Infections

Adult bronchiectasis management is evolving: 9 new recommendations


There’s no doubt that bronchiectasis is becoming more recognised in clinical practice and evidence for its treatment is evolving, but questions remain around the burden of disease in Australia and the impact of long-term macrolides on bacterial resistance, Australian respiratory physicians say.

Writing in a review of the chronic lung condition published in this week’s MJA, Sydney-based respiratory physicians Dr Simone Visser, Professor Peter Bye, and Associate Professor Lucy Morgan said that historically non-CF related bronchiectasis was a disease that was neglected in research.

However, over the last five years research had gained worldwide momentum with the establishment of registries and at a national level, the setting up of the Australian Bronchiectasis registry in 2016 and the creation of a bronchiectasis-specific code added to the Australian Refined Diagnostic Related Group Classification system.

Given the evolving evidence base and increasing recognition of the disease a review of its management in adults was timely, the physicians said.

The goals of therapy are to improve symptoms, reduce exacerbations and limit progression of disease and effective airways clearance remained the cornerstone of management and should be managed and reviewed regularly by a respiratory physiotherapist, they noted.

Furthermore the routine use of long-term inhaled corticosteroids and long-acting bronchodilators should be avoided unless a patient had coexisting COPD or asthma.

And while there was now robust evidence for the long term use of oral macrolide antibiotics in order to reduce the frequency of exacerbations they stressed that their benefits must be weighed against the risk of resistance and side effects.

“Reduced exacerbation frequency comes at the expense of an increase in macrolide resistance organisms in the oropharynx and sputum, however the significance of this is unclear at present,” they wrote.

“Data from the Australian Bronchiectasis registry and the addition of an Australian Refined Diagnostic Related Group bronchiectasis code will provide insight into the burden of disease and pattern of care in Australia,” they concluded.

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