Normal spirometry doesn’t rule out bronchiectasis: Australian registry data


By Mardi Chapman

23 Jul 2019

Clinicians should be aware that patients with moderate to severe bronchiectasis can still have normal spirometry, Australian respiratory specialists say.

A first report on baseline data from 589 adults in the Australian Bronchiectasis Registry, has shown airflow obstruction was the predominant pattern of lung function in patients with severe disease.

However 36% of patients with severe disease defined by the Bronchiectasis Severity Index (BSI) and 19% of those with severe disease defined by FEV1, Age, Colonisation, Extension, Dyspnoea (FACED) criteria had normal spirometry.

Co-author Dr Simone Visser, from the department of respiratory medicine at Royal Prince Alfred Hospital, told the limbic clinicians should not be falsely reassured by normal spirometry.

“If you have a patient with normal spirometry, it does not rule out bronchiectasis and it does not rule out even severe bronchiectasis. People can have normal spirometry or they can have obstruction or some patients even have a suggestive restrictive pattern, so really any pattern of lung function can occur.”

The study also identified a subgroup of patients with a high burden of disease and healthcare utilisation.

“The frequent exacerbators have more hospitalisations, lower quality of life and poorer lung function, and that would be a group that should be followed up more closely and treatment optimised.”

She said there was good evidence for long-term, low-dose macrolide antibiotics to reduce the frequency of exacerbations, but the drugs were not subsidised by the PBS.

“Some hospitals can access it through hospital drug committees but it’s not easily accessible outside of tertiary clinics.”

It was therefore important to “make sure the basics are right” including smoking cessation, daily airway clearance, good nutrition, exercise and flu vaccinations.

The study identified a gap in the routine collection and culture of sputum samples.

“Even in tertiary centres, only approximately 60% of patients had standard bacterial cultures and roughly 30% had cultures for mycobacteria.”

She said future studies from the registry would look at treatment and treatment gaps.

“And it will be even more valuable, when we will be able to look at longitudinal outcomes of the patients in three or five years and identify groups of patients with poorer outcomes.”

“That will be extremely valuable and especially if we can improve data completeness and collection on Indigenous patients and look at comparisons of characteristics and outcomes between Indigenous and non-Indigenous patients.”

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