Management of Australian Adults with Bronchiectasis in Tertiary Care

Evidence-Based or Access-Driven?

Simone K. Visser, Peter T.P. Bye, Greg J. Fox, Lucy D. Burr, Anne B. Chang, Chien Li Holmes-Liew, Paul King, Peter G. Middleton, Graeme P. Maguire, Daniel Smith, Rachel M. Thomson, Enna Stroil-Salama, Warwick J. Britton, Lucy C. Morgan

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Purpose: Australian data regarding the management of patients with bronchiectasis is scarce. We sought to compare the management of adults with bronchiectasis attending tertiary Australian centres with recent national and international guidelines. 

    Methods: The Australian Bronchiectasis Registry is a centralised database of patients with radiologically confirmed bronchiectasis unrelated to cystic fibrosis recruited from 14 tertiary Australian hospitals. We excluded children (<18 years) and those with incomplete data, leaving 589 adults for cross-sectional analyses. We compared the proportion of patients receiving certain therapies, as compared to the proportion eligible for those treatments according to the current guidelines and baseline clinical information available from the registry. 

    Results: Pulmonary rehabilitation was attended by 22%, although it was indicated in 67% of the cohort. Airway clearance was undertaken in 52% of patients, although 71% reported chronic productive cough. Sputum bacterial culture results were available for 59%, and mycobacterial culture results were available for 29% of the cohort. Inhaled antibiotics were used in half of potentially eligible patients. Despite guideline recommendations against routine use, inhaled corticosteroids were used in 48% of patients. Long-term macrolides were used in 28% of participants. 

    Conclusions: Discrepancies exist between guideline recommendations and real-world treatment of bronchiectasis in Australia, even in tertiary centres. These findings suggest the need for increased patient referral to pulmonary rehabilitation, increased attention to airway clearance, increased collection of sputum samples (especially for mycobacterial culture) and rationalisation of inhaled corticosteroid use. These findings encourage a review of treatment access and will inform ongoing education to promote evidence-based care for people living with bronchiectasis.

    Original languageEnglish
    Pages (from-to)803-810
    Number of pages8
    JournalLung
    Volume197
    Issue number6
    DOIs
    Publication statusPublished - Dec 2019

    Fingerprint

    Bronchiectasis
    Tertiary Healthcare
    Guidelines
    Sputum
    Registries
    Adrenal Cortex Hormones
    Rehabilitation
    Lung
    Macrolides
    Therapeutics
    Cough
    Tertiary Care Centers
    Cystic Fibrosis
    Referral and Consultation
    Cross-Sectional Studies
    Databases
    Anti-Bacterial Agents
    Education

    Cite this

    Visser, S. K., Bye, P. T. P., Fox, G. J., Burr, L. D., Chang, A. B., Holmes-Liew, C. L., ... Morgan, L. C. (2019). Management of Australian Adults with Bronchiectasis in Tertiary Care: Evidence-Based or Access-Driven? Lung, 197(6), 803-810. https://doi.org/10.1007/s00408-019-00280-x
    Visser, Simone K. ; Bye, Peter T.P. ; Fox, Greg J. ; Burr, Lucy D. ; Chang, Anne B. ; Holmes-Liew, Chien Li ; King, Paul ; Middleton, Peter G. ; Maguire, Graeme P. ; Smith, Daniel ; Thomson, Rachel M. ; Stroil-Salama, Enna ; Britton, Warwick J. ; Morgan, Lucy C. / Management of Australian Adults with Bronchiectasis in Tertiary Care : Evidence-Based or Access-Driven?. In: Lung. 2019 ; Vol. 197, No. 6. pp. 803-810.
    @article{a44d911ec99f4f3eb1d9f7c945ef87ff,
    title = "Management of Australian Adults with Bronchiectasis in Tertiary Care: Evidence-Based or Access-Driven?",
    abstract = "Purpose: Australian data regarding the management of patients with bronchiectasis is scarce. We sought to compare the management of adults with bronchiectasis attending tertiary Australian centres with recent national and international guidelines. Methods: The Australian Bronchiectasis Registry is a centralised database of patients with radiologically confirmed bronchiectasis unrelated to cystic fibrosis recruited from 14 tertiary Australian hospitals. We excluded children (<18 years) and those with incomplete data, leaving 589 adults for cross-sectional analyses. We compared the proportion of patients receiving certain therapies, as compared to the proportion eligible for those treatments according to the current guidelines and baseline clinical information available from the registry. Results: Pulmonary rehabilitation was attended by 22{\%}, although it was indicated in 67{\%} of the cohort. Airway clearance was undertaken in 52{\%} of patients, although 71{\%} reported chronic productive cough. Sputum bacterial culture results were available for 59{\%}, and mycobacterial culture results were available for 29{\%} of the cohort. Inhaled antibiotics were used in half of potentially eligible patients. Despite guideline recommendations against routine use, inhaled corticosteroids were used in 48{\%} of patients. Long-term macrolides were used in 28{\%} of participants. Conclusions: Discrepancies exist between guideline recommendations and real-world treatment of bronchiectasis in Australia, even in tertiary centres. These findings suggest the need for increased patient referral to pulmonary rehabilitation, increased attention to airway clearance, increased collection of sputum samples (especially for mycobacterial culture) and rationalisation of inhaled corticosteroid use. These findings encourage a review of treatment access and will inform ongoing education to promote evidence-based care for people living with bronchiectasis.",
    keywords = "Australia, Bronchiectasis, Guidelines, Registry, Treatment",
    author = "Visser, {Simone K.} and Bye, {Peter T.P.} and Fox, {Greg J.} and Burr, {Lucy D.} and Chang, {Anne B.} and Holmes-Liew, {Chien Li} and Paul King and Middleton, {Peter G.} and Maguire, {Graeme P.} and Daniel Smith and Thomson, {Rachel M.} and Enna Stroil-Salama and Britton, {Warwick J.} and Morgan, {Lucy C.}",
    year = "2019",
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    doi = "10.1007/s00408-019-00280-x",
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    Visser, SK, Bye, PTP, Fox, GJ, Burr, LD, Chang, AB, Holmes-Liew, CL, King, P, Middleton, PG, Maguire, GP, Smith, D, Thomson, RM, Stroil-Salama, E, Britton, WJ & Morgan, LC 2019, 'Management of Australian Adults with Bronchiectasis in Tertiary Care: Evidence-Based or Access-Driven?', Lung, vol. 197, no. 6, pp. 803-810. https://doi.org/10.1007/s00408-019-00280-x

