;72(6):1832–1840. doi: 10.1093/jac/dkx060.
    1. Yan J, Hawes L, Turner L, Mazza D, Pearce C, Buttery J. Antimicrobial prescribing for children in primary care. J Paediatr Child Health. 2019;55(1):54–58. doi: 10.1111/jpc.14105.
    1. Kinghorn B, Singleton R, McCallum GB, et al. Clinical course of chronic suppurative lung disease and bronchiectasis in Alaska native children. Pediatr Pulmonol. 2018;53(12):1662–1669. doi: 10.1002/ppul.24174.
    1. Milton B, Whitehead M, Holland P, Hamilton V. The social and economic consequences of childhood asthma across the lifecourse: a systematic review. Child Care Health Dev. 2004;30(6):711–728. doi: 10.1111/j.1365-2214.2004.00486.x.
    1. Black LI, Zablotsky B. Chronic School Absenteeism among Children with Selected Developmental Disabilities: National Health Interview Survey, 2014–2016. National Health Statistics Reports; no 118. Hyattsville: National Center for Health Statistics; 2018.
    1. Lum A, Wakefield C, Donnan B, Burns M, Fardell J, Marshall G. Understanding the school experiences of children and adolescents with serious chronic illness: a systematic meta-review. Child Care Health Dev. 2017;43(5):645–662. doi: 10.1111/cch.12475.
    1. Paranjothy S, Dunstan F, Watkins WJ, et al. Gestational age, birth weight, and risk of respiratory hospital admission in childhood. Pediatrics. 2013;132(6):E1562–E15E9. doi: 10.1542/peds.2013-1737.
    1. Satırer O, Yesil AM, Emiralioglu N, et al. A review of the etiology and clinical presentation of non-cystic fibrosis bronchiectasis: a tertiary care experience. Respir Med. 2018;137:35–39. doi: 10.1016/j.rmed.2018.02.013.
    1. Brower KS, Del Vecchio MT, Aronoff SC. The etiologies of non-CF bronchiectasis in childhood: a systematic review of 989 subjects. BMC Pediatr. 2014;14(1):299. doi: 10.1186/s12887-014-0299-y.
    1. Jepsen N, Charania NA, Mooney S. Health care experiences of mothers of children with bronchiectasis in Counties Manukau, Auckland, New Zealand. BMC Health Serv Res. 2018;18(1):722. doi: 10.1186/s12913-018-3532-9.
    1. Chang AB, Bush A, Grimwood K. Bronchiectasis in children: diagnosis and treatment. Lancet. 2018;392(10150):866–879. doi: 10.1016/S0140-6736(18)31554-X.
    1. Schmit KM, Coeytaux RR, Goode AP, et al. Evaluating cough assessment tools: a systematic review. Chest. 2013;144(6):1819–1826. doi: 10.1378/chest.13-0310.
    1. O’Grady K-AF, Drescher BJ, Goyal V, et al. Chronic cough postacute respiratory illness in children: a cohort study. Arch Dis Child. 2017;102(11):1044–1048. doi: 10.1136/archdischild-2017-312848.
    1. Marchant J, Masters IB, Champion A, Petsky H, Chang AB. Randomised controlled trial of amoxycillin clavulanate in children with chronic wet cough. Thorax. 2012;67(8):689–693. doi: 10.1136/thoraxjnl-2011-201506.
    1. Petsky HL, Acworth JP, Clark R, Thearle DM, Masters IB, Chang AB. Asthma and protracted bronchitis: who fares better during an acute respiratory infection? J Paediatr Child Health. 2009;45(1–2):42–47. doi: 10.1111/j.1440-1754.2008.01433.x.

Source: PubMed

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