Not just a cough: Wet cough research prompts significant change in clinical and community practice

Results from a world first-study measuring prevalence of chronic wet cough and protracted bacterial bronchitis in four Kimberley Aboriginal communities have highlighted the enormity of the health problem – leading to a change in the way clinicians and families treat this issue.

The Kids Research Institute Australia and Perth Children’s Hospital clinician-researchers André Schultz and Pam Laird have been trekking between Perth and the Kimberley region several times a year for 11 years now.

Initially simply running regular respiratory clinics in conjunction with local health services – during which they would see dozens of babies and children with a range of respiratory complaints – they grew concerned at the number of cases they were seeing of bronchiectasis, permanent scarring of the lung. This scarring can often be prevented if chronic wet cough is detected in a timely way and correctly managed by doctors.

A few years ago – determined to better understand the extent of the problem and how it might be feeding into debilitating long-term lung conditions for young Aboriginal people – Dr Schultz, a respiratory paediatrician with PCH and researcher with The Kids, and Ms Laird, a respiratory physiotherapist at PCH and The Kids researcher, commenced a series of research projects in parallel with their clinical visits.

Their findings – and subsequent collaboration with local communities to raise awareness of the problem – have transformed health care in the Kimberley.

In the first study to examine prevalence of chronic wet cough and protracted bacterial bronchitis (PBB) in WA children, Dr Schultz and Ms Laird reviewed 94 per cent of all children under seven across four Kimberly communities – 203 children in total – and found 13 per cent had chronic wet cough, while 10 per cent had PBB. They were able to demonstrate a high degree of accuracy and precision, knowing the numbers they captured would be critical to driving the work that needed to be done.

“The figures we were able to demonstrate are concerningly high – much higher than most people would have expected,” Dr Schultz said.

PBB is a low-grade bacterial infection of the mucus in the lower airways or lungs that is typically characterised by a chronic wet cough, and can lead to progressive, irreversible, and life-shortening lung disease.

“If a child has a wet cough that lasts more than four weeks, there’s a high chance that child has PBB,” Dr Schultz said.

“It doesn’t always make the child very sick overall, so they may look healthy while having a wet cough, but if you leave it, it eats away at the inside of the lungs and the airways become wider and wider and can eventually end up with big holes in them. By this point, the damage is irreversible.”

The results of the paper, published in the European Respiratory Journal, highlighted the need for culturally secure information and education to inform Aboriginal families and their health practitioners of the importance of chronic wet cough in children.

Dr Schultz and Ms Laird began working with Kimberley communities and Aboriginal health services to raise awareness and develop a culturally secure community campaign that was put into place in several WA Aboriginal communities.

The campaign featured West Coast Eagles player and Balgo local Francis Watson and was hugely successful, with the rate of parents seeking help for children with chronic wet cough almost tripling. Clinicians in the area began managing chronic wet cough according to national guidelines, and local children were getting their wet cough treated.

“Working with local people, the Kimberley Aboriginal Medical Services and the Broome Regional  Aboriginal Medical Service ensured that the campaign was relevant to community,” Ms Laird said. “During our analysis of the campaign (results of which are to be published soon), families said they could relate to the posters, Facebook page and video, because they featured Francis with local children and the messaging was direct and clear.”

The team also developed the state’s first teaching modules for medical staff to provide culturally secure management of PBB and chronic lung disease in Aboriginal children.

If chronic wet cough is identified and treated early, disease progression can be halted.

“We’ve found wet cough has become normalised, partly because it’s so common in this area,” Dr Schultz said. “It’s relatively easy to pick it up early, manage it correctly, and stop PBB from progressing to an irreversible, permanent condition. When the children we saw got into clinic and got the right treatment, they got better – and some of them had been coughing for almost a year.”

What's next?

• The researchers have completed their formal evaluation of the wet cough campaign and its impact on practitioners and communities and results will be published in the coming months.
• Dr Schultz has received $1.43 million in NHMRC funding to work with collaborators in the Northern Territory and Queensland to prevent permanent disease in children with chronic wet cough.
• Kimberley communities have now invited the respiratory team to return to the area to screen school-aged children, and they are commencing plans for broadening to other health areas.