Disparities in kids’ bronchiectasis management highlighted in ERS guidelines

Public health

18 Feb 2021

New guidelines on bronchiectasis in children are aiming to raise more awareness of key aspects of diagnosis and treatment in younger age groups, after evidence found there are large disparities in standards of care and outcomes.

There are substantial differences between the condition in children and adolescents and when it presents in adults, the recommendations from a European Respiratory Society Task Force point out.

This includes different different lower airway microbial profiles and likely treatment outcomes but also that bronchial dilatation is reversible in children if treated properly at an early stage, the Task Force said.

The guidelines address a current gap of up-to-date international evidence-based recommendations in this group, according to co-author Prof Andrew Bush, a consultant paediatric chest physician at the Royal Brompton and Harefield NHS Foundation Trust, London.

Speaking with the limbic, he pointed out that bronchiectasis in children was very much an orphan speciality, and there was still a lot that wasn’t known about the most effective management. Still, there was more recognition about the importance of early diagnosis.

“There’s no question that if you initiate treatments early and aggressively you can reverse bronchial dilatation.”

He added that when you look back at the medical history of some adults, their symptoms go back into childhood but were never picked up.

“Children who have chronic wet cough, that is something that needs to be taken very seriously indeed,” said Prof Bush. “We are getting there but I’m still seeing patients who have been referred to me who have been coughing for months and months and it hasn’t really been taken seriously.”

One recommendation was around the importance of getting management plans in place for exacerbations; this was found to be “one of the three top issues for parents” in a European Lung Foundation survey.

It is important to increase patient, parent or carer, and health professional education in recognising exacerbations and starting additional treatments, the ERS Task Force recommended.

The guidelines also found strong evidence to recommend a 14-day systemic course of an appropriate antibiotic in children or adolescents with bronchiectasis having an acute respiratory exacerbation.

But Professor Bush points out there is still a lot to learn in this group, with trial evidence for many potential treatments being close to zero.

“A lot of what we do is extrapolated from cystic fibrosis, and that doesn’t necessarily work in bronchiectasis,” he said. “We need to come together and do more research and hopefully this guideline is the beginning of that.”

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