British Thoracic Society Guideline for bronchiectasis in adults

Hill, Adam T.; Sullivan, Anita; Chalmers, James D.; Soyza, Anthony De; Elborn, J. Stuart; Floto, R. Andrés; Grillo, Lizzie; Gruffydd-Jones, Kevin; Harvey, Alex; Haworth, Charles; Hiscocks, Edwin; Hurst, John R.; Johnson, Christopher; Kelleher, William P.; Bedi, Pallavi; Payne, Karen; Saleh, Hashem; Screaton, Nicholas; Smith, M. A.; Tunney, Michael; Whitters, Deborah; Wilson, Robert; Loebinger, Michael R.

doi:10.1136/thoraxjnl-2018-212463

Cited by 377 publications

(434 citation statements)

References 357 publications

(298 reference statements)

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“…While one may assume that the results of HITH vs hospitalization is the same for children with bronchiectasis with or without CF, there is a need to specifically determine the efficacy of HITH for children without CF as there are several important differences between CF and non‐CF bronchiectasis. These differences include the differing lower airway microbiology between the two groups, 24,25 using single‐agent therapy for non‐CF bronchiectasis compared to two antibiotic types for CF, and the nature of non‐CF bronchiectasis being a heterogenous disease, compared to the one‐gene disease of CF.…”

Section: Discussionmentioning

confidence: 99%

“…This is especially significant given one of the important purported benefits of home‐based treatment is an improved QoL for the patient and family 11 . Further, it is likely that the duration of therapy was somewhat predetermined as the use of 14 days of IV antibiotics is the current common practice, 24,25 especially those with PsA positive states, without consideration to clinical response or outcomes. Our comparative groups were not entirely HITH vs hospital as all children in the HITH commenced their treatment in the hospital.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Is out‐patient based treatment of bronchiectasis exacerbations in children comparable to inpatient based treatment?

O’Rourke

Schilling

Martin

et al. 2020

Pediatric Pulmonology

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Background and Objective Children with bronchiectasis have recurrent exacerbations and may require hospitalization. “Hospital in the home (HITH)” is used as an alternative to hospitalization for children with cystic fibrosis (CF) but to date, there is no published data on children without CF. We describe our experience of HITH (intravenous [IV] antibiotics and at least once‐daily physiotherapy‐treated airway clearance therapy) in a cohort of children with bronchiectasis, comparing outcomes between hospital and HITH‐based pathways. Methods Medical records were retrospectively reviewed in children with bronchiectasis who were hospitalized in our center from July 2016 to July 2018. We compared treatment duration, symptom resolution, adverse events, oral antibiotic prescription on discharge and “time‐to‐next hospitalization” between children managed with the two treatment pathways. Results Exacerbations in 63 children (median age = 6 years [range: 1‐17]; females = 33, indigenous = 8) with bronchiectasis treated with IV antibiotic therapy were analyzed (HITH n = 45, 71.5%). Duration of treatment and symptom resolution was similar between groups (hospital: median = 14 days [interquartile range {IQR}: 14‐14] and 12/18 [66.6%], respectively vs HITH: 14 [14‐15.5] and 31/45 [69%]; P = .53 and .85, respectively). There was no significant difference in adverse events (16.6% vs 9%), prescription of oral antibiotics on discharge (44% vs 24%), or “time‐to‐next hospitalization” (median 42 [IQR: 24‐100] vs 67 [IQR: 32‐95] weeks) between hospital and HITH groups, respectively. Conclusions In children with bronchiectasis treated for a severe exacerbation, receiving treatment in the home setting with HITH does not compromise short‐term clinical outcomes compared to hospital only treatment. Prospective studies are required to provide more robust evidence in this under‐researched area.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Is out‐patient based treatment of bronchiectasis exacerbations in children comparable to inpatient based treatment?

