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Management of Australian Adults with Bronchiectasis in Tertiary Care: Evidence-Based or Access-Driven?

Abstract

Purpose

Australian data regarding the management of patients with bronchiectasis is scarce. We sought to compare the management of adults with bronchiectasis attending tertiary Australian centres with recent national and international guidelines.

Methods

The Australian Bronchiectasis Registry is a centralised database of patients with radiologically confirmed bronchiectasis unrelated to cystic fibrosis recruited from 14 tertiary Australian hospitals. We excluded children (<18 years) and those with incomplete data, leaving 589 adults for cross-sectional analyses. We compared the proportion of patients receiving certain therapies, as compared to the proportion eligible for those treatments according to the current guidelines and baseline clinical information available from the registry.

Results

Pulmonary rehabilitation was attended by 22%, although it was indicated in 67% of the cohort. Airway clearance was undertaken in 52% of patients, although 71% reported chronic productive cough. Sputum bacterial culture results were available for 59%, and mycobacterial culture results were available for 29% of the cohort. Inhaled antibiotics were used in half of potentially eligible patients. Despite guideline recommendations against routine use, inhaled corticosteroids were used in 48% of patients. Long-term macrolides were used in 28% of participants.

Conclusions

Discrepancies exist between guideline recommendations and real-world treatment of bronchiectasis in Australia, even in tertiary centres. These findings suggest the need for increased patient referral to pulmonary rehabilitation, increased attention to airway clearance, increased collection of sputum samples (especially for mycobacterial culture) and rationalisation of inhaled corticosteroid use. These findings encourage a review of treatment access and will inform ongoing education to promote evidence-based care for people living with bronchiectasis.

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Acknowledgement

The Australian Bronchiectasis Registry is generously supported by the Australian Lung Foundation, Insmed Incorporated and the Zambon Group. Drs Bye, Burr, Chang, Holmes-Liew, King, Middleton, Maguire, Smith, Thomson and Morgan have been involved in clinical research related to bronchiectasis. Dr Chang is supported by a National Health and Medical Research Council (NHMRC) practitioner fellowship (Grant 1154302) and Dr Visser by a NHMRC post-graduate scholarship (Grant 1134081). Neither pharmaceutical company, nor any sponsoring or supporting body had any input to the interpretation of data or preparation of the manuscript.

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Correspondence to Simone K. Visser.

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Visser, S.K., Bye, P.T.P., Fox, G.J. et al. Management of Australian Adults with Bronchiectasis in Tertiary Care: Evidence-Based or Access-Driven?. Lung 197, 803–810 (2019). https://doi.org/10.1007/s00408-019-00280-x

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Keywords

  • Bronchiectasis
  • Treatment
  • Guidelines
  • Registry
  • Australia