    Management of Australian Adults with Bronchiectasis in Tertiary Care : Evidence-Based or Access-Driven? / Visser, Simone K.; Bye, Peter T.P.; Fox, Greg J.; Burr, Lucy D.; Chang, Anne B.; Holmes-Liew, Chien Li; King, Paul; Middleton, Peter G.; Maguire, Graeme P.; Smith, Daniel; Thomson, Rachel M.; Stroil-Salama, Enna; Britton, Warwick J.; Morgan, Lucy C.

    In: Lung, Vol. 197, No. 6, 12.2019, p. 803-810.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Management of Australian Adults with Bronchiectasis in Tertiary Care

    T2 - Evidence-Based or Access-Driven?

    AU - Visser, Simone K.

    AU - Bye, Peter T.P.

    AU - Fox, Greg J.

    AU - Burr, Lucy D.

    AU - Chang, Anne B.

    AU - Holmes-Liew, Chien Li

    AU - King, Paul

    AU - Middleton, Peter G.

    AU - Maguire, Graeme P.

    AU - Smith, Daniel

    AU - Thomson, Rachel M.

    AU - Stroil-Salama, Enna

    AU - Britton, Warwick J.

    AU - Morgan, Lucy C.

    PY - 2019/12

    Y1 - 2019/12

    N2 - Purpose: Australian data regarding the management of patients with bronchiectasis is scarce. We sought to compare the management of adults with bronchiectasis attending tertiary Australian centres with recent national and international guidelines. Methods: The Australian Bronchiectasis Registry is a centralised database of patients with radiologically confirmed bronchiectasis unrelated to cystic fibrosis recruited from 14 tertiary Australian hospitals. We excluded children (<18 years) and those with incomplete data, leaving 589 adults for cross-sectional analyses. We compared the proportion of patients receiving certain therapies, as compared to the proportion eligible for those treatments according to the current guidelines and baseline clinical information available from the registry. Results: Pulmonary rehabilitation was attended by 22%, although it was indicated in 67% of the cohort. Airway clearance was undertaken in 52% of patients, although 71% reported chronic productive cough. Sputum bacterial culture results were available for 59%, and mycobacterial culture results were available for 29% of the cohort. Inhaled antibiotics were used in half of potentially eligible patients. Despite guideline recommendations against routine use, inhaled corticosteroids were used in 48% of patients. Long-term macrolides were used in 28% of participants. Conclusions: Discrepancies exist between guideline recommendations and real-world treatment of bronchiectasis in Australia, even in tertiary centres. These findings suggest the need for increased patient referral to pulmonary rehabilitation, increased attention to airway clearance, increased collection of sputum samples (especially for mycobacterial culture) and rationalisation of inhaled corticosteroid use. These findings encourage a review of treatment access and will inform ongoing education to promote evidence-based care for people living with bronchiectasis.

    AB - Purpose: Australian data regarding the management of patients with bronchiectasis is scarce. We sought to compare the management of adults with bronchiectasis attending tertiary Australian centres with recent national and international guidelines. Methods: The Australian Bronchiectasis Registry is a centralised database of patients with radiologically confirmed bronchiectasis unrelated to cystic fibrosis recruited from 14 tertiary Australian hospitals. We excluded children (<18 years) and those with incomplete data, leaving 589 adults for cross-sectional analyses. We compared the proportion of patients receiving certain therapies, as compared to the proportion eligible for those treatments according to the current guidelines and baseline clinical information available from the registry. Results: Pulmonary rehabilitation was attended by 22%, although it was indicated in 67% of the cohort. Airway clearance was undertaken in 52% of patients, although 71% reported chronic productive cough. Sputum bacterial culture results were available for 59%, and mycobacterial culture results were available for 29% of the cohort. Inhaled antibiotics were used in half of potentially eligible patients. Despite guideline recommendations against routine use, inhaled corticosteroids were used in 48% of patients. Long-term macrolides were used in 28% of participants. Conclusions: Discrepancies exist between guideline recommendations and real-world treatment of bronchiectasis in Australia, even in tertiary centres. These findings suggest the need for increased patient referral to pulmonary rehabilitation, increased attention to airway clearance, increased collection of sputum samples (especially for mycobacterial culture) and rationalisation of inhaled corticosteroid use. These findings encourage a review of treatment access and will inform ongoing education to promote evidence-based care for people living with bronchiectasis.

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