Developing a Diagnostic Bundle for Bronchiectasis in South Korea: A Modified Delphi Consensus Study

Choi, Hayoung; Lee, Hyun; Won, Seung; Jang, Jong Geol; Lee, Ji-Ho; Jhun, Byung Woo; Park, Hye Yun; Jung, Ji Ye; Lee, Seung Jun; Jo, Kyung-Wook; Rhee, Chin Kook; Kim, Changwhan; Lee, Sei Won; Min, Kyung Hoon; Kwon, Yong-Soo; Kim, Deog Kyeom; Lee, Jin Hwa; Park, Yong Bum; Chung, Eun Hee; Kim, Yae-Jean; Yoo, Kwang Ha; Oh, Yeon‐Mok

doi:10.4046/trd.2021.0136

Cited by 12 publications

(4 citation statements)

References 36 publications

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“…We conducted a conventional Delphi method, a technique well introduced, and widely used in medical field, 5 , 6 with two rounds of survey. The survey consisted of three sections with questions to be answered by experts anonymously: the first section for diagnosing Hr-TB, the second section for the treatment of Hr-TB, and the third section for general opinions on Hr-TB ( Appendix 1 ).…”

Section: Methodsmentioning

confidence: 99%

Delphi Survey on the Current and Future Korean Guidelines for Isoniazid-Monoresistant Tuberculosis

Seo¹,

Kim²,

Lee³

et al. 2023

IDR

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Purpose Isoniazid-monoresistant tuberculosis (Hr-TB) has emerged as a global challenge, necessitating detailed guidelines for its diagnosis and treatment. We aim to consolidate the Korean guidelines for Hr-TB management by gathering expert opinions and reaching a consensus. Patients and Methods A conventional Delphi method involving two rounds of surveys was conducted with 96 experts selected based on their clinical and research experience and involvement in nationwide tuberculosis studies and development of the Korean guidelines on tuberculosis. The survey consisted of three sections of questionnaires on diagnosis, treatment, and general opinions on Hr-TB. Results Among the 96 experts, 72 (75%) participated in the two rounds of the survey. A majority of experts (96%) strongly agreed on the necessity of molecular drug susceptibility testing (DST) for isoniazid and rifampin resistance in all tuberculosis patients and emphasized the importance of interpreting mutation types (inhA or katG) and additional molecular DST for fluoroquinolones for confirmed isoniazid-resistant cases. Over 95.8% of experts recommended treating Hr-TB with a combination of rifampin, ethambutol, pyrazinamide, and levofloxacin for six months, without exceeding 12 months unless necessary. They also acknowledged the drawbacks of long-term pyrazinamide use due to its side effects and agreed on shortening its duration by extending the duration of the rest of the treatment with a modified combination of choice. Conclusion This Delphi survey enabled Korean tuberculosis experts to reach a consensus on diagnosing and treating Hr-TB. These findings will be valuable for developing the upcoming revised Korean guidelines for Hr-TB management.

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Section: Methodsmentioning

confidence: 99%

Delphi Survey on the Current and Future Korean Guidelines for Isoniazid-Monoresistant Tuberculosis

Seo¹,

Kim²,

Lee³

et al. 2023

IDR

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“…Infective exacerbation is another complication frequently observed in PTLD patients with bronchiectasis. A robust correlation exists between chronic bacterial infection and exacerbation of bronchiectasis [89][90][91]. Notably, Pseudomonas aeruginosa has been identified in numerous bronchiectasis patients, showing a prevalence rate of 15.0%.…”

Section: Management Of Infective Exacerbationmentioning

confidence: 99%

Long term management of people with post-tuberculosis lung disease

Seo,

Kim,

Kim

et al. 2024

Korean J Intern Med

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Post-tuberculosis lung disease (PTLD) is emerging as a significant area of global interest. As the number of patients surviving tuberculosis (TB) increases, the subsequent long-term repercussions have drawn increased attention due to their profound clinical and socioeconomic impacts. A primary obstacle to its comprehensive study has been its marked heterogeneity. The disease presents a spectrum of clinical manifestations which encompass tracheobronchial stenosis, bronchiectasis, granulomas with fibrosis, cavitation with associated aspergillosis, chronic pleural diseases, and small airway diseases—all persistent consequences of PTLD. The spectrum of symptoms a patient may experience varies based on the severity of the initial infection and the efficacy of the treatment received. As a result, the long-term management of PTLD necessitates a detailed and specific approach, addressing each manifestation individually—a tailored strategy. In the immediate aftermath (0–12 months after anti-TB chemotherapy), there should be an emphasis on monitoring for relapse, tracheobronchial stenosis, and smoking cessation. Subsequent management should focus on addressing hemoptysis, managing infection including aspergillosis, and TB-associated chronic obstructive pulmonary disease or restrictive lung function. There remains a vast expanse of knowledge to be discovered in PTLD. This review emphasizes the pressing need for comprehensive, consolidated guidelines for management of patients with PTLD.

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“…Non-cystic fibrosis bronchiectasis (hereafter referred to as bronchiectasis) is a chronic lung disease characterized by abnormal and permanent dilation of bronchi and respiratory symptoms ( 1 ). Once considered an orphan disease, the prevalence and disease burden of bronchiectasis have also been increasing worldwide ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Impact of air pollution on healthcare utilization in patients with bronchiectasis

Lee,

Kim,

Lee

et al. 2023

Front. Med.

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IntroductionAir pollutants are increasingly recognized to affect long-term outcomes in patients with bronchiectasis. We aimed to figure out the association between air pollutants and the risk of healthcare utilization in patients with bronchiectasis.MethodsData for 1,029 subjects with bronchiectasis in Seoul were extracted. The air pollutants included particulate matter of 10 μm or less in diameter (PM10), particulate matter of 2.5 μm or less in diameter (PM2.5), sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), and nitrogen dioxide (NO2). The outcome was all-cause healthcare uses, defined as outpatient visit, emergency department visit, or hospitalization. The concentration–response curves between each air pollutant and relative risks for healthcare utilization were obtained.ResultsThere were significant correlations between air pollutant concentrations and the risk of healthcare utilization, particularly for PM10, NO2, SO2, and CO. This risk was observed even at concentrations below the recommended safe thresholds for the general population. The slopes for the association between PM10 and NO2 and the risk of healthcare use showed a logarithmic growth pattern, with the steepest increase up to 30 μg/m3 and 0.030 parts per million (ppm), respectively. The curves for SO2 and CO showed an inverted U-shaped pattern, with a peak at 0.0045 ppm and a slow upward curve, respectively. No specific trends were observed for PM2.5 and O3 and the risk of healthcare use.DiscussionIncreased concentrations of PM10, NO2, SO2, and CO were associated with increased healthcare utilization in patients with bronchiectasis. For patients with bronchiectasis, there were no safety thresholds for those air pollutants, and even low levels of air pollutant exposure can negatively impact bronchiectasis outcomes.

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Developing a Diagnostic Bundle for Bronchiectasis in South Korea: A Modified Delphi Consensus Study

Cited by 12 publications

References 36 publications

Delphi Survey on the Current and Future Korean Guidelines for Isoniazid-Monoresistant Tuberculosis

Delphi Survey on the Current and Future Korean Guidelines for Isoniazid-Monoresistant Tuberculosis

Long term management of people with post-tuberculosis lung disease

Impact of air pollution on healthcare utilization in patients with bronchiectasis

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