Volume 194 - Issue 4
Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand
Author: Anne B Chang
Med J Aust 2011; 194 (4): 213. || doi: 10.5694/j.1326-5377.2011.tb03790.x
Published online: 21 February 2011
Published online: 21 February 2011
In reply: We thank Gillis and Riminton for their comments highlighting the inclusion of IgG subclasses in the list of suggested investigations when reviewing a patient with chronic suppurative lung disease or bronchiectasis.
We agree that a finding of one or more low IgG subclasses in isolation is not an indication for immunoglobulin therapy and that interpretation of serum IgG subclass concentrations is difficult. Indeed, this was debated at length by the position statement authors. However, after considerable discussion, we decided that measurement of IgG subclasses should be included. Although the data are weak, it is an important area of possible aetiology, and there are varying opinions regarding associations with impaired adaptive immunity.1-3 As with some other investigations, an abnormal test result in the context of a child or adult with suppurative lung disease would lead to discussion with an appropriate subspecialist for advice on interpretation and/or further evaluation.
Space limitations in the Journal version of our position statement did not permit us to elaborate further.4 In the full document available online,5 we stated that:
Competing interests
See original article for authors’ competing interests.4
References
- King PT, Hutchinson P, Holmes PW, et al. Assessing immune function in adult bronchiectasis. Clin Exp Immunol 2006; 144: 440-446.
- DeBaets F, Kint J, Pauwels R, Leroy J. IgG subclass deficiency in children with recurrent bronchitis. Eur J Pediatr 1992; 151: 274-278. 0_pgfId-2231406
- Kutukculer N, Karaca NE, Demircioglu O, Aksu G. Increases in serum immunoglobulins to age-related normal levels in children with IgA and/or IgG subclass deficiency. Pediatr Allergy Immunol 2007; 18: 167-173. 0_i1095842
- Chang AB, Bell SC, Byrnes CA, et al. Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand. A position statement from the Thoracic Society of Australia and New Zealand and the Australian Lung Foundation. Med J Aust 2010; 193: 356-365. <eMJA full text>
- Chang AB, Bell SC, Byrnes CA, et al. Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand. A position statement from the Thoracic Society of Australia and New Zealand and the Australian Lung Foundation. http://www.lungfoundation.com.au/professional-resources/guidelines/chronic-suppurative-lung-diseaseanz-2010 (accessed Dec 2010).