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

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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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Authors and Affiliations

  1. Central Clinical School Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia

    Simone K. Visser, Peter T. P. Bye & Greg J. Fox

  2. Department of Respiratory Medicine, Royal Prince Alfred Hospital, Level 11, Missenden Rd, Camperdown, NSW, 2050, Australia

    Simone K. Visser, Peter T. P. Bye & Greg J. Fox

  3. Department of Respiratory and Sleep Medicine, Mater Health, South Brisbane, QLD, Australia

    Lucy D. Burr

  4. Mater Research, University of Queensland, St Lucia, QLD, Australia

    Lucy D. Burr

  5. Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Queensland University of Technology, Brisbane, Australia

    Anne B. Chang

  6. Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia

    Anne B. Chang

  7. Department of Thoracic Medicine, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia

    Chien-Li Holmes-Liew

  8. Monash Respiratory and Sleep Medicine, Monash Medical Centre, Melbourne, VIC, Australia

    Paul King

  9. Department of Respiratory Medicine, Westmead Hospital, Westmead, NSW, 2145, Australia

    Peter G. Middleton

  10. Western Clinical School, University of Melbourne, Melbourne, 3021, Australia

    Graeme P. Maguire

  11. General Internal Medicine, Western Health, Melbourne, 3011, Australia

    Graeme P. Maguire

  12. The Prince Charles Hospital – Thoracic Medicine, Brisbane, Australia

    Daniel Smith

  13. QIMR Berghofer Medical Research Institute – Lung Inflammation and Infection Laboratory, Herston, Australia

    Daniel Smith

  14. Department of Respiratory Medicine, Greenslopes Private Hospital, Greenslopes, QLD, 4120, Australia

    Rachel M. Thomson

  15. Lung Foundation Australia, Milton, QLD, Australia

    Enna Stroil-Salama

  16. Centenary Institute, The University of Sydney, Sydney, NSW, 2006, Australia

    Warwick J. Britton

  17. Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia

    Lucy C. Morgan

  18. Department of Respiratory Medicine, Concord General Repatriation Hospital, Concord, NSW, 2137, Australia

    Lucy C. Morgan

Authors
  1. Simone K. Visser
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  2. Peter T. P. Bye
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  3. Greg J. Fox
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  4. Lucy D. Burr
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  6. Chien-Li Holmes-Liew
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  7. Paul King
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  8. Peter G. Middleton
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  9. Graeme P. Maguire
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  10. Daniel Smith
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  11. Rachel M. Thomson
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  12. Enna Stroil-Salama
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  13. Warwick J. Britton
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  14. Lucy C. Morgan
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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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  • DOI: https://doi.org/10.1007/s00408-019-00280-x

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