Perspective: Using Bronchiectasis Action Management Plans for Children With Bronchiectasis—Can It Improve Clinical Care?

Abstract

While once thought to be rare, bronchiectasis has been increasing globally over the last 15 years. Bronchiectasis is a major contributor to chronic lung morbidity and mortality but remains a neglected disease in respiratory health globally. Currently, few high-level evidence-based management strategies are available for children with bronchiectasis. Strategies to improve clinical outcomes associated with exacerbations are important. In other respiratory conditions such as asthma and chronic obstructive pulmonary disease, use of personalized written management plans have been shown to improve clinical outcomes. Personalized management plans have also been recommended as part of treatment plans in adults with bronchiectasis. We thus undertook a review of the current literature to determine available evidence, and to establish whether a personalized written bronchiectasis action management plan (BAMP) improves clinical outcomes in children with bronchiectasis. Our search identified 43 articles; 16 duplicates were removed and a further 23 were excluded on titles and abstracts alone. Four full-text articles were reviewed but excluded. In the absence of any published studies, it remains unknown whether the use of BAMP is beneficial for improving clinical outcomes for children with bronchiectasis. These results have highlighted this clinical gap and identified the need for high-quality research to inform practice. Until high-quality evidence is available, clinicians are advised to adhere to current national and/or international guidelines.

Burden of Care for Children with Bronchiectasis from Parents/Carers Perspective

“…To date there are no studies evaluating an action management plan in children with bronchiectasis [26]. The ERS and ELF have highlighted the need for an action management plan for respiratory exacerbations amongst the highest clinical needs for parents of children with bronchiectasis [7].…”

Utility of a personalisedBronchiectasisActionManagementPlan (BAMP) for children with bronchiectasis: protocol for a multicentre, double-blind parallel, superiority randomised controlled trial

“…To date, there are no such studies in children or adults with bronchiectasis. 23 24 A recent systematic review specific to the use of an action plan for bronchiectasis in children confirmed the absence of randomised controlled trials (RCTs). 23 A Cochrane review on self-management in bronchiectasis further highlighted the paucity of evidence in both adults and children, 24 finding only two small poor quality trials in adults using interventions of education and/or rehabilitation, neither with an action plan intervention and highlighted the need for research in children.…”

“… 23 24 A recent systematic review specific to the use of an action plan for bronchiectasis in children confirmed the absence of randomised controlled trials (RCTs). 23 A Cochrane review on self-management in bronchiectasis further highlighted the paucity of evidence in both adults and children, 24 finding only two small poor quality trials in adults using interventions of education and/or rehabilitation, neither with an action plan intervention and highlighted the need for research in children. With this major research gap of whether using a personalised BAMP improves clinical outcomes, it is not surprising that a BAMP is not used routinely, even in tertiary centres, when managing children with bronchiectasis.…”