Bronchiectasis in African children: Challenges and barriers to care

Bronchiectasis (BE) is a chronic condition affecting the bronchial tree. It is characterized by the dilatation of large and medium-sized airways, secondary to damage of the underlying bronchial wall structural elements and accompanied by the clinical picture of recurrent or persistent cough. Despite an increased awareness of childhood BE, there is still a paucity of data on the epidemiology, pathophysiological phenotypes, diagnosis, management, and outcomes in Africa where the prevalence is mostly unmeasured, and likely to be higher than high-income countries. Diagnostic pathways and management principles have largely been extrapolated from approaches in adults and children in high-income countries or from data in children with cystic fibrosis. Here we provide an overview of pediatric BE in Africa, highlighting risk factors, diagnostic and management challenges, need for a global approach to addressing key research gaps, and recommendations for practitioners working in Africa.

Bronchiectasis (BE) is a chronic condition affecting the bronchial tree, characterized by the dilatation of large and medium-sized airways secondary to damage of the underlying bronchial wall structural elements (1). The European Respiratory Society (ERS) defines childhood BE as “an umbrella term for a clinical syndrome of recurrent or persistent wet/productive cough, airway infection and inflammation, and abnormal bronchial dilatation on chest computed tomography (CT) scans” (2). The condition is therefore an end-point of chronic inflammation from severe or recurrent insults, and an important cause of respiratory disease in children (3). Despite an increased awareness of childhood BE, there is still a paucity of data on the epidemiology, pathophysiological phenotypes, diagnosis, management, and outcomes in Africa where disease burden is likely to be higher than in high-income (HIC) settings. Although over 50% of the world's children live on the African continent, where infectious risk factors for BE are common, there is a gross paucity of relevant data from this region to inform prevention and management practices. Diagnostic pathways and management principles have largely been extrapolated from approaches in adults and children in HIC or from literature on cystic fibrosis (CF). This commentary provides an overview of pediatric BE in Africa, highlighting risk factors for BE, diagnostic and management challenges, the need for a global approach addressing key research gaps, and recommendations for practitioners working in Africa.