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Lung. 2019 Dec;197(6):803-810. doi: 10.1007/s00408-019-00280-x. Epub 2019 Nov 5.

Management of Australian Adults with Bronchiectasis in Tertiary Care: Evidence-Based or Access-Driven?

Author information

1
Central Clinical School Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia. simone.visser@health.nsw.gov.au.
2
Department of Respiratory Medicine, Royal Prince Alfred Hospital, Level 11, Missenden Rd, Camperdown, NSW, 2050, Australia. simone.visser@health.nsw.gov.au.
3
Central Clinical School Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
4
Department of Respiratory Medicine, Royal Prince Alfred Hospital, Level 11, Missenden Rd, Camperdown, NSW, 2050, Australia.
5
Department of Respiratory and Sleep Medicine, Mater Health, South Brisbane, QLD, Australia.
6
Mater Research, University of Queensland, St Lucia, QLD, Australia.
7
Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Queensland University of Technology, Brisbane, Australia.
8
Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
9
Department of Thoracic Medicine, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia.
10
Monash Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, VIC, Australia.
11
Department of Respiratory Medicine, Westmead Hospital, Westmead, NSW, 2145, Australia.
12
Western Clinical School, University of Melbourne, Melbourne, 3021, Australia.
13
General Internal Medicine, Western Health, Melbourne, 3011, Australia.
14
The Prince Charles Hospital - Thoracic Medicine, Brisbane, Australia.
15
QIMR Berghofer Medical Research Institute - Lung Inflammation and Infection Laboratory, Herston, Australia.
16
Department of Respiratory Medicine, Greenslopes Private Hospital, Greenslopes, QLD, 4120, Australia.
17
Lung Foundation Australia, Milton, QLD, Australia.
18
Centenary Institute, The University of Sydney, Sydney, NSW, 2006, Australia.
19
Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia.
20
Department of Respiratory Medicine, Concord General Repatriation Hospital, Concord, NSW, 2137, Australia.

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

PMID:
31691027
DOI:
10.1007/s00408-019-00280-x

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