Abstract
This position statement, updated from the 2015 guidelines for managing Australian and New Zealand children/adolescents and adults with chronic suppurative lung disease (CSLD) and bronchiectasis, resulted from systematic literature searches by a multi-disciplinary team that included consumers. The main statements are: Diagnose CSLD and bronchiectasis early; this requires awareness of bronchiectasis symptoms and its co-existence with other respiratory diseases (e.g., asthma, chronic obstructive pulmonary disease). Confirm bronchiectasis with a chest computed-tomography scan, using age-appropriate protocols and criteria in children. Undertake a baseline panel of investigations. Assess baseline severity, and health impact, and develop individualized management plans that include a multi-disciplinary approach and coordinated care between healthcare providers. Employ intensive treatment to improve symptom control, reduce exacerbation frequency, preserve lung function, optimize quality-of-life and enhance survival. In children, treatment also aims to optimize lung growth and, when possible, reverse bronchiectasis. Individualize airway clearance techniques (ACTs) taught by respiratory physiotherapists, encourage regular exercise, optimize nutrition, avoid air pollutants and administer vaccines following national schedules. Treat exacerbations with 14-day antibiotic courses based upon lower airway culture results, local antibiotic susceptibility patterns, clinical severity and patient tolerance. Patients with severe exacerbations and/or not responding to outpatient therapy are hospitalized for further treatments, including intravenous antibiotics and intensive ACTs. Eradicate Pseudomonas aeruginosa when newly detected in lower airway cultures. Individualize therapy for long-term antibiotics, inhaled corticosteroids, bronchodilators and mucoactive agents. Ensure ongoing care with 6-monthly monitoring for complications and co-morbidities. Undertake optimal care of under-served peoples, and despite its challenges, delivering best-practice treatment remains the overriding aim.
Original language | English |
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Pages (from-to) | 339-349 |
Number of pages | 11 |
Journal | Respirology |
Volume | 28 |
Issue number | 4 |
Early online date | 2 Mar 2023 |
DOIs | |
Publication status | Published - Apr 2023 |
Bibliographical note
Funding Information:: Open access fees were provided by the TSANZ. Supported by the National Health and Medical Research Council (NHMRC) Centre for Research Excellence in bronchiectasis for children (grant 1170958). Anne B. Chang is funded by a NHMRC practitioner fellowship (grant 1154302) and the Queensland Children's Hospital Foundation. Open access publishing facilitated by Charles Darwin University, as part of the Wiley ‐ Charles Darwin University agreement via the Council of Australian University Librarians. Research funding
Funding Information:
Health professionals who contributed to the Delphi statement: Nurses and Physiotherapists: Kathleen Hall, Christine Wilson, Annemarie Lee, Donna Mason, Gabrielle McCallum, Anna Middleton, Lesley Versteegh, Kathy Lawton. Adult-based Medical Practitioners: Lucy Burr, Bart Currie, John Kolbe, Lata Jayaram, Chen Li Holmes-Liew, Peter Middleton, Jonathan Rutland, Frank Thien, Grant Waterer, Conroy Wong, Tim Baird, Daniel Smith, James Geake, Rachel Thompson. Paediatric-based Medical Practitioners: Vikas Goyal, Peter Morris, Anna Mulholland, Brent Masters, Andre Schultz, Gurmeet Singh, Dhanusya Sivananthan, Rahul Thomas, Danielle Wurzel, Julie Marchant, Bernadette Prentice, Hiran Selvadurai. General Practice: Kylie Vuong. Research funding: Open access fees were provided by the TSANZ. Supported by the National Health and Medical Research Council (NHMRC) Centre for Research Excellence in bronchiectasis for children (grant 1170958). Anne B. Chang is funded by a NHMRC practitioner fellowship (grant 1154302) and the Queensland Children's Hospital Foundation. Open access publishing facilitated by Charles Darwin University, as part of the Wiley - Charles Darwin University agreement via the Council of Australian University Librarians.
Funding Information:
Catherine A. Byrnes: Trustee, Bronchiectasis Foundation; Editor, New Zealand Formulary for Children at the Starship Children's Hospital. Has received funds from Health Research Council of New Zealand research, CureKids research and FluLab International research on the subject matter. Anne B. Chang: European Respiratory Society (ERS) Guidelines Committee Member, ERS Long Strategy Member, APSR Strategic Planning Member and Australian Bronchiectasis Consortium and Registry. Has written for UpToDate and has received multiple NHMRC and MRFF grants on the subject matter. Sarah Mooney has received funds from Asthma NZ to present at GP and annual conference. Lucy Morgan: Past Chair of Australian Bronchiectasis Consortium and Registry. Has received personal funds from Astra Zeneca, Zambon, Insmed and Glaxo; and administrative support from the Lung Foundation of Australia. Received payment as a PI in commercial clinical trials. Betty Poot: Currently involved in recruiting patients to the NZ bronchiectasis registry where data has been used for conference presentations and for writing up manuscript for publication. Scott C. Bell, Paul Dawkins, Keith Grimwood, Anne E. Holland, Emma Kennedy, Paul T. King, Pamela Laird, Marianne Parsons and Paul J. Torzillo have nothing to disclose.
Publisher Copyright:
© 2023 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.