Aboriginal lung health and lung function. Graham Hall Telethon Kids Institute and Curtin University

Transcription

1 Aboriginal lung health and lung function Graham Hall Telethon Kids Institute and Curtin University

2 Why Lung function? Lung function underpins clinical respiratory medicine, vital to: diagnosis of lung disease clinical management guidelines Tracking response to treatments Assessing harm Used in health assessment for: Industry (e.g. resources sector) defence forces recreational activity screening

3 Structure of the Lung Courtesy of Prof. Peter Gehr, Institute of Anatomy, Bern

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5 Smoking, asthma and FEV 1 decline James et al AJRCCM 2005

6 Risk factors for adult lung function European Community Respiratory Health Survey adults (20-45 yrs) recruited in followed 9 years later Svanes et al Thorax 2010

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8 Hancox et al Thorax 2009

9 Preterm birth and lung development

10 Lung Function trajectories in preterm children Age (years) P redicted FE V 1 Z sc ore P re d ic te d F E V 1 /F V C Z s co re Age (years) Predicted FEV1 z-score Predicted FEV1/FVC z-score (-0.14, -0.07) * No BPD BPD (-0.11, -0.03)* (-0.14, -0.07)* Simpson ERS 2016

11 Lung growth and development Respiratory outcomes in throughout life influenced by a range of factors in pregnancy, infancy and childhood Maternal health and nutrition Birth size Low lung function Airway hyper-responsiveness

12 Lung health in Aboriginal Australians

13 Lung disease in Aboriginal Australians Lung disease imposes a significant health burden in Aboriginal and Torres Strait Islander Australians Prevalence of lung disease higher in Aboriginal compared to non- Aboriginal Australians Asthma: 16.5% vs. 10.2% COPD: 3.8% vs. 3.0%

14 Chronic disease in Aboriginal Australians The health and welfare of Australia s ATSI people, 2011, AIHW

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16 So what s normal?

17 GLI Global cooperation in action The final GLI results included ~74,000 healthy nonsmokers aged 3-95 years from around the world in order to create the 1 st multi-ethnic all age lung growth charts

18 The GLI 2012 equations Quanjer et al ERJ 2012

19 Ethnic diversity and spirometry Ethnic differences in FEV 1 and FVC (% reductions) when compared to white subjects Males Females FEV 1 FVC FEV 1 /FVC FEV 1 FVC FEV 1 /FVC African American N East Asian S. East Asian Other Quanjer et al ERJ 2012

20 GLI Spirometry a new global benchmark Major step towards providing robust assessments of lung function Internationally endorsed Cover entire life span and different ethnic backgrounds Will assist in standardising the interpretation of lung function results Current activities focus on assisting dissemination and implementation addition of currently under-represented populations New ATS/ERS Task force to collate and define reference equations for gas transfer and lung volumes Find out more at

21 Why is this important? Kirkby et al ERJ 2012

22 Improving Aboriginal lung health Defining lung function in healthy Aboriginal Australians.

23 Aboriginal lung function: What s normal? Bremner AJRCCM 1998

24 Aboriginal lung function: What s normal? Cooksley 2015 Cooksley Respirology 2015

25 Does healthy Aboriginal spirometry match GLI? Review of two WA Aboriginal community studies with matched spirometry and health data (n=756) Health questionnaires screened for Smoking ever, Dr Dx of lung disease ever, recent self-reported recurrent Sx 86 children and adults Average age 23.3 :5.5 to 76.1 years; 42 male FEV1: 2.12 ( )L FEV1/FVC: 86.5 (72-98) %

26 Impact of reference range choice Mean (SD) Z scores 0.06 (0.84) 0.26 (0.83)

27 Impact? Caucasian spirometry reference equations are not appropriate in healthy Aboriginal Australians Compelling evidence that the GLI FEV 1 /FVC data is ethnic independent matches Aboriginal Australians The use of GLI 2012 FEV 1 /FVC offers an interim measure for diagnosis of obstructive lung disease.

28 Impact in real life Case MS Pred_W Pred_B Case SM Pred_W Pred_B Age Sex Male Female Ht: Wt 181 : : 94 Dx ILD incr. SOB CABG work up FEV (56%) 2.39 FVC (64%) 3.26 FEV1/FVC (66%) (76%) (86%) (83%) (99%) (97%) Predicted presented as Z scores (% predicted): Predicted and derived from GLI 2012

29 AIMS Defining lung function in healthy Aboriginal Australians in partnership with AMS Characterise normal lung function in Aboriginal Australians spirometry, gas transfer and static lung volumes. Develop healthy lung function data for Aboriginal Australians PLAN Recruit and assess 750 participants ( ). 50% aged 5-25 and 50% aged > 25 years Aiming to achieve > 500 individuals within final dataset No history of known lung disease or recurrent respiratory symptoms and life time non-smokers.

30 Crystal ball gazing

31 Preventable hospitalisations

32 Preventable health burden Smoking rates in Aboriginal peoples remain high. Tobacco use accounts for over 40% of preventable lung disease in Aboriginal Australians.

33 What do the COPD guidelines recommend? COPD diagnosis requires demonstration of airflow limitation which is not fully reversible Indications for spirometry include: breathlessness; chronic cough; frequent sputum production; relapsing acute infective bronchitis; and risk factors; including smoking, occupational dusts and chemicals, and a strong family history of COPD.

34 Presence & extent of abnormalities - COPD

35 Presence & extent of abnormalities - COPD

36 Can better tests and detect lung damage earlier? Smoking accounts > 40% of lung disease in Aboriginal Australians Improving how and what may enrich information given to smokers Can we use better and/or different lung function tests to identify damage early Spirometry may not be best option, what about other tests? Exhaled CO monitors with fetal CoHb in antenatal smoking cessation? Develop range of culturally appropriate lung health information across spectrum

37 No one type of intervention that will support the reduction of tobacco use in Indigenous communities Programs that include the following most likely to succeed Use a comprehensive approach inclusive of multiple activities Centre Aboriginal leadership Make long term community investments Provide culturally appropriate health materials Minichiello et al BMC Public Health 2016

38 What does the future hold? 0