A clinical approach to chronic respiratory disorders in Aboriginal and Torres Strait Islander Australians in primary care

BACKGROUND: Chronic respiratory disorders in the adult Aboriginal and Torres Strait Islander population are common, but there is a sparsity of literature detailing an approach to clinical management. OBJECTIVE: This paper describes a clinical approach to chronic respiratory disorders for clinicians working with Aboriginal and Torres Strait Islander people, particularly in the remote Australian context. DISCUSSION: There are significant differences in the way chronic respiratory diseases manifest in Aboriginal and Torres Strait Islander people compared with non-Indigenous Australians. Chronic obstructive pulmonary disease (COPD), bronchiectasis and asthma often overlap in clinical features, and can be present concurrently. Restrictive impairment on spirometry is common. The presence of bronchodilator response might indicate asthma, but can also be observed in patients with asthma/COPD/bronchiectasis overlap. Because the management of each of these conditions differs, accurate diagnosis and disease severity classification are important, particularly in the prescribing of guideline-recommended inhaled pharmacotherapy.