Airway clearance techniques for bronchiectasis

Lee, Annemarie L.; Burge, Angela T; Holland, Anne E

doi:10.1002/14651858.cd008351.pub3

Cited by 117 publications

(111 citation statements)

References 111 publications

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“…24,25 It is thus vital to achieve early identification of bronchiectasis and initiate evidencebased therapies that have been shown to slow the rate of lung function decline or improve quality of life. 9,10 Twiss et al 25 guideline recommends "regular" review which is defined as "at least an annual review in adults" and "6-monthly review in children". 1 Given the findings of our study, these recommendations may not meet the requirements for the burden of illness bronchiectasis patients have.…”

Section: Discussionmentioning

confidence: 99%

“…All subjects with CF were seen by a respiratory physician at least three times in the calendar year analyzed. By comparison, subjects with bronchiectasis had far fewer visits, median (range) 5.5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12) (13). By comparison the mean (SD) number of inpatient physiotherapy consults for admitted patients with CF was greater at 21 (9) but the difference was not statistically significant (P = .31).…”

Section: Respiratory Physician Appointment Frequency and Physiothermentioning

confidence: 90%

“…However, it is generally accepted that airway clearance and intensive and early treatment of lower respiratory tract infections are also the mainstay of treatment for patients with bronchiectasis. 1,[8][9][10][11] Targeted antibiotic therapy is achieved by regular microbiological surveillance and taking respiratory tract samples for culture. There is a risk that suboptimal care, including delayed or missed diagnosis or less intensive respiratory and nutritional support, may result in accelerated respiratory decline, unnecessary treatments and side-effects, such as inappropriate treatment with asthma medications.…”

Section: Introductionmentioning

confidence: 99%

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Children with bronchiectasis have poorer lung function than those with cystic fibrosis and do not receive the same standard of care

Prentice

Wales

Doumit

et al. 2019

Pediatric Pulmonology

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Background Children with cystic fibrosis (CF) are routinely managed in a multidisciplinary clinic at tertiary pediatric centers. However, children with bronchiectasis may not be managed in the same way. We sought to compare the management model and clinical outcomes of children with bronchiectasis with children diagnosed with CF, in a single pediatric center. Methods We identified patients with bronchiectasis from hospital medical records at an urban tertiary pediatric hospital and identified a sex‐ and age‐matched CF patient at the same center to compare lung function, nutritional status, frequency of physiotherapy and respiratory physician visits, and number of microbiological samples taken for bacterial culture. Results Twenty‐two children with bronchiectasis were identified, mean (standard deviation [SD]) age was 11 (3) years. The most common known etiology for bronchiectasis was postinfective (6 of 22) but was unknown in 8 of 22. The cohort with bronchiectasis had poorer lung function (FEV1 mean [SD] percent predicted 78.6 [20.5] vs 94.5 [14.7], P = .005) and had less outpatient reviews by the respiratory physician (P < .001) and respiratory physiotherapist (P < .001) when compared to those with CF. Nutritional parameters did not differ between the groups. Many children (10 of 22, 45%) with bronchiectasis did not have any microbiological respiratory tract samples taken for evaluation. Conclusion Children with bronchiectasis at this institution have poorer lung function than children with CF, and are deserving of improved multidisciplinary care.

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Section: Discussionmentioning

confidence: 99%

Section: Respiratory Physician Appointment Frequency and Physiothermentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Children with bronchiectasis have poorer lung function than those with cystic fibrosis and do not receive the same standard of care

Prentice

Wales

Doumit

et al. 2019

Pediatric Pulmonology

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“…In a Cochrane review done in 2015, on ACT in bronchiectasis, looking at seven studies, of which only one included children, studies show significant improvement in QOL with no safety issues (38). …”

Section: Possible Treatment Determinants Of Qolmentioning

confidence: 99%

Review: Quality of Life in Children with Non-cystic Fibrosis Bronchiectasis

Nathan

Bruyne

et al. 2017

Front. Pediatr.

