Consensus recommendations for managing bronchiectasis in Indigenous children and adults living in rural and remote regions were developed during a multidisciplinary workshop and were based on available systematic reviews.
Successful diagnosis, management and prevention of bronchiectasis in Indigenous Australians requires access to comprehensive health care services, as well as improved housing, education and employment and reduced poverty levels.
Diagnosis of bronchiectasis requires a chest high-resolution computed tomography scan. Children who have bronchiectasis symptoms but non-diagnostic scans are described as having chronic suppurative lung disease (CSLD), rather than bronchiectasis. Untreated CSLD may progress to bronchiectasis.
Chronic wet cough (> 4 weeks) or recurrent wet cough (> 2 episodes/year) are important but often under-reported symptoms. Bronchiectasis is suspected when chronic cough is excessively prolonged (> 12 weeks) or if a chest radiographic abnormality persists despite appropriate therapy.
Intensive treatment aims to improve symptom control and quality of life while preserving lung function and reducing acute exacerbation frequency.
Antibiotics should be prescribed for acute infective episodes according to culture results of respiratory secretions, local susceptibility patterns and clinical severity. Patients not responding promptly to oral antibiotics should be hospitalised for more intensive treatment.
Ongoing care requires regular primary health care and specialist review, including monitoring for complications and comorbidities. Corticosteroids, bronchodilators and mucoactive agents may be used in individual cases, but routine use is not recommended. Physiotherapy and exercise should be encouraged, nutrition optimised, environmental pollutants (including tobacco smoke) avoided, and immunisations maintained.
- 1. Standing Committee on Aboriginal and Torres Strait Islander Health and Statistical Information Management Committee 2006. National summary of the 2003 and 2004 jurisdictional reports against the Aboriginal and Torres Strait Islander health performance indicators. Canberra: AIHW, 2006. (AIHW Cat. No. IHW 16.) http://www.aihw.gov.au/publications/index.cfm/title/10234 (accessed Jul 2008).
- 2. Australian Bureau of Statistics. National Aboriginal and Torres Strait Islander Health Survey, 2004–05. Canberra: ABS, 2006. (ABS Cat. No. 4715.0.)
- 3. Chang AB, Masel JP, Boyce NC, et al. Non-CF bronchiectasis: clinical and HRCT evaluation. Pediatr Pulmonol 2003; 35: 477-483.
- 4. Chang AB, Grimwood K, Mulholland EK, Torzillo PJ; Working Group on Indigenous Paediatric Respiratory Health. Bronchiectasis in Indigenous children in remote Australian communities. Med J Aust 2002; 177: 200-204. <MJA full text>
- 5. King PT, Holdsworth SR, Freezer NJ, et al. Outcome in adult bronchiectasis. COPD 2005; 2: 27-34.
- 6. Keistinen T, Säynäjäkangas O, Tuuponen T, Kivelä SL. Bronchiectasis: an orphan disease with a poorly-understood prognosis. Eur Respir J 1997; 10: 2784-2787.
- 7. Steinfort DP, Brady S, Weisinger HS, Einsiedel L. Bronchiectasis in Central Australia: a young face to an old disease. Respir Med 2008; 102: 574-578.
- 8. Chang AB, Bilton D. Non-cystic fibrosis bronchiectasis exacerbations. Thorax 2008; 63: 269-276.
- 9. Kiechl S, Egger G, Mayr M, et al. Chronic Infections and the risk of carotid atherosclerosis: prospective results from a large population study. Circulation 2001; 103: 1064-1070.
- 10. Hill SL, Morrison HM, Burnett D, Stockley RA. Short term response of patients with bronchiectasis to treatment with amoxycillin given in standard or high doses orally or by inhalation. Thorax 1986; 41: 559-565.
- 11. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ 2004; 328: 1490-1497.
- 12. Vakil N, van Zanten SV, Kahrilas P, et al; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101: 1900-1920.
- 13. Cymbala AA, Edmonds LC, Bauer MA, et al. The disease-modifying effects of twice-weekly oral azithromycin in patients with bronchiectasis. Treat Respir Med 2005; 4: 117-122.
- 14. King P. Is there a role for inhaled corticosteroids and macrolide therapy in bronchiectasis? Drugs 2007; 67: 965-974.
