Self-management for bronchiectasis

Kelly, Carol; Grundy, Seamus; Lynes, Dave; Evans, David; Gudur, Sharada; Milan, Stephen J; Spencer, Sally

doi:10.1002/14651858.cd012528.pub2

Cited by 36 publications

(42 citation statements)

References 72 publications

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“…Amongst the subset of participants with bronchiectasis, there was a trend in improvement in mean SGRQ scores for both groups, but this did not meet statistical significance at 6 weeks, 3 or 12 months follow‐up . Although the mean difference in SGRQ scores between the groups exceeded the minimum clinical important difference, the lack of power from the small sample size ( n = 20) means conclusions are unable to be drawn . The authors of the systematic review concluded that there is insufficient evidence to determine if self‐management interventions impact HR‐QoL or exacerbations …”

Section: Self‐management Plansmentioning

confidence: 99%

“…A systematic review assessed the efficacy, cost‐effectiveness and adverse effects in self‐management interventions amongst patients with bronchiectasis that included two adult‐based RCT . One was a proof‐of‐concept RCT comparing usual care with an expert patient programme described no differences in SGRQ total scores between the groups post‐intervention, at 3 or 6 months after intervention .…”

Section: Self‐management Plansmentioning

confidence: 99%

“…The other RCT of early rehabilitation, self‐management and usual care (6 weeks of intervention) compared to usual care in adults with chronic respiratory disease, which included 20 individuals with bronchiectasis . Amongst the subset of participants with bronchiectasis, there was a trend in improvement in mean SGRQ scores for both groups, but this did not meet statistical significance at 6 weeks, 3 or 12 months follow‐up . Although the mean difference in SGRQ scores between the groups exceeded the minimum clinical important difference, the lack of power from the small sample size ( n = 20) means conclusions are unable to be drawn .…”

Section: Self‐management Plansmentioning

confidence: 99%

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Paediatric and adult bronchiectasis: Monitoring, cross‐infection, role of multidisciplinary teams and self‐management plans

Navaratnam

Forrester

et al. 2018

Respirology

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Bronchiectasis is a chronic lung disease associated with structurally abnormal bronchi, clinically manifested by a persistent wet/productive cough, airway infections and recurrent exacerbations. Early identification and treatment of acute exacerbations is an integral part of monitoring and annual review, in both adults and children, to minimize further damage due to infection and inflammation. Common modalities used to monitor disease progression include clinical signs and symptoms, frequency of exacerbations and/or number of hospital admissions, lung function (forced expiratory volume in 1 s (FEV 1 )% predicted), imaging (radiological severity of disease) and sputum microbiology (chronic infection with Pseudomonas aeruginosa). There is good evidence that these monitoring tools can be used to accurately assess severity of disease and predict prognosis in terms of mortality and future hospitalization. Other tools that are currently used in research settings such as healthrelated quality of life (QoL) questionnaires, magnetic resonance imaging and lung clearance index can be burdensome and require additional expertise or resource, which limits their use in clinical practice. Studies have demonstrated that cross-infection, especially with P. aeruginosa between patients with bronchiectasis is possible but infrequent. This should not limit participation of patients in group activities such as pulmonary rehabilitation, and simple infection control measures should be carried out to limit the risk of cross-transmission. A multidisciplinary approach to care which includes respiratory physicians, chest physiotherapists, nurse specialists and other allied health professionals are vital in providing holistic care. Patient education and personalized self-management plans are also important despite limited evidence it improves QoL or frequency of exacerbations.

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Section: Self‐management Plansmentioning

confidence: 99%

Section: Self‐management Plansmentioning

confidence: 99%

Section: Self‐management Plansmentioning

confidence: 99%

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Paediatric and adult bronchiectasis: Monitoring, cross‐infection, role of multidisciplinary teams and self‐management plans

Navaratnam

Forrester

et al. 2018

Respirology

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“…As of May 2018, a total of 22 systematic reviews examining one or more learning focused interventions for people with respiratory‐related conditions compared to usual care had been published in the Cochrane Database of Systematic Reviews . The patient population groups include adults with asthma (11 reviews), COPD (3 reviews), smoking cessation (2 reviews), cystic fibrosis (1 review), bronchiectasis (1 review), acute upper respiratory tract infections (1 review), lung cancer (1 review), obstructive sleep apnoea (1 review) and tuberculosis (1 review) . The reviews reported two main categories of educational interventions: (i) didactic‐focused teaching for knowledge and (ii) learning experiences for developing self‐management strategies.…”

Section: Impact Of Education Within Prmentioning

confidence: 99%

Rehabilitation in lung diseases: ‘Education’ component of pulmonary rehabilitation