O’Rourke

Schilling

Martin

et al. 2020

Pediatric Pulmonology

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“…Short‐term goals are to provide more effective sputum clearance that improves ventilation and reduces cough impact and breathlessness. Longer term goals are reducing further airway damage by halting the vicious cycle of bacterial colonization and subsequent inflammation, reducing the number of pulmonary exacerbations and hospitalizations and improving HRQoL …”

Section: Airway Clearance In Bronchiectasismentioning

confidence: 99%

Airway clearance, mucoactive therapies and pulmonary rehabilitation in bronchiectasis

2019

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This paper aims to provide physiological rationale for airway clearance, mucoactive therapy and pulmonary rehabilitation (PR) (or exercise interventions) in bronchiectasis. There is increasing emphasis on the role of airway clearance techniques (ACT) in the management of bronchiectasis. No single ACT has currently shown superior effect over another. Given the large range of different techniques available, consideration of the physiological effects underpinning a technique including expiratory flow, ventilation and oscillation, is essential to effectively personalize ACT. Key clinical trials of mucoactives in bronchiectasis are underway and will provide clarity on the role of these agents in the management of patients with bronchiectasis. Prescription of mucoactive therapies should be done in conjunction with ACT and therefore the mechanism of action of mucoactive drugs and their timing with ACT should be taken into consideration. PR and/or exercise training are recommended in all current bronchiectasis guidelines. There is a clear physiological rationale that muscle weakness and physical inactivity may play a role in disease progression as well as impacting health‐related quality of life, frequency of pulmonary exacerbations and ability to mobilize sputum. However, there are residual unanswered questions surrounding the delivery and accessibility to PR. This review summarizes the physiological principles and supporting evidence for airway clearance, mucoactive medication and PR, which are key components in the management of bronchiectasis.

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Section: Introductionmentioning

confidence: 99%

“…Currently, the mainstay of bronchiectasis management is early initiation of culture‐targeted antibiotic therapy for infective exacerbations and regular airway clearance . Trials of common respiratory medications such as inhaled corticosteroids (ICS), long‐acting muscarinic antagonists (LAMA) and long‐acting beta agonists (LABA) remain unproven therapies in bronchiectasis due to a lack of randomized controlled trials (RCT) and are not recommended as maintenance therapy unless there is co‐morbid obstructive airway disease . Understandably, there has been much focus on the role of suppressive antibiotic therapy in these patients, and there have been numerous trials focusing on the role of long‐term macrolides and inhaled antibiotics, which are commonly prescribed off‐label by tertiary care centres .…”

Section: Introductionmentioning

confidence: 99%

Emerging therapies in adult and paediatric bronchiectasis

Regan

Hill

2018

Respirology

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Bronchiectasis is a chronic respiratory disorder characterized by persistent productive cough and recurrent chest infections secondary to permanent structural airway damage. The current treatment strategies for this debilitating disorder are limited to prompt antibiotic treatment of infective exacerbations and regular airway clearance techniques. Despite its high morbidity and associated mortality across all age groups, it has been a neglected area of research in respiratory medicine and there remain no licensed disease‐modifying therapies. In this review, we have explored the numerous potential therapeutic targets to break the vicious cycle of infection and inflammation seen in these patients and the novel therapeutic agents that have been developed to target them. We have reviewed the role of novel anti‐inflammatory agents designed to target the persistent neutrophilic inflammatory infiltrate seen in bronchiectatic airways, including neutrophil elastase inhibitors, CXCR2 (CXC chemokine receptor 2) antagonists, DPP‐1 (dipeptidyl peptidase 1) inhibitors, PDE4 (phosphodiesterase 4) inhibitors and statins. Furthermore, we have explored novel targets to improve mucociliary clearance, namely ENaC (epithelial sodium channel) inhibitors, and discussed the potential of alternative antimicrobial strategies such as inhaled phages. Our review highlights the importance of a multi‐faceted approach to bronchiectasis management, which aims not only to eradicate or suppress bronchial infection but also to break the cycle of persistent airway inflammation that results in progressive lung damage in these patients.

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British Thoracic Society Guideline for bronchiectasis in adults

Cited by 377 publications

References 357 publications

Is out‐patient based treatment of bronchiectasis exacerbations in children comparable to inpatient based treatment?

Is out‐patient based treatment of bronchiectasis exacerbations in children comparable to inpatient based treatment?

Airway clearance, mucoactive therapies and pulmonary rehabilitation in bronchiectasis

Emerging therapies in adult and paediatric bronchiectasis

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