Spanish Guidelines on the Evaluation and Diagnosis of Bronchiectasis in Adults

Abstract

In 2008, the Spanish Society of Pulmonology (SEPAR) published the first guidelines in the world on the diagnosis and treatment of bronchiectasis. Almost 10 years later, considerable scientific advances have been made in both the treatment and the evaluation and diagnosis of this disease, and the original guidelines have been updated to include the latest scientific knowledge on bronchiectasis. These new recommendations have been drafted following a strict methodological process designed to ensure the quality of content, and are linked to a large amount of online information that includes a wealth of references. These guidelines cover aspects ranging from a consensual definition of bronchiectasis to an evaluation of the natural course and prognosis of the disease. The topics of greatest interest and some new areas are addressed, including epidemiology and economic costs of bronchiectasis, pathophysiological aspects, the causes (placing particular emphasis on the relationship with other airway diseases such as chronic obstructive pulmonary disease and asthma), clinical and functional aspects, measurement of quality of life, radiological diagnosis and assessment, diagnostic algorithms, microbiological aspects (including the definition of key concepts, such as bacterial eradication or chronic bronchial infection), and the evaluation of severity and disease prognosis using recently published multidimensional tools.

Bronchiectasis: Treatment decisions for pulmonary exacerbations and their prevention

“…Three bronchiectasis guidelines recommend that patients having more than three exacerbations annually and or those chronically infected with P. aeruginosa could be considered for inhaled antibiotics with no preferred protocol given . One guideline recommends use for any ‘potentially pathogenic’ bacteria with two exacerbations in the community or one hospitalization, and highlighting preference for inhaled antibiotics rather than systemically administered therapy . There seems to be more success with longer continuous use of inhaled antibiotics, but there are significant concerns with emergence of antimicrobial resistance.…”

“…No RCT have been undertaken to address this question. Guidelines vary in the recommended approaches (drug choice, duration and combinations) from oral ciprofloxacin with or without an inhaled antibiotic (tobramycin or colistin) which may be continued for up to 12 months . The role of i.v.…”

“…When faced with a patient with a newly identified P. aeruginosa culture, these options should be considered in parallel with current clinical status of the patient (stable vs recent decline), time since isolate detected, assessment of patients’ level of engagement in a complex regimen and availability of specific antibiotics. For example, in the recently published Spanish guidelines, initial treatment with ciprofloxacin 750 mg/12 h for 3 weeks is recommended. An inhaled antibiotic for 3 months can be added if the patient is unable to use ciprofloxacin (intolerance or allergy), where the patient has evidence of severe bronchiectasis and/or is immunosuppressed.…”

“…It would be pragmatic to assess sputum culture (at least once) at the next clinic appointment after antibiotics are completed and to assess regularly in the year following. The Spanish guidelines recommend sputum culture to be performed monthly for the first 3 months after completing initial treatment and every 2 months thereafter for 1 year …”

“…Bronchiectasis guidelines recommend long‐term antibiotics for those with ≥3 exacerbations per year, with or without chronic infection with P. aeruginosa, but the more recent guideline suggests use for ≥2 exacerbations in the community or one hospitalization as indications for long‐term antibiotics. None of the guidelines have recommended rotational antibiotic use, although this practice is standard care in CF with inhaled antibiotics …”