- 15. Chang AB, Redding GJ, Everard ML. Chronic wet cough: protracted bronchitis, chronic suppurative lung disease and bronchiectasis. Pediatr Pulmonol 2008; 43: 519-531.
- 16. Webb WR, Müller NL, Naidich DP. High-resolution CT of the lung. Philadelphia: Lippincott, Williams & Wilkins, 2001: 467-546.
- 17. Matsuoka S, Uchiyama K, Shima H, et al. Bronchoarterial ratio and bronchial wall thickness on high-resolution CT in asymptomatic subjects: correlation with age and smoking. AJR Am J Roentgenol 2003; 180: 513-518.
- 18. Chang AB, Masel JP, Boyce NC, Torzillo PJ. Respiratory morbidity in central Australian Aboriginal children with alveolar lobar abnormalities. Med J Aust 2003; 178: 490-494. <MJA full text>
- 19. Shoemark A, Ozerovitch L, Wilson R. Aetiology in adult patients with bronchiectasis. Respir Med 2007; 101: 1163-1170.
- 20. King PT, Holdsworth SR, Freezer NJ, et al. Characterisation of the onset and presenting clinical features of adult bronchiectasis. Respir Med 2006; 100: 2183-2189.
- 21. Croxatto OC, Lanari A. Pathogenesis of bronchiectasis; experimental study and anatomic findings. J Thorac Surg 1954; 27: 514-528.
- 22. Stockley RA. Role of bacteria in the pathogenesis and progression of acute and chronic lung infection. Thorax 1998; 53: 58-62.
- 23. Valery PC, Torzillo PJ, Mulholland EK, et al. Hospital-based case–control study of bronchiectasis in Indigenous children in Central Australia. Pediatr Infect Dis J 2004; 23: 902-908.
- 24. Judson MA. Noninvasive Aspergillus pulmonary disease. Semin Respir Crit Care Med 2004; 25: 203-219.
- 25. Chan CH, Ho AK, Chan RC, et al. Mycobacteria as a cause of infective exacerbation in bronchiectasis. Postgrad Med J 1992; 68: 896-899.
- 26. Ellerman A, Bisgaard H. Longitudinal study of lung function in a cohort of primary ciliary dyskinesia. Eur Respir J 1997; 10: 2376-2379.
- 27. Evans DJ, Bara AI, Greenstone M. Prolonged antibiotics for purulent bronchiectasis. Cochrane Database Syst Rev 2007; (2): CD001392.
- 28. Southern KW, Barker PM, Solis A. Macrolide antibiotics for cystic fibrosis. Cochrane Database Syst Rev 2004; (2): CD002203.
- 29. Tramper-Stranders GA, Wolfs TF, Fleer A, et al. Maintenance azithromycin treatment in pediatric patients with cystic fibrosis: long-term outcomes related to macrolide resistance and pulmonary function. Pediatr Infect Dis J 2007; 26: 8-12.
- 30. Rubin BK. Aerosolized antibiotics for non-cystic fibrosis bronchiectasis. J Aerosol Med 2008; Feb 7 [Epub ahead of print].
- 31. O’Donnell AE, Barker AF, Ilowite JS, Fick RB. Treatment of idiopathic bronchiectasis with aerosolized recombinant human DNase I. rhDNase Study Group. Chest 1998; 113: 1329-1334.
- 32. Button BM, Heine RG, Catto-Smith AG, Phelan PD. Postural drainage in cystic fibrosis: is there a link with gastro-oesophageal reflux? J Paediatr Child Health 1998; 34: 330-334.
- 33. Patterson JE, Bradley JM, Elborn JS. Airway clearance in bronchiectasis: a randomized crossover trial of active cycle of breathing techniques (incorporating postural drainage and vibration) versus test of incremental respiratory endurance. Chron Respir Dis 2004; 1: 127-130.
- 34. O’Brien C, Guest PJ, Hill SL, Stockley RA. Physiological and radiological characterisation of patients diagnosed with chronic obstructive pulmonary disease in primary care. Thorax 2000; 55: 635-642.
- 35. Karadag B, Karakoc F, Ersu R, et al. Non-cystic-fibrosis bronchiectasis in children: a persisting problem in developing countries. Respiration 2005; 72: 233-238.
- 36. National Health and Medical Research Council. The Australian immunisation handbook. 9th ed. Canberra: NHMRC, 2008.
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