Challenges of diagnosing and managing bronchiectasis in resource-limited settings: a case study

Adetiloye, Adebola; Erhabor, Gregory E; Awopeju, O.F.; Adewole, Olanisun Olufemi; Onini, Ebimobowei; Adewuya, Oladapo

doi:10.11604/pamj.2019.32.82.18167

Cited by 5 publications

(5 citation statements)

References 33 publications

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“… [7] It is known that most LMICs experience resource limitations, so there is a financial barrier to extensive investigations. [16 , 18] A second limitation is that this was a single-centre study, so not all the findings can be extrapolated to other institutions and/or regions in SA. Thirdly, this was a retrospective record review, and details for some of the information were missing in the patient files.…”

Section: Discussionmentioning

confidence: 99%

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Non-cystic fibrosis bronchiectasis: A single-centre retrospective study in Johannesburg, South Africa

Titus,

Hassanali,

Feldman

2023

Afr J Thoracic Crit Care Med

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Background. Bronchiectasis, once rarely encountered, appears to be increasing in prevalence in South Africa (SA) and globally. There is a lack of published data on non-cystic fibrosis (CF) bronchiectasis, specifically in low- to middle-income countries, despite the high rates of risk factors such as HIV, pulmonary tuberculosis, and other infections. Objectives. Given this lack of data, to review the characteristics of adult patients with non-CF bronchiectasis at a tertiary academic hospital in Johannesburg, SA. Methods. This was a single-centre, retrospective record review, including all cases of non-CF bronchiectasis that were in the records of the adult pulmonology clinic at Charlotte Maxeke Johannesburg Academic Hospital as of April 2017. Results. There were 197 patients, with a slight predominance of males, and the patients were generally young. The HIV rate was higher than the national average (34.8% v. 13.7%), and the HIV-positive patients had a high TB prevalence (86.9%). Pseudomonas spp. were cultured from sputum in 15.3% of cases. Fewer than half of the cohort had the diagnosis of bronchiectasis confirmed by high-resolution chest tomography. Airway obstruction (forced expiratory volume in 1 second/forced vital capacity ratio <70%) was observed in 47.0% of patients. Treatment with a short-acting beta-2-agonist was prescribed in 62.9%, a long-acting beta-2-agonist in 43.6% and inhaled corticosteroids in 51.3%. Antibiotic therapy during exacerbations was used in 44.2%, mainly amoxycillin-clavulanate (66.7%). Conclusion. While single centre and retrospective, this study adds to the data on non-CF bronchiectasis in sub-Saharan Africa and should encourage further research to increase our understanding of adult non-CF bronchiectasis in SA.

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Section: Discussionmentioning

confidence: 99%

“…HRCT is considered expensive in Nigeria, largely owing to poverty and lack of health insurance. [18] Additionally, relatively few medical centres in SA are equipped with computed tomography scanners. It therefore appears likely that there may be financial reasons for the low rate of HRCT imaging.…”

Section: Discussionmentioning

confidence: 99%

Non-cystic fibrosis bronchiectasis: A single-centre retrospective study in Johannesburg, South Africa

Titus,

Hassanali,

Feldman

2023

Afr J Thoracic Crit Care Med

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“…Bronchiectasis is a progressive respiratory disease characterized by chronic airway inflammation resulting in irreversibly dilated, thick-walled bronchi and progressive decline in lung function [ 19 ]. Criteria for surgery included unsuccessful medical therapy with recurrent respiratory infections, persistent sputum production, chronic cough, persistent lung abscess or hemoptysis, and localized bronchiectasis [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Pneumonectomy for severe post-tuberculosis bronchiectasis: A successful of case report and review of the long-term outcome

Zulfa,

Habibie

2023

Narra J

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Limited clinical intervention studies highlight the absence of evidence-based international guidelines for effectively managing post-tuberculosis lung disease, emphasizing bronchiectasis. The aim of this study was to describe a case of left pneumonectomy for severe post-tuberculosis cystic bronchiectasis and to provide a review of the post-surgical mortality rate, complications, survival rate, and the patient's quality of life following the pneumonectomy procedure. A 36-year-old Indonesian male smoker presented with worsening breathing difficulties and fever. The patient had a history of pulmonary tuberculosis six years ago and reported negative tuberculosis tests after completing TB treatment. However, lung function of the patient progressively declined over the years. Bronchoscopy, chest X-ray, and high-resolution computerized tomography (CT) scan revealed infected cystic bronchiectasis and identified a prominent left lung collapse with calcification in the left pleura. The patient underwent left pneumonectomy through left posterolateral thoracotomy under general anesthesia. The patient was discharged after seven post-operative days with no eventful course. No further complications were found after a one-year post-surgery follow-up, and the patient returned to normal activities, improved fitness, and was fitter in daily life. Based on the literature review, post-surgical mortality rates of pneumonectomy are acceptable, with bronchopleural fistula, cardiac arrest, and thoracic hemorrhage being common causes. Yet, the chances of a complete cure are high. Complications can occur in approximately one-third of patients, including arrhythmia, pulmonary infection, fever, and wound infections. The overall 5-year survival rate following pneumonectomy is generally favorable. Regarding the quality of life, pneumonectomy can have mixed effects. While it could improve symptoms and quality of life, it may impair the quality of life for certain patients, particularly elderly patients and those with lower preoperative quality of life. Although the post-surgical mortality rate, complications, and long-term survival rates of pneumonectomy are generally satisfactory, the expectation of improved post-surgical quality of life should be discussed with the patient prior to surgery.

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Section: Introductionmentioning

confidence: 99%

“…Bronchiectasis is a progressive respiratory disease characterized by chronic air way inflammation resulting in irreversibly dilated, thick walled bronchi and progressive decline in lung function [ 1 ]. It commonly affects proximal and medium sized bronchi [ 1 ]. Although it is regarded as an orphan disease in the developed world, it is still major cause of respiratory morbidity for children of developing nations as most are undiagnosed and untreated leading to early decline of respiratory function [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Pediatric bronchiectasis: An orphan disease ending in pneumonectomy: A case report

Mindaye

Tesfay

Erge

2020

International Journal of Surgery Case Reports

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Challenges of diagnosing and managing bronchiectasis in resource-limited settings: a case study

Cited by 5 publications

References 33 publications

Non-cystic fibrosis bronchiectasis: A single-centre retrospective study in Johannesburg, South Africa

Non-cystic fibrosis bronchiectasis: A single-centre retrospective study in Johannesburg, South Africa

Pneumonectomy for severe post-tuberculosis bronchiectasis: A successful of case report and review of the long-term outcome

Pediatric bronchiectasis: An orphan disease ending in pneumonectomy: A case report

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