Pediatric Bronchiectasis Action Management Plan to Improve Clinical Outcomes: A Randomized Controlled Trial

Abstract

BACKGROUND: Managing bronchiectasis exacerbations is a priority for patients, parents, and caregivers of children with bronchiectasis. However, evidence-based strategies among the pediatric population remain limited. RESEARCH QUESTION: Does the use of a personalized, written bronchiectasis action management plan (BAMP), compared with standard care, reduce nonscheduled physician visits among children and adolescents with chronic suppurative lung disease (CSLD)/bronchiectasis? STUDY DESIGN AND METHODS: This multicenter, double-anonymized, superiority, randomized controlled trial enrolled children from 3 Australian respiratory departments between June 2018 and December 2020. Children and adolescents aged < 19 years with CSLD/bronchiectasis were randomized to receive a personalized BAMP (intervention) or standard care (control participants). The primary outcome was the annual rate of acute nonscheduled physician visits for respiratory exacerbations, after randomization. Secondary outcomes were the annualized rate of acute exacerbations, scores on the 8-item Parent Cough-specific Quality of Life questionnaire, and proportion receiving timely annual influenza vaccination. RESULTS: Of the 207 children enrolled, 194 were included in the known-case intention-to-treat analysis (BAMP group, n = 99; control group, n = 95). There was no significant difference in the annualized rates of nonscheduled respiratory-related physician visits (median [interquartile range]: BAMP, 2 [0-4]; control, 2 [0-4)]; incident rate ratio, 0.98 [95% CI, 0.71-1.36]). However, in the sensitivity analysis limited to pre-COVID-19 data (BAMP group, n = 42; control group, n = 44), there was a reduction in nonscheduled respiratory-related physician-related visits in the BAMP group (incident rate ratio, 0.63; 95% CI, 0.38-1.04; P = .07). In the intention-to-treat analysis, patients in the BAMP group were significantly more likely than control partcipants to receive timely annual influenza vaccination (74 of 103 vs 58 of 102, respectively; OR, 2.03; 95% CI, 1.13-3.65; P = .017). INTERPRETATION: Among children and adolescents with CSLD/bronchiectasis, using a BAMP was shown to improve timely influenza vaccination uptake but did not significantly reduce nonscheduled physician visits. However, the results were likely influenced by the COVID-19 pandemic, and data prior to the COVID-19 pandemic show a clear trend toward efficacy of the BAMP, with a 37% reduction in unscheduled physician visits. In addition, consumer feedback was strongly positive regarding the BAMP's usefulness and practicality. CLINICAL TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Register; No. ACTRN12618000604202; URL: www.anzctr.org.au.