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.Clin Respir J. 2016 Nov;10(6):731-739. (PMID: 25620629); Arch Phys Med Rehabil. 2017 Apr;98(4):774-782.e1. (PMID: 27320420); Arch Bronconeumol. 2018 Feb;54(2):88-98. (PMID: 29128129); Med J Aust. 2017 Nov 20;207(10):436-442. (PMID: 29129177); Am J Respir Crit Care Med. 2012 Oct 1;186(7):657-65. (PMID: 22744718); Med J Aust. 2015 Jan 19;202(1):21-3. (PMID: 25588439); Eur Respir J. 2014 Aug;44(2):382-93. (PMID: 24925920); Eur Respir J. 2016 Jan;47(1):186-93. (PMID: 26541539); Am J Respir Crit Care Med. 2000 Aug;162(2 Pt 1):481-5. (PMID: 10934074); Eur Respir J. 2017 Sep 9;50(3):. (PMID: 28889110); N Z Med J. 2015 Sep 04;128(1421):30-8. (PMID: 26370753); JAMA. 2013 Mar 27;309(12):1260-7. (PMID: 23532242); Am J Respir Crit Care Med. 2014 Apr 15;189(8):975-82. (PMID: 24625200); Thorax. 2019 Jan;74(Suppl 1):1-69. (PMID: 30545985); Lancet Respir Med. 2014 Sep;2(9):738-49. (PMID: 25154045); Eur Respir J. 2018 Sep 15;52(3):. (PMID: 30049739); Pulm Pharmacol Ther. 2014 Oct;29(1):80-8. (PMID: 24594263); Lancet Respir Med. 2019 Mar;7(3):213-226. (PMID: 30658914); JAMA. 2013 Mar 27;309(12):1251-9. (PMID: 23532241); Lancet. 2018 Sep 8;392(10150):880-890. (PMID: 30215383); Respir Med. 2012 Dec;106(12):1647-54. (PMID: 22947443); Thorax. 2014 Dec;69(12):1073-9. (PMID: 25246664); Eur Respir J. 2019 Jan 17;53(1):null. (PMID: 30578381); Respirology. 2014 Apr;19(3):295-7. (PMID: 24620757); Cochrane Database Syst Rev. 2015 Nov 23;(11):CD008351. (PMID: 26591003); Pharmazie. 2016 Sep 1;71(9):491-498. (PMID: 29441843); PLoS One. 2013 Aug 01;8(8):e71109. (PMID: 23936489); Cochrane Database Syst Rev. 2018 May 16;5:CD000996. (PMID: 29766487); Am J Respir Crit Care Med. 2018 Jun 1;197(11):1410-1420. (PMID: 29357265); Chest. 2012 Aug;142(2):432-439. (PMID: 22302301); Am J Respir Crit Care Med. 2014 Mar 1;189(5):576-85. (PMID: 24328736); Ann Am Thorac Soc. 2015 Nov;12(11):1602-11. (PMID: 26356317); Eur Respir J. 2018 Jan 25;51(1):. (PMID: 29371384); Respir Res. 2014 Apr 15;15:44. (PMID: 24731015); Lancet. 2012 Aug 18;380(9842):660-7. (PMID: 22901887); Chest. 1998 May;113(5):1329-34. (PMID: 9596315); Eur Respir J. 2018 Jan 31;51(2):. (PMID: 29386336); Lancet Respir Med. 2018 Sep;6(9):715-726. (PMID: 29478908); Eur Respir J. 2018 Jan 25;51(1):. (PMID: 29371383); Ann Am Thorac Soc. 2018 Oct;15(10):1169-1176. (PMID: 30213194); Respirology. 2014 Apr;19(3):321-9. (PMID: 24417869); Thorax. 2017 Nov;72(Suppl 2):ii1-ii64. (PMID: 29054853). Linking ISSN: 03412040. Subset: MEDLINE; Date of Electronic Publication: 2019 Nov 05. Current Imprints: Publication: New York : Springer Verlag; Original Imprints: Publication: Heidelberg, Springer International. <br />