A wet cough for four weeks means it’s time to get it checked out



Lung disease can often be prevented with culturally appropriate health care and information.
Pamela Larid

Pamela Laird, Telethon Kids Institute and Andre Schultz, Telethon Kids Institute

As respiratory clinicians, we have been conducting outreach clinics to the Kimberley, in northern Western Australia, for about ten years, treating children with bronchiectasis, a chronic lung disease in which the breathing tubes in the lungs are damaged.

If left untreated, bronchiectasis can eat away at the lungs and cause devastating long-term effects.

Our research, published today in the journal Respirology, shows how Aboriginal health providers, visiting clinicians, and Aboriginal families can work together to detect illness that may lead to bronchiectasis as symptoms first appear, using local language, stories, and resources.

These resources, including an animated video, highlight that chronic wet cough, in the absence of any other symptom or sign, can be the earliest and often only warning sign of lung disease.

Let’s kick this wet cough.

Why early detection is key

A persistent, low-grade wet cough is often a sign of mucus in the airway that has become infected. Over time, this mucus begins to destroy the lung tissue.


Joshya/Shutterstock

Limiting the extent of lung damage is predicated on timely recognition and management of the chronic wet cough. Treatment may include antibiotics and chest physiotherapy.

If left untreated, the disease can progress and result in a lot of coughing, feeling breathless, losing sleep, feeling worried and helpless, and, eventually, early death.

In Australia, lung infections are the most common reason Aboriginal children are hospitalised. Young Aboriginal children in WA are up to 13 times more likely to be admitted for lung infections than non-Aboriginal children.

More than a quarter of young Aboriginal children admitted with lung infections will go on to develop potentially life-shortening chronic lung disease.

Lung disease is a major contributor to the gap in life expectancy between Indigenous and other Australians. Indigenous Australians hospitalised with bronchiectasis die, on average, 24 years earlier than non-Indigenous Australians with the condition.




Read more:
How Australians Die: cause #4 – chronic lower respiratory diseases


Understanding the delay

Each quarter, Perth Children’s Hospital sends a multidisciplinary team to see about 30 children, mostly Aboriginal, who have been referred for specialist care by doctors from across the vast Kimberley region.

We have witnessed the consequences of lung disease being diagnosed too late. We once treated an adolescent Aboriginal boy with end-stage bronchiectasis. He was so sick that he was unable to walk or lie flat. His lung function was less than 25%, well below the threshold for lung transplantation.

This boy was dying from an illness that could have been halted or reversed had someone treated him effectively before his disease had progressed this far. A note in his medical record stated: “Lost to the system.”




Read more:
Words from Arnhem land: Aboriginal health messages need to be made with us rather than for us


In our clinics, we noticed a high prevalence of Aboriginal children with lung disease who were seen too late, when preventable lung damage was already permanent.

We found we were not always eliciting accurate histories from families. Specifically, when we asked engaged parents if their children had a wet cough, the parents would say “no” when, in fact, the children did have a wet cough.

Accurate medical history taking is crucial to providing good medical care, as is the provision of culturally appropriate care. But we realised a barrier was preventing us from communicating effectively with families, and preventing those families seeking timely medical care for their children.

From mucus to goonbee

We addressed the issues through partnerships with Aboriginal families, researchers, Aboriginal health providers, and government. We identified the barriers and enablers for both families and clinicians to recognise and manage early lung disease and stop it progressing to serious life-limiting illness.

We interviewed 77 Aboriginal families and clinicians in the Kimberley, and discovered that families had never heard that a daily wet cough for more than four weeks could indicate serious infection.

Coughing was so prevalent among Aboriginal children that symptoms were being normalised.

When families were given culturally appropriate health information, they sought medical help. Parents also gave an accurate history about the presence of wet cough once they better understood the topic.

This child, accompanied by her siblings and mother, undergoes chest physiotherapy as part of her daily routine to combat chronic lung disease.
Pamela Laird

Culturally appropriate information included use of local language terms – such as goonbee for mucus in Yawuru language – and use of stories or images that families could relate to.

Clinicians can liken the lungs to an upside-down tree, for instance, where the tree trunk is the windpipe, the branches are the breathing tubes, and the leaves are the air sacs where oxygen is transferred to the blood.

We also developed culturally relevant educational resources for clinicians and families, including an animated film and an information flip chart.

Through collaboration, mutual respect, and knowledge translation in our clinics, we are now witnessing little lungs growing stronger, Aboriginal families empowered with knowledge and advocating for their children, and clinicians skilled to provide culturally informed care to children. These observations are being supported by research soon to be published.

By engaging and working together, we will find sustainable solutions to kick chronic wet cough and help prevent Aboriginal children with sick lungs from flying beneath the radar.




Read more:
‘Have you been feeling your spirit was sad?’ Culture is key when assessing Indigenous Australians’ mental health


The Conversation


Pamela Laird, Senior Respiratory Physiotherapsit & Researcher, Telethon Kids Institute and Andre Schultz, Paediatric Respiratory Physician and Research Fellow, Telethon Kids Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Australia: Sydney – Harris Park Station Landslip


Wet weather has continued to dominate coastal NSW into the first day of July 2013. June 2013 was incredibly wet and the latest wet weather event has led to a massive landslip in Sydney at the Harris Park Railway Station. The link below is to an article reporting on the slip.

For more visit:
http://www.smh.com.au/environment/weather/passengers-warned-to-expect-delays-after-train-station-wall-collapses-20130630-2p533.html

BUSHFIRE SEASON HAS STARTED


The bushfire season is off and running in New South Wales, Australia. There have already been several fires in my region of the Mid North Coast.

On Saturday there was a fire just south of Bulahdelah that closed the Pacific Highway for two hours. From what I understand the fire is thought to have begun by a discarded cigarette thrown from a car travelling on the highway.

The fire started at about 3.30 pm and as the fire intensified cars were seen travelling on the wrong side of the highway in a bid to keep clear of the fire. With the thick smoke about this was not the best move to make.

Another fire was burning off the highway near the Karuah Bridge on Monday, again producing thick smoke.

With the massive amount of growth in the bush over the last couple of wet growth seasons, the fuel load is now massive and fuel reduction burns have been limited. With temperatures already peaking in the low thirties (Celsius), the season ahead looks grim.

THE HEAT IS ON … Spring has Arrived


It was only a very short while ago that my region of New South Wales (in Australia – Bulahdelah to Tea Gardens) was in the grip of its coldest winter in many years. In fact last weekend the region was in the middle of an east coast low that brought cold temperatures, torrential rain and gale force winds, resulting in flooding around the lower areas of Bulahdelah, as well as some wind damage with fallen trees, etc. Exactly a week on and the surrounding rivers are still to return to their pre-flood levels, yet we are basking in summer-like conditions, with the temperature today expected to be in the high 20s or even perhaps 30 degrees Celsius. Last week the temperature was in the low to mid teens.

What a strange time spring is with such fluctuating weather conditions. The rain is expected to return tomorrow, however, this will be on the back of the season’s first thunderstorms if the predictions turn out to be true. Certainly the ‘feel’ today is that thunderstorms arriving this afternoon would be the expectation.

With the arrival of spring comes the expectation of bushfires in the near future. Last season we had a fairly negligible bushfire season, with plenty of wet weather. However, the drought has continued to bite across most of south-eastern Australia and conditions are right for a particularly bad bushfire season, with massive loads of material just waiting to be burnt in the Australian bush. Coastal regions have had plenty of rain, but not too far inland the country remains gripped by drought and perilously low water supplies.

For now though, we are welcoming the arrival of spring and the retreat of what has been the coldest winter for many years.