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Non-cystic fibrosis bronchiectasis (NCFB) has gained renewed interest, due to its increasing health-care burden. Annual mortality statistics in England and Wales showed that under 1,000 people die from bronchiectasis each year, and this number is increasing by 3% yearly. Unfortunately, there is a severe lack of well-powered, randomized controlled trials to guide clinicians how to manage NCFB effectively. Quality-of-life (QOL) measures in NCFB are an important aspect of clinical care that has not been studied well. Commonly used disease-specific questionnaires in children with NCFB are the St George’s Respiratory Questionnaire, Short Form-36, the Leicester Cough Questionnaire, and the Parent Cough-Specific Quality of Life questionnaire (PC-QOL). Of these, only the PC-QOL can be used in young children, as it is a parent-proxy questionnaire. We reviewed pediatric studies looking at QOL in children with NCFB and cystic fibrosis. All types of airway clearance techniques appear to be safe and have no significant benefit over each other. Number of exacerbations and hospitalizations correlated with QOL scores, while symptom subscales correlated with lung function, worse QOL, frequent antibiotic requirements, and duration of regular follow-up in only one study. There was a correlation between QOL and age of diagnosis in children with primary ciliary dyskinesia. Other studies have shown no relationship between QOL scores and etiology of NCFB as well as CT changes. As for treatments, oral azithromycin and yoga have demonstrated some improvement in QOL scores. In conclusion, more studies are required to accurately determine important factors contributing to QOL.

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“…The core components involve postural drainage, percussion, vibration of the chest wall, and coughing (96), and specific techniques include active cycle of breathing techniques, forced expiration techniques, autogenic drainage, postural drainage, oscillating positive expiratory pressure, high frequency chest wall oscillation, and exercise and/or pulmonary rehabilitation (96). While a Cochrane review found these techniques have clinically important effects on health-related QoL scores in adults (97), it identified only one study in children with bronchiectasis (98). This study involved only nine children with bronchiectasis and the intervention was oscillatory positive expiratory pressure administered three times a day with lung function measured after a 3-month period.…”

Section: Preventionmentioning

confidence: 99%

The Likelihood of Preventing Respiratory Exacerbations in Children and Adolescents with either Chronic Suppurative Lung Disease or Bronchiectasis

O’Grady

Grimwood

2017

Front. Pediatr.

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Chronic suppurative lung disease (CSLD) and bronchiectasis in children and adolescents are important causes of respiratory morbidity and reduced quality of life (QoL), also leading to subsequent premature death during adulthood. Acute respiratory exacerbations in pediatric CSLD and bronchiectasis are important markers of disease control clinically, given that they impact upon QoL and increase health-care-associated costs and can adversely affect future lung functioning. Preventing exacerbations in this population is, therefore, likely to have significant individual, familial, societal, and health-sector benefits. In this review, we focus on therapeutic interventions, such as drugs (antibiotics, mucolytics, hyperosmolar agents, bronchodilators, corticosteroids, non-steroidal anti-inflammatory agents), vaccines and physiotherapy, and care-planning, such as post-hospitalization management and health promotion strategies, including exercise, diet, and reducing exposure to environmental toxicants. The review identified a conspicuous lack of moderate or high-quality evidence for preventing respiratory exacerbations in children and adolescents with CSLD or bronchiectasis. Given the short- and long-term impact of exacerbations upon individuals, their families, and society as a whole, large studies addressing interventions at the primary and tertiary prevention phases are required. This research must include children and adolescents in both developing and developed countries and address long-term health outcomes.

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Airway clearance techniques for bronchiectasis

Cited by 117 publications

References 111 publications

Children with bronchiectasis have poorer lung function than those with cystic fibrosis and do not receive the same standard of care

Children with bronchiectasis have poorer lung function than those with cystic fibrosis and do not receive the same standard of care

Review: Quality of Life in Children with Non-cystic Fibrosis Bronchiectasis

The Likelihood of Preventing Respiratory Exacerbations in Children and Adolescents with either Chronic Suppurative Lung Disease or Bronchiectasis

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