Blackstock

Evans

2019

Respirology

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Pulmonary rehabilitation (PR) is a complex intervention with described core components of individualized exercise training and inter-disciplinary education in international guidelines. Compared to the overwhelming evidence of benefit for exercise training, the education component has received little attention. Educating patients about their symptoms and disease management appears intuitive to improve their health, but how and when is less clear. PR has provided an opportunity for educational activities and traditionally this has been delivered in the form of didactic lectures. The field is evolving and challenges are apparent raising important questions. What is the purpose and outcomes of the education component? Do specific diseases require specific education or PR programmes? How to provide interdisciplinary education? Is the timing optimal within the disease trajectory (most patients are referred to PR with moderate to severe disease)? Can technology help? Our review explores the recent evidence for the 'education' component of PR synthesizing the global guidelines. We discuss the challenges for patients as learners, healthcare professionals as educators and propose future directions for this core component of PR.

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“…For bronchiectasis, a Cochrane review assessing self-management techniques that included airway clearance techniques, adherence to therapy, exercise or education had insufficient evidence to assess the efficacy of such self-management approaches (205).…”

Section: Self-management Strategiesmentioning

confidence: 99%

Cognitive behavioural therapy (CBT) for patients with chronic lung disease and psychological comorbidities undergoing pulmonary rehabilitation

Pumar¹

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Background: Anxiety and depression are psychological conditions that are highly prevalent among patients with chronic lung disease. These conditions are associated with increased morbidity and, in certain groups, increased mortality. Cognitive behaviour therapy (CBT) has shown potential as a treatment of anxiety and depression among patients with COPD, asthma and bronchiectasis. Pulmonary rehabilitation has the strongest evidence regarding its benefit in these patients, mainly through improved physical capacity and education. Consequently, the combination of both treatments (CBT and pulmonary rehabilitation) is promising, with potentially enhanced therapeutic benefits. The primary aim of this thesis was to determine the impact of cognitive behavioural therapy (CBT) as a treatment for patients with chronic lung disease and psychological comorbidities undergoing pulmonary rehabilitation. The study also assessed risk factors for the presence of anxiety and depression in patients attending pulmonary rehabilitation, the effect of CBT on quality of life and, through a subgroup analysis, the impact of mild cognitive impairment on CBT.Methods: A parallel group, randomised controlled trial (RCT) was conducted, with longitudinal follow-up of 12 months. Participants were screened from the pulmonary rehabilitation program at The Prince Charles Hospital and recruited if they had Geriatric Depression Scale (GDS) ≥4/15 or Geriatric Anxiety Inventory (GAI) ≥3/20, suggestive of depression or anxiety, respectively. In addition to pulmonary rehabilitation, the Intervention group received CBT comprised by two face-to-face sessions and 4 phone sessions, while the Control group received usual care. The main outcome measures were GDS and GAI; secondary outcomes were St. Georges Respiratory Questionnaire (SGRQ), pulmonary rehabilitation attendance and 6 minute walk test (6MWT). Results:The majority of patients attending pulmonary rehabilitation had COPD (58.5%), with the remainder having asthma (19.7%), interstitial lung disease (ILD) (9%) and bronchiectasis (12.4%). Of the patients screened, 25 (13%) had only symptoms of anxiety, 33 (17%) of only depression and 62 (32%) had symptoms of both anxiety and depression. Anxiety and depression were strongly correlated with SGRQ (p<0.01) and pulmonary rehabilitation program attendance. GDS scores were also correlated with 6MWT (p<0.01), past smoking (p<0.01), body-mass index (p<0.01), and body-mass index, airflow obstruction, dyspnea, and exercise capacity index (BODE) scores (p<0.01); while GAI was not correlated with other parameters. 65 patients were randomised to the study (24 in the Intervention group, 41 in the Control group). Of the 24 patients in the Intervention group, 10 (42%) failed to attend pulmonary rehabilitation or withdrew from the study. In the Intervention group, GDS significantly improved, compared to baseline, at the end of rehabilitation (mean difference -3.1, 95% CI -4.39 to -1.7; P<0.01), 3 months follow-up (mean difference -1.46, 95% CI -4.17 to -0.75; P<0.01) and 12 m...

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Self-management for bronchiectasis

Cited by 36 publications

References 72 publications

Paediatric and adult bronchiectasis: Monitoring, cross‐infection, role of multidisciplinary teams and self‐management plans

Paediatric and adult bronchiectasis: Monitoring, cross‐infection, role of multidisciplinary teams and self‐management plans

Rehabilitation in lung diseases: ‘Education’ component of pulmonary rehabilitation

Cognitive behavioural therapy (CBT) for patients with chronic lung disease and psychological comorbidities undergoing pulmonary rehabilitation

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