Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Level 5a, 501 Stanley St, Brisbane, QLD, 4101, Australia.
Centre for Children's Health Research, QLD, Queensland University of Technology, Brisbane, Australia.
Lung. 2020 Apr;198(2):361-369. doi: 10.1007/s00408-020-00332-7. Epub 2020 Feb 20.
Indigenous Respiratory Outreach Care (IROC) is a culturally appropriate specialist respiratory service established to deliver multidisciplinary respiratory care to regional and remote Queensland communities. Our objective was to evaluate the impact of an outreach specialist respiratory service on the spirometry of children attending IROC clinics, particularly Indigenous children with asthma and bronchiectasis.
Retrospective single-arm cohort study of 189 children who performed spirometry at twelve sites across regional and remote Queensland between October 2010 and December 2017. Each child's baseline spirometry was compared to their best spirometry at follow-up visit occurring within (1) 12 months of their most recent visit with at least 12 months of specialist care and; (2) each year of their first 3 years of care.
Forced expiratory volume in one second (FEV) and forced vital capacity (FVC) z-scores improved significantly across the whole group from baseline to follow-up (change in z-scores (Δz) of FEV = 0.38, 95% CI 0.22, 0.53; ΔzFVC = 0.36, 95% CI 0.21, 0.51). In subgroup analyses, lung function significantly improved in Indigenous children (n = 141, ΔzFEV = 0.37, 95% CI 0.17, 0.57; ΔzFVC = 0.36, 95% CI 0.17, 0.55) including those with asthma (n = 117, ΔzFEV = 0.41, 95% CI 0.19, 0.64; ΔzFVC = 0.46, 95% CI 0.24, 0.68) and bronchiectasis (n = 38, ΔzFEV = 0.33, 95% CI 0.07, 0.59; ΔzFVC = 0.26, 95% CI - 0.03, 0.53). Significant improvements in FEV and FVC were observed within the first and second year of follow-up for Indigenous children, but not for non-Indigenous children.
The IROC model of care in regional and remote settings leads to significant lung function improvement in Indigenous children with asthma and bronchiectasis.
原住民呼吸外展护理（IROC）是一项文化适宜的专科呼吸服务，旨在为昆士兰州偏远地区的社区提供多学科呼吸护理。我们的目的是评估外展专科呼吸服务对参加 IROC 诊所的儿童（尤其是患有哮喘和支气管扩张症的原住民儿童）的肺功能的影响。
对 2010 年 10 月至 2017 年 12 月期间在昆士兰州偏远地区的 12 个地点进行肺功能检测的 189 名儿童进行回顾性单臂队列研究。将每位儿童的基础肺功能与随访时（1）距离最近就诊后 12 个月内且接受至少 12 个月专科护理，（2）前 3 年中每年的最佳肺功能进行比较。
在整个研究组中，用力呼气量（FEV）和用力肺活量（FVC）z 评分从基线到随访均显著提高（FEV 的 z 评分变化（Δz）为 0.38，95%CI 0.22，0.53；FVC 的Δz 为 0.36，95%CI 0.21，0.51）。在亚组分析中，原住民儿童（n=141）的肺功能明显改善（ΔzFEV 为 0.37，95%CI 0.17，0.57；ΔzFVC 为 0.36，95%CI 0.17，0.55），包括哮喘儿童（n=117）（ΔzFEV 为 0.41，95%CI 0.19，0.64；ΔzFVC 为 0.46，95%CI 0.24，0.68）和支气管扩张症儿童（n=38）（ΔzFEV 为 0.33，95%CI 0.07，0.59；ΔzFVC 为 0.26，95%CI-0.03，0.53）。在原住民儿童中，FEV 和 FVC 在随访的第一年和第二年都有显著改善，但在非原住民儿童中则没有。
在偏远地区，IROC 护理模式可显著改善患有哮喘和支气管扩张症的原住民儿童的肺